Healing Combat Trauma

Quotable Quotes -- Audie Murphy on Getting Over Combat

Audie Murphy, left, in his day, was the most decorated American soldier from World War II, winning the Medal of Honor, among 27 others. He also famously told a reporter, "You know, you never get over combat. I don't think you ever do." (Quoted in Chaim F. Shatan, M.D.'s famous text, "The Grief of Soldiers," from 1973.) He died at 45 years old.

We would wish for every Audie Murphy, and every other combat veteran, more relief from his struggles, and more healing, than Murphy himself was able to know. Let it be so.

© 2010 by Lily Casura / Healing Combat Trauma. All rights reserved. Use with attribution.

 

Provider Burnout among Combat Stress Healthcare Practitioners

It's been interesting to follow the Tweets from the conference at Mass. General Hospital this Friday and Saturday, on the "Complexities and Challenges of PTSD and TBI." It sounds like it was a great conference. One of the items that stood out to me was the statistics being shared about provider burnout. Check these out:

"Not enough social workers, therapists, etc. to help all the people who need help."

"146,000 mental health providers in U.S. Medical Command (MEDCOM),...a huge centralized training that's re-assessed annually for improvements...now (with) significant training resources in place to help providers manage stress." 

Studies that MEDCOM has done indicate that provider "burnout" is approximately "35% among deployed psychiatrists," "20% in deployed psychologists," "15% in deployed social workers," and "26% in non-deployed." (Source: LTC Graeme C. Bicknell, PhD, LISW, LTC, MS, Deputy Chief, Behavioral Health Division US Medical Command.)

We've written about "Caring for the Caregivers" frequently on this website, most recently here, in a post entitled, "Too Long a Sacrifice Can Make a Stone of the Heart:The Tao of Self-Care." Acknowledging provider burnout is another aspect OF "caring for the caregivers." The takeaway? Combat stress injures troops AND mental health providers; servicemembers and practitioners alike need stronger support. 

(There's a great article by Charles Figley on the topic, "The Art and Science of Caring for Others without Forgetting Self-Care, linked here, suggested by one of the readers on the Facebook site for this website, which is linked here.)

Editor's note: You can follow the PTSD Conference, now over, on Twitter, @PTSDConference; and you can follow this website on Twitter @HealingPTSD.

Quotable Quotes -- The Dalai Lama on Life Purpose and Satisfaction

That Dalai Lama -- he's amazing! If "personal outlook" were a software package, I'd ask for the Dalai Lama upgrade: because I like how he thinks. So compassionate and kind and reasonable, but not afraid of science. A fascinating, compelling combination. 

Some of his great quotes lately:

"We can't be useful to ourselves unless we're useful to others. Whether we like it or not, we're all connected, and it is unthinkable to be happy all by oneself. Anyone concerned only with his own well-being will suffer eventually. Anyone concerned with the well-being of others takes care of himself without even thinking about it. Even if we decide to remain selfish, let us be intelligently selfish -- let us help others." -- The Dalai Lama.

And another:

"Once you shift your focus from yourself to others and extend your concern to others, this will have the immediate effect of opening up your life and helping you to reach out. The practice of cultivating altruism has a beneficial effect not only from a religious point of view but also from a mundane point of view; not only for long-term spiritual development but even in terms of immediate rewards."

And another:

"The world's major religious traditions all give the development of compassion a key role. Because it is both the source and the result of patience, tolerance, forgiveness and all good qualities, its importance is felt to extend from the beginning to the end of spiritual practice. Even without a religious perspective, love and compassion are clearly of fundamental importance to us all."

And another:

"Satisfaction is characterized by inner peace. It arises from generosity, honesty and what I call ethical conduct, a way of behaving that respects others' rights to be happy."

---

Bringing this all back around to veterans with combat-based PTSD and their families, think how crucial what he's expressing are. Eighteen veterans a day kill themselves -- a shocking statistic -- and we seem to be at the beginning, not the middle or the end -- of that particular trend. Army and Marine suicides -- they see the bulk of the action, after all, in these wars -- are both up, despite the "best of intentions" on the part of the services to bring down the numbers. Pep talks on prevention and more prescriptions aren't solving the problem, nor are they likely to. Because, as one combat vet with PTSD said, "pep talks are hard to take seriously because that is for the normal life of a normal person, not for a veteran contemplating suicide because of combat trauma." True, that.

It's coming up on two years, shortly, of my first phone conversation with the combat vet, a Vietnam vet, Marine, with 40 years(!) of severe, chronic PTSD, which plagued his life, despite "all the best" of what the VA threw at him (his words, not mine), including an inpatient, residential PTSD program that was cutting-edge at the time. (Would it surprise you to know that most of his classmates in that program, according to him, are now dead, also from suicide?) After our first conversation, which seemed relatively pleasant and positive, he followed up with an email about wanting to drink and put a gun in his mouth to end it all, because he was sure God hated him; after all, he himself did. Sparkly stuff. Lots of unicorns and rainbows and fluffy clouds there...not one bit.

Of course, the end of his story is quite a bit more positive, mostly because it didn't end. He's made the transition from bleak, grim and grisly to mostly inspirational and awesome. And it took a while, a solid footing, a hand reaching across the abyss and pulling him up and out -- a hand which he importantly grabbed (it doesn't work if you don't ;-). It took some specific therapeutic treatments to help remove trauma from the body. We tried a few, intentionally, and they worked; there are others that might as well. And it took a huge motivation on his part to reach out -- however ugly his mess at the time -- to get some help and be real about where he was really at. For years, decades really, he'd been the one other vets' wives called to take the gun out of the mouths of their husbands. Now he finally had some hope to offer others. But it took commitment on his part, believing that the hope was out there, and going after it with all he had. Not always pretty, but effective :-)

(He's the veteran in the "Eyewitness to Combat" series on the site. Here are two items about his turnaround, linked here and here. The second is in his own words.)

Anyway, the upshot of the whole experience is wanting to build a program to bring other combat veterans with PTSD through, and help their families as well, who are often left holding the bag (of misery) but not really getting the help they need either. Combat veterans with PTSD have often lost their life purpose completely, and as we've been talking about lately, purpose is key.

The "eyewitness to combat" veteran, described above -- he and I share a purpose. It's helping others overcome. It's possible. And as the Dalai Lama says, that's being intelligently selfish -- taking care of those 18 vets a day who'll be killing themselves, BEFORE it happens. So it doesn't HAVE to happen. That's the best use that you and I could put our time and energy and compassion to. Please join in helping others so that they don't have to suffer so intensely, when there is a way out.

Editor's Note: A California-based psychology grad student is doing a Ph.D. thesis on Iraq vets with PTSD and life purpose. If you qualify based on the above criteria, he'd like to talk to you, and will pay you $50 for your efforts if you participate. Here's the link to his study. His brother is a combat vet. 

Additionally, you can "follow" the Dalai Lama on Twitter -- @DalaiLama -- and you can follow us on Twitter as well @HealingPTSD.

Quotable Quotes -- Former U.S. Senator Bill Bradley on PTSD

Former U.S. senator Bill Bradley (D-NJ), NBA Hall of Famer, and Rhodes Scholar, had this to say in a commentary published in Vanity Fair today about PTSD. The occasion was the premiere of the Tom Hanks/Steven Spielberg/HBO miniseries, "The Pacific," about U.S. Marines in the Pacific during World War II, also getting screened privately at the White House today.

Bradley thinks there are several things that the president and the first lady should be thinking about while they watch the miniseries. One of those topics is PTSD. Says Bradley:

"Both The Pacific and Band of Brothers focus on the horrors of the war and the emotional trauma that a soldier or Marine can endure. P.T.S.D. should be treated with as much seriousness as a gunshot wound. If the president is going to send tens of thousands more troops [into combat], he also needs to consider the emotional payload. With suicide rates up among veterans -- accounting for 20 percent* of all suicides among Americans -- the government must dedicate more money to support programs for our returning troops."

Editor's note: If 8,000 veterans kill themselves every year, conservatively, and the national suicide rate is close to 34,000, according to the NIMH, the percentage of suicides who are veterans is closer to *25%. They also represent almost 50% of the homeless population. So yes, please, let's do that...and sooner rather than later...

(The full commentary is linked here.)

Shneidman and Camus -- Suicide as "the Fundamental Question" of Philosophy

"Suicide is up in the military once again, and it's also up among veterans -- those who have been deployed previously. While "National Mental Health Awareness Month" may still be a few months off -- in May -- but it's interesting to note what existential philosopher Albert Camus wrote in his book, "The Myth of Sisyphus":

"There is but one truly serious philosophical problem, and that is suicide. Judging whether life is or is not worth living amounts to answering the fundamental question of philosophy."

And also humanity, we might add...because it figures in there, too.

Dr. Edwin Shneidman, the compassionate genius considered the "father" of suicidology, who sadly passed away a few months ago, wrote about how suicide is a narrowing of the distressed person's field of vision, until they can see only two options: staying or going. Without broadening the options to three or more, the way that healthier people think, a distressed person may vacillate between these two options until the pressure in their life mounts, and they can only "see" the one option, and their timing suddenly becomes a desperate "now."

(Clearly, suicide is an event with much collateral damage, particularly to those around the person in pain, who can have an understandably extraordinarily difficult time coming to terms with how or why that decision was made. Read Shneidman; he understands. In one poignant passage, quoted here, he describes the mind of the suicidal person closing down in restricted vision until, not that the victim doesn't care, that he or she can no longer see who else is in the picture, so great is their personal pain.)

While there's much material on this website about suicide, particularly here -- and also help numbers to call if you're in distress, linked here -- I mention the Camus quote to give a certain backhanded respect to the topic as a whole. Many times people claim, rightly or wrongly, that suicide is the quintessentially weak move, "the coward's way out," reserved for those who can't, or won't, face their problems, others say judgmentally or even sometimes accurately. Yet for those who are suffering greatly, and contemplate it periodically -- as many honestly do -- it's "nice" to see someone with real cultural weight give the question some credence or respectability as a topic. To paraphrase Shakespeare, "to stay or not to stay" may turn out to be the real question, after all...

What the Camus quote implies is that even robustly mentally healthy people, if they're philosophically inclined, have dwelt on or wrestled with at least the abstract reality of the question. (Ironically,  Shneidman's obituary in the L.A. Times, linked here, mentions the same quote, and that Shneidman was a fan of Camus.) If we combine their perspectives imaginatively, true mental health might mean wrestling with the topic conceptually, but then enlarging the field of choices so that it doesn't have to become an option that is used. Could open discussions arise from removing the stigma around even broaching or discussing the topic? More on that later...

Editor's note: Cribbed directly from my friend Kathie Costos' blog, Wounded Times, here are the phone numbers and the information for veterans questioning suicide -- some of which support family members as well:

• Vietnam Veterans of America, Crisis Phone Number. Special Notice: If you are a veteran in emotional crisis and need help RIGHT NOW, call this toll-free number 1-800-273-8255, available 24/7, and tell them you are a veteran. All calls are confidential. http://www.vva.org/.
• Also, Veterans’ Crisis Intervention Hotline: 1-888-899-9377. A Crisis Intervention Hotline has been established by the VA Heartland Network to assist veterans who may be dealing with a mental health crisis or difficult issue in their lives. The hotline will also aid family members or friends of veterans who need help in assisting a veteran in crisis.

Picking up the Pieces of Shattered Lives: Treatment or Prison

The other day was a momentous day in the life of two different combat vets. One, an older warrior, Marine, from the Vietnam war, the other, an Army vet, from the war in Iraq. Each of them wounded in combat.  Each of them knowing  intimately the sufferings of PTSD. Each of them having failed, at various times, sometimes spectacularly, other times less so, at "keeping it together" or being the person they wanted to be, for themselves, their employers or their families, because of their PTSD.

Yet what brought the two together this day was the one taking the other to an inpatient PTSD program at the VA; the older bringing the younger to a program he’d gone through himself, years ago; and one vet to another, the Vietnam vet to the Iraq war vet, encouraging him to pay attention, and to begin the process of change.

 Nobody goes to an inpatient program because they're doing so astoundingly well with their life or with their PTSD symptoms. Sometimes it's a diversionary program offered in the place of jail, which is why the Iraq vet this week was going. Drinking heavily, he'd been arrested for domestic violence, and the older vet stood up for him in court, but requested that the judge send him to treatment, in lieu of further jail time. This time, the Iraq vet was "lucky." There was room for him in the program. Many other Iraq and Afghanistan war vets -- Gulf war vets -- Vietnam vets -- have not been so lucky. They end up with extensive prison sentences for being in the wrong place at the wrong time, and getting arrested when their finely-tuned combat-trained hair-trigger reactions are out of sync with civilian life.

Talking with some young Iraq and Afghanistan combat vets a few months ago, guys who were residents in another cutting-edge residential treatment program for PTSD, they told similar stories, of having been given the chance to do the inpatient program after being arrested for something they did, fully inappropriate for the civilian world, when they first returned from combat. One guy told a story of going with his wife and kids to Walmart, and having her touch him from behind, which startled him, and as he told the story, when he "came to," he had his hands around his wife's neck, choking her. An inpatient PTSD program seemed like a better choice than jail. And for what it's worth, it did sound like he was sorry, and it also sounded like his wife was still with him -- but, everyone involved acknowledged that he needed treatment, including him.

It's reasonable to ask, how do we know whether inpatient programs do much good for the combat veterans with PTSD who go through them? We'll have to wait and hear from the graduates, but also, watch their lives, so to speak, for years afterwards, and see how things really turn out.

The older combat vet, the Marine, who took the younger vet to the program the other day, recalls that from the graduating class of his own program, most today are dead: many took their own lives, despite what they'd learned in the program. At most, he credits the time in his own life with learning to recognize what many of the danger signals of PTSD are, the "red flags" that a situation is escalating. At this remove, he considers what he learned to be "behavior management" -- learning coping skills for managing a disorder that nobody really expected to be healed or cured, at least through conventional means. Hmmmn.

In other parts of the country, veterans are doing jail time for similar offenses, even some seemingly more light-weight. Whether a veteran goes to a treatment program or to jail seems at this point to be mostly the luck of the draw. There’s also some concern, among veterans advocates and others, that the way police arrest combat vets with PTSD can further escalate the vets’ reactions. Many first responders are military veterans themselves, sometimes with their own cases of PTSD – from combat or the job. Training is needed so that arresting a combat veteran in the throes of a PTSD-fueled reaction can go as smoothly as possible, with as little collateral damage as possible. Additionally, when combat veterans with PTSD are arrested and imprisoned, they lose their VA benefits – and are often left completely untreated. This only compounds the problem/tragedy further.

Jamie Keyes daily endures the struggle of knowing that her son, Nathan, jailed for a PTSD-fueled reaction, might have benefited from treatment, but instead is doing time. A highlight of her Christmas vacation was driving to another state, where he is jailed, to spend a few short hours with him. She worries what incarceration will do to her son, and even to her elderly father, who raised Nathan as a boy, and is heartbroken to know that he’s in jail.

The story of what happened to Nathan Keyes is here – but if you want to see a mother’s perspective even more strongly, watch the video she made about Nathan, here, before his trial.

Jamie Keyes writes, 

“This is a tribute to my son, Nathan Keyes, who is a veteran with PTSD. Nathan spent 8 years in the Army and two long tours in Iraq, before returning home bearing the mental wounds of war. Nathan is now incarcerated for an act resulting from his PTSD, and will spend three years in prison. The state of Florida wanted to give him more than 15 years for his offense, instead of giving him treatment. Instead he took a plea deal that will leave him with a felony record for the rest of his life and 3 years in prison without treatment. Nathan sought help from the VA but never got adequate treatment, and was subsequently failed by our criminal justice system. This is how we treat the returning veterans in this country. This type of incident is happening in epidemic proportions all over this country, and it is a dishonor to those who so selflessly served their country.”

Treating combat veterans with PTSD who commit crimes in inpatient PTSD programs “sounds” a lot better, on the surface, than jail time – definitely. Questions still remain about how effective the inpatient treatment programs are, but it’s obvious that they’re preferable to jail – which takes away the opportunity for treatment, and further harms the veteran, on several levels. However – it’s also necessary that first responders learn how to arrest combat veterans with PTSD who may be in the middle of a PTSD episode when they’re arrested. No one knows right now how many police departments across the U.S. even recognize this is an issue to be addressed. Ideally, before too long, all first responders will be trained to recognize the signs and symptoms of PTSD and how to deal with combat veterans when they have to arrest them. Averting forseeable tragedies is always a worthy goal.

43,000 Troops Found "Unfit to Serve": Non-Deployable but Sent Anyway?!

Several weeks ago I watched a wonderful Bill Moyers interview on PBS with Oliver Stone, noted filmmaker and Vietnam veteran. The whole interview was great, but a figure Moyers used at the beginning was just stunning -- for the implications it has for soldiers with PTSD and their families.

Moyers said:

"...I read a report based on military records which revealed that from 2003 to 2008 some 43,000 troops had been sent to Iraq and Afghanistan despite having been classified as "non-deployable" for medical reasons. In plain English, they weren't healthy enough to go, but were sent, anyway."

Yowser. It's hard to imagine a circumstance in which being considered unfit to serve for medical reasons, and being deployed anyway, improves your situation. It sounds like all it would do is reinforce the difficulties you were already having, or pile more trauma on top of the pre-existing trauma.

Additionally, troops who have fought in Iraq, when they're deployed next to Afghanistan, find that to be a completely different experience. So Afghanistan for them isn't "more of the same," it's new and different, with all the challenges that implies.

(See news report from November 29, 2009, entitled "Afghanistan, Iraq: Different Wars -- U.S. Soldiers: Afghanistan War Dramatically More Difficult, Challenging Than Iraq," linked here.)

Editor's Note: For the link to Bill Moyer's Journal and his excellent interview with Oliver Stone, shown on December 4, 2009, click here.)

"Not Victims, but Veterans": Max Cleland Writes an Open Letter to Other Combat Veterans

Max Cleland, decorated Vietnam war hero, triple amputee, head of the Department of Veterans Affairs under President Carter, and PTSD sufferer, who came to that knowledge in later life, decades after his military service, has written a new book, called Heart of a Patriot: How I Found the Courage to Survive Vietnam, Walter Reed and Karl Rove.

There was an interview with Cleland on NPR's Morning Edition yesterday, October 6, 2009, linked here.

But most interesting for our purposes -- since this blog is about combat veterans and PTSD -- is the "open letter" to other veterans that Cleland writes, and which is excerpted as part of the NPR piece.

