Healing Combat Trauma

Honoring Women Veterans Who Served and Suffered

October 12th through 16th is "Military Rape Awareness Week." In observation of that, the story of Colleen Mussolino, as retold by veterans advocate Susan Avila-Smith:

In Memory of Colleen Mussolino, Women Veteran Trailblazer

"I wanted to be an aviation engineer," Mussolino said.  "The recruiter said I could get into the program, but I found out that was closed to women." Instead she became a cook.  Soon the young WAC would find out just how differently women were regarded in the military.  On December 29, 1965, Colleen was raped by four men and left for dead.  She spent one night in the hospital and was sent right back to her barracks.  Colleen was treated like a prisoner of war, interrogated and was blackballed on the post trying to force her to sign a paper that she would not prosecute. Threatened with a dishonorable discharge, Mussolino signed the paper and was honorably discharged in March 1967.

For the next 20 years, Mussolino raised two sons, and lived her life.  But as time went by, the traumatic assault that was supposed to be covered up and forgotten began to take its toll.  "I was getting more and more short-tempered," Mussolino said. "My temper was just bad."  One day, while fishing with a World War II veteran, he told her she was entitled to veterans benefits.  She applied and began to receive benefits. She also joined a women's support group at the Brooklyn, N.Y. VA Medical Center.  "I was looking for other women who went through what I went through," Mussolino said. "Your civilian counterparts have no clue."

Women Veterans of America
With talk of the war breaking out in the Persian Gulf, she realized more women would be involved in combat than ever before.  In response, she co-founded Women Veterans of America to offer support and attention to the issues facing women in the military.  "The transition from military to civilian life is difficult," Mussolino said. "Once the uniform goes on, it never comes off." Their mission: Information and support for women veterans; liaision to government agencies; obtaining veterans' benefits and health care; advocacy in local and national isues affecting women veteran and women serving in the military. Pressure on Congress and the Department of Defense to cahnge the Uniform Code of Military Justice to include a fair avenue for victims of assault and rape to be able to report their cases and get their day in court. Punish those who perpetrate such crimes and offer protection from intimidation and threats for women who report the assaults. "The repercussions from the way the victims are treated only adds to the problem and can cause severe PTSD symptoms," the statement reads. "The UCMJ does not protect the victim, but instead rewards some perpetrators with promotion, and does not punish except with a slap on the wrist and a finger shaken in the face it continues.  It is difficult for many to fathom the emotional and physical turmoil that the men and women of the armed forces are put through.  To add sexual assault to the burden is unconscionable."

In November 1996, reports of sexual harrassment and sexual assault against women at the Army Proving Ground in Aberdeen, M.D., prompted "20/20" to put together an investigative piece on the military's handling of sexual assault.  A member of Women Veterans of America wrote to 20/20 about her own experience. "She was afraid to be interviewed because she had been given death threats," Mussolino said.  Instead, Mussolino agreed to share her own story of sexual assault and cover-up in the military with Peter Jennings. "I figured if anything came out of it, women would know they are not alone, and there is help," Mussolino said.  "Not only women are raped, but men are raped. The story seemed to validate them, too." During the show's airing, the Department of Veterans Affairs made a toll-free number available for women to call in for counseling.  "Over 3,000 women called that night from all diferent wars and branches of service," Mussolino said.  "The Department of Veterans Affairs realized more had to be done for women veterans." "A lot of Vietnam veteran women in this country don't come forward," said Mussolino.  They don't talk about it.  Those are the ones I want to reach. There is help. There is therapy by talking to a brother or a sister."

Despite her disabilities which have put her in a wheelchair, she would be at every significant event for MST and Vietnam vets, and was the primary point of contact for the media since the early 1970s.  Since Colleen's terminal illness, Women Veterans of America "decided that WVA is taking too much time on the issue of MST, and has dropped it from their services."

PTSD from Military Sexual Trauma (MST) is caused by sexual harrassment, rape and intimidation, or any improper sexual behavior.  Perpetrators often go unpunished, and have no "record" in an effort to play down the prevalence of assault and harrassment.

Editor's note: There's a "fan page" for Colleen Mussolino on Facebook, linked here.

Two Retreats for Veterans This Summer and Fall in Upstate New York

For our 650th post -- my, how time flies! -- an item about two upcoming retreats that may be of interest to veterans and their families -- both to be held in upstate New York later this summer and early fall.

