Healing Combat Trauma

The New Face of Veteran Homelessness

If you asked the average American this Veterans Day to describe a homeless veteran, you’d probably get a description like this: older white male, Vietnam-era, probably single, often with a drug or alcohol problem.

What you might be surprised to learn is that there’s a new face of veteran homelessness, and it is increasingly young, black and female.

Women today represent roughly 15 percent of the U.S. armed forces and about 19 percent of post-9/11 veterans — a population that is projected to grow. While the number of male veterans has been declining over the past few decades, the number of female veterans has doubled since the 1980s. The Department of Veterans Affairs expects female veterans to number more than 2 million, or close to 10 percent of the veteran population, by 2020.

Researchers have known for years that veterans make up a disproportionate share of the homeless population — as many as one in four. But they’ve never been able to identify a clear link between military service and homelessness. Instead, they’ve pinpointed certain factors, like post-traumatic stress disorder, that increase a veteran’s chances of becoming homeless. Still, the root causes remain largely unclear, especially given the protective factors — such as the world-renowned VA health and benefits system — that military service offers.

But welcome to the new 2014 model, in which the fastest-growing segment of the homeless veteran population appears to be women, many of whom have children. Statistically, female veterans are between two and four times as likely as their civilian counterparts to become homeless, according to recent studies. And if they’re young and black, those chances seem only to rise.

Among these “new” homeless veterans, one risk factor stands out: a past history of sexual trauma — whether before, during or after military service, and sometimes all three. In a survey of the roughly 130,000 homeless veterans who used VA outpatient services in 2010, about 40 percent of the females, and 3 percent of the males, said they’d experienced military sexual trauma (MST). In another study that compared homeless female veterans with housed female veterans, over 50 percent of the homeless population reported experiencing MST — twice the rate of their housed counterparts. Suddenly, trauma appears to be linked to homelessness among female veterans, and MST on top of prior trauma may be an even bigger risk factor.

The homeless have always been hard to count accurately, and homeless veterans are no exception. One prominent female veteran who was homeless for years after suffering MST during her Army career said the problem is compounded because “it’s hard to count women who don’t want to be found.” As researchers learn more about trauma among homeless female veterans, the struggle begins to find gender-specific housing facilities that can accommodate these young women and their children. As one national advocacy group said last month in a comprehensive report, female veterans “are being put at risk by a … system designed for and dominated by men.”

As the VA nears the end of its five-year initiative to eradicate veteran homelessness, it’s a good sign that the numbers overall are dropping. But the ranks of homeless female veterans are growing, and that means there’s still work to be done. 

Published originally in the Texas Tribune, linked here: http://bit.ly/1pKBhQq

"War Creates Brothers" -- U.S., Afghansti Vets Share Stories, Bond Together

A recent quote from the inimitable Dalai Lama: "To the extent that our experience of suffering reminds us of what everyone else also endures, it serves as a powerful inspiration to practice compassion and avoid causing others pain. And to the extent that suffering awakens our empathy and causes us to connect with others, it serves as the basis of compassion and love."

We've written on the site before about how combat vets "get" what other combat vets go through, and how they share that "wet bond of blood" brotherhood, here and here and many other places as well. (There's even something about it from the Civil War era, here; as well as Ernie Pyle, superstar war correspondent who "got" it, exemplifying it and communicating it from the boys on the front to the families back home, here.) We've started writing lately about "ritual" as a way that "primitive" societies, including sometimes our own, ceremonially bring back in the warrior from the war, embraced by his or her community. The work of Malidoma Somé is impressive as heck; but there are others shortly to speak on this as well, including other veterans who understand it and have lived it, and now want to share it with others.

But if we really want to envision the extent of what the Dalai Lama quote, above, embodies, let's take a look at a cross-cultural, multinational gathering of hard-core combat veterans from more than a decade ago. 

“War Creates Brothers”

U.S., Soviet vets share pasts on Peninsula

By Kevin Patterson

Peninsula Daily Times

Port Angeles – Larry Heinemann doesn’t know the word’s Russian spelling; Igor Zakharov doesn’t speak the English translation. But the word “brat,” which sounds like “brot,” instantly brings the two men together in a shoulder-shaking hug.

“My brat, my brother,” Heinemann explains.

There is much that should separate the two men. Heinemann is 45, an award-winning author, a Vietnam veteran.

Zakharov is 25. A machinist. An Afghansti – a Soviet military veteran who served in Afghanistan.

But they sat side-by-side on a rough cedar-plank bench, sharing American cigarettes and talking about coming home from war. Brothers. Soldiers. Grunts.

American “grunts,” G.I. slang for the everyday soldier, have been coming to this place west of the Elwa River for most of the 1980s. Counselor Bruce Webster has gained national prominence for his role in helping Vietnam veterans re-live their war experiences and confront memories that torment them.

Last weekend, Webster’s beachfront back yard ... became a bivouac for Vietnam vets and a handful of Russian veterans and counselors. It was more fruit from a budding relationship borne of war and government indifference to its warriors.

Heinemann and Zakharov met last December, when a group of Vietnam veterans toured the Soviet Union. Their mission was to make contact with Afghansti , while shunning official government representatives. [Heinemann wrote about his visit in a recent issue of a national magazine.]

“Our welcome by the Afghansti – perhaps 30 men in their early and middle 20s – was profuse, prolonged and astonishingly friendly: hand-shakes and warm smiles and immediate conversation,” Heinemann wrote.

Heinemann said the Vietnam vets saw a lot of ourselves in the young Russian veterans. It is a bond that transcends differences in language, culture and politics.

Afghanistan is often referred to as the Soviets’ Vietnam. It was a part-time war waged in a distant land for ill-defined reasons.

Soviet soldiers who fought in Afghanistan came home to discover that most people did not understand what the army was doing there. The government-controlled news media reported that troops in Afghanistan were there as advisers or to build public works.

Until 1985, soldiers killed in action were sent home in zinc coffins to be buried in secret, Heinemann said. Families often did not know how or where their sons died.

“They call it the false face of welcome,” Heinemann explained. “One man we met said his son might as well have been killed in a bar fight, for all he knew.”

The Vietnam veteran has faced an uphill struggle to win recognition of the scars left by the war. Post-traumatic stress disorder – PTSD – is the living monument to men who fought a senseless war against an enemy who played by different rules.

Heinemann knows about PTSD. His novel, “Paco's Story,” won the 1987 National Book Award. It was a fictional account of a Vietnam vet struggling with PTSD.

Help for veterans has been slow. Complaints about the U.S. government’s response to Vietnam vets are common. So are stories of Vietnam veterans wracked by the awful psychological after-effects of war. People’s understanding of what the war did to some of the soldiers is still evolving.

The Soviet veterans now grapple with some of the same problems, including a government indifference to their needs, Heinemann said. Their 10-year war ended in February, about 16 years after U.S. troops began pulling out of Vietnam.

Heinemann said Vietnam vets know some of what lies ahead for the Afghansti.

“I think that the Afghansti have a chance to save themselves a lot of grief, learning from our mistakes,” Heinemann said. “That’s why I wanted to bring them out here.”

Zakharov sat next to his American comrade, listening to a foreign language and struggling to answer a reporter’s questions.

He served two years in Afghanistan, the usual length of service for Soviet troops. He used a stick to draw 1982-1984, his time in Afghanistan, in the sand and sawdust of the outdoor conversation pit.

Heinemann said Zakharov was with an airborne unit. He was a minesweeper, whose job was to probe for landmines. His navy blue and white –striped undershirt, standard issue for airborne troops, mostly hid the scar he carries from a bullet wound to his left shoulder.

On his right wrist is a red band. The name of a U.S.  Army sergeant, killed in Vietnam, is inscribed there. It’s a memento of his visit to the Vietnam War Memorial in Washington, D.C.

“These are great guys,” Heinemann said. “They’re young and they’re tough and they’ve been through the mill.”

Reprinted with permission of the Peninsula Daily News.

Veterans, PTSD and Suicide: The Overlooked Element of Contagion

This is an article I'd first started writing two years ago now. I did the research, and located the main, most often-cited study's principal investigator, long since retired, and asked him to confirm whether the trend is still true, though he first published it back in the 1970s. He affirmed that it was. What it is is an important and often-overlooked "connection" that will make more sense when we start describing it. It also fits into the category of things where the information is out there, but for some reason is also strangely ignored. Another instance was a few years ago, when the military kept saying, "We don't know what PTSD is tied to"; essentially, "we have no idea." Yet at the time, and this goes back several years now, I was able to read through the existing literature and learn, PTSD is tied to combat exposure. In other words, the more combat, the greater the chances of developing PTSD. And I wrote about it, here, at the time the military was saying, in essence, we don't know what it's linked to.

So it isn't that that wasn't known...it's that no one was paying attention to what was out there. (And these days, several  years later, they ARE admitting publicly that more exposure = greater chance of developing PTSD. But it does make me laugh a little bit to hear that now, thinking, we were talking about it here well before that was being said publicly. And not because of some strange prophetic abilities on our part; just from reading the available literature, and drawing what seemed like obvious conclusions.)

There's the old saying that "those who refuse to learn from history are condemned to repeat it." Well, much of what's known about PTSD has been known for decades now, with another fair part of the knowledge base has been increasing exponentially. I read an article the other day about a Harvard-trained psychiatrist who worked at the V.A. in Boston during the Vietnam war, and was "shocked" to learn that there wasn't a single book on war trauma in the library there. Today, one would hope, that situation has changed quite a bit. 

But to the point at hand...

As I read through my Twitter feed today (you can follow us @HealingPTSD on Twitter), I noticed several suicides being Tweeted by various sources. One was that of Mel Turpin, a former All-American basketball player and NBA star, dead at 49; and then the troubling news, especially to us in the veterans community, of a Marine Corps veteran, James F. Popkowski, 37, who apparently died in a "suicide-by-cop" or armed confrontation outside the V.A. in Bangor, Maine. (See those stories linked here and here, as well as a longer quasi-obituary of Popkowski, here.) At first the headline said only "an armed man" had died in a confrontation with police near a local VA -- and as soon as I read that, I hoped -- but yet somehow knew -- that it would be a veteran, with a painful story of his own. Later the news matured to show that in fact he was a veteran, who was struggling with this illness (cancer) and its treatment. But the fact he was a veteran and committed suicide reminded me instantly of the news from the last few days, where the Seattle Times did such a good job covering the suicide of a veteran with PTSD from Whidbey Island, Orrin McClellan. (I wrote about Orrin's life and death here and here.) So many suicides in the media, and superstitious types tend to think those run in threes -- though technically McClellan's death was in mid-May, with the coverage of it in the media happening over the last few days.

I need to branch off in two different directions here, to cover this material. 

One is to talk about the V.A. suicide's statements about his own condition, because veterans with PTSD and their family members may recognize their own veterans in those words. And the other is to introduce something very different, which is the effect that media coverage of suicides has on "successful" suicide attempts by others during the same general news cycle, especially young men (who are, after all, the majority of those who serve.) 

On that second point, as the military has generally speaking tried and failed to lower the suicide rate lately, I haven't seen much recognition (OK, any) of the idea that suicides are to some degree contagious. There's quite a bit of medical literature on the subject...and it's been documented in studies around the world, starting in the 1970s, that suicides reported in the news will have a demonstrated effect on increasing suicide attempts from specific populations who hear the news. Since suicide is a broad category -- many single-car or single-motorcycle accidents are also suicides -- and the military attempts periodically to crack down on motorcycle safety, etc., it would also be wise to enlarge the conversation to not only what other methods qualify as suicides, but also to take a look at how one suicide making the news can, depending on how it's portrayed, have an effect on increasing the number of other suicides that take place in the same general time frame, especially among those prone to committing suicide, because of depression and other factors. And we haven't even mentioned yet here the effect that some prescribed pharmaceutical medications can have on increasing suicidal thoughts.

(While it's somewhat unlikely that Popkowski, in Maine, was reading the Seattle Times' coverage of Orrin McClellan's death -- one, we never know; and two, in the age of the Internet, geographical barriers have disappeared and the news is instantaneous -- especially if you include other social media, like Facebook and Twitter, which can serve as additional sources of the same news. We're so much more wired now than when these studies first started being done, so we can't assume Popkowski didn't read the Seattle Times coverage, even though it's most likely that he didn't. For the sake of this argument -- because if it didn't happen with this case, it surely does with others, let's pretend that Popkowski did spend some time over the last few days reading the coverage of McClellan's suicide on the Internet.)

There's enough material to cover here that I need to go as far as I can with it now and then circle back around to it again soon. We'll introduce the science (below) but also cover what Popkowski said about his failing health, because his words will resonate with other veterans, who struggle not with cancer but with PTSD.

According to the article in the Portland, Maine Press Herald today, Popkowski, who had undergone a stem cell transplant for his cancer back in 2003 at the National Institutes of Health, struggled valiantly with the effects of the cancer and its treatment (both difficult), as well as sleep problems, depression and the like. In a letter to the editor of the magazine "New Scientist" back in 2008 he wrote,

"Suicide is like a little devil, always on my shoulder and always tempting me. Concern for the care of my three dogs after I am gone, my dogs being the only things I feel anything resembling passion for, is the only thing I think that has kept me from pulling the trigger on the loaded pistol, which rests next to my pillow."

He continued,

"The best way to describe the mental and emotional issue is that I am numb and passionless. Nothing brings joy or pleasure. I graduated magna cum laude with a (Bachelor of Science degree) in computer info systems and business management in just three years. Now, I cannot mentally focus enough to read a newspaper."

He added,

"I have lost count of the number of sleep aids NIH and my local VA have tried. Like the anti-depressants, none have worked."

And he described leaving his bunker, in terms that a veteran with PTSD would understand, only for brief forays out to re-provision with groceries and return, if his health even allowed him that. He wrote:

"For weeks at a time I will only leave my house once, and only briefly at night, to buy groceries and other supplies. Most of the time, the only time I drag myself into the shower, is when I have to go into town to buy groceries."

---

Now, we hope that no veteran ever crosses the bridge to suicide in his or her lifetime, and especially is not discouraged enough reading news of how another distressed veteran felt to contemplate it. Please use the resources at your disposal, including hotlines, buddies, and compassionate others as lifelines to not give up hope, because there IS hope, and you can get better. But for the rest of us, we need to keep pushing on with this narrative because there's something to learn here, including for decisionmakers who wonder about how better to educate about suicide prevention. This is where the element about the notoriety/publicity level of a suicide influences other at-risk populations.

To the science on this.

• Back in 1977, in the journal Science, DP Philips showed that "motor vehicle fatalities" (including "suicides by motor vehicle") increase in the time frame "just after publicized suicide stories." From the abstract: "The average increase in motor vehicle fatalities is 9.12 percent in the week after a suicide story. The more publicity given to the story, the greater the rise in motor vehicle deaths thereafter. This rise apparently occurs because suicide stories stimulate a wave of imitative suicides, some of which are disguised as motor vehicle accidents."
• In 2006, an Australian journal, Social Science Medicine, published a similar study, further demonstrating the "relationship between media reporting of suicide and actual suicide." They studied data on "4,635 suicide-related items appearing in Australian newspapers and on radio and television news and current affairs shows between March 2000 and February 2001. The study found that 39% of media items were followed by an increase in male suicides, and 31% by an increase in female suicides. Media items were more likely to be associated with increases in both male and female suicides if they occurred in the context of multiple other reports on suicide (versus occurring in isolation), if they were broadcast on television (versus other media), and if they were about completed suicide (versus attempted suicide or suicidal ideation). Different item content appeared to be influential for males and females, with an increase in male suicides being associated with items about an individual's experience of suicide and opinion pieces, and an increase in female suicides being associated with items about mass- or murder-suicide." They concluded, "Further research on this topic is required, but in the meantime there is a need to remain vigilant about how suicide news is reported. Mental health professionals and suicide experts should collaborate with media professionals to try to balance 'public interest' against the risk of harm."
  
• Versions of the original study were repeated over and over in the intervening years, and 30 years later, in 2007, the International Journal of Epidemiology published a study which showed "the influence of media reporting of the suicide of a celebrity on suicide rates," where a male television celebrity in Taiwan committed suicide, followed by a wave of somewhat "copy-cat" suicides among young men. (The "celebrity" element may initially confuse, but think of it this way -- it's a well-publicized suicide when it happens, which means it reaches most of the target audience. It also happens, according to other studies, when non-celebrities commit suicide. The distinguishing factor is how well publicized the suicide is/how much media attention or coverage is given to it. The more coverage, the more people know about it, including those in somewhat fragile populations.) Back to the study's results: "After controlling for seasonal variation, calendar year, temperature, humidity and unemployment rate, there was a marked increase in the number of suicides during the 4-week period after media reporting (relative risk = 1.17, 95% CI 1.04-1.31). The increase was in men (relative risk = 1.30, 95% CI 1.14-1.50) and for the individuals using the same highly lethal method (hanging) as the TV  actor did (relative risk = 1.51, 95% CI 1.25-1.83). However, the age groups in which the increase occurred were younger than the age of the celebrity. CONCLUSIONS: The extensive media reporting of the celebrity suicide was followed by an increase in suicides with a strong implication of a modelling effect. The results provide further support for the need for more restrained reporting of suicides as part of suicide prevention strategies to decrease the imitation effect."
• Also in 2007, a study was conducted in Taiwan around the fact pattern of the same television celebrity's suicide and published in the Journal of Affective Disorders. It attempted to define the "influence of media reporting of a celebrity suicide on suicidal behavior in patients with a history of depressive disorder," and what it found was "Among 438 depressive patients exposed to the media report, 38.8% reported an influence on subsequent suicidal behaviors, including 24 (5.5%) with a suicide attempt. The risk of such influence was highest among patients in a severe depressive state just prior to the media report (adjusted OR 7.81, 95% CI 3.28-18.59). Such influence on a subsequent suicide attempt was highest in patients with a most recent suicide attempt within one month prior to the media reports (adjusted hazard ratio 11.91, 95% CI 3.76-37.72)." The authors concluded, "This study has provided more convincing evidence suggesting negative influences of media reporting of a celebrity suicide on subsequent suicidal behaviors among depressive patients. Particular attention in terms of potential negative media influences should be paid to patients who are younger and currently depressed and have made a recent suicide attempt."
• This year (2010), another Taiwanese study took a look at suicide rates after media reporting of another celebrity suicide, this time a female singing star. Their premise was that "Suicide attempters are known to be vulnerable to the influence of media reporting of suicide events. This study investigates possible influences of media reporting of a celebrity suicide on subsequent suicide attempts and associated risk factors among suicide attempters." In their study, "Sixty-three suicide attempters registered in a surveillance system of Taipei City Suicide Prevention Center were assessed using a structured interview soon after media reporting of the suicide of a young female singing star." Their results? "Forty-three (68%) respondents had encountered with the suicide news. Among them, 37% reported being influenced by the media reporting on their subsequent suicide attempts." Most hard-hit by the news? "Men (adjusted OR 6.36, 95% CI 1.29-31.44) and younger age groups (adjusted OR 4.93, 95% CI 1.04-23.45) were more susceptible to the media reporting." And the authors concluded, "This study has provided further evidence for suicide imitation among vulnerable people encountered with media reporting of celebrity suicide, and for the need to actively restrain reporting of suicides to decrease the imitation effect."

It's also true that young men -- the dominant demographic of who the all-volunteer military is these days, though approximately 11% are women -- are more prone to suicide than other age groups. Back to the science:

• According to statistics from a fact sheet on youth and violence provided by the CDC, "In 2005, 17% of high school students seriously considered attempting suicide, and 13% made a plan about how they would attempt suicide during the 12 months preceding the survey." (The reference cited is CDC. Youth Risk Behavior Surveillance - United States, 2005.  Morbidity and Mortality Weekly Report 2006; 55 (SS-5): 1-112.)
• Similarly, according to the CDC, "approximately 14% of all deaths among children and adolescents aged 5-19 years result from suicides."  The numbers climb according to age ranges, with younger children having the fewest, and older children the most.  Suicided ages 10-14: 283.  Suicides ages 15-19: 1,700.  (The reference cited is CDC, National Center for Injury Prevention and Control, Office of Statistics and Programming. Web-based Injury Statistics Query and Reporting System (WISQARS). Online at http://www.cdc.gov/ncipc/wisqars/. Accessed September 6, 2007.)

There's more that we could talk about here -- responsible reporting guidelines about suicide, when disseminated and implemented, seem to have the effect of reducing the number of copycat suicide attempts after a successful publicized suicide (a study in Austria shows that) -- but the intended effect here, which we can elaborate on in future posts, is to introduce the idea that one publicized suicide by, say, a veteran, can also most likely encourage an increased number of suicide attempts, some of them successful, by members of at-risk populations, such as young/depressed/men. Do any of those words correlate with anyone who might be suffering from PTSD, or taking medications that might also increase suicidal thoughts? And we haven't even added into the mix the effects of alcohol, which many PTSD sufferers self-medicate with, and how that would affect suicidal thinking. There's much, much, much more to talk about on this topic -- not just here on this site but nationally -- but we hope this dense, rather convoluted post has at least gotten you thinking about not so much that we need to protect veterans with PTSD from seeing or reading the news, which might contain an item about another veteran's suicide -- but that suicides can almost go in waves (read the literature on prison populations, etc. for this), where one suicide spurs others in the same population -- because publicity surrounding a suicide has the unintended consequence of increasing suicidal tendencies in other affected people. Since many, many veterans with PTSD are to a degree on edge already...it might be good to realize the effect that reading about another veteran's demise could have on an already depressed, stressed or demoralized individual.

And since the larger goal for all of should be preventing suicides among PTSD-injured veterans, it's highly worth having this conversation.

Anatomy of a PTSD Suicide: Orrin McClellan Was "Only Halfway Home" from War

"Happy families are all alike," wrote Leo Tolstoy, the famous Russian novelist (and combat veteran), in the opening lines of "Anna Karenina," adding, "every unhappy family is unhappy in its own way." And certainly few families are unhappier than those who've lost someone they love deeply to suicide, as Orrin McClellan's parents have, who've recently lost their Airborne soldier son to the aftermath of PTSD.

We wrote about Orrin McCllelan yesterday, the 25-year-old OEF veteran who took his own life in May of this year. The article, "Anatomy of a Suicide: OEF Veteran Orrin McClellan, RIP from PTSD," is linked here. The underlying Seattle Times article, also from yesterday's paper, is very good, and combines multimedia with the telling the story of McClellan's all-too-short life and struggle. It also documents the pain and suffering McClellan's parents are going through.

There is no "purple heart" for PTSD. There is no "war memorial" that lists those who died by suicide from PTSD, even when combat was the most likely explanation. And maybe there should be... But in the meantime, all we can do is try to reconstruct what we can find about who Orrin McClellan was in the 25 short years he was here.

Digging around on the Web, we can find out much about who McClellan was. The exercise becomes less macabre, or voyeuristic, than the assembling of an online shrine to the memory of someone we never knew, who's now too soon gone. There are the two online journals that McClellan kept, at MySpace and LiveJournal. There is his photo stream on Flickr. There is an obituary by a caring friend, who attended his memorial service. There is McClellan's listing at an online dating service, "Hot or Not," which he set up when he was in Afghanistan, and elsewhere pans with the single word, "whatever." There are some videos that a friend shot of him, who mourns his passing and wishes he had captured a few more shots of McClellan while he was still alive. There are the photos and the poems that his family shared with the Seattle Times, that are part of the original article. And there is a truly beautiful video about his deployment to Afghanistan, called "They Carry," that McClellan himself pieced together, shown on YouTube, and set to music: not heavy metal, but classical...He uploaded it in late September, 2007, after he got back from Afghanistan, and it carries the interesting descriptor: "this generation's wars from eyes on the ground...the faces and names are placeholders. those who were there remember. the rest can only watch." WELL worth viewing...

His interests, as he discloses them on one of the two online journals he kept, are nothing out of the ordinary: places he's been, music he likes, hobbies: "airborne, american beauty, army, dave barry, death cab for cutie, flickr, glen phillips, haruki murakami, italy, langley, lava lamps, led zeppelin, military, muse, orbital, photography, pink floyd, quentin tarantino, seattle, the big lebowski, toad the wet sprocket, vicenza, washington, whidbey island."

There's his brief description of the key dates and places in his short life, again from an online journal:

"Born in Milwaukee, WI. But home is between the Cascades and Olympics on the Puget Sound. Grew up in Langley, on Whidbey Island, Washington. Enlisted in the Army in late '03, started Basic in Feb '04, Airborne School that June, got to Italy that July, and to Afghanistan Mar '05. Getting out Feb '07."

(In September of 2007, he uploaded the excellent video, "They Carry," of his time in Afghanistan.")

And then there are the news items about him, focusing on an arrest, locally. And what look like three court cases: in July of 2008, January of 2009, and September of 2009, listed on King County Superior Court's website.

In July of 2008, he was in the local paper, for assaulting some cops at a concert, allegedly threatening to kill them, gouging one of their eyes, and basically asking for them to shoot him. In October of 2008, he's back in the news locally, after being acquitted of assaulting and threatening police officers in the earlier event. He spent time as an inpatient at the VA for PTSD. He also lived too far away to make regular treatment a likelihood, and getting there, via a ferry trip and highway driving on I-5, was triggering.

His parents, who describe themselves as self-employed and dedicated (i.e., more available than most) seem to be doing everything in their power to help him, but he is melting down. The previous article, yesterday, describes some of the symptoms of his raging PTSD. The two articles in the local papers also detail the attempts his family made to get him help.

In one of the articles, his mother is quoted as saying, "We must not stop with research and development of the healing of visible wounds and helping the veterans become whole with prostheses for severed arms and legs. We have a responsibility to get just as expert at healing the inner wounds of the body, mind, emotions and spirit.”

She also goes right to the heart of the matter when she says, also quoting from those articles, "Our military is well-versed at training our sons and daughters to be experts in weapons, combat and killing, and distrust of the other, but they fail to complete their warrior training of our troops by failing to train them in the skills of regulating the emotional responses of the body, mind and spirit after experiencing the traumatic horrors and terrors of war, and in the skill of reintegrating into families and communities.” 

When she talks about her son's difficulties, she is very clear: "Our son, only halfway, came home from the war; half of him is still fighting over there, within his body, mind, heart and soul,” Gorman said. “Every day, all the time.”

Unfortunately, on May 18, 2010, Orrin McClellan lost that fight. And his family, and everyone concerned about combat veterans and PTSD in America, grieves with them.

Anatomy of a Suicide: OEF Veteran Orrin McClellan, RIP from PTSD

The Seattle Times has an article in yesterday's paper about a young Whidbey Island OEF veteran who unfortunately killed himself in May of this year. Orrin Gorman McClellan served with the 173rd Airborne Brigade Combat Team in Afghanistan in 2005-2006. He took a lot of photos of his experience in Afghanistan, and he also wrote, poignantly, about his experiences as a soldier in an online journal, where he wrote every day. (The article doesn't reveal the location of that journal.) In what's known in the journalism biz as a "package," the article also has two multimedia presentations included with it: a video of his parents leafing through a book they're putting together of poems Orrin wrote, linked here, and a video narrated by his parents of some of his photography from Afghanistan, linked here. "I've become numb," McClellan writes, "but not comfortably so."

It's wrenching watching his parents in the videos sit side-by-side on the couch, in a tableau no doubt repeated across America, as the parents of the approximately 18 veterans a day who kill themselves must do, trying to make sense of why Orrin had to go, and still actively grieving, trying to come to terms with their own loss. In Orrin's case, his mother is a social worker, who the article says specializes "in the treatment of traumatized individuals." Of course, not even a mother with this background can necessarily save her son, which only adds to the tragedy. It says his mother even "took a counseling job with the Whidbey Island NAS and helped her son navigate through the VA system." He was retired with a 100% disability due to PTSD. The article quotes the mom as saying that as a community, we all need to listen better to our vets. And practice "deep listening" to their stories of what they've gone through.

What makes the article good, from this reader's perspective, is that it positions Orrin McClellan's death against the backdrop of the statistics of veterans suicides across the country, and then projects how those statistics affect Washington state, where the Seattle Times is based, and where Orrin lived. Eighteen deaths of veterans a day, the number of suicides approximating deaths in combat this year -- these are shocking statistics, but like so many others, we become numb to them over time. Bringing it closer to home, those same statistics mean of the almost 36,000 OIF and OEF veterans from Washington state, a dozen would be lost to suicide. In 2010, Orrin McClellan was sadly one of that number.

(Army veteran Chris Loverro, who served with the Stryker brigade from Fort Lewis, Washington, did a poignant video of his own about PTSD and suicide in the life of a veteran. We've shown it in a recent article, linked here.)

McClellan's mother, Judith Gorman, says that her son never really came all the way back home, because of his PTSD. Retired Army General Eric Shinseki, now head of the VA, is also quoted in the article, as ruminating -- perhaps not about McClellan's death in particular but about veterans' suicides in general -- that he often asks himself, "Why do we know so much about suicides, but so little about how to prevent them?" That's a fabulous quote, but it's also quite a profound question.

Edwin Shneidman, the so-called "father of suicidology" -- who ironically got his start leafing through files at the VA, reading suicide notes of veterans -- is someone we've written about a fair amount on this site. He's also known as the originator of the concept of a "psychological autopsy," where someone, reasoning backwards from the fact of the a person's death, tries to reconstruct the extent and timing of the stressors in that person's life, to determine how and why it became too much for them (the "when" having already been determined.)

I'm not sure, but I would hazard a guess that, other than the families of veterans who commit suicide, who are directly involved, there isn't much of an effort made on a larger level to reconstruct what stressors became unbearable in the lives of those who kill themselves, during or after military service. Perhaps a broader study into this, a la Shneidman's methods, would produce important or helpful conclusions.

McClellan's story is in many ways all too typical...except for the social worker mother, and the wonderful legacy he left behind in the poems he wrote and photographs he took. He struggled, as many veterans with PTSD do, with drugs and alcohol, with trying to fit back into his life, with impulse control, with hypervigilance, with nightmares, with combining alcohol with prescription medications, with grief and perhaps blaming himself over the deaths of two close friends. And he struggled with long drives to the VA, which was located quite a distance from his home.

His parents sound like amazing people, who tried so hard. They even established a Veterans Resource Center, on the island where they lived, "to offer referrals, networking and other assistance," to help other veterans in addition to their son. In the wake of his son's death, they may also publish a book of his writings, to raise awareness about PTSD.

Digging around on the Web, especially within social media, it wasn't hard to find some of McClellan's thoughts. He had two journals where he kept his writings, one on MySpace and one on LiveJournal. I've chosen not to link to them, to protect his privacy in case that's an issue. But in one he quotes from T.S. Eliot's famous poem, "The Hollow Men," which closes with the memorable lines about "this is how the world ends, not with a bang but a whimper."

It also contains an entry from September of 2008, while McClellan was actively struggling with PTSD, but a full year and a half before he ended his life. In an entry called "What the hell happened to me?" he writes:

"I read some entries in my journal from two years ago" 

[2006, the end of his Afghanistan deployment and beyond]

I love who I was.

Why did I do this to myself?

Was it war?

Did I implode from all the shit I saw?

Or was it something else?"

Questions really with no answer. He goes on for a bit more, and then concludes with the poignant question:

Why did I let myself

Get so lost?

RIP Orrin McClellan, gone too soon, and comfort to your family and your friends.

Editor's note: The photo is of a point on Whidbey Island, a thoroughly beautiful place in Washington state.

"The Hell of War Comes Home" Almost Nets Reporter a Pulitzer Prize

The Pulitzer Prizes in journalism were announced today. A semi-finalist in the "local reporting" category was Dave Philipps of The (Colorado Springs) Gazette for" his stories on the spike in violence in a battered combat brigade returning to Fort Carson after bloody deployments to Iraq, leading to increased mental health care for soldiers."

Go here to read the series, "The Hell of War Comes Home." The link goes to the first installment in the series; other installments are linked to that initial article. There's also video.

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

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

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

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

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

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

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

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

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

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

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

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

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

More Numbers to Remember: 3 Then, 7 Now

A newspaper article reports today, "In the Vietnam war, for every soldier killed, three came home wounded. In Iraq, for every soldier killed, seven come home wounded." Those are some substantial numbers...and I wonder if they're even accounting for PTSD in them, which is often considered an "invisible wound," and one which shows up usually after the fact.  The numbers could be even that much higher...

Roughly 5,000 killed to date -- 35,000 wounded (by that estimate) -- and for every veteran, another 50 people who he or she affects (see Fred Gusman comment about that, which we blogged about earlier -- linked here).  If we add the number killed and the number wounded together, then multiply the 50 each veteran affects directly in his or her life, that's 2 million Americans affected by veterans' sacrifices.

Feel Like Just a Number / War's Psychic Toll

The New York Times has a good op-ed piece today by Bob Herbert, entitled "War's Psychic Toll," linked here.

One point he makes, in the wake of the shooting deaths at Camp Liberty, is that:

"The fallout from the psychic stress of the wars in Iraq and Afghanistan has been vast, but there was no reason for its destructive effects to have surprised anyone. There was plenty of evidence that this would be an enormous problem. Speaking of Iraq back in 2004, Dr. Stephen C. Joseph, who had been an assistant secretary of defense during the Clinton administration, said, “I have a very strong sense that the mental health consequences are going to be the medical story of this war.”

He also further clarifies a point that a number of people have been making over the last several years, which is that an all-volunteer military concentrates the inevitable "psychic toll" of warfare into too few combatants on our side.  Herbert writes:

"Because we have chosen not to share the sacrifices of the wars in Iraq and Afghanistan, the terrible burden of these conflicts is being shouldered by an obscenely small portion of the population. Since this warrior class is so small, the same troops have to be sent into the war zones for tour after harrowing tour.

As the tours mount up, so do the mental health problems. Combat is crazy-making to start with. Multiple tours are recipes for complete meltdowns."

We've already seen, in previous blog posts, how more combat => more opportunities for PTSD. The relationship is direct.

At some point, with the same people serving multiple deployments, being injured becomes a numbers game.  And increasingly servicemembers who keep going back, if they've managed to avert injury so far, become concerned that their luck can't hold out forever.

A Recon Marine, with multiple deployments under his belt -- some would say, the toughest of the tough -- headed back to Afghanistan on Monday.  "I'm scared," he told his friends and family, unashamedly.  War is a dangerous game, and multiple deployments wreaks havoc on those who go, and those who stay behind and wait.

---
In the old Bob Seger song about working on an assembly line, "Feel like just a number," he sang, "I feel like just another / Spoke in a great big wheel / Like a tiny blade of grass / In a great big field."  Seger insists he's gonna "cruise out of this city / Head down to the sea / Gonna shout out at the ocean / Hey its me!" "I feel like a stranger / A stranger in this land," he sings.  "I feel like a number / But I'm not a number / I'm not a number -- Dammit, I'm a man! / I said, I'm a man."

I recall a conversation with another Marine, who between tours of Vietnam, had a premonition that he wouldn't survive his second tour.  What worried him even more than the dream was that everyone he knew who'd had a dream like that, and shared it with his buddies, subsequently was killed.  This Marine talked it over with his dad, a heavily-decorated Army officer, who told him, in sort, to buck it up and suck it up and go back -- because if he didn't, he'd be running from every other experience like this in his life.  Well, the premonition had a lot of weight to it -- he was shot multiple times and almost died, and took years to recover from his injuries. So we know that the Recon Marine in today's story, headed back to Afghanistan, does have something to be worried about -- even if he hasn't had a dream like this.

Ultimately, whether he and servicemembers like him think of themselves as "just a number" in the larger war machine or not, their more pressing concern, with multiple deployments in harm's way, is whether this time their number is going to be up.  And let's hope it won't be.  But of course, for society at large -- who stays behind -- the broader public health worry is that even if these warriors come home relatively "unscathed" -- in body, more likely than in mind -- their struggle with dealing with the after-effects of combat will just have begun.

Editor's note: To listen to the Bob Seger song mentioned above, on YouTube, click here.

Puget Sound Veterans Hospital Tries Meditation for PTSD

The Seattle Times reports in today's paper that a veterans hospital in the Seattle area is trying a version of mindfulness meditation for combat veterans with PTSD.  The article is called, "Seattle hospital teaches meditation to troubled vets," by Michelle Ma.  The eight-week course, which has been held for a year, has proved to be of some value to veterans, and current plans are to study the effects more in-depth. 

The article in the Seattle Times is linked here.

For links to other posts we've done about mind-body medicine, including meditation, and PTSD, click here.

PTSD, Suicide and the Primary Importance of ... Sleep

There's a great article in today's San Antonio Express-News by Sig Christenson, called "War Lingers, GI Suicides Rise."  (The article is linked here.)

It quotes my favorite, retired Veterans Affairs psychiatrist, Jonathan Shay, M.D., Ph.D., and it quotes him on, among other things, the absolute primary importance of SLEEP, which we've talked about many times on the blog before. (Click here for a link to those posts, many quoting Shay himself.)

Quoting Christenson's article, from today:

"The armed services' high operational tempo for the past decade definitely is part of the problem, said (Jonathan) Shay (M.D., Ph.D.). Though alcohol abuse “is a major risk factor,” he said the military's rapid training and deployment cycles short-change troops on the one critical ingredient to good physical and mental health: sleep.

“I've been agitating for years the importance of getting truly realistic policy on sleep,” Shay said. “This is a slow slog because it is so contrary to the macho culture and so contrary to the self-sacrificial culture, which sees self-care like sleep as self-indulgence.”

Let's recap some absolute basics about sleep:

• It's absolutely necessary for mind and body healing, and down regulation of bodily systems;
• It's vital for decision-making and mental health. Studies on drivers who operate on lack of sleep of sleep show that it impairs functioning to the level of alcohol intoxification.
• It's hard to get in a war zone, for any number of reasons: from the operations that go on for days and nights at a time, to the noises of combat, etc.;
• It's hard to get after combat, thanks to nightmares, hypervigilance and arousal, and often the desire to avoid sleep (which brings on intrusive memories, nightmares, night sweats, and the like);
• Chronic lack of sleep impairs mental, physical and emotional health;
• And yet without adequate, nightly sleep -- how is healing going to take place?

There's a great story told about beloved Marine veteran, Travis Twiggs, who we've written about in other contexts.  Apparently his nickname was "War Pig," and it was given to him during a tour of duty at Guantánamo Bay, where after being up for umpteen hours straight, and finally getting a break, he had fallen into such a heavy sleep that he couldn't be roused, and a passing a general had stuck over his sleeping form a sign that said, “Here Lies the Mighty War Pig.”

I know another hardcore combat veteran and former Marine who came with me once to a program that was designed to help people learn how to sleep better.  He bitched and moaned while we were there, quite a bit, about how this wasn't really suited to combat veterans like himself, but whatever -- he persevered, and tried what they had to offer.  The next day, after he flew home, I worried about him because I hadn't heard how he was doing. A day later, he called me back. "I came home and slept for 31 hours straight," he said.  "I hadn't been able to sleep more than two hours at a time since before I left for Vietnam." So my guess is that the method was of some help to him ;-) But imagine not sleeping for more than two hours at a time?  How well would you be able to heal?

Editor's note: Read the rest of the articles we've included about sleep, from previous posts, linked 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.

---

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.

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

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

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

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

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

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

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

Students' Documentary on Veterans: "It's a Privilege to Hear Their Stories"

The Boston Globe has a GREAT front page story today called "Battling a Different Kind of War," by Peter Schworm. The subhead gives you a clue to the content: "military college students document the struggles veterans face when they return." The students in question are from Norwich University, in Northfield, Vermont, and the documentary, done entirely by students, talks to Iraq and Afghanistan veterans about their readjustment issues on returning home.  As such, it's both a truthful and a cautionary tale, for those on both sides of the camera.  Great job!

Let's hope the documentary soon will be available for viewing publicly, to further enhance all of our understanding of what combat veterans go through when they willingly go to war, and return -- hoping, but maybe not always able, to pick up their lives "right where they left off." Because the students involved are at a military college -- and some of them have already served their country -- they're probably a little more sensitive to some of the issues involved, and presenting a less-biased approach than those who are necessarily "for" or "against" military service.  From the sounds of the Globe article, everyone involved seemed pretty aware and respectful of the price that veterans pay to serve their country. (The quote in the title above was said by one of the filmmakers in the story...)

Editor's note: The Boston Globe article is linked here.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Investigative Report on Desperate Troops with PTSD Who Go AWOL

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

In the News: Scientific American on PTSD

This month's issue of Scientific American has a long article on PTSD, called "Soldiers' Stress: What Doctors Get Wrong about PTSD."  Go here to read it. The key takeaways from the article, the authors say, are the following:

• The syndrome of post-traumatic stress disorder (PTSD) is under fire because its defining criteria are too broad, leading to rampant overdiagnosis.
• The flawed PTSD concept may mistake soldiers' natural process of adjustment to civilian life for dysfunction.
• Misdiagnosed soldiers receive the wrong treatments and risk becoming mired in a Veterans Administration system that encourages chronic disability.

Commentary to come. 

One, Two, Now Three Military Generals Discuss Their PTSD Candidly

Here's something you don't see every day -- military generals sharing openly about their struggles with PTSD. 

CNN has a very brief story on their website today about two generals doing just that -- and if nothing else, the generals' refreshing candor should raise the profile of healing combat trauma and PTSD just because of who they are.  Says Brig. Gen. Gary S. Patton, tellingly, "We need all our soldiers and leaders to approach mental health like we do physical health. No one would ever question or ever even hesitate in seeking a physician to take care of their broken limb or gunshot wound, or shrapnel or something of that order. You know, we need to take the same approach towards mental health." Absolutely. This should be very helpful towards combating the stigma that exists about admitting there's a problem, or countering the somewhat prevalent "blame the victim" notion that servicemembers who do struggle with PTSD were somehow already "broken" -- previously unfit,or otherwise "less than" other combat veterans because they suffered in this manner.  Hmmmn.

In November of 2008, we discussed another Army general, this time Major General David Blackledge, coming forward and talking about his own experience with PTSD.  At the time, it seemed like possibly a one-off, once in a lifetime experience.  (That blog post, entitled "Army General and PTSD -- the Courage to Admit All is Not Well," is linked here.) 

Now, with two more generals -- Brig. Gen. Gary Patton, and Gen. Carter Ham (pictured) -- coming forward and self-disclosing about their own experiences with PTSD, there's even more hope that PTSD can be seen as a genuine consequence of combat, and not an opportunity for continuing silence and shame.

For a link to the story on CNN, click here.

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

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

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

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

---

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

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

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

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

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

In the News: Two Articles Worth Reading Recently

Two articles worth reading that have been in the news recently:

"How the VA Abandons Our Vets," by Joshua Kors, in The Nation, linked here; and the poorly-headlined but otherwise worthwhile"Military Town Newspaper Challenges U.S. Military on Murder of Military Women," by Ann Wright, in TruthOut.org on the Web, linked here. 

Kors' article talks about the recent veterans' class-action lawsuit against the VA, fought in Federal court, and WHY it was necessary -- and there are some interesting and unexpected points, which didn't show up elsewhere in enough detail.  The biggest one is about the "fuzzy math" the VA employs to calculate claim times, and how this uniformly works against veterans (no pun intended on the "uniformly" thing.) It also confirms a longheld impression on my part that a veteran who struggles intensely with the mammoth difficulty of being his or her own advocate in the process, and ends up committing suicide, is actually counted as a "victory" for the VA, who calls their claim "resolved" in the time it took them to kill themselves.  In other words, fellow veterans killing themselves while waiting for their claims to be resolved actually makes the VA look "better and faster" at resolving claims, if you can believe that.  Yikes.  Talk about a system that needs to be overhauled and addressed...

Another great point Kors makes is that "someone" already attempted -- but was fired for her efforts.  That "someone" is Frances Murphy, M.D., who in 2004, according to Kors, "helped draft the Mental Health Strategic Plan, a blueprint for overhauling the VA.  The plan called for 256 changes to the organization, among them: installing a tracking system to stay in touch with suicidal veterans, creating rehabilitation programs that involved veterans' families, and streamlining the benefits process to resolve wounded veterans' immediate needs."  However, after expressing her frustration in public (to mental health providers) about the barriers the VA erects to veterans' speedy care, and how this causes veterans to suffer additionally and unnecessarily -- she was summarily fired.

Read the Kors piece to understand what wounded veterans have to go through, and how unfair it is; and to get a better picture on the fuzzy math that's employed to make things seem much better than they are.

The Ann Wright piece talks about military wives and women servicemembers murdered recently by other servicemembers, and mainly serves to remind us of how this is a problem that isn't going away.  The "news peg" for her article is a recent editorial in the Fayetteville, NC Observer -- Fayetteville is close to huge Army and Marine bases -- called "Our View: Military Domestic Violence Needs More Aggressive Prevention" (speaking of odd word choices).  That editorial is linked here.  The editorial references a recent vigil to memorialize the murdered women locally.

In conjunction with the Helen Benedict material and the other writings on Military Sexual Trauma, blogged about recently, here -- this is a topic worth keeping in the forefront of our minds.  Collateral damage from combat trauma? Or just crimes committed by otherwise sick individuals who happen to be in the military?  Either way, "more" needs to be done about this terrible problem.  (A similar and related topic is the "non-combat deaths" one we discuss from time to time, which can sadly be what's used to describe what more actually is a victim's suicide or a "domestic violence" type murder, of one servicemember by another.) We're just about to add a series of blog posts about domestic violence, and why it's important to leave when you're at risk, but ideally how to do so in a way that preserves your life.  Look for that shortly.

About the authors:

Joshua Kors is an investigative reporter for The Nation, where he covers military and veterans' issues. He is the winner of the National Magazine Award, George Polk Award, IRE Award, National Headliner Award, Casey Medal, Mental Health Media Award, and the Military Reporters and Editors Award.  He was also a finalist for the Michael Kelly Award, Tom Renner Award, Harvard's Goldsmith Prize for Investigative Reporting, and the American Bar Association's Silver Gavel Award.

Ann Wright is a retired US Army Reserves colonel with 29 years of military service. She also was a US diplomat who served in Nicaragua, Grenada, Somalia, Uzbekistan, Kyrgyzstan, Sierra Leone, Micronesia and Mongolia. She is the co-author of "Dissent: Voices of Conscience," profiles of government insiders who have spoken and acted on their concerns of their governments' policies.

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

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

Lisa Chedekel, Veteran Reporter on Veterans Issues, Allegedly to Take Courant Buyout

In the "Another One Bites the Dust " Dept., it's discouraging to learn that Lisa Chedekel, one of only a handful of truly great reporters on veterans issues – and by handful I really do mean, five or fewer -- is apparently taking a buyout offer from The Hartford Courant, the newspaper where she has reported for years, at least according on media-watcher blog, linked here.  (Sorry, Lisa, about the dismal, DMV-ish photo -- it's all I could find to identify you with to readers. )

 

This is particularly sad news for veterans, their families, and anyone else who wants to learn about the perils of their frequently inadequate mental health and treatments, because Chedekel, who specializes in what she calls "in-depth, old-fashioned shoe-leather reporting," has provided wonderful coverage of these topics over the years.  It’s disappointing to learn that Chedekel will be leaving the Courant, because it means one fewer voice covering this subject well; and perhaps no one to replace her who can do it nearly so well.

 

(There are others, of course, who do a great job covering veterans and mental health issues, but they are few and far between: The Washington Post's reporting duo of Anne Priest and Dana Hull, who did the seminal Walter Reed series; independent journalist Aaron Glantz, who's a new Rosalynn Carter fellow in mental health reporting this year; Mark Benjamin, who wrote about this topic in Salon and elsewhere well before it was popular on any level to do so; and Kathy Dobie, who seems to have a trauma survivor's insider's take on why this topic is so important.)

 

A 1982 grad of Wesleyan University, Chedekel's work has frequently been nominated for the Pulitzer Prize.  Her fantastic investigative piece, Mentally Unfit, Forced to Fight, is fortunately still available on the Web, as is her recent article, "Mental Health Providers Too Few for Troops," linked here, and another titled, "Army Sees Record Number of Suicides in Iraq," linked here. 

 

Mentally Unfit, Forced to Fight, is one of the best articles to date that covers the murky ground where mental illness and military readiness co-exist, and specifically covered the U.S. military's cavernous gaps in mental health care for its soldiers.  Calling Chedekel's "Mentally Unfit, Forced to Fight," an "impressive investigation," a reporter at the renowned British paper, The Guardian, summarized its impact when he wrote:

 

The Hartford Courant found that, despite an order by Congress that the US military should assess the mental health of all deploying troops, fewer than one in 300 US personnel saw a mental health professional before deployment.

 

The paper says there is evidence of the US military "recycling" troops with mental health problems, redeploying them even if they develop PTSD. It also notes that the number of troop suicides in Iraq reached a high of 22 last year. The Courant says at least 11 of the soldiers who killed themselves were kept on duty "despite showing signs of significant psychological distress".

 

(This was news at the time, and we owe Chedekel’s reporting, and the  Hartford Courant’s resources, for contributing to growing public awareness of the problem. In the mostly misplaced anger that particularly military bloggers direct at the alleged "main stream media" -- sorry, that's two words, not three -- reporters come in for a lot of flak, as though inferior coverage starts and ends with them, as opposed to also the commercial concerns of running a newspaper, often one allied with business interests.  Since many of these disgruntled types seem reasonably unaware of the part that good journalism can play in helping move society forward -- by spotlighting a problem that needs to be solved, and writing persuasively about it so that people start to care -- I sometimes feel the urge to spell that out.  That's what Chedekel's work did for veterans, and we're thankful that at least some important changes came about, because of it.  Here's what that effort took.)

 

According to the Courant's website:

 

To report this series, The Courant obtained records under the federal Freedom of Information Act, including never-before-released pre-deployment screening data for nearly a million troops and investigative reports into dozens of service members' deaths.

The Courant also interviewed more than 100 mental health experts, service members, family members and friends. The military does not publicly identify suicide cases. But The Courant was able to identify -- in most cases for the first time -- the service members who killed themselves in Iraq through records and interviews. Details of their deaths came from investigative reports and interviews with family, friends and fellow troops.

(The series was first published in May 2006.)

---

Here are some articles from Lisa Chedekel and the  Hartford Courant's coverage of PSTD and the military, hyperlinked so you can go right to them:

 

Mentally Unfit Soldiers

The military is focused on retaining troops in combat, even when they exhibit clear signs of psychological distress, a Courant investigation uncovered in 2006.

Army Sees Record Number Of Suicides In Iraq

The Army is losing its battle to stem suicides among troops serving in Iraq, with a new report showing that 32 soldiers killed themselves in the war zone last year — a record high since the war began five years ago.

Special Report: Mentally Unfit, Forced To Fight

The U.S. military is sending troops with serious psychological problems into Iraq and is keeping soldiers in combat even after superiors have been alerted to suicide warnings and other signs of mental illness, a Courant investigation has found.

'Jeffrey Was Really Messed Up'

There is not enough guilt to go around here, so intent is each woman in Jeffrey Henthorn's life on owning a piece of the blame.

Slipping Through The System

In the 17 months after their son, Eddie, announced he was heading off to fight the war on terror, Margaret and Edward Brabazon of Bensalem, Pa., had held their breath.

Potent Mixture: Zoloft & A Rifle

When Army Sgt. 1st Class Mark C. Warren was diagnosed with depression soon after his deployment to Iraq, a military doctor handed him a supply of the mood-altering drug Effexor.

Amid Patriotism, Anger And Questions

Just off the two-lane main street of this southern Maryland town, a couple doors shy of the big lumber mill that rumbles all day like thunder, Ann and Jim Guy's modest dwelling is the picture of a patriotic American home.

Still Suffering, But Redeployed

Eight months ago, Staff Sgt. Bryce Syverson was damaged goods, so unsteady that doctors at Walter Reed Army Medical Center wouldn't let him wear socks or a belt.

Use Of Unfit Troops Blasted

U.S. Sen. Joseph I. Lieberman called Wednesday for a federal investigation of mental health screening for troops deploying to Iraq, after The Courant reported in a series that mentally ill service members are being sent to war and kept there, sometimes with tragic consequences.

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.

---

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.

---

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.

 ---

"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...

Combat Trauma into PTSD: "We're Going to Be Paying for This for a Long Time..."

Christian Science Monitor reporter Jill Carroll -- you may remember her from her own capture ordeal in Iraq -- has an excellent story in today's paper, featuring many of the names covered heavily on this blog, among them, SSgt. Travis Twiggs, and Norfolk, Mass. District Attorney William Keating.  The article is called, "When the War Comes Back Home," and it's subtitled, "When veterans of Iraq and Afghanistan bring their [war] troubles home, police and judges are often the first to deal with them."  How they deal with them becomes the gist of Carroll's story, and it's well worth reading -- and linked here.

(We'll update this blog post as we have opportunity, but wanted to get the information out there.  Carroll's article is full of good information and tightly written --  so to rehash her main points or the things you'd want to know about would take as long as having you just read the original.  Not to mention, it's good practice to do that.  So please just go read the original.  The quote in the post title is from the article, as civic officials contemplate how long the problems of PTSD from combat trauma are going to remain with us.)

Don't forget we've also written, on this blog, about the similarities between police and veterans in how they develop PTSD from repeated exposure to trauma.  While police departments across the country, and the judiciary, are contemplating ways to manage the increased incidence of crime that can be traced to returning veterans (even if it's not much, it may still need greater awareness of PTSD and special challenges to veterans to handle) -- one thing both sides might want to remember is how they're probably more alike than different.

And I'm still loving this old headline from the New York Times, decades ago, about a far different war. Any old excuse to use it is just amusing to me.  I guess people were afraid that the "crime wave" they had on their hands was due to veterans, and the New York Times had to reassure them that it wasn't.  Argh.  

When the Marine Corps Misses the Bigger Picture -- Zoriah, Eric Acevedo, and Censorship

It's discouraging to even have to post about this, but there it is:

In a fight between the Marine Corps and freedom of the press, the Marine Corps seems like it wants the win.  According to Google Playfights (see gimmicky graphic illustrating this post) it already has.  (Learn more about Google Playfights elsewhere: it's not central to this post.)

Following the recently-embedded independent photojournalist Zoriah's travails on his blog, it seems that he's just now been kicked out of Iraq, and risks being completely blacklisted as a war photographer, because of at least some higher-up Marine Corps officers' displeasure with images he posted.  Images that centrally could help America to really get a better grip on the true cost of war for its participants.  If you believe the experts -- and the poets --no one comes back from war unchanged.  Whether it's what you've done/seen/participated in or not been able to do/see/participate in, it exacts a tremendous psychic cost.  That doesn't mean we should stop fighting in wars -- just that we should be more aware of the actual costs to those who do.  For every combatant killed, so many more are injured, and will come home with injuries that in many cases will profoundly transform their lives, and that of their families, for decades to come.  It's a shame the Marine Corps doesn't seem to really want the rest of us wrap our brains around this concept more fully.  It would help make us better empathizers with the true cost of war to its participants.

I had my own experience with Marine Corps censorship, earlier, on this site.  In an attempt to humanize the story of an apparent PTSD sufferer who'd killed his girlfriend, I dug through the Marine Corps (public) archives on their website, and found a little backstory about the Marine, Eric Acevedo, who'd been accused of the crime.  In and amongst the materials were some very key items: a photo that showed the human side of his grief and pain; and some material -- if you knew where to look -- that explained just what he'd been exposed to, in terms of combat trauma, while he was on the deployment that apparently harmed him the most.  It was a tragic tale, but it was also public knowledge -- at least, information accessible by the public, that could be pieced together by someone like a journalist who knows how to dig and highlight the important parts of the story.  I posted what I found, in an entry linked here -- and within three days, the Marine Corps had taken pains to scrub ALL identifying information about this poor guy, Acevedo, from their site.  The photo was gone, the article about the memorial service he attended, for the multiple guys KIA from his battalion on the tour in question -- all gone.  I learned about this new development when a reporter from the Dallas Morning News contacted me and said that all my links were down (I'd included them in the original piece, so anyone could follow and see what my sources had been).  Together, we backtracked through the Marine Corps archives, and found NOTHING -- the site had been scrubbed clean of multiple mentions of the accused -- and has stayed that way ever since.

Nobody likes bad publicity, of course, including the Marine Corps -- but really, there's so much more at stake than that.  When it comes to combat trauma and PTSD, the focus of this site -- it's important as a society that we see, learn, and otherwise come to understand what veterans go through -- or we won't have the compassion that we need to, and we won't pull for them to get the services they deserve, otherwise.  We also need to see more clearly the link between instances of combat trauma, and ultimately developing PTSD.   Not so that "no one else will join the military" -- not at all.  So that those who do can get the help they need, and those in charge can allocate their resources accordingly.

It's my firm conviction that combat veterans don't "give" PTSD to themselves.  They "get" it from what they've experienced.  And this is a true cost of war, for the Marine Corps and others to "count" in advance, so that the right opportunities for treatment and ideally recovery can be provided.  We can see from the late SSgt. Travis Twiggs' battle with PTSD -- or many others like him -- just how powerful, thorough, and deadly an opponent it really is.  What we're not seeing, unfortunately, from the Marine Corps -- in these two instances -- is a reasonable, big picture view on how the horrors of war are not something the American public needs to shy away from, but embrace.  And where the two may be linked up, as in the Eric Acevedo story, it's crucial that the Marine Corps not distance itself from its warriors, even when they're dented with significant wounds, visible and invisible. Sanitizing war?  Why bother... Actually supporting the troops who go? Oh, definitely.  If knowledge is power -- we need more, not less - in order to do so, more effectively.

In the Zoriah situation, it sounds like someone may have snapped under the strain and started a bad ball rolling with that -- created a polarized position that no one could retreat from, gracefully.  If that's the case, that's a real shame.  There's a much bigger picture here, and finding a workable compromise would be greatly important.  I remember reading one Marine officer's published dispatches from Iraq, which got progressively darker and unpleasantly snappier as his tour went on, to the point that it sounded like another person writing them.  I commented about this to someone who knew that Marine, who told me a little side story that explained a lot.  Things had been going well until that Marine's superior, to whom he was very close, was seriously injured and almost died, taking part in a humanitarian mission with the Iraqi government.  At that point, the junior officer hit a wall, got bitter, and got very angry with the Iraqis who could have done that, while the Americans were just trying to help.  What I had been picking up in the Marine officer's writing reflected the personal struggles he was genuinely going through -- struggles which are highly understandable to anyone interested in human nature.  My guess is here, someone who felt very stressed and angry because of Marines he cared about being injured and dying, snapped down on the whole situation instead of privately (or publicly) processing his natural grief -- and the ultimate impact might be, if this continues to go wrong, to keep the rest of us from being able to experience war a little bit more, even vicariously - in order that we better understand, and grieve, with those who suffer.  I hope the Marine Corps finds a way to resolve this situation that respects the points of view of all sides involved, including the American public, which does have a need to know.  The same goes for the Eric Acevedo situation, and scrubbing the information from their archives.

The American public pays the bill for these wars: we have a right to know what they're like for those fighting them.  And those who fight them pay the ultimate price: and we respect their efforts and the character it takes to be warriors, very much.

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I shared a very bleak, grim quote with a Marine Corps Vietnam vet the other day, from an Italian in the Middle Ages who said, "Life is a voyage on uncharted waters, ending in shipwreck.  There are no survivors."  The former Marine, still struggling all these years later with PTSD, said the quote was almost right -- but would be better if we switched out "life" with "combat" or, "war."  Then, he said, it would be more accurate, because, quoting him, there are no true "survivors, only shipwrecked lives..."

Editor's Note: You can read about Zoriah's developing situation on his blog, linked here.  You can also read previous entries on this blog where we've mentioned him, here and here.  You can read about the Travis Twiggs story here, and in many other entries on this blog; and the Eric Acevedo story here; both as I've blogged about them. 

And while you're at it, considering asking the Marine Corps to put the Eric Acevedo material (and anyone else's they've removed, in similar circumstances) back on their publicly-searchable archives, as it was before.  I'm sure his defense lawyer would appreciate it, because any good defense of this client is going to need to advance theories that involve his extenuating circumstances (combat) and things that speak to his state of his mind (PTSD), both of which it's hard to picture were NOT service-related.  Acevedo's crime?  A  truly terrible one.  The combat trauma he experienced, and the PTSD he likely developed?  Also terrible.  Without war coverage like Zoriah's "tragic and amazing" photography, also a big picture we're likely to miss.

"Disposable Heroes" - Washington Times and ABC News Investigates Drug Testing on Veterans

On June 16th, the Washington Times, which has been following the "Chantix harm to veterans" story doggedly, and ABC News, produced an investigative piece called "Disposable Heroes," about the drug testing that takes place on veterans, sometimes with lethal consequences.   That interactive piece is linked here. (Ironically, earlier this week, we posted an entry about veteran' similar exposure, this time from the Vietnam War, that is still coming to light.  That post is linked here.)

Here's the lead from the Washington Times' story, by Audrey Hudson:

The government is testing drugs with severe side effects like psychosis and suicidal behavior on hundred of military veterans, using small cash payments to attract patients into medical experiments that often target distressed soldiers returning from Iraq and Afghanistan...

In one such experiment involving the controversial anti-smoking drug Chantix, the Department of Veterans Affairs (VA) took three months to alert its patients about severe mental side effects.  The warning did not arrive until after one of the veterans taking the drug had suffered a psychotic episode that ended in a near lethal confrontation with police.

If you want to find other entries in the Washington Times' extensive coverage of Chantix and veterans, use this link here, which will produce a list of the articles, or go to their website, linked here, and do a search for "Chantix".  Be forewarned, however. Although the information on the website is well worth learning, the Washington Times has an especially cumbersome user interface, irrespective of browser.  Get ready to enable popups, and then, even so, only be able to pull up the stories with great difficulty.  Someone really needs to improve that...)

Going Frantic over Chantix - Anti-Smoking Drug Causes Problems for Veterans with PTSD

An anti-smoking drug, Chantix, prescribed to veterans, including those with PTSD, has been linked to significant health problems:

The Washington Times reported on February 2, "Government regulators said the connection between Pfizer's anti-smoking drug Chantix [Vanericline] and serious psychiatric problems is "increasingly likely." The Food and Drug Administration said it has received reports of 37 suicides and more than 400 of suicidal behavior in connection with the drug."

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On May 16, the FDA issued a Public Health Advisory, linked here, about the drug, and mentioned -- of particular concern to those with PTSD -- that use of Chantix "may cause worsening of a current psychiatric illness even if it is currently under control and may cause an old psychiatric illness to reoccur." The FDA warned those taking Chantix about the "possibility of severe changes in mood and behavior," as well as about "vivid, strange and unusual dreams" -- problems already for veterans with PTSD. Similarly, the FDA described symptoms that Chantix might cause may include "anxiety, nervousness, tension, depressed mood, unusual behaviors and thinking about or attempting suicide."  Grrrreat.  Apparently, according to the health advisory, problems occurred both while taking Chantix, and during withdrawal.

Approximately a week later, on May 22, the Washington Times again reported that the FAA had banned Chantix for use by its pilots and air traffic controllers, after concerns about its use.

 

NPR Local Affiliate KQED's Story about VA Being Sued over Veterans' Healthcare

According to a story aired today on KQED -- a San Francisco public radio and television station, and NPR affiliate -- Berkeley, California's Disability Rights Advocates recently filed a lawsuit "that could affect thousands of veterans returning from Iraq and Afghanistan. They allege that the Department of Veterans Affairs is unable to provide timely mental health treatment for returning veterans. It describes a backlog of 600,000 claims for vets seeking care — some dating all the way back to the Vietnam War." To listen to the approximately five minute story, click here.  (And yes, this is the lawsuit that's produced the incendiary emails that have lately been in the news, including the infamous "shhh..." one about veterans suicides, which we blogged about earlier, here.)

Editor's Note: For more information about the veterans access to healthcare lawsuit in Federal court, as provided by the Disability Rights Advocates website, click here.

Patriot Hills: A Recreation and Wellness Center for Wounded Warriors Planned for Upstate New York

The Albany Times-Union has an article in Friday's paper, linked here, called "A Bridge from Wartime to Civilian Life: Fundraising begins for Patriot Hills, a planned wellness center for National Guard soldiers."  According to the article, Jeannine Mannarino, 48, a retired Army National Guard master sergeant, and dozens of volunteers are creating a nonprofit group to fundraise a planned $21 million to crate a "wellness and recreation center for wounded warriors in the Adirondack foothills."  The article says Mannarino, who is divorced from her husband, a Vietnam veteran who became "a different person" once he had PTSD, "envisions Patriot Hills of New York as the first Armed Services Recreation Center geared to National Guard members and the treatment of military-related maladies," including PTSD.  As the article mentions, "The concept of combat veterans recovering through recreation and professional therapy is innovative and timely," said Mannarino," and adds,

"Patriot Hills would be a therapeutic mountain resort for National Guard soldiers and others who return from war or are diagnosed with trauma. It would give them access to sports and entertainment, but also counseling in a relaxing environment."

This sounds like a great idea.  The National Guard in particular seems underserved, nationally, and we wish this project and Ms. Mannarino, every success.  It will not be the only initiative of its kind: several private initiatives have sprung up over the last few years, but their current status is unclear.  There's the proposed Veterans' Village in Guerneville, California, which is currently getting opposed by its NIMBY-conscious neighbors; and The Sanctuary for Veterans and Families, envisioned by Stacy Bannerman, author of When the War Came Home: the Inside Story of Reservists and the Families They Leave Behind, which seems to have stalled out, either temporarily or permanently.

The Double Whammy: Women Combat Veterans with PTSD and Military Sexual Trauma

What's blowing up right now -- on the Web -- in terms of searches, within combat trauma and PTSD: definitely this one. People, the VA included, are looking for resources on treating women combat veterans who are victims of Military Sexual Trauma (MST) (see our index to entries discussing that, linked here). 

That means one of two things (prediction coming): either there's a scandal brewing, and about to hit the news, on this topic; or, the VA and others are fairly well bereft of resources and wondering how best to treat sufferers of this problem, who are apparently reaching the VA in greater numbers.  (One possibility: news items like this that show studies recently have shown an unsurprising but nevertheless unfair disparity in care between men and women veterans.)

Unfortunately, this is another case where civilians have a better situation going for them than the troops do.  In the civilian world, women can take their employers to court for providing a sexual harrassing or otherwise hostile work environment, and their victories in this arena put other employers on notice not to go and do likewise.  Sadly, the troops have no such protection.  It's completely a double whammy: combat trauma AND trauma from rape or other sexual crime.  Women servicemembers who've been affected by it say that in their minds, predominantly, the military sexual trauma is even worse than the PTSD, though they often occur together. 

It's clear we don't have a handle yet on treating PTSD; unfortunately, PTSD concerns even more people; and MST is probably further down the list of where resources are focused right now.  But whether through growing public awareness, better reporting, or for whatever reason, if searches are any indication, the VA is in a quandary about how best to treat MST, and even who the experts / what the resources are.  We wish them, and particularly those who have been injured and mistreated in this manner, all the best, and hope the situation resolves positively, and quickly, for our women veterans, who have been doubly injured.

PTSD, Puppies and Misplaced Values - We're Having the Wrong Conversation, America

Now that media coverage of SSgt. Travis Twiggs -- the five times-deployed Marine and gen-u-ine American hero who killed himself recently after a protracted and unsuccessful fight with PTSD -- has safely faded from view, America can go back to talking about what really interests it - like the Marine tossing the puppy off the cliff in Hawaii.  Here's a great quotable quote from Kathie Costos, a senior chaplain with the International Federation of Chaplains and a longtime, tireless advocate for veterans with PTSD, both personally and professionally on her blog, WoundedTimes, linked here.  After noting that a mention of the news update on "that jerk" with the puppy toss sent blog traffic sky-high, Costos said, most quotably -- "I hate the fact a puppy toss gets more attention than a Marine killing himself because the DOD and the VA won't do what they are supposed to do."  Amen, sistah.  (I don't believe that she's talking about the Twiggs case there, specifically, but just in general.)

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On this blog here, other than news about Travis Twiggs, which people were searching for because they cared about him, what really sends the hit meter aflying is any mention of THTIOKARR -- The Hotness That is Otherwise Known as Rudy Reyes -- who I mention from time to time only because, other than the obvious (hotness!!!), he seems to be an interesting amalgamation of "yin" and "yang" -- the reflective, centered, holistically-minded, nevertheless deadly warrior.  (Sort of the Bruce Lee Lite for our generation, or if Bruce Lee were a veteran, that sort of thing.)  That gives me hope that he's processing his own stuff, whatever that may be, from combat in as effective a way as possible, and being somewhat of a guiding light to others who have shared his experience.  On the other hand, I'm pretty sure people are just searching for photos of Rudy Reyes -- and where they're coming from is often fairly entertaining (defense installations everywhere, and multiple foreign countries, as well as our own.)  I enjoy learning news about Rudy Reyes, however faint, as much as the next person; or cringe over more news about the deranged puppy-tosser, but here's some veterans news we actually SHOULD care about, and it's happening NOW, and it affects us all:

From Brian McGough, at VoteVets, quoting Anne Weismann, general counsel for Citizens for Reponsibility and Ethics in Washington [CREW], in a blog entry linked here:

Today, [Citizens for Responsiblity and Ethics in Washington] CREW received a truly remarkable response from the Department of Veterans Affairs (VA) to its Freedom of Information (FOIA) request for documents relating to the VA’s abhorrent practice of under-diagnosing PTSD in veterans to save money. According to the VA, CREW is not entitled to a fee waiver -- meaning it has to pay for the costs of finding and copying responsive documents -- because there is no longer any public interest in this issue! Ignoring the wealth of news articles triggered by CREW’s and VoteVets.org's release of an internal VA email and the congressional hearing that release prompted, the VA claims that any records CREW requests “would not reveal anything new.”

(Those VA emails are at the heart of a Federal court case in San Francisco, put on by two veterans' rights groups suing the government over better care.  The judge in the case certainly seems to think they're relevant -- perhaps there are more, and that's why the requests were spurned.  Hey, can they even DO that?  They shouldn't be able to...)

But those don't seem to be the topics we're "alarmed" about -- how PTSD from combat trauma can be so bad it can kill you, and how the healthcare system in place to tend to veterans when they come back needs to do a better job of fully taking care of them.  No, instead we're searching for what amounts to celebutainment, and leaving the weightier matters -- for whom? If not us, who? It better be us, and all of us -- there isn't actually anyone else but us who oughta be caring, and who it concerns.  You don't have to actually put on combat boots to "get" that veterans are being underserved, particularly in the area of healthcare (TBI, PTSD, MST) and benefits (foreclosures! the GI Bill), and that it's up to us to care enough about it, that we do something about it, as a nation.  We CAN do that.  Otherwise, the note scrawled on the white board in the photograph, above, in Iraq, is really going to be our epitaph.  America isn't at war -- we're at the mall.

Editor's Note: Sign the petition for the new GI Bill, here. Love the slogan: "We sent them to war.  Why can't we send them to college?"  Why, indeed.

Israeli Military's Proactive Plan for Identifying and Treating Soldiers Who Have PTSD

Here in the U.S., in our usual myopic way, we can get bogged down in the news about returning servicemembers with combat trauma and PTSD and forget just how many other countries in the world have struggled with this problem as well, and often found their own solutions.  Internationally, Japan, Israel, Australia, England and Canada frequently search the Internet for news about who's doing what, and what's working, for treating PTSD worldwide -- according to data from Google's analytical trends.  Today, the Jerusalem Post has an article about how Israel's Defense Ministry is about to unveil a plan for evaluating and treating soldiers systematically who have been exposed to PTSD as part of their military service.  (The article in question is linked here.)  Their expectation is that 2,500 Israelis suffer from PTSD, in a country where military service is compulsory, and conflicts in the region frequently boil over into sustained violence. 

The significance of the Israeli announcement is that the soldiers will be treated according to a "set psychological and medical format," meaning systematically and methodically.  Their understanding is that PTSD treatment succeeds better if initiated earlier, so evaluating all soldiers soon after military service will increase the chances of favorable treatment outcomes.  According to the article, three years ago the military started thinking through how to create a protocol that would involve every soldier, and optimize chances of finding and treating PTSD.  The protocol was developed by Zeev Waisman and Dr. Dan Dolfin.

Two interesting comments from the article express a vision that the U.S. might be wise to emulate:

"A soldier who comes out of battle will immediately be evaluated and we will see what type of treatment he needs," Waisman said. "Nothing is done today in a regulated fashion and we want all treatment to be according to a protocol."

The process begins by inserting the soldier's profile into the system which will then offer several courses for treatment that could include medicines, psychological therapy, family therapy, sex therapy and others. Waisman said that the Ministry of Defense hoped to convince other organizations to adopt the new format which will be evaluated in two years.

Stateside, it's not even clear that the various branches of the Armed Forces share a similar protocol for identifying and treating PTSD -- most likely, they do not.  With far more servicemembers at risk for PTSD than the Israelis have, we could do worse than to imitate what the Israeli Defense Ministry is putting into action as a plan to deal with PTSD, and return exposed servicemembers to better mental and emotional health.

"Give an Hour" Helps Fill Veterans Counseling Gap

Give an Hour -- the foundation that matches member psychogists and counselors with veterans and their families in need of counseling at no charge -- to fill the currently unmet gap in mental health services, has been in the news recently.  (You can learn more about Give an Hour's founder, Barbara V. Romberg, Ph.D., in her bio, linked here). It's truly fantastic to see this public-spirited act of service on the part of Give an Hour; at the same time, it's a shame that private industry, so to speak, has to jump in to fill the unmet gap of mental health care -- the need for which care is an entirely predictable "soft cost" of going to war.  Nevertheless, good stuff, and very altruistic and forward-thinking on the part of Dr. Romberg and her organization.

From a press release:

The American Psychiatric Foundation, Lilly Foundation And Give An Hour Join Forces To Provide Mental Health Care To Iraq And Afghanistan Veterans

Heeding the call of a growing public health crisis -- the unmet mental health needs of returning soldiers and their families -- Give an Hour (GAH) and the American Psychiatric Foundation (APF) announced a major expansion of a nationwide effort to help U.S. veterans returning from Iraq and Afghanistan.

GAH and APF, the philanthropic and educational arm of the American Psychiatric Association (APA), will be using a $1 million grant from the Lilly Foundation to recruit and educate volunteer mental health professionals, who will become part of a network aiming to bridge the gap in mental health services for soldiers returning from service, as well as their families. Among troops returning from Iraq and Afghanistan, approximately 40 percent of soldiers, a third of Marines, and half of the National Guard members report psychological problems, but mental health services are in short supply.

"This all-volunteer effort provides badly needed support to help our veterans, many of whom come home with mental health needs," said U.S. Representative Steve Buyer (R-Indiana), Ranking Member, House Committee on Veterans' Affairs. "I applaud the hard work of Give an Hour, the American Psychiatric Foundation, and the Lilly Foundation, which are stepping up to help those who have selflessly served."

Efforts will be made to create a large, national, volunteer network over the next three years to address postwar mental health issues such as post-traumatic stress disorder (PTSD), traumatic brain injury (TBI), drug abuse, anxiety and depression.

"This grant will allow us to get out the message that help is available. We want to normalize what our military personnel and their families are experiencing and support the sacrifices that they are making by providing critical mental health support at no cost," said Barbara V. Romberg, Ph.D., founder and president of GAH. "We will be educating the military community and broader public about these mental health needs in hope of helping veterans keep their lives and families intact."

GAH is recruiting mental health professionals to volunteer one hour each week for a minimum of one year to provide direct services in person, by phone or in consultation with schools and community organizations that serve the military community. Services are wide-ranging and include marital and family therapy, substance abuse counseling and treatment for PTSD. APF brings strong ties to the psychiatric community and is actively encouraging psychiatrists to join the network.

"This grant will help us reach our goal of recruiting 10 percent of the 400,000 mental health professionals in the United States by 2015 to assist in this effort," said Dr. Richard K. Harding, M.D., president of the APF. "It is an ambitious goal, but we are confident it can be achieved."

The Department of Defense (DoD) is making an unprecedented attempt to encourage personnel to seek mental health treatment, but a significant increase in demand, in some areas, has forced the rationing of services, created long waiting lists and limited individual counseling sessions. In addition, some members of military families such as parents, siblings and unmarried partners do not qualify for care through the Veterans Administration or DoD but are affected nonetheless by the mental health of the veteran.

"We're privileged to be able to give something back to our troops, but we know there's still much more to be done," said Steven Paul, M.D., executive vice president for science and technology and president of Lilly Research Laboratories. "Lilly is fully committed to assuring that the best possible medicinal treatments are available, but unfortunately, we also know that having access to the best care -- in this case mental health services -- is essential."

About Give an Hour
Give an Hour is a nonprofit 501(c)(3), founded in September 2005 by Dr. Barbara V. Romberg, a psychologist in the Washington, D.C., area. The organization's mission is to develop national networks of volunteers capable of responding to both acute and chronic conditions that arise within our society. Currently, GAH is dedicated to meeting the mental health needs of the troops and families affected by the ongoing conflicts in Iraq and Afghanistan. Give an Hour now has approximately 1,200 providers across the nation and continues to recruit volunteer mental health professionals to its network. For more information or to volunteer to become part of the effort, please visit http://www.giveanhour.org.

About The American Psychiatric Foundation
The American Psychiatric Foundation is the charitable and educational subsidiary of the American Psychiatric Association. The mission of the foundation is to advance understanding that mental illnesses are real and can be effectively treated. For more information, please visit the foundation's web site at http://www.psychfoundation.org.

About Lilly
Lilly, a leading innovation-driven corporation, is developing a growing portfolio of first-in-class and best-in-class pharmaceutical products by applying the latest research from its own worldwide laboratories and from collaborations with eminent scientific organizations. Headquartered in Indianapolis, Ind., Lilly provides answers -- through medicines and information -- for some of the world's most urgent medical needs. Additional information about Lilly is available at http://www.lilly.com.

From Give an Hour's website:

Our Mission
Our mission is to develop national networks of volunteers capable of responding to both acute and chronic conditions that arise within our society. Our first target population is the U.S. troops and families who are being affected by the current military conflicts in Afghanistan and Iraq. Give an Hour is asking mental health professionals nationwide to literally give an hour of their time each week to provide free mental health services to military personnel and their families. Research will guide the development of additional services needed by the military community, and appropriate networks will be created to respond to those needs. Individuals who receive services will be given the opportunity to give an hour back in their own community.

Our Focus
Our organization is currently focusing on the psychological needs of military personnel and their families because of the significant human cost of the current conflicts. Over 1.6 million troops have been deployed in Afghanistan, Iraq, and the Persian Gulf since September 11, 2001. Nearly 550,000 of these troops have been deployed more than once. According to the U.S. Department of Defense, as of May 15, 2008, nearly 4,600 American troops have died in Iraq and Afghanistan. Roughly 32,875 U.S. troops have been injured during these conflicts.

In addition to the physical injuries sustained, countless servicemen and servicewomen have experienced psychological symptoms directly related to their deployment. According to a RAND report released in April 2008, over 18 percent of troops who have served in Iraq and Afghanistan--nearly 300,000 troops--have symptoms of post-traumatic stress or major depression. At the same time, about 19 percent of service members reported that they experienced a possible traumatic brain injury. And let us not forget: millions of Americans belong to the families of these servicemen and servicewomen. Spouses, children, parents, siblings, and unmarried partners of military personnel are all being adversely affected by the stress and strain of the current military campaign.

Our military leaders are well aware of the human cost of this campaign. Indeed, they are attempting to address the psychological needs of the troops through a variety of programs within the military culture. Unfortunately, the tremendous number of people affected makes it impossible for the military to respond adequately to the mental health needs in its greater community. For example, according to the RAND study, only 43 percent of troops reported ever being evaluated by a physician for their head injuries. Moreover, returning combat veterans suffering from depression, anxiety, and post-traumatic stress disorder (PTSD) are not routinely seeking the mental health treatment they need. RAND also reports that only 53 percent of service members with PTSD or depression sought help over the past year.

A major barrier preventing military personnel from seeking appropriate treatment is the perception of stigma associated with treatment. Many fear that seeking mental health services will jeopardize their career or standing. Others are reluctant to expose their vulnerabilities to providers who are often military personnel themselves, given the military culture’s emphasis on strength, confidence, and bravery. Servicemen and servicewomen might be more inclined to seek help if they know that the services provided are completely independent of the military. By providing services that are separate from the military establishment, we offer an essential option for men and women who might otherwise fail to seek or receive appropriate services.

We are also offering services to parents, siblings, and unmarried partners who are not entitled to receive mental health benefits through the military. Although these individuals may have access to mental health services through other means, they are less likely to seek the help they need and deserve if that help is difficult to find or costly. Our goal is to provide easy access to skilled professionals for all of the people affected by the current war. The participating mental health professionals offer a wide range of services including individual, marital, and family therapy; substance abuse counseling; treatment for post-traumatic stress disorder; and counseling for individuals with traumatic brain injuries. Whether it is a young military wife who is anxious because her four-year-old has had nightmares since her husband’s deployment or a father who is struggling to cope with his son's loss of a leg as a result of an explosion in Iraq, both will receive the assistance they need to move through their experience. The healthier the support system for the returning troops, the lower the risk of severe or prolonged dysfunction within these military families.

Our Plan
Give an Hour is reaching out to the military community in several ways. As a member of America Supports You, a Department of Defense program that provides opportunities for citizens to show their support for the U.S. Armed Forces, we are identifying individuals involved in post-deployment processing of returning troops. We are developing collaborative relationships with the commanding officers of returning troops so that these officers are aware of and comfortable with the services we provide. We are also working closely with a number of veterans service organizations to promote our services directly to the family members of troops. Furthermore, we are working with individuals affiliated with Walter Reed Army Medical Center in Bethesda, Md. We are also collaborating with the Veterans Administration to distribute information about our services through Vet Centers across the country.

Finally, we are promoting our services to the military community and the public through a media campaign that includes print, television, and radio coverage. In fact, our founder and president, Dr. Barbara Romberg, has been interviewed in national media outlets from the Washington Post to NPR's Diane Rehm Show, Ladies' Home Journal, and HD Net's World Report.

Give an Hour recruits mental health professionals in several ways. We have been endorsed by the American Psychiatric Association and the National Association of Social Workers and are seeking endorsements from other major mental health organizations. Only licensed mental health professionals are included in the network. Licenses are verified. Non-licensed pastoral providers may be included in the network as long as they meet other criteria, including membership in professional organizations. In addition to coordinating with national organizations, we also recruit mental health professionals through professional publications and Web sites.

As of May 2008 we have a redesigned Web site, expanded to include materials to guide visitors seeking services as well as reference materials to inform mental health professionals. Only mental health professionals trained and experienced to work with trauma victims will identify themselves as available to work with soldiers who have experienced combat. We are working with experts in the trauma field to prepare materials for our Web site and to find appropriate mental health professionals for recruitment.

The Eli Lilly and Company Foundation recently awarded Give an Hour, in partnership with the American Psychiatric Foundation, a major grant that will allow us to spread our message to the leaders of the mental health community in every state. 

We are recruiting volunteers from a number of organizations and institutions as well as through our Web site to assist us in the implementation of our program. Volunteers from retired military personnel to members of military families to concerned civilians throughout thte country are helping Give an Hour. Volunteers are checking licenses, distributing brochures, and coordinating community partnership opportunities for those troops and family members interested in giving back an hour to their own community.

Our Vision
Our primary focus will always be to attend to those in need by linking them to individuals in our society best equipped to respond effectively. In addition, we will develop research and educational programs to further promote the value and importance of a new kind of volunteerism. We hope to encourage an increase in shared responsibility for those citizens who are suffering. We need only look at the outpouring of aid and support following both the terrorist attacks of September 11, 2001, and Hurricane Katrina in August 2005 to see the potential we have to become a truly compassionate and united nation. And we need only look at the significant costs of the war in Iraq and the relief efforts for Katrina’s victims to see that federal and state governments are already strained beyond their means. We have not only the potential but the duty to help one another in times of need.

For more information, contact Barbara V. Romberg, Ph.D., Founder and President, Give an Hour.  Her email address is linked here.

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.

Pick Up the Phone, Hon - That's the VA Calling!

In a seemingly odd, but -- one would hope -- nonetheless proactive move -- the Department of Veterans Affairs (VA) is now placing outgoing calls to in a nationwide campaign to inform and connect returning combat veterans with the services the VA provides.  The calls, which are being outsourced to a provider called EDS, are initiated by the VA and follow a very specific, and laudable intention,  In a PR blurb published on the Web at TCRNet, the following information was provided about the program:

The Combat Veteran Call Center is expected to make more people aware of health care and benefits eligibility for veterans of the wars in Iraq and Afghanistan. It’s the first task order awarded under the General Services Administration’s $2.5 billion USA Contact contract vehicle, according to EDS.

Calls to veterans began on May 1 and plans include reaching out to nearly 570,000 recent wartime veterans over the next six months. The campaign will initially focus on roughly 17,000 veterans who, based on their wartime injuries or illnesses, are considered candidates for care management.

The second phase will include contacting about 550,000 Operation Iraqi Freedom and Operation Enduring Freedom veterans who have not yet enrolled for VA health care services."

Additionally, "Officials at the company say EDS phone representatives will make initial calls to veterans to complete interview that will assess their needs. Representatives also will provide information about available VA health care services and benefits. Follow-up calls will also be completed to ensure that the veteran has had his or her needs met."

 

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At least one Veterans Service Officer I spoke with, while praising the existence of this program, also cautioned that its emphasis on prioritizing contact with OIF/OEF veterans over those of previous wars, could have the unintended consequence of creating friction between Vietnam veterans and Iraq and Afghanistan veterans -- groups which have been reasonably supportive of each others' existence, so far.  In fact, Vietnam veterans have been incredibly gracious about seeing that veterans of more recent conflicts get the help they feel was denied to them.  So any move that pits the two groups against each other in triaging care runs the risk of causing unnecessary friction and competition for what amounts to limited resources.  And speaking of limited resources -- although the proactive calling is in some ways a good idea (and positive PR for the frequently embattled agency) -- more and different solutions are desperately needed.  Examples include: hiring more psychotherapists, exploring treatments other than drugs and group therapy, making sure patients get seen quickly, expanding services to include outreach and education for family members, and freeing up some cash for paying private providers who are now giving their time for free, to make sure veterans get seen.  Oh, and eliminating the stigma of mental health care to career veterans, who are sometimes afraid to be seen for the impact it might have on their career advancement.  We're not even gonna mention the "shhh!!!" email here -- or the tendency to want to call PTSD by any other name including adjustment disorder -- there's enough about that in the news already.

Army Broadens View of Possible PTSD Therapies, Includes Complementary and Alternative Medicine

A Military.com article published on May 29th reports on the U.S. Army's increasing openness to non-traditional therapies to treat PTSD.  The article by Bryant Jordan is called, "East Meets West in Army Mental Therapy," and it quotes Col. Elspeth Ritchie on the Army's increasing openness to options beyond traditional counseling and medication, to include items like yoga, acupuncture, meditation, and of course, virtual reality. The headline is positive, but in truth, the Army may be taking only baby steps towards including nontraditional therapies, often known as Complementary and Alternative Medicine (CAM).

(Some "definition of terms" is in order.  "Alternative medicine" means treatment choices other than conventional medicine, to be used instead of conventional medicine; "complementary medicine" means treatment choices to be used in addition to conventional medicine -- so the term "CAM," or "Complementary AND Alternative Medicine" is meant to be inclusive of both approaches.  This ends up being an important distinction, because responsible M.D.s are often more in favor of patients adding complementary therapies in to their treatment protocol, rather than replacing a conventional treatment protocol with fully alternative therapies. "Complementary" is misspelled in the Military.com article as "complimentary," which further confuses the terminology.) 

The article states that "Therapies that are "kind of tried and true" remain at the forefront of treating Soldiers with behavioral problems, [Col.] Ritchie said. These include behavioral therapy and exposure therapy -- where patients are "exposed" by degrees to scenarios that may be at the core of the problem -- and medication."  And it further quotes Col. Ritchie as saying that although CAM therapies "are interesting, we don't have the hard data to show which therapies are useful for what population. So we're really in the research phase of this for yoga, acupuncture and some other therapies."

The Military.com article is linked here.  A previous article by Noah Shactman in Wired magazine on March 25 discussed similar material, and mentions a Department of Defense grant opportunity with a closing date of May 15, providing $4 million in funds to study therapies with possible benefits for PTSD and/or TBI, including but not limited to "music, animal-facilitated therapy, art, dance/movement, massage therapy, EMDR program evaluation, virtual reality, acupuncture, spiritual ministry, transcendental meditation, yoga and other novel approaches."  (The grant opportunity announcement is linked here.)  According to the Wired article, reading from the grant application, the Army is willing to contemplate as well the potential effectiveness of "biologically-based treatments, botanicals, and nutritional supplements for enhancing cognitive function and mood in patients with trauma spectrum disorders, including TBI and/or PTSD, depression, anxiety, and/or substance dependence/abuse," and adds, "Even proposals for wild-sounding "therapies using bioenergies such as Qi gong, Reiki, distant healing and acupuncture" would be accepted."  The Wired article is linked here.

I'm unclear whether the Army is leading the way of all the military branches in considering the potential of CAM for PTSD; but whether it is or isn't, kudos to it for being reasonably open-minded.  One of the problems that seems to keep coming up with PTSD is that no one obvious choice comes up in treating it, that works every time.  There are a variety of pharmaceutical drugs that are prescribed, but no one remedy in particular appears to be the wonder drug, or cure-all.  (You hear the frustration about this when you listen to the stories of combat veterans who are taking a handful of pills to combat PTSD, sometimes as many as 20 or 30 separate medications - a scary cocktail, indeed.)  Other approaches for PTSD, such as talk therapy, cognitive therapy, EMDR, etc., all have their place in the pantheon of treatments, and each has their adherents/proponents, but again, there doesn't seem to be a one-size-fits-all, cure-all for PTSD.  In the absence of the medicinal "silver bullet" that cures all PTSD, it's great that the Army is at least embracing the concept of possible adjunct therapies, while asking them to prove themselves clinically, as much as possible.

In the following weeks, we will report on complementary and alternative therapies that appear to have some benefit in treating PTSD; in addition to the more mainstream approaches that are already in use.  (Virtual reality is another type of treatment entirely: dependent on technology, it doesn't fit the typical rubric of CAM, nor should it.)

More Combat = More Trauma, and More Chance of Developing PTSD, Study Shows

For anyone who's every wondered about whether troops' increased exposure to combat trauma results in greater chances of their developing PTSD, the answer is a definite "yes," according to a study released in the February issue of the Psychiatric Times, linked here.  The article from which excellent graphic (left) is taken is entitled, "Posttraumatic Stress Disorder in Veterans," and it makes the point that cumulative exposure to combat trauma predicts PTSD in a linear fashion.  Less exposure (fewer firefights) -- lower rates of PTSD; higher exposure (greater number of firefights) -- higher rates of PTSD.  According to the article, it really is that simple.

The article's authors cite an earlier published report of OIF (Iraq) and OEF (Afghanistan) servicemembers, and found high rates of exposure to both "traumatic situations and combat."  "According to the study, about 33% of soldiers in Afghanistan and 71% to 86% of soldiers in Iraq experienced a firefight. PTSD rates ranged from 6.2% for veterans of Afghanistan's OEF to more than 12% for OIF veterans. The risk of PTSD was found to increase linearly with the number of firefights (see graphic, above). Having been wounded, a condition previously found to be predictive of PTSD, was also significantly associated with PTSD. As is commonly found in patients with PTSD, rates of depression and alcohol use also increased following combat exposure."

When we think of tragic stories of what we can only assume to be PTSD-fueled incidents in the news -- the recent suicide of Marine SSgt. Travis Twiggs, the arrest of Marine LCpl. Eric Acevedo for murder, and others like them -- we should really stop to pause and wonder, how many times have these servicemembers been deployed, for how long have they been in combat, and to what have they been exposed (meaning, how many firefights)?  Twiggs, it turns out, had done four(!) tours of Iraq, and one of Afghanistan (earlier reports mentioned four total, but they were wrong); Acevedo had done three tours of Iraq by the time he was 22, including one that involved a horrific battle, where 10 members of his battalion died on a single day, and several others were wounded.  To not take the effects of their cumulative exposure -- what they saw, did, were witness to -- is just unconscionable.  We have a very love-hate relationship with the glory of serving in this country: we glorify our military heroes for their astounding feats of endurance (Brad Kasal, the Marlboro Marine, etc.), but we also equally unreasonably vilify them when they crack under the all-too-obvious strain.  It seems like what we need most of all is just the sober estimation: the more servicemembers have gone through -- and suffered -- the more we can expect them to have problems later on, with developing PTSD.  As noted Australian Vietnam War researcher Hedley Peach said in a slightly different context, what we're really looking at here is not something unusual -- it's the generic effect of combat.

WA Legislator Shows Concern for Vets, PTSD

Washington state, which counts a large number of deployed servicemembers, veterans, and their families among the state's population, has shown some real leadership in veterans' issues, particularly with Senator Patty Murray (D-WA) -- a tireless and vocal veterans' advocate, who is a member of the Senate's committee on veterans affairs.  Now representative Jim McDermott (D-WA), apparently the only psychiatrist serving in Congress (hmmm, that would explain a lot!), according to a news article in yesterday's Seattle Post-Intelligencer, has also done something good for veterans.  He sponsored a veterans' forum to "honor, help and heal our soldiers," according to the PI, and basically provided an opportunity for local, Washington state veterans to vent about their difficulties with getting appropriate care.  Not sure if anything more constructive than venting was really the purpose of the meeting, but hey, even that sometimes really helps -- for people like veterans who may not feel that anyone is really listening to how difficult a struggle they're in, coming back from deployment and being faced with a number of serious obstacles to getting the help they need.  The article is linked here.

More Camp Pendleton Marines Died Non-Combat Deaths Than Died in Iraq Last Week, Marines Admit

Here's a troubling story, where the above headline basically says it all.  An article by Rick Rogers from last Friday's issue of the San Diego Union-Tribune, entitled "Marines hit by rash of non-combat fatalities," and linked here -- has this stunning factoid tucked away, several paragraphs into the story:

At least 13 Marines from the 1st MEF – most of them stationed at Camp Pendleton – have died this year. Most of the causes are believed to have been vehicle crashes, homicides and suicides, although some cases are still being investigated.

By comparison, six Camp Pendleton-based Marines have died from combat in Iraq during the same time period, according to the Defense Department.

The reporter also notes, "None of the Marine officials interviewed for this story could remember a worse week in terms of noncombat losses."  So sad.

It's important to note that sometimes reckless driving is "just" that, and sometimes it's a form of vehicular suicide, whether fueled by alcohol and/or drugs, including prescription medications, whether mixed with alcohol or not.  (Much like "suicide by cop" has become something other than a random altercation with police.)  The Marines, faced with an increase in motorcycle fatalities, are taking pains to educate the troops more about the risks involved -- risks which are probably fairly well understood, though not necessarily attended to.  Heartbreaking news from Southern California, in any case -- for all the Marines, and their families, not to mention those who've served with them.

The Tragic Last Days of Travis "T-Bo" Twiggs

Well, the national reporting on this story that we broke on Tuesday of last week has finally dribbled in – some of it good, most of it painfully mediocre – and none of it frankly enlightening, if you’ve been following his story here at all. (And btw, CNN hasn't covered it yet, though logically at some point they will have to, if only to keep up with the Joneses.  It's pretty embarrassing to see what they deem worth covering instead, versus treating this American hero's death with any coverage at all.  Here is a slate of what CNN deemed more worthy of coverage just today (the breathless exclamation points are mine, but they seem in keeping with the "Mad magazine meets Entertainment Tonight!" reportage topics -- or is it becoming, "News of the World," with a little political commentary thrown in?)  More worth covering than Travis Triggs, four tours of duty and PTSD sufferer, we have: "Cancer survivor pitches no-hitter!" "Photographer snaps own javelin-spearing!" "Autistic boy, 13, banned from church!" "Wealthy Town Wants Its Own Currency!" and best/worst of all: "Yearbook [staff] switches kids' heads, bodies [in yearbook]!"  (I'm firmly convinced CNN is now staffed entirely by two prepubescent boys, and the story line-up on any given day is an accurate reflection of what they'd find interesting, given that they're 11 years old, and boys, and all.) 

A hard shock in the recent, actual news coverage about Travis Triggs was learning that his wife, Kellee, though she knew her husband was deeply troubled by PTSD, didn’t realize he was in Arizona, and didn’t learn that he killed himself, until she saw it on a news report. That has to just add to the horror of the whole situation.  (At the end of this entry, we'll share some nice things people have been saying in Travis Twiggs' memory, about the man and the Marine.)

One of the things that’s been great is the interviews she’s given to the media, captured in video and audio files, such as we blogged about here – because what we’re getting there is the wife’s perspective on what went wrong with T-Bo, from someone who knows him (pun coming) intimately, and also someone who’s known him for years. (They grew up together in Louisiana.)  (I've linked to the main raw interview footage in this blog entry, here.)

At some point I’d like to make an actual transcript of the interview with the Arizona TV reporter, Suzanne Kennedy, and put it up on this site, because even in the printed word, it will convey a lot of what she’s feeling. And not to say that she’s right about what she’s saying, but it’s definitely her perspective, and it’s well worth hearing.

It’s always curious trying to unravel what makes someone who’s struggling with something as serious as PTSD snap, and do something irreversible. Recently in the news we had the story of Eric Acevedo, another four tour of duty Marine who killed his girlfriend in Saginaw, Texas. As I blogged about earlier on this site, here, once I did a little digging into Acevedo’s backstory, I realized he had seen some horrific things in his third tour of duty. Three days after I posted about what I found on this blog, here, the Marine Corps purged the information off their site, as I learned from a reporter at the Dallas Morning News, who contacted me to tell me that my links were broken. Hmmmn.

This time, I pulled up the Eric Acevedo blog entry again, linked here, wondering if the hard times he’d experienced were anything near in time to the hard times Travis Twiggs experienced. It turned out they were only a few months apart – October and December, 2005 – in Iraq – and both of them “snapped” recently, to use the vernacular. If you delve into the topic of PTSD at all, you will learn that many people have a delayed reaction to what they experience, especially if they’re “medicating” themselves with alcohol, drugs, or workaholism – they can essentially keep the pain and possibly the memories at bay for years. (That’s part of why PTSD screening needs to happen at intervals after a servicemember returns from combat, to catch the experiences that happen later on.)

In the material Travis Twiggs wrote about his own battles with PTSD, he shares that he definitely mixed alcohol and medications, and weaning himself off alcohol apparently improved his situation for a time.

But now let’s splice in to the conversation what we learned from Kellee Twiggs, about her husband’s struggles. These are some of the elements that stood out to me, with observations included, where appropriate.

Kellee Twiggs says that her husband was in and out of three locked psychiatric facilities – aka, mental wards – in the last six months to a year.  She brings this up to say, I’m not sure why he was still out and about, working, driving, etc., during the times between those – in other words, he was really sick.

Definitely. But it also calls into question why the Marine Corps Gazette published what amounted to his “success” story back in January, 2008, which we talked about here (Includes a link to the original article).  At least in the non-military publishing world, one of the first things you’d want to vet before publishing a victory story in print, is that the person is still overcoming or still succeeding at whatever they were doing – otherwise, it’s embarrassing for all concerned. Did the Marine Corps Gazette not know he was struggling? From what Kellee Twiggs is saying, he was in and out of locked psychiatric wards during the same time period that article was published as his overcoming story. I’m personally still glad they printed it – I think it served to give people hope – but I have questions about why they did that, if they knew that he was still in the midst of valiant struggles with PTSD. At the very least, they should have checked, and maybe written a caveat – like, at press time, Twiggs appears to be relapsing, but we wish him all the best with his continued recovery.

• She says that at one point, he was on 19 different medications for PTSD.  Obviously, this isn’t a good thing. She mentions that his treatment fell short – overmedicating him and locking him up in a psychiatric ward just turned him into a zombie, and didn’t “fix” what was wrong with him. Agreed. Her preference would have been to have him treated at a special facility in New Jersey, but perhaps her impression of that is overhyped, and it too might not have been able to help.

I think what Kellee is on to is the fact that nobody really knows what medications to put someone on for PTSD. There was even a report going back a few years now that that’s one of the things that should be studied first, is what works and why. I know I’ve seen an article in print about a young servicemember’s struggles with PTSD, and his telling the tale that he went to the doctor (most likely at the VA), and whoever he saw, gave him essentially a bag full of pills, and said, try this, try that; we’re not really sure what works, so you figure it out – see what you think is helping.

Obviously that’s not a good solution, however true it might be. And given how many drugs interact poorly with one another, or cause other symptoms, a 19 drug cocktail isn’t in anyone’s best interests, or even sounds like good practice. If that’s what really happened to him, it does sound pretty bad.

• She says that Travis Twiggs was seen at Quantico, not by a doctor, but by a Physician’s Assistant (“PA”) who was known to be “their expert” in PTSD. She has a comical remark where she says, essentially, the Marine Corps is a huge, worldwide operation – you meant that they can’t either spend the money for a doctor or find one who’s qualified?

Again, if this is the case, that is pretty shocking. There needs to be a higher standard of care than that.

• In a TV interview with Kellee and her older daughter, Ireland, 8 or 9, soon after Travis Twiggs’ suicide, her daughter talks on camera (a surprising move, in general) and says how hard it was for her dad to lose the guys in his platoon, blogged about here – “especially when one passed away in his arms” (I’m paraphrasing). Wow. If that’s what really happened – and I wonder why anyone would have told her if it wasn’t – that’s also a level of trauma even beyond being around the guys when they died. From what I’ve read elsewhere, and blogged about here, it sounded like the two guys in his platoon who died on his third tour – one died instantly and the other died in the combat hospital later that day. Either way, it’s heavy spaghetti – all the more so if how it happened was quite that personal. I can’t picture why the daughter would think that unless it were true – sounds like something an adult would have told her, so that she could better understand the difficulty of what her dad was going through.

The Wounded Warrior Regiment connection. Later press reports made much of the fact that Travis Twiggs had been working with the Marine Corps’ Wounded Warrior Regiment, and had in fact met President Bush a few months ago, hugged him and said how willing he’d be to go back to Iraq for the president. I’m not going to touch the politics of this with a ten foot pole, but given how badly Travis Twiggs was struggling with PTSD, both before and after – that sounds to me like something someone says as much to convince himself as whoever he’s talking to. Obviously a noble, big-hearted guy, who wants to do the right thing. But a realistic read on how able he was to do that? Not so much.

A much more interesting aspect to the Wounded Warrior Regiment red herring – which in turn circles back to the topic at the beginning of this post about just what causes someone to finally snap is this.

I wrote elsewhere on this blog about my trying to get in touch with Travis Twiggs by email at the beginning of March, and also the Marine Corps Gazette, in order to republish his story in full, and how I never heard back. My sense is he was struggling hard with PTSD then, and it caused everyone to back off from wanting further publicity for his “overcoming” story, since it was starting to seem like it had holes.

But here’s something very telling. In one of her interviews, Kellee Twiggs talks about how much her husband Travis enjoyed working with the Marine Corps’ Wounded Warriors Regiment, and in turn, how much the guys in the regiment enjoyed or adored him. Perfectly understandable so far. Many people who knew him talk about what a great guy he was, and what a huge heart he had for others. But watch what comes next.

In one of her earliest interviews with a reporter late last week, Kellee said that her husband had been promoted to Gunnery Sergeant, but then stripped of his rank (I’m paraphrasing) when it became apparent that he was continuing to struggle with PTSD, and demoted to Staff Sergeant.

I had heard that little factoid early on, but not connected it with any other part of the story, still wondering why he went AWOL from the Marine Corps on Monday, May 5^th, and then showed up in Arizona, a place his own wife didn’t realize he had plans to visit.

Then it turns out…

She says Travis was doing much better, working with the Wounded Warrior Regiment, and getting back in the groove of responsibility and discipline and interacting with his guys. He thought he had been put in charge of the group, and perhaps he had, or was already functioning in that capacity, awaiting official confirmation.

Then, suddenly, a few weeks ago, according to Kellee Twiggs, the order came down that he was not to work with the Wounded Warrior Regiment, not to be their company gunny, and basically this was the moment when Travis snapped, and started struggling violently with PTSD again. Potentially because it was also the moment when Travis Twiggs felt like the Marine Corps has lost confidence in him. What happened next – going AWOL, showing up in Arizona, the armed carjacking, the 130-mile police chase, ending in murder-suicide, I have to say, it sounds very much like Travis Twiggs hit his own personal wall.

This was a man who was obviously very much caught up in the Marine Corps culture of “one for all and all for one.” The most devastating psychic injury he’d suffered, that he talked about at least, was the death of two young guys in his platoon, on October 27, 2005. In his essay on struggling with PTSD, published in January, 2008, he talks very transparently about fears that he had disappointed his command. This seems to be a guy who is extremely concerned with perhaps the external manifestations of leadership – and is heartbroken when he feels he’s failed either his guys that he leads, or the ones who lead him.

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At one point in the interviews, Kellee Twiggs says, in the most grief-stricken of ways, how crushed she is that Travis Twiggs died, leaving their two beautiful girls to grow up without their dad. Almost as if to say, “Was Travis not thinking about how painful that was going to be?”

There’s a well-regarded Australian study that we blogged about here that shows, at least with a rigorous, long-range study of Vietnam veterans, that CHILDREN of combat veterans who suffered from PTSD are at a much higher risk for suicide and other psychological struggles than are their peers. I’m sure that wasn’t exactly what was on Kellee’s mind when she said that, but it’s part of the heartache. The Twiggs’ “two beautiful little girls,” Ireland and America (love the names, seriously) now do have to grow up without their father, and probably will never understand the pain and torment he felt on likely a daily basis. And they will run the risk of feeling abandoned by him, in a very real way.

But the problem is, I believe, by the time that Travis Twiggs died, what was on his mind was essentially saving face with the Marine Corps, and how he’d lost his role. That would explain why his wife, who seems in every interview we see of her, to both love him and be a reasonable person, under the circumstances – to not have heard from him for two weeks, to not know that he was headed to Arizona, and of course to wonder how he (paraphrasing) could not have been thinking of her and their daughters when he killed himself. My sense is, he probably had his situation with the Marine Corps much more on his mind at the time, as sad as that may be to say. It doesn’t mean he loved them less, but it does mean, in his self-respect for himself as a leader, he may have felt that he’d finally lost the opportunity to lead, and experienced this as a fatally crushing defeat.

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There’s always the possibility that in potentially unfamiliar territory – Arizona desert, which certainly shares some visuals with Iraq – at the level of hallucinations that it sounds like he experienced – that during the car chase with police, that he might have flash backed to Iraq, and lost his contact with reality. It would be interesting to learn whether he was driving (or whether his brother was), and from the couple who was carjacked, which of the Twiggs brothers seemed to be leading and who was following, or whether they were both pretty well matched. It probably doesn’t matter in the long run, though, but it would, as they say in the legal biz, speak to Travis’ state of mind at the time.

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I’ve already blogged somewhere else about how it doesn’t sound all that relevant that “they didn’t leave a note.” Since the authorities blew up the large bag they were traveling with, on the offchance it was booby-trapped, no biggie. Any note might have blown into smithereens. But leaving a note also indicates presence of mind, and in Travis Twiggs’ wild, PSTD-fueled ride, it sounds a bit mutually contradictory or unlikely.

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There’s been a certain amount of crappy reporting that I would imagine is hard for the family to stomach. The initial press reports talked about both brothers’ “violent criminal histories.” Huh? If that’s not true, it should be retracted. No proof was ever provided, and that tangent never got developed. When Kellee talked in her interviews about the pain she felt hearing her loving husband portrayed as a monster, I couldn’t help but think of that remark, publicized quite heavily at the beginning of last week. See this media report, linked here, as evidence.

Of my two other least favorite reporting moments with this story, one was the leading question asked by the television reporter to Kellee Twiggs, on what looked like her porch. “Here, grieving widow, microphone stuck in face (I’m paraphrasing) – who do YOU think killed Travis Twiggs – the Marine Corps?” Yikes. Give the lady a little room, and don’t put words in her mouth, even if you think that makes for good television. Seemed like a low moment in shallow or manipulative reportage, just to get the quote.

Another was Tucson, Arizona KOLD 13 news producer, Stephanie Johnson, referring to the Twiggs brother's "crime spree" in the Grand Canyon, linked here.  Wasn't sure whether they also knocked over a liquor store or passed bad checks in the gift shop while they were there, but seriously -- doesn't a "crime spree" imply more than a single event (the carjacking)?  It just seemed pretty ridiculous, and inflammatory for the sake of being inflammatory.

And not in the news department, but just in the generally offensive department, as soon as "Travis Twiggs" started being a popular search on the Web last week, someone at AOL Live Journals threw up a porn site, liberally sprinkled with "Travis Twiggs" name in the metatags, and it shot up in the Google page ranks, to about number six -- even though the violent porn had nothing to do with Twiggs himself. And talk about offensive to the grieving family.  Very deliberately manipulative.  Fortunately, the editors at AOL's Live Journal caught the porn in time and disabled the links.  Grotesque how people attempt to profit off someone else's huge misfortune/tragedy.

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Well, on that cheery note, perhaps you'd like to hear some good news -- some of the POSITIVE things that rolled in about Marine Staff Sergeant Travis Twiggs, from those who knew him before he died, in an attempt to flesh out the picture we have of him, and/or set the record straight.  Here are a few:

From his neighbor, and landlord, who I believe is a prominent international philanthropy official in the Washington, DC area:

Having known Travis Twiggs and his family for 2 years, they rent a house we own near Quantico , my wife and I firmly believe the real story here is not about a chase/suicide. The real story is captured in the link right at the beginning of your article which most people won't open.

The real story is how this war, and PTSD devastates lives and families. The real story is also how the Marine Corps blew it.

Contrary to the impression given, Travis Twiggs was a very good man. One had just to watch him interact with Kellee and the girls, or see him jump in to help his neighbors to know this. He loved the Marine Corps. He'd often get up pre-dawn to work out to ensure he stayed in shape.

While he was at Bethesda Naval Hospital I would occasionally e-mail him with words of encouragement. The first time I did it I said, "I hope you don't mind". It took a while for Travis to respond. He said he couldn't get to a computer often, but my words "meant more than you'll ever know".

Travis loved his family and loved the Corps. That is what we will always remember [about him].

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From one of his social workers, who treated him at Quantico:

Staff Sgt Twiggs was seen by me at Quantico for many months and treated for his TBI/PTSD. He was an honor to know and to work with. He served our country with many deployments to Iraq and Afghanistan and served his men and led them well. The trauma and death he experienced is a very common story by our military people coming back. Many do not appear to be harmed because they have no "visible" wounds. However for those of us in the Mental Health field that work with the men and women who serve in the Military every day, know how deep these wounds go. Staff Sgt. Twiggs was given the best medical treatment the USMC has to offer. We stood by him and loved him and were committed to his recovery everyday.

What the Public needs to understand that our men and women coming back from this war suffer on many levels and some just can not come back from their experiences. Staff Sgt. Twiggs served his country up until the moment he died. I knew him very well and he was running from his deep, deep pain and I am grief struck that his story ended this way. Please, Please know this is but a very sad moment in a mans life who was a Hero and an Awesome and very loved Marine. Please think of him in this way and not by the end of the Story. Honor him please as I will do the rest of my life. He was a blessing to know and I was very honored to have shared in his life for as long as I could. Please honor all of our military who serve this country. They deserve you respect, your love and your support.

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From a family member (in-law):

T-Bo was a loving brother, son, husband and father not to mention a loyal and dedicated Marine. This I can vouch for.

Editor's Note: If you haven't done so already, spend a few minutes watching the raw video footage of the interview with Kellee Twiggs last week.  It's quite good, and gives you a renewed appreciation for how hard Travis Twiggs was struggling with PTSD, before he died, and how much his wife and family loved him.  That blog entry is linked here.

The PTSD Obituary for Travis Twiggs

In a separate entry that I'm working on as often as I can stomach it, I'm putting together what I'm starting to think of as Travis Twiggs' obituary from PTSD, linked here.  In reality, no one writes lengthy obituaries of non-famous people, and somebody who died in a blaze of probably self-inflicted gunfire, after an armed carjacking and a multiple day police chase, is probably really unlikely to receive one.  Not to mention, there really is no such thing as a PTSD obituary, but maybe there should be.  The verdict is still years away on whether we think, as a society, that combat veterans who die from PTSD are also worthy of special honor -- say, a purple heart -- and initial results do not look promising.  (See survey on Military.com, linked here, which at least last night was registering only about 31% of votes as positive ones.)

There's something very Bonnie and Clyde -- or at least, Clyde and Clyde -- about Twiggs' premature, violent death.  It brings back memories to me at least of the end scene in that famous 70s classic, "Butch Cassidy and the Sundance Kid," with Robert Redford and Paul Newman, in an era when either one would have qualified for People magazine's "Sexiest Man on Earth" (a magazine contest they'd yet to invent.)  In the end scene, as I remember it, outlaws Butch & Sundance have escaped to Bolivia, are convinced they're pretty much surrounded by the Federales, and plunge off the cliff, armed and together, in a basic "F.U." move to those who are in pursuit.  (This classic cinematic ending is replicated later, chick version, in "Thelma and Louise.")

We don't, of course, know what the heck Travis Twiggs and Will Twiggs were thinking, on their escapade, and how fully planned out their exit was, or whether it just came to them at the time, and they winged it.  We don't know what Will Twiggs, from Louisiana, was struggling with, that got him involved in this particular endgame, but we do know enough about Travis Twiggs' story to know about his struggles with PTSD.  That's at least a partial answer.  (Update: from what Travis Twiggs' wife, Kellee, has said publically, it now sounds a little bit like Will Twiggs may have been going along with Travis Twiggs to keep him company and to watch out for him, and they both had announced plans to visit ailing relatives in Louisiana.  But they were in Arizona.  It really doesn't make sense yet, and maybe never will.  News reports point out that they apparently left no suicide note; at the same time, authorities blew up a large bag they had with them, on the off-chance it was booby-trapped -- so if they did leave a note, but it was in the bag, well, that's long gone as well.)

What made them journey to the Grand Canyon, half a country away from either one of them, pack -- according to press reports -- large backpacks, and then carjack a couple's 2008 car when theirs got disabled, before leading police on a multi-day chase, ending in gunshots (allegedly, the Twiggs brothers died in a murder-suicide, possibly with Travis shooting his older brother, Will, then killing himself).  Some press reports, and all of them are minimal, suggest that the Twiggs guys headed out to the Grand Canyon to die -- with the strong possibly of driving their car off a cliff -- but then when their car was disabled, they carjacked the other car, to have transportation.  If that's true, the backpacks make no sense at all.  In any case, they're gone, we're not going to learn anything more, and the best we can do is put together the pieces of what we do know, which when it relates to Travis, has an awful lot to do with PTSD - a condition he fought, talked about, and ultimately -- we believe -- succumbed to.

Why take the time to tell his story, at all?  Given the way that he died, and initial press reports that suggested a long-term, violent criminal history for both Twiggs and his brother (we have no idea if this is true or not, but Travis Twiggs spent enough time in the Marine Corps this doesn't make a whole lot of sense - it may just have been a mistaken impression, given the carjacking.)  Well, if you'll excuse the informality of expression, I'm writing this because I think it pretty much sucks that he died, and I'm very sorry that he took himself out, for reasons best known to himself, but which nevertheless are somewhat easy to understand.  Here was a guy who for whatever reason, could never forgive himself for what he saw, did or experienced in combat -- particularly the loss of the lives of the guys who died on his watch. He wrote about it, plagued himself with it, prayed over it, and ultimately, couldn't come to terms with it.  It may not have been the only thing bothering him, but it's obvious from his story that it was significantly bothering him.

If, through a rhetorical device, we combine phrases from letters he wrote to both of the guys, we hear him saying this:

"I want you to know that not one day has passed since "I" lost you. I wish that I could erase that horrible day from my memory...but I can't. I feel responsible and always will for not bringing you both home. I miss you, brothers."

Was Twiggs' death in Arizona ultimately an attempt to erase that memory from his mind?  We believe that it was (among other things), and mourn his passing.

Travis Twiggs' Suicide - Only Questions Remain

About USMC SSgt. Travis N. Twiggs' recent apparent suicide in Arizona with his brother, Will Twiggs, so little is known that really only questions remain. Don't look to the way-less-than-mediocre coverage of his death by the national news media, it's essentially not even there.  If you find anything at all, it'll be the same basic, scant details of a very small story, repeated endlessly by one outfit after another, adding nothing new, shedding no actual light on the subject.  In situations like this, you don't even have to be a Taoist to realize, sometimes the questions that are left are more profound or thought-provoking than the actual facts that we know.  And since he apparently didn't leave a note, this is all we have to go on.

Here's what we do know, and it's admittedly not enough -- then, later, the questions.  (I may have to update this throughout the day, b/c it's just taking too long to write.  I feel like I'm writing his damn obituary, after all -- in case no one else ever does.  Or at least one that reads a little bit between the lines, and gives perhaps a fuller picture of who he was.)

His full name was Travis Nathaniel Twiggs.  He was 36 years old, which makes him born in 1972, give or take a few months.  He was recently an active duty Marine, at Quantico, although it's possible, according to delayed news, that he may have been AWOL from Quantico since May 5th.  He served five tours(!) that we now know about, one in Afghanistan (OEF), four in Iraq (OIF), most recently in Fallujah.  By February, 2006, he was back in the U.S., because he was doing a little PR on his own time, delivering a flag that had flown in Fallujah to the Thor-Lo sock company in Statesville, NC.

His background with the Marines was this: SSgt Twiggs enlisted in the Marine Corps in 1993 and went through recruit training at Marine Corps Recruit Depot Parris Island. He served as an 0311, infantry rifleman, and deployed to Afghanistan for Operation ENDURING FREEDOM in 2002 and three times in support of Operation IRAQI FREEDOM between 2003 and 2006.  In one of his most recent deployments, to Fallujah, he was part of 2nd Battalion, 6th Marines, Company G, part of 2nd Marine Division, II Marine Expeditionary Force, based at Camp Lejeune, N.C..  In October of 2005, he lost two guys in his battalion -- Robert Eckfield, Jr., and Jared Kremm -- a loss that would painfully stay with him always, perhaps along with others.  Back in Quantico, VA, he served as Infantry Weapons chief at the Marine Corps Warfighting Laboratory.  At one point, he was a course instructor for the Marine Corps Martial Arts Program or "MCMAP" Instructors' Course, and taught it to a group of Marine Corps reservists in New Orleans, LA.  (That's the group pictured, above, with Twiggs on the far right.)

On the personal side, we know this.  Twiggs was married -- his wife, Kellee, very unfortunately says she only learned of his death through an Arizona tv news report; it sounds like she thought he and his brother, Wills, were on a roadtrip to visit relatives in Louisiana, and had been out of contact for some days.  They have two daughters -- Ireland, 8, and America, 4.  (If you know anything about PTSD, you know it isn't easy to be involved with someone who has it.  They can be -- not saying Travis Twiggs was -- unpredictable, explosive, and generally draining to be around.)  He had at least one sibling, Will Twiggs, full name Willard Jay Twiggs, the man who died with him in the apparent murder-suicide (which they now suspect was Travis killing his older brother, and then turning the gun on himself.)  It sounds like his brother Will may have been along for the ride, so to speak, trying to take care of his brother and watch out for him in his struggles.  But we don't know.  Twiggs' father understandably refused to speak with reporters about his sons' deaths.  His wife said that he was a "wonderful husband, and a great Marine" (you can almost hear the emphasis in that sentence); and that he "bled green" for the Marine Corps. 

If you don't count Afghanistan and Fallujah, plus other places in Iraq, we know that Travis Twiggs lived in at least the following places: Florida (Sunny Isles Beach, Lake Worth and Lantana); Louisiana (Metairie and Ama); North Carolina (Jacksonville and Midway Park), South Carolina (Beaufort) and Virginia (Stafford); and probably most recently, Stafford, Virginia.  He died in Arizona.  It's unclear where he was born, or what local paper will eventually publish his obituary.

The Statesville, NC newspaper, the Statesville Record & Landmark, which previously published an article by reporter Chyna Broadnax about Twiggs' visit to Thor-Lo on the paper's website, and has since inexplicably removed this article from its archives, is featuring the hard-hitting article "Showers Likely, Thunderstorms Possible" as today's top story, but making no mention of Twiggs or his death.  If you manage to find an archived copy of that earlier article, you'll learn that Loren Simpson, Thor-Lo's director of sales, spent three weeks with Twiggs in Baghdad a few years ago while he was deployed, apparently getting up close and personal with active duty troops to figure out how to make a sock that better suited their specific needs.  (In case you weren't aware, comfortable combat boot socks are a big deal to servicemembers, and Thor-Lo clearly went the extra mile to customize their product.)  Then Thor-Lo generously donated socks to outfit his battalion.  When Twiggs returned stateside, he presented Thor-Lo's president, Jim Throneburg, with a flag flown over the American Combat HQ in Fallujah as a gesture of appreciation, in a celebration it sounds like the whole company turned out for.

Later that year, in October, Twiggs was yakking it up in the Marine Corps' Quantico Sentry, in an article by Lance Corporal Justin P. Lago, about just how much he loved on-base spinning classes -- to the point of taking two a day.  Hmmn.  That's a little extra-intense, for anyone's purposes, even a Marine: although it is known that exercising large muscle groups, like the legs, helps to burns off strong, aggressive emotions like anger better than other exercises do.  (I got that little factoid from a great British book on mental wellness, Free Yourself from Harmful Stress, by Trevor Powell -- linked here.)  Two spinning classes a day suggests he may have felt he had a whole lot of stuff needing to be burned off, since I highly doubt he was a male anorexic.  (Later on, he was equally vocal in his enthusiasm for martial arts training, and the "help" it gave him in dealing with his PTSD.)

What makes him signficant to us is that Twiggs was the first Marine we knew of who courageously and openly published an account of his struggles with PTSD in the Marine Corps Gazette, in January of 2008.  (The Marine Corps Gazette archives unfortunately seem to be limited to just subscribers, but you can find that article in at least two places on the Web, in full: here and here.)  Marines aren't typically known for their radical openness about weakness and struggles, for any number of reasons.  It's part of the mystique, the brand, and what makes them "cool" -- and Marines seriously ARE cool -- but, it's also pretty much of an occupational handicap.  If you want to read more about this topic, read Kathy Dobie's great piece in the Nation, from a few months ago.  It's called "Denial in the Corps," and I blogged about it here.  (That also includes a link to the actual story.)

Even though I found Twiggs' own story a little too prematurely rah-rah about his recovery from PTSD -- PTSD is notoriously difficult to "kick," and many old vets out there wish they could say they're free from it, despite years of struggle -- I knew he was breaking truly important ground by talking about his struggles so openly.  What he did could help many others, who needed to hear that message from someone else who served.  If you know anybody in the military who's struggled with combat trauma, you know how much they prefer hearing the truth from someone else who knows it -- someone who's been where they've been.  Twiggs was providing that hugely important resource to others.  If you read  between the lines of his essay, you can tell he's still pretty tortured -- by the memories of the guys he lost, by the questions that wracked him, about whether he had done enough (seriously, not a good question to obsess over, since it's never going to resolve positively, except to forgive yourself for whatever happened.)  He dedicates his essay, almost as an afterthought, to the memory of Lance Corporals Robert F. Eckfield, Jr., and Corporal Jared J. Kremm, two guys who were obviously still very much on his mind.

Both Lance Cpl. Robert F. Eckfield, Jr., 23, from Cleveland, Ohio, and Lance Cpl. Jared J. Kremm, 24, of Hauppauge, N.Y., died on October 27, 2005 from an "indirect fire explosion'' in Saqlawiyah, Iraq, according to the military.  Kremm died at the scene of the explosion, and Eckfield died of injuries later at a battlefield medical center where he was evacuated.

If you're wanting to get really heartbroken about stuff, you can read on the Web, I won't say where, notes that Twiggs wrote earlier to these guys, in their memory:

"Jared -- I want you to know that not one day has passed since "I" lost you and Robert. I know that you are safe now and in a better place, but at the same time, I want more than anything for you to be back here with your family. Kellee and I pray daily that your family has found some sense of peace. I miss you brother." -- Twiggs Family of Quantico, Va.

"Robert -- I just finished writing a letter to Jared and it applies to both of you as does this one. I know you are at peace where you are, but I wish you were here with your family and your lady. I wish that I could erase that horrible day from my memory...but I can't. I feel responsible and always will for not bringing you both home. Kellee and I pray daily that your family can find peace. I miss you brother."  -- Twiggs Family of Quantico, Va.

Tom Ricks, well-known military correspondent and author of various books including Making the Corps, wrote a brief article in the Washington Post on January 6, 2008, mentioning Travis Twiggs' essay on PTSD that had just been published in the Marine Corps Gazette.  Ricks introduced it by saying, "People sometimes talk about the sacrifices made by U.S. troops without grasping just what that means."  He hoped that by sharing some of Twiggs' pain, torment, and yes, also moments of victory with his readers, that more people would be able to do that.

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What happened in the months leading up to Travis Twiggs' death?  I'm not sure we as the larger public will ever be privy to that.  It sounds like Travis was in and out of psychiatric facilities in April, and had possibly gone AWOL on May 5th.  At the beginning of March was when I tried contacting him several times at various email addresses, and also the Marine Corps Gazette, to see about reprinting his essay in full, in case it could help more people.  I never heard anything back, from any of my attempts, and even though I had his cell phone number, which came through in one of the auto-replies to my emails, I didn't think to call it because I didn't want to intrude.  But my guess was the no contact back from him or the Gazette meant he wasn't doing too well and didn't want to talk about it, which is understandable.

By the end of today (Thursday, May 15) a Phoenix television reporter had reached Kellee Twiggs by phone at the Twiggs home in Stafford, Virginia.  She sounded both aggrieved and ticked off as she said about Travis, "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..." and there the sound clip ended.  In another interview, this one in print, which may have been part of the same conversation, she elaborated, "All this violent behavior, him killing his brother, that was not my husband. If the PTSD would have been handled in a correct manner, none of this would have happened."

For someone like Travis Twiggs who intimately knew the ravages of PTSD, and had tried to warn his fellow veterans about them (see his writing on the subject, and a particularly good quote about it, linked here), it's very much a tragedy that it ultimately took his life, or at least ground him down to the point where that's what he saw as a solution.  As we learn more about what Travis Twiggs went through in combat, what we may find is that the human being, no matter who he is, is just not that durable or resilient to endure or bounce back from repeated assaults on their psyche, especially when they happen back to back.  People may just reach a breaking point, no matter what their training or their level of resolve.  It may turn out that people can handle some combat trauma, but not back to back deployments filled with heavy amounts of it, as the type of warfare veterans have experienced has been changing.  It may just be too grueling for many people to handle without something inside them snapping, after which they sadly really never are the same.

If you read between the lines of Travis Twiggs' own story about PTSD, it sounds like things just got harder and harder for him, and the light that he saw at the end of the tunnel, queue the old joke, wasn't quite illuminating the exit, but was from the oncoming train (continuing PTSD).  Think of how little the average person is going to know about Travis Twiggs' "before" picture -- including people in Arizona who are only learning about him through the carjacking and his violent death.  There's so much more to his life, his family, his sacrifice -- things people will never know, outside of his friends and family and people who served with him.  But not to talk about the broader picture, just to capsulize him in the shorthand of wire service news reports as just some whacked-out guy, perishing in a shootout off the highway, after leading police on a 130-mile chase -- does him and any other combat veteran who has seen and done too much -- a real disservice.  Want to "support the troops?"  Then learn more about what they actually go through, and the toll that it takes on them and their families.  And if all you learn about them is the two second newsbyte about them on their way out the door, realize there's much more of a previous history than you're likely to learn, and some of it is very important to know.  Of all the things I've learned about Travis Twiggs, the one that's going to stay with me is not how he died, but his literal anguish over the death of two of his men, which seems to have broken something deep within him.  Whatever comes of this whole episode, let's just not compress the impact of his life into the last few days or even weeks of it.  It has to have been so much more than that.

In the immortal words of the wonderful poet, e.e. cummings, "...for life's not a paragraph, and death i think is no parenthesis."  The impact that Travis Twiggs was starting to have about healing combat trauma -- "I pray that no Marine or sailor, or any servicemember for that matter, ever has to go through what I went through -- needs to keep on going, despite his own personal exit.  RIP, Travis N. Twiggs.

The Ballad of Travis Twiggs

I'm personally still reeling from the apparent murder-suicide of USMC SSgt. Travis N. Twiggs and his brother, Will Twiggs, as the cops closed in on them in Arizona yesterday.  (See umpteen shallow news reports for the same basic information, but no explanatory context or any insights as to why.)  Our previous blog entries about Travis Twiggs are here, here, here and here.

While I make my feeble attempt to sort through what is known and what is not, and blog about it later, I'm struck by one comment Twiggs made in the essay he published about his own signficant struggles with PTSD.  The comment is specifically about PTSD:

"I pray that no Marine or sailor, or any service member for that matter, ever has to go through what I went through." -- Travis N. Twiggs, RIP, 5/14/2008.

RIP Travis N. Twiggs, USMC PTSD Sufferer

Very sad just breaking news in the USMC Staff Sergeant Travis N. Twiggs story we blogged about yesterday.  See link for details.  It sounds like authorities who were searching for Twiggs and his brother, wanted in an armed carjacking in the Grand Canyon on Monday, learned that they just killed themselves as they were being surrounded by police in Arizona today, in a potential murder-suicide (though no one is speculating who killed whom at this point). The real tragedy that you won't necessarily learn about elsewhere, is that Twiggs, one of the few Marines to come forward and write both convincingly and publicly about his significant struggles with PTSD.  He was the the author of an article called "PTSD: The War Within, A Marine Reflects on His Struggles with PTSD," that was published in the January issue of the Marine Corps Gazette, and noted in an article by Washington Post correspondent and military historian, Tom Ricks. Click here to read a copy of that original article by Twiggs, whose recommendations must now of course be considered in light of his subsequently tragic, self-inflicted death.

While several elements in Twiggs' realistic but optimistic story cast doubt to this writer on whether he'd actually overcome his demons, his words undoubtedly gave hope to many, and provided a flesh and blood example of a combat veteran who truly understood.  It's with great sadness that we note the literal "end" to the Travis Twiggs story.  We hope that the five(!) tours of duty he gave his country as a Marine, first in Afghanistan, and then four more in Iraq, are remembered more than his untimely and tragic end.   And we hope that much greater attention will be paid to the cumulative effects of back-to-back deployments and lifetime total load of triggering exposure to the things that cause PTSD.  RIP, Ssgt. Travis Twiggs.  You gave what you had to give, both before and after combat.  It's just a very sad tale that it had to end this way.

Mark Twain had a famous line about truth needing to be stranger than fiction, because fiction at least needed to observe some sort of structure in order to make sense.  In that light, there's a particularly, to me, poignant end to Twiggs' own article.  He tells his guys -- the ones he knew, and the ones he didn't yet -- "My e-mail is [omitted], and I will help anyone in need."  That's a great, kind statement, and particularly sad in light of the realization that Twiggs himself apparently wasn't able to get all the help he needed, either.

Editor's Note: If you want to learn more about who Travis Twiggs was, go to this longer entry, linked here. 

No Surprise Here: Recovery is Expen$ive

USA Today has a story in today's paper about the surging costs associated with veterans care, linked here.  This should come as no surprise to anyone who's been following the topic for the last several years.  Today's veterans are sustaining severe, disabling injuries and they seem less reluctant than their predecessors were to know about or file for the benefits they're due, which is a good thing.  Studies like the recent one from the non-profit Rand Corporation, blogged about here, and books like The Three Trillion Dollar War: The True Cost of the Iraq Conflict, by Nobel prize-winning economist, Joseph E. Stiglitz and Harvard's Kennedy School of Government professor Linda J. Bilmes, taken together show both the number of veterans affected, as well as the cost of caring for the wounded for the rest of their natural lives.  The USA Today article suggests that, according to the VA's own estimates, almost 1/4 of OIF/OEF veterans have filed for some form of disability: 181,000 of 755,000 veterans, which is a pretty substantial portion.  However, the payout to individual veterans is usually anything but huge.  If you've read stories like Army veteran Tony Neff's "All I Want is What I Deserve: A Soldier's Own Story of Service, Injury and Neglect," blogged about here earlier, you've seen the hardship money actually involved.  It's not exactly a "get rich quick" scheme for veterans, who can often not even pay their bills based on the disability pay they receive.  Not to mention, combat injuries like PTSD can make it hard to hold down a job, keep a marriage or a family together, or stay in school.  Truly, the costs are staggering, and it's not surprising that they continue to climb.  That said, as a society, we have no other choice but to pay them, and not with reluctance, either, as a tribute to those who served.  Fair is fair.

Editor's note: I'm curious to know whether military contractors' future disability payments are included in these totals or not; and whether they become part of the Tricare or VA system's healthcare delivery program after they return.  They typically earn much higher pay than deployed military, an understandably sore subject to veterans who serve alongside them; but, contractors are often sometimes former military who are returning to a combat zone after several deployments.  Either way, the injuries are piling up and getting more expensive, and in cases like PTSD, cumulative exposure to combat increases the risk of developing the disability.

The Katz Email: Can We Just Call "Bullshh!it"?!

By far the most distressing revelation from the lawsuit by veterans against the VA, currently making its way through Federal court in San Francisco has to be the toxic email, disgracefully titled, "Shh!" and written by Ira Katz, M.D., the VA's top psychiatrist, about the not-exactly-light 'n humorous topic of veterans suicides.  The email essentially attempts to cover up the severity of the number of veteran suicides that are taking place by those who are undergoing treatment at the VA.  The contents of that email by now are fairly well known -- and the general reaction is to Katz's words, not surprisingly, is revulsion.  Senators Patty Murray (D-WA) and Tom Harkin (D-IA) are two legislators calling for Katz' removal.  There's been just enough stink about his ill-chosen words that Katz has been moved to make a very superficial apology for them, a la Roger Clemens.  An article in today's Seattle PI, linked here, quotes CBS News as saying Dr. Katz now calls his word choice "unfortunate."

Erm, well, can we just call "bullshit" on this?  Because, really, it's more than the choice of words people are reacting to -- they're sensing the specious and supercilious attitude behind them.  In the immortal lines from Oliver Wendell Holmes, "Even a dog knows the difference between being kicked, and being tripped over." 

The "Shh!" email brings to mind another bureaucratic bumbler of late, Michael Brown, head of FEMA during the Katrina crisis, who ostensibly fiddled while Rome burned, writing superficial emails to his colleagues preening about his choice in ties and lamely wondering if it was time for him to go home yet. "'Can I quit now?' FEMA chief wrote as Katrina raged," according to an article archived here on CNN.com.

Brown certainly seemed to be over his head (no Katrina puns intended) at FEMA; perhaps Katz, because of his psychiatry training is actually not.  However, they both have a world of learning to do in how to project empathic leadership.  There's nothing confidence-affirming about either one of their responses. Wounded warriors deserve a lot better from the top psychiatrist at the VA responsible for their care.  Those aren't just poorly-chosen words, there's an attitude of callous disregard for the patients behind them as well, that no thin veneer of apology really corrects.  Combat veterans struggling with alarmingly high and well-documented rates of PTSD and suicide need compassionate leaders with a vested interest in their care, not someone making light of the size and the severity of the problem.  In anyone but a psychiatrist, whose field after all is mental health, we might find this easier to understand or excuse.  But in a psychiatrist whose professional responsibility is the mental health of veterans?  Absolutely not.  That's a vote of no confidence, in someone who's sworn to uphold the Hippocratic oath to "first, do no harm."  The bumbling and apparent cluelessness of FEMA's Michael Brown in the face of a huge need for crisis management and control spurred calls for him to resign; perhaps outrage over Katz' email will do the same.  There's really no way to spin that into a positive.  The damage has already been done.

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Here's the content of the email Katz titled "Shh!" for those who haven't seen it.  According to the article in the Seattle PI, "Our suicide-prevention coordinators are identifying about 1,000 suicide attempts per month among the veterans we see in our medical facilities," Katz wrote in a Feb. 13 e-mail to Ev Chasen, the department's communication director. "Is this something we should [carefully] address ourselves in some sort of release before someone stumbles on it?"

Dr. Ecstasy Will See You Now

An article in yesterday's Sunday Times (London, UK) talks about the drug, Ecstasy, as having therapeutic potential for treating severe, unremitting PTSD.  The article, which is titled "Ecstasy is the Key to Treating PTSD," by Amy Turner, is linked here.  The drug in question is more properly known as MDMA, or 3,4-methylenedioxy-N-methylamphetamine, pictured here.

The article says that MDMA's potential therapeutically wasn't noticed until 1976, "when the American chemist Alexander Shulgin tried it on himself. He noted that its effect, “an easily controlled altered state of consciousness with emotional and sensual overtones”, could be ideal for psychotherapy, as it induced a state of openness and trust without hallucination or paranoia. It quickly became known as a wonder drug, and began to be used widely in couples therapy and for treating anxiety disorders. None of these tests was “empirical” in the scientific sense – no placebos, no follow-up testing – but anecdotally the results were almost entirely positive."

The therapeutic potential for treating PTSD is apparently to be found, according to the article, "in the trust it establishes."  One researcher familiar with the drug, quoted in the article, states:

“Many people with PTSD have a great deal of trouble trusting anybody, especially if they’ve been betrayed by someone who abused their trust, like a parent or a caregiver,” he says. “MDMA has this effect of lowering fear and defenses. It also allows more compassion for oneself and for others. People can revisit the trauma, feel the original feelings but not be retraumatized, not feel overwhelmed or have to numb out to cope with it.”

This is obviously good news for PTSD sufferers.  The study is still in its early phases, and the reality is, that if PTSD is able to be treated with one or just a few doses of MDMA, versus potentially years of psychotherapy and/or lengthy courses of pharmaceutical antidepressants, etc., this news is likely to be welcomed more warmly by patients eager to get well than by healthcare providers who previously expected to be providing maintenance doses of psychotherapy and/or pharmaceutical care for years to come.

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The formal study analyzing MDMA's therapeutic effects on PSTD is being conduced by Michael and Annie Mithoefer, under the auspices of MAPS, the Multidisciplinary Association for Psychedelic Studies, linked here.  While this might sound like a highly "hippy dippy" research project, the reality is, the other day I called a research group at the University of Arizona's Department of Psychiatry, and listened to a recorded message about a trial of psilocybin and OCD.  (See article, linked here.)  Mainstream medicine is apparently, if only slightly, open to studying the therapeutic uses of controlled substances.  In the meantime it's important to note that the street drug, Ecstasy, which may or may not be based on MDMA, depending on the purity, is not a substitute for taking part in a clinical trial like the Mithoefers', and there is always considerable risk in attempting to self-medicate any serious health condition, especially with illicit drugs.  Read the Sunday Times article, linked here -- it's quite informative.  And keep track of this ongoing research, which looks promising for some sufferers.

Editor's Note: In a feeble attempt at true-to-life humor, this was the license plate I saw recently on a very nice, late model Acura, parked in the driveway at a state veteran's home.  Perhaps it was just a visiting DJ.

Rand Study Estimates PTSD Figure is 1 in 5

One In Five Iraq and Afghanistan Veterans Suffer from PTSD or Major Depression

Nearly 20 percent of military service members who have returned from Iraq and Afghanistan — 300,000 in all — report symptoms of post traumatic stress disorder or major depression, yet only slightly more than half have sought treatment, according to a new RAND Corporation study.

In addition, researchers found about 19 percent of returning service members report that they experienced a possible traumatic brain injury while deployed, with 7 percent reporting both a probable brain injury and current PTSD or major depression.

Many service members said they do not seek treatment for psychological illnesses because they fear it will harm their careers. But even among those who do seek help for PTSD or major depression, only about half receive treatment that researchers consider "minimally adequate" for their illnesses.

In the first analysis of its kind, researchers estimate that PTSD and depression among returning service members will cost the nation as much as $6.2 billion in the two years following deployment — an amount that includes both direct medical care and costs for lost productivity and suicide. Investing in more high-quality treatment could save close to $2 billion within two years by substantially reducing those indirect costs, the 500-page study concludes.

"There is a major health crisis facing those men and women who have served our nation in Iraq and Afghanistan," said Terri Tanielian, the project's co-leader and a researcher at RAND, a nonprofit research organization. "Unless they receive appropriate and effective care for these mental health conditions, there will be long-term consequences for them and for the nation. Unfortunately, we found there are many barriers preventing them from getting the high-quality treatment they need."

The findings are from the first large-scale, nongovernmental assessment of the psychological and cognitive needs of military service members who have served in Iraq and Afghanistan over the past six years. The RAND study is the first to comprehensively assess the current needs of returned service members from all branches of the military.

Researchers concluded that a major national effort is needed to expand and improve the capacity of the mental health system to provide effective care to service members and veterans. The effort must include the military, veteran and civilian health care systems, and should focus on training more providers to use high-quality, evidence-based treatment methods and encouraging service members and veterans to seek needed care.

Since October 2001, about 1.6 million U.S. troops have deployed to the wars in Iraq and Afghanistan, with many exposed to prolonged periods of combat-related stress or traumatic events. Early evidence suggests that the psychological toll of the deployments may be disproportionately high compared with physical injuries.

Tanielian and project co-leader Lisa Jaycox headed a group of 25 RAND researchers who conducted a three-pronged assessment of the needs of returning service members: a national survey of those who had served in Iraq and Afghanistan to assess their psychological and cognitive injuries; economic modeling to estimate the cost not only of providing needed treatment, as well as the costs associated with lost productivity and suicide; and an assessment of treatment services that are available to service members, as well as barriers to treatment.

Researchers surveyed 1,965 service members from 24 communities across the country to assess their exposure to traumatic events and possible brain injury while deployed, evaluate current symptoms of psychological illness, and gauge whether they have received care for combat-related problems.

Service members reported exposure to a wide range of traumatic events while deployed, with half saying they had a friend who was seriously wounded or killed, 45 percent reporting they saw dead or seriously injured non-combatants, and over 10 percent saying they were injured themselves and required hospitalization.

Rates of PTSD and major depression were highest among Army soldiers and Marines, and among service members who were no longer on active duty (people in the reserves and those who had been discharged or retired from the military). Women, Hispanics and enlisted personnel all were more likely to report symptoms of PTSD and major depressions, but the single best predictor of PTSD and depression was exposure to combat trauma while deployed.

Researchers found many treatment gaps exist for those with PTSD and depression. Just 53 percent of service members with PTSD or depression sought help from a provider over the past year, and of those who sought care, roughly half got minimally adequate treatment.

"If PTSD and depression go untreated or are under treated, there is a cascading set of consequences," Jaycox said. "Drug use, suicide, marital problems and unemployment are some of the consequences. There will be a bigger societal impact if these service members go untreated. The consequences are not good for the individuals or society in general."

Service members report many reasons for not seeking treatment. Many are worried about the side effects of medication or believe that family and friends can provide more help than a mental health professional. Even more reported that they worried seeking care might damage their career or cause their peers to lose confidence in their abilities.

The RAND report recommends the military create a system that would allow service members to receive mental health services confidentially in order to ease concerns about negative career repercussions.

"We need to remove the institutional cultural barriers that discourage soldiers from seeking care," Tanielian said. "Just because someone is getting mental health care does not mean that they are not able to do their job. Seeking mental health treatment should be seen as a sign of strength and interest in getting better, not a weakness. People need to get help as early as possible, not only once their symptoms become severe and disabling."

Researchers also found an urgent need to train more mental health providers throughout the U.S. health care system on delivering evidence-based treatments to service members and veterans. While many opportunities for treatment exist for active-duty personnel, there is no system in place to monitor the quality of those services to ensure they are getting the latest science-based forms of treatment.

The Department of Defense's newly created Defense Center for Excellence for Psychological Health and Traumatic Brain Injury may provide a historic opportunity to change the culture of psychological health within the military and to promote and monitor the use of high-quality care to service members. The RAND report provides information that the center could use to pursue these objectives through the use of innovative care models and performance measurement techniques.

Researchers suggest special training programs are needed to instruct mental health providers in the military, veterans and civilian health systems about the type of evidence-based treatments needed by service members. Only providers with such training should be eligible to treat service members and payment programs should be retooled to reward providers who use science-based treatments.

"It's going to take system-level changes — not a series of small band-aids — to improve treatments for these illnesses," Tanielian said.

The RAND study estimates the societal costs of PTSD and major depression for two years after deployment range from about $6,000 to more than $25,000 per case. Depending whether the economic cost of suicide is included, the RAND study estimates the total society costs of the conditions for two years range from $4 billion to $6.2 billion.

The RAND study also estimates that about 320,000 service members may have experienced a traumatic brain injury during deployment — the term used to describe a range of injuries from mild concussions to severe penetrating head wounds. Just 43 percent reported ever being evaluated by a physician for that injury.

While most civilian traumatic brain injuries are mild and do not lead to long-term impairments, the extent of impairments that service members experience and whether they require treatment is largely unknown, researchers said. In the absence of a medical examination and prognosis, however, service members may believe that their post-deployment difficulties are due to head injuries even when they are not.

One-year estimates of the societal cost associated with treated cases of mild traumatic brain injury range up to $32,000 per case, while estimates for treated moderate to severe cases range from $268,000 to more than $408,000. Estimates of the total one-year societal cost of the roughly 2,700 cases of traumatic brain injury identified to date range from $591 million to $910 million.

The report is titled "Invisible Wounds of War: Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery." The full report and several summaries are available at http://veterans.rand.org/.

The project, jointly conducted by RAND Health and the RAND National Security Research Division, was sponsored by a grant from the California Community Foundation.

RAND Health, a division of the RAND Corporation, is the nation's largest independent health policy research program, with a broad research portfolio that focuses on quality, costs and health services delivery, among other topics.

The RAND National Security Research Division conducts research and analysis for the Office of the Secretary of Defense, the Joint Staff, the Unified Commands, the defense agencies, the Department of the Navy, the U.S. intelligence community, allied foreign governments and foundations.

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Marines and the Stigma of Mental Health Issues

If you haven't done so already, you owe it to yourself to read the excellent article published recently in The Nation, called "Denial in the Corps."  The author, Kathy Dobie, did another great piece for GQ recently, which we blogged about here.  (That entry was entitled, "Superb Writing about a Vietnam Vet's PTSD and Subsequent Nervous Breakdown.")  Kathy Dobie is a superb writer, who crafts an excellent narrative -- every sentence in the Nation piece is worth reading, and both informs and moves the story along.  Regrettably, the story is a painful one to tell, about how Marines haven't yet fully risen to the challenge of taking care of their own who have been used up, broken down, or shattered into pieces by their experience at war.  Three paragraphs are the sum of the story:

"According to civilian and military defense lawyers, mental health professionals and veterans' advocates, the trajectory of [one of the Marines profiled]'s postdeployment life, with untreated PTSD leading to misconduct and then punishment, is all too common in the Marine Corps. A marine endures one, two, even three tours in Iraq, serves honorably and well, but returns suffering from combat trauma and starts to drink or abuse drugs or becomes violent at home, and suddenly finds himself ostracized, punished and drummed out of the Corps with an other-than-honorable or bad-conduct discharge. A history of service is tarnished, and the marine is denied benefits--even the treatment necessary to recover from combat trauma--and left with only a bitter sense of betrayal. A Corps review in 2007 of 1,019 other-than-honorable discharges issued to combat veterans during the first four years of the Iraq War found that fully a third of the discharged marines had evidence of PTSD or another combat-related mental illness. Lt. Col. Colby Vokey, the Marine Corps's legal defense counsel for the western United States, estimates that of all the Iraq combat veterans his office defends, one-third have PTSD or another combat-stress mental health issue. Many of these clients have served at least two tours in Iraq.

The factors leading to the abandonment of combat-broken marines are both cultural and operational. The Marine Corps is the youngest, most male, most junior and least married of all the services. Sixty-six percent of the troops are 25 or younger; 13 percent are teens; and 39 percent hold the rank of private, private first class or lance corporal. Fewer than 7 percent are female. The Corps's deeply macho culture, which values stoicism in the face of pain and disdains "weakness," makes it hard for marines to seek help. Judith Broder, a civilian psychiatrist who treats Iraq and Afghanistan vets, says, "They all know of stories where buddies have asked for help and have been ridiculed by the chain of command or given some kind of treatment that is not really adequate and told they have to go back."

This harsh culture is exacerbated by the relentless tempo of training and deployment, which pressures commanders to quickly replace broken marines with deployable ones. "You read the Marine Corps values and you'll find that anybody that gets hurt isn't courageous or doesn't have honor," Judith Litzenberger, a civilian defense lawyer and twenty-one-year Navy veteran, explains. "That's how the marines interpret it: 'I went to Iraq and I didn't whine and I didn't claim that I had a mental disorder, and damn well marines don't do that--we suck it up.' And it has to be that way because they have a mission that's bigger than the number of people they have. They can't spend all their time taking care of people who have mental disorders. They've got to wash them out quickly and move on."

There are institutional benefits for washing them out quickly and moving on, and the articles goes on to suggest what those are.  At its most extreme, it's ultimately all about the money.  One retired Air Force colonel, in charge of medical operations in the Air Force's European headquarters, who is quoted in the story, cuts right to the point: "Every kid that gets kicked out with PTSD is gonna be a lifetime of disability payments for the government. Every kid who gives up and kills himself, nothing."

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The trouble is, though, the thing that gets people in this predicament -- PTSD -- is war itself.  Marines and other servicemen and women aren't creating PTSD -- they're developing it, from and in combat.  And combat at a level -- longer tours, more deployments, less time between tours -- that is just unprecendented.  Rather than preparing for the logical outcome of that -- more PTSD cases, a greater need for care -- and PLANNING on and for that -- the tendency seems to be, still to some degree, to blame the participant, and refuse to acknowledge the greater problem -- or the link between the two: combat and PTSD.

A current and disturbing example, surfaced on this blog, is the case of Lance Corporal Eric Acevedo, accused of murdering his former girlfriend in Saginaw, Texas, in what certainly "seems" be a PTSD-related event.  We dug a little bit into his background, and found the extent of the combat he'd seen in the Marines, and what had happened on his tour.  (Read about that here.)  Even found the great, iconic photograph of him, in the Marine's own photo archives, pictured above.  What happened?  WIthin three days, the Marines had removed all trace of Eric Acevedo from their publically-searchable archives.  No photo, no attached story, no reference to the memorial service he attended (where the photo by Heidi Loredo was taken), where ten of his fellow Marines who died in Fallujah were honored.  All references to Lance Corporal Eric Acevedo -- VAPORIZED.  As though he no longer existed; or had in fact, never existed.  What disturbs me the most about this is the simple, brutal fact.  If Lance Corporal Eric Acevedo, a three tour Marine, ended up with PSTD, no matter what he did AFTER he had it -- it's clear where he got it, and how.  For the Marines to distance themselves like that from him goes against all the Three Musketeer-ing sentiment we usually associate: the all for one, and one for all stuff that gets so many guys (and gals) through their unbelievably rigorous training, and in and out of battle.  It creates a terrible impression, too: that while the Marines may be all for one another, on the battlefield, so long as it's a reasonably level playing field; but is the top brass really all for the average Marine?  Only time will tell, but if the Eric Acevedo story is any indication, the perspective is, get in trouble and you're expendable.  In fact, we never knew you.

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The Marine Corps's legal defense counsel for the western United States, Lieutenant Colonel Vokey, quoted in the Nation article says prophetically: "The problem is I don't think the system accounts for these folks with PTSD. There's got to be another way to handle this without lumping them in with every other marine who commits misconduct. They were fine when they went to Iraq, we broke them, this is what combat did to them, and I think we should feel some responsibility for what happens to them." Absolutely; that's EXACTLY the point.

Finally, Some Good News

The Washington Post has an article in Thursday's paper about some positive improvements being made to patient care at Walter Reed. The article is entitled, "The Young Lions of Able Troop," and the subtitle is, "to the cadre on the front lines of improving care at Walter Reed, the challenge can rival combat."  Indeed.  The story, which is written by Steve Vