Healing Combat Trauma

What's Involved with the Art of REALLY Listening to One Another?

We've written before on this site about the wonderful adage from Christian existentialist Paul Tillich that "the first duty of love is to listen." With the month of November being Military Family Month (per presidential proclamation last year at this time), maybe we need a little more encouragement to really listen to the military families around us.

Of particular concern is the fact that approximately 85% of caregivers are women -- and in the case of military families where one member has combat-based PTSD, it's also possible that his or her caregiver has also served, and has struggles of his or her own. The plight of the two-servicemember couple, where one or both have PTSD, and one or both are also caregiving: Imagine the difficulties.

Are we as a community really listening -- or asking first appropriately and then listening caringly -- to how difficult that can be, or how few resources there are at their disposal? More on that later, but in the meantime, a further definition of what real listening is, so we can set our hearts and minds to it better, for the benefit of others:

Psychologist Abraham Maslow defined "real" listening as: to listen "without presupposing, classifying, improving, controverting, evaluating, approving or disapproving, without dueling (about) what is being said, without rehearsing the rebuttal in advance, without free-associating to portions of what is being said so that succeeding portions are not heard at all."

Editor's note: When informal listening isn't enough, professional listening services are available from Give an Hour and The Soldiers Project. Those programs are staffed by trained counselors who offer their services to military members and their families, without charge and in some cases for as long as it takes. (Contact those programs for specifics.) The nation's network of Vet Centers also offers counseling services to family members, once their veteran has registered (even if he or she doesn't partake of services there). There's also the suggestion, in this well-written opinion piece, that we turn Veteran's Day, November 11, into a national "Day of Listening" to our veterans -- and their families.

Willingness to Learn from Our Vets Can Be Very Healing for Them, Too

We've written before here about Thich Nhat Hanh's wonderful comment, as quoted by Claude Anshin Thomas, about how veterans understand deeply the nature of suffering, and because of that can be "a powerful force for healing in the world."

In the same vein are these comments by Patience Mason, in her book "Recovering from the War." While she was writing specifically about the Vietnam combat experience, once can substitute the word "combat" throughout and receive the benefit of her wisdom on this. The emphasis is still on letting the veteran guide the extent of sharing about his (or her) combat experience; and encouraging supportive listening, which communicates respect and appreciation for the vet and what he or she experienced. Mason writes:

"Saying to your vet, "I never realized what you had been through" can mean a lot to any vet -- brother, son, father, husband or lover. In its way, that's a paraphrase of his entire experience and an invitation. Willingness to learn from our vets can be very healing for them, too. They are the experts on [their combat experience]. When they came home they found that this expertise was a handicap. Some buried it. Some lived with it every day. It is still there for all of them, and sharing it can give them a sense of appreciation and respect that was owed when they got back from [combat] but never paid. Discussing [their combat experience], if it is done at all, should be done at your vet's pace."

Editor's note: Patience Mason's book, "Recovering from the War," is linked here. Claude Anshin Thomas' book, "At Hell's Gate: A Soldier's Journey from War to Peace," is linked here. For more on the all-important communication skills between a veteran and his or her loved ones, click here.

The Hard -- But Necessary -- Work of Welcoming Veterans Finally HOME

With Veteran's Day approaching, it's time to think about an often-neglected theme, which is the "Welcome Home" that many veterans never had. The Vietnam veterans, who fought, died, and suffered -- not only on the battlefields of Southeast Asia, but also here at home. 

Talk to any group of Vietnam veterans, or even singly, and you find most still feel the pain and ache of no one welcoming them home -- with a parade, with open arms, with gratitude and appreciation for their sacrifice and service. It's an open wound that still smarts today' and it's also our national shame.

One Vietnam veteran, John, who served in the Army, was writing about how this indignity still rankles him today -- because it goes much deeper than the community at large not welcoming him home. His own family didn't even!

Here's his story:

"Time to bring my younger self home, back from combat? To be honored? In PERSON?

I'm sure this is a well intended idea - but, I don't know how to do that, and I'm not even sure I would -- if I even could.

Sometimes I think I left that young man there, on purpose, to keep fighting for the freedom of the South Vietnamese -- and, yet, I find him deep inside me -- still, surviving, struggling, striving for strength! He is the -- MY -- ultimate Warrior Within -- MY Primordial Personhood -- the very Soul of Soldiering! He's ME.

It's been 38 years - and no one in my family has ever cared enough to even ask about him! I remember finding my Grandmother crying over her kitchen sink one day, weeping out loud that "My Sweet Johnny has been lost to War!" And I recall, thinking "She's right - I'll never, ever be the same!" All I could do was hold her and let her cry for awhile...then, we said not a word between us - and I left my hometown behind forever!

A few years ago we did have a big "Welcome Home"-themed Veterans Day Parade dedicated to Vietnam vets - and I couldn't even get a single family member to attend (when I was one of many being specially honored) -- like most, they just want to forget it all, while we are obligated to remember and honor our fallen -- too many Americans don't even want to admit reality, let alone face the facts, or take responsibility in the slightest degree!

In fact, we're having a long-overdue family reunion, and one family member mentioned that "No one wants to even hear the "V" word! So, I'm going with the "What about those (insert sports team name here)?" and "Is it getting hotter (cooler)?" strategy of only safe-talk...oh, and there's to be no discussion of politics or religion either - you know, because they are all experts in these subjects - sad, Sad, SAD!

I suspect, after all these years, they are carrying the shame of knowing how they did not even lift a finger to get me the help I needed when I came home - even when I became homeless...and I want so much to tell them there's no rational reason for any such shame -- they didn't know what to do - no one knew what to do for combat vets back then, we didn't even have the diagnosis of PTSD back then!

I want them to know I do love them, and that I do take full responsibility for the decisions I've made in my life, and how I have forgiven their lack of effort long ago... I want them to know they too paid a price for peace in my volutarily sacrificing on their behalf -- that I went to war to protect their peace - and it's all O.K., Freedom is not FREE! But, I'm not sure how to say it, or when -- I'm not even sure they even care? Ideas anyone? "

(Reprinted with permission.) 

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

 

A Veteran Spouse Asks the Key Question: Will You Love Them Enough to Learn?

Longtime veterans advocate and ecumenical chaplain Kathie Costos is a hero of mine. On dealing with the spouses and the families, it's hard to find anyone wiser, having lived through the crucible of her own experience -- being married to a Vietnam vet for lo these many years (28, at last count), and raising a family with him, after he got back from the war.

In conversation, she admits she had to learn it all the hard way -- as many do. When she gives advice, she says it's like she's speaking to her 26-year-old self; giving out the advice she wishes she'd gotten at the time but had to learn on her own.

Here she is on a crucial question many folks should come to terms with: Do you care enough about them (veterans) to learn what they went through? She writes about some who do, and many who do not:

"My husband was married before we met. He was married soon after he came back from Vietnam. During their six years together, she didn't want to know about Vietnam, had no tolerance for his nightmares, flashbacks or short term memory loss. She didn't want to hear anything about Vietnam and they separated so many times he lost count. She just couldn't take it and this, this was when his PTSD was mild. 

His Dad, a WWII veteran with a Purple Heart and Bronze Star, didn't want to talk to him about war at all other than a few stories about some of his friends. His Mom didn't want to talk to him about anything other than what she wanted him to do for her.

Friends didn't want to listen and he never felt he could talk to any of them even if they were willing to listen. A few of them were also Vietnam veterans but they didn't talk about much either. There was no communication and no support. They had nothing to really connect. No emails with buddies back home in the states. No news reports from around the country. No books on PTSD with personal stories were written. There were only clinical books for me to read when we met and I wanted to find out why this veteran was so much different than everyone else in my family.

My Dad was a disabled Korean Vet and my uncles served in WWII. My husband was totally different.

Today there is the Internet, books, videos, media attention, sites like this one putting together news reports from around the country and more programs than I can remember, yet today there are still high numbers of divorce, suicides and attempted suicides with more and more veterans ending up homeless from Iraq and Afghanistan. Their families and friends are not perfect. Most of them have the same attitude my husband's inner circle did when they could have been trying to be supportive instead of telling him to "get over it" and stop.

Today wives like me are no longer left in the abyss trying to claw their way out alone because they have a lifeline to reach for, but too many never take hold of it. Their families, spouse and kids, suffer just as much as they do but they have the power to end the suffering and begin the healing. They have the power within their reach but they just won't take it.

Do they love their veteran enough to learn? Do they care enough to find out what they can do to help instead of judge and blame?

My husband's ex-wife didn't care enough to find out what she was facing and their marriage ended after six years. We've been married for 26 years and with all the heartache and struggles, I wouldn't have missed a day of it because in the process of learning what I could do for him, I discovered a more marvelous man under all the pain he carried.

All of us can discover the people they really are under all the pain when we care enough to learn and help them heal. In the process, we heal ourselves, forgive what caused us pain because we understand what is behind it and know how to respond to help them see the person they are under all of it."

Reprinted with permission. For Kathie Costos' blog, Wounded Times, click here.

There's "Room at the Inn" for Veterans and Their Loved Ones on November 10th

More about the good work of innkeepers celebrating military and veterans, which we talked about yesterday, here. From today's mailbag:

Veteran's Day is Turning Into a Reciprocal Chain of Kindness

Hundreds of Bed and Breakfasts Give Veterans a Free Night; Restaurants, Others, Chime In

NEW YORK, Oct. 13 _ An effort of good will started by the bed and breakfast community to offer a free night stay to veterans on Veteran’s Day is turning into a reciprocal chain of kindness, pay-it-forward-style. Now hundreds of bed and breakfasts have offered complimentary rooms. Meanwhile, restaurants, even massage therapists have joined the effort, offering everything from free meals to free pampering. It seems an ember of kindness can spark into a really big deal.

“There’s a basic human emotion called moral elevation. When we see acts of service, sacrifice, and generosity, it moves us. Such acts give us a warm feeling in our chest and motivate us to do good deeds ourselves,” explained Jonathan Haidt, professor of psychology at the University of Virginia and author of two books on positive psychology. Haidt, who actively studies positive emotions, such as elevation, admiration, and awe says kindness can be contagious. “Many of us in America are elevated by the sacrifice and service of our veterans. A natural expression of this is the desire to do something good for them, to call attention to the service they’ve done for us,” he said.

The bed and breakfasts were the first group to come together, teaming up to offer a free night’s stay to veterans on Wednesday, November 10th, the night before Veteran's Day.  Men and women currently serving or those who have previously served our country are eligible for a complimentary stay at a participating inn. The only requirement for these rooms is a valid military identification. Veterans can obtain an I.D. from the Veterans Administration.

The program, started in 2009 by the West Virginia B&B Association used to include about a dozen inns. This year it’s grown dramatically to more than 600 inns, 40 states, plus other countries. Gillum House Bed & Breakfast and The Thomas Shepherd Inn sponsor the site that lists participating inns at www.bnbsforvets.org. So much changes each day that the Thomas Shepherd Inn has found it challenging to timely mark inns as “full” and add new properties. Not to mention, ready for guests at the inn now and prepare for veterans coming to stay there too; the inn has contributed three rooms to the promotion. Jill and Wade Linger, a veteran Air Force computer programmer, will be in one of them. “I read about it in the newspaper,” said Wade. “I thought it would be a great idea, something different to do with my wife.” (For more info on the Thomas Shepherd Inn, click here.)

Mass emails to veterans, social media, and press have made it possible for vets to learn of the program, it’s also made it hard to turn them away. Jan Leksich, owner of the Victoria Resort Bed & Breakfast in South Haven, Michigan initially planned to set aside one room at the inn for a veteran. “The calls kept coming. I booked five of my nine rooms for veterans. It’s a big chunk out of my inventory but what can I say? I have a soft spot." Leksich’s father was a veteran, as is her best friend’s husband. “I feel it’s the least that I can do,” she said. The Victoria Resort B&B is now offering vets that missed the free room a buy-one-get one night free the following week Sunday through Thursday. (For more info on the Victoria Resort B&B, click here.)

At the White Cedar Inn in Freeport, Maine, innkeepers Monica Kissane and Rock Nadeau have donated all of their rooms to the cause, and then went a step further and called local restaurants trying to get their soon-to-stay vets some complimentary meals. “We approached some restaurants and three said they would foot the bill for the service person’s dinner,” said Monica. Now Azure Café, Jameson Tavern, and Grittys Brew Pub are pitching in on this wonderful effort too.  (For more info on the White Cedar Inn, click here.)

“We’re over here trying to make a living and they’re over there fighting for our freedom, trying to take care of us. When our veterans need a break Jameson Tavern wants to be able to help out,” explained dining room manager, Carol Brown, who took the call from Monica weeks ago.

An update on MyMilitaryMommy.com alerted Tricia Knack to the promotion. She and her husband Tyler, an inspector general with the Air Force scheduled to deplane in Baghdad in January, are planning a visit to theTimmermann House Bed and Breakfast in Aviston, Illinois. When Sandy Timmermann first got the call she took the reservation but felt she needed to do more. “I immediately called the massage therapist that comes here to do massages for our guests, who jumped at the chance to participate with complimentary massages… then I called Popeye’s Chop House and spoke with the owner, he’s a vet too. The restaurant will offer its food buy-one at full price and the second at half price,” she said. The women who sell jewelry at the inn told Sandy to make sure Tricia chooses something she likes.

Masseuse Donna Rhoads who frequents the Timmermann House said the cause really hits home. “I have a son in San Antonio and he’s sixth generation Army. When Sandy called me out of the blue it just seemed like the right thing to do. For me it’s you give and God gives back. These people suffered and their families sacrificed everything and I think they deserve it,” said Donna, who is offering two-hour massages to both Tricia and Tyler. (For more info on the Timmermann House, click here.)

And though the promotion really lasts for a day, many inns have incorporated special discounts to service men and women throughout the year. For more information on military specials visit the Salute Our Heroes specials page on BnBFinder.com, linked here.

For a full list of inns participating in the bnbsforvets program visit http://www.bnbsforvets.org.

For more information on Veteran’s Day specials or bed and breakfasts for military personnel, visit BnBFinder.com or contact Maria Coder at 212.480.0414 x 16 or email [email protected] . And tell them Healing Combat Trauma sent you! :-)

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About BnBFinder.com
BnBFinder.com is a comprehensive online bed and breakfast directory, providing site visitors with more than 130 search categories, including availability, price, location, and local attractions. Founded in 1998, BnBFinder.com was the first directory to offer advanced interactive technologies, including RSS feeds, a blog, downloadable content for mobile devices, and guest reviews. BnBFinder.com is a 5-Star Rated directory with thousands of B&Bs, inns, and small hotel listings from all over the world.

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

Bed and Breakfasts "Salute our Heroes" on November 10th

What are you and your significant other doing on November 10th? Here's an idea from the mailbag, today -- and certain gracious bed and breakfast owners across America:

"Hundreds of bed and breakfasts across the country are teaming up to offer a free night’s stay to veterans on Wednesday, November 10th, the night before Veteran's Day. Men and women currently serving or those who have previously served our country are eligible for a complimentary stay at a participating inn.

The program, started in 2009 by the West Virginia B&B Association has grown to include over 40 states and more than 600 inns. For a full list of participating bed and breakfasts visit www.bnbsforvets.org. The only requirement for these rooms is a valid military identification. Veterans can obtain an I.D. from the Veterans Administration.

Innkeepers’ appreciation for our men and women in uniform continues year round and packages honoring our heroes can be found by clicking here.  For example, the Andon-Reid Inn Bed and Breakfast in Waynesville, North Carolina has created a special promotion where two active military couples in need of a special getaway may send an email or letter and qualify to win an all-inclusive two day getaway (Sunday-Thursday, non-holiday) starting mid-March. The stay includes signature candlelit breakfasts, snacks throughout both days, and free use of the inn’s fitness studio and sauna, among other perks. All letters from interested participants must be received no later than February 1, 2011. One letter per person is allowed. (For more details visit Andon-Reid, linked here.)

• Andon-Reid is participating in the free night’s stay this November as well but the inn is now fully booked. In the meantime, BnBFinder.com has put together a sampling of inns that, at press time, still had availability for a free night for military service people on November 10^th:
• The Candlelite Inn in the heart of the scenic Lake Sunapee Region is offering a free night’s stay to men and women with heart – aka veterans and active military personnel. Located in historic Bradford, New Hampshire this Victorian inn features a parlor with a cozy fire, games, and complimentary apple cider. It’s also minutes to major ski areas, restaurants, and seasonal outdoor activities. The inn serves a full three-course breakfast daily, including homemade dessert, jellies and jams, and freshly baked muffins and pies. 
• The Huffman House at Creekside Farm in Newport, Virginia is offering a free night stay for active and retired military personnel to show its appreciation. The Huffman property features three historic buildings, including the inn, an early nineteenth century barn and a farmhouse built in the 1800s, which was remodeled in 1906. The inn, listed on the national register of historic places, is still a working farm. It sits on 61-acres of streams, ponds, and pastures, with abundant wildlife. Despite its old time appeal, Huffman is minutes from downtown Blacksburg and modern day conveniences.

For more inns participating in the B&Bs for vets program and those offering special deals, discounts, and add-ons for uniformed heroes visit the BnBFinder.com "Salute our Heroes" page, linked here. 

Editor's note: For a full list of which B&Bs are participating, and their vacancy status, by state, click here.

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

When Is PTSD NOT PTSD? When Stubborn Pride Takes Control

Editor's note: We're not giving you medical or psychological advice here; consult with your own health care practitioner for that. What we are doing is sharing a longtime PTSD sufferer's opinion with you about his own situation, on the off-chance that it may instruct or enlighten. We have the feeling, now that he's outed himself, others may quite enjoy learning the distinctions he shares from his own life. And when we say "others," we mean spouses, significant others and family members...

From the subject of "Eyewitness to Combat," a Vietnam vet, Marine, with 40 years of "experience" on the subject:

"Post-Traumatic Stress Disorder has many faces and it sometimes masquerades as a behavioral problem; conversely, there are times when behavioral abnormalities masquerade as PTSD.  In other words, sometimes PTSD is mistaken for just stubborn Pride; and sometimes stubborn Pride is excused as PTSD.  There is also a third face, the one in which we appear completely “Normal.” So the “trick” becomes knowing which one is in control – the PTSD one; the PRIDEFUL one; or the NORMAL one. 

One of the most frustrating and difficult problems in sorting this out with traumatized MST or PTSD combat vets is that by their very nature, MST and PTSD sufferers are very complicated individuals, to say the least. It’s almost as if we are different people at different times.  And in fact we are.  My wife used to say she “never knew which one” of me “was coming home.” In other words: “PTSD really screws us up: mentally, emotionally, socially, personally, professionally and physically”.  However on many of the occasions that get blamed on PTSD, it is in fact our own personality “quirks” that have intervened, kidnapped and magnified the suffering from PTSD. And in the healing process, this habitual behavior must be sorted out before any true healing can “stick.” It’s true that we can be healed from our PTSD “disorder” but also allow our pride, habitual bad habits and negative attitude to completely mask any real improvement.