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For women veterans only, in mid-August, The Adirondack Women Veterans’ Reintegration Retreat 2009 will be held from Monday, August 10th to Wednesday, August 12th, 2009, at the Wiawaka Holiday House (a retreat center for women) on Lake George, New York.

Their program says, "The Adirondack Women Veterans’ Arts & Reintegration Retreat is open to any woman who has served our country in any branch of the military at any time. The retreat will focus on reintegration issues arising out of military service. We will provide a safe space to share experiences, learn from others who have served our country, gain skills that will enhance quality of life,  enrich a sense of self and sense of community and build a network with other women who have served our country.

Our retreats have become known as a place where women can connect with others and their inner selves. In many sessions, we have had people from the same community meet each other for the first time and discover new friends and support that they can maintain after they leave."

Click here for a link to that program or to register. Scholarships are available -- hurry! -- and the campus is drug- and alcohol-free.

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In mid-October, the Omega Institute in Rhinebeck, New York will be hosting "The Costs of War, Violence and Denial" -- subtitled "A retreat open to veterans and their families" -- with Claude Anshin Thomas, who we've written about on this blog frequently.  Thomas is a Vietnam combat veteran, now Zen Buddhist monk, and the author of "At Hell's Gate: A Soldier's Journey from War to Peace," linked here. The retreat runs from Wednesday, October 21st through Sunday, October 25th. 90% of the cost is being underwritten for veterans and their families; the remaining 10% is the price of registration, and in some cases that may also be able to be waived.  The Institute asks that you register for the retreat by September 25th.  Click here for a link to information about the program and registration.

The Omega Institute notes: "This 5-day retreat with Claude Anshin Thomas is substantially funded. Scholarships cover up to 90% of tuition, meals, and accommodations. No one will be turned away. Complete scholarship details are available online or call 800.944.1001."

Editor's note: We've talked about Claude Anshin Thomas and his book before on the blog, here, here, here, here, and here. And thanks to all who let us know about these events -- Susan, Sue and Frances.

Recent Women Vets with PTSD Use Mental Health Services Differently, Not Enough -- Study Says

According to a recent item published by Boston University's School of Public Health, younger women combat veterans with PTSD under-utilize specialized mental health treatment programs provided by the VA. Just why this is the case hasn't been determined yet, but the study highlights some interesting results  -- and in any case it's progress that the needs of this special population (women combat veterans) are being studied. From the press release:

"Younger women veterans with substance abuse problems, post-traumatic stress disorder and other mental health diagnoses were significantly less likely to utilize specialized Veterans Health Administration (VHA) mental health services in 1999, after the first Gulf War, than their male counterparts, a study led by BUSPH researchers has found.

Veterans of recent conflicts have been shown to have significant mental health needs," says the study, published in the journal Women's Health Issues. "Examining the effects of gender on disease burden and health care utilization in this growing group of veterans is important."

The study found that younger women (under 35) were significantly less likely to use mental health services in comparison to men. However, middle-aged and older women were more likely to use the services than men."

In terms of specialty mental health services, women veterans under the age of 55 were significantly less likely to use PTSD or substance abuse services. The authors speculated that women with substance abuse problems "may be averse to using male-dominated therapeutic groups," may seek treatment in general medical settings or may not seek treatment at all, as described in prior literature on women and substance abuse.

If underutilization of [substance abuse] services continues in newer women veterans, a significant percentage...may remain untreated," the authors cautioned.

The researchers said the underutilization of specialized PTSD services by younger women could be due, in part, to the fact that a significant proportion of PTSD in female veterans is associated with a history of military sexual abuse: "Women with a history of military sexual trauma may not feel comfortable either in mixed-gender groups or using services in which treatment is oriented primarily toward combat-related PTSD.

Overall, a higher percentage of women veterans than men utilized outpatient mental health services, other than the specialized PTSD and substance abuse programs. The study also found that women veterans who used VHA services had a higher prevalence of mood/anxiety disorders and bipolar or psychotic disorders than their male counterparts.

The researchers said that, if the utilization trends found in the study persist, an increasing number of women veterans with significant mental illness and comorbidity could be expected to rely on the VHA for care.

They said their findings highlight the complexity involved in crafting mental health services for the new wave of women veterans."Further research is warranted as to how to address the complex needs for specialty mental health services in this newly emerging group of veterans," they said.

They noted that examining gender differences alone, without taking age, diagnosis and other factors into account, may not provide an adequate picture of women veterans' mental health service needs."

Source: "The Insider," from Boston University's School of Public Health, June 29, 2009. Submitted by Lisa Chedekel.  Link is here.

Pulling the Pin: Combat Vets, PTSD and Troubled Personal Relationships

Combat veterans with PTSD often have tremendous difficulty with their closest personal relationships: marriages and families.  Divorces, multiple marriages, and short-term relationships that end unhappily are very common: All situations that compound the pain and suffering that already exists with PTSD.

While there are a few books out there that provide some helpful advice about the difficulty of combat vets with PTSD sustaining good relationships, some insight is also in order.  While many obstacles could be mentioned, we'll stick to just a few important ones.

1.    Needing to have a constant enemy. Combat veterans will tell you that their training requires a constant enemy for alertness, vigilance, what amounts to staying alive. Once combat ends -- or between episodes of combat -- that "role" needs to be filled by somebody.  The most obvious candidate to fill that role?  The combat veteran's usually unwitting, and unwilling, partner. If the spouse or partner isn't available, the next best candidate is a child. The combat veteran is often unaware that he or she is using this tactic at all, and the one victimized by it can often tell "something is wrong," but isn't always clear on exactly what that is.

2.    Pestering and teasing doesn't feel like love, but it does feel like irritation. Let's say the coast is clear.  It's a sunny day, everything seems (temporarily) all right in the combat veteran's world. But he or she teases and pesters a spouse, partner or family member (e.g., a child) incessantly, until that person gets fed up and walks away.  "But I was just teasing!" says the combat veteran.  Yes, but the frictional nature of the allegedly good-natured teasing has a predictable effect: it drives close others away, much like bad behavior also does. Now the combat veteran can be left alone: But is that what he or she really wanted?  Perhaps.  Perhaps not.  The main thing, combat vets say informally, that inspires this strategy, even on an unconscious level, is that too much peace and calm is off-putting, and creating (or re-creating) a little "chaos" in interpersonal relationships puts the combat vet with PTSD back where he or she is more likely to be comfortable.

Now factor either (or both) of these two behavioral patterns (among several others that could have been discussed) with the combat veteran's periodic desire for intimacy -- and imagine the realistic toll that such behavior, even if unintentional, takes on the spouse or partner's desire for intimacy.  More likely, either one or both of these behaviors is more likely to shut down or numb the spouse or partner, who then is more tempted to resist attempts at intimacy.  Is turning down intimacy the problem?  Is it the only problem, or even the central problem?  Probably not, if either of these fairly typical behaviors are an issue.

Combat Veterans, PTSD and Domestic Violence - A Sometimes Deadly Combination

Domestic Violence a Growing Problem for Veterans

“The increasing number of veterans with posttraumatic stress disorder [PTSD] raises the risk of domestic violence and its consequences on families and children in communities across the United States,” says Monica Matthieu, Ph.D., an expert on veteran mental health and an assistant professor of social work at Washington University in St. Louis. “Treatments for domestic violence are very different than those for PTSD. The Department of Veterans Affairs [VA] has mental health services and treatments for PTSD, yet these services need to be combined with the specialized domestic violence intervention programs offered by community agencies for those veterans engaging in battering behavior against intimate partners and families.”

Matthieu and Peter Hovmand, Ph.D., a domestic violence expert and an assistant professor of social work at Washington University, are merging their research interests and working to design community prevention strategies to address this emerging public health problem.

“The increasing prevalence of traumatic brain injury and substance use disorders along with PTSD among veterans poses some unique challenges to existing community responses to domestic violence,” says Hovmand. “Community responses to domestic violence must be adapted to respond to the increasing number of veterans with PTSD. This includes veterans with young families and older veterans with chronic mental health issues.”

VA research shows that male veterans with PTSD are two to three times more likely than veterans without PTSD to engage in intimate partner violence and more likely to be involved in the legal system.

— Source: Washington University in St. Louis

The Woman's Bill of Rights to Sexual Intimacy and Pleasure

Periodically we revisit the all-important topic, "Healthy Sexuality for Combat Veterans."  In this installment, we include a "bill of rights" that's essentially written for the woman partner, from Gina Ogden, Ph.D., author of "The Heart and Soul of Sex," and, most recently, "The Return of Desire." The author of five books, Ogden is a marriage and family therapist and a sex therapist.  In a conversation directed primarily to women, she says:

"It's important for you to know what your sexual rights are -- no matter what your age or sexual orientation or physical ability.  Some of us seem to know our rights instinctively and are able to set effective boundaries and ask for what we want.  But many of us have never thought about our rights to intimacy and pleasure -- or even imagined that we had such rights.  When we're unaware, we're extra vulnerable to being taken advantage of by others, whether they intend to take advantage of us or not."

The following advice comes from a guide by Ogden for women about "how to say "yes" to pleasure and "no" to unsafe sex."

My Rights to Intimacy and Pleasure:

1.  I have a right to my own body and all of its sensations, including pleasure and pain;

2.  I have a right to think my own thoughts, whatever they may be;

3.  I have a right to feel the full range of my emotions – excitement, joy and anger, sorrow and depression, love and fear – whether or not my feeling them is acceptable to others;

4.  I have a right to acknowledge my memories, whether they are memories of delight or of abuse, and to base present relationship decisions on them;

5.  I have a right to be – or not to be – a sexual person at all ages and stages of my life, and a right to chose how I define what I mean by sexuality;

6.  I have a right to expect that my partner respect my body, thoughts, feelings, and general well-being, and a right to insist on respect, if necessary;

7.  I have a right to ask for what I want;

8.  I have a right to say “no” to any sexual encounter that feels unsatisfactory or threatening – physically, emotionally, spiritually, or sexually;

9.  I have a right to say “yes” to pleasure that is physically, emotionally, spiritually and sexually safe; and

10.  I have a right to feel good about saying both “yes” and “no.”

-- Source: "The Heart and Soul of Sex," by Gina Ogden, Ph.D.

Military Sexual Trauma Increases Likelihood of Mental Health Problems, VA Says

From a press release, this fairly obvious conclusion:

Military Sexual Trauma Associated With Higher Rates of Mental Health Problems.

According to preliminary research results from the VA, approximately 15% of recently returned female veterans utilizing the VA healthcare system report experiencing sexual trauma during military service.

The cross-sectional study, presented at the American Public Health Association’s 136th Annual Meeting & Exposition in San Diego, examined healthcare screening data of over 100,000 veterans of Operation Enduring Freedom in Afghanistan and Operation Iraqi Freedom who utilized medical care at any Veterans Health Administration facility during a six-year period.

Along with the more than one in seven women, 0.7% of males also reported having experienced military sexual trauma. Both males and females reporting military sexual trauma were more likely to be diagnosed with a mental health condition than patients who did not report military sexual trauma.

“These data highlight the importance of the VA’s universal screening policy,” said Joanne Pavao, MPH, a VA researcher on the study, “as well as early intervention among veterans who have experienced sexual trauma, to prevent long-term consequences.” Veterans Health Administration policy requires that all male and female veterans are screened for experiences of military sexual trauma and that free treatment for military sexual trauma-related conditions is provided at all VA healthcare facilities.

— Source: American Public Health Association

Marching for Suicide Awareness and Prevention among Veterans at Army's Fort Drum

NPR on its Weekend Edition has a good story today about a march held on Sept. 12th at the Army's Fort Drum in upstate New York, to highlight veteran suicide.  The article says that Penny Pierce, who works at Fort Drum, organized the march, in part because the taboo surrounding suicide makes soldiers vulnerable (to not asking for or getting the help that they need.) The article is linked here. Great work, Penny! (And NPR.)

The Other Purple Heart: For Wives, Husbands and Partners of Those with PTSD

The Bible, in the section known as Proverbs (from the Wisdom Literature tradition), has a stunning description of a woman known as the "Proverbs 31 Woman," or the "wife of noble character."  Here's just one sampling of what she's said to be like: "A wife of noble character who can find? She is worth far more than rubies. Her husband has full confidence in her and lacks nothing of value. She brings him good, not harm, all the days of her life."

From the spiritual to the secular, we have another example of the same in the praise that well-known philanderer Ben Franklin (and yes, that's a man who collects paramours, not stamps -- in his case, on two sides of the Atlantic) heaped on his wife, Deborah, for being the highly-cliched but apparently in their case, true, "wind beneath his wings."  While Franklin became famous for, among other things, his witticisms about wealth in "Poor Richard's Almanac," he often credited his wife and her good habits with being the reason they saved any money at all. (I'll find the reference later, but it's true.)

Well, if you scratch the surface of PTSD and veterans, you quickly find how many of the perhaps less famous (guys get famous) , nonetheless vitally key players, heroes and and true angels, are women.  There's Sarah Haley, who we read about the other day; Kathie Costos; Patience Mason; Aphrodite Matsakis; the list goes on and on.  (We fully expect that Kellee Twiggs was that kind of woman, too; as is Bet Ison; as is the highly-impressive Jennifer Briest, though that's TBI not PTSD.) And now, there's Pat Kemm Mann who we can add to the list.  (Not the same "Pat," whose wonderful insights and recollections into his time at war we've been reading about in the "Eyewitness to Combat" series.)  This lady is one impressive person, in her tremendous caring for her husband who she met and married when he had PTSD, as well as her remarkable smarts and strength of character in being the support he and their subsequent family needed.  Just an amazing woman. 

Not saying she's likely to be the only one out there -- actually, she reminds me very much of Kathie Costos, through whose blog I learned about her story, and secured permission to reprint it here -- but she IS very much worthy of our admiration, and she is also articulate and organized enough to tell her story in a compelling way: a story she's willing to share in the hopes that it helps younger wives and women learn what it takes to "love someone with PTSD" and be a real support to them in the life they build together.  As we read about yesterday in the Tao of Caring for Others, sometimes caring for someone else can be just an expression of who you are.  In Pat's case, that's the story.  Here it is, in her own words, about "loving someone with PTSD":

"At the age of 32, I met a man who wasn’t intimidated by my independence or education. A man who made me laugh, introduced spontaneity into my life and who cherished me. He was a 30 year old Nam vet...and twice divorced. But we shared the same family values and dreams for the future. When he proposed, I told him that I was not going to be his third wife; I would be his LAST wife. I only intended to get married once.

He told me that he had a dark side. I had no idea what he meant. I was to find out within months of our marriage. He was driven at work. Always put in more than was required. Naively, I just assumed he had a strong work ethic. I didn’t realize he was trying to escape demons. He had warned me about nightmares; told me how to wake him so he wouldn’t inadvertently hurt me. As a GI Brat growing up in a family with a strong, military tradition, I didn’t think it that unusual since I had several uncles with the same problem.

3 months after we married, however, his behavior began to change noticeably. He began “self-medicating” with alcohol. And he began seeing things that weren’t there. Hearing people calling him for help. Sometimes hearing a child cry would make him jumpy. The smell of urine would bring flashbacks. He had to sit with his back to the walls in restaurants. Anxiety attacks in crowded places. Sudden noises, like party balloons popping or a car back-firing would make him jump or even “hit the deck”. He would be embarassed and apologetic, telling me it sounded like small arms fire.

I was to learn that he had entered a 6 month period of “anniversary dates”. Not pleasant anniversaries. Anniversaries of the Tet Offensive, of being left for dead under a pile of bodies, of being a VC POW (until he managed to escape), of ambushes, being overrun, of being shot down, wounded and crawling and hiding for 7 days until he reached a friendly LZ. All of them crashing down on him like an avalanche of horror.

One day he came home from work and instead of coming into the kitchen where I was washing baby bottles, he went downstairs to the basement. That was unusual but I didn’t think too much about it. Then suddenly I felt an overwhelming sense of panic. I dropped the baby bottle and ran down the stairs. He was standing under them, in the dark, with a pistol in his hand. He was exhausted and terrified of going to sleep because at least when he was awake, he could see what was happening around him as well as the “film” his mind was playing. But he couldn’t make himself blow his brains out because he didn’t want me to have to live with that image forever burned in my brain.

The term PTSD wasn’t known then, or at least not known by many. But I knew my husband was suffering from “Combat Fatigue”. He didn’t want to believe that. Hell, he was a Hillbilly. A rough, tough coal miner. A combat hardened Marine. A third generation Marine... But one who’d been on Valium (through a civilian doctor) since he finished his second tour of duty.

He ended up starting therapy before our first anniversary. The man I had fallen in love with was slowly disappearing, being overshadowed by an often cold, uncommunicative loner. Sometimes I felt like a Life Guard, hanging on to a drowning man, refusing to let him go under.

But I had an advantage that many of the younger wives of combat vets didn’t have. Growing up on military bases. A brother and friends who’d gone to Vietnam while I was in college. I was 33 years old. And I had enough psych courses under my belt that I was able to "deal" with the nightmares, hallucinations, rages, and suicidal ideations as well as monitor and administer the massive quantities of anti-psychotic medications the VA was doling out... (and to eventually question the efficacy of most). Even so, the pain of seeing him look at me, with total confusion in his eyes - knowing he doesn’t know who I am but thinks he should... the pain and sorrow was indescribable.

His cup of stress was full to the brim from memories alone. Anything at all, no matter how minor, was like that one extra drop that causes the cup to overflow. Every car “accident” - always single car accidents, one near fatal - happened immediately following his 6 months of anniversary dates, when he had reached the limits of his endurance.

At one point, we lived on the Texas coast. Driving to the Houston VA was a challenge. It’s a nice, straight highway but for long stretches, it has rice paddies on both sides. He drove hunched over the steering wheel , knuckles white. Eyes darting constantly left and right. Muttering about damn rice paddies. I knew what he was doing and finally told him “I’ll drive. You watch for Gooks.” After that, I always drove that stretch.

I found myself “interpreting” other people’s actions and comments to my husband so he wouldn’t deck someone who had merely glanced our way but whom he thought was challenging him. He was quick to anger and quick to fight. But he was mostly able to keep his promise not to get in fights after I told him I knew he could take care of himself but no matter how the other guy looked, it hurt me to see him with scraped and swollen knuckles.

It wasn’t easy. And it wasn’t fun. But the man I loved was still in there and I was determined to beat back the demons that were dragging him down. We lost some friends who just saw him as crazy or irrational or scary. I remember once asking “Who are we not friends with this week?” His head kind of jerked, he looked at me for a moment and then he laughed. It stopped another rampage over an imagined insult or slight.

He had no patience at all. If we decided to go somewhere, the girls and I had to be ready to go the second he was. I’d remind him that no one’s life was in jeopardy if we were slower than he wanted. The thing that did the trick, though, was the time I finally took the car keys from him, handed over our two small daughters and told him that this time, HE could get them ready to go. I’D sit in the car and honk the horn.

He started group therapy and we found friends who understood because they were going through the same thing with minor variations. Almost all had done the “geographical tour”, moving from job to job or state to state as they tried to escape what was inside them. Some had used alcohol, prescription drugs or even street drugs to escape the psychological pain. And, like so many of the guys, his previous marriages didn't last simply because he couldn't let himself care that much and did everything he could to protect his fragile emotions from being fully engaged. A lesson he learned too well from losses in combat.

For some reason, he trusted me enough to open up about a few things that happened in Nam - things that clawed and burned in his mind. Which was both a good and a bad thing for him. He knew he had a safety net but letting those painful memories out (those he hadn't completely blocked, anyway) ripped the scabs off some horrendous memories.

Our two daughters were old enough to know that their Daddy was different from most of their friends’ daddies. But our daughters maintain that the thing that helped them understand their dad the most was that I always explained his behavior to them in terms that were age appropriate. One thing I'm especially proud of was when a VA Therapist asked me how I'd managed to raise such normal kids. While they didn't always LIKE him or what he was doing, they always loved him and knew that he loved them in return, even when he would "go bush", miss out on important events in their lives, or self medicate to excess.

And yes... he went to counseling and group therapies. We went through marital counseling and family counseling as well after one particularly rough patch. All of which were extremely helpful only because he was able to get outside his comfort zone, accept the validity of our feelings and make the effort to change certain behaviors.

When his PTSD, appointments and hospitalizations began to interfere with his ability to support his family, we began the torturous process of applying for disability. And we had to do it all over again for Social Security. Writing to every doctor he’d ever seen, every hospital he’d ever been in and trying to locate witnesses who had made it home, up to ten years after the fact.

I had to help him with the VA claim statement. I remember sitting, after the girls were in bed, writing down what he said as he spilled his guts and his pain all over the dining room table. Crying inside because of the horrors he went through and yet not daring to show any emotion on my face because it would have made him stop talking - for fear of upsetting me, disgusting me, or making me think less of him. And then having to sort through the jumble and make complete, intelligible sentences out of it.

I am eternally grateful to the PVA (Paralyzed Veterans of America) service rep who took the 13” thick stack of documents covering 10 years and went to bat for my husband.

In spite of one VA doctor who attempted to keep me out, I sat in on every appointment with my husband after I realized that the doctor didn’t know half of what was going on. This was something I felt very strongly about. I had to play an active role in his treatment. No one knew him better than I did.

The doctor would ask “How have you been since I last saw you?” And my husband would reply “Fine.” Then I’d jump in and tell the doctor what I’d observed. He WASN’T “fine”. And the fact that he couldn’t recognize his actions as irrational proved my point! Reactions that can keep you alive in combat are not always appropriate Stateside. Asking some of these guys how they are is like trying to get a blind person to describe the color yellow.

And I remember the anger I would feel each time a new doctor was assigned to my husband. The dreaded First Three Questions: Have you ever seen anyone killed? Have you ever been in fear of your life? Have you ever killed anyone? Check his records! 3 Purple Hearts. Siver Star. Bronze Star. Presidential Unit Citation. Combat Air Crew Wings with 3 or 4 devices. You don’t get those sitting behind a desk!

We've had our share of difficulties and I've often been asked why or how I stuck it out with him. My answer was always very simple: He's a good, kind, and decent man with serious problems. I wouldn't leave him if he had Cancer; I won't leave him because he's got emotional or mental problems. With close friends, I laugh and say "Because I'm strong, stupid or stubborn. Haven't figured out which yet!"

After almost 30 years, we're still married. Our family is stronger and closer than ever. The grandchildren all love their Pa-Pa and he adores them. Both daughters have chosen careers in medical fields where they can help others and are totally comfortable dealing with what some of their co - workers call "crazy Nam vets". And they're quite vocal in the defense of these guys. I'm proud of them. But then, almost all of our best friends are men (and their families) that we met while they were in the “Nuts and Flakes” wards at various VA Hospitals.

And I'm proud of my Marine, a crew chief and door gunner on med-evac choppers who served two tours (during which he endured being shot down 13 times, left for dead 3 times and 58 days as a POW of the VC). Once, he apologized to me for "being so weak". I told him he was the strongest man I'd ever met and that I would never want to be with a man who saw and went through what he did... without it bothering him.

My husband is worth the effort it’s taken and the rewards are immeasurable. He’s not “well” by any means, and he may never be because serious help came too late. But we have a good marriage filled with humor, love, respect and trust that goes both ways. Even with the problems, that’s still more than many have.

I have hope for our new Walking Wounded. No one questions the reality of PTSD anymore. More help is out there. I just hope that those who need it are informed that it is available... without the stigma my generation had to fight and without the delays that make it less successful.

Pat Kemm Mann
Fruitland Mesa
Crawford, CO 81415

Sarah Haley - Psychiatric Social Worker, PTSD Pioneer, Friend of Veterans

Gerald Nicosia's book Home to War: A History of the Vietnam Veterans' Movement, is fascinating reading, if only to keep in mind the wisdom of the George Santayana quote, "If we do not learn from the mistakes of history, we are doomed to repeat them."  Nicosia goes into much detail about how the PTSD diagnosis was first determined and included into the DSM, and along the way he paints the picture of many of the key participants, including Sarah Haley, in first treating Vietnam veterans for combat trauma and the resultant PTSD.

Whenever we look at history like this, it becomes apparent that whoever is impressive today in this work owes so much to pioneers like Haley (who Nicosia discusses) and Lawrence Kolb, M.D. (who Nicosia oddly does not).  "Standing on the shoulders of giants" is the semi-cliched expression about what present practitioners owe as a debt to the pioneers of the past, and it is certainly true about Haley's work: she was a true giant.

Here I'm going to excerpt, with Nicosia's permission, parts of the many passages about her work so you can see three important things: what her background was, which gave her a special compassion for the truth the veterans first presented with; the extent of her rapport with and trust established with the veterans themselves, which allowed her to help them; and some of her more intuitive leaps about what PTSD really meant from the lives of veterans with whom she consulted.  What a truly remarkable person; and what a shame she's no longer with us, so that we can continue to benefit from her truly outstanding work with veterans.  (Few of these quotes are continuous; most skip around from important part to important part, with the gap indicated by the ellipses)

Haley's background:

"It was a woman .. a psychiatric social worker named Sarah Haley, in the big VA outpatient clinic in Boston, whose research into veterans’ stress disorder literally blew the existing psychiatric definitions to pieces and began to put a whole new definition on the map.

"Sarah Haley [initially] seemed the least likely person in the world to make waves…

Her friends all warned her that the VA’s psychiatry program was “fifth-rate,” that she would find herself treating ‘chronic schizophrenia and passive-dependent men with bleeding ulcers,’ and that her career would surely go down the tubes.  But despite the fact that she entered upon her new VA job with the meagerest of expectations, she couldn’t help being ‘shocked at the low caliber of the general run-of-the-mill health person there.’  As she recalls, ‘These were not mental health people that you would want anybody in your family to get near.’"

 

Haley's first astounding discoveries:

"One day, a young man in a highly agitated state was brought into the clinic by his parents.  He had only been home from Vietnam for three days, and his parents had no idea what to do with him.  He was having total body tremors and exhibiting ‘startle response’ every few minutes.  If a car backfired or a door slammed, he would dive under the nearest table.  After much rambling, the young man told her he had been at a place called My Lai, that terrible things had happened there, but that it was difficult to piece it together.  He was confused and experiencing a lot of amnesia, but he did remember seeing the bodies of women and children and vomiting into the bushes.  He also remembered that he could not shoot anybody himself, that he had thrown his gun down.  The American soldiers who did the killing had sought to intimated him and the others who didn’t shoot: ‘If you ever tell anybody, we’ll come get you.  Or we may come get you anyway.’

 

…

"Indeed, any other intake worker might have dismissed [this recent Vietnam veteran] as delusional, but Haley had reason to believe him.

(Her father had been on special operations with the OSS in North Africa during World War II, a self-admitted ‘assassin for the government.’  He had told her about seeing a truckload of German prisoners who were led out and made to kneel in front of a ditch, where an American officer shot each one of them methodically in the back of the head.  Then the Americans dumped their bodies in the ditch and shoveled it over.  Thus Haley, as she puts it, had “no illusions about war.”)

 

How Haley worked with veterans and understood their particular trauma:

"Haley had nothing to go on but a big hunch, but she decided to follow it.  It seemed to hear that a lot of mental health professionals – especially those at the Boston VA clinic – had great difficulty in listening to the recital of trauma: as a defense, they either disbelieved it off the bat, turning it into the less threatening notion of “delusion,” or else withdrew from the patient as quickly as possible so as not to have to hear more about it. 

 

The other horn of this troubling dilemma was that the traumatized person, especially if he was a Vietnam veteran, would almost never come in and spill his guts to a perfect stranger.  Trauma patients need to establish trust with a therapist, and the Vietnam veterans coming into the VA clinic were never being given the chance to do this.  It was by the merest lucky chance that the My Lai veteran had seen something in Sarah Haley that made him believe he could confide in her, thereby opening the door not only to his own dark secrets, but also to possible help for a whole generation of trauma victims.

Haley perceived correctly that the reason the My Lai vet could not remember all the details of his trauma was that much of the most painful material had been repressed.  In the coming years, she would encounter the same phenomenon in hundreds of Vietnam veterans, some of whom could only recall five or six months of their 12- or 13-month tours of duty.

 

More insights into how Haley worked with veterans, and uniquely modified the approach for dealing with combat trauma:

"She further realized that the stuff was eating away at them would have to be brought slowly and steadily to the surface – that there were no quick fixes, like ‘5 mg. Stelazine daily.’  Equally ineffective, she would soon discover, was ‘the sort of non-authentic treatment’ where the professional would talk about family issues or other daily matters that were troubling the patient, but never bother asking about the existence of trauma in his past; for if the professional didn’t ask, the trauma victim would seldom bring it up on his own. Haley was aghast to learn, for example, that an analyst friend of hers had “successfully” treated a Vietnam veteran solely on the basis of working through the rivalry with his father and never even asked the veteran about his [combat experience.]

"Most of the Vietnam veterans Haley found were coming in to see a VA psychiatrist merely so that they could get their next month’s supply of Valium.  Haley would go to the psychiatrists and inquire whether they had ever asked these veterans about their Vietnam experience; the usual reply from the shrinks was that they had stopped asking because the veterans didn’t want to talk about it.  Haley was flabbergasted that none of the VA psychiatrists – with the exception of two notable women, Lillian Rodriguez and Constance Hartwell – evinced any interest in learning the cause of the tremendous anxiety for which they were blithely prescribing shelves of medication.

Unique problems to Vietnam veterans that Haley noted:

"During those first few years at the VA, Haley encountered a great many vets who talked about participation in atrocities.  she found most of them to be ‘terribly guilty, feeling unclean, and not worthy to be back in the world.’

…

 

"… Instead of hearing, “Doc, I have a bellyache,’ or “Doc, I’m seeing visions,” or “Doc, I’m terribly depressed,” what Haley would hear time after time was, “Doc, I think I’m a murderer… I slaughtered innocent civilians.”

 

And finally, Haley's substantial impact:

"Working with these men and the material they brought up was so painful that it took Haley almost two years to complete her article…which was immediately recognized as a landmark work.  By precise delineation of the symptoms of several veterans she had treated, Haley established that the Vietnam veteran who had witnessed or taken part in atrocities could not be handled merely as a traditional case of traumatic war neurosis, but presented a completely new challenge to psychotherapy."

Sarah Haley was indeed a remarkable woman, and a great Friend to Veterans.  So much of the unique and compassionate approach to understanding PTSD's impact on veterans comes directly from this woman's work, and for that we are deeply appreciative and honor her in memoriam.