"As combat veterans," he writes, "we have been through some of the most traumatic life experiences possible. War is as close to hell on earth as anything ever could be. That does make us different from our loved ones back home. War marks us all, some more deeply than others."

There's some wonderful, heart-felt expression in this letter:

"The soldier's lot is to be exposed to traumatic, life-threatening events — happenings that take us to places no bodies, minds, or souls should ever visit. It is a journey to the dark places of life — terror, fear, pain, death, wounding, loss, grief, despair, and hopelessness. We have been traumatized physically, mentally, emotionally, and spiritually. Some of us cope with exposure to hell better than others. Some are able to think of their combat experiences as but unpleasant vignettes in a long and wonderful life. It is not to those veterans I am speaking. I love them, but I am not afraid for them.

I am speaking to the rest of my brothers and sisters, those who find themselves trapped in the misery of memories as I was for so long. For them, I am afraid.To those veterans I say, you are not alone.

Many of us have been overwhelmed by war. Many of us have been unable to cope on our own with what has happened to us or with what we have done. Many of us have been left hopeless, lost, and confused about ourselves and our lives in ways we never thought possible.

That does not make us victims. It makes us veterans."

The rest of the open letter is equally wonderful, and well worth reading. In it, Cleland talks about his own personal highs and lows, what he understands about PTSD and his own case, and what has helped him get through. It's clear the concern and caring he feels for other combat vets. The letter is linked here.

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.

Understanding Trauma: Exposure to The Darkest and Most Violent Forces of Human Nature

Periodically we run across a quote that seems worth sharing, to create a larger understanding of what those who experience trauma have gone through. Here is such a quote, directed in this case to practitioners.

"The examination of PTSD patients can be very stressful to clinicians. As Blank (1985) notes:

PTSD is caused by contact between the individual and the darkest and most violent forces of human nature. War, murder, rape, floods, etc. take the victim over the edge of life into serious confrontations with death or uncontrolled violence. Some individuals are therefore transformed and become, at some level, bearers of the traumatic experience. The (examiner) with whom they come into contact is thus inevitably exposed to war, rape, flood, etc. (p. 88)."

Source: Post-Traumatic Stress Disorder, by Kirtland C. Peterson, Maurice F. Prout, Robert Alan Schwarz

Traumatic War Experiences Predict Future Health Woes, Study of Civil War Vets Shows

In some medical news that you might have missed, a study came out that was published in the February, 2006 issue of the Archives of General Psychiatry that studied historical records pertaining to Civil War veterans, the amount of trauma they experienced in combat, and what the after-effects were in later years to their health.  Fascinating stuff, of course.

According to the article, "An archival examination of military and medical records of Civil War veterans was conducted. Degree of trauma experienced (prisoner-of-war experience, percentage of company killed, being wounded, and early age at enlistment), signs of lifetime physician-diagnosed disease, and age at death were recorded." Additionally, "The US Pension Board surgeons conducted standardized medical examinations of Civil War veterans over their postwar lifetimes. Military records of 17,700 Civil War veterans were matched to postwar medical records."

The conclusion?  "Greater exposure to death of military comrades and younger exposure to war trauma were associated with increased signs of physician-diagnosed cardiac, gastrointestinal, and nervous disease and more unique disease ailments across the life of Civil War veterans." In other words, younger soldiers were at greater risk; and the more brother (or today, also sister) soldiers who died, the harder it was for the combat veterans.  Makes sense, doesn't it?

Editor's note: The study's citation is: Arch Gen Psychiatry. 2006 Feb;63(2):127-8, and it's linked here. 

"Anything is Subject for a Poem" -- Even Combat and Its Aftermath

It's hard for me to believe I haven't already posted this, but that's what the blog search says -- and I must believe it. Here's an interesting item from the always-fabulously-insightful Deng Ming-Dao, on how "anything is subject for a poem," and why a regular discipline of "writing down the bones" can be advantageous to any of us, even -- or especially -- combat veterans.  He writes:

Anything is subject for a poem:
A catalog of boxing equipment, a collage of other poems,
Serpentine trail of incense, raised deer fur, old shoes pointed pigeon-toed,
Glass and steel cityscape, almond eyes of a saint, weeping tiny flowers,
Sunlight on whitewashed walls, blue shadows of stooped women,
A spring mousetrap, a trickle of blood in the gutter,
The homing swoop of a gull, chill white-capped bay, scent of eucalyptus.
Green lawn of broken blades, clods of fat earth.
Anything is subject for a poem.

Even in sleep, write a poem.
When waking, write a poem.
While loving, write a poem.
Even voting, write a poem.
When angry, write a poem.
While dreaming, write a poem.

The sages say quite seriously that those who wish to know Tao better should cultivate the poet in themselves.

-- 365 Tao: Daily Meditations, by Deng Ming-Dao.

A Harvard Study Confirms More Combat Exposure = More PTSD

The Atlantic magazine this month has a story about the Grant Study, a longitudinal study which followed 268 "Harvard Men," from the classes of '42, '43 and '44, from their sophomore year in college, through for the next 42 years.  The Grant Study men, those who are still alive, are now in their 80s, and approaching death. It wasn't the purpose of the study, but because so many of the men served in World War II, the study was able to comment that, among other things:

"More than 80 percent of the Grant Study men served in World War II, a fact that allowed (the study's administrator) Vaillant to study the effect of combat. The men who survived heavy fighting developed more chronic physical illnesses and died sooner than those who saw little or no combat, he found. And “severity of trauma is the best predictor of who is likely to develop PTSD.” (This may sound obvious, but it countered the claim that post-traumatic stress disorder was just the manifestation of pre-existing troubles.)

The full story, called "What makes us happy," by Joshua Wolf Shenk, is linked here.

Hanging Tight to the Narrative, to Pull You Out of Hell...

More Tyler Boudreau, from "Packing Inferno: The Unmaking of a Marine," on why he writes:

"They say war is hell, but I say it’s the foyer to hell.  I say that a lot.  I say coming home is hell, and hell ain’t got no coordinates.  You can’t find it on the charts, because there are no charts.  Hell is no place at all, so when you’re there – you’re nowhere -- you’re lost.  The narrative, that’s your chart, your own story.  There are guy who come home from war and live fifty years without a narrative, fifty years lost. They don’t know their own story, never have, and never will.  But they’re moving amidst the text every day, and every long night without even realizing it.  They’re out there beyond the wire, trudging through the sentences, tangled in the verbs, suffocating on the adjectives, wrecked by the names.

They live inside the narrative like a cell, and their only escape is to understand its dimensions.  Once you get it, maybe you can start tearing down the walls.  Every soldier’s mind is different.  There is no single code to break.  It’s ever-changing.  I don’t have a recipe, but there’s one thing I do know, and that is the power of the narrative.  Put the story together.  Understand the story.  Ask questions of the story; make it answer you.  Make it.  You don’t take no for an answer.  You keep building that narrative until the answer comes around.  That’s the low road out of hell."

Okay, the low road out of hell: Maybe. It's not the first time someone's thought that telling their story -- just getting the words down on paper -- would have curative powers.  Read another Marine captain, Nate Fick's, essay for Powells, the great used book store in Portland, Oregon, about why he wrote "One Bullet Away: The Making of a Marine Officer."  See other veterans from other eras -- for example Claude Anshin Thomas, who wrote At Hell's Gate: a Soldier's Journey from War to Peace -- as they grapple with the narrative, to pull themselves to safety -- or sanity.  See and feel the way they fight for it, with every breath, with every word on the page. The same goes for the veterans who are the authors and the poets in Maxine Hong Kingston's anthology, Veterans of War, Veterans of Peace. Many,  many people feel...that this way lies redemption.

Or does it?

A little over a year ago, I was "gifted" with a narrative worthy of a Charles Dickens, if Charles Dickens had been to war.  Forty years the combat veteran had spent, trying to crack his own case (of severe, combat-induced PTSD), trying to get it all down on paper.  To make sense of it for himself, to make sense of it for his family.  And 40 years is not an insignificant amount of time.  He followed the narrative, all right; he clung to it like a rope.  But you know what?  All it did is lead him to the precipice of healing.  It wasn't even the precipice itself. What it did do was, in a way, detail the exhausting of his options, and get him in touch with the many things he'd tried -- including, in his case, religion -- so that he could he could continue the search, this time going even deeper.

Ironically, and we had several conversations about this -- he never finished the narrative, even after 40 years.  He didn't finish it, and he couldn't finish it -- we eventually agreed because it was his LIFE, and there was no real need to sum that up as though it was already over, because it wasn't.  It, and he, were still very much "a work in progress." And there weren't any simple answers, that would put everything into perspective.  Not for the combat veteran, not for his family either.  It was a pretty good narrative of what he endured, and the sense he was able to make of it.  But it was not in any way curative, though getting it down on paper was powerful, and compelling, and both moved his readers -- and himself.  It moved his readers (including his family) towards empathy, or a better, deeper understanding of what he'd gone through.  And it moved himself to continue going after the true prize, which was healing -- not just setting down what he had experienced.  IF writing were truly curative, we'd see more mentally unbalanced, yet otherwise fabulous authors experience "the cure."  (And one has only to think of the great Virginia Woolf, her pockets loaded with rocks, headed into the water to drown herself, to reflect on the apparent wisdom encoded in that statement.) What writing is, or can be, is deeply cathartic.  What it isn't, is the actual "cure."

When the Darkness Has Fallen...Just Me, in the Wake of Battle

I've been reading Tyler Boudreau's "Packing Inferno: the Unmaking of a Marine."  Probably a wise choice, in light of the news recently about combat stress and how servicemembers do and don't tolerate it.  I was drawn to reading Boudreau's book because I'd read several of his essays recently, and pretty much felt like they didn't go far enough -- and I was trying to understand the backstory.  His backstory, that is.  And how better to do that, than to actually read his book.  Boudreau comes across well, as he earnestly attempts to untangle the ordeal of his experience, both serving and (more to our point), coming home.  Within the first ten pages of the book, he's already described his PTSD, and it's a nice, succinct, almost poetic expression, which will help others who don't quite understand it yet.  Here it is, in Boudreau's own words:

"I’m hemmed into the night.  My brain has come to prefer the darkness.  I can’t say with any certainty if this is a product of never sleeping – that is, if it’s just a bad habit I’ve got to break – or if there’s something else going on, like the systematic avoidance of those bloody dreams.  I told the doc I wasn’t sleeping when I got home, and he glanced (up) casually from his desk and said, “That’s normal.  It’ll pass.”

Normal, he said.  When I told him I was just about jumping out of my skin every time I heard a loud noise, he said that was normal, too.  Normal, as in commonplace, as opposed to, say, pathological, like it would have been abnormal not to jump out of my skin.  It’s what they expected from me.  They figured I was in good working order, I guess.

Then they blew off my rage with the same line. “Everybody’s got that,” they said.  I wonder if they’d call me normal now, with all that I’ve got to say.  Three years later, my heart was still pounding, I was still raging, and I still wasn’t sleeping.  I was up, thinking about the war.  I finally told myself it’s like a bad back or a trick knee; you just learn to live with it and you walk. on.  So as I’m walking on, night after night when the darkness has fallen, and the rest of the world is silent, I go looking for my narrative."

(The narrative is something we've talked about earlier, here, and in Boudreau's case, we'll also talk about again -- but later, in another post.)  Suffice it to say, he finishes the foregoing description with a very potent, and poignant, explanation of who he is right now:

"The Marine Corps made a schizophrenic out of me, figuratively speaking.  I used to have only one voice, one point of view.  All right, so I’ve got a new perspective now. It happens.  But it’s not like I changed my mind.  My mind changed.  It split, two, three, and four ways over.  Now there are voices coming at me from all sides.  There’s no coherence to them, and no clear distinction either.  There’s the angry voice, and there’s the broken-hearted one.  There is the tender me and the savage.  And of course, there is the Marine.  There will always be the Marine, standing tall inside me, speaking smartly about values and patriotism.  There there’s all the rest of me, the part of me that was left over when I left the Corps.  He has no name, no identity, or credentials, or skills.  He has no title or rank.  He has no cause.  He is just me in the wake of battle."

With these words, both simple and profound, Boudreau expresses many, many combat veterans' experiences, that they will often spend decades trying to come to terms with, often failing, sometimes succeeding, and sometimes also killing themselves, in a forlorn attempt to, ultimately, attempt to bring resolution to that exact conflict.  Not the external one, in which they were involved as a warrior; but the internal one, with the battle that continues to rage, that they often feel they cannot escape.  Good for Boudreau for putting words to his experience, so that others -- veterans and the public at large -- can relate.

Editor's note: Boudreau's book, "Packing Inferno: the Unmaking of a Marine," is linked here.

Combat Veterans, PTSD and Acupuncture

We've written about acupuncture before on this blog, in posts linked here. And an article in the current issue of "Acupuncture Today" magazine (May, 2009) discusses -- tangentially -- the use of acupuncture for PTSD.  It especially emphasizes the costs savings, particularly when used as a form of pain control (a typical use of traditional acupuncture, known as TCM). Here's a story, though, that shows the human side of acupuncture's worth for a combat veteran.

Recently I met a Marine who was part of a wounded warriors unit.  I won't say who he was or where he was located, to protect his privacy, but he had completed several hazardous deployments in Iraq and had come back to the Marine base to continue his service. I happened to learn that he sampled a few modalities from the "complementary and alternative medicine" spectrum we've discussed on this blog before, and one of the therapies he'd tried was acupuncture.  I happened to catch him in an unguarded moment, when he had his mind on other things (what amount to pain control, at the time) and I asked him to describe his experience, because I wasn't sure who he'd seen or what type of acupuncture it had been.  He described that he'd been interested in checking it out, but that the commanding officer  had considered it to be some form of "voodoo," so was pretty much against it.  But there was one acupuncturist from the town near the base who was willing to come on base and offer it, and do that for free.  So that removed some of the initial barriers to trying it, and the commander okayed it.  With those circumstances in mind, I asked him what his experience was like.  This is what he said:

"After she stuck me (needled me), I went back out to my truck, and I just sat there, for about an hour and a half, just GLOWING (his words.)."  His eyes moistened briefly as he said, "I realized it was the first time I had felt happy in two and a half years," he volunteered, continuing, "I had forgotten what it was it like to feel real joy."

I couldn't leave well enough alone -- I had to track down the acupuncturist he'd seen.  I figured out who she was, called her up, she answered the phone, we identified him as the patient in question, and then had a brief conversation about what he'd shared.  She told me she had goosebumps from hearing the story, which she hadn't known before, and added, "this is why we do what we do."

With all the lip service -- and, one hopes, quite a bit more than that -- these days being paid to treating combat veterans in more comprehensive ways that meet their needs better, I hope ancient methods will merit due consideration.  When I remember this short conversation with the very much moved Marine, it's hard not to appreciate its merits. Neatly, there are several types of acupuncture -- one which specializes in addiction treatment, one which focuses on treating body, mind and spirit, and a general, all-pupose form (along with many others).  With many offerings to choose from, and increasingly more research to support its efficacy, acupuncture truly deserves a place at the table in treating the hidden wounds of combat veterans.  I have only to remember the glow in this Marine's retelling of his experience to remember why.

Travis Twiggs: The Un-Happy One Year Anniversary of Combat PTSD's Perhaps Most Visible Death

Just a brief note to mention, it was one year ago today that Travis Twiggs passed from this earth, by his own hand, the veritable poster boy of combat-based PTSD.  It also marks his brother Willard's passing, who left this earth with Travis, apparently by Travis' hand.  It's an absolute tragedy, for any number of reasons -- from the family members and friends the Twiggs brothers leave behind -- to the fact that Travis, personally, was making an impact as a Marine who broke the code of silence, so to speak, and spoke openly about his PTSD.  Twiggs wrote about his ordeal in the January, 2008 issue of the Marine Corps Gazette, in an article that has been widely circulated, and is still available on the Web.

Travis Twiggs' suffering was something that really stood out to me -- perhaps because of his very willingness to speak openly about his struggles, something Marines.Just.Don't.Do.  We actually broke the news of his death on this blog, before the mainstream media had reported on it -- and in fact, the early reports were wrong on the facts but widely repeated, making the damage that much more painful.  (He and his brother were reputed to be hardened criminals, for example, which they were not, although they had been -- at the last -- involved in a carjacking, as part of their initially ill-fated but ultimately successful desire to end their lives.  In fact, Twiggs was a much-decorated Marine with multiple combat tours behind him, who had recently met the president, and whose Marines (and his family) deeply loved him.  His brother, Willard, was well-loved as well.  A year later, not a day goes by that people don't find this site out of a search they're doing for Travis or Willard; and in the days after their death, searches for Willard were almost as popular as those for Travis, though Willard was obviously shyer and less well known. And these tragedies were not the only ones the Twiggs family suffered in a very short amount of time: their beloved grandmother also passed away within days of the Twiggs' brothers' deaths. Hard, hard times for the Twiggs' family, and for all those who loved Travis and Willard.

It's hard to explain my own involvement in this saga except to say, I had a bad feeling about how Travis was really doing, without even knowing him, just based on reading what he wrote, and how it didn't seem to add up.  So the month before, without realizing he'd already been confined to an inpatient PTSD program at Bethesda Naval Hospital, and was therefore unable to answer, I repeatedly tried to get ahold of him and/or the Marine Corps Gazette, which had published his somewhat optimistic article months before.  When neither would reply, I started to really worry that something was amiss.  Then when the first news reports came out of the National Park Service about the "armed, tattooed and dangerous" Twiggs brothers, involved in a carjacking, I just knew it had to be Travis, and that things had somehow gone terribly wrong. Hoping to offset the "bad news" (and mistaken news" about who Twiggs really was -- not a lifelong criminal, but a decorated Marine, who everyone loved, who'd struggled mightily with PTSD -- I went out on a limb, and wrote, as I realized he was dying, what became a "PTSD obituary" to this at the time unknown Marine, who'd undoubtedly died from the consequences of his uncured, but not untreated PTSD.

In the days that followed, as I waited for any national attention to be focused on his case -- none was -- the blog here received heavy, heavy traffic, as those who loved Travis and his brother came to essentially pay their respects, much as I had tried to myself, and also tried to come to terms with the brothers' passing.  Over time, various reporters kicked into gear and started covering the Twiggs' story in lengthy pieces. (I had to put the "use with attribution" notice up on this blog when one reporter spent, no joke, 40 hours mining this site, without acknowledging where he got his information.  Ugh.) Richard Ruelas wrote about the saga for the Arizona Republic (the brothers had died in Arizona), Bill Finnegan's at the New Yorker magazine, and there was a two-part series in the New Orleans-based Times Picayune. CNN, to its discredit, never once mentioned the brothers' passing.  I think once they missed the initial window, it was too embarrassing to catch up, but to this day, they never have, whereas pretty much everyone else has had something to say about it -- or them.