I do know that true healing from the destructiveness of PTSD is possible and real. I know this because I lived with all three faces of it for forty years and I have been healed.  Not “cured” but healed to a point that I now have a mostly “normal” a life rather than a mostly PTSD, prideful, bad habit and negative attitude life.  From this very long journey to healing I am able to speak from wisdom and experience on behavioral abnormalities disguised as PTSD.  I have been there; done that; and, for the most part, “have gotten away clean with it.” Now looking back, I am embarrassed and ashamed of myself for falling into the “pity party” that “works for me” trap.  I allowed myself to become “victimized,” believing that I was “entitled” to feel sorry for myself and that everyone else should feel sorry for me as well.  My PTSD actually made me feel “special” as everyone was made to “tiptoe” around me like a king walking among his subjects, so as not to “set me off”.  Trust me when I say that “this gets very old very quick” to those who love you, care for and about you; and it should be of no surprise when they begin to get a little bitter and non-empathetic toward our behavior.  It just gets tiring!  Upon entering the 90 day VA in-house PTSD treatment program years ago, I came face-to-face with a sign over the door of our billet, made by one of the previous vet therapists, that said: “How long would YOU put up with YOU?!  Well, not very damn long, I can tell you that – and that sign made the point for all of us.  So why should we expect others to do so?!  And if that’s true, why do we resist healing? Suffering from PTSD for most of my life made me very familiar with all of its symptoms and destructive consequences, along with what it does to our own physical body.  I am well aware of how devastating it is upon the family, friends and employers of those suffering from this disorder.  Today though, when I’m substantially healed, (see “before and after” story, linked here) I find that I can still act like a full blown PTSD’er.  The only difference is that now it’s my choice when to move into that arena, or not.  As my youngest grown son would say, “I’m going with NOT!”.  So in going there now it’s a premeditated decision to do so, not one dictated by PTSD. It’s premeditated because I first think about it, usually when my feelings get hurt, and then I stop taking my meds, as in “I’ll show them”, followed by then I stop doing what I know to do to keep me grounded and clear of stress such as EFT or Qi Gong.  Then I isolate myself in my all-too-familiar bunker, and “Away I go!” But this time it’s stubborn, God-damned pride that is pushing my behavior and keeping it in play, NOT PTSD. It might look like PTSD, sound like PTSD, feel like PTSD – and I am enjoying the effects. My world is now totally miserable, and I am glad – because I am back in control! The poet John Dryden put the sequence this way, “We first make our habits, and then our habits make us”.  Relinquishing control to our Prideful self is a habit we simply cannot afford if we suffer from PTSD.  It will destroy us and everyone around us. Again, if it is so miserable and so devastating, why stay in it? They “why” is PRIDE: Stubborn God-dammed, destructive PRIDE, a shitty attitude and very bad habits.  How does this fit into having PTSD?  It doesn’t fit into HAVING PTSD at all, but it DOES fit into KEEPING it!  And why would we want to KEEP Post-Traumatic Stress Disorder going, when we have the tools to get rid of it? Because it’s comfortable; it’s normal to us; it gives us control whenever we want; it gives us an excuse for bad behavior; it gives us an identity; it’s amusing to “shock” others; it draws attention to us; we don’t have to follow the rules and get a pass for doing so; it gets us “stuff”; it makes us somebody special and we can even be “paid” to have it.   And if you are getting “paid” to have it, it makes you a professional PTSD’er.  Sooooo why not act like one and let the spouse go to work; you get paid not to! You can sit on the couch and own the friggin’ remote and when you want to watch something cool you can clear the room and get a beer delivered to you in the process.  All the while someone can give you the beer, the TV and the couch.  I also know this to be true because I have spent up to a month terrorizing everyone in my life with my fucking PRIDE disguised as PTSD.  And I enjoyed the whole experience! But eventually even my pride got to a point that I couldn’t stand it anymore.  I allowed myself to be ashamed of this childish behavior and to apologize and ask for forgiveness so that I could come out of the corner.  NOW I really am ashamed of myself because I hurt those I loved and they didn’t deserve it at all.  But now I know what it is and will not go there again. (Publishing this handy little guide to PTSD vs. PRIDE of course will help!) I’ll use the tools I have been given in healing and use them gladly.  I do not want my loved ones to suffer the fool that I could become.  Scripture puts it this way in 1 Corinthians 13:11: “When I was a child, I talked like a child; I thought like a child; I reasoned like a child. When I became a man, I put childish ways behind me”.  In other words “it’s time we grow up!” Understand I am NOT talking about what “reaction” PTSD compels us to do that is destructive.  What I am talking about is what keeps us continuing the destructive behavior AFTER our PTSD moment has PASSED.  The fact that we suffer from a trauma-induced survival skill does not make us “crazy” or “insane” or incapable of being aware of our surrounding and how our actions affect others.  We still have the ability to know right from wrong and we know when we hurt others and we know when we hurt ourselves.  PTSD also doesn’t change our “moral code”.  If you were a nice person before; you are generally still a nice person and that becomes your “Normal” face.  If you were a courteous person before; you are generally still a courteous person and “Normal”.  If you were a grateful person before; you are generally still a “Normally” grateful person.  If we are truly remorseful for our actions which harm others, as we should be when we are “Normal”, then the abnormal behavior will stop until triggered again. And in our “Normal” state we are ashamed, embarrassed and truly sorry.  If we are not at least remorseful and/or our misbehavior is enjoyable, then we are either a narcissistic “asshole” or we are pretending to continually have PTSD behavior for control and that is our “Prideful” face.  If we are ashamed, embarrassed and sorry but continue in bad behavior, then we are stubborn “Prideful” fools using the ole, “That’s my story and I’m stickin to it” crap.  It will lead to your destruction and that of your family.  And PRIDE becomes the driving force, not PTSD, and the NORMAL face is destroyed.    That was PTSD.  But then I would get embarrassed and mad when “corrected” and take the Prideful mental position of: “Well I sure fucked that one up; so screw them all” and I would then “dig my heels in” and really make everyone miserable.  And I enjoyed it.  I was “showing them” for getting justifiably upset at me for my action.  That was PRIDE.  “They would learn to leave me alone whenever I would go into one of my “Marine Corps Moods”, as my kids would call it.  Yep, goddamn Marine Corps PRIDE!  (In truth, I have three kinds of pride: Texas pride! Irish pride! And Marine Corps pride! And that is a whole giant bucket of PRIDE…) Understand that I DID have severe PTSD and those triggering events happened a bunch but the moment I realized I had screwed up, PTSD ended and PRIDE took over to magnify the damage.  I was too proud to admit that I was wrong and then ask for forgiveness or even to say I was sorry.  For a Marine to apologize was a “sign of weakness”.  To take this action with those who love you only adds INSULT to INJURY.  However for a father, a husband, a son, a partner, to apologize is essential and your “Normal” self and is a great sign of love, appreciation, humility, strength, self-confidence and courage. When scripture states that “the meek shall inherit the earth,” it is not talking about the weak but the gracious, strong, self-confidently humble who attempt to right the wrongs they have done to others. Our families and loved ones know when that moment of awareness happens, and they appreciate it and respond to it, but conversely, with no remorse on our part they start to lose empathy for our plight, and rightfully so.  If our prideful attitude and bad behavior keeps up, they become aloof, distant, uncaring and bitter – and here’s the thing, we’ve helped to make them that way through our actions. PTSD is what causes the hyper-vigilance and other survival reactions triggered by events in our lives, but PRIDE is what causes us to stay in the now habitual act of PTSD.  True healing can only come when we understand that we will have the tendency to move into survival mode for the rest of our lives and that there are things we can do to effectuate a smooth, peaceful, happy life.  AND it is essential that we do those things consistently for the rest of our lives. (Examples would be taking our medication, and using the tools we can do at home for our own self-care, such as meditation, deep breathing, qi gong, EFT, music therapy, aromatherapy, etc. -- and knowing when it's PRIDE that's taken control!) We also must learn to be grateful to those around us who put up with our “moments” and have enough respect for them to swallow our pride and say we are sorry and mean it; then sincerely ask for forgiveness in love.  If you are unwilling to do this, then you are not ready to be healed because you are enjoying being miserable and making others miserable too much.  And I really feel sorry for you.  When we realize we have just had one of those “moments”; STOP, regain your composure, look around at what you have effectuated and apologize and mean it.  But if you do nothing else, just STOP and go to your corner.  When you have calmed down, then correct it before PRIDE takes control and kills everyone around you or before it forces you back into the “bunker”.  Your families know when you are faking PTSD and when it is real; so grow up and get your shit together."Pride goeth before destruction, and a haughty spirit before a fall.” Proverbs 16:18. Even with PTSD!"

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

 

Sometimes You Have to Choose to Love -- A Love Story after PTSD

Into the dearth of "good news" about combat veterans with PTSD and their partners comes the remarkable love story of Josh and Helen, who met and fell in love AFTER his service, his suicide attempts, and his PTSD diagnosis. While PTSD can seem like the "third partner" in a relationship -- the ever-present elephant in the room -- in Josh and Helen's story, it's what brought them together, and love, wisdom and maturity is what keeps their union intact.

I had the pleasure of getting to spend a few days recently with Josh and Helen, and was impressed by both of them, and the sheer fun of their relationship, which can be too rare among partners where one has PTSD. I was struck by Helen's clear-eyed, open-hearted approach -- the education she sought about PTSD, as she was falling in love with Josh -- and the way in which she's really becoming a wise "spokesperson" for how love is possible after PTSD. For all the broken relationships out there, and all the partners barely enduring and tolerating one another, I felt like Josh and Helen's story needed to be told, so I asked Helen to tell it. Just as a point of reference, Josh served in the U.S. Army from 2002 to 2008. He was honorably discharged in 2008, and served in Iraq from 2005 to 2006.

Here is Helen's story:

"I met my husband Josh on December 27th, 2008. That's about two years after he returned from Iraq and about two months after he tried to commit suicide for the second time. He was at my house attending an after-Christmas-before-New-Years party that my then roommate Chris was throwing, and he was there against the medical advice and wishes of the team of specialists overseeing his psychiatric care at a well-known men's inpatient program for PTSD.

He was home for the weekend to visit his family and in order to do so he was required to fill out a schedule of where he'd be, what he'd be doing, and with whom. If they'd known he'd be at that party, they more than likely wouldn't have let him go home. And if they knew he'd meet me, they'd probably have chained him to the wall. Of course I don't know that for certain because it's not the way things happened. He did come to the party, I was there even though I had other tentative plans that night, and we did meet each other.

Josh told me later that he wasn't looking for anything other than to feel normal for a few hours. He hadn't really expected to feel comfortable at all and certainly had no intention of telling me that he had PTSD. Again, not the way things happened. He started by telling me that he was a soldier which really intrigued me. In my head I can't help but equate military service with nobility, honor, and authority, probably because the only other people I knew that had been in the military were my grandfather -- who had served in the Navy in World War II -- and a family friend who took unfair advantage of my googly eyes at the tender age of 15, later dubbed "evil Army guy" though I never really associated the service with the man.

I had heard of PTSD and sort of knew what the letters in the acronym stood for. It was a pretty basic concept; formerly known as "shell shock" which Great Uncle Paul, Grandpa's brother had. I remember thinking when it became apparent that Josh and I were going to have a relationship that I should probably be concerned, but I wasn't. I don't know why. I had also heard that men with PTSD could be violent and do harm to the people they most loved. But then again, so can most of the people I know. I knew I'd have to educate myself on what exactly PTSD is, a fact that was compounded when I came up against some opposition from a friend of mine who thought Josh would kill me and then take his own life. She thought this because a friend of her grandmother's had been murdered by her husband, a veteran of either Korea or WWII. I started with the basics (the basics being the extraordinarily reliable source of Wikipedia....you can't tell, but that was written in a sarcastic voice) which actually gave me a pretty decent base.

From there I moved on to other sources including the VA, National Institutes of Mental Health, and last but not least, Josh's therapist. Josh took me to see him because, he said, "I want you to know what you're getting into". Among other things, what I learned was that, aside from the fact that Josh's PTSD was focused inwardly and therefore he wouldn't hurt me, he was being monitored by so many mental health professionals as well as regulating himself that he was the least likely person in the world to do so.

We got lucky. One of the most interesting things I learned was that PTSD is, for lack of a better word, normal. When a person is placed in an extremely traumatic and/or stressful environment, their mind enacts hyper-vigilance, paranoia, insomnia, etc. to enable survival. In a war zone, PTSD is useful. It's when the soldier comes home in time of peace that there are problems. Actually, many people with PTSD have it because of domestic violence. Some people get it from car accidents. The list goes on.What Josh told me really helped him was that I didn't push. When he told me about Iraq, I didn't launch questions at him that he probably wouldn't want to answer. I waited. I focused on him as best I could, I listened carefully.

Eventually he opened up to me, but the fact that I fostered an environment where he felt safe to talk about it, without judgment, without questions, without a sense of urgency helped him immensely. Communication is not our weak point because both of us took a chance at being safe with one another. At first it was scary, but it was completely worth it. One of the most important lessons I've ever learned thus far is that sometimes you have to choose to love. I took on the attitude (I was newly in love so it wasn't too hard for me...plus he's awesome) that he was (and is!) the most incredible, sexy, wonderful, manly man on Earth. I tell him frequently that he is an excellent provider, that he takes good care of his family, that he satisfies my basest urges (*giggle*), that I choose him and marry him every day and will have only him for the rest of my life, and most importantly that I love him so much and love him for who he is. I mean every syllable of it, it's completely true, and I stand by my bold statements and declarations. My heart melts every time because I see him sheepishly look down or puff his chest out, or I notice that he's walking just a little bit taller. He loves it, and his life is made easier and he is made happier knowing that I adore him and that I'm there for him (and he responds in kind).

This is not to say that it's always a cake walk. It isn't. Marriage is hard enough work without mental illness in the mix. His anxiety will act up, he'll get scared, he'll feel depressed and useless and insecure and jeez, we haven't even gone in to MY issues. But he knows that I'm always there for him. We made the conscious decision to put in the effort to speak, to care, to look out for one another, and to work through our arguments and disagreements. Sometimes that is damned hard. But in the end, loving him is easy because of it.

I know that our relationship is different than many other spouse-vet relationships for a variety of reasons. First, I met Josh after he came home from Iraq, after his suicide attempts, after he started treatment for PTSD. I never had to wait for him, never had to live away from him during deployment, never had to worry that the phone would ring or I'd get a knock on the door. I didn't have children to be both mother and father to while he was away, never had to experience my husband being a different man now than he was when he left me. I don't pretend to know what that must have been like.

But if there's anything that I can offer, anything that WE can offer, it's that there is hope. Josh was convinced once that the only good thing he could do was destroy himself; get rid of the burden. Find peace in death, in drinking, in drugs, ANYTHING. He had a plan in place to move to Seattle with just some basic gear with which to live on the streets, and he chose Seattle because their Department of Public Health has a clean needle exchange program. Almost two years later, he's married with a loving wife, a service dog who needs him, two cats who love to annoy him, a sound support system, and more and more he is learning that he's not alone. I am, and by choice always will be, his biggest fan, his cheering section, his advocate, his confidante, and his partner. As his wife, my job, my goal, my honor, my privilege and my pleasure is make sure he never feels otherwise."

Editor's note: The photo of Josh and Helen is used with their permission.

Quotable Quotes -- A Spouse's View on How War Changes the Veteran

We wrote about Vietnam veteran, Marine and National Book Award-winning author and poet Larry Heinemann yesterday, and his quote about "War and the Veteran's Heart," linked here. And we've certainly written quite a bit -- as in very often -- about the spouse or partner's point of view, of living with the combat veteran with PTSD. Those articles are linked here. Today we bring those both together, with an excerpt from Larry Heinemann's wife, Edie, about how war and combat changed him. We're sure that many spouses and family members can relate. From a long article about his writing:

"They met at a college dance almost 26 years ago, six months before Heinemann left Fort Knox, Kentucky, for Vietnam. Edie Smith, from Long Island, New York, was doing her undergraduate work at Nazareth College in nearby Bardstown. "He was a clown, very funny and very easygoing," Edie says. "He told some good stories, about his family, about his grandfather." Edie Heinemann says everything about her husband Larry, including his complicated relationships with women, his moods, his present sense of humor, and why he became a writer, was forged by Vietnam.

 "I don't think I've ever told this to anybody on the record, but I married a completely different man than the one I met. Larry had a warmth, a genuineness, a humor about him, even a naivete that was completely stripped away when he was in Vietnam. When he came home all I saw was the bitterness and the edge and the distance. For so long he held so much of this inside, and I don't think I ever fully realized how much pivoted on his experiences in Vietnam. Only recently, with the work he's done, the writing and the other things, has he begun to shed what happened to him, revealing more humor and everything else that was taken away in Vietnam."

Source: "Heinemann's New Style," by Patrick Z. McGavin in the Chicago Reader, (date unknown, but possibly July 23, 1992), linked here.

The PTSD Veteran Parent or Spouse: Occasionally Disconnected at the Source

Gayook Wong, who writes about PTSD occasionally in her own blog, focused on Qi Gong -- which we've written about, here -- talks about the disconnect she regularly experiences with her own children, because of her own longtime PTSD. The scenario she describes should be very familiar to spouses, significant others and family members of those with PTSD.

She writes:

"I have suffered from PTSD since I was a child, even though I never knew what it was. I couldn’t understand why I had so many nightmares, why awful moments of terror would suddenly come upon me accompanied by dry sweats and rancid fear in the pit of my stomach. 

Many of my clients have expressed similar outrage at what they are going through. Some have even told me they felt were being punished, but didn’t know why.  When a survivor is enveloped in PTSD symptoms, he/she cannot even begin to consider anyone else. 

 When these symptoms come upon me, I am not my chronological age. I’ve stepped back into the past, where I feel terrorized all over again. I am no longer here. Unfortunately, my children feel most the brunt of my trauma. I am not the mother they know and trust.  I become a stranger to them. They have told me that they feel abandoned, that I don’t carry through what I’ve told them I would do. They have accused me of lying to them, that they can’t trust me, so they feel they have to take over the role as adults and figure things out in a crisis. 

 My children have told me many times over the years that when I have bouts of anger or periods of regressing back to a terrorized child, they feel absolutely helpless. They don’t know what to do to help me. Over time, this helplessness has turned into resentment. They don’t understand why I can’t just get over it -– it’s been so long. 

There are times, I’m sure, that they feel I’m using this to control them – which only adds to the resentment.It is only after some recovery that I am able to hear them, to see how my trauma has affected them. And, how the effects of the trauma gets yet passed onto the next generation. My children learned that, when I “space out”, as they label it, they have to be the adults. In many ways, this has happened since their childhood. As for me, I just want them to understand that the symptoms appear sometimes out of nowhere, and I feel like I’m defenseless, that no one and nothing can help me. But, of course, they don’t. And, logically, I can’t expect them to. 

I want them to understand that it’s not something that I want to have happen, that I feel like I’m going to die in there.  I really make an effort to return to the present moment. Some times are easier than others. It depends on what gets triggered. Even as I am learning more about PTSD and how these symptoms have defined my and the lives of so many others, the labeling of my periodic states  brings up another scare for my children, my daughter especially. She reacts angrily when I label myself. She is afraid that the label gives me more reasons not to heal, that I am using the symptoms to control.   

However, for me, understanding  what has been happening to me all these years and why,  has helped me to name the symptoms faster. Once I name them, I am able to come out of it much quicker.  And, the quicker I can come out, the less adverse affect it will have on my family and friends."

She also recommends counseling:

"Close family members, especially if they are caregivers, need to also have a support system,. Find others who are undergoing similar circumstances. It helps to know that you’re not alone. I strongly urge counseling to families, either together and/or individually. When tragedy befalls one family member, there is no way that others will not also be affected. My family and I have all gone through counseling through the years, together and individually. Now, they know what’s happening to me, we have a code that helps me to come back into the present moment. This helps me to recognize what’s happening to me. And, even better, my children don’t feel as powerless because they are part of the solution."

Gayook Wong makes so many good points in this post. Most of all, she is doing a good job of describing the disconnect that PTSD can connect, the unreachability of the sufferer when he or she is in the throes of their symptoms. Afterwards, of course, things can improve, but sometimes too the damage has been done. The "not being able to consider anyone else" truly takes its toll on friends and loved ones. Others may come to regard the sufferer warily, and the sufferer himself or herself wonders if they can be trusted again, when there are no guarantees.

While few programs offer resources for family members of veterans suffering from PTSD, some do. Check out the Vet Centers in your geographical area, and also The Soldiers Project, which offers free, confidential counseling to family members as well as veterans.

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."

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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.

Going to the Bunker: A Combat Veteran with PTSD on the Purpose of Protective Isolation

Every combat veteran with PTSD knows what is meant by their "bunker," or what "going to their bunker" means. It's a walled-off, isolated situation that allows them to get some space to themselves, away from other people (including family and friends), when they feel particularly triggered, and they need to stay in there for, well, as long as they're going to. They come out when they're ready, and not a moment before. Obviously this situation can be very frustrating to others in the vet's life, but for the vet it affords him or her some very necessary, protective isolation.

The rest of us who aren't combat vets with PTSD I suppose could think of it as the vet putting himself or herself in a time-out from the world, by taking themselves out of the mix, and away from people and stimulation, both bad and good. And the time-out will be over when it's over, because they decide when it's up.

The recent Fourth of July with its fireworks that remind many vets of combat was a classic bunker situation. Many, many vets were making plans before the Fourth for how to protect and insulate themselves from being triggered by the fireworks (noise, smoke, crowds). One Gulf War vet with PTSD who had already isolated himself, wrote of putting a pillow over his head and just wanting it to be over, so that he didn't have to experience it. The next day, fireworks all exploded, he was better. But during, he had to be in the bunker. Another combat vet with PTSD, from the Iraq war this time, talked about staying in her bunker for days, making brief provision runs, every fourth day or so, to the grocery store and then...back to her bunker. When she needed to be in her bunker...

The bunker concept/construct is so typical to combat vets with PTSD that I thought I'd ask one who I know fairly well how he'd describe it. He has decades of PTSD "experience" under his belt, and I've also seen him retreat to his bunker at various times. A month one time, a week another time, the last time, a day. Sometimes even a few hours. But however long the episode lasts, during that time: totally unreachable. And realistically, you better not even try...because it just makes the situation worse. 

The more chances I've had to experience this with him, the more certain I can be that, short time or long, he'll emerge from his bunker, when he's good and ready, and with a new and improved outlook on why he went in the bunker in the first place. (For those who don't know, the bunker can be anywhere...a shed, a garage, a spot in the woods, a room in a house, even a chair. But it's sacred, inviolate, untouchable space...and the vet goes there in retreat, partly to spare those around him, but also strongly to get control over what he's feeling. (He or she, obviously.) So I figured he'd be able to offer his personal/expert advice on this.

Here's how the conversation went.

Me: "What typically sends vets to their bunkers?"

Him: "Any situation -– losing a job, losing their cool, a fight with their kid -- that makes them lose control sends them back to their bunker, so they can regain control. It may not be much, but while they're there, at least they have control over that little room they're in."

Me: "What's the longest time you've ever spent in your bunker?"

Him: "A year."

Me:  "!!!"

And then he clarified. (Remember, this is just his opinion, but it's worth sharing, because of the number of vets he knows and has observed, as well as what he knows about himself.) "Each time a vet goes into their bunker, they go in for a longer period of time. Until one time they go in and they don’t come out." (He does know an awful lot of other vets who have sadly killed themselves. That happens in bunkers, too. No wonder families and friends are justifiably concerned.)

The progression he just mentioned...vets spending longer and longer times each time in their bunkers...is actually the opposite of what he's been doing, since I've known him (which coincides with his getting better). Each time he goes to his bunker, it's both less frequent, and for shorter and shorter times each time, to the point that the last "bunker" episode I observed him in was actually only about half an hour.

In the middle of a frustrating conversation, not quite an argument, but one where emotions were high and we weren't communicating smoothly, he "withdrew" to his bunker of self-enclosed, protective space -- without moving from the couch he'd been sitting on. I saw him cross his arms, very agitated, close his eyes, and start doing something that looked like huffing and puffing. Even on an animal instinct level I knew, give this person his space. All the body language was daggers. I stepped away, and a short while later, he bounced back, and resumed where things left off, able to manage the conflict without any undue strain. Turns out what he'd been doing during the huffing and puffing phase was actually deep breathing, to calm himself down and regain control. Very smart. On the outside, he looked furious. On the inside, he was doing what he could to get back under control. As a result, he was able to "emerge" from his bunker in record time -- which speaks to the tremendous benefits of learning coping skills and stress-reduction techniques, as he has.

When I first knew this vet, he talked about what he'd learned at an inpatient PTSD program at the VA years ago. It was the cutting-edge program at the time, and he speaks of it with great appreciation, even though many of the guys he went through the program with sadly did not make it. ("Did not make it" is euphemistic code for "sadly, later killed themselves.") One of the biggest things he learned in the program, according to him, was about "red flags" and "triggers," and how to get away before you make things worse. Heading for the bunker, just like in the description of the vet with the pillow over his head,  is one way to keep things from getting worse. For the vet, that is -- for the family or loved ones, it's very difficult to experience, and hard to ignore, though one of the secrets seems to be, going on with your own life, while maintaining a compassionate (but not nagging) concern for how they're doing.

One of the distinctions he likes to make, though, between what he learned from the behavioral modification skills, above, in the VA program, and what he's learned since then, following more of a healing path, is that now he has some ability to not just "avoid" triggers but also "deal with" situations as they come up. The red flags still show that the problem is coming, but instead of being ONLY triggered, there are now new ways to deal with it that don't only involve avoiding or isolating.

The situation above, of being in conflict but being able to "be" with it, and breathe through it, meant that the conflict didn't have to explode into a multi-day saga or a physical exit to an actual bunker, which could last for weeks or months -- or even a year(!) Ahhh, progress is a beautiful thing...

Editor's note: For Part II, "Busting Out of the Bunker at Last," go here.

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

Too Long a Sacrifice Can Make a Stone of the Heart: The Tao of Self-Care

"Too long a sacrifice can make a stone of the heart," wrote Irish poet William Butler Yeats. He wasn't necessarily a caregiver to anyone, like a veteran, with PTSD -- but he sure seems to understand the predicament. 

The "365 Tao" book that I'm so fond of -- what's not to love about an item at Amazon that has 65 ratings, and they're ALL five stars?! -- had a wonderful item today about how caring for another appropriately is wonderful, but that there is "too much" of a good thing, and it can backfire terribly on the caregiver. Read what it says:

CARING

"Don't go out looking for good deeds to do

But if one comes your way, do not refuse.

If you meet someone who is suffering, you must help them."

And then, importantly:

"Those who follow Tao believe in using sixteen attributes on behalf of others : mercy, gentleness, patience, nonattachment, control, skill, joy, spiritual love, humility, reflection, restfulness, seriousness, effort, controlled emotion, magnanimity, and concentration. Whenever you need to help another, draw upon these qualities. Notice that self-sacrifice is not included in this list. You do not need to destroy yourself to help another. Your overall obligation is to complete your own journey along your personal Tao. As long as you can offer solace to others on your same path, you have done the best that you can."

It's so crucial to note what the author says about "notice that self-sacrifice is not included in this list." (And, previously, that non-attachment was.) So many people on this path or journey, trying to help vets with PTSD, in their own families, their brothers and sisters they served with, etc., are bound to follow the completely self-sacrificing path. We understand that impulse...but see where it leads? It leads to personal disaster. Please take better care of yourself than that. It's not necessary to give your complete and entire all to do your best, to give your best. There has to be a "you" left at the end of the day, or the night. Please find and treasure that self...and don't let it be destroyed, even in the guise of being...the care-giver. 

What can you do for yourself today to improve your health and stress level? What nurtures you and gives you peace of mind? Is it exercise, spending time with friends, having alone time -- what is it? There are many things you can do for yourself that are inexpensive and take good care of you. Please make a list for yourself of what those are, and find a way to bring them back into your life. It will make a world of difference. Some of the very same recommendations or suggestions for veterans with PTSD are ones you might like yourself. A simple exercise like Qi Gong, which creates a feeling of being "relaxed, balanced and energized" -- is just one example of positive self-care, and there are many others.

At the opposite extreme, of not taking care of yourself, what can we guess happens with too long a sacrifice, for others, no matter how worthy, needy or deserving? According to the poet, it can "make a stone of the heart." And following this along...what happens to a stone heart? It shatters and breaks. Keep a soft heart...take care of yourself first...so you can continue to care for others. Not instead of yourself. Importantly, after yourself. So that you can give the best care of all...and not be depleted, broken or crushed. 

Military Spouses and Families -- Resource List of Books and Articles

In honor of today being "Military Spouse Appreciation Day" -- hey, shouldn't that be all year long, given what they do?! -- here's a really stupendously great bibliography of books and articles relating to military families, spouses and children and all the various issues they can encounter in the mental health/social work realm.

Unfortunately, I don't remember where I found it on the Web back in February of this year, so I can't credit it appropriately. (And I've Googled it a bunch of different ways to find it again, but with no luck.) Like every bibliography, there are possible additions, subtractions and revisions -- but "as is, where is," it's a tremendous resource of information for finding out more about these very important subjects.

REFERENCE LIST: Military Families 

Children

Barker, L. H. and K. D. Berry (2009). "Developmental Issues Impacting Military Families With Young Children During Single and Multiple Deployments." Military Medicine 174: 1033-1040.

Barnes, V. A., H. Davis, et al. (2007). "Perceived stress, heart rate, and blood pressure among adolescents with family members deployed in Operation Iraqi Freedom." Mil Med 172(1): 40-3.

Brom, D., R. Pat-Horenczyk, et al., Eds. (2009). Treating Traumatized Children: Risk, Resilience and Recovery Taylor & Francis, Inc.

Chandra, A., S. Lara-Cinisomo, et al. (2010). "Children on the Homefront: The Experience of Children           From Military Families." Pediatrics 125(1).

Chandra, A., L. T. Martin, et al. (2009). "The Impact of Parental Deployment on Child Social and      Emotional Functioning: Perspectives of School Staff." Journal of Adolescent Health In Press,         Corrected Proof.

Chandra, A., R. M. Burns, et al. (2008). Understanding the Impact of Deployment on Children and    Families: Findings from a Pilot Study of Operation Purple Camp Participants R. Corporation: 69.

Chartrand, M., D. A. Frank, et al. (2008). "Effect of parents' wartime deployment on the behavior of young children in military families." Arch Pediatr Adolesc Med. 162(11): 1009-1014.

Chartrand, M. and B. Siegel (2007). "At War in Iraq and Afghanistan: Children in US Military Families " Ambulatory Pediatrics 7(1): 1-2.

Cozza, S. and A. Lieberman (2007). "The young military child: Our modern telemachus " Zero to Three 27(July): 27-33.

Cozza, S. J., R. S. Chun, et al. (2005). "Military families and children during Operation Iraqi Freedom." Psychiatric Quarterly 76(4): 371-378.

Ender, M. G. (2006). Voices from the backseat: Demands of growing up in military families. Military Life: The Psychology of Serving in Peace and Combat, The Military Family. C. A. Castro, A. B. Adler and T. W. Britt. Westport, CT, Praeger Security International. 3: (pp. 138-166). viii, 262.

Flake, E. M., B. E. Davis, et al. (2009). "The Psychosocial Effects of Deployment on Military Children." Journal of Developmental and Behavioral Pediatrics 30(4): 271-278.

Fallon, M. A. and T. J. Russo (2003). "Adaptation to stress: An investigation into the lives of United States military families with a child who is disabled." Early Childhood Education Journal 30(3): 193-198.

Goodman, R. F. (2002). Caring for Kids After Trauma and Death: A Guide for Parents and Professionals. A. Gurian, The Institute for Trauma and Stress at The NYU Child Study Center: 57.

Hardaway, T. (2004). Treatment of psychological trauma in children of military families. Mass Trauma and Violence: Helping families and children cope. N. B. Webb. New York, NY, Guilford Press: 259-282.

Horton, D. (2007). The impact of deployment on children in military families, Horton, Denise: Walden U , US.

Houston, J. B., B. Pfefferbaum, et al. (2009). "Children of Deployed National Guard Troops: Perceptions       of Parental Deployment to Operation Iraqi Freedom." Psychiatric Annals 39(8): 805-811.

Huebner, A. J. and J. A. Mancini (2005). Adjustments Among Adolescents in Military Families When A           Parent is Deployed, Military Family Research Institute at Purdue University: 50.

Huebner, A. J., J. A. Mancini, et al. (2007). "Parental deployment and youth in military families: Exploring uncertainty and ambiguous loss." Family Relations 56(2): 112-122.

Hutchinson, J. W. (2006). "Evaluating risk-taking behaviors of youth in military families." Journal of Adolescent Health 39(6): 927-928.

Jensen, P. S., S. N. Xenakis, et al. (1991). "The "military family syndrome" revisited: "By the numbers."." Journal of Nervous and Mental Disease 179(2): 102-107.

Kelley, M. L. (1994). "The effects of military-induced separation on family factors and child behavior." American Journal of Orthopsychiatry 64(1): 103-111.

Kelley, M. L., Hock, E., Smith, K.M., Jarvis, M.S., Bonney, J.F., and Gaffney, M.A. (2001 ). "Internalizing and externalizing behavior of children with enlisted navy mothers experiencing military-induced separation." Journal of the American Academy of Child & Adolescent Psychiatry: 40(4): 464-471.

Lamberg, L. (2004). "When military parents are sent to war children left behind need ample support." JAMA: Journal of the American Medical Association 292(13): 1541-1542.

Lemmon, M. and L. Chartrand (2009). "Caring for America's Children: Military Youth in Time of War."          Pediatrics in Review 30(6): E42-E48.

Lincoln, A., E. Swift, et al. (2008). "Psychological adjustment and treatment of children and families with parents deployed in military combat." Journal of Clinical Psychology 64(8): 984-992.

Mmari, K., K. M. Roche, et al. (2009). "When a Parent Goes Off to War  Exploring the Issues Faced by Adolescents and Their Families." Youth & Society 40(4): 455-475

Morris, A. S. and T. R. Age (2009). "Adjustment among youth in military families: The protective roles of effortful control and maternal social support." Journal of Applied Developmental Psychology 30(6): 695-707.

Paden, L. B. and L. J. Pezor (1993). Uniforms and youth: The military child and his or her family. The Military Family in Peace and War F. W. Kaslow. New York, NY, Springer Publishing Co: 3-24.

Ryan-Wenger, N. A. (2001). "Impact of the threat of war on children in military families." American Journal of Orthopsychiatry 71(2): 236-244.

Warren, Z. E. (2006). Cognitive and behavioral development of at risk infants and toddlers exposed to stressful life events: The effects of trauma in early childhood, Warren, Zachary E : U Miami, US.

Wethington, H. R., R. A. Hahn, et al. (2008). "The Effectiveness of Interventions to Reduce Psychological Harm from Traumatic Events Among Children and Adolescents: A Systematic Review." American Journal of Preventive Medicine 35: 287-313.

 

Communities of Support

 

Huebner, A. J., J. A. Mancini, et al. (2009). "Shadowed by War: Building Community Capacity to Support Military Families." Family Relations 58(2): 216-228

Kudler, H. and K. Straits-Tröster (2009). "Partnering in Support of War Zone Veterans and Their      Families." Psychiatric Annals online 39(2): 64-70.

Levin, A. (2009). "Military Hopes Civilian Clinicians Can Shrink Treatment Gap." Psychiatry News August       21, 2009 44(16): 16.

 

Culture

 

Danieli, Y. (2007). Assessing trauma across cultures from a multigenerational  perspective. Cross-Cultural Assessment of Psychological Trauma and PTSD. J. P. a. T. Wilson, Catherine So-kum. New York, NY, Springer Science + Business Media. Part 1: . (pp. 65-89). xxvi, 405.

Harris, J. J. and N. G. Jones (2007). African-American military service members and their families: A different environment. Human Behavior in the Social Environment from an African-American Perspective. L. See, A. New York, NY, Haworth Press: (2007).  (2nd ed.). (pp. 133-150). xliii, 782.

Lowe, T. B., J. G. Hopps, et al. (2007). Stressors experienced by African-American armed service personnel during the Iraq War. [References]. Human behavior in the social environment from an African-American perspective. L. A. See. New York, NY, Haworth Press: 519-542.

Osterman, J. E. and J. T. V. M. de Jong (2007). Cultural issues and trauma. Handbook of PTSD: Science and Practice. M. J. Friedman, Keene, Terence M. and Resick, Patricia A. New York, NY, Guilford Press: pp. 425-446.

 

Death

 

Bonanno, G. A. (2004). "Loss, Trauma, and human resilience, Have we underestimated the human capacity to thrive after extremely aversive events?" American Psychologist 59(1): 20-28.

Goodman, R. F. (2002). Caring for Kids After Trauma and Death: A Guide for Parents and Professionals. A. Gurian, The Institute for Trauma and Stress at The NYU Child Study Center: 57.

Lieberman, A., N. Compton, et al. (2003). Losing a Parent to Death in the Early Years Zero To Three Press.

Network, N. C. T. S. (2008). "Traumatic Grief in Military Children." Traumatic Grief in Military Children: Information for Medical Providers, from http://www.nctsnet.org/nctsn_assets/pdfs/military_grief_medical.pdf.

Network, N. C. T. S. (2008). "Traumatic Grief in Military Children." Traumatic Grief in Military Children: Information for Families, from http://www.nctsnet.org/nctsn_assets/pdfs/Military_Grief_Families_final3.pdf.

Pearson, G. (2007). "Review of Military Widow: A Survival Guide." Perspectives in Psychiatric Care 43(1): 65.

Pfefferbaum, B., S. J. Nixon, et al. (1999). "Posttraumatic stress responses in bereaved children       after     the Oklahoma City bombing." Journal of the American Academy of Child and Adolescent         Psychiatry 38(11): 1372-1379.

Ronel, N., U. Lebel, et al. (2006). "When parents lay their children to rest: Between anger and forgiveness." Journal of Social and Personal Relationships 23(4): 507-522.

Stoppelbein, L. and L. Greening (2000). "Posttraumatic stress symptoms in parentally bereaved children       and adolescents." Journal of the American Academy of Child and Adolescent Psychiatry 39(9):           1112-1119.

Wright, K. M., L. M. Burrell, et al. (2006). Military Spouses: Coping with the Fear and the Reality of Service Member Injury and Death. [References]. Military life: The psychology of serving in peace and combat (Vol 3): The military family. C. A. Castro, A. B. Adler and T. W. Britt. Westport, CT, Praeger Security International: 64-90.

 

 

 

Deployment

 

Basham, K. (2009). "Commentary on the Keynote Lecture Presented by Dr. Jonathan Shay, Friday, June      27, 2008 titled <i>The Trials of Homecoming: Odysseus Returns from Iraq/Afghanistan</i>, and additional reflections." Smith College Studies in Social Work 79(3): 299-309.

Basham, K. (2008). "Homecoming as safe haven or the new front: Attachment and detachment in military couples." Clinical Social Work Journal 36(1): 83-96.

Bowling, U. B. and M. D. Sherman (2008). "Welcoming them home: Supporting service members and their families in navigating the tasks of reintegration." Professional Psychology: Research and Practice 39(4): 451-458.

Burton, D. L. (2009). "Commentary on the Reaction Panel in Response to the Keynote Lecture presented      by Col. Carl Castro and Dr. Mark Chapin titled <i>The Deployment Cycle: Expectations and     Implications</i>." Smith College Studies in Social Work 79(3): 283 - 285.

Garran, A. M. (2009). "Commentary on the Reaction Panel in Response to the Keynote Lecture presented     by Dr. Jonathan Shay titled <i>The Trials of Homecoming: Odysseus Returns from         Iraq/Afghanistan</i>." Smith College Studies in Social Work 79(3): 310 - 313.

Haas, D. M. and L. A. Pazdernik (2006). "A Cross-Sectional Survey of Stressors for Postpartum Women during Wartime in a Military Medical Facility." Military Medicine 171(10): 1020-1023.

Herzog, J. R. and R. B. Everson (2007). The crisis of parental deployment in military service. Play Therapy with Children in Crisis: Individual, Group, and Family Treatment N. B. Webb. New York, NY, Guilford Press: 228-248.

McFarlane, A. C. (2009). "Military deployment: the impact on children and family adjustment and the need for care." Current Opinion in Psychiatry 22(4): 369-373

Packman, J., T. Paone, et al. (2006). When a Parent Gets Deployed: Helping Military Families Deal With Stress. Compelling Perspectives on Counseling G. Walz, Bleur, J. and Yep, R. Alexandria, VA, American Counseling Association: 67-69.

Pawlowski, L. M. (2005). Coping with military deployment: The C.A.R.E.S. resource for couples, Pawlowski, Lisa M : Regent U , US.

Peebles-Kleiger, M. J. and J. H. Kleiger (1994). "Re-integration stress for Desert Storm families: Wartime deployments and family trauma." Journal of Traumatic Stress 7(2): 173-194.

Rand, H. and R. N. S. R. Division (2008). Post -Deployment Stress: What Families Should Know, What Families Can Do, Rand Health and Rand National Security Research Division.

Russell, D. and D. Hamilton (2008). Reunion and re-integration with the family after deployment. Proceedings of the 6th Rocky Mountain Region Disaster Mental Health Conference. G. W. Doherty. Ann Arbor, MI, Rocky Mountain DMH Institute Press/Loving Healing Press: 95-98.

Scaturo, D. J. and P. M. Hayman (1992). "The impact of combat trauma across the family life cycle: Clinical considerations." Journal of Traumatic Stress 5(2): 273-288.

Shay, J. (2009). "The Trials of Homecoming: Odysseus Returns from Iraq/Afghanistan." Smith College          Studies in Social Work 79(3): 286 - 298.

Slosky, L. H. (2008). The use of rituals and routines in military families experiencing deployment, Capella U , US.

Taft, C. T., J. A. Schumm, et al. (2008). "An examination of family adjustment among Operation Desert Storm veterans." Journal of Consulting and Clinical Psychology 76(4): 648-656.

Warner, C. H., G. N. Appenzeller, et al. (2009). "Psychological Effects of Deployments of Military      Families." Psychiatric Annals 39(2): 56-63.

           

 

 

Grandparents

 

Bunch, S. G., B. J. Eastman, et al. (2007). "A profile of grandparents raising grandchildren as a result of parental military deployment." Journal of Human Behavior in the Social Environment 15(4): 1-12.

 

 

Intergenerational Transmission of Trauma

 

Brom, D., R. Pat-Horenczyk, et al., Eds. (2009). Treating Traumatized Children: Risk, Resilience and Recovery Taylor & Francis, Inc.

Dekel, R. and H. Goldblatt (2008). "Is there intergenerational transmission of trauma? The case of combat veterans' children." American Journal of Orthopsychiatry 78(3): 281-289.

Egolf, J. (2008). Flyboy's daughter. [References]. Proceedings of the 6th Rocky Mountain Region Disaster Mental Health Conference. G. W. Doherty. Ann Arbor, MI, Rocky Mountain DMH Institute Press/Loving Healing Press: 67-78.

Leiner, B. (2009). "The Legacy of War: An Intergenerational Perspective." Smith College Studies in Social     Work 79(3): 375 - 391.

Scharf, M. (2007). "Long-term effects of trauma: Psychosocial functioning of the second and third generation of Holocaust survivors." Development and Psychopathology 19(2): 603-622.

           

 

 

Interventions 

 

Brom, D., R. Pat-Horenczyk, et al., Eds. (2009). Treating Traumatized Children: Risk, Resilience and Recovery Taylor & Francis, Inc.

Budzik, C. L. (2008). "Providing well child care for military families: what every provider needs to consider." Pediatr Ann 37(3): 185-8.

Collins, R. C. and M. C. Kennedy (2008). "Serving families who have served: Providing family therapy and support in interdisciplinary polytrauma rehabilitation." Journal of Clinical Psychology 64(8): 993-1003.

Erbes, C., R., M. A. Polusny, et al. (2008). "Couples therapy with combat veterans and their partners." Journal of Clinical Psychology: In Session 64(8): 972-983.

 

Gambardella, L. C. (2008). "Role-exit theory and marital discord following extended military deployment." Perspectives in Psychiatric Care 44(3): 169-174.

Faran, M. E., M. D. Weist, et al. (2005). Promoting resilience in military children and adolescents.     Community Planning to Promote Resilience on Children. C. Clauss-Ehlers and M. Wiest. New York,             Kluwer Academic/Plenum Publishers: 233-248.

Goodman, R. F. (2002). Caring for Kids After Trauma and Death: A Guide for Parents and Professionals. A. Gurian, The Institute for Trauma and Stress at The NYU Child Study Center: 57.

Guha, V. (2005). Stress, coping and adaptation to wartime separation by families of National Guard personnel, Guha, Vatsala: U Hartford, US.

Hall, L. K. (2008). Counseling military families: What mental health professionals need to know. New York, NY, Routledge/Taylor & Francis Group.

Herzog, J. R. and R. B. Everson (2007). The crisis of parental deployment in military service. Play Therapy with Children in Crisis: Individual, Group, and Family Treatment N. B. Webb. New York, NY, Guilford Press: 228-248.

Hutchinson, J. and L. Banks-Williams (2006). "Clinical issues and treatment considerations for new veterans: Soldiers of the wars in Iraq and Afghanistan." Primary Psychiatry 13(3): 66-71.

Jenkins, D. M. and M. J. Barry (2007). "Relationship 101: Couples therapy in theater." Military Medicine 172(6): iii-iv.

Lemmon, K. M. and E. M. Stafford (2007). "Recognizing and responding to child and adolescent stress:         The critical role of the Pediatrician." Psychiatric Annals 37(6): 431438.

Moon, P. K. (2006). Sand Play Therapy With U.S. Soldiers Diagnosed With PTSD and Their Families. [References]. Vistas: Compelling perspectives on counseling 2006. G. R. Walz, J. C. Bleuer and R. K. Yep. Alexandria, VA, American Counseling Association: 63-66.

Saldanha, D. (2002). "Family intervention in the treatment of post-traumatic stress disorders." Journal of Projective Psychology & Mental Health 9(1): 57-61.

Schumm, W. R., R. J. Crock, et al. (2008). "Reliability and validity of the Kansas Marital Satisfaction Scale with different response formats in a recent sample of U.S. Army personnel." Individual Differences Research 6(1): 26-37.

Storey, C. L. (2009). "The Psychotherapeutic Dimensions of Clinical Case Management with a Combat          Veteran." Smith College Studies in Social Work 79(3): 443 - 452.

Webb, N. B., Ed. (2007). Play therapy with children in crisis: Individual, group, and family treatment (3rd Ed.). New York, NY, Guilford Press.

Wilson, R. M., S. Leary, et al. (2009). "Military Veterans Sharing First-Person Stories of War and      Homecoming: A Pathway to Social Engagement, Personal Healing, and Public Understanding of             Veterans' Issues." Smith College Studies in Social Work 79(3): 392 - 432.

 

           

Maltreatment 

 

Bradley, C. (2007). "Veteran status and marital aggression: Does military service make a difference?" Journal of Family Violence 22(4): 197-209.

Clark, S., B., K. Koenen, C., et al. (2007). "Intimate Partner Psychological Aggression and Child Behavior      Problems." Journal of Traumatic Stress 20(1): 97-101.

Gibbs, D. A., S. L. Martin, et al. (2008). "Child maltreatment and substance abuse among U.S. Army soldiers." Child Maltreat 13(3): 259-68.

Gibbs, D. A., S. L. Martin, et al. (2007). "Child maltreatment in enlisted soldiers' families during combat-related deployments." JAMA: Journal of the American Medical Association 298(5): 528-535.

McCarroll, J. E., Z. Fan, et al. (2009). "Alcohol Use in Nonmutual and Mutual Domestic Violence in the U.S. Army: 1998-2004." Violence and Victims 24(3): 364-379

McCarroll, J. E., J. H. Newby, et al. (2008). "Responding to domestic violence in the U.S.Army-The Family    Advocacy Program." Family and Intimate Partner Violence Quarterly 1(1): 5-23.

McCarroll., J. E., R. J. Ursano, et al. (2004). "Classification of the severity of US Army and civilian reports           of child abuse." Military Medicine 169(6): 461-464.

McCarroll, J. E., F. Zizhong, et al. (2008). "Trends in US army child maltreatment reports: 1990-2004."         Child Abuse Review 17(2): 108-118.

Newby, J. H., R. J. Ursano, et al. (2003). "Spousal aggression by U.S Army female soldiers toward employed and unemployed civilian husbands." American Journal of Orthopsychiatry 73(3): 288-293.

Rentz, E., S.W. Marshall, et al. (2007). "Effect of deployment on the occurrence of child maltreatment in military and nonmilitary families." American Journal of Epidemiology 165(10): 1199-1206.

Rentz, E., S. L. Martin, et al. (2006). "Family violence in the military: A review of the literature." Trauma, Violence, & Abuse 7(2): 93-108.

           

 

Marriage        

 

Adler-Baeder, F., J. F. Pittman, et al. (2005). "The Prevalence of marital transitions in military families." Journal of Divorce & Remarriage 44(1-2): 91-106.

Goff, B. S. N., J. R. Crow, et al. (2007). "The Impact of Individual Trauma Symptoms of Deployed    Soldiers on Relationship Satisfaction." Journal of Family Psychology 21(3): 344-353.

Huffman, A. H. and S. C. Payne (2006). The Challenges and Benefits of Dual-Military Marriages. [References]. Military life: The psychology of serving in peace and combat (Vol 3): The military family. C. A. Castro, A. B. Adler and T. W. Britt. Westport, CT, Praeger Security International: 115-137.

 

 

Military Families        

 

Adams, G. A., D. B. Durand, et al. (2005). "Direct and Indirect Effects of Operations Tempo on Outcomes for Soldiers and Spouses." Military Psychology 17(3): 229-246.

Adams, G. A., S. M. Jex, et al. (2006). Work-Family Conflict among Military Personnel. [References]. Military life: The psychology of serving in peace and combat (Vol 3): The military family. C. A. Castro, A. B. Adler and T. W. Britt. Westport, CT, Praeger Security International: 169-192.

Bowen, G. L., J. A. Mancini, et al. (2003). "Promoting the adaptation of military families: An empirical test of a community practice model." Family Relations 52(1): 33-44.

Castro, C. A., A. B. Adler, et al., Eds. (2006). Military life: The Psychology of Serving in Peace and Combat The Military Family. Westport, CT, Praeger Security International.

Chapin, M. (2009). "Deployment and Families: Hero Stories and Horror Stories." Smith College Studies in      Social Work 79(3): 263 - 282.

Clark, D. (2006). "Review of Courage After Fire: Coping Strategies for Troops Returning From Iraq and Afghanistan and Their Families." International Journal of Emergency Mental Health 8(3): 218-219.

Durand, D. B. (2006). Army Wife, Army Mother. Military life: The psychology of serving in peace and combat (Vol 3): The military family. C. A. Castro, A. B. Adler and T. W. Britt. Westport, CT, Praeger Security International: 3-10.

Harmon, A. L. (2008). A descriptive study of military family needs following a polytraumatic injury, Harmon, A Lisa: Virginia Commonwealth U, US.

Henderson, K. (2006). While They're at War: The True Story of American Families on the Homefront, Houghton Mifflin Harcourt

Hoshmand, L. T. H. a. A. L. H. (2007). "Support for military families and communities." Journal of Community Psychology 35(2): 171-180.

Huitink, J., M. Rajnik, et al. (2006). "International Adoptions by Military Families: A Reexamination." Military Medicine 171(12): 1201-1205.

Kelley, M. L., M. J. Schwerin, et al. (2007). "A participant evaluation of the U.S. Navy parent support program." Journal of Family Violence 22(3): 131-139.

MacDermid, S. (2006). Multiple Transitions of Deployment And Reunion For Military Families The Military Families Research Institute at Purdue University.

MacDermid, S., R. Samper, et al. (2008). Understanding and Promoting Resilience in Military Families.          Military Family Research. M. F. R. I. a. P. University. West Lafayette, Purdue University: 1-28.

Martin, J. and M. D. Sherman (2009). The Impact of Military Duty and Military Life on Individuals and           Families: Resources and Intervention. Families and Change: Coping With Stressful Events and   Transitions. S. J. Price, C. A. Price and P. C. McKenry. Thousand Oaks, CA Sage Publications.

Matsakis, A. (2007). Back from the front: Combat trauma, love, and the family. Baltimore, MD, The Sidran Press.

Palmer, C. (2008). "A theory of risk and resilience factors in military families." Military Psychology 20(3): 205-217.

Pavlicin, K. M. (2005). Surviving Deployment: A guide for military families Elva Resa Publishing LLC.

Pinder, R. J., D. Murphy, et al. (2009). "A Mixed Methods Analysis of the Perceptions of the Media by            Members of the British Forces during the Iraq War." Armed Forces & Society 36: 131-152.

Richard, E. M. (2008). Constructing and contesting the public and private lives of military families, Richard, Elizabeth M : Arizona State U , US.

Rieth, L. S. (2007). Changes in the air force couple's ability to pay debts: Evidence from the 1997 and 1999--2000 air force community needs assessments, Rieth, Linda S: Capella U , US.

Robbins, L. S. (2005). Disorganized attachment in a military sample: Contributions from maternal trauma history, expressed sadness and narrative errors, Robbins, Leah Susan: Alliant International U, San Diego, US.

Sayers, S. L., V. A. Farrow, et al. (2009). "Family Problems Among Recently Returned Military Veterans       Referred for a Mental Health Evaluation." Journal of Clinical Psychiatry 70(2): 163-170

Schachman, K. A. (2010). "Online fathering: the experience of first-time fatherhood in combat-deployed        troops." Nursing Research 59(1): 11-17.

Taylor, N. E., S. M. Wall, et al. (2005). "Mother and Soldier: Raising a Child With a Disability in a Low-Income Military Family." Exceptional Children 72(1): 83-99.

Ursano, R. J., H. C. Holloway, et al. (1989). "Psychiatric care in the military community: Family and military stressors." Hospital & Community Psychiatry 40(12): 1284-1289.

Wiens, T. W. and P. Boss (2006). Maintaining family resiliency before, during, and after military separation. Military life: The Psychology of Serving in Peace and Combat: The Military Family. C. A. Castro, A. B. Adler and T. W. Britt. Westport, CT, Praeger Security International. 3: 13-38.

           

 

 

Military Service Members

 

Castro, C. C. (2009). "Impact of Combat on the Mental Health and Well-Being of Soldiers and Marines."        Smith College Studies in Social Work 79(3): 247 - 262.

Cohen, S. P., C. Brown, et al. "Diagnoses and factors associated with medical evacuation and return to                     Freedom: a prospective cohort study." The Lancet 375(9711): 301-309.

 

Hoge, C. W., C. A. Castro, et al. (2004). "Combat duty in Iraq and Afghanistan, mental health problems,       and barriers to care." N Engl J Med 351(1): 13-22.

            Kennedy, C. H. (2006). Understanding one of our nation's greatest assets: Military personnel, PsycCRITIQUES Vol 51 (38), 2006.

Litz, B. T. (2007). "Research on the impact of military trauma: Current status and future directions." Military Psychology 19(3): 218-238.

Pierce, P. (1998). "Retention of Air Force Women Serving During Desert Shield and Desert Storm." Military Psychology 10(3): 195-213.

           

 

Moving Relocation     

 

Burrell, L. M. (2006). Moving military families: The impact of relocation on family well-being, employment, and commitment to the military. Military Life: The Psychology of Serving in Peace and Combat, The Military Family. C. A. Castro, A. B. Adler and T. W. Britt. Westport, CT, Praeger Security International. 3: 39-63

Weber, E. G. and D. K. Weber (2005). "Geographic Relocation Frequency, Resilience, and Military Adolescent Behavior." Military Medicine 170(7): 638-642.

           

 

National Guard Reserves

 

Chisolm, J. S. (2007). The emotional impact and pastoral care implications of mobilization and deployment on national guard and reserve military members and their families, Chisolm, Joseph Steven: Texas Christian U , US.

Darwin, J. (2009). "Families: They Also Serve Who Only Stand and Wait." Smith College Studies in Social      Work 79(3): 433-442.

Edwin, J. A. (2008). An evaluation of a military family support program: The case of operation: Military Kids in Indiana, Edwin, James Augustine: Purdue U , US.

Faber, A. J., E. Willerton, et al. (2008). "Ambiguous absence, ambiguous presence: A qualitative study of military reserve families in wartime." Journal of Family Psychology 22(2): 222-230.

Guha, V. (2005). Stress, coping and adaptation to wartime separation by families of National Guard personnel, Guha, Vatsala: U Hartford, US.

Renshaw, K. D., C. S. Rodrigues, et al. (2008). "Psychological symptoms and marital satisfaction in spouses of Operation Iraqi Freedom veterans: Relationships with spouses' perceptions of veterans' experiences and symptoms." Journal of Family Psychology 22(4): 586-594.

Renshaw, K. D., C. S. Rodrigues, et al. (2009). "Combat exposure, psychological symptoms, and marital       satisfaction in National Guard soldiers who served in Operation Iraqi Freedom from 2005 to         2006." Anxiety Stress and Coping 22(1): 101-115.

Sahni, N. (2005). Perceptions of those left behind: An exploration of family dynamics within military reservist families during the 2003 Iraq wartime deployment, Sahni, Nameeta: Alliant International U, San Diego, US.

Tollefson, T. T. (2008). "Supporting spouses during a military deployment." Family & Community Health 31(4): 281-286.

 

Policy

 

Jackonis, M. J., L. Deyton, et al. (2008). "War, Its Aftermath, and US Health Policy: Toward a          Comprehensive Health Program for America's Military Personnel, Veterans, and Their Families."    Journal of Law Medicine & Ethics 36(4): 677-689.

 

 

Posttraumatic Stress Disorder/Mental Disorder

 

Browne, T., L. Hull, et al. (2007). "Explanations for the increase in mental health problems in UK reserve      forces who have served in Iraq." British Journal of Psychiatry 190: 484-489.

Evans, L., T. McHugh, et al. (2003). "Chronic posttraumatic stress disorder and family functioning of             Vietnam veterans and their partners." Australian and New Zealand Journal of Psychiatry 37(6):          765-772.

Frenz, M. (2007). Combat Veterans Diagnosed with Post Traumatic Stress Disorder: The Effects on Their Children: A Phenomological Study, University of Phoenix. Doctor of Management in Organizational Leadership: 187

Galovski, T. and J. A. Lyons (2004). "Psychological sequelae of combat violence: A review of the impact       of PTSD on the veteran's family and possible interventions." Aggression and Violent Behavior         9(5): 477-501.

Grieger, T. A., S. J. Cozza, et al. (2006). "Posttraumatic stress disorder and depression in battle-injured        soldiers." American Journal of Psychiatry 163(10): 1777-1783.

Litz, B. T. (2007). "Research on the impact of military trauma: Current status and future directions." Military Psychology 19(3): 218-238.

Manguno-Mire, G., F. Sautter, et al. (2007). "Psychological Distress and Burden Among Female Partners of Combat Veterans With PTSD." Journal of Nervous and Mental Disease 195(2): 144-151.

Nemeroff, C. B., J. D. Bremner, et al. (2006). "Posttraumatic Stress Disorder: A State-of-the-Science            Review." Journal of Psychiatric Research 40: 1-21.

Outram, S., V. Hansen, et al. (2009). "Still living in a war zone: Perceived health and wellbeing of    partners of Vietnam veterans attending partners' support groups in New South Wales, Australia."            Australian Psychologist 44(2): 128-135.

Rand, H. and R. N. S. R. Division (2008). Post -Deployment Stress: What Families Should Know, What Families Can Do, Rand Health and Rand National Security Research Division.

Ray, S. L. and M. Vanstone (2009). "The impact of PTSD on veterans' family relationships: An         interpretative phenomenological inquiry." International Journal of Nursing Studies 46(6): 838-      847.

Riddle, J. R., T. C. Smith, et al. (2007). "Millennium Cohort: The 2001-2003 baseline prevalence of mental    disorders in the U.S. military " Journal of Clinical Epidemiology 60: 192-201

Samper, R. E., C. T. Taft, et al. (2004). "Posttraumatic stress disorder symptoms and parenting satisfaction among a national sample of male Vietnam veterans." Journal of Traumatic Stress 17(4): 311-315.

Stein, M. B. and T. W. McAllister (2009). "Exploring the Convergence of Posttraumatic Stress and Mild           Traumatic Brain Injury." American Journal of Psychiatry 166(7): 768-776.

            

Psychological Toll      

 

Karney, B. R., R. Ramchand, et al. (2008). Invisible wounds, a working paper, Rand Health and the Rand National Security Research Division: 182.

Richardson, J. D., J. Sareen, et al. "Psychiatric problems in medically evacuated service members." The       Lancet 375(9711): 257-259.

           

 

Reference Handbook 

 

Ainspan, N. D. a. W. E. P. (2008). Returning Wars', Wounded, Injured, and Ill, Praeger Securit International

 

 

Schools

 

Aydlett, A. E. (2006). Dealing with Deployment: a Small-Group Curriculum for Elementary and Middle     School Students. Alexandria, VA: American School Counselor Association

Fitzsimons, V. M. and C. A. Krause-Parello (2009). "Military children: when parents are deployed              overseas." J Sch Nurs 25(1): 40-7.

Horton, D. (2005). "Consultation with military children and schools: A proposed model." Consulting          Psychology Journal: Practice and Research 57(4): 259-265.

Network, N. C. T. S. (2008). "Traumatic Grief in Military Children." Traumatic Grief in Military Children:    Information for Educators. from                http://www.nctsnet.org/nctsn_assets/pdfs/military_grief_educators.pdf.

Secondary Traumatization

Bride, B. E. and C. R. Figley (2009). "Secondary Trauma and Military Veteran Caregivers." Smith College      Studies in Social Work 79(3): 314 - 329.

Burton, D. L. (2009). "Commentary to Reaction Panel in Response to the Keynote Lecture presented by        Drs. Brian E. Bride and Charles R. Figley titled <i>Secondary Trauma and Military Veteran      Caregivers</i>." Smith College Studies in Social Work 79(3): 330 - 334.

Chara, K. A. (2008). Secondary PTSD transmission among survivor families of World War II sailors of the United States ship Emmons: A descriptive and correlational analysis of reported and perceived long-term symptoms among veterans, their wives, and adult offspring, Chara, Kathleen A : Capella U , US.

Dekel, R. and Z. Solomon (2007). Secondary traumatization among wives of war veterans with PTSD. [References]. Combat stress injury: Theory, research, and management. C. R. Figley and W. P. Nash. New York, NY, Routledge/Taylor & Francis Group: 137-157.

Dekel, R. and H. Goldblatt (2008). "Is There Intergenerational Transmission of Trauma? The Case of Combat Veterans’ Children." American Journal of Orthopsychiatry Vol. 78(3): 281-289

Fals-Stewart, W. and M. Kelley (2005). "When Family Members Go To War--A Systemic Perspective on Harm and Healing: Comment on Dirkzwager, Bramsen, Ader, and van der Ploeg (2005)." Journal of Family Psychology 19(2): 233-236.

Figley, C. R. (2005). "Strangers at Home: Comment on Dirkzwager, Bramsen, Ader, and van der Ploeg (2005)." Journal of Family Psychology 19(2): 227-229.

           

Single Military Parents

 

Kelley, M. L. (2006). Single military parents in the new millennium. Military life: The psychology of serving in peace and combat C. A. E. A. Castro, Amy B (Ed); Britt, Thomas W (Ed). ,Praeger Security International. 3: 93-114.

Roper, L. L. (2007). Air force single parent mothers and maternal separation anxiety, Roper, Lawanda L : Capella U , US.

 

Spouses          

 

Dana, K. L. (2006). Careers of their own: Role-identity negotiation among air force officers' wives, Dana, Krista Lorrell: U Oklahoma, US.

Dekel, R., H. Goldblatt, et al. (2005). "Being a Wife of a Veteran with Posttraumatic Stress Disorder." Family Relations 54(1): 24-36.

Gorbaty, L. R. (2009). "Family reintegration of reserve service members following a wartime deployment:    `A qualitative exploration of wives' experience." Dissertation Abstracts International: Section B:    The Sciences and Engineering 69(7-B): 4421.

Hobson, T. A. (2006). The impact of deployment on the stay-behind spouse of active duty navy women, Walden University.

Jebo, J. L. (2008). An untraditional life: Male spouses of female military personnel, Jebo, Jennifer L : Virginia Polytechnic Inst And State U , US.

Keener, M. (2007). Shared Courage: A Marine Wife's Story of Strength and Service Minneapolis, MBI            Publishing Company.

Mansfield, A. J., J. S. Kaufman, et al. "Deployment and the Use of Mental Health Services among U.S.          Army Wives." N Engl J Med 362(2): 101-109

Matsakis, A. (2005). In harm's way: Help for the wives of military men, police, EMTs & firefighters. Oakland, CA, New Harbinger Publications.

Orthner, D. K. and R. Rose (2009). "Work Separation Demands and Spouse Psychological Well-Being." Family Relations 58(October): 392-403.

Sahlstein, E., K. C. Maguire, et al. (2009). "Contradictions and Praxis Contextualized by Wartime       Deployment: Wives' Perspectives Revealed through Relational Dialectics." Communication         Monographs 76(4): 421-442.

Spera, C. (2008). "Spouses's ability to cope with deployment and adjust to Air Force Family demands." Armed Forces & Society 35(2): 286-306.

Westman, M. and D. L. Etzion (2005). "The Crossover of Work-Family Conflict From One Spouse to the Other." Journal of Applied Social Psychology 35(9): 1936-1957.

Wright, K. M., L. M. Burrell, et al. (2006). Military Spouses: Coping with the Fear and the Reality of Service Member Injury and Death. [References]. Military life: The psychology of serving in peace and combat (Vol 3): The military family. C. A. Castro, A. B. Adler and T. W. Britt. Westport, CT, Praeger Security International: 64-90.

           

Traumatic Brain Injury          

Anderson, M. I., T. R. Parmenter, et al. (2002). "The relationship between neurobehavioural problems of      severe traumatic brain injury (TBI), family functioning and the psychological wellbeing of the            spouse/caregiver: path model analysis." Brain Injury 16(9): 743-757.

Cernak, I. and L. J. Noble-Haeusslein (2009). "Traumatic brain injury: an overview of pathobiology with       emphasis on military populations." J Cereb Blood Flow Metab.

Collins, R. C. and M. C. Kennedy (2008). "Serving families who have served: Providing family therapy and    support in interdisciplinary polytrauma rehabilitation." Journal of Clinical Psychology 64(8):     993-1003.

Committee on Gulf War and Health: Brain Injury in Veterans and Long-Term Health Outcome, Board on       Population Health and Public Health Practice, et al. (2008). Gulf War and Health: Volume 7: Long       Term Consequences of Traumatic Brain Injury.

French, L. M. and G. W. Parkinson (2008). "Assessing and treating veterans with traumatic brain injury." J Clin Psychol 64(8): 1004-13.

Friedemann-Sanchez, G., J. M. Griffin, et al. (2008). "Communicating Information to Families of       Polytrauma Patients: A Narrative Literature Review

            " Rehabilitation Nursing 33(5): 206-213.

Groom, K. N., T. G. Shaw, et al. (1998). "Neurobehavioral symptoms and family functioning in         traumatically brain-injured adults." Archives of Clinical Neuropsychology 13(8): 695-711.

Griffin, J., G. Friedemann-Sánchez, et al. (2009). "Families of patients with polytrauma: Understanding         the evidence and charting a new research agenda." Journal of Rehabilitation Research &       Development 46(6): 879-892.

Hoge, C. W., D. McGurk, et al. (2008). "Mild traumatic brain injury in US Soldiers returning from Iraq."         New England Journal of Medicine 358(5): 453-463.

Jaffee, M. S., K. M. Helmick, et al. (2009). "Acute clinical care and care coordination for traumatic brain   injury within Department of Defense." Journal of Rehabilitation Research & Development 46(6):          655-666.

Kreutzer, J. S., T. M. Stejskal, et al. (2009). "A preliminary investigation of the brain injury family    intervention: Impact on family members." Brain Injury 23(6): 535-547.

Lezak, M. D. (1978). "Living with the Characterlogically Altered Brain Injured Patient." Journal of Clinical      Psychiatry 39: 593-598.

Lefebvre, H., D. Pelchat, et al. (2005). "The experiences of individuals with a traumatic brain injury,             families, physicians and health professionals regarding care provided throughout the continuum."          Brain Injury 19(8): 585-597.

Lew, H. L., J. H. Poole, et al. (2007). "Program development and defining characteristics of returning           military in a VA Polytrauma Network Site." Journal of Rehabilitation Research & Development     44(7): 1027-1034.

Perlesz, A., G. Kinsella, et al. (1999). "Impact of Traumatic Brain Injury on the Family: A Critical Review."    Rehabilitation Psychology 44(1): 6-35.

Pessar, L. F., M. L. Coad, et al. (1993). "The Effects of Parental Traumatic Brain Injury on the Behavior of             Parents and Children." Brain Injury 7(3): 231-240.

            Ponsford, J., J. Olver, et al. (2003). "Long-term adjustment of families following traumatic brain injury          where comprehensive rehabilitation has been provided." Brain Injury 17(6): 453-468.

Rand, H. and R. N. S. R. Division (2008). Post -Deployment Stress: What Families Should Know, What Families Can Do, Rand Health and Rand National Security Research Division.

Sahlstein, E., K. C. Maguire, et al. (2009). "Contradictions and Praxis Contextualized by Wartime       Deployment: Wives' Perspectives Revealed through Relational Dialectics." Communication         Monographs 76(4): 421 - 442.

Sinnakaruppan, I. and D. M. Williams (2001). "Family carers and the adult head-injured: a critical review     of carers' needs." Brain Injury 15(8): 653-672.

Uysal, S., M. R. Hibbard, et al. (1998). "The effect of parental traumatic brain injury on parenting and          child behavior." Journal of Head Trauma Rehabilitation 13(6): 57-71.

Verhaeghe, S., T. Defloor, et al. (2005). "Stress and coping among families of patients with traumatic           brain injury: a review of the literature." Journal of Clinical Nursing 14: 1004-1012.

Wells, R., J. Dywan, et al. (2005). "Life satisfaction and distress in family caregivers as related to specific     behavioural changes after traumatic brain injury." Brain Injury 19(13): 1105-1115.

Social Support a "Powerfully Protective Factor" Often Not Available to PTSD Sufferers

A quote about PTSD and its impact on the individual sufferer's ability to receive support from those around him or her:

"Social support is a powerful protective factor (Brewin, Andrews & Valentine, 2000) that includes the capacity of an individual to accept or utilize social support when it is made available (Benight & Bandura, 2004). This may be especially problematic in PTSD where symptoms such as avoidance, alienation and detachment impair affected individuals from benefiting from available marital, family, and social support."

Source: Oxford Handbook of Anxiety and Related Disorders, by Martin M. Antony, Murray B. Stein, linked here.

Upcoming Seminar on Warrior Health: PTSD, Depression and TBI

The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., presents:

A Center for Deployment Psychology Training Program:

"Addressing the Psychological Health of Warriors and Their Families: PTSD, Depression and TBI."

When: Mon 22 Jun 2009 through Fri 26 Jun 2009.

Where: The Cheyenne Mountain Resort, Colorado Springs, Colorado.

What: This intensive course, which is comprised of 4 modules, will train civilian mental health providers to better address the behavioral health needs of military personnel and their family members throughout the deployment cycle.

Who: The intended audience is civilian mental health providers who provide behavioral health care to the military population or military family members, including veterans and their loved ones.  This training is NOT intended for active duty military providers, but rather for civilian or private practice/community providers.

Supported by: Fort Carson Soldier Readiness Center, National Organization on Disability, Operation TBI Freedom and Regis University.

For more information about this upcoming seminar or to register online, click here.

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.

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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.

Domestic Violence: Personal and Family Safety Pocket Guide

The Washington state Dept. of Social and Health Services puts out these excellent pocket cards, in English and other languages, called the "Safety Plan Pocket Guide" for victims of domestic violence.  It looks like they were produced over ten years ago now, but Seattle-area businesses and medical offices still have them available, and the suggestions look current and practical.  Here they are:

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

Within Washington state: Domestic Violence Hotline: V/TTY: 1(800) 562-6025.

Safety Plan Pocket Guide:

PLAN AHEAD:

• Develop a plan with your children;
• Arrange to have a place to go;
• Make copies of important papers and hide them;
• Have available important phone numbers;
• Pack and hide an overnight bag;
• Put aside money and spare keys;

DURING AN INCIDENT:

• Call for help (9-1-1);
  Get out if you can;
  Bring important items listed above;

IF YOU CAN'T LEAVE THE SITUATION:

• Avoid rooms with only one exit;
• Avoid the kitchen, bathroom and garage;
• Call for help;

IN YOUR HOUSE:

• Change lock, secure doors and windows;
• Arrange to have someone come stay with you;
• Change your phone number(s);
• Obtain a protection order;
• Notify trusted friends and family;

AT THE WORKPLACE, SCHOOL AND PUBLIC AREAS:

• Inform your work, daycare and schools;
• Change your daily routine;
• Plan ahead for unexpected contact with the abuser.

Editor's note: For previous coverage of domestic violence, PTSD and combat veterans, look to this blog post, linked here, or the index of blog posts on the topic, linked here.

"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.)

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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.

The Good Work of Elmo: Sesame Street Special Supports Military Families

In celebration of April being "Military Family Month," the venerable public television institution Sesame Street rolled out a half-hour special called "Coming Home: Military Families Cope With Change," which they consider one of their most important efforts in a 40-year history.  The show features Queen Latifah,
who mentions on the show that she was raised by a Vietnam veteran with PTSD, who later got help; plus John Mayer and Elmo.

According to press material, "This half-hour special tells stories of service members who return home with injuries, visible and invisible, and explores the heroic struggles their families face in discovering a new way of finding a new normal. It salutes the extraordinary courage and strength of these military families and offers the general public a powerful glimpse into what they often must endure. The special will air on PBS on April 1, 2009 at 8PM (check local listings)." For more information about the program, click here.  To see videos about the behind the scenes making of the special, choose either one of the following links:Behind the Scenes, I and Behind the Scenes, II.

Kudos to Sesame Street for taking on this important issue, in such a positive and accessible way.

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.

Sometimes a Photo Just Says It All...

Libraries Across America Offer Veterans Information Next Week for Veterans' Day

The American Library Association (ALA) is spearheading a series of activities during the week of Veteran's Day, November 11, 2008 at libraries across the country to make information available to help veterans and their families better understand the education benefits available under the new Post 9/11 GI Bill.

ALA's Office of Government Relations (OGR) is working with a group of four national organizations in this effort, including the American Legion National Headquarters, the American Council on Education, the National Association of Federally Impacted Schools, and the National Military Family Association.

(Realistically, knowledgeable reference librarians are always happy to help veterans and their families with information at their disposal; next week, however, appears to be a special push to get this information into the hands of veterans and their families, in honor of Veterans Day.)

For more about the services available, click this very Wikipedia-looking link, provided by the American Library Association.

Books Fall Open, We Fall In: Reading to Better Understand the Vietnam War and Its Veterans

The kindly and indulgent boyfriend, GuvBoy, left for the local library book sale with instructions to purchase anything that looked good about the Vietnam war and several other blog-related topics. As a former journalist and all-around smart person, he knows how to figure that out, so I knew I was in good hands.  As it turns out, he returned with some good ones, that seem to have been lost to history.  So I thought I would point them out here, in case they help anyone else who's interested in digging deeper into what went on and what the combatants experienced. 

(In case it's never been clear what orientation the categories of books in the various columns flanking this blog have, here's the breakdown:

The column to the right here on this blog lists various books of poetry about war, any war; followed by a section of all sorts of excellent first-person narratives about various wars, the better to give us an understanding of what veterans went through.  Those first-person narratives are organized by war, to make it more self-explanatory.  The column to the left here lists therapeutic resources for dealing with combat trauma up on top; and various miscellaneous things that get mentioned on the blog further down).

For Vietnam-era veterans who want their families (i.e., children and grandchildren) to better understand what the war was like, I'm still recommending "Home to War: A History of the Vietnam Veterans Movement," by Gerald Nicosia, because while he's talking about the veterans movement, in 700 pages, he's capturing all sorts of history of the era and feelings for and against.  The book is actually pretty neutrally, historically written, and it's a very good resource.  I've blogged about it earlier, here.  Except for its oversight of the extremely impressive (to me, anyway) Lawrence Kolb, M.D., I can't say enough good things about Nicosia's book.  There's a fascinating wealth of information about the legitimization of the PTSD diagnosis in the book as well.

Here are a few others:

Stanley Karnow's Vietnam: A History, is also good.  The cover calls it "The first complete account of Vietnam at war" -- maybe it should actually say, the first complete account of Americans at war in Vietnam -- so it has its place.  It was written as the companion to the long-ago PBS series of the same name.

Plus three new finds, though, thanks to the pleasantly-disposed boyfriend and his handful of small bills:

"Long Time Passing: Vietnam and the Haunted Generation," by Myra McPherson; "Healing from the War: Trauma and Transformation after Vietnam," by Arthur Egendorf; and "Vietnam: the Valor and the Sorrow" (from the home front to the front lines in words and pictures), by Thomas D. Boettcher.

Each of these books has a particular reason why it's good and worth perusing.  McPherson was a Washington Post and New York Times reporter who carried on 500 interviews with veterans and others to get her material; Egendorf, who Nicosia writes about in his history, was a Harvard graduate, Vietnam vet and psychologist who became one of the founders of the first rap groups to help veterans deal with the personal fallout from the war; and Boettcher was a graduate of the U.S. Air Force Academy who served in Vietnam in the press corps.  His book has more than 500 photographers, many never before published, which adds greatly to its interest (it's also very well-written and well-paced, not deadly.) 

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Additionally, we've already blogged about Lori Sekala's great bibliography on PTSD and war in the blog post entitled, "A Good Librarian is a Wonderful Resource," linked here.  (Sekala is the collection management librarian at the U.S. Army War College library).  But here's something we haven't talked about yet -- possibly THE definitive bibliography on books about the Vietnam war, to better understand the experience.  It's linked here.  Enjoy :-)

When Two Are Better Than One: A Relationship That Can Save You

Although at first glance, we should really save ourselves -- not be saved by others -- there's something wrong with looking externally for something that should come ultimately from within -- still, relationships can exert powerful forces for good in our lives.  It's painful reading about the Vietnam veterans, for example, who are "unable to touch intimacy," or who still clearly keep intimate relationships at a distance, because they're afraid of the weight of failure, among other things. 

There's a nice segment of a poem from T.S. Eliot that speaks to this.  Eliot was a famous Modernist poet, from the school that developed around World War I, and while he wasn't sensational about this in his own life -- his first wife, Vivien, to whom the words "My nerves are bad to-night.  Yes, bad.  Stay with me." are attributed in Eliot's famous poem, The Waste Land, is also a woman he institutionalized; still, he is able to write these comforting words, which perhaps he practiced himself, and perhaps did not.  (They could also be about his marriage to his second wife, which was apparently much happier, though shorter-lived.  He was married to her at the time he wrote these lines.)  In any case, they can still serve to inspire us with their truth:

"If a man has one person, just one in his life,
To whom he is willing to confess everything --
And that includes, mind you, not only things criminal,
Not only turpitude, meanness and cowardice,
But also situations which are simply ridiculous,
When he has played the fool (as who has not?) --
Then he loves that person, and his love will save him."

-- T.S. Eliot, The Elder Statesman (1958).

Editor's note: For our ongoing series on "healthy sexuality and the combat veteran," go here.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Pat Kemm Mann
Fruitland Mesa
Crawford, CO 81415

Helping Military Families Cope and Heal from Stressors of Deployment and Combat

(From a press release)

Helping Military Families Help Themselves

For a civilian, it’s hard to fathom the stress a military family faces when a parent or spouse is sent to combat zones. Long and often multiple wartime deployments take a toll not only on the service member on the front lines but on family members back at home. According to recent figures released by the RAND Corporation, one in five veterans of the Iraq and Afghanistan wars may suffer from psychological health problems, which can add the strain on military family members.

Now, a program initiated at the University of California, Los Angeles (UCLA) and supported by the U.S. Navy’s Bureau of Medicine and Surgery is reaching out to military families to help prevent the personal and family problems such stress can bring. Project FOCUS (Families OverComing Under Stress) is now being rolled out to nine military bases across the nation and in Okinawa, Japan.

“There is increasing awareness that military families, especially the children, can be significantly affected when a parent is deployed, and there is even greater psychological wear and tear when there are multiple deployments,” says Patricia Lester, MD, an assistant professor of child and adolescent psychiatry at UCLA and the director of the FOCUS program. “The spouse left behind is suddenly thrust into the role of being a single parent; routines are interrupted; the children may not understand where their mom or dad has gone; and the service member on the front lines is constantly worried about how their family is doing back home.”

The FOCUS program provides parents and children with customized training that will address the impact of wartime deployment on families and helps them learn very specific communication and problem-solving skills to address these challenges. In addition, FOCUS trainers will provide outreach to groups within military communities to raise awareness about the kinds of pressures families face and to let them know help is available to cope with deployment.

“We build resiliency,” Lester says. “It’s a three-pronged approach to restore a psychological balance to the family, promote future resiliency, and increase knowledge and understanding among the military family culture.”

Families meet with counselors in multiple sessions. Some of the sessions are only with the parents, some are only with the children, and the rest are family sessions. Each session focuses on helping family members identify and share their concerns and fears about a spouse or parent being deployed to a war zone. In separate sessions with parents and children, FOCUS trainers teach them skills to help manage their emotions, solve problems within the family, set goals, and communicate with one another.

“If there are five family members, there’s a good chance that there are five different stories of what that most recent deployment experience was like,” Lester says. “Family members often don’t want to ‘burden’ each other with their personal problems, but in these exceptional circumstances of long-term separations, building a shared family narrative can be very helpful in reestablishing a close family identity and building its strength.”

— Source: University of California, Los Angeles, Health Sciences

Between the Sheets: Healthy Sexuality for Combat Veterans

This is going to be the beginning of an extended cycle of posts on "healthy sexuality for combat veterans," a subject that desperately needs to be addressed.  There's too much to cover in just one sitting, though, so stay tuned for a few here because we're first going to have to cover the problem, in depth, before we can turn to some of the solutions.  It's really pretty surprising that no one is talking about this stuff professionally -- other than the veterans themselves, if they can ever work up the courage to.  So here goes. I have my "focus group" of veterans: they're telling me what they want to hear discussed out in the open.

You'd be surprised, as I was, if you reviewed the literature on veterans and PTSD, and found literally almost nothing written on this subject. Well, unless you count references to "sex addiction."  Addiction, really?  That's apparently a tell-tale marker for chronic PTSD.  Ahhh...but thankfully "sex addiction" isn't all that firm a professional diagnosis.  What seems like addiction to one, seems like the actual engine of life, to another.  And fortunately we're able here to consider both perspectives as we talk about it.

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Here's one of the best items we've found in the literature, and it's from Aphrodite Matsakis, Ph.D.'s book, Vietnam Wives.  It talks about sex for the veteran with PTSD as "the total stroke."  Here goes:

"On one level, this intense need for sex [on the part of the combat veteran] can be related to the veteran's loneliness. Socially isolated people are often lonely. Although they may desire to be separate, their isolation often results in their becoming "stroke deprived" -- they do not receive the smiles, the hugs, the compliments, or any of the visual, verbal, or physical recognitions (strokes), large or small, which naturally come about when with supportive others. In this state of deprivation, the vet may turn to sex to meet his social and relationship needs. Sex becomes a substitute for in-depth emotional communication, or even casual socialization.

One vet called sex the 'total stroke.' For a long time, he believed that sex would satisfy all his hungers -- his hunger for sex, as well as his hunger for human companionship and intimacy. Like many persons, he confused sex with love and emotional closeness. When sexual activity without communication left him unsatisfied, he increased his sexual activity. Even after more sex, however, he still felt restless and empty inside. Eventually he found that some communication with his sexual partner and more time spent socializing with others, not more "pure sex," helped satisfy him.

On another level, the vet's need for sex can be intense because, biologically, sexuality is "the antithesis of anxiety." As has been repeatedly proven in studies of both men and women, anxiety interferes with sexual performance, especially with orgasm. Conversely, it is difficult, if not impossible to be anxious while highly sexually aroused. Hence, for some vets, sex is more than sex. It is a form of tranquilizer or sedative for their anxieties and other tensions. Not only does sex provide a sense of physical peace, but an emotional peace as well...in this sense, sex can be used like a mood-altering drug."

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Says Jonathan Shay, M.D., Ph.D., in his book, Achilles in Vietnam:

"The overwhelming majority of combat veterans whom I have known are painfully aware of the absence of intimacy, tenderness, light playfulness, or easy mutuality in their sex lives. For many, sex is as sure a trigger of intrusive recollection and emotion from Vietnam as the sound of explosions or the smell of a corpse. Sex and anger are so intertwined that they often cannot conceive of tender, uncoerced sex that is free of rage. When successful treatment reduces their rage, they sometimes report that they have to completely relearn (or learn for the first time) the pleasures of sex with intimacy and playfulness."

(To be continued...)

Moving Violations, or the Needle in the Red Zone - Combat Veterans and Adrenaline Addiction

Adrenaline in combat helps the servicemember stay alive, and execute the plan.  Being addicted to the same adrenaline rushes after combat, though -- back on the home front -- can go from being an asset to a liability -- especially behind the wheel or on the motorcycle, and contributes to the sad phenomenon known as "non-combat deaths" from various origins.

Enough returning combat veterans kill themselves through reckless driving that different steps are being taken to warn participants of the semi-obvious dangers:

The Guardian (UK) newspaper has a story in today's paper, previously published yesterday in the Observer (UK), about the the British military's current advertising campaign to warn returned servicemembers about the dangers of amped-up, reckless driving.  The article, "Ads warn soldiers back from war zones against reckless driving," is linked here.

Says the article, "British soldiers are twice as likely as civilians to die as a result of reckless driving, because they have difficulty adjusting to normal life after returning home from active duty, according to official statistics."  The ads feature catchy slogans, such as "Drive Carefully.  You're Tough, but Not Invincible," and one directed to motorcyclists, "You're An Accident Waiting to Happen."  Hmmmn.  Those ads are likely to catch people's attention -- in fact, almost 60% of troops surveyed said they would think about slowing down, said the article, after considering them.

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Rick Roger's article in the May 23 issue of the San Diego Union-Tribune talked about the rash of non-combat fatalities among Marines at Camp Pendleton, many of whom had died in motorcycle fatalities.  Five Marines had died in the past eight days, where the "confirmed or probable causes" were homicide, suicide and traffic accidents. The article described Marine commanders and commands "backtracking to see if we need to do anything different to avoid these things happening again.”

It also clarified:

“Two of these deaths were caused by apparent motorcycle accidents, an area of deep concern for our Corps as motorcycle fatalities continue to rise at an alarming rate,” the statement said. “In a recently released All-Marine Message, the commandant outlines guidance and directives designed to curb motorcycle injuries and fatalities.”

Motorcycle-related deaths in the Marine Corps have risen every year since 2004, when there were seven. Last year, there were 19, according to the Naval Safety Center.

As for efforts to minimize combat stress and substance abuse, Camp Pendleton officials said the base has programs, policies and officers devoted to outreach and education. They also said each unit conducts monthly random drug tests on a mandated percentage of its Marines."

(Since that article was published, even more Marines have died as a result of motorcycle accidents.  See the article by Trista Talton in Friday's Marine Corps Times, linked here.  She writes, "Twenty Marines have died in motorcycle wrecks since Oct. 1, making this fiscal year the deadliest on record despite the Corps’ efforts to reduce two-wheel fatalities."  YIKES.

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From an article in the May 13, 2008 edition of the Marine Corps Times:

The new order, a work in progress for about six months, was initiated because of the number of motorcycle fatalities and injuries occurring within II MEF. From October 2007 to January 2008, more II MEF Marines died in motorcycle wrecks than in combat.

According to the order, released April 29, most of those deaths involved junior Marines and included things such as reckless behavior, blatant disregard of orders and policies, lack of proper training, little driving experience, alcohol and willfully disobeying state and federal traffic laws.

Information about the order is linked here.

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"Adrenaline addiction" is a familiar concept but by no means an official diagnosis (there are, however, informal support groups for it, on the Web, although I wonder if they're not just catchy names for invitations to drag racing and hang gliding events :-).

Sgt. Chad T. Jones wrote about it, back in April of 2004, in an article called "Flipping Off the Switch Can Save Your Life," linked here, first published in a Fort Bliss military publication, called the NCO Journal.  He introduced the article by saying:

A Soldier who has recently returned from Iraq might experience a need for a combat-level rush, called adrenalin addiction. The cravings for this excitement could kill him, but a patient, informed leader can intervene to save the Soldier’s life.

This information is a little on the generic side (in other words, seems like common sense) -- but apparently it's worth thinking about for those who haven't already considered it.  (It would be interesting, too, to learn the age ranges of those surveyed, above, who thought that just seeing the ad's message would reinforce their behavior towards slowing down and being more reasonable.  My guess is those were the older survey participants, because with age comes wisdom -- or so they say -- and/or the change to experience a few close calls with reckless behavior, which also has an impact on slowing us down.

From the same 2004 article:

Adrenaline addiction is something Soldiers returning from deployment are susceptible to, and is described as the need to engage in excitement-seeking behavior, said Col. Robert Gifford (Dr.), associate professor of psychiatry, Uniformed Services University of Health Sciences.

“Soldiers, when they come back from a deployment, have often been observed engaging in ‘excitement-seeking behavior.’ It includes a lot of people who liked excitement before and
Soldiers who come back [from a deployment] and miss the excitement, and sense of purpose that comes with a deployment,” Gifford said.

Usually, Soldiers are able to adjust their lifestyle or compensate for the lower operation tempo, but unfortunately other Soldiers “can’t find adequate ways to fulfill themselves, and they become excitement junkies,” said Lt. Col. (Dr.) David M. Benedek, associate professor of psychiatry, Uniformed Services University of Health Sciences.

Specific evidence stating why a Soldier seeks danger is not existent, Gifford said. But a popular opinion among medical professionals is that Soldiers are trying to replace the constant adrenaline needed to be successful in a combat environment.

“Operational or combat environments require a sense of alertness all of the time and it is very difficult to turn that off when you return home. Even though Soldiers are glad to be home, many found features they enjoyed while deployed,” Gifford said. “Sure it’s hot and miserable, but there is a sense of purpose. Suddenly, you’re home and those senses of purpose or excitement are suddenly gone, and people may not want to give that up so quickly.”

One way emotion leads to the reckless behavior is that Soldiers feel indestructible when they get home because they survived combat. That carelessness or sense of being indestructible can be dangerous, Gifford said. “Clearly any person who gets involved with risky behavior puts themselves in a position to get hurt, or killed,” he said.

While "adrenaline addiction" or being an adrenaline "junkie" isn't a true "addiction," as defined by the experts, there are some obvious similarities, including developing cravings for the environmental stimulants that provide the adrenaline rush -- many of which were available in combat situations, but not on the home front.  It's hard for many returning servicemembers to calm down -- and this is understandable -- after the rigors and the scares of combat.

Says the article:

"Upon detection [of the problem], leaders have many options they can use to help the Soldier. “There are a variety of mental health sources,” he said, but many Soldiers feel more comfortable talking to Chaplains or someone else. The important thing is to get the problem surfaced.”  Once the problem is brought to light, it’s important to figure out why the behavior is occurring. “Reckless behavior may be a signal of a number of illnesses or situational things that might resolve itself on its own or it might take a medical professional to figure out what to do,” [Col. Robert] Gifford said."

As I'm typing this out, though, I'm reading an email from a favorite Vietnam vet, telling me about the battle for Hill 881, and saying, in part, "without masses of adrenaline rushing through us, we couldn't have done this..." Aye, there's the rub.  Sometimes it's a total asset to have it; and just as easily, it becomes a grave liability.  Context is everything.

If you remember watching the Kellee Twiggs video (SSgt. Travis Twigg's wife, speaking after his death from PTSD), you will recall her talking about how jumpy her husband was -- how he couldn't sit still long enough to watch a movie with her and the kids; that his legs were always twitching.  To a certain degree, this must be a conditioned response from combat -- all that hyper-alertness turns into just plain jumpiness, with nowhere to go.  No wonder people try to bleed it off, doing risky things -- it keeps the feedback loop primed.

Sad to say, though, it's a feature of post-deployment life that servicemembers will need to get a handle on, through any reasonable means necessary -- and with good advice from practitioners they trust -- because failing to do so will prolong their suffering, and put their safety and sometimes that of other people's at risk.  Good for the British to be doing these ads, but as the popular saying goes, you can't really regulate human behavior. Suggesting that there might be a problem, though -- may be what amounts to a start.  An attempt to get the needle back out of the red zone...

We Made History Together: The Oral and Written Histories of Combat Veterans

Combat veterans - where did your memories go?  Not as in, "have you lost your memories?" but more to the effect of, "how are you saving them or transmitting them, for posterity?"

This marvelous photograph was taken by photographer Jeremy Hogan, and is used with permission. Hogan wrote the "Poem for My Father" which we blogged about earlier, and in his free time, he's helping to document the history of his father's squadron in Vietnam.  He says about this photo, taken over Memorial Day weekend, that the subject is, "Ron Klus, who served with my dad at Quan Loi, and received a Distinguished Flying Cross with an Oak Leaf Cluster. Unfortunately, Klus died due to issues related to his PTSD and now the VA is now denying his widow death benefits."

Recently, I've been privileged to receive several veteran's memoirs, bound up in book form -- one is a work in progress, the other already published.  I know that Jeremy is working with at least one of the guys from his dad's old squadron (13th Signal Battalion, part of the 1st Cavalry Division Airmobile), a combat photographer who did multiple tours of Vietnam, on cataloging his old photos, and creating some sort of archive for posterity.  That photographer says he's been interviewed as well, and is the subject of an upcoming article in a military magazine, but admits that dredging up the memories has been extraordinarily painful, because all those memories just come rushing back, from where they've been suppressed all these years.  That situation is challenging enough -- but what of others, who will die before they set anything down on paper, or on tape, about what they went through?  Those memories, painful and otherwise, which capture who the person was, will forever be lost to time. Unless...they're preserved some kind of way.

We've written on this blog before about the exceptional StoryCorps project -- click here for that link -- but what else is there out there, that archives veterans' recorded stories of their adventures and misadventures in combat?  (By recorded, we mean "set down" -- which could be on paper, digitally, or taped.)  One thing I've run across -- and please let us know if you know of other things like this, that are national in scope, not just regional or local -- is the "Veterans History Project," a project of the "American Folklife Center" at the Library of Congress, linked here. 

To participate in the project takes a few easy steps (their words, not mine), and seems pretty straightforward.  You register for the project, print the project field kit, prepare f the interview, conduct the interview, and send the resulting work product to the collection at the Library of Congress (of course keeping at least one copy for yourself).  Students and teachers can make this an educational project for school credit, -- that information is linked here -- but veterans themselves should think about getting involved. There's even a very cool place on the site where you can search for histories by other people who've participated -- for all you know, you might find a wartime buddy via that search engine, which is linked here.

I recently shared a quick conversation and a hug with longtime Friend of Veterans Maxine Hong Kingston, and asked her my one burning question, which was how long it took veterans before they were willing to talk about their experiences.  She said, "20 years."  I'm hopeful it doesn't always take that long -- or won't take that long, for the current crop of veterans -- but when you read some individual's war experiences you can see exactly why that would be. 

Current veterans like Tony Neff, author of the short autobiographical piece on his injury and convalescence, called "All I Want Is What I Deserve," which was published on this blog a few months ago, definitely took the plunge and jumped right in -- good for him. (His story is linked, here.)  I just have the feeling the current group of vets, thanks to the Internet and technology, etc., and their general comfort level with same, is going to break through all previous barriers more quickly with getting their stories told and out there, for the general public and to memorialize what they went through. In fact, it will seem unusual for them not to! 

But for everyone else, from previous wars, it's gonna take a little more coaxing and cajoling. So what of it -- is it time to start getting involved, and sharing with the world what only you know and experienced?  It might even help your loved ones understand you a little bit better -- and in the process, perhaps help you to understand and forgive yourself a little more, too.  Can you hear me cheering you on from the sidelines?  That's good -- because that would be the point :-)

"Purple Mountains' Majesty and PTSD": Colorado VA Hospital Hosts Three-Part Series on PTSD

According to an article in today's Grand Junction (Colo.) Free Press, the local Veterans Affairs hospital is sponsoring a three-part series for veterans, their families, and the community on PTSD.  The series apparently started yesterday (Wednesday) and will continue on the following two Wednesdays, July 16 and July 23.  According to the article, session was led by social workers Gerry Mitchell and Austin Sorensen and "educated the group on the symptoms, perceptions and impacts of PTSD on the soldier and his or her family."  Next session will discuss "veterans’ family members coping with PTSD." (Hey, I hope they see our blog entry from yesterday on that exact subject -- "Home Sweet Home -- After Deployment, What? Support for Returning Veterans and Families," -- linked here!)  The third week's session will let veterans discuss their own experiences with PTSD. (My buddy, Kathie Costos, over at "Wounded Times," mentioned this upcoming series with great excitement the other day.  As she knows, veterans are often not that eager to seek help, but this series looks like a very positive development.)

Editor's Note: The article, by Marija B. Vader, called "PTSD attracts crowd at VA hospital," is linked here. The main website of the VA Hospital in Grand Junction, Colorado, is linked here.  (That site also includes driving directions.)  The hospital is located at 2121 North Avenue, in Grand Junction, CO 81501, and the phone number is (local) (970) 241-0731 and Toll Free:(866) 206-6415.  The sessions apparently start on Wednesdays at 5:30 p.m. in Building 6 on North Avenue.

Home Sweet Home -- After Deployment, What? Support for Returning Veterans and Families

Some words of wisdom from Vietnam veteran, professor of social work, and author, Raymond Monsour Scurfield, D.S.W., for returning veterans and their families.  For everyone who searches this blog looking for "ways to support returning veterans," I hope these words will provide some constructive help and solutions:

The partner back home, the children, significant extended family members all also have their unique combinations of pre-war characteristics, strengths and problems. These inevitably become intermingled with their life experiences while the veteran has been deployed. And, similar to the veteran, their combination of pre-deployment and life experiences and characteristics and patterns during the partner’s absence while on deployment now come face-to-face with the returned veteran who has been extraordinarily impacted by war.

And so, just what is the family to say and do in regard to a veteran who has recently returned from deployment and who appears to be quite different, appears to have been significantly impacted by the war? Should the partner and family remain silent and just avoid talking with the returned active duty about these noticeable changes (that are negative) in the hope that he/she eventually will revert back to how he/she was before being deployed? Also, there could be positive changes (discussed later).

But the rest of the family has needs and wants right now. And the family has just as much right and needs as does the returning veteran to be reached out to, listened to and understood, and their issues and feelings respected and addressed. To be of optimal help to your veteran partner, you first must understand what your primary needs and wants are right now, as you and the family are readjusting to the veteran being back and adjusting to someone who has been profoundly touched by war.

Are you resentful, relieved, entrenched in daily habits developed while your veteran partner was deployed, resistant or very ambivalent that your veteran partner has disturbed whatever homeostasis you had achieved in his/her absence? Do you want to just drop all the responsibilities onto your veteran partner, because you are exhausted and angry and needy and want your own space that was impossible to have while your partner was deployed? Are you so happy to have him/her back that you choose to bury or deflect all or most of your or the family’s pent-up feelings and issues and defer to your veteran partner’s needs and wants?

Do you have really mixed feelings about your military spouse being back now? Perhaps you are missing the freedom, that life was perhaps actually simpler in some or many ways, with fewer hassles and explaining to do, when your spouse was not around. (Sometimes my wife tells me, when I might hover around her too closely in the kitchen or in the bedroom when she wants her personal time, that “I am taking her oxygen.” :-) And, you are very glad that he or she is back. Yes, for some, absence does make the heart grow fonder.

On the other hand, there are military personnel and their spouses who realize they at least partly actually prefer that they are separated by periodic deployment. And indeed, for some, their relationship and their lives work as well as they do precisely because there are periodic deployments—and both partners (or only one) prefers it this way.

Of course, you also must pay close attention to what is going on with your veteran partner recently returned from deployment overseas. The vast majority of veterans who are recently returned from war appear to be all right, do not want to dwell on what has happened to them while they were in the war, don’t want to spend much time talking about it, thinking about it, or feeling about it. Rather, they want to put it aside, deflect it or bury it and get their lives back. This is normal and expectable.

There is a substantial sub-group of returned veterans who remain totally or partially preoccupied with the war and what happened, are obviously impacted about what they have experienced, are either sorely troubled and/or become quite isolated. Ironically, most of this group, similar to the first group, also does not want to dwell on it, don’t want to talk about it, think about it, or feel about it. They too want to put it aside, deflect it, bury it, as a way to get their lives back to normal.

There is a third sub-group who revel in/savor the war, miss it, yearn for it, talk or think about it a lot—to the point that it interferes with living in the here-and-now with you. This group is probably very resistant to changing anything about themselves, may not really like much about normal civilian life, and make it very difficult for you to connect with them in a meaningful way. Or, they feel stuck and don’t know how to ask for help.

A smooth and successful readjustment may require a remarkable balancing act by both the returned service member and the family. The veteran is responsible to be aware of when he or she is struggling with deployment-related issues and problems, and doing something about it. However, the service member may be in denial about this.

And so, the family may have to decide if it is necessary to confront the service member about his/her denial and/or do a balancing or juggling act to some degree between and amongst the array of competing needs and wants of the veteran, partner, any children and any involved extended family members. If and when do you need to become more assertive with your concerns to your veteran partner and not just allow a bad situation that is not showing much sign of improving to stagnate or become entrenched and chronic. Did anyone say that life was fair?

The vast majority of vets who are trying to deflect, deny, minimize or bury what has happened in the war and what may be going on inside themselves about the war, may need a wake-up call about their denial and avoidance. This might be from a close friend, religious confidant, and/or perhaps from the partner. The family may have to decide if you are willing to do what you have to do to stay – or get – skilled at balancing patience and persistence, diplomacy and assertiveness, and giving to your veteran partner while also being vigilant to taking care of your and your family’s needs and wants. This is not an easy row to hoe, and why getting assistance and support for you may be very advisable.

--Used with permission.

PTSD Trauma for Veterans and Their Families is Predictable - "The Generic Effects of Combat"

In an article from Australia, there's a great quote about combat trauma/PTSD, and its very ordinariness.

(The article's topic is how "mental health problems caused by war service afflict veterans' families and children too.)  One of the premises of the article is that, based on a study, "Sons and daughters of Vietnam veterans are three times more likely to commit suicide than those of similar age in the general population (Australian Institute of Health and Welfare 2000, Suicide in Vietnam veterans' children: Supplementary report no.1).  According to the same report, "They are also more likely to die of accidental death, experience depression and abuse alcohol or other drugs."

That's the overall pretext for the article.  However, now comes the excellent quote, with a bit of preamble from the article itself, linked here:

According to Professor Hedley Peach, conducting research into veterans' sons and daughters is vital, not only to examine in detail the reasons behind their poor health but to set up support services that work for them.  He is also eager for doctors to consider war service when treating patients, as in many cases it could help diagnosis ....  Peach, a member of the scientific committee advising the Government on the feasibility study and professorial fellow at the University of Melbourne, says the Government should also consider studying grandchildren of Vietnam veterans to avoid more problems spiralling down through the generations.

''If the sons and daughters have got mental health problems and have young children themselves, what effect will that have on the grandchildren? We have to break the cycle.''

He suggests stressful familial environments could be behind the children's mental health problems, already highlighted by existing research. While many people with mental illness have a genetic predisposition to their condition, veterans were screened for mental illness before they went into the service, making stress a more likely factor in the children's ill health.

''In studies done by clinical psychologists running PTSD clinics for Vietnam veterans, children have reported a high level of dysfunction in families,'' he says. ''When we focused on Agent Orange so much in the past we missed the bigger picture. We are seeing the same sorts of problems in veterans of the Iraq and Gulf Wars, and fighters in World War II are now saying they suffered from the same problems. It is not due to any specific war, it is the generic effect of combat.''

Thanks to Kathie Costos for this reference...

Survivors Quilt: Combat Veterans Patch Meaning Together in Quilts about PTSD, War and Loss

You've heard of survivors' guilt - here we've got survivors' QUILTS.  (Bad pun, I know -- but true.)

We've been talking a bit lately about art therapy, and how combat veterans with PTSD use it successfully to tap into, and work through, some of the pain they feel inside. The photos here, by Mike Kane, at the Seattle Post-Intelligencer, are from a story published on March 19 about how the inpatient PTSD program at the VA hospital in Seattle has a "wall" of quilt squares, made by combat veterans, and encouraged by a nurse, Betsy Shapiro (she's at right, above), now retired, who gave deeply hurting veterans 6x6" cotton squares, on which to draw something or paint something that related to their experience: something they could leave behind, to let others know about them and what they had gone through. 

Initially, there was moaning and groaning, and reluctance to comply.  But shortly thereafter, everyone produced something, and the results were really pretty impressive.  The veterans also gave input into how they wanted the resultant squares displayed -- not set in pretty frames, like squares in a regular patchwork quilt might be, but together, side-by-side, touching.  The article, by Mike Barber, is called "Veterans tell stories in patchwork of memories," and it's linked here.

In an earlier article, from the Honolulu Advertiser from October 2, 2007, linked here, Glenn Reys, an Air Force vet in Honolulu worked through his recovery from drugs and alcohol by immersing himself in making a Hawaiian quilt, symbolic of his homeland, but also incorporating patriotric U.S. symbols.  He found himself devoted to the practice, and able to quilt for hours at a time.  "This kept me busy," Reys said. "When I do sewing like this, I can sew for like six or eight hours, and it's no problem. That's what I do in my continuing recovery."

In one of the best articles I've read about a Vietnam vet, Cecil Ison, struggling with PTSD, the author, Kathy Dobie, talks about visiting his home in Kentucky and watching his wife, Bet, a quilter, work on a quilt with Vietnam themes. Cecil and his two brothers all served in combat in Vietnam, and each responded in a different way.  Cecil's wife, Bet, attempted to capture her view of what they suffered in the quilt, turning an abstract -- feelings about the war, and the isolation it produced -- into something very concrete -- the quilt. She says that the quilt is too painful for Cecil to address directly, but through it, she is able to give vent to some of her feelings, about what she has watched her husband and his brothers go through.  Kathy Dobie writes:

[Cecil's wife, Bet, and I are spending time one afternoon.] We’re talking upstairs in the sewing room while she works on her Vietnam quilt. The room is stuffed with fabric: tweeds, cottons, velvets, hundreds of men’s ties. Bet sews at a small table by the window. She listens to oral histories of Vietnam veterans as she works. On the left side of the quilt is an army-green map of Vietnam, showing the three cities where James, Cecil, and Arnold served. The rest of the quilt is blue, and three male figures float there, separated from one another and bearing labels: anger, despair, and guilt. The quilt reads: "my husband and his brothers came home from vietnam…three islands in an ocean of silence."  James is the Angry one, Cecil the figure of Despair, and Arnold is Guilt.

(This is the quilt in question, pictured to the right.  From top to bottom, you can see "Anger," "Despair," and "Guilt," and "Vietnam" is written lengthwise, on the left.)  Quilt copyright Bet Ison.

Below is another quilt with Vietnam imagery by Bet Ison.  Both quilts are copyright Bet Ison, and property of the author.  Photos are shared with Bet Ison's permission.

(The article by Kathy Dobie article in GQ, is called "The Long Shadow of War," and we blogged about it earlier, here.  Dobie is also the author of the excellent article in the Nation, recently, called "Denial in the Corps" -- about Marines and the stigma of mental health issues, including PTSD, which we've also blogged about, here.)

Quilting is a uniquely American tradition.  Not that other countries haven't had their own versions of it, but it's uniquely tied up in the "fabric," as it were, of American history.  There are so many examples, from crazy quilts made of just scraps of silk, satin and wool garments, patched together on wagon trains as Americans headed West, to quilts made from flour sacks by pioneer women, to Civil War era "album quilts," to today's photo transfer quilts.  Quilts are often about "making do" with just the materials available, and there's something therapeutic about the needlework involved.  In 1837, American writer Nathaniel Hawthorne wrote in The Scarlet Letter, "Women derive a pleasure, incomprehensible to the other sex, from the delicate toil of the needle."  Well, by the 1970s, even he-men like football great Rosey Grier had picked up the needle, though not necessarily to quilt (he favored needlepoint instead).  Quilting is an unusual 3D art form that combines texture (the fabric, and the stitchwork) with color and design, and has a long and storied American history, besides.  It's interesting that combat veterans and their loved ones would find an outlet for some of their feelings in quilting.  Whether it's a square, a bed quilt, or a wall hanging, quilting allows for freedom of expression, and a form of "art therapy" that may just help those who are hurting to focus and transform their experience into something physical that they can share with others. 

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Editor's Note: If you want to continue this conversation about quilting and paying homage to a combat experience, your own or someone else's, email tributequilts AT gmail DOT com. 

SSgt. Travis Twiggs - Well-Loved U.S. Marine and Hurting PTSD Hero - the Update

It's nice to know that the exceptionally tragic story of PSTD sufferer and well-loved Marine SSgt. Travis N. Twiggs hasn't completely faded from view -- a story we broke here, days before the national media even picked it up.  This weekend it looks like the Times-Picayune has a two-part series about Twiggs on the NOLA.com website, linked here, and the story is both well-written, and contains - gasp - actual reporting, including conversations with the dad and stepmom, both Louisiana residents.  (The Twiggs brothers spent their formative years in Ama, Louisiana.)  It's a shock to me that CNN never covered the Twiggs story -- although they did cover the story of the Marine on leave who was murdered over $8 in his pocket.  I guess the fear-mongering, anxiety-producing shock value of that "news," while terrifically sad in itself, beats the prospect of actually covering a story with some complexity and depth, in which we as Americans could stand to learn more about the life and background of an American hero whose death we mourn.  Weird values, CNN (or maybe complete lack of them...)

One nice development since our original reporting on this story, back in mid-May when it happened.  The Marine Corps Gazette, which originally published Travis Twiggs' story about his battle with PTSD, put the article back in print.  It's available on their website now, linked here.  And they added a nice little blurb about mourning his passing and extending their condolences to his family, which is appropriate.  It also sounds like there was a Memorial Service for the extremely well-loved Staff Sergeant at Quantico a week ago, which allowed his fellow Marines and those he'd come in contact with over the years, to pay their respects.  Also a very nice, and well-deserved touch.  (So much better than just sweeping the whole situation under the rug, because it had such a tragic ending.)

Other nice developments include hearing more from Travis Twiggs' wife, Kellee, about her husband's ongoing and difficult battle with PTSD.  We've blogged about her here and here, and those entrees are well worth reading, to learn more about the spouse and family's battle with PTSD, since it ultimately involves them very much.  Kellee is an impressive American hero herself, and their two lovely girls will now grow up without their dad -- and with undoubtedly many questions about why he had to die -- because of this terrible opponent he faced, which ultimately defeated him.  (And don't think they won't struggle with that: research has shown that PTSD does have consequences into future generations.  We've blogged about that elsewhere here.)

It turns out that Kellee Twiggs and Travis Twiggs went way back, and had known each other since childhood, though married for the last decade. In other words, a wife who really knew her husband, and what was, or wasn't, normal for him to be like, behavior-wise.  I still remember some of her first words from a tv report, on learning of her husband's violent death in Arizona.  It's from an audio clip, and she's obviously upset, and her words at the end just trail off, like she's debating about whether she can even say what she's wanting to say. The quote?  "He was sick, mentally. with PTSD. and this is the result of it.  He now leaves me, and two beautiful daughters, because NOBODY in the Marine Corps, here at Quantico, wanted to take the time..." To do what?  Here's where it gets so difficult...

To listen? PTSD sufferers often don't want to talk about what they're really going through.  A note from someone who was undergoing treatment with Travis at Bethesda let me know that as great a guy as Travis was, and he really WAS, his friend emphasized, he definitely didn't want to talk about his down times.  To treat it?  Sounds like Travis Twiggs had gone through multiple forms of treatment for his PTSD, but none of them were effective -- and that's pretty par for the course, in some ways.  The current thinking seems to be, hand someone a handful of pills -- at one time, Travis was taking 19 different medications -- and hope for the best.  There was some counseling involved, but it sounds like very little -- and the whole emphasis of the medication is on "forgetting" or "blurring out" (numbing out) the memories -- so when you're on the medication you're pretty much a zombie (his wife speaks of his being -- great made-up word -- in "comatose-dom" while he was on medication), and when you're off, why, the memories of what you're trying to forget just come flooding back.  Intrusive memories (meaning, you get them when you don't want them) are a hallmark of PTSD.

And Twiggs had some memories he was very much trying to forget.  Not things that he was at fault for, per se -- but things that troubled him at the deepest possible level, and for which he felt some, perhaps unfounded, responsibility.  His loss of "two of his boys" --  Lance Cpl. Robert F. Eckfield, Jr., 23, from Cleveland, Ohio, and Lance Cpl. Jared J. Kremm, 24, of Hauppauge, N.Y., who died on October 27, 2005 from an "indirect fire explosion'' in Saqlawiyah, Iraq. (Kremm died at the scene of the explosion, and Eckfield died of injuries later at a battlefield medical center where he was evacuated.)  Twiggs felt, whether accurately and wisely, or not -- the burden of their deaths -- as a form of guilt he never overcame.  And here's where I wonder whether the Marine Corps' heavy emphasis on never leaving a brother behind, while laudable, can also be overdone a bit -- to the point that someone with a sensitive conscience -- for lack of any better way to describe it -- can't manage the pain afterwards of realizing some died on his watch.  "Everything in balance," the Taoists used to say -- and that includes troubling, painful emotions like grief.  In a heartbreaking, terrible situation like this, you can perhaps see why.

I've been reading Raymond Scurfield, DSW lately -- in particular, A Vietnam Trilogy: Veterans and Post-Traumatic Stress: 1968, 1989, 2000 -- and some things really never change, including the nature of combat, and its affects on those who suffer its obvious trauma.  (Scurfield, a social work professor, worked for years with the VA on PTSD, and started his career as a social work medic in Vietnam.)  At the very beginning of his book, he talks about meeting a (deranged) Marine, who'd had a serious psychotic breakdown in Vietnam.  In moments of lucidity, this Marine would plead, in absolute anguish, for Scurfield to help him get back to Vietnam to rescue his buddies -- buddies he had left behind.  But this Marine, unlike Twiggs, had deserted his guys -- or at least believed that he had.  Desertion in the actual military sense of the word.  Not so, Twiggs.  The Vietnam-era Marine cried out to Scurfield the social worker, "I have got to get back!  I let my fellow Marines down terribly [when he broke down and was medically evacuated.]  I have to go back -- to prove that I am a man!  Can you help me, to get back?"  Even 40 years later, you can still hear the anguish of that man's cries.  AND his confusion over whether he'd actually deserted his men, by getting so sick that he had to leave.  Scurfield writes about what a tortured experience that was to go through, because he knew that the man of course was never going to be able to get back, in his present condition, and would likely be broken by the guilt he felt about the matter.  "He could never make right," Scurfield writes, "What I later came to understand, is perhaps the most unforgiveable and egregious shame that can befall any combat soldier -- 'deserting' or otherwise letting down one's buddies in the heat of battle."  ("The image of this tormented soldier stays with me still," Scurfield concludes.)

Of course, Twiggs wasn't guilty of deserting his buddies in battle -- they died because they were attacked, and he was powerless to prevent their death.  But that wasn't the way he looked at it, apparently -- and an additional "head trip," that probably only added to this -- was the event Twiggs talks about in his PTSD essay, where unbeknownst to him, some of the first people he met upon hitting the ground at the homecoming ceremony for his battalion, just back from Iraq -- were the FAMILIES of those two men, who he apparently was not expecting to see.  Apparently seeing them in the midst of an otherwise mutedly joyful occasion just further seared into Twiggs' mind that the reason those guys weren't here with the rest of them was somehow, inexplicably, his fault.

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I do think this is where the Marine Corps needs to bear some responsibility, unless it already does, for right training on the matter - again, a matter of "balance."  OF COURSE you want to do everything in your power, from boot camp all the way through repeated deployments -- to keep your buddies alive and as safe from harm as you can make them -- but the important points are, taking responsibilty for only what's within your power to have happen (disregarding fate), and, realizing that beyond obviously, we're talking combat here, and people are gonna die.  It seems like both sides of that coin -- care for your brothers, and understanding that not everyone comes back alive -- are equally important, and maybe only philosophical, sophisticated thinkers can balance both sides of that concept at the same time.  I'm not making fun here, a favorite Marine officer who was grievously wounded in Iraq once told me that he thought the ability to balance two contradictions in your mind at once, without denigrating the importance of either, was high intelligence indeed.

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I know that the Marine Corps includes Sun Tzu's famous Chinese classic on the art of military strategy, The Art of War, in its Commandant's reading list -- that every Marine reads through, appropriate to his or her grade -- but it might be a good idea to broaden the exposure to what other Taoists think, since they're such admirable realists about the dual nature of life.  (Curiously, Taoism is such a non-possessive school of thought that someone can be a practicing Catholic, Unitarian, Wiccan, or no religion at all, and not find a conflict of religious "allegiance".)  Here's what one latter-day Taoist philosopher and poet had to say about the compulsive nature of intrusive thoughts and worry, and it relates directly to what Travis Twiggs and others underdo all the time, in combat and its aftermath.  "Worry is an addiction that interferes with compassion," writes Deng Ming Dao in 365 Tao, and continues, "Worry is a problem that seems to be rampant.  ... Whatever the source, it is clear that worry is not useful.  It is a cancer of the emotions -- concern gone compulsive.  It eats away at body and mind."

"It does no good to say," he continues, "'Don't think about it'."  You'll only worry more.  It is far better to keep walking your path, changing what you can.  The rest must be dissolved ... In this world of infants with immune deficiencies, economic imbalance, personal violence, and international conflict, it is impossible to address everyone's concerns.  Taking care of yourself and doing something good for those whom you meet [and serve with?!] is enough.  That is compassion, and we must exercise it even in the face of overwhelming odds [combat?!].  Whenever you meet a problem, help if it is in your power to do so.  After you have acted, withdraw and be unconcerned about it..."  (Not to belabor the obvious, but not "unconcerned" in the sense of "we don't care," unconcerned in the sense that, we've already done what we can, and let's not continue to ruin more lives in the process, with needless worry...)

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Back to Ray Scurfield, for a moment.  Isolation is a hallmark of PTSD, because of the very real risks that NOT isolating yourself from others, in combat, creates.  Unfortunately, it's hard to turn this skill "on" and "off" like a light switch.  But in combat, you bond heavily with others at your (eventual) peril.  It's possible that SSgt. Travis Twiggs, well-loved by his Marines and his family, just didn't "get" this, and it's part of what eventually killed him, when he broke under the strain of his perhaps misplaced guilt and PTSD.  Writes Scurfield, "Indeed, the bonds formed during war can be so powerful that men become closer than brothers.  Unfortunately, this is a two-edged sword.  Brothers-in-arms protect each other, look out for each other, help to get each through the war." "On the other hand," he continues," if something happens to your close buddy, it can be devastating.  Many vets talk about how, at some point during their war tour, they suffered the tragic loss of someone whom they had let themselves get close to; the impact is profound."

Scurfield includes a story from a suffering Vietnam vet who did just that, to drive home his point.  Scurfield retells the story in the man's own words: "I had been warned by some of the seasoned vets not to let other people get close to you -- "because it hurts too much if something happens to them."  In spite of my better judgment, I did get close, real close [to another veteran, during combat] ... [He] and I got closer than I have been with anyone before or since; we became as close as any two people could possibly be."  And, after [his buddy] got killed, I hurt so bad...And I knew right then, I was never going to let anyone get close to me again.  And I didn't. I looked out for number one. Period."

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"A great guy, a horrible tragedy"

Travis Twiggs, who from all accounts was a very big-hearted, loving guy, apparently never did close himself off like the Vietnam vet in Scurfield's account did.  If you know anyone who knows Travis Twiggs, you know that he was a well-loved guy.  His Marines loved him, his wife loved him, his family loved him -- heck even his landlord loved him, and people he'd just barely met -- even when his PSTD was full-blown.  And if that isn't a testament to what kind of guy he was, I don't know what is.  (His landlord in Virginia, "Mr. Bob," as his Twiggs' wife, Kellee, sweetly calls him, the head of a famous international philanthropic organization in the D.C. area, basically broke all land-speed records trying to get the word out, after Twiggs' death, that he was being mischaracterized in the media as a violent criminal, when in fact he was the sweetest and warmest guy imaginable, who literaly would do anything for anybody.  Many who knew Twiggs seemed to feel the same way.)

One of the true delights of having broken this story early was hearing in emails from people who did know Travis, and let's just say for the record -- it was all good.  Here's one of the best ones I received, though, from a professional guy in Washington, D.C., who spent some time in the same ward at Bethesda as Travis Twiggs did, back in March of this year (the same time period where I was trying to get in touch with him, and getting worried about what his silence actually meant.)  Here's what this guy had to say:

"In the two weeks I was there as a patient, I got a chance to know Travis. Travis was a great guy, he had a heart of gold and would befriend anyone. The staff loved him - he had been there the longest (two months). While I was there, I had a few conversations with him - mostly about what his current duty was and his plans for discharge. While he was a outwardly friendly guy, it was clear he was also in a great deal of pain (I never asked him the details of his PTSD - one learns quickly that those are depressed (like me) can talk more openly than those who have PTSD - who typically are reluctant to open up). So, I did not know the extent of his pain, just that he was in alot of pain. When he was in pain, he tended to withdraw. When not in pain, he was quite lively and was always the center of attention. I think he really wanted to get better and heal, but just got caught in a bad situation and did not reach out to those who could have helped. I don't know anymore beyond what I have been told and what I have read. Like I said, he was a great guy and this is a horrible tragedy.

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I know I spent quite a bit of angst in March wondering what had happened to Travis Twiggs, well before his untimely end, and hoping I could get in touch with him -- both to see how he was really doing (I had my doubts), and to see if I could republish his original article from the Marine Corps Gazette, in full -- because I believed it could greatly help other veterans who were suffering.  I got an email back from him -- an autoreply -- mentioning another email address of his, referencing "War Pig."  It made me curious just what was behind this "War Pig" reference -- was his battalion nicknamed that, like Eric Acevedo's had been nicknamed, War Dogs?  (It wasn't.)  Did it have to do with some fondness for Light Armored Vehicles?  (Also nicknamed War Pigs.)  That seems a bit much, even for a Marine :-)  (No, it turns out it wasn't.)  Or did it maybe have to do with some lyrics from an old "Black Sabbath" song called War Pigs, which Twiggs was himself old enough to remember?  But those are pretty anti- at least the insanity of war, pretty un-likely for a guy who'd been a career active duty Marine.  (Twiggs was such a gung-ho Marine that, on top of his five deployments(!), he'd actually left the Marine Corps at one point -- and come back!)

It turns out there's a much better story to what "War Pig" signifies, told by a Twiggs family member.  Apparently when Twiggs served in Cuba, he was up so many days straight being a Marine, doing his duty, that when he finally got to sleep, he slept for literally days.  So long, in fact, that a commanding officer wrote a sign and stuck it over his sleeping form, "Here lies the War Pig."  Indeed.

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It's heartbreaking that Travis Twiggs, straight-ahead U.S. Marine, loving father, husband, son and brother, leader of Marines, hospitable neighbor, friend of many, including those he'd barely met -- lost his painful, deeply personal struggle with PTSD.  It's especially heartbreaking to think of how much of the trouble he suffered seemed to revolve around the loss of his guys -- a loss he would have been powerless to prevent, and for which he had suffered, and grieved, already enough.  The rending cruelty of PTSD is that by his own dying, not only did he not take the pain of his Marines' losses away, but he also actually added to it, with his own.  Now his Marines grieve, but also his family grieves, and everyone has to go forward without him, who was heavily there for others, but ultimately couldn't be so for himself.

There are a lot of lessons from Travis Twiggs' needless death from PTSD, and I don't think we're in any position to realize all of them, yet.  Or to attend to them, and "fix" their consequences, so things like this don't happen anymore.  We're sadly still a long way off from that.  One "clue" in all this was left by Travis himself: that a handful of medications doesn't really work to solve the problem, if the underlying felt problem is guilt.  All the medications do -- besides complicate matters -- is keep the patient numbed out, but not capable of working through his very real torment.  Take away the medications, some of which are probably vital, but not all -- and the torment is right where it was before, more or less unchanged.  More needs to be done to uncover the roots of PTSD -- who gets it, and why, and most of all, how to treat it, successfully -- but whatever ends up being the "magic bullet" will undoubtedly be a combination of things: medication, talk therapy, and even the seemingly far-fetched (see our recent series on Complementary and Alternative Medicine and PTSD).  It would be pretty Taoist to say, whatever ends up helping, let's use it, because what we care about is not what type of solution it is, but how much it helps those who are suffering, in the throes of it.  We can already tell what doesn't work, which is pretty much the status quo: a handful of medications to mix (against the rules) with drugs and alcohol, combat veterans' frequent and very understable choice.

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At the risk of oversimplifying things, what's killing veterans with PTSD is what they can't forget, and what they feel somehow responsible for seeing, doing, experiencing -- or not, in some cases.  It's this responsibilty that may be ultimately wrongly placed.  As combatants, they're just doing the best they can, under the circumstances.  In war, more so than any other situation on earth, it's pretty clear that sh*t happens, and that's hard enough to deal with, without going away thinking for years that it's your fault.  Maybe it's time to cut back a little on the gung-ho warrior's creed of never leaving a brother on any level, because it's messing with people's heads when they ultimately have to, through no fault of their own.  Couldn't at least some sort of balance be taught?  You want to give your all for your brothers (and sisters), but when stuff happens, and you can't, you've done things to the best of your abilty, and maybe you can let it go -- let IT go, not THEIR memories.  Again, a powerfully difficult concept to live -- but nevertheless, an equally powerfully freeing one. "Right thinking" needs to become part of right warfare -- because the casualties of not having that are starting to become really obvious.  Far more young guys (and women, but mainly guys) kill themselves as combat veterans when they just can't take it anymore -- it's much less common when older guys do.  At 36, Twiggs was older than many Marines he served with.  Undoubtedly, he felt that only added to his responsibilty.  But even this week, there are stories in the news about older OIF/OEF veterans who have killed themselves from PTSD -- one is an Army major in the Midwest, who was about to get orders to go back. 

So the horrible finale of PTSD -- suicide -- while primarily a young servicemember's act, is by no means limited to them.  (We're in the midst of blogging about this topic; look for more on this, later.)  We're also dealing with an all-volunteer military that has an average age that is strikingly quite young.  The one career Marine I know who's been deployed almost as many times as Twiggs was, but did get help for his PTSD -- did it because he knew that without it, he was affecting his family too much.  Extremely commendable.  He got the help, and stayed a Marine.  And he's still alive today.  Twiggs, whose case may have been worse, tried some to get help, and couldn't get past what was killing him, despite his love for his family, and his Marines.  It's a sad, sad tale that ends this way, with the crushing feeling that it really didn't have to, but how?!!  I'm glad that more all-encompassing coverage is finally being given to who Travis Twiggs was, not just how he died -- but I can't help thinking about his death, and how, "Here Lies the War Pig," finally getting his rest, at last, is at least as fitting a tribute, as any.

Travis Twiggs' Widow, Kellee, Puts a Human Face on the Suffering of PTSD

I come away just so impressed with Kellee Twiggs, the grieving, sympathetic widow of the late USMC Staff Sergeant Travis Twiggs, who passed away recently, one might say, from PTSD complications, after a long and difficult battle with that powerful adversary.  Kellee was as much in the dark about the events immediately leading up to Twiggs' suicide as anyone else watching this painful scenario unfold; but she was and is very clear on the ravages PTSD took on her wonderful husband, who she dearly loved.  There's been a great raw video interview footage on the Web for the last few days of Arizona tv reporter, Suzanne Kennedy, interviewing Kellee Twiggs about PTSD and her husband, Travis.  Because it's unclear how long that video will stay on the Web, and also because so much of the Twiggs' story is worth knowing, I took the time to create a transcript of the interview, a downloadable copy of which is available here, Download transcript_of_kellee_twiggs_interview.pdf.

In the interview, Kellee Twiggs, who I very much hope has a future as a patient advocate, given what she's gone through, and how personally she knows the ravages of PTSD in a combat veteran's life, comes across very well -- as a kind, sympathetic, reasonable person, who ultimately feels that the Marine Corps did not do enough to save her husband's life (and that the current courses of treatment for PTSD -- at least the ones Travis was exposed to, with their emphasis on locked wards and overmedication with a slew of pharmaceuticals -- aren't the most effective treatments possible.  From her vantage point, they were tried with her husband, and they just didn't work.  Is her point of view that of a treatment professional?  No.  But it's very much as someone who loved her husband, and cared what he was going through -- and ultimately saw the system fail.  One of the most interesting parts of the video to me was how she isolated the need to address the guilt that her husband felt, and was apparently unable to overcome, from letting others down.  It's a very interesting video interview.  Watch the entire clip, here; or read the transcript, linked above.  And keep the Twiggs family in your thoughts and prayers this Memorial Day and after.  It's hard enough to be a military family with a deployed servicemember.  It's even harder to be a military family grieving a terrible, combat-related loss, as the Twiggs are presently.

Hey Mama: Celebrating Mother's Day for Veterans

Happy Mother's Day to the mothers who've served in combat, and to the mothers, stepmothers, grandmothers, and adoptive or foster mothers of those who've served, not to mention the wives and girlfriends of combat veterans.  The veteran pays a heavy price for his or her sacrifice; but so do the generally unsung heroines on the homefront.  They're the ones struggling to make sense of the distance and loneliness; trying to hold down a job to keep the family afloat and tend to the children as well; and they're often called upon to pitch in as 24/7 caregivers or patient advocates when the need arises after injury.  Some of these women who we know personally are truly amazing role models, and due an enormous debt of gratitude and respect.  However, they're ALL worthy of appreciation for the mighty roles they fill.  Let's hope this Mother's Day they get just some of the gratitude they deserve.

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One veteran's mother, Frances Richey, did something unusual.  She wrote a book of poetry about being the mother of a son at war, called The Warrior.  Amazon.com, in its product description, calls it "A heartwrenching and powerful memoir in verse from a mother grappling with the reality of her son at war in Iraq."  Richey, a single mother, raised a son who went through West Point and became a Green Beret, serving multiple tours in Iraq.  Recently, the Seattle PI wrote an article about the book, called "Mother's poetry illustrates the pain she felt while her son fought in Iraq."  Click here for a link to the book, and here for a link to the article in the Seattle PI.   

"Abandon Hope, All Ye Who Enter Here..."

It sounded like potentially good news for veterans and their families at the time, but I'm wondering if it ever really happened.  Human guides were proposed to lead wounded veterans through the maze of healthcare.  On November 1, 2007, the Kaiser Daily Health Policy Report published a news item called "DOD, VA Team To Provide Care Coordinators for Servicemembers, Veterans."  These "Federal Recovery Coordinators," as they were termed, were established "to help veterans with health care and recovery." 

According to the Kaiser Daily Health Policy Report, the Department of Veterans Affairs and the Department of Defense would establish “federal recovery coordinators” responsible for helping guide wounded servicemembers and veterans through their health care and recovery.  Apparently this was an idea introduced by the Dole-Shalala Commission, although it also could be a common sensical approach conceived of by any overburdened friend or family member of an injured veteran.  The concept was that ideally these coordinators would not just aid their clients in navigating the healthcare options available to them, but also produce better coordination between the two departments, Defense and Veterans Affairs.  Strangely enough, the goal to have ten coordinators trained and ready to go by January, 2008 -- a mere two months later -- and in place at the largest veterans healthcare installations. 

It's mid-2008, and I don't know about you, but I've not heard another thing about this.  Do they exist?  Was the plan scrapped because it was too ambitious or otherwise untenable?  Are they out there, but keeping a very low profile?  Inquiring minds want to know...

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This is what the Kaiser Report said at the time:

The departments of Defense and Veterans Affairs on Wednesday signed an agreement to establish "federal recovery coordinators" who will be responsible for guiding wounded servicemembers and veterans through their medical care and recovery, the Washington Post reports. The recovery coordinator position was a key element of a presidential commission's recommendations to help improve health care services for military members and veterans returning from the wars in Iraq and Afghanistan (Vogel, Washington Post, 11/1).

The coordinators will be responsible for overseeing care coordination between the two departments' health care systems, and they will assist family members as well (AP/Contra Costa Times, 10/31). The first 10 coordinators, who will be provided by VA and trained by January 2008, will be assigned to large military health care facilities. Michael Dominguez, principal deputy undersecretary of defense for personnel and readiness, in a statement said, "This agreement will help ensure our nation's wounded warriors and their families receive the care they need and deserve at the right time, right place and by the right person across the continuum from recovery through to their reintegration into their communities" (Washington Post, 11/1).

All we want to know is, then what happened?

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Editor's note: for all the non-literature majors in the crowd, the title comes from Dante's Divine Comedy, and is supposed to be what the poet imagined was written over the gates of hell.

Kathie Costos, Chaplain

Kathie Costos, also known as "Nam Guardian Angel," is a certified, ordained Chaplain and member of the International Fellowship of Chaplains ("IFOC").  The daughter of a Korean War veteran, and the wife of a Vietnam veteran, she has been active in veterans issues since the 1970s.  For the last 25+ years, she has focused on Vietnam veterans with Post-Traumatic Stress Disorder.

As a chaplain with a devout Greek orthodox background, Kathie nevertheless believes that "no matter what church people belong to, they belong to the family of God as God's children."  Years of volunteering with Vietnam veterans and their families has taught her to take care of the spiritual needs of people and not just the already "faithful."

Kathie is the author of a well-regarded book, called For the Love of Jack, His War/My Battle -- about how her family coped with the legacy of PTSD that her husband returned with from the Vietnam War.  She self-published the book immediately after 9/11, out of concern that the word needed to get out about what PTSD was, before many more people began to suffer from it.  The book is available for downloading on her website, and Kathie has also produced many educational videos about PTSD that are also available on her website.  A list of those videos include the following, but because Kathie is always expanding the list of videos she's made about this topic so close to her heart, it also makes sense to "favorite" her on YouTube, where a list of all her videos is linked, here.  A list of those videos current as of this writing include the following (each is hyperlinked to YouTube or Google video, so you can watch them directly):

• Wounded Minds: PTSD and Veterans (Google)
• Coming Out of the Dark: PTSD and Veterans
• When War Comes Home, Part One
• When War Comes Home, Part Two
• Hero After War
• Death Because They Served - PTSD Suicides (Google)
• Wounded and Waiting, Part One
• Wounded and Waiting, Part Two
• Women At War
• The Voice, Women At War
• Nam Nights Of PTSD Still
• PTSD After Trauma
• PTSD Not God's Judgment
• Homeless Veterans Day

A link to Kathie's website about PTSD is here.  For a direct link to the book she wrote about her husband and family surviving PTSD, click here. For a link to her ever-expanding list of videos about PTSD and veterans, click here.

A favorite quote of Kathie's: "The willingness with which our young people are likely to serve in any war, no matter how justified, shall be directly proportional to how they perceive veterans of early wars were treated and appreciated by our nation." -- George Washington.

Helping Families to Recognize Veterans' PTSD

The Northern California news website, InsideBayArea.com, has a good article in today's edition, entitled, "Families Can Help Spot Vets' PTSD."  Click here for the link.  The article quotes Byron J. Wittlin, M.D., Director of Mental Health Services at the VA Clinic in San Bruno, CA.  Says Dr. Wittlin, "I think it's crucial for (military) family members to be aware of the potential mental health problems of their loved ones."  It's great to see the VA doing outreach to family members, who are in a unique position to see for themselves veterans' difficulties readjusting to life after combat.  (For a very good video about veterans, PTSD, and readjustment issues, click this link to an earlier blog post, where we highlight the "PTSD and Veterans: Beyond the Yellow Ribbon" video put together by the Norfolk County District Attorney's office, in Canton, Massachusetts.)

The article covers some important topics, including typical PTSD symptoms, veterans' reluctance to seek care, the perceived stigma surrounding mental health issues, and whether or not a loaded gun is wise to keep in the house.  Wilkins offers some hope about PTSD, that sufferers can get better.  And while he acknowledges that it takes a trained expert to actually diagnose PTSD, family members can play an important role in moving that process along, and encouraging their veteran to get help.  According to the article, "We encourage family members to be supportive, to mainly listen," Wittlin said. "And if they feel the vet needs some help, to call the VA and to refer them into us. This is really a complicated problem. And in our system, we have a lot of experience. And this is one of the services we want to offer."  Excellent news, for veterans and their families.

Editor's note: The Dept. of Veterans Affairs facility in San Bruno, CA is linked here.

Words of Wisdom for Veterans from Down Under

The Vietnam Veterans Association of Australia -- whose excellent motto, "Honour Those Who Died, But Fight Like Hell for the Living," we strongly agree with -- is a good source of information on the Australian government studies on the health of Vietnam veterans and their families.  These are important studies for any number of reasons, but for our purposes, because they make the point that combat trauma affects not just the veteran but also his or her family, and transfers effects into the next generation.  Their extensive information about the original Australian study, first published in 1998, is linked here.  They comment: "The responses themselves tend to support the hypothesis that the health status of the veteran has an effect on the health status of his immediate family."

Here are some specifics: "36% of veterans report that service in Vietnam, or health problems arising as a consequence of their service in Vietnam, have had a serious adverse effect on current or past partners.  Some 40% report physical or psychological health problems in their partners that they feel may be related to the veterans' Vietnam service.  Stress (40%), anxiety (34%), and depression in partners are the most commonly cited conditions.  Thirty nine percent (39%) of all veterans with partners report that treatment has been required for these conditions.  Those with greater length of service in Vietnam report higher levels of problems."

Though they noted that "the report notes difficulties that may have affected the accuracy of reporting and the accuracy of the comparison data" regarding the children of veterans, they found that settling those difficulties and verifying the results was an urgent matter, because the study concluded that, besides physical consequences to veterans' children (e.g., birth defects, etc.), that "deaths from suicide of children were reported at three times the expected rate, and deaths from accident or other causes were reported at twice the expected rate."

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The Australian Broadcasting Corporation did a news segment on "The 7:30 Report" on June 1, 2006, about these studies, called "Veterans Fear War's Impact on New Generations."  The main reporter was Natasha Johnson, and a key interviewee was Melbourne University professor Hedley Peach, an Australian public health researcher, and adviser to their government's Department of Veterans Affairs, who had spent two years evaluating the study.  Professor Peach remarked, "there's absolutely no doubt that the effects of war [are] not going to be confined just to the person who went to war."  The Australian study showed "significant mental illness among veterans also showed their children had a high rate of accidental death and a suicide rate three times that of their peers in the general community."  The problem with studies, Peach pointed out, is if they serve to simply describe the problem accurately.  It's the government who should "develop strategies in the meantime to promote resilience and break the cycle of mental illness."  The interesting transcript of that short program is linked here.  One result of the studies is that the Australian government has made counseling services available to all veterans and their families. The U.S. House Veteran Affairs subcommittee on health is contemplating expanding veterans' mental health care to families as well.  Read more about the Australian counseling decision in the PDF linked here.

Mental Health of Veterans' Family Members Deserves Attention, Too

Just a quick note to mention that Todd Bowers, Director of Government Affairs at the highly pro-active Iraq and Afghanistan Veterans of America ("IAVA") recently testified before the House Veterans' Affairs Subcommittee of Health about an additionally important topic: the mental health of veterans' family members.  The topic?  "Mental Health Treatment for Families: Supporting Those Who Support Our Veterans" -- that would make a great slogan.  (A few days later, the Christian Science Monitor also covered this topic, in an article entitled, "A New Push to Help Families of Veterans."  That article is linked here.)

It's no secret though perhaps it should get much more attention that combat trauma affects not only veterans but also those in their immediate families.  A veteran's suffering affects his or her family members significantly, as the burden of caregiving falls most strongly on the veteran's immediate family.  There are physical, emotional, social and financial costs to caregiving, not the least of which is strained mental health.  At least with Vietnam veterans, studies have shown that children of veterans with PTSD are at increased risk for suicide themselves. (Although it's the subject of some controversy, an Australian government study of their own Vietnam veterans concluded that children of veterans were three times as likely as the general population to commit suicide.)  It's great to see that the IAVA is making the case that more resources need to be allocated for families' mental health resources as well.  For more information on this important topic, see the IAVA blog entry linked here, or the House subcomittee's site, linked here.  For a link to the audio coverage of the hearings, click here.  For earlier blog posts on caring for the caregivers, click here; or about the family, click here.

Editor's Note: It's interesting to note that just today, the Australian government published its conclusion, that counseling services would be made available to their veterans and families.  To read more about it, download this PDF.  To learn more about the Australian Vietnam veterans health studies, click this link to a subsequent blog post.

Loving Someone with PTSD - How It Affects You

The VA has an excellent "Fact Sheet" devoted to the special problems and opportunities of PTSD in a relationship.  It's well worth reading.  Click here for the link.  The fact sheet is entitled, "Partners of Veterans with PTSD: Caregiver Burden and Related Problems," but the "related problems" are so many more than alluded to in that simple and generic title.  In the "meat" of the fact sheet quite a few topics are covered, including: marital adjustment and divorce rates; interpersonal violence and domestic violence; mental health of partners (because PTSD can have a negative effect on others, as well); and caregiver burden.  If you or a loved one suffer from combat trauma, please take the time to read and review this short but useful handout.

Why is this topic so important?  As the fact sheet says, "Research that has examined the effect of PTSD on intimate relationships reveals severe and pervasive negative effects on marital adjustment, general family functioning, and the mental health of partners. These negative effects result in such problems as compromised parenting, family violence, divorce, sexual problems, aggression, and caregiver burden."  That's a whole lot of important topics, with significant impacts on the individual sufferers, and their friends and families.

Aphrodite Matsakis, Ph.D., and Patience Mason have both written powerfully about the spouse and family member's experience of a veteran with PTSD.  Matsakis' most recent book is Back from the Front: Combat Trauma, Love and the Family.  It's somewhat of a restatement of her earlier classic, brought up to the present, called Vietnam Wives: Facing the Challenges of Life with Veterans Suffering Post-Traumatic Stress.  Patience Mason, who's devoted the last umpteen years to writing words of wise counsel to others about living with a PTSD sufferer, authored the classic, Recovering from the War: A Guide for all Veterans, Family Members, Friends and Therapists.  As Charles Figley, Ph.D., writes about the topic, these women both know "about living with someone with a disability (PTSD) that, like a disease, destroys people and their relationships with others."

Upcoming PTSD Conference on Care of Rural Veterans and Their Families

Geisinger Health Systems of Danville, PA, is planning a national conference for May 13, 2008 on "Combat Stress Injuries (PTSD): Care of Rural Veterans and Their Families" Click here for more information about that conference.  The conference is designed for health and allied health providers, social workers, mental health counselors, veteran advocates, educators, researchers and policy makers. There are no prerequisites.  The registration fee is extraordinarily in-expensive ($85), and the list of speakers and their bios follows: 

Faculty
Guest Faculty

Charles Figley BS, MS, Ph.D.

Dr. Figley directs the award-winning Florida State University FSU Traumatology Institute and Psychosocial Stress Research and Development Program. The Institute was recognized in 2000 as the best program of its kind by the University Continuing Education Association. He is a Fulbright Fellow and Professor, College of Social Work at FSU. He is also a psychologist and family therapist. Professor Figley received both graduate degrees from the Pennsylvania State University and his undergraduate degree from the University of Hawaii, all in the interdisciplinary field of human development. He has been editor of a number of journals (e.g., the Founding editor of the Journal of Traumatic Stress) and book series (e.g., the Innovations in Psychology Book Series with Taylor & Francis. His current editorships include Editor (founder), Traumatology, the International Journal, 1995-present and Editor (founder), Routledge ( formerly Brunner/Mazel ) Psychosocial Stress Book Series, 1983-present. He has written more than 200 scholarly works including 19 books mostly on stress.  (Editor's Note: Figley is the editor of Mapping Trauma and Its Wake: Autobiographic Essays by Pioneer Trauma Scholars.)

Michael Hwang MD

Associate Chief of Staff, Mental Health VA Medical Center Wilkes Barre, PA and Associate Professor of Psychiatry Robert Wood Johnson Medical School University of Medicine and Dentistry of New Jersey

Evelyn Llewellyn Psy.D.

Co-Founder Executive Director Director of Family and Youth Programs Life Matters New York, NY

Michael Lonski Ph.D.

Chief of Mental Health Clinical Services 244th Medical Services New York State Division of Military and Naval Affairs Captain, New York State Guard New York, NY

Keith Martin

WBRE Veteran TV Anchor Retired National Guard Brigadier General Former Pennsylvania Director of Homeland Security Wilkes Barre, PA

William Nash MD

William P. Nash, M.D., is an active duty Captain in the U.S. Navy Medical Corps, with nearly thirty years of active military service. He is a graduate of the University of Illinois, College of Medicine, in Chicago, and of psychiatry residency training at Naval Medical Center, San Diego. In addition to leading two Navy SPRINT crisis response teams, he has directed two Navy psychiatry residency training programs, and has served as the Director of Clinical Services of the hospital ship USNS MERCY. CAPT Nash has been stationed with the Marine Corps since 2000, including deploying to Iraq in 2004 with the 1st Marine Division as a psychiatrist embedded with ground combat forces. He was awarded a bronze star medal for his service in Iraq in support of combat operations there. Since October, 2005, CAPT Nash has been stationed at Headquarters, Marine Corps, in Quantico, Virginia, where he directs and coordinates combat/operational stress control policies and programs for the United States Marine Corps. He is an Assistant Clinical Professor of Psychiatry at the University of California, San Diego, and has co-edited a book on combat stress injuries released in late 2006.

Edward Rendell BA, JD

He is an Army Veteran and Pennsylvanias 45th Governor who began a second term of office on January 16, 2007, following a landslide re-election victory. As Governor, he serves as chief executive of the nations 6th-most-populous state and oversees a $27.5 billion budget. He is building on his efforts to make government more responsible to the public, and more responsive to the publics needs. He has cut wasteful spending and improved efficiency to save more than $1 billion and is pursuing a legislative agenda that includes commonsense political reforms to put progress ahead of partisanship.

Steven Silver Ph.D.

PA Army National Guard Former Director, PTSD Treatment Program VA Medical Center, Coatesville, PA

Jessica Wright BA, MA

Major General Jessica L. Wright is the Adjutant General of Pennsylvania. In this State cabinet-level position, General Wright, headquartered at Fort Indiantown Gap, is responsible for command, control, and supervision of all Air and Army National Guard units allocated to the State of Pennsylvania. She is also responsible for six (6) state-owned veterans' homes, Scotland School for Veterans' Children, and programs for Pennsylvanias 1.3 million veterans. --- The objectives of the conference are that -- at the completion of this course, the participant should be able to: define the necessary components of a comprehensive assessment of combat stress injuries and the importance of each in a multimodal approach to patient care; discuss degrees of success attained by treatment in terms of effect on function and quality of life; cite key evidence, including peer-reviewed medical literature that can help the practitioner get the veteran the right care at the right; identify and manage association events related to combat stress injuries. To register for the conference, please click this link.

Combat Trauma and Veterans' Families

Social Work Today has an article in their current issue on "Trauma and the Military Family: Responses, Resources and Opportunities for Growth."  The article title promises more than the article actually delivers -- it's pretty slim on "responses, resources and opportunities for growth" -- but to the extent that it's at least coverage on this important topic, however minuscule, it's worth knowing about.  The article overly cites Down Range: to Iraq and Back (by Bridget C. Cantrell, Ph.D. and Chuck Dean), to the exclusion of the many other important books on the subject, and it's pretty basic.  But at least it makes the point that a combat veteran's struggles with PTSD affects not just the veteran, but his or her family as well.  The article's author, Michelle D. Sherman, Ph.D., is the director of the Family Mental Health Program at the Oklahoma City Veterans Affairs Medical Center, and she devotes the second half of the short article to discussing "Support and Family Education ("SAFE")," an "18 session family education program for people who care about someone with mental illness."  The entire curriculum of this program is on the Web, linked here, with one specific segment oriented to PTSD, linked here.  The PTSD information looks helpful, and there are two handouts included as part of it, one called "PTSD and Its Impact on the Family," linked here, and the other called "What We'd Like Our Family Members and Friends to Know about Living with PTSD," linked here.  (The last item, because it was written with the suggestions of Vietnam veterans as to what to do and not to do, is particularly interesting and practical.)  Kudos to the VA and to Dr. Sherman for making this material available to veterans and their families.

Superb Writing about a Vietnam Vet's PTSD and Subsequent Nervous Breakdown

GQ magazine has a superb, hauntingly beautiful (and eloquently written) article called "The Long Shadow of War."  The description reads, "As a young soldier in Vietnam, Cecil Ison saw something, something so horrific that he buried the memory of it for thirty years and swore he'd never allow it to surface again.  Then, on March 20, 2003 -- the day after we started bombing Iraq -- the past leapt up and grabbed him."

There's no two ways about it: this is the best writing I've read in years, especially on this topic.  The story is long -- but practically every sentence is a gem.  It covers most of the grand themes surrounding PTSD in really an epic sweep.  There's the Vietnam War itself, always a player; Cecil, the cantankerous Appalachian individualist at the center of the story; his lovely, long-suffering and adorable wife, who loves and attends to Cecil and his various states, and quilts something lovely for him and his brothers about their Vietnam experience; his two brothers who are also battling their own demons from war, but handling it differently; his mother, who sent all three sons off to Vietnam to fight; the VA and its therapists, who minister to Cecil in his nervous breakdown; the countryside, whose silence and remoteness helps nurture Cecil in his darkest times; and finally, the writer, Kathy Dobie, whose talent is just off the charts phenomenal.  (Although it's also a close race with Cecil himself, and his wonderful wry way of putting his life into perspective, when he can, reminiscent of the humor of that 60s icon, Richard Brautigan.)

An example, from Cecil, when Kathy the writer asks him if he's a Vietnam vet:

“Yes, I received a letter from the president of the United States one day,” he said with sardonic cheerfulness. “I was out playing Whiffle ball, just having a wonderful time, and I got the mail and it said, ‘Greetings. Your friends and neighbors have selected you to serve in the Armed Forces.’ At that point, I knew I had no friends and no neighbors.”

As just one small example of the writer's deep psychological attunement and her innate grace with language, she first bonds with Cecil, thinking about his breakdown, by sending him the opening lines from Dante's Divine Comedy: "In the middle of the journey of our life I came to myself within a dark wood where the straight way was lost."  He responds a few days later with, "The mind is a strange thing—how it can paint over harsh images for decades but then for some reason they can emerge as quickly as the bare wood on a whitewashed fence after a rain. (One thinks) this is something that other people experience but not me, until it strikes like a blow from a sledge hammer. You are most welcome to explore my condition. I’m still struggling with the fact that this is a real condition and many, many others struggle with the same thing…"

Dobie is the best writer I've read in I don't know how long, on a topic I absolutely love.  She's the author of a memoir about trauma called, The Only Girl in the Car: A Memoir, a fact which explains some of her sensitivity and emotional depth in the Cecil Ison story.  Apparently she sold that book to the publisher on the strength of the book's "brilliant writing and emotional power."  Fantastic.  What a wonderful treatment of a powerful topic, and a quirky, charismatic "hero."  (His wife is also a hero, and sounds just adorable.)

A Military Dad Looks for Answers -- and Action -- in Aftermath of Soldier Son's Suicide

NPR had an excellent story on Tuesday about the proactive anguish of retired Master Sergeant Chris Scheuerman in the aftermath of his son Jason's suicide while deployed in Iraq.  It's a story everyone should read, because it raises any number of salient points about the topic, including who military psychologists are really working for anyway.

The main article is called, "Father Blames Military for Son's Suicide," and if you read the story, you'll see why that is.  The text of Army Private 1st Class Jason Scheuerman's suicide note is included, and it's quite sobering.  There are several linked stories that are well worth reading as well: The timeline of Jason's last days is here.  And the article that the Associated Press did about Jason, "A Soldier's Suicide: Did He Have to Die?" is also linked here.  If you want a short course in what the issues are surrounding young soldiers who suffer combat trauma and are driven to kill themselves, these three articles give a pretty good education in the basics.  There's no shortage of participants behaving badly, and the "system" not really "working" to protect a very troubled soldier from himself. 

It's actually pretty heart-breaking to read the story, and to put yourself in the place of the dad, who was highly tenacious about finding out what really happened to his son.  The truth gets revealed to him little by little, as documents he demanded from the Army under the Freedom of Information Act (FoIA) slowly trickle their way to his house.  The Army doesn't even initially release the son's suicide note; in fact, they say there wasn't one.  (It shows up randomly later on.)  It's pretty clear that if this were a civil situation, the "employer" would be sued for wrongdoing, and there would be the potential for an enormous jury verdict for the family.  But in this case, the employer is the Federal government, and as the dad says, when the Army psychologist is an arm of the "employer," it's very unlikely that they're going to go against their self-interest, and advocate for the troubled soldier.  According to NPR's story, Chris Scheuerman says, "Military psychologists work for the employer. Their career is ...[dependent on or tied to] the decisions they make to ensure that soldiers go back to the front. That is an inherent conflict of interest, and I believe that conflict of interest prevents the provider from being a true advocate for the patient."  Scheuerman concludes, "The psychologist who saw my son was not an advocate for his safety."

Read the articles -- Jason Scheuerman's situation is hardly unique.  (We've blogged recently about the rash of young soldier suicides, including here.)  There are way too many Jasons who aren't being helped when they need it, and who not only fall through the cracks, are sometimes even given a nudge or a push. In Jason's case, that's basically what happened.  Was it malicious?  Or just incredibly insensitive and poorly timed?  Who knows.  It certainly was tremendously ill-informed, and counter-productive.  Poor Jason and his family.  It seriously sucks to be mis-understood by everyone around you, at the time when you need help the most.  Let's hope his death isn't going to be in vain -- that's exactly what his family hopes.  I'm glad they had the courage to make their painful story public -- it will help show the way to other agonized families, in the wake of son's and daughter's suicides, how to backtrack and really find out what happened.  And probably the biggest "lesson" of the story: how do you throw someone a lifeline when they really need it, and not miss that chance?  Or worse, push them off the ledge? 

And what, if any, is the duty of care owed to a troubled soldier when he or she sees a psychologist on the battlefield?  Is it substantially different from that in civilian life?  Because it seriously seems as though Jason's case was handled poorly.  He didn't help matters -- "contributory negligence" -- but seriously, he was sick.  It's much more concerning the overall low level of perceptive, sensitive treatment with which his fairly dire case was handled, by pretty much everyone he came in contact with.  Anyway, soapbox over.  Great articles on a troubling topic.  Well worth reading and thinking about. 

Don't Make it a Blue Christmas - Veterans, Depression, Suicide and the Holidays

There is a dominant impression that many of us have that suicide somehow spikes at the winter holidays.  Fortunately this turns out to be just a myth -- though there is an increase in suicide after the holidays -- perhaps in part because of the general letdown after a period of increased stress, combined with frequently crummy weather and potentially mounting financial pressure from holiday overspending.  Even if suicide didn't peak anywhere near this time of year, it's still worth looking at what can be done to help people feeling the pressure and stress of the holiday season.  Combat veterans (and their families) face special stresses at holiday times, including increased time with family and friends, often increased exposure to alcohol and drugs, and the special pangs of realizing loved ones -- combat buddies -- are no longer with them or able to celebrate the holidays with their own families (survivor's guilt).

Fortunately there are some decent resources out there for lending a hand.  First off, the generic but helpful ones; secondly, the more veteran-specific ones.

Good, generic advice:

• "Ten Tips for Coping with Holiday Stress" 
• "How to Remain Sober and Healthy During the Holiday Season"
• "Dealing with Grief in the Holiday Season"

An excellent one on "Coping with a Family Member's PTSD During the Holidays;" and

Veteran-specific advice:

• Article by a Vietnam-era vet, who tried to kill himself on his first Thanksgiving back after combat.  He's got a very interesting point of view in this article.  One of the things he says is that since he arrived in Vietnam first on Christmas morning, it was hard for him for years afterward to ever have a good Christmas.  He covers all the big topics from his point of view, including anger, flashbacks/hallucinations, fear, dread, hyper-vigilance, anxiety, intimacy issues, drug and alcohol abuse, avoidance/immersion, sleep disorders, guilt, memory loss/cognitive dysfunction, intrusive thoughts, and depression.  Pretty good stuff, and he definitely can relate.  He also talks about "anniversary reactions," which is another important topic in the discussion of veterans and combat trauma.
• Patience Mason's wonderful advice for veterans and their families.  This is a link to an article specifically on "PTSD and the Holidays," and it's quite comprehensive and excellent.  She also covers the anniversary reaction the veteran may be having, and talks about how to create a healthy balance between who can handle what at the holidays, without fostering resentment and anger between the veteran and his or her loved ones.  Excellent stuff, again from someone who can relate.

"Listening is an Act of Love" -- Book & Project

Just in time for the holidays -- when families and friends traditionally gather to spend gobs of potentially boring OR bonding (and sometimes, both!) times with one another -- here's an idea whose time has definitely come.  Listening is an Act of Love is a new book by Dave Isay, as part of the national StoryCorps Project, which encouraged average citizens to tell their stories to interested others, who recorded them and assembled them for future listeners, in no less than the Library of Congress, so they'll be available to all Americans.  Here's what some impressive people had to say about the project:

"Dave Isay's vision of collecting the everyday stories of Americans is so simple and yet so powerful. Listening Is an Act of Love will make you laugh, cry and think. These stories come from the souls of individual Americans. Collectively, they are who we are as a people. You cannot read this book without feeling proud of your country." -- Former U.S. Senator Bill Bradley

"StoryCorps asks Americans to reflect upon their experiences, their times of travail, their achievements. In so doing, these individuals create an encompassing national narration: a people's hopes, fears and aspirations, all rendered poignantly to attentive listeners whose respect has enabled, finally, a presentation of a people's mind, heart, soul." -- Dr. Robert Coles, James Agee Professor of Social Ethics, Harvard University

"This book is absolutely remarkable. Listening is an Act of Love is history in the richest sense of the word, the kind that makes people feel like they count. It's a celebration of the lives of the uncelebrated. In our world today people feel helpless, but once they speak of their lives they become alive! This is what our country is all about. Never has a book been more timely or necessary."  -- Studs Terkel, prolific writer and master oral historian.

Here are three ways to get involved: 1) buy copies of the book, for yourself and to give as holiday gifts this season.  2) interview some people you know who might have stories to tell -- get them talking about the stories only they can tell, and record them for posterity, too, as part of this project.  Details on how to do that at the StoryCorps Project website, linked here.  (Don't force anyone to talk about anything they don't want to, but be a receptive, inquisitive audience for those who do.)  3) go to a book signing of the author, whose book tour is about halfway complete at this point.  Details on the book tour linked here.

Some background information about StoryCorps:  StoryCorps is an independent nonprofit project whose mission is to honor and celebrate one another’s lives through listening.  By recording the stories of our lives with the people we care about, we experience our history, hopes, and humanity. Since 2003, tens of thousands of everyday people have interviewed family and friends through StoryCorps. Each conversation is recorded on a free CD to take home and share, and is archived for generations to come at the Library of Congress. Millions listen to our award-winning broadcasts on public radio and the Internet. StoryCorps is the largest oral history project of its kind, creating a growing portrait of who we really are as Americans.

Editor's Note: The book title itself is interesting.  Sounds a little bit like the Paul Tillich quote we wrote about earlier, here, that the "first duty of love is to listen."

Life Preservers for Navigating an Ocean of Grief

Particularly relevant to our readers, now that the holiday season is upon us, it's time to talk about grief, and its relationship to the survivor of combat trauma; the veteran, and his or her family.  For the emotion grief is also part of combat trauma: both the direct grief of the veterans themselves, that never leaves, of the horrors of war, of seeing buddies die, of doing things, and seeing things, that sometimes bring them shame and agony -- and the direct or indirect grief of the family members, when trauma or PTSD drives a veteran to hopelessness, homelessness, or suicide.  There's also the indirect combat trauma-based grief: grief that comes when a veteran dies.  Grief is a normal, healthy, healing process, that, like combat trauma, can be a "normal reaction" to an abnormal situation occurring. 

What is grief?  Heavy-hearted woe, suffering, and pain, when recollecting a previous event or loved one who is no longer here.  According to Roget's Thesaurus, "grief" is "Mental anguish or pain caused by loss or despair: heartache, heartbreak, sorrow.  Grief is, according to the dictionary, "deep mental anguish, such as that arising from bereavement.  See "regret" (yikes.)  The word itself comes from a root word meaning to harm (aggrieve.)  Poets have handled it deftly over the years.  Think of Emily Dickinson's lines on grief:

I MEASURE every grief I meet      

  With analytic eyes;      

I wonder if it weighs like mine,    

  Or has an easier size.   

 

I wonder if they bore it long,        

  Or did it just begin?    

I could not tell the date of mine,   

  It feels so old a pain.   

 

I wonder if it hurts to live,    

  And if they have to try,        

And whether, could they choose between,   

  They would not rather die.

Fortunately, several books shed light on the experience of losing a combat veteran spouse -- these two are from deaths in the Vietnam war era, but the principles apply today as well.  The books are, Grief Denied: A Vietnam Widow's Story, by Pauline Laurent, and Sacred Shadow, Sacred Ground: A Vietnam War Widow's Journey through Unresolved Grief, by Glenda Carter.  Both are five stars on Amazon.com.  (See sidebar for books, or click on their hyperlinks, above.)  Laurent is one of the authors featured in Maxine Hong Kington's edited anthology, "Veterans of War, Veterans of Peace, discussed earlier in this blog; and she's featured in the Bill Moyers documentary on the book as well. 

There's also a very good psychological help guide on the Web, at HelpGuide.org, which describes the difficulty of grief and loss, and possible ways to handle them constructively.  The guide is called, "Coping with Grief and Loss: A Guide to Grieving and Bereavement."  It has many good parts, including how to take care of yourself when you're suffering, and the special issues relating to grieving a death by suicide.  Click here for that link.  There's also a related guide to helping or supporting someone else who is grieving: "helping your child, friend or parent cope with the death of a loved one."  Click here for that link.  They also have some very good material on combat trauma and PTSD.  Click here for that link.  There's also a very pleasant, British, low-key book called Free Yourself from Harmful Stress, that also is worth checking out.  I don't have my copy handy so I can't remember if it covers combat trauma or not -- it might not.  But it does cover all garden-variety psychology health issues, and is written in a very straightforward, pleasant and constructive manner.

[Editor's Note: Helpguide was created in 1999 by the Rotary Club of Santa Monica with active participation by Rotarians Robert and Jeanne Segal following the tragic suicide of their daughter Morgan. Since then, a dedicated team of talented people have collaborated to create a free, non-commercial resource for people in need.  Helpguide’s mission is to empower you and your loved ones to understand, prevent, and resolve health challenges.  Helpguide served over eight million visitors during the past 12 months and is growing by 20% per year. ]