While many, many aspects of being the one to break this story -- on a blog, not in a newspaper or a wire service -- have been exceedingly frustrating, I'll spare you my angst on that one.  The blessings have also been there -- getting to "meet" online and sometimes in person, some of the key players in the brothers' lives, and have them express their appreciation for what I did to help to humanize their brothers, while the rest of the print world was essentially doing the opposite (at least initially). I'm still concerned for how Travis' wife, now his widow, Kellee, to whom the news of Travis' whereabouts and obviously his death, came about as a shock, as well as for the Twiggs' parents, whose loss of two sons at once is just incalculable.

In the New Age-y world, people do talk about being careful about what your intention is, and how your intention will carry the day.  Without going into what "intention" means, overmuch, it can be simplified to say, whatever the vision is of an outcome, that you carry in your heart, or that you express to the world.  In this case, it was very, very clear.  Back exactly a year ago today, as Travis Twiggs and his brother were in their last moments, and time was running out, I wanted the world to NEVER FORGET who Travis Twiggs was, and what the legacy of unresolved PTSD looks like.  If ever there were a poster child for PTSD, it was Travis Twiggs.  He took the first step when he told the world his secret in that powerful, much-read article in the Marine Corps Gazette, when he broke the silence for his Marines, and the rest of OEF/OIF veterans.  What I held in my heart that day -- despite the professional disappointments that may have followed -- was that when people thought of PTSD, they would think of Travis Twiggs.  And given that his legacy is still very much alive, one year later, I do believe that intention accomplished exactly what it was supposed to.

As Twiggs himself said, he was willing to come forward and talk about what he went through, because he wanted no other soldier, sailor, airman or Marine to suffer like he had -- in silence.  With his death, and that of his brother, unfortunately for the much-beloved Twiggs brothers, but mercifully for the rest of us -- it's a conversation we will all keep having.  RIP, Travis and Willard Twiggs. You are not forgotten.

---

Editor's note: The original blog entries about Travis Twiggs from a year ago are: "One Marine Reflects on His Battle with PTSD," linked here (before his death); "PTSD -- "The War Within" -- Claims Another Victim," linked here; "RIP Travis N. Twiggs, USMC PTSD Sufferer," linked here; "The Ballad of Travis Twiggs," linked here; "Travis Twiggs' Suicide - Only Questions Remain," linked here; "The PTSD Obituary for Travis Twiggs," linked here; "Bleeding Green with PTSD," linked here; "Twiggs' Wife: 'The PTSD Drove Him Crazy'," linked here; "The Tragic Last Days of Travis 'T-Bo' Twiggs," linked here; "Travis Twiggs' Widow, Kellee, Puts a Human Face on the Suffering of PTSD," linked here;and, finally, "SSgt. Travis Twiggs - Well-Loved U.S. Marine and Hurting PTSD Hero - the Update," linked here.

After Combat: Looking for Health in a Handful of Pills?

From a week ago: The Savannah Morning News had an excellent article, by Pamela E. Walck, called "One soldier's struggle: Sgt. fights anger, treatment system," linked here. (There's also video, but it's not as on target as the article is.)

Sergeant John Jones, now part of the Warrior Transition Unit at Fort Stewart, Georgia, is the subject of the article, and by any standard he has a lot on his plate.

He was deployed with the 3rd Infantry Division's  2nd Brigade's 1st Battalion, 30th Infantry as a gunner, serving his second combat tour at age 29, when he was injured by an IED blast in July of 2007.  Less than six months later, doctors also discovered a brain tumor, and operated.  Since then, though the difficulties you could anticipate from those incidents alone would be enough for one person to cope with, there's been more. Symptoms of PTSD, trouble with authority both on and off the base, difficulty sleeping, the sense in Jone's own words that his personality is not what it was before, a (fortunately) failed suicide attempt, etc.  Really a painful story, of what sounds like a good man, having trouble coping with the after-effects of his injuries. The one peace in his life appears to be a rented cabin, where he goes for solace (and to fish!), yet is in danger of being taken away from him.

Walck does a great job reporting the story, and not settling for just the usual details. Through her work and Jones' own words, you're drawn into the story of what amounts to really a typically "wounded warrior." And while you find yourself pulling for Jones to survive and thrive, you can't help noticing that the "hope" held out for him is not much more than a handful of pills. Who he feels like he's lost, in his words -- echoing that of so many other combat vets with PTSD -- is "the old John," who he's now all but lost entirely. How he's going to get that guy back... is unfortunately anybody's guess. (As an additional difficulty, it's unclear whether his brain injury is making his behavioral issues worse -- it's likely that it is.) In the meantime, we can hope for peace and a healthy solution for Sgt. John Jones -- but for those who want a broader-than-usual, fully-developed "portrait" of one wounded warrior, struggling with the ravages of combat and PTSD, be sure to go here and read his story.

"I Have PTSD," But "I Am Not PTSD"

This conversation goes back a while ago with a combat veteran of the Vietnam era, who has been trying various therapeutic methods for addressing his decades-long case of severe PTSD, and finding, by degrees, some actual and substantial relief.

Over the past few months, as his situation has greatly improved, aspects of his PSTD have fallen away, symptom-by-symptom.  But lest this lead you to believe that such progress, or success, is all "positive" -- the reality is, it doesn't always feel that way to the veteran, who has become habituated to seeing the world through the context of their having PTSD.  PTSD, of course, affects virtually every important aspect of their lives: from how social they are, to relations with their family, to how they can hold a job, how much pain they are in on a daily basis, how much stress they can manage, and how many medications (with their attendant side-effects) they take.  Psychological symptoms, physical symptoms, even "social" symptoms: they're all there.

And after a lifetime of identifying yourself as a "crazy, f*cked-up Vietnam vet," f'r instance, if that "identity" should start to fall away -- as you progress towards actual health and wholeness...mmmmnn, what do you replace it with?  Because there needs to be something.  Having relied on one identity for years (even decades) to manage life, and keep others at bay, suddenly that "crutch" or that "coping system" is no longer there.  And with all the other problematic pieces stripped away, piece by piece, what's actually left is a raw, brand new...baby. At least in terms of trying to cope with who you are in the world.  Amazing stuff.  And as great as it might be to get some symptom relief, and some ultra-positive life changes, at the same time...fear comes into play.  Who will I be without this shell I've learned to rest upon for so long?

Even the Bible talks about, in a slightly different context, how if you're going to sweep a place clean and remove all the demons, you have to immediately replace the empty space with something good, lest more demons come by (boy, the Bible is awful cheery; I'd forgotten...) and, finding the place vacant, immediately seek to fill it up with something "ten times worse" than what had been removed.  Mmmm. Lovely.  But the principle is a worthy one: If you're been relying on one thing, for a long, long time -- and you suddenly remove it -- you'd better find a way to be comfortable with the new self, because it's what's you have from here on out.

Having been privy to these struggles with one veteran as he walks his path, it's been surprising to me to see how "upsetting" the concept of healing can be -- initially upsetting, that is.  There's an old Tony Robbins line that human nature will do much more to avoid pain than they will to seek pleasure, and I think that comes in to play here, too. Change is painful; growth is painful; heck, even healing -- in that context only -- can be painful.  It's all new; it requires new skills; a new outlook; even new hope.  But ultimately, it's (obviously) the best way.  Most ironic of all is when the combat veteran, for example, has been the one to pursue the healing so radically -- and then when it starts to happen, in shock, he draws back, startled, as if realizing, ahhh, this is going to be my new life: how strange. I wonder if I recognize me in this at all.

Of course, over time, the progress coming in waves, as more methods are tried and proven useful, the experience gets better, and the veteran gets to be more at peace in his own skin.  Symptoms with which he has lived for decades start to abate, and be replaced by ... peace... and better experiences with himself, his family and loved ones. Overall, though the process is bumpy, the progress is sure.  There's no turning back: the combat veteran continues to WANT his healing, and his healing is happening.

And suddenly, the revelation, at least in his mind: "I have PTSD," he declares, decades into the fight, "but I am NOT PTSD."  Previously, of course, the unspoken assumption was that there was no distinction.  PTSD so consumed his life than in fact he WAS PTSD.  Now, he can say that he has it -- increasingly, even better, that he HAD it -- but that it is not him.  Wow.

Violence at Camp Liberty: Shocked, Maybe, but Not Surprised

 Allow a little venting of spleen here: The violence at Camp Liberty today in Iraq, where an American active duty servicemember allegedly opened fire on others at the stress clinic, a location where other servicemembers go for counseling, killing 5 at 2:00 p.m. local time -- if we're shocked that this happened, that's okay; but seriously, America-- why are we still "surprised"?!

Here's 10 reasons NOT to be surprised, though feel free to continue to be shocked:

1.    Tours are too long, putting considerable and unprecedented strain on the all-volunteer military. The AP reports, "The U.S. military is coping with a growing number of stress cases among soldiers in Iraq and Afghanistan - many of whom are on their third or fourth combat tours. Some studies suggest that about 15 percent of soldiers returning from Iraq suffer from some sort of emotional problems." The ones who initially deployed?  Strong and willing.  But as the tours wore on, how many stayed that way?  Certainly not everybody.
2.    Resources for stress management are inadequate, and there's often peer pressure not to make use or take advantage of them -- and then the broader question: what are we really offering to help soldiers heal?  Is there anything in the conventional medical world that's actually working? There's talk therapy and there's medication, and those who follow this topic in-depth know that there are problems with either or both of those approaches.  Anecdotally, of the three combat veterans whose lives I follow most closely, all three of whom had recently pronounced substantial healing  -- two of the three who relied on the most conventional approaches -- were re-hospitalized within the past month for psychiatric reasons, each within several weeks of pronouncing how much better they were doing, thanks to their course of treatment.  (The third combat veteran, who follows a less conventional path, is actually truly doing better -- or so it would currently seem.) When it comes to combat-based PTSD, the "cure," such as it is -- is a long way off -- particularly if we only look along conventional channels.
3.    Access to firearms is...ummm...not an issue: they're everywhere.  It's war, and we're armed to the teeth.  It's part of what we do.  But carrying a weapon in a stress clinic?  Doesn't seem on the face of it to be a wise safety choice;
4.    Workplace violence is a fact of civilian life, too: OSHA reports that homicide is the fourth leading cause of workplace fatalities. On an average workday, according to one site, "three people will be murdered on the job in the U.S."  Annually, "one million workers are assaulted, and more than 1,000 are murdered." Concerns are that half these cases go unreported, so the figures might even be doubled. Mondays, in fact -- today  when the Camp Liberty incident took place is a Monday, after all -- are a prime time for incidents to take place.  Something about people stewing about their real or imaginary mistreatment over the weekend, and coming back in and deciding to "do something about it."  Read the cases: Monday is often when disgruntled American workers, at the very least, choose to settle the score;
5.    Sleep deprivation is a chronic problem in the over-extended military.  As a technique for inducing symptoms along the spectrum from abject misery to forms of psychosis, it's effective enough that it's used (by the U.S.) as a form of torture, like waterboarding. Going without sleep, which the military chronically does, puts soldiers at risk on a regular basis.  Not that there are any easy answers to this, but that needs to be taken into account. Not sleeping is very dangerous to your health: and if to yours, by extension to those around you, too. Experts like veterans advocate Jonathan Shay, M.D., Ph.D. have long warned about the dangers of exhaustion and sleep-deprivation.  It's time to pay greater attention;
6.    Talking heads and pundits attempt to minimize the problem by saying, it's only the fifth case of soldiers killing one another since the war began but REALLY -- are they serious?!  How about adding the qualifier, "known" case -- as in, proven.  (Even the New York Times said, more accurately, "The killing of American troops by their fellow soldiers is infrequent, but not unheard of.") Think of the many cases of noncombat deaths in Iraq.  How many of these, because of insufficient, inadequate, or misguided investigations -- or cover-ups -- might turn out to be soldier upon soldier violence, if we but knew the facts? A percentage of the noncombat deaths are murders, not just accidents or suicide.
7.    Felony waivers. While many -- or most -- of the military may be fine and upstanding individuals -- better, in fact, than most of their less patriotric, more self-centered peers -- the reality is, as the war continues, an increasing few who have less savory backgrounds or mental states are being given waivers and allowed to join anyway -- then deployed with the rest of the troops, and put under the same types of strain, which perhaps they don't bear very well -- or as well as their peers;
8.    If recruiter suicides are up (and they are) -- recruiters being in a good position to know the true costs of going to war on the troops -- and suicide is effectively giving up on their being a solution to one's problems -- shouldn't  this ring some greater warning bell than it has, that perhaps we're asking people to do and to sacrifice, far beyond their actual ability to?
9.    We can't discount the fact that some people are just unbalanced -- and some of the ones who are, unavoidably, also serve in the military.  The last well-publicized statistic on the subject was that roughly 10% of the (overall) population suffers from mental illness. Some of these people are in the military, and under stresses and strains greater than most of us have ever endured, some will snap.  that in itself should not really...surprise us.  It's not a diss against the military: it's a fact of life. If anything their challenges are stronger than anyone else's.
10.  Interpersonal violence and suicide are both extreme versions of "lashing out" at what's perceived to be an unjust fate.  Domestic violence rates in the military ARE worthy of some "shock 'n awe" of their own.  During the same news cycle, where the Camp Liberty incident is being broadcast across all possible news outlets, other, equally horrendous incidents are also happening among servicemembers and veterans -- horrendous to the victims and their families, as well as to the families of those who commit the crimes. Here's an example of the same from today's news cycle, though it's all been pushed off the page by the greater prominence of the Baghdad story. The Colorado Springs Gazette reports that Thomas Woolly, 24, was arrested in the shooting death of a 19-year-old woman.  As the Gazette describes, "Woolly ... was a heavy machine gunner in the 4th Infantry Division's 2nd Battalion, 12th Infantry Regiment.  Members of the 500-soldier unit, nicknamed the Lethal Warriors, have been involved in stabbings, beatings, brawls, domestic violence, shootings, at least two attempted murders and four homicides in Colorado Springs. Another soldier who served with the unit in Iraq has been accused of murder in California. The unit has also been plagued by drug abuse and suicide..."

By bringing this up -- that this violence might be "shocking," but surely shouldn't be "surprising" -- it isn't intended to single out servicemembers or veterans as "bad" -- if anything, they're under abnormally large stressors.  It is to say, this stuff happens -- not always as well broadcast as when it happens in a group.  But it happens all the same. Forgetting even Iraq and Afghanistan for the moment -- across AMERICA -- do we honestly believe that fewer than five people -- including the servicemembers and veterans involved -- had their lives in actual, mortal danger from incidents like this? (In the Woolly incident above, for example, one woman was killed, but another one was injured, according to published reports.)

Again, if we were but able to "see" across the broad expanse of all the people this affects, and into all their homes and lives, even on one given day, I think we might be quite surprised to see the continuing emotional toll and strain that combat stress and its aftermath produces. Continuing to look at incidents like whatever happened at Camp Liberty today -- as the facts continue to come out, over time -- as "isolated" incidents, instead of a very visible part of the mostly in-visible spectrum of pain and suffering -- only allows us to stay in the dark on this topic a little longer than we should. 

For the health of servicemembers, veterans and their families, it's time to start admitting what a difficult problem we have: and one that takes more than lip service, and conventional modes of treatment, to "handle" and ultimately to "solve."

"The Hard Part Comes Later" - about PTSD, Grief and Letting Go

The Associated Press had a story on its wire tonight, called "Stream of horrific crimes takes toll on town cops," about the child murder in Tracy, CA. For our purposes, we're going to excerpt just a few lines from the story.  Because while we've talked before about the similarities in how police officers and combat veterans develop PTSD, here too is another similarity: how focus on the mission is paramount, and afterwards -- the grief sets in.

From the story:

"Police were especially stressed by the disappearance and murder last month
of 8-year-old Sandra Cantu. The department's sworn officers and staff pulled
2,966 hours of overtime on that case alone.

And tougher than the intense work is the lull that follows, when the mask of
professional composure comes down and doubts, sadness and anger come
through, said Tracy police chaplain Dan Higgins.

"When they're able to focus on their jobs and do their part, they have an
outlet," Higgins said. "The hard part comes later."

In other words, personal grief and coping with the horrors of the work (be it combat or in this case, police work) can be set aside effectively, sometimes, mostly, to get the job done.  The grief gets sublimated to or displaced by the job.  And that's effective -- as a coping mechanism -- only so long as it lasts.  Afterwards, when it's removed, the full feeling of the grief and the loss starts to creep back in, to the vacuum that's been created.

Again, from the story:

Detective Nate Cogburn worked 200 hours in two weeks in the search for Sandra and then for
her killer, the article said, adding:

"This meant little sleep, no breaks, a canceled second wedding
anniversary weekend in Napa with his cancer-stricken wife and less time with
his 10-year-old stepson.

[Even though police now have a suspect,] Cogburn remains haunted by the case.

"I feel nothing in terms of a sense of relief or solace. I feel nothing but
devastation. Nothing," he said. "It is a good thing that we've identified a
suspect ‹ a good thing for the investigation, for the D.A.'s office, for
being able to close this case, hopefully for the family. But emotionally
it's a vacuum."

Earlier I've written on this blog about a WWII combat veteran who only "noticed" his PTSD in his 80s, when he was finally retired. In other words, when work was no longer front and center in his life, and in the vacuum that removing his prior, sustaining focus on work created, the nightmares and the cold sweats from combat flooded back in.  Decades after his actual service.  This story was told to me by the local veterans service officer, who helped the man to realize that what he might be struggling with was PTSD, and to get some help.

We all know about how combat veterans can seek to numb their pain, whether successfully or unsuccessfully, and perhaps only for a time, with drugs and/or alcohol. We need to also realize how workaholism, Type A behavior, and focus on the job -- even though warranted -- can also be a way to "keep the demons at bay."  Unfortunately, when the focus changes, as it often will, in time, the vacuum that's been created when the main focus gets removed, can also exert a powerfully destructive pull on the individual.  Drugs, alcohol and work -- we can use them all as ways to keep PTSD at bay, however temporarily.  But ultimately, none will be completely successful, or produce thorough, functional results.  Always better to deal with the issues involved, however painful, and however incrementally we might need to do so.

"Love Shouldn't Hurt": Combat Veterans, PTSD, and the Deadly Serious Topic of Domestic Violence

Domestic violence is an enormous public health problem in our society today. Domestic violence among families of combat veterans is also a significant problem -- if you take "significant" to mean, "important to those it affects." According to a fact sheet produced by the National Center for PTSD (NCPTSD), part of the VA, domestic violence is "the most frequent cause of serious injury to women, more than car accidents, muggings, and stranger rapes combined."

Among veterans, studies show that "domestic violence rates among veterans with post-traumatic stress disorder (PTSD) are higher than those of the general population. Additionally, according to studies, domestic violence rates among "active-duty military men (Heyman & Neidig, 1999), couples seeking relationship therapy (O'Leary, Vivian, & Malone, 1992), and Vietnam veterans with and without post-traumatic stress disorder (PTSD; Jordan et al., 1992) have been found to be higher than those from the general population." 

One academic paper adds, making a crucial point, "Research has yet to study couples seeking relationship therapy in which the veteran has PTSD to explore how these relationships compare with other couples. Given the elevated risk for violence among these couples due to the PTSD, the treatment-seeking behavior, and the relationship distress, couples seeking relationship therapy are an especially vulnerable population." (And of course, couples not seeking relationship therapy might be even more under-served -- it's just they can't be as easily surveyed.)

---

Casey Taft, M.D., an associate professor of psychiatry at Boston University, has recently been awarded a $1.5 million grant from the Department of Defense to study this topic. From an article published by BU, announcing the grant, quoting Taft, and linked here:

"People who are exposed to trauma, and in particular those who develop PTSD, are at very high risk for aggressive behavior,” says Taft, who also works at the Boston Veterans Affairs Medical Center and the National Center for PTSD. “In one Vietnam war study, they found that among vets with PTSD, one third had engaged in physical violence against their partner in the past year. This rate was almost three time the rates they found among vets without PTSD. Since we know that current vets in Iraq and Afghanistan have been exposed to significant trauma and many of them have been on multiple deployments and they’re coming back with high rates of PTSD and other mental health issues, it would stand to reason that they would also engage in high levels of aggression and partner violence, though we don’t have the specific data to back that up.”

(Hence the study).

In the meantime, know that domestic violence can be "deadly serious."

Domestic violence is serious. Risks include death, serious physical injury, and psychological injury as well -- including PTSD and secondary PTSD. Just some of the psychological effects (often less obvious initially than the physical effects) are: depression and being at greater risk for subsequent suicide.

Again, according to the NCPTSD, "60% of battered women report depression," and "25% of suicide attempts by Caucasian women and 50% of suicide attempts by African American women" have been "preceded by abuse."

Some more sobering statistics about the magnitude of the problem:

• 20-30% of American women will be physically abused by a partner at least once in their lifetimes; 
• 30-40% of women's emergency room visits are for injuries due to domestic violence;
  
• 30% of women killed in the U.S. are killed by their husbands or boyfriends;
  
• 50% of men who assaulted their female partners also assaulted their children;
  
• 3.3 million children witness domestic violence each year.
• 1.3 million women and 834,732 men are physically assaulted by an intimate partner annually;
• 201,394 women are forcibly raped by an intimate partner annually;
• 11% of women in homosexual relationships and 23% of men in homosexual relationships report being raped, physically assaulted, and/or stalked by an intimate partner;
• 503,485 women and 185,496 men are stalked by an intimate partner annually;
• 1-25% of all pregnant women are battered during pregnancy;

What to do if you're in crisis?  There's a

National toll-free Domestic Violence hotline: 1-800-799-SAFE (7233)

There's an excellent "Fact Sheet" put out by the NCPTSD, linked here; and

There's a "safety plan pocket guide," linked here.

The NCPTSD's fact sheet, they say, provides "information regarding the definition of domestic violence, the prevalence of domestic violence, the dynamics of abusive relationships, the effects of domestic violence, treatment for victims and perpetrators, and resources offering assistance."

There are also some good resources at other websites, including FamilyOfAVet.com, linked here.

Wyoming Plans Conference for Combat Veterans on PTSD, etc.

According to a recent press report, the Wyoming Department of Health and the state Military Department will hold the ''Wounded Warrior Wellness Conference'' in Casper next month to discuss the unique psychological needs of returning soldiers and their families. Unfortunately, no further information is forthcoming via either an in-depth Google search OR a search of the Wyoming Department of Health's main website.  The conference is not listed under May, 2009; nor does a search for "warrior" or PTSD reveal it. So if you're interested in finding out more, read the article about it here, or contact Regina Dodson, Housing and Veterans Service Coordinator, at the Wyoming Department of Health, (307) 777-8627. (And while you're at it, ask them to publish some material on their website ABOUT this conference, if they want people to actually...attend.)

On the plus side, it does look like the Wyoming Department of Health has a good page of veterans' resources, linked here. It has links to: Issues for Veterans; Resources for Veterans; Resources for Providers; and Resources for Families of Veterans.

A Look in "The Mirror" -- Great Britain Seeing War Trauma Now in 3 Years, Not 13 As Before

Because Americans are notorious for paying little attention to things that happen elsewhere, even among other English language-speaking countries, here's some news from Great Britain's tabloid-esque "The Sunday Mirror" today about their soldiers' battles with PTSD on the homefront -- soldiers who served in Iraq and Afghanistan.  For the link to the article, called "War's Silent Victims," by Rupert Hamer, click here. (The tabloid nature of the newspaper explains the fairly breathless writing style, but let's hope the facts and the reporting are accurate nonetheless.)

Points worth mentioning from the article include:

"Alarmingly, the charity [Combat Stress, see below] say[s] the figures are just the "tip of the iceberg" and add that the rate at which soldiers are developing the condition has accelerated. Usually it takes 13 years for cases of post-traumatic stress disorder to develop in veterans.

But psychiatrists at Combat Stress's pioneering centre say the men and women now being treated have come forward after just THREE years.

Also:

Dr Walter Busuttil, a consultant psychiatrist at Combat Stress, said: "What we are seeing now is just the tip of the iceberg.

"Because there has been no proper study of post-traumatic stress disorder among troops in this country we have no idea of the true scale of the problem.

"The same thing happened in the US after Vietnam. The Government tried to dismiss the disorder as a myth - then the whole thing exploded. Now when I speak to my colleagues in America they tell me: 'You are going through your Vietnam'."

And finally:

Dr Busuttil, 49, a psychiatrist in the RAF for 16 years, says the Government has covered up the severity of the conflicts from the public.

"The worst thing for a serviceman or woman is to come back from a war and for people not to have any idea what they have been through.

Editor's note: For a link to Great Britain's charity, Combat Stress, click here.  To find them on Facebook, click here. We've written about them before on this blog, but according to their website, "Combat Stress is the leading charity specialising in the care of British Veterans who have been profoundly traumatised by harrowing experiences during their Service career and who are suffering from poor mental health as a result."

A Combat Veteran Asks Himself, Who Am I, on the Inside?

The combat veteran, one with decades of severe PTSD, asks himself that question, and the answer that comes back isn't pretty.  "What's your biggest problem right now?" he was asked, and then handed some implements with which to draw his answer.  Describe what you've drawn, he was asked.  "My biggest problem?" he said, "It's that I'm 'an exploding ball of hate'...on the inside." (Comment and drawing, used with permission.)

Now, on the one hand, this doesn't tend to give you a lot of hope.  Forty years out, still thinking about life this way.  Ugh.  That's intense.  And so, so very tragic.

On the other hand, the story has a "happier" ending -- or at least, progress report.  The same person who said that is doing much better now (and has the drawings to prove it.)

But I was reminded of this story again today when I read of the terrible story of Marcus Luttrell, the former Navy SEAL, awarded a Navy Cross for his heroism, whose entire team was wiped out in a horrendous firefight in Afghanistan, and who suffered greatly because of that experience.  (Luttrell is also the author of "Lone Survivor," about that experience.) This past week, his lovely yellow Labrador retriever therapy dog -- who he named DASY, after a combination of the initials of his SEAL team buddies who were killed and himself,  who, parenthetically, says he also died on that mountain, with his team that day -- was shot in cold blood outside his house, apparently in a pointless thrill-killing by some heartless local punks.

From articles about the incident in the Houston Chronicle and on MSNBC, which described the 40 mile high-speed chase an injured (he was recently hospitalized) Luttrell went on to capture the perpetrators, assisted by the police:

"I did everything right; I didn’t do anything wrong," (Luttrell) said. "Make sure everyone knows they cold-bloodily murdered."

In other words, he was heavily provoked. (It's remarkable the self-control he exercised, just helping to capture, but not kill, the jerks who shot and killed his beloved therapy dog.)

The saddest part for me, after reading and hearing about this story, were these poignant lines from Luttrell, after the incident, no doubt disillusioned, despondent, as well as totally triggered.  Reportage said that Luttrell "said he had left his Huntsville home and [like Vietnam veterans before him, who took themselves out into the woods rather than deal with society that was hard for them to navigate anymore] was in "the middle of nowhere," adding that Dasy's killing -- of course! -- was a "huge setback" in his life. (A huge and completely unfair setback, too...cruel beyond cruel, and so completely pointless.)

Here are the heartbreaking lines of Luttrell's, as he's trying to come to terms with what just happened, not that he had any fault in the matter:

"I was trying to talk myself out of being who I am," he told the Chronicle. "Talking to myself about not doing the one thing I am good at."

Those are the words that should stick with people on this, who care about the topic of healing combat trauma, that is.  War -- and even training for war -- breaks people down and builds them back up in the mode of the warrior, in which they have a new, and very authentic skill set -- but one which they won't find much use for in civilian life, or are basically constrained by society from using.  Nobody wants to talk about it much, but the ability to kill, and the confidence and esteem that gets created by being "good at what you do," even if it's very much relegated to the combat experience, is a very hard thing to shake afterwards.

I can come back later and supplement this with references, but read the literature, watch the interviews with people who have combat-based PTSD.  There's a very uncomfortable relationship with killing: it's a high that's hard to deny, but also hard to live with, about yourself (no pun intended).  And that dilemma is at the basis of the combat veteran's, above, remark about what his biggest problem is: being "an exploding ball of hate," on the inside. 

It's very hard to get a grip on that, particularly when killing has become a significant skill set, and very hard to unwind from.  In many cases, veterans covertly mention, mostly to one another, it's become an addiction of its own.  Perhaps just the feeling of being amped up and in command of the situation, not necessarily the killing part, but whatever: it's a way they say they felt truly alive for the moment, and hard to replace in civilian life, which operates according to completely different rules, and is often ridiculously boring and unfair, by comparison.

No judgment intended: far from it.  It's the reality of the situation.  And it's part of why, as much as the military concentrates on breaking someone down to become the perfect warrior, there needs to be an equal and opposite side of the coin -- how to help someone reintegrate, so they can keep their skills, but become a whole person again who, most importantly, can look at himself or herself with appreciation and respect, for every aspect of their personalities.

Editor's note: For a video of Marcus Luttrell being interviewed by Matt Lauer, several years ago, about his book and the incident fighting the Taliban that inspired it, click here.

(Also, the second drawing, above, is done by the same combat vet mentioned in the first illustration, but it's not the one that shows improvement. It's another from the same day, where he answers the question about drawing himself "as I am now" -- in other words, with two very distinct sides to himself, darkness and light.

Getting Past the Blame Game...Especially Blaming Self

Two vignettes, both true, both involving combat veterans and PTSD:

A Marine with multiple tours of duty in Iraq and elsewhere, who can't allow himself to move after the death of two of his guys, for which he feels responsible -- even though objective third parties wouldn't see it his way at all.  It's clear from messages he left behind that he wasn't able to move on past the guilt, and eventually takes his life, and that of another person.

A former Marine with multiple combat tours in Vietnam, and one of his few buddies who survived from his platoon, who for decades spent their annual "Alive Day" getting together and staging a recreation of the battle that almost killed them with toy soldiers.  They laid out the toy soldiers in the positions of the battle they remembered from that day, and continually changed the way they arranged them, to see if there's any way the battle could have gone differently, and they could have saved any more of their men.  Was this replaying of the fatal battle at all therapeutic for them, despite how many times they did it?  Did it ever actually help?  "No," he answered, "all it did was make us mad."

I was lucky enough to have a conversation the other day with Dr. Farris Tuma, director of the Trauma Stress Research program at the National Institute of Mental Health (NIMH), part of the National Institutes of Health (NIH) in Washington, D.C.  As part of the conversation, he was telling me about what they've learned, over the years, in terms of resiliency -- who's likely to rebound after suffering a tragedy, and who is not.  Ironically?  Or maybe not so ironically -- those who hold onto blame (including self-blame) -- who need to find someone at fault -- "don't adjust as well, over the long term."  It's relatively easy to see why.  Blame, even self-blame, keeps you stuck in the terrible, tragic moment, while life -- with all its implied suffering, challenges and growth -- continues to move on.  It's very natural, Tuma said, for people to want to find someone to be at fault, at least initially.  That's hard-wired into us as humans, he said. When it becomes a problem is when that isn't just a phase we go through -- but one we're not able to leave.

The solution?  He says it's to connect with mental health professionals who are "capable and trained," and are able to address "issues like [misplaced or unhealthy] guilt," when the person is ready -- ideally, as soon as possible. What you want to overcome in situations like this is the innate cognitive bias -- the tendency to see things a certain way, different from the way they really happened, and believe that, rather than the truth, per se. Continuing to carry the baggage from the incident, continuing to blame yourself keeps you from getting past it.  What's important is to work with someone qualified who can help you see that "you didn't do something wrong."  Improved mental health can often be located on the other side of that particular statement; and unfortunately, there's lots of resistance to letting go, as though it disgraces the memory, or dishonors the deaths of those who died.  Big, thorny, difficult subject...the point of bringing it up is only to say, excessive guilt and self-blame where you can't seem to move on can be a distortion of reality, and there is a way to get help. 

Investigative Report on Desperate Troops with PTSD Who Go AWOL

Seattle's KOMO-4 television station broadcast an investigative report on the 11 o'clock news about local troops with active PTSD who chose to go AWOL because of concerns their PTSD was not being addressed.  For a link to the story, entitled "Shattered Soldiers Say There Was No Help When They Needed It," click here. It sounded better (as in, more interesting) than it actually was.  It's a brief segment, mentioning three soldiers, and focusing on one's case who may or may not have PTSD.  The other soldiers, whose stories are less dramatic, do seem to have PTSD.  Hmmmn. This might be a case of a story that could have been more effective as a national story than as a local one, in part because there could have been more individuals covered, across a broader spectrum of people.  Maybe that will happen. 

Study Shows Young Adults with PTSD More Likely to Commit Suicide

On the one hand, this sounds like fairly self-explanatory science.  So why the inclusion on this blog?  Because of the (young) age of many active duty military, and even recent veterans -- news like this is relevant.

Young Adults With PTSD May Be More Likely to Attempt Suicide

"Posttraumatic stress disorder (PTSD)—but not exposure to traumatic events without the development of PTSD—may be associated with subsequent attempted suicide in young adults, according to a report in Archives of General Psychiatry.

Approximately 421,200 to 842,400 Americans aged 15 to 24 attempt suicide every year, according to background information in the article. Holly C. Wilcox, PhD, of Johns Hopkins Children’s Center, Baltimore, and colleagues studied 1,698 young adults of a group of 2,311 who had been tracked since entering the first grade in Baltimore public schools. Fifteen years later, 90-minute interviews were conducted with the participants (average age of 21) to assess the occurrence of traumatic experiences, suicide attempts, and the development of PTSD.

Of the participants interviewed, 1,273 (81%) had been exposed to a traumatic event and 100 (6%, or 8% of those exposed to trauma) developed PTSD. Suicide had been attempted by 10% of those with PTSD, compared with 2% of those who were exposed to trauma but did not develop PTSD and 5% of those who had never been exposed to traumatic events.

“The mechanisms involved in the association between PTSD and suicide attempts are not known,” the authors wrote. “There could be a common pre-existing predisposition to PTSD and suicide attempts that was present before the trauma occurred. Studies of early trauma and suicidal behaviors have implicated depression and impulsivity as possible mediators or possible pre-existing susceptibility traits.”

— Source: American Medical Association

The Ongoing Struggle for Combat Veterans

"I know I have to deal with it (PTSD): Because I'm either going to destroy it...or it's going to destroy me." -- Vietnam combat veteran.

EFT: "Emotional Freedom Technique" for Combat Veterans

If you know anyone who's watched "The Secret," with its emphasis on "the Law of Attraction" -- heck, if you know anyone who's watched Oprah, who promoted "The Secret" extensively on her shows -- you know someone who's probably heard of EFT.

What you might not realize is there's a body of work developing that shows its effectiveness with PTSD.  And some of its biggest fans are the veterans themselves, who've tried it.

"EFT," or "Emotional Freedom Technique," is a form of what's known as "energy psychology," or "energy work."  It was developed by a Stanford engineer -- note, not a psychologist -- Gary Craig, who calls it accurately "a needle-free form of acupuncture."

Craig and EFT practitioners have done some remarkable work with PTSD veterans.  If this subject interests you, or you've looked into various forms of treatment before, and you're even slightly open-minded about trying something with a large upside and very little (or nonexistent) downside, this video in particular is worth watching.  Here's the link. 

The most moving part of the video, in my opinion, is the obvious before and after shots of the veterans themselves, going from visibly struggling, to visibly coping, in very short amounts of time. The excitement of a family member, shown later on the video, is also palpable.  A few studies have also been done on EFT and PTSD -- a book has also just been published -- with more studies to come.  The results are refreshingly impressive, though, for such a low-tech technique.  According to the video, veterans report symptoms drop 63% after treatment, according to a self-reporting scale used by the military.  Symptoms of depression and anxiety reduced by 50%, on average. Cortisol levels -- we've talked about their significance here, here and here -- drop 25% after one hour-long treatment.

Watch the video first, to orient yourself as to what EFT is and how the sample of combat veterans from various wars -- Vietnam, the Gulf War, and Iraq -- responded to it. Then, to learn more, here's an article from the Scottish press about a combat vet and his experience with it.  Here's a story about a Vietnam vet and his experience with EFT. There's a new book by Gary Craig on EFT for PTSD. If you're a veteran, there's a study you can be part of that we blogged about the other day, and that study includes several sessions of EFT. (That post is linked here.)

But if you're intrigued -- after watching the video -- and you want to know more, you probably want to find an EFT practitioner to try it out with.  There's a subset of practitioners listed on the Web, linked  here, who are interested in working with veterans, including -- gasp! -- some who already work at the VA.  If there's no one in your area, you could try this link instead, to find an EFT practitioner who may not have a special interest in veterans, and yet could introduce you to the practice.  It seems to be something low-tech, affordable, simple to learn, and an after an initial introduction, very much DIY (Do It Yourself).  Practitioners may also be willing to negotiate or lower their fees for veterans: Ask.

---

Editor's note: Talking about EFT, or any other technique, should not imply or be misread as an endorsement. In any case, YMMV (your mileage may vary).

 

Combat Veterans Behind Their Personal Walls -- "It Would Be Weird for Me to Say I Was Happy..."

There are probably better ways to title this post but the point is to connect with veterans WHO do feel this things, and who have SAID these very things, to themselves or to others. 

The word "compassion," as we've talked about before on here, is from the Latin, meaning "to suffer with" (another).  Here's a full definition: "Deep awareness of the suffering of another coupled with the wish to relieve it."

You can't, or shouldn't, get to know much about combat veterans without developing some of this. And you might need to, because -- while they hold this for each other -- they often distinctly DON'T have it for themselves.  "Why did I deserve to live when others died?" "I don't deserve to be happy." "I should go back..." All these phrases, and thoughts, are common among combat veterans with PTSD.

As we've talked about before here, the goal is going to be...find some way to achieve catharsis with these feelings.  Don't invalidate them ... they're real, they're true, and they DESERVE to be there.  They're a very "natural" reaction to a very abnormal situation (combat).  But what also needs to happen, while acknowledging these feelings, is somehow to bleed the toxins out, to be at peace, or reconciled, or achieve some "normalcy" with these powerful emotions, but without letting them control your life, or dictate your decisions.  That's a pretty tall order, it would seem, depending on how badly things are going, on a given day: but let's hold that hope out there, it's still real.

As one hardened combat vet told me the other day, there really is a severe dichotomy -- the academic world would call it -- or a "split" -- the rest of the world would call it -- in the mind and behavior of a vet with PTSD.  On the one hand, he (or she), deeply wants to believe they can overcome, and see a brighter day -- somehow be reconnected to the self they dimly remember, but have functionally lost (and who they mourn, as beyond being able to be accessed anymore, except in memory).  At the same time, breaking away from who they've become with PTSD can be exceptionally hard. Not necessarily by anyone's ever wishing it to be so, the shell, or the mask, of PTSD has started to feel like a part of who they are.  It's both "not me" and "me."  Or maybe, a very undesirable outcome, who has nevertheless become me, without wanting this to happen.  And it can be very, very hard to contemplate breaking away from this person you've become...because the shell has somehow gotten comfortable.  Or manages to keep people away -- or the demons at bay -- or whatever it is.  There is some payoff here, as grotesque as the experience can be. And considering breaking free of this, and leaving this mask or this shell behind, as no longer serving you?  Tough, very tough.  Because it's become familiar...and in familiarity, there is a certain amount of safety.

Odd that there would be such a struggle here, but it's true.  "I want to get well..." or "I want to get better" -- and "I desperately want to believe that I can" -- versus, "I wonder what the world is like beyond this wall I've erected..." "I wonder if I can handle it..." "I wonder if I'm safer not even trying."

Heavy questions.  Very hard, very difficult, very real.  But even when you're struggling with this, you're still acknowledging that there is some tiny shred of belief here that things can get better.  On some level, find a way to give yourself credit for that.  And keep the hope, however miniscule, unlikely, or fakey it seems, alive.  Because it just might be the eternal flame (old reference to JFK's grave...look it up) that never goes out...and ends up lighting the way to something that DOES help you.  Let's hope.

Helping Vets with PTSD: Rolling up Your Sleeves vs. Keeping an Arm's Length Distance

We've talked before on this blog about Paul Tillich's fabulous quote, that "the first duty of love is to listen." 

Here's a story that neatly conveys the polar opposite of that; or at least how someone, a VA provider, got actually PUNISHED for doing that (thanks to Ilona Meagher for noticing the story). But first, an aside.

I was at a dinner a while back that concluded a week's worth of focused training for health care providers, mostly psychologists, psychiatrists and social workers -- many of whom dealt with combat veterans.  Seated across the table from me was a VA provider, a Ph.D. psychologist who, to his credit, was of the Vietnam era but hadn't served, and who had gone into working with the VA so that he could "help" his generation of veterans, who he saw as being tremendously underserved.  True and good, so far.

As we sat at dinner, he told the private practice psychiatrist to one side of him, and the veterans service officer (and Iraq War combat vet/single mom) to the other side of him, about something "new" called "EMDR," that neither one had ever heard of, and that he had just learned about, and  was fairly enthusiastic about himself.  EMDR, for "Eye Movement Desensitization and Reprocessing," for one thing, is NOT new.  It's been in existence for years -- since the 80s, when it was developed by Francine Shapiro, Ph.D..  Something like 16 clinical trials have shown its efficacy. Heck, we've got several blog posts about it, from two years ago. So it's not really great news that the provider was "just learning about it" recently.  EMDR was one of the first quasi-"alternative" treatments offered in the psychological community for PTSD.  It's been widely studied and fairly widely recommended for PTSD ever since.  It's also something I've personally tried, so my ears perked up when I heard it.  "This stuff is so great," the VA psychologist enthused, warming to his true point: "You can treat people, and you don't even have to hear their stuff!"

Ohmigoodness.  If that isn't just the gold standard of what we want to be doing.  I'm holding out hope we'll find an arm's' length cure for healing combat trauma (kidding, absurd).

In this article, a VA provider who seems like a serious, intense, and concerned practitioner -- as well as a favorite among the veterans who were her patients -- gets fired and reprimanded for "talking an Iraqi vet down off the ledge," so to speak.  It's a pretty shocking story.  The provider has yet to be re-instated, and the OIF/OEF veteran who narrowly survived killing himself, thanks to her intervention, also has been left scarred by the situation, and more antisocial/less trusting than before.  Ugh.  Is this the kind of care we really want to be delivering?

The VA, particularly now (as in, these days) is supposed to be "very concerned" about its reputation, and really adamant about "no more bad PR."  If that's the case, maybe it's time to examine some of the decisions that get made, and why they get made -- from what happened in this story, to the psychologist above who was so thrilled to learn about a treatment mode that he could practice without having to get too involved.

Somehow, this seems to be the EXACT OPPOSITE of the care and concern and COMPASSION that someone like Sarah Haley exhibited, herself a VA psychiatrist, through whose landmark work the shame of My Lai was able to come forth and be addressed, etc. A true hero in the pantheon of those who addressed PTSD at its roots -- and, coincidentally, ALSO someone very well loved by her patients.  Hmmmn.  There might be a not-so-subliminal message in that. 

Here's what Gerald Nicosia, author of Home to War: A History of the Vietnam Veterans' Movement, says in part about Haley (to whom he devotes more than a dozen pages of narrative):

"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."

 

And, separately:

 

"What Haley did not realize was that John [the aforementioned patient, who spilled the beans on My Lai] had come to her initially because he had been told she was trustworthy by his friend Mike, whom she had treated previously.  A year later, John showed up in her office again under the pretext of bringing Mike back for further counseling.  At this time, John confessed to her that "he had needed to believe that just one person cared, that one person could be trusted to know what he had done, and not reject him.""

 

Hmmmn.  Food for thought, all the way around: but most especially for the VA, and their apparently quite shabby treatment of psychologist Sidney Ornduff, and by extension, the other veterans whose lives she could have been helping.

 

Another Hidden Cost to Veterans: Decades of Suicide Watch for Your Peers with PTSD

I had an interesting conversation with a treasured Vietnam veteran the other day -- interesting in the sense that the Chinese mean it.  I thought he was planning on being one place and then when his plans changed at the last minute, I found out why.  He was, in his words, "taking the loaded gun out of the mouth" of one of his dearest friends, a Silver Star winner who also served in Vietnam -- and not for the first time, either. I've heard some of the other stories, too, as they were happening.

Just out of curiosity I asked him, having recently heard that although he's usually "successful" at this particular task -- a combination of skill and luck, I am sure, and I've heard how he does it, it's really pretty cool -- he's also "gotten there too late," in about five people's cases -- how many people has he actually tried to "rescue" over the years in the same way?  Literally "taking a loaded gun out of their mouths" (although that really amounts to persuading the fellow vet to lay it down, not physically trying to take it.)

"About 100," he said, and wasn't too happy to have to say it, either.

Just think of that for a minute.  His odds are probably pretty good.  I'm sure some of the 100 were actually different tries by the same people, but even so...five dying, 95 successfully averting...but 100 attempts?  From your peer group?  That would seriously suck.  And I know he's made a few himself.

So when we as a country try to estimate and analyze the "hidden costs" and the "lifetime costs" of struggling with PTSD, let's remember the psychic costs as well.  I'm not sure any of us are particularly well-suited to be taking loaded guns out of each other's mouths...for decades.  And the irony to me of this whole situation is that of course, he does what he does out of love: because he can't let them do it.  And yet...he's often not much more than a few steps ahead of where the other person is, at that moment.  Granted, he's sharing everything he's got.  But really: is this a solution?  I'm sure if he hadn't been there for those guys, the suicide toll among Vietnam combat veterans would be that much higher.  Which would be a tremendous loss, and a continuing disgrace (that they have to, not that they did.)  But at the same time -- think about it from a mental health standpoint.  How great would yours be, if decades after a war, you could also look forward to THIS grim duty?  Good grief...The poets and the politicians both agree, sometimes: War is Hell.  But so can the aftermath be, sadly. Even for those who survive.

Editor's note: For veterans in crisis, call the National Veterans Foundation.  Staffed with crisis counselors -- other vets, just like you.  As their website says, "The NVF is standing by to provide you with personal assistance and advice. We are staffed by veterans with experiences from Vietnam to Iraq.  We are trained not only in Veterans issues but also in crisis management for PTSD and suicide prevention. If there is anything we can do for you, please ... simply call us at (888) 777-4443."

PTSD in Antiquity -- the Apostle Paul

Those of us who've spent more time than we care to admit it around religi-anity are familiar with the story of the Apostle Paul.  Probably a Hellenic Jew, he had a strong background persecuting -- i.e., killing -- Christians -- which all the more shocked first century Christians when he converted and became one.  Christian churches often use the story of Paul, an aggressive non-believer, as an example of how "anyone can become a Christian," even one fervently opposed to Christians and their teaching, such as he was in his early years.

As he says about himself, in Acts 22: "⁴I persecuted the followers of this Way to their death, arresting both men and women and throwing them into prison..." And later in the same passage, "'Lord,' I replied, 'these men know that I went from one synagogue to another to imprison and beat those who believe in you. ²⁰And when the blood of your martyr Stephen was shed, I stood there giving my approval and guarding the clothes of those who were killing him.' "

For our purposes here, though, there's something more interesting about the Paul story.  How the frustrations he espouses in his later life are really textbook PTSD hallmarks: from killing Christians. 

¹⁵I do not understand what I do. For what I want to do I do not do, but what I hate I do. ¹⁶And if I do what I do not want to do, I agree that the law is good. ¹⁷As it is, it is no longer I myself who do it, but it is sin living in me. ¹⁸I know that nothing good lives in me, that is, in my sinful nature. For I have the desire to do what is good, but I cannot carry it out. ¹⁹For what I do is not the good I want to do; no, the evil I do not want to do—this I keep on doing. ²⁰"

(The foregoing passages are from Romans 7.) Paul pitches this as a battle between good and evil,   between sin and God; but we can just as easily see this as the characteristics of PTSD that Paul could not shake, even though he had left his former life as a killer of Christians, and reconciled himself to God.

How many combat veterans with PTSD sit in the wreckage of ruined family celebrations, and wonder the same things? To have the intention to experience one thing with their loved ones, but end up being blindsided by feelings and reactions they can't control? And who end up feeling terribly ashamed for how things turned out, when they really meant for them to be so very different?

Many veterans with PTSD "solve" this dilemma by "taking themselves out of the mix," either figuratively or literally, by sequestering themselves "off in their bunkers" away from family and friends, mainly out of a desire to protect their loved ones from one more disaster at their hands, and to avoid the all-too-familiar triggers.  Unfortunately, quality of life is lost somewhere along the way, and trigger-avoidance only goes to behavior control, not finally lessening the symptoms or reducing the overall sum of what's there to be triggered.

Seems that current suffering veterans, with or without specifically religious leanings, may have an antecedent of their own in none other than the Apostle Paul.

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Editor's note: More than a hat tip to Pat, whose insight this really was...

What Would Hope Regained Do for Combat Veterans?

I was in a conversation the other day with a Vietnam era psychologist, who I respect and admire a great deal, but who was nonetheless giving me static for the way I talked about "hope" in a previous blog post, as it concerned combat veterans.  "You talk about it as though it's an abstract, but then immediately move into talking about its RESULTS," he said (I'm paraphrasing.)  Rrrright.  And that would be exactly the point.  Hope is a great and a necessary thing -- but our goal here is to find ways to get over combat trauma, to the extent possible -- at least to reduce its effects on veterans -- and in that regard, yes, we're all about the results.  Are there any?  And what can those be?  Because if they're legitimate at all, in the vacuum of hope-lessness and despair created by a complete lack of reasonable solutions, let's figure out what those are, and let's try them out.  Are combat veterans game?  Many are.

Here's something I ran across the other day, in the middle of a [draft] journal article.  The author was talking about a type of therapy he used -- a therapy he's famous for developing, and which has been around and in use for decades -- on combat veterans, mostly from the Vietnam era, and the results he was able to achieve with them.  I have some inside knowledge of his program, but this was the first time I'd read something in print about it.  In the middle of quite an extensive article, charting this result and that, he happened to mention the results of one of the tests he did on the 22 vets, both before and after the two weeks of treatment.  This is what he wrote:

"Scores on the Beck Hopelessness Scale fell from an average of 11 before treatment to 3 following treatment.  In clinical practice, scores of 9 or more are used to indicate serious hopelessness.  A score of 4 is expected in the general population.  The veterans went from having pre-test scores characteristic of hopelessness, suicidal ideation and predictive of suicide attempts, to having scores typical of the general population.  Thirteen veterans had scores above 9 before treatment, one had a score above 9 after treatment. (That individual's score had dropped from 17 to 10.)  Nineteen out of 22 scores dropped; two remained the same (scores of 1 and 2); and one score increased [negligibly] (from 4 5o 5).  Marked decreases in pessimism are indicated, and it seems safe to conclude that the treatment group felt considerably more hopeful at the program's conclusion."

Do you see what's embedded in that, if true?  In two weeks of treatment, combat veterans with PTSD that went back decades started feeling better to a degree, on average, better than the general population?  That's remarkable...

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So I ask you, what would HOPE do for veterans today, and their families?  It's pretty clear that when it comes to suicide, people are able to go forward with the act because they've given UP hope.  (That's why the Beck test, for example, is able to link the two: hopelessness and suicide, both ideation and attempts.)  We've seen in previous blog posts how the "focus" of a suicidal person becomes narrower -- it's not that they "don't love their family" or "aren't thinking about the consequences to others," they simply have narrowed their focus down to an either/or choice, and the rest of the considerations, no matter how otherwise dear, are simply "not in the picture." 

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Now it's entirely possible that the veterans in the above-mentioned program didn't functionally "stay" that perky and optimistic, and that's why more follow-up studies, such as retests at longer intervals, would have contributed more information worth knowing.  Many times, at the end of a program, irrespective of what type of program it is, participants feel most buoyed and optimistic about future performance, lighter about their burdens, and more likely to discount the negative effect of future obstacles they may encounter.  However, even so it's significant to note how good those scores seemed to be, given the great degree of difficulty the same participants had having hope beforehand.

It's not just veterans -- it's also their families.  How often do family members say things like, "But you were only in the war for two years...how can you let it affect you for the whole rest of your life?"

If combat veterans are able to access health care that adequately deals with their symptoms, and reduces their symptom load to a manageable extent, and gives them back HOPE -- they will have the ability to resume their lives with some degree of normality, and prevent any number of negative consequences that come from NOT having hope, from having given up.  The tremendous societal costs from combat trauma we have to start understanding not only affect the veterans involved -- they affect their families, the communities in which they live, future generations, etc.  Veterans with hope -- who get their hope back -- will be functional and integrated into all aspects of their lives, and actively participate in their various roles as spouses, parents, employees, citizens, etc.  Veterans who lose hope, and who we do not help to regain hope, will lose out.  And this loss will affect them first, and then like the ripple effect of a pebble thrown into a pond, concentric circles of effect will spread out from them to others in their lives: their immediate families, their workplaces, their schools, their communities, even future generations in their families.

Far from being an abstraction, I believe HOPE is pretty central to the whole concept of "healing combat trauma."  We've got to help combat veterans to hang on and have some, and they themselves have to believe it's possible to get better.  Then we have to make sure we're connecting them with the very resources that can deliver the results.

An Over-Reliance on Expecting Medication Alone to Fix What's Broken

I really should be packing for a conference, not figuring out more stuff to blog about, but I saw an item in today's Boston Globe that I just couldn't resist, because it speaks so closely to what we're talking about on this blog. A woman pediatrician wrote an OpEd piece, in part, about the insufficiency of the strictly pharmacological solution for healing a broken childhood. 

In our case, since we're talking about combat trauma, the target is different, but the concept is identical.  Read what she has to say, and then think of the ways this applies to healing combat trauma.  Far too many health care providers -- and even veterans and their families -- are putting their faith exclusively in a pharmaceutical solution.  It isn't a Tom Cruise point to say, that's not really going to do the whole job. 

As we've seen and heard from too many veterans, the trouble with pharmaceuticals alone are many and varied...from giving veterans a grab bag of ones to mix and match and medicate themselves (yikes)...to the dangers of over-medicating (numbing out, not feeling like themselves) and under-medicating (well, that hardly ever happens, but still...)  Anyway...here's the pediatrician's extended commentary.  Make the application to veterans suffering from combat trauma and you'll see what we mean:

On one recent day in my pediatric practice, I saw or spoke with parents of eight children who had experienced a range of significant trauma. One was in foster care after living on the streets with drug-abusing parents. Some had been adopted following severe abuse and neglect. One had recently lost a parent to death, one had been abandoned by a parent. They were failing in school, impulsive, distracted, angry, and depressed. They were receiving minimal to no mental health support.

What they all had in common was a diagnosis of attention deficit hyperactivity disorder. Each parent expected that I would either: refill the medication, change the medication, change the dose of medication, or have the medication given at a different time.

When I suggested that medication alone was not the solution, I ran into walls. One mother had tried to get an appointment with a child psychiatrist, but the only one in town who accepted her insurance wasn't taking any new patients. My attempts to refer families for therapy were thwarted by many things, including lack of time and clinicians who did not take their insurance. One parent was irate that I asked so many questions and didn't just refill the prescription. These parents were discouraged and angry, and by the end of the day, so was I.

Our society has bought into a belief that manipulating medications will fix these complex problems. Not only parents, but teachers, physicians, and certainly the health insurance and pharmaceutical industries join in promoting this expectation. With our overreliance on psychoactive medication, we have created another Ponzi scheme where, just as Bernard Madoff's investment fund was not really earning any money, we are fooling ourselves into thinking that we are helping these children in any significant way.

Interesting and poignant, on so many levels.  The expectation, impatience and frustration of the patients' families, that manipulating the patients' biochemistry was the only "solution" expected or desired; the practitioner's frustration that she couldn't refer effectively to other providers who might have helped; and the generalized problem with only seeing a headache as an Excedrin deficit, so to speak, rather than looking for the broader understanding of what's sometimes at work with a specific symptom.

Fortunately there are complementary and alternative medicine ("CAM") modalities, including mind-body medicine, that look for and deliver other solutions, often by taking a more "holistic" view of the problem itself.  Not as a symptom that exists in a vacuum, but one that is part of an overall gestalt of the person's total physiological, psychological, spiritual and emotional health.

There's a form of acupuncture that professes to treat "body, mind and spirit."  I once questioned a practitioner of this type about what percentage of ailments patients present with that she would ascribe to each.  Interestingly, her response was that MOST patients' symptoms, well over 90%, according to their practice's teachings, were actually spiritual in nature.   Hmmmn. Even if only 10% were, even if only 1% were, think how inadequate a purely pharmacological solution would be.

With something as complex as combat trauma, it's just another reminder -- this time from a superficially unrelated source -- to look beyond a single, too-simple, purely pharmaceutically-based solution, to something that captures the more complex, multifactorial experience of being human.

The Double-Edged Sword Called "HOPE"

"Got hope?" the Obama bumper sticker asked.  (Hey, we're non-partisan here, it's just an illustration to make a point.)

The reality is, hope turns out to be VITAL, not optional, in someone's struggle to "heal."  And "healing," of course, is not specifically an end-result, a "one and done" event -- but a progress along a continuum. 

Even the Bible talks about how, "without vision, the people perish."  Emily Dickinson, who it's easy to imagine as a profoundly depressed, but nevertheless highly imaginative New England poet, referred in one of her more famous poems to hope "as a thing with feathers."  Meaning, pretty airy, light-weight, and able to fly away.  Hard to trap and catch, hard to hang onto.  If you put the two concepts together, though, hope is both necessary AND hard to hard to hang onto.  No wonder it's so important.

Over the last few months, I've been watching as a hardened combat veteran, with severe PTSD, has stepped out of his comfort zone, and put his "hope" to the test: Hope that there was a life for him outside the realms of severe combat trauma.  It's been incredibly interesting and refreshing to see what's happened to him since.  And hope shows up at every turn.  Without going into it in much depth here -- there'll be another time and place for that -- I've been able to see his physiology as well as his psychology change, in just a few short months -- and I've seen the renewal of "hope" this has caused within him.  For one thing, hope to be considered more than just another "crazy, effed-up combat veteran" -- the mask he's apparently worn for society for years (decades, in his case).  Hope that he can have an actual life and happiness beyond what he had been reconciled to, by virtue of "throwing off" some of what's hindered him (the Biblical wording here is purely incidental.)

The deal about having a mask that you wear, as a combat vet, because it's what society expects of you -- and it's also what allows you to keep other people at bay -- is a very interesting concept in its own right.  It helps, but it also hinders. It frees, but it also constrains.  And suddenly, with better health, comes the realization that it may be time to consider laying that mask down, at least part-time.

Whoa.  Strangely...that turns out to be a tad problematic.

Because there is comfort to be found behind that mask, and safety, and worst of all -- familiarity.  We all struggle with, "better the devil you know...than the devil you don't know."  And even a self-imposed mask offers a modicum of comfort, though at great cost (what you miss out on, wearing it).

The combat veteran and I had a conversation the last few days that mirrors several others we've had over time, as he's received extremely positive -- surprisingly positive -- news from his medical providers.  The sum of it is, he seems to feel he had an easier time picturing he was going to fade out and die...than actually revive and live.  Strange, isn't it -- the rest of us just want to get well.  But to the combat vet with PTSD, sometimes there's a fair amount of comfort (from the familiarity) of knowing things are bad...and likely to stay the same or keep getting worse.

What I've seen with this very courageous individual, as I've watched him fight to take this new hill, called health, is how hard it's been to reconcile himself to having hope now for an actual future, unmarred substantially by the PTSD that's dogged him so much from the past.  Not that he'll ever be "over" it completely -- but getting quite a bit better, and healing both on the outside and on the inside?  On the one hand, priceless. On the other hand, definitely scary.  Stay tuned...this has been an incredibly interesting journey to watch, and it will continue to be.

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

One Veteran's View - Dissociative PTSD, Criminality and the Combat Veteran

You've heard of Bruce Lee -- warrior, philosopher, actor -- now hear about Scott Lee -- Gulf War combat veteran, social work student, blogger.  Scott writes an excellent blog, PTSD: A Soldier's Perspective, linked here, which has been a finalist for the MilBlog award (given to military bloggers). 

Of particular interest to us, though, is this paper he just completed for a class in social work law, about PTSD, criminality and veterans.  Scott's background as a veteran and a student gives him a unique perspective not shared by most, and what he writes could serve to open many people's eyes to the problems faced by returning combat veterans. 

Scott has kindly given us permission to reprint his paper in full on this blog, so we're going to do that in two parts, because of length.  First up, the section that follows; a subsequent post will include his guide for returning combat veterans and their loved ones, if the veteran has been charged with a crime.  Scott isn't giving legal advice here (nor are we); he's sensitizing us all to the problem at hand.

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Scott Lee writes:

The following is a paper that I have completed for my Social Work Law class, parts of the paper I have been writing about in my blog. The paper ties together the evolution in my train of thought concerning the veteran or soldier consumed by the ravages of full blown PTSD.

 

The paper is long, but relevant to the plight of our returning combat soldiers and veterans. If you want to understand more about why a veteran or soldier runs afoul with law and society then you should read this.

  

VETERANS, DISSOCIATIVE PTSD AND CRIMINALITY

  

Scott A. Lee

Kent School of Social Work, University of Louisville

November 3, 2008

The Modern Combat Veteran:

Dissociative Posttraumatic Stress Disorder & Influences

on Criminality

Statistics

 

As of August 27, 2008, according to the Congressional Research Service (2008) 4,726 soldiers have lost their lives in combat and 32,977 troops were wounded in action, with 8,089 suffering from Traumatic Brain Injury (TBI). The USA Today (2008) reported that 68% of all soldiers have been deployed to a combat zone, 31% have been deployed more than once and 2,358 have had more than five tours of duty.

 

The United States Department of Justice (2004) reports that, “[t]he majority of veterans in State (54%) and Federal (64%) prison served during a wartime period….[that] Vietnam War-era veterans were the most common wartime veterans in both State (36%) and Federal (39%) prison.” The 57% majority of State prisoners were serving time for a violent crime compared to less than half of non-veterans who were serving less time for similar crimes. The report indicates the Iraq-Afghanistan era veterans comprise 4% of both prison populations (U. S. Department of Justice [USDJ], 2004).

 

Posttraumatic Stress Disorder (PTSD), Dissociation and Other Considerations

PTSD is a life-long endeavor; there is no cure for it. The triggering traumatic event changes the landscape of the mind, it no longer works in the same fashion that it did before. The mind has been rewired; the neuropathways have been altered into a continuous loop. The PTSD triggering incident converts the fight or flight response in the primitive portion of our brain. Imagine having that scared feeling you get without the fear while keeping the bodily reactions; the tenseness, the adrenalin rush, the mind racing, heightened senses, and the hyper response reflex to react without thinking.

 

The incident that solidifies the mental wound of PTSD results in a mind numbing, or psychic shift. In response to the trauma of combat, the person needs to make a mental detachment to do what needs to be done. The survival mode of operation forgoes the higher levels of functioning and depends on the primitive reactionary portion of the brain. When this unconscious detachment has been activated to frequently or for extended amounts of time it becomes part of conscious processing and interferes with everyday interactions (Lee, 2006; & Cerone, 2006). According to Howell (2005), dissociation refers to the separation of mental and experiential contents that would normally be connected.

 

The word dissociation is laden with multiple meanings and refers to many kinds of phenomena, processes, and conditions. Dissociation is both adaptive and maladaptive, both verb and noun, both cause and effect….Dissociation is often psychologically defensive, protecting against painful affects and memories, but can also be an organismic an automatic response to immediate danger….Dissociation can be understood as taxonic or, varying in degrees….It is both occurent and dispositional….It refers to such psychical events as spacing out, psychic numbing, and even experiencing oneself as floating above one’s body. Dissociation has been thought of in spatial metaphor, as acts of ‘keeping things apart’ as well as ‘vertical splitting’ (p. 18).

 

The mind can develop into split affective regions where multiple self-states dissociate incompatible values systems and set up residence along with establishing a unified substructure within matching internal guidance systems. The dissociated subsystems run parallel to other self-states and emerge when a particular skill set needs asserting pertaining to situational interactions. Here trauma based disorders may lead the symptomology to further entrenchment and compartmentalization that may lead to personality disorders. “A war veteran with PTSD might have more significant structural dissociation, involving the sequestration of more and larger portions of experience” (p. 22).

 

A defined preconditioned set of beliefs and values, the combat schema enables the warrior to navigate efficiently through the adversity of combat without a detailed consideration of consequences. I propose a unique set of beliefs, Combat Values Theory (CVT), based on the survival of self in relation to the context of war and the “combat-othering”, for we must wholly demonize our adversary and in the process dehumanize ourselves. The combat veterans primitive fight or flight defensive mechanism has been repressed through the training in the military, conditioning the troop to take up the fight portion leaving a proclivity for violence without a concern for personal safety. To engage in a mortal fight with the enemy this schema spells out the actions in a given situation without becoming preoccupied with survivability in the moment which could get a soldier killed.

 

The warrior with PTSD has grown accustomed to the value and belief systems of war and feels threatened when they become faced with having to let go of this security in an attempt to reintegrate back into society. Howell describes animal defensive and posttraumatic biological states,

 

The human animal may have a repertoire of discrete behavioral states that are adaptive to conditions of predation….[t]hese animal defense states may underlie different dissociative parts of the personality….[t]his begins a neurophysiological alarm reaction…[and]…a tendency to over read cues as threatening, which can increase the probability for violence (p. 29).

 

The ambiguity inherent in social dynamics can lead to mixed feelings or even a lack of feelings depending on the degree of interpersonal relatedness to the returning combat veteran (RCV). We rely on our parental figures to shape healthy personality and values structures through attachments with significant others, the attachments become avenues of exchange, a distillation of proper interactions and expectations according to society norms. When this exchange becomes distorted to the point of the child becoming a repository of negative energy, instead a healthy exchange solidifying proper boundaries, then the nature of our attachments may become warped and disorganized further compounding the RCV’s reintegration.

 

The combat attachments born of blood do not leave us because we depart the battlefield; they become an empty feeling inside of us. The soldier develops a highly narrow functioning self-organization in conjunction with his or her other squad members. This organization, "troop-organism," becomes an extension of the combat-self, no different than an arm or leg. We do not will our arms or legs to move, we react from the expectations of intentional imagery based upon the combat values structure. It happens, such as the members of the "squad-herd" where each part of the troop-organism and acts in a homogeneous way, each troop becoming part of the others self-states.

 

These attachments to the other require a splitting within the interpersonal self-states where many such dissociated selves birth into existence, as each of the value system constructs do not match and out of necessity, develops into a complete compartmentalized persona while maintaining the "whole" sub-self organizations. Each of the self-states run parallel to one another and have the capacity of switching back and forth when the proper situation requires appropriate specialized skill sets. The interpersonal self of the civilian self becomes supplanted and filed away by the combat self due to the incompatibility of the value structures for survivability that requires a conforming from a civilian society to the norms of the combat environment.

 

Attachments can be considered the path to rigidity or vehicles of spontaneity; to become spontaneous the person must develop a mechanism for the free exchange of intimacy through beneficial interpersonal skill sets. Without a healthy development of attachments then disorganized attachments (d-attachments) form. The d-attachments become the mechanism to gauge interactions in the environment and in doing so they become rigid, an if this then that experiential existence. The d-attachment arraignment only allows for what can be controlled under a series of contingencies plans, or procedural knowledge, usually modeled after our parental attachments, an identification with the aggressor or other such negative role model. Becoming an identity of an exclusionary “personal culture” where the individual becomes estranged from regular society and defending their boundaries as they were national borders between two hostile countries (Howell, 2005; & Lee, 2006).

 

The cycle of procedural enactments play out in significant others that we allow in our lives, the reason why we keep having the same dramatizations and arguments while never finding a resolution. We enact our past roles and project them into our relationships cast from our childhood in an attempt to resolve the attachments constructively. Since we have not been shown healthy attachment enactments we reside in the cycle of d-attachments and further compound our disorders through retraumatization and or neglect, predisposing the person to develop trauma based disorders and or personality disorders (Howell, 2005).

 

Without a reintegration of the self and of attachments and d-attachments, a combat veteran can and will run afoul of friends, family and society. The returning combat veteran faces hurdles that they have not been trained to handle, the training and experiences they have navigated and survived will lead them to think a civilian life will be easy compared to the battle life. What they fail to realize is that they have replaced their civilian self with an operational combat value system and attachments, where in American society the individual has the utmost consideration further combining and compounding issues of integration. Little concentration on developing healthy attachment systems the untenable situation can lead the RCV with severely dysfunctional interpersonal skills and a mechanism of perpetual isolation.

 

Indoctrination

Combat alters and modifies the value system, a preconditioned set of beliefs, entailing a value-orientated constitute of definitions of situation in terms of direction of solutions and action dilemmas, formulating a culture of killing, stripping the combat vet of the niceties that lubricate society’s interactions, which in combat would result in death. In combat the fluidity of boundaries becomes awash in the relational adaptation to an integral cohesion with their battle buddies, a devolution of survival mindset develops and provides a sense of safety; the germination of base natural selection process by successful integration of the combat value system. With a disproportionate 56% of Army veterans incarcerated, the Army culture seems to generate people more prone to violence (USDJ, 2004).

 

The war zone recons the birthing of the “trooper organism,” where the firing squad becomes integrated with one other with a culture of survival. The individual boundary of the soldier submerges within the organismal boundaries of the trooper organism while shedding the individual identity. The troop organism allows for the diffusion of immense responsibility over all involved making the transition to an evolution of survival more manageable wherein the herd mentality brings forth the primitive instinctual remnants and the decentralization of obligation. Military culture portrays the combat arms military occupational specialty (MOS) as having more cultural capital and esteem. The infantry MOS with combat decorations increases the rate of promotion, rank and respectability while non-combat soldiers tend to be overlooked (Lee, 2006; & Howell, 2005).

 

Situational Imprisonment

Military enculturalization subsumes CVT into an identification born of survival and dependant on the assimilation of the “firing squad mind set”, where one troops thoughts relates to an extension of his battle buddies. The fluidity of boundaries births the “troop organism” and forever impairs the RCV to return home without his “other selves.” Now the RCV has to try and interrelate without his relational attachments and attempts to reintegrate back into the civilian world where nothing makes sense anymore, where boundaries cross without attachments as a normative experience triggering perceived threat-states. This leads RCV to become his own “isolated island organism,” or an identity incomplete without the other part of the firing squad, that thinks, feels and acts as they do. The RCV becomes unable to interrelate with family and community in a meaningful way, impeded by the fluidity of boundaries.

 

As their safety has been compromised, a feeling of abject detachment has arisen from the conditioned reality of the combat organism that depended upon the battle buddy “having his back.” Therein leading to a sense of safety, the combat vet needed only to worry about their own personal “line of sight” in a battle field environment requiring a 360 degree threat radius. On his own in society this burden becomes an impossibly overwhelming sense of danger engulfing the RCV, leading to a susceptibility to triggers. A culture of 360 degree radius in the battlefield and shackled intimately with the culture of combat values, hereinto relying on the troop attachments and the evolution of survival, the RCV becomes stuck on the troop-organism functionality.

 

The troop-organism capacity becomes problematic to the integration of the “civilian-self” as it now has become supplanted by the “combat-self.” An attachment of the self to the self that is the identity of one whom sufficiently succeeds in suffering, completing the veteran and familial rift. The fluidity of boundaries in an intimate relationship with a loved one becomes a threat to the RCV due to the misidentification of signals between the two, one having adapted an independent perspective and the other a dysfunctional dependent state. The crossed-signals of the significant others has complicated the adaptation from independent relational skills verses over dependence and the perceived threatening self states with both parties expectations of returning to “the way it was.”

 

Compounding the issue, the RCV has now been conditioned to the “culture of killing” and the relational fluidity of boundaries between the two have become incompatible, further given rise to the RCV’s sense of threat as he where in combat. In combat a registering between non-compatible boundaries would be reconciled by a reflexive reactionary exercise of survival, triggering the culture of killing (Kirmayer, Rousseau, and Lashly, 2007). “Those supporting the use of culture as a defense argue that is it intrinsically unfair to judge someone exclusively by the rules and values of a society that he or she does not know” (p. 98). The above goes to the creation of a Veterans Court, where culture competency would require a special understanding of combat vets cultural “shaping.”

 

Criminal Behavior, Context and Responsibility

“[T]rauma exposure and symptoms of PTSD are prevalent among incarcerated veterans….[e]xposure to combat was the trauma most likely to lead to PTSD among males in a general population survey of 5, 877 individuals, [totaling] 19 percent” (Saxon, A. J., Davis, T. M., Sloan, K. L., McKnight, K. M., McFall, M. E. & Kivlahan, D. R., p. 962, 2001). Saxon et al. indicated a higher prevalence for PTSD in incarcerated veterans than the general population. Additionally veterans who screened positive for PTSD had significantly higher numbers of childhood trauma, indicating a possible correlation between peritraumas, military culture and past traumatization.

 

Taking culture into account means that the purposes of the criminal justice system—which include prevention and rehabilitation—can be achieved more effectively. Cultural awareness must be coupled with an equally astute political awareness that traces the consequences of clinical or forensic consultations out into the larger society (Kirmayer et al., 2001, p. 101).

 

Before the Insanity Defense Reform Act of 1984, questions of the “ultimate issue” when a defendant pled insanity in federal court was whether he lacked “the substantial capacity either to appreciate the wrongfulness of his conduct or to conform his conduct to the requirements of the law” (As cited in Buchanan, 2006, p. 14). After the bill was enacted, the question now goes to whether he “appreciated the nature and quality or the wrongfulness of his acts” (p. 14). “Case law and the Rules’ legislative history suggest also that in less clear cases an issue’s ‘ultimate’ status hinges on who has the authority to decide it….because it amounted to an ‘ultimate opinion’” (pp. 14-15). Psychiatric expertise falls under the Civil Procedure Rules (CPR), Part 35, whereby the duty of the assessor, in an expert capacity, is to help the court. A mental defense with the question of competency will rely on the weight of cognitive capacities.

 

With our modern soldiers averaging two to three tours of combat, we will begin to see an increasing epidemic of incarcerated veterans. In the next 10 to 15 years the American public will see a sharp rise in veterans suffering from Post-Traumatic-Stress-Disorder, to the point of epidemic proportions. You see, never before in war have our troops been subjected to such prolonged exposure to combat and life threatening situations. In World War II our troops were fighting a defined enemy while engaging real objectives with sufficient downtime in between engagements. Most of the troops to see combat were infantry soldiers fighting on a distinct front, not the ones "in the rear with the gear". With a real threat to our sovereignty and way of life soldiers of this era were less affected by the trauma of war.

 

The significant political interference of the Vietnam War generated little to no tangible objectives for our soldiers solidifying and branding their levels of anxiety and forever troubling their minds. Guerrilla warfare, an inherently cognitively damaging military action compounded the neuropathic damage experienced by our troops in Vietnam. Even with the troops having regular downtime in between engagements the cognitive fractures of these veterans were enhanced by more intense combat and the rejection of our returning soldiers.

 

The soldiers in the Iraqi war have been sent on multiple deployments with an average of two or three tours of duty with little time in between. While in Iraq, there are no friendly countries or areas to spend leave time to relieve stress while residing on constant alert and most, even non-combat soldiers, see combat or threats on a daily basis. Now combine this with the most intensive warfare possible, guerrilla warfare in an urban environment. We get troops that are overextended and overexposed to life threatening situations within unprecedented levels of combat. Our troops in Iraq have no respite from danger, further entrenching the effects of PTSD through the hyper levels of neurotransmitters (Lee, 2008).

 

Dissociated attachments reenact combat trauma somatically and between interstates within the RCV resulting in a “civil war” amongst oneself. A seemingly supra-intelligent guidance of the unconscious, this device of PTSD that engages in the survival defensive mechanisms that has sustained the combat veterans life on a persistent basis. Thus becoming the protector and a “conceptualization of hostile self-states in ‘personified narcissistic and sociopathic defenses’ that defend against dependency, vulnerability, and guilt…[and]…applies just as well to pathological narcissism” (Howell, 2005, p. 224). The ‘diminished capacity’ rule would apply when dissociative episodes result in a “psychotic” break, whereby a thought disorder could be ascribed.

 

Diminished capacity resulting in a thought disorder would be split between two categories; one being “disturbances in the content of thinking and perceiving (hallucinations and delusions), and… [the second would be]…disturbances in the form of thinking (formal thought disorder)” (Young, 2003, para. 7). Procedural memory becomes disengaged from experiential memories where reactionary encoding enables the maladaptive somatic response encoded reactions needed during survival in the moment situations. Multiple self-states dissociate and boundaries within boundaries abound.

 

I am just now starting to sift through the sea of case law and journal articles on the considerations of PTSD and criminality; unfortunately I think that there will be an ever increasing need for individuals well versed in the pitfalls of combat trauma and difficulties in reintegration. I feel as you do that something needs to be done to address this issue head on, such as a Veterans Court much like the one just established in Minnesota. Additionally, we have only begun to see the tide of returning veterans with psychological troubles facing criminal charges.

 

Never before in the history of American warfare have we seen such high numbers of soldiers who have been under unimaginable stress. In WWII 18% of our soldiers actually engaged in combat, with Vietnam it was 30-40%, today 68% have actually engaged in combat (Veterans for common Sense & Veterans United For Truth, Inc v. Veterans Administration, item 54, & National Center For PTSD Fact Sheet, Aftermath of Violence section, paragraph 2). Not only have more soldiers engaged in combat, they have been in combat longer with an average of 2 to 3 tours of duty. Many have been on 5 tours and some as much as 6. As high as 80-90% of soldiers (Hoge, C. W., Auchterlonie, J. L., & Charles S. M., 2008, results section, paragraph 5) have seen someone get killed, or been in a combat zone, we have reached "Combat Saturation."

 

Today 15% (300,000; Rand Corporation, 2008) of our soldiers and veterans have been diagnosed with PTSD and this seems like it may be a smaller number compared to other wars. 30% PTSD rates in Vietnam, 15% estimated in WWII and 15-20% of Gulf War I vets reported to have PTSD. It took Vietnam veterans up to 10-20 years before their symptoms reached the point of becoming debilitating. The implications for our modern veterans will have monumental deleterious effects in the next 10 years, it has been projected that PTSD rates in today's wars will reach 50-60%. We will be inundated with mentally ill veterans who have few options and nowhere to turn and they will run afoul with the law (Lee, 2006).

 

Today we have become faced with a growing trend of soldiers and veterans becoming enmeshed in the court systems. In direct conflict with the perception in the media I propose the theory that our veterans and soldiers face an insufficient mental health care which has a major impact to their lives, families and communities. The problem is not individualistic but systemic requiring major changes in how we view and treat PTSD. The care of our soldiers and veterans is not being met and we have just begun to see the aftereffects of the mind shattering results of combat trauma. Untreated PTSD can destroy the lives of many, not only the soldier and veteran. We send our soldiers to war for our freedom and then lock them up when they are broken and of no use anymore (Lee, 2008).

 

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References

Appelbaum, P. S., Jick, R. Z., Grisso, T., Givelber, D., Silver, E., & Steadman, H. J. (1993). Use of posttraumatic stress disorder to support an insanity defense [Electronic version]. American Journal of Psychiatry, 150(2), 229-234.

 

Brook, T. V. (2008, August 12). Report: 57% of troops sent on combat tours. USA Today. Retrieved October 12, 2008, from http://www.navytimes.com/news/2008/08/gns_deployments_081108/

Bourget, D., & Whitehurst, L. (2007). Amnesia and crime [Electronic version]. Journal of the American Academy of Psychiatry and the Law, 35(4), 469-480.

Buchanan, A. B. (2006). Psychiatric evidence on the ultimate issue [Electronic version]. Journal of the American Academy of Psychiatry and the Law, 34(1), 14-21.

Cercone, K. (2006). Brain based learning. In E. K. Sorensen (Ed.), Enhancing learning through technology (pp. 293-322). Hershey, PA: Information Science Publishing.

Congressional Research Services (2008). United States military casualty statistics: Operation Iraqi Freedom and Operation Enduring Freedom. CRS Report RS22452. Retrieved on October 29, 2008, from http://assets.opencrs.com/rpts/RS22452_20080909.pdf

Hoge, C. W., Auchterlonie, J. L., & Charles S. M. (2006). Mental health problems, Use of mental health services, and attrition from military service after returning from deployment to Iraq or Afghanistan [Electronic version]. Journal of the American Medical Association, 295, 1023-1032.

Howell, E. F. (2005). The dissociative mind. Hillsdale, NJ: The Analytic Press.

Kimayer, L. J., Rousseau, C. & Lasley M. (2007). The place of culture in forensic psychiatry [Electronic version]. Journal of the American Academy of Psychiatry and the Law, 35(1), 98-101.

Lee, S. A. (2006). Effects of combat on returning veterans. Unpublished manuscript, Jefferson Community and Technical College at Louisville Kentucky.

Lee, S. A. (2008). Combat veterans and institutions: A systems analysis. Unpublished manuscript, Kent School of Social Work at the University of Louisville.

National Center for PTSD. (n. d.). The unique circumstances and mental health impact of the wars in Afghanistan and Iraq. Retrieved December 23, 2008, from http://www.ncptsd.va.gov/ncmain/ncdocs/fact_shts/fs_iraqafghanistan_wars.html

Mezey, G. (2006). Post-traumatic stress disorder and the law [Electronic version]. Psychiatry, 5(7), 243-247.

Poortinga, E., & Guyer, M. (2007). Criminal responsibility and intent [Electronic version]. Journal of the American Academy of Psychiatry and the Law, 35(1), 124-125.

Powers, R. (2005). Deployment rates, United States military. About.com. Retrieved on December 26, 2008, from http://usmilitary.about.com/od/terrorism/a/deploymentrates.htm

Rand Corporation (2008). Invisible Wounds of War: Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery. Retrieved December 23, 2008, from http://www.rand.org/pubs/monographs/2008/RAND_MG720.pdf

Robinson, C. L. (1999). Observations on cognition and insanity [Electronic version]. American Journal of Forensic Psychology, 17(4) 63-75.

Saxon, A. J., Davis, T. M., Sloan, K. L., McKnight, K. M., McFall, M. E. & Kivlahan, D. R. (2001). Trauma, symptoms of posttraumatic stress disorder, and associated problems among incarcerated veterans [Electronic version]. Psychiatric Services, 52(7), 959-964.

Young, D. W. (2003). Varieties of thought disorder in the criminal context. Washington State Bar Association. Retrieved October 29, 2008, from http://www.wsba.org.media/publications/barnews/2003/mar-03-young.htm

United States Department of Justice. (2004). Veterans in state and federal prison system, 2004. Retrieved November 20, 2008, from http://www.ojp.usdoj.gov/bjs/pub/pdf/vsfp04.pdf

Veterans for America (n. d.). Talking points: The consequences of churning & weekend warriors to frontline soldiers. Retrieved October 29, 2008, from http://www.veteransforamerica.org/wp-content/uploads/2008/04/talking_points.pdf

Veterans for Common Sense & Veterans United For Truth, Inc v. Veterans Administration, C-07-3758-SC, 2007 U.S. Dist.

 

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(To come...Scott's guide to dealing with PTSD and the law for veterans and their loved ones, linked here.) 

Therapeutic Resources - Books on Healing Combat Trauma and PTSD

Just an "FYI" to say, we've hit 100 books listed as therapeutic resources now on this blog -- look left to see them, they're in a column of their own, starting in the upper left of the page here.  All are recognized as reasonable sources of information -- or sources of reasonable information! -- with some therapeutic utility -- by reputable authors and experts, as well as some up-and-coming ones -- and all have been rated at least four stars, if not four and a half or five -- by their readers on Amazon.com.  Click on any of them to go right to the book on Amazon and purchase.

On the right hand side of the blog are lists of first person narratives from the various wars that adhere to the same standards.  If you're trying to understand the mind and "back story" of a combat veteran with PTSD, how better than to learn what they actually went through in the time they served?  That's where those lists of book come in handy.  All will give you a feel for what combat veterans actually went through during their time of service.

There are many other resources on this blog as well, including "healing* multimedia" (look to lower left for that list) -- but at 100 therapeutic books listed, it was time to highlight what these resources are.

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Editor's note: We'll discuss the term "healing" shortly, but healing should be understood to be a continuum towards health, in which every incremental improvement brings satisfying relief, rather than a "goal," or a single event/result. 

"The Frontiers of Trauma Treatment" - Seminar

Bessel A. Van Der Kolk, M.D., and Dana Moore will be presenting "Frontiers of Trauma Treatment" at Kripalu in Western Massachusetts, from January 9-11, 2009.

The program is designed, according to the informational material,

For licensed therapists, yoga instructors, and other individuals interested in studying the nature and processes of trauma.

Traumatic experiences alter people’s relationship to their bodies in ways that leave them feeling uptight, helpless, disconnected, hurt, on edge, frantic, and at odds with themselves and their environment. Research is demonstrating that physical sensations and action patterns are the very foundation of consciousness. The experience of physical mastery that yoga and other body-based practices provide is often necessary in order to initiate new ways of perceiving reality. By learning to pay close attention to internal experience and working with the felt sense, people can reclaim authority over their lives.

In this weekend, we will explore recent developments in the neurosciences, attachment research, and new psychotherapeutic treatments. This course is not meant to serve as personal trauma treatment but as an introduction to the neuroscience of trauma and attachment. It offers a chance to be exposed to an array of body-centered approaches for dealing with trauma, including EMDR, yoga, theater work, and tai chi. These approaches help in dealing with hyperarousal and processing traumatic memories, and promote mastery over the posttraumatic legacy of constriction and feeling lost in the world.

CE Credits

This program is eligible for :

• 8 credits for nurses (CS, NP, RN, LPN), $20 additional charge
• 8 credits for social workers, $20 additional charge
• 8 credits for certified counselors (NBCC), $20 additional charge
• 8 credits for physical therapists (PT), $20 additional charge
• 8 credits for athletic trainers (BOC), $20 additional charge
• 8 credits for psychotherapists (APA), $20 additional charge
• 8 credits for yoga instructors (YA), $20 additional charge

For further information about the weekend or to register, click here.

"Just in Time for the Holidays" -- Stress-Reduction Exercises for PTSD

Various stress-reduction or relaxation exercises and techniques are available these days in a number of places, online and otherwise; and at least a few of them make a passing reference to PTSD (though rarely combat trauma). 

Relaxation at first may seem to be an impossible goal for those with combat trauma, because jumpiness and hypervigilance appear to be hallmarks of the experience that also have helped keep troops alive. 

However, the continual wearing-down and weakening of the nervous system over years from adrenaline surges and frequent experiences of "fight or flight" shows just how important it is to develop greater familiarity and experience with relaxation exercises. 

Like riding a bike, it's a much better (and more effective) idea to DO these things than just READ about them -- especially if you want to give yourself a chance to "feel" the effects in your own body, and "test" for yourself whether these techniques really "work."  (And don't forget the caregivers, partners or spouses of those suffering from PTSD: They also carry around a fair amount of stress... )

The emerging field of Mind-Body Medicine (ironic since the idea of mind-body medicine is actually quite old) is full of techniques and tools for stress-reduction and relaxation.  Yoga and meditation, among others, are known for their ability to reduce stress.  But occasionally on the Web there's also a good guide for sufferers about how to relax and renew.  Just such a "technique" guide exists here: The subject is "Relaxation and Relaxation Exercises," and the guide was produced at the Trauma Center, with the funding of the Massachusetts Office for Victim Assistance (MOVA), under a federal Anti-Terrorism Supplemental Grant (ATSG), to aid Victims of and Responders to the 9/11 Terrorist Attacks.  Click here for a link to the guide online.

Also look on the left-hand column of this blog to see a number of resources in the form of books, CDs, and DVDs for stress-reduction and relaxation, including music designed to help people relax and de-stress. A section called "Healing Multimedia" is located about 3/4 of the way down the page (if you think of the blog as a single page, and just cursor down to that), or you could do a search (Cntrl F on most computers, or Apple F on Macs) for "healing multimedia" to find that section of recommended resources. Enjoy!

News from Hell before Breakfast: Journalists, War Trauma and PTSD

"I hate newspapermen. They come into camp and pick up their camp rumors and print them as facts. I regard them as spies, which, in truth, they are. If I killed them all there would be news from Hell before breakfast." -- attributed, perhaps erroneously, to Civil War General William Tecumseh Sherman.

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A different quote:

"On Thursday, June 26th, I witnessed the immediate aftermath of an Al-Qaeda suicide bomb attack.  Several dozen people lost their lives... children, old men, civilians, police, and military men.  The scene was horrific beyond words, even for someone like me who has a fairly high threshold for such things.

I found it nearly impossible to look through the viewfinder.  What I saw was abhorrently graphic, yet far too important for the world to ignore.  I present images that provide an uncensored view of a terrible event, and some small measure of dignity to those who lost their lives."

-- Zoriah, international humanitarian photographer, whose gripping images from that event were later censored by the U.S. military, and he was evicted from his embed assignment with the Marines. (The link to the post where he talks about those images, and shows them, is here.)

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PTSD from being a combat journalist of photographer, embedded or otherwise:  Not everyone who's exposed to combat trauma develops PTSD, as we know.  Recently, Kimberly Dozier, CBS correspondent and author of Breathing the Fire, says she didn't develop it from her horrific near-death incident in Iraq in May of 2006, though ironically -- according to Dozier -- almost everyone she interacts with believes thatshe must have.  (See article to that effect by Dozier, linked here.)  However...many do; and for others, the signs and symptoms take time to manifest themselves. 

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Journalists bear witness, both to some of the most savage atrocities of wartime, though without the training and the mindset of combatants, and also to the suffering of the survivors, military and civilian.  Says one photographer who served in Vietnam:

It has been very difficult for me [to recount some of his memories from the past] as it has brought back many of the horrible nightmares that I had thought that I had finally put away. It did get them out in the open and off my chest so to speak and now my family now knows why I sometimes have to take those walks out into the woods alone to just get away. Hard to explain. I do have severe survival guilt as I have lost far to many friends in combat in up close and personal confrontations. I have many photos of me smiling and yes there were many good times. However; there were enough bad times to more than compensate for the good ones. I have learned to cope with this new world that I came home to only because I still feel a great need to help my fellow veterans. We 'Nam veterans are all but forgotten in my eyes.

Two significant resources: Dr. Anthony Feinstein's work, and the Dart Center for Journalism and Trauma.

Two excellent books:

Dangerous Lives: War, and the Men and Women Who Report It, by Anthony Feinstein (2002); and Journalists under Fire: The Psychological Hazards of Covering War, by Anthony Feinstein. (2006).  (Recommended by Jonathan Shay, M.D., Ph.D., noted PTSD expert.)  Shay wrote: "the first and only book about the occupational [psychological] hazards of being a war correspondent.  Published in Canada, will come out in the US next year from Johns Hopkins UP with a new chapter on embeds."

Dr. Anthony Feinstein is a professor of psychiatry at the University of Toronto and a neuropsychiatrist at Sunnybrook and Women's College Health Sciences Centre in Toronto. He is an expert on Post-Traumatic Stress Disorder in war journalists. Feinstein received a 2001 Guggenheim Fellowship to pursue his research. Dr. Anthony Feinstein's bio is linked here.  Much better bio, linked here.

For reporters: War, Journalism and Stress: The Self-Assessment Test, linked here. (General description of the test, linked here.)

What Feinstein has to say:

More than anything, says Feinstein, he’s learned that, “War is not good for journalists. They suffer from it.”

Specifically, they suffer post-traumatic stress disorder, substance abuse and anxiety disorders. One in five journalists, over the course of a long (15-plus-year) career, endures significant PTSD, says Feinstein. That means, among other things, bad dreams, flashbacks, numbness, an overly sensitive startle response and an inability to get close to others emotionally. One in four experiences depression. “And a number drink very heavily as well,” says Feinstein, “but I don’t know how many, because I never know for sure what they’re telling me.”

The most surprising revelation of the research for Feinstein? “I didn’t realize that the journalists were in such great danger. You see them when they report the news: cool, collected, with everything seemingly going on behind them. But these people are really right in the middle of it all.”

He is particularly sympathetic to still photographers. More than anyone, he says, these professionals have no choice but to get into the thick of things to do their jobs well.

The Dart Center for Journalism and Trauma, located on the campus of the University of Washington in Seattle, is a particularly good, targeted resource for journalists about reporting and trauma: both externally reporting, and internally experiencing trauma from reporting in war zones.  Click here to look through their extensive offerings, which are really superb.

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Who's the handsome young man in the photo? 

That's Robert W. "Grif" Griffin.  Griffin says, "I was a combat photographer with the 1st Cavalry Division Airmobile from 1966 to 1968 and 1970. I was in country [in Vietnam] as a photographer from 1966 to 1968, and back again in 1970."  (He was shot down near Quan Loi in 1970.)  He adds that he "spent 20 years in the Army mostly as a photojournalist/motion picture and still photographer."

According to Griffin, "the photographer who took the photo is Jere L. Smith, a fellow combat photographer and a Specialist E5 at the time. We were both assigned to the 13th Signal Battalion, which was part of the 1st Cavalry Division Airmobile."  At the time the photo was taken, Griffin was duplicating some slides for his Command for a Division briefing that was to take place in several locations at the same time: hence, the dupes.

Army General and PTSD: The Courage to Admit All is Not Well

In honor of Veterans' Day -- hey, every day should be Veterans Day, but we're not so lucky -- there's an important story to let people know about, because it so stands out from the crowd, in more ways than one.

In the wake of a recent apparent suicide by a top military officer, Air Force Brigadier General Thomas Tinsley, from unknown causes, this general's admission about his personal struggle with PTSD is all that much amazing. 

"Officers just don't get PTSD," one combat-hardened Vietnam-era veteran told me recently, knowing full well that it's not so much that they don't get PTSD, but that there's no real way to admit that they struggle with it.

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An Associated Press report from the weekend talks about Army Maj. Gen. David Blackledge's courage to come forward, after returning from Iraq, and getting psychiatric help to deal with the trauma of war.  As the article says, by doing so, Blackledge is (fortunately) "defying the military's culture of silnece on the subject of mental health problems and treatment."

Says Blackledge, quoted in the article, "It's part of our profession ... nobody wants to admit that they've got a weakness in this area," Blackledge said of mental health problems among troops returning from America's two wars. "I have dealt with it. I'm dealing with it now," said Blackledge, who came home with post-traumatic stress. "We need to be able to talk about it."

The article focuses on the perceived "stigma" in the military culture about admitting there is a problem, seeking help and getting treated -- as well as indications that some positive change is afoot in this area.  Blackledge, who served in Civil Affairs in Iraq, and now works at the Pentagon, is clearly leading by example.  He was involved in several traumatic incidents in Iraq -- his convoy was ambushed, his driver was killed, and he was in a hotel that was bombed by suicide bombers -- and he's successfully sought help dealing with the incidents, help which he believes has strengthened him.

Given that we all pretty much know the statistics of how few people seek treatment vs. the ones who should, as well as how pervasive the culture of silence and fear of retribution is, it's GREAT to see Maj. Gen. Blackledge's openness -- and on this Veterans' Day, we can only hope it encourages many other servicemembers to go for help. The article is linked here. (Thanks to veteran John M. for the heads up!)

Editor's note: That's Maj. Gen. Blackledge 2nd from left in the photo, standing just to the right of Bob Dole, in this picture from a charity fundraiser for the Jericho Project.

"I Had My Hard Lessons in Life" - Ambrose Bierce, Literary Poster Boy for TBI and PTSD

It's getting hard for me to think of Ambrose Bierce as anything but the quintessential, though unrealized, poster boy for PTSD (and secondarily, TBI) from the Civil War era -- in addition to his stature as a journalist and writer of quite macabre short stories...and the funny-as-hell classic, "The Devil's Dictionary."  

(The painting pictured, too, shows Bierce with the human skull he allegedly kept on his writing desk "for inspiration".)

The more I read about Bierce, the more his symptoms jump off the page -- really consistent, too, with the extreme amounts of combat trauma he experienced.

More on that later, as it comes up, but here's an item from an unrelated book I've just been reading, which mentions Bierce's "mentorship" of another San Francisco-based writer, George Sterling.

"This was Sterling's first lesson.  Many more followed.  Bierce...obliged him to visit the city morgue, where he bribed an attendant to display bodies for them to "strengthen the spirit."  When Sterling had to rush from the place and vomit in the gutter after viewing the corpose of a drowned man, Bierce said, "Don't be embarrassed...When I was eighteen, I had to go out and bury soldiers and horses who had been lying in the sun for a week.  I had my hard lessons in life, too."

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That passage is followed by another in the same book, where a different San Francisco writer -- Jack London -- reinterprets Bierce's fixation with death to the same young writer, George Sterling:

"They walked up Grant Avenue and Sterling told London about the evening that Bierce had dragged him around the city, ending up at the morgue.

"That figures," London snorted.  "Bierce is fascinated with death because he detests life.  He's afraid of it, I think.  He doesn't want to live in the real world. Anyway, I'm not taking you to any damned morgues tonight.."

-- Source: Realms of Gold: The Colorful Writers of San Francisco, 1850-1950, by George Rathmell.

Another intepretation of course is that perhaps Bierce had seen "too much" of the real world... and was still trying to put the pieces together, for himself, even decades later.

In Honor of Veterans Day: Community Acupuncture Clinics for Veterans

In honor of Veterans Day, Acupuncture without Borders is holding community acupuncture clinics for veterans in the following cities:

Newark, CA;

West Los Angeles, CA;

Stamford, CT;

Ft. Lauderdale, FL;

St. Augustine, FL;

St. Petersburg, FL;

Tamarac, FL;

Boston, MA;

Cambridge, MA;

Albuquerque, NM;

Santa Fe, NM;

Carson City, NV;

New York, NY;

Glenside, PA;

McLean, VA;

Longview, WA;

Seattle, WA; and

Racine, WI.

For more information on these clinics, click here.  NOTE: Do not assume that they are each being held on Veterans Day itself.  Most are held on a day either before or after, so check the schedule first several days in advance by clicking the aforementioned link.

Editor's note: For more on why acupuncture might be a suitable or interesting treatment modality for combat trauma and/or PTSD, click here.

Acupuncture Without Borders: Treating Veterans, Addressing Trauma

An organization called "Acupuncturists without Borders," (after the organization of doctors called Medicins Sans Frontiers) has been treating veterans and their particular concerns regarding combat trauma and PTSD.  Says one veteran:

“I served two tours of combat in Vietnam. I’m 100% disabled because of PTSD. When I first started coming to the AWB clinic in Albuquerque, I had spent years suffering from high anxiety. I believe that because of the acupuncture I have become calmer and my anxiety has drastically come down. I don’t want the new vets to suffer for years like I did. Acupuncture is helping me get my life back.” -- Raul Rojas

Richard H. Thompson, a four star general (retired), adds, "I have participated and believe it can help. I fully support the efforts of this organization."

According to Acupuncture without Borders, veterans acupuncture clinics are currently open in the following cities: Fort Myers, Florida; Warm Mineral Springs, Florida; Chicago, Illinois; Portland, Maine; Framingham, Massachusetts; Grants Pass, Oregon; Portland, Oregon; Madison, Wisconsin; Portland, Maine; Portland, Oregon; Rochester, New York; Rockland, Maine; Albuquerque, New Mexico; Pojoaque (Santa Fe area), New Mexico; Times Square, New York City, New York; and Stevens Point, Wisconsin; with future acupuncture clinics for veterans pending in Arlington, Massachusetts; Ann Arbor, Michigan; Ithaca, New York; New York City, New York; Charlotte, North Carolina; Philadelphia, Pennsylvania; and others.

For a list of the currently operating veterans acupuncture clinics, click here.

If you're an acupuncturist who wants to become involved, there are future trainings scheduled in Albuquerque, Los Angeles and Orlando, Florida, in the coming months.  Click here for a list of the trainings.

For a link to the organization itself, click here.

Pilot Study on Mind-Body Medicine Intervention Techniques Looking for Oregon Veterans

A study of mind-body medicine getting underway in Portland, Oregon will test whether veterans with post-traumatic stress disorder can benefit from meditation, neurofeedback and other healing alternatives.

Researchers at Oregon Health & Science University are seeking 45 volunteers, including combat veterans troubled by PTSD and veterans who lack combat experience or have never suffered from PTSD.  They are accepting veterans between the ages of 18 and 70 who are in good health.

The pilot study, which could lead to a larger clinical trial, will measure how stressful and relaxing situations change a subject's hormone levels, heart rate, brain activity, and immune system functioning.  Helané Wahbeh, a naturopathic doctor and postdoctoral fellow at OHSU, is leading the study with funding from OHSU's department of neurology as well as the National Institutes of Health (NIH).

 “Mind-body medicine appears to be an ideal way to help people with PTSD because the disorder affects the body’s immune system, hormone system and nervous system,” says Helané Wahbeh, N.D., a naturopathic physician researcher at OHSU. “I don’t believe you can effectively treat PTSD by only focusing on one aspect of the illness. For example, if we only give people suffering from PTSD anti-depressants, we may only be treating one aspect of the illness.”

The first phase of the OHSU study will measure changes in hormones, heart rate, brain activity and the immune system in both relaxing and stressful situations. Mary Lu, M.D., a psychiatrist with the Portland VA Medical Center, will provide PTSD screening.

Veterans interested in volunteering for the study, which will take up to about six hours of their time (probably broken up over time) can call (503) 494-3528 for more information.

Editor's note: If the study will measure hormone levels, undoubtedly it will measure cortisol levels -- and we've talked about cortisol, stress and sleep quite a bit previously on this blog. Unfortunately, good luck to the study's researchers on finding older vets who are also in "good health," especially ones who suffer from combat-based PTSD. Typically this creates a cascade of other physiological problems as veterans age -- however, on the plus side, mind-body relaxation techniques ideally will help even older veterans with health problems to achieve greater quality of life.  Either way it's an interesting study.

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Additionally, here's a little more about the study from OHSU's own site, including some goals and a short video, linked here. And here's a description of the study (confusingly saying that it's not yet open for participation yet -- call the phone number instead to be sure) from the NIH's own Clinical Trials site, linked here.

Reserved to Fight: New Documentary Features Young Veterans Realizing "You Are Not Alone"

There's a new documentary out, showing on PBS this month (click here to find your local station), co-produced by the Iraq and Afghanistan Veterans of America (IAVA) and called "Reserved to Fight." This is how the director describes it:

"In May 2003, Fox Company of Marine Reserve Unit 2/23, returned home from front-line combat in Iraq. Reserved To Fight follows four Marines of Fox Company for four years through their postwar minefield of social and psychological reintegration into civilian life. The return to their communities proves as formidable a battle as the more literal firefights of previous months. Living among loved ones who don’t yet understand them and how they have changed, contending with a media focused on the politics rather than the human experience of war, and suffering from a psychological disorder that is difficult to acknowledge, these young veterans grapple to find purpose and healing.

For each Marine, their new status as a young veteran leaves them often without goals, camaraderie, or an immediate channel for the adrenaline that their combat-ready bodies still produce, even many months later. Most significantly, they lack a safe place internally to store the images, sounds, and experiences collected from war. Encroaching civilian reality only serves to widen the painful gap that exists between them and the society in which they live; a gap which they feel so personally and painfully.

Taking anti-war media personally, Mark Patterson returns home adamantly speaking out against those who oppose the war. He is unwilling to admit that the war has affected him, and his life becomes consumed with trying to convince his peers that his actions in Iraq were correct. But when his long-time girlfriend and emotional support, Jana, suddenly breaks up with him, severe depression forces him to confront his past, drastically reshaping his future. Matt Jemmett is immediately diagnosed with Post-Traumatic Stress Disorder (PTSD) after his return home, but when traditional therapy doesn’t work, he decides he needs seclusion and takes a job in a remote desert location
working with at-risk youth.

Raised in a strict religious society, Earl Simmons’ abuse of alcohol to fight traumatic memories of the war leaves him unable to fulfill a two-year church mission. Returning to his community for a second time, shame and seclusion force him to face his demons. Upon returning home, Chris Nibley just wants to be normal: “start a family and have a lot of kids.” However, finding himself depressed, he soon
realizes that he does not fit into this concept of “normal”. As a result he is left feeling isolated and without direction. All attempts to find happiness only leave him hopeless of ever finding his sense of purpose in America again and he makes a rash decision to volunteer for a second tour in Iraq; knowing, almost hoping, he will die.

As the Marines’ individual stories unfold, we discuss the mental stress of war and its affect on veterans of WWII and Vietnam.

Ray Howarth, a prisoner of war and purple heart recipient of WWII, struggled with severe emotional stress resulting in random bursts of rage. Forty years after the war he decided to visit a therapist and found “I was never deprogrammed from war.” Now Howarth has dedicated his life to helping veterans
readjust. Terry Haskell, a Vietnam veteran, reflects on his experience after coming home and shares “I was lost for ten years, I think time finally healed me. I could forgive.”

It is the stories of these veterans that make this film distinctive. While their lives are the vehicles for this story, it is ultimately about all veterans. Today, thousands of veterans walk a similar tight rope hinged on confusion, loneliness, isolation, and despair. This film will help them realize they are not alone, while offering awareness both for the veterans and their communities."

Sounds worth watching.  In reality, reservists face special challenges unique to them.  Non-career military, they are expected to "resume" normal lives as quickly as possible, but with all the same difficulties, sometimes even more, than those who are active-duty military.  Like the National Guard, special care needs to be paid to the unique challenges of reservists.  Wrenched from the common experience of wartime, they go back to civilian lives separated from their buddies, with whom they could otherwise hope to process the combat experience.  Similarly, they also return to families, jobs and communities that frequently expect them to be more or less "fine," because they're now back from the war, yet with few resources to help them or their families integrate these divergent experiences.

Editor's note: If you want to read about another Marine battalion that served in Iraq, 1/25, also known as "New England's own," read this earlier blog entry, linked here, which mentions and links to the extensive coverage by the Boston Globe -- which gave reporter Charles Sennott a year to follow the battalion -- and the Providence Journal Bulletin. A good video, which we've also blogged about earlier, here, is from the Norfolk County (Massachusetts) District Attorney's office, called "PTSD and Veterans: Beyond the Yellow Ribbon." It talks about various re-adjustment issues after combat and particularly focuses on reservists.  Highly recommended.

Upcoming Workshop on Using Art Therapy in Treating Trauma - Boston, MA

Beyond Words: Creating a New Language for Healing; The Use of Art Therapy in Trauma Work

Date: Friday, November 14, 2008

Time: 9:00 A.M.-5:30 P.M.

Location:The Trauma Center at JRI, 1269 Beacon Street, Brookline, MA

Cost: $160

Presenters: Erika Lally, LMHC and Michelle Harris, LMHC

Trauma survivors are often challenged by the use of words in communication. The very nature of trauma and the inherent qualities of dissociation may leave the client struggling to articulate his or her exprience. Reliance on a verbal language approach in treatment may, at times, generate even more frustration and distress. With art materials and the art process, it is possible to access the inner experience without reliance on words as the starting place. Art therapy is a treatment modality that utilizes art media, art process and art products as communication within therapy. Art therapists learn to attune to the nonverbal cues of their clients and have a lexicon for the kinesthetic properties of art that help them in the formulation of individualized media interventions and art therapy treatment approaches. The Trauma Center is pleased to offer a one-day training to introduce both these basic art therapy concepts and specific considerations crucial to using an arts-based aproach in trauma treatment. This training is a hands-on, highly experiential workshop with information also presented through slides, case examples, and discussion.

This training will:

-- Integrate the basic tenets of effective trauma treatment within an art therapy framework.

-- Highlight the potential of retraumatization when including image making as part of trauma therapy work.

-- Address safety through increased attunement to client and clinician responses to artmaking.

-- Bring all the senses, movement, and creativity into trauma work with affect regulation as the goal.

-- Structure a creative process that is strength-based for problem-solving, organization of thoughts, naming "what is" and meaning making.

This training is intended for both the art therapist looking for a trauma treatment framework as well as the trauma clinician who is drawn to using art within their treatment. Previous art making experience not required. Participants should be prepared to immerse themselves in art activities and dress comfortably.

About the Presenters:

Erika Lally, LMHC, ATR-BC, holds a Masters in Art Therapy from the School of the Art Institute of Chicago. She is a Licensed Mental Health Counselor in Massachusetts and a Registered, Board Certified Art Therapist as recognized by the American Art Therapy Association. She has provided trauma treatment for both children and adults for fifteen years. Ms. Lally is a clinician, supervisor and trainer at the Trauma Center. She additionally coordinates the Trauma Center's Child Evaluation Services and consults on the Multidisciplinary Assessment Team at the Cambridge Department of Social Services. Erika also is an adjunct faculty member at Lesley University, teaching in their Master's Level Expressive Therapies Division. Erika specializes in treating complex trauma and she is EMDR level two certified.

Michelle Harris, MA, ATR-BC, LMHC, is an art therapist specializing in trauma work with children, adolescents, and adults. She is clinical intake coordinator at the Trauma Center and has been leader of the Positive Sensory Group, a structured skills-building group focusing on self-care and safe alternatives to numbing, avoidance, and shut-down responses in daily life. Ms. Harris also specializes in collaborative community art projects such as the Coast Miwok/Southern Pomo tribe's quilt on faith and tribal identity. She is currently creating a traveling quilt series with incest survivors called "Speaking Truth" to address intergenerational trauma and how trauma survivors can be preventative and proactive when telling their history in a developmentally appropriate frame for children in their life. Ms. Harris is an art tutor at Harvard University and faculty at Lesley University in the Expressive Therapy Department and in the Trauma Center Certificate Program.

For more information or to register, click here.

Editor's note: to read more blog entries about art therapy and combat trauma/PTSD, click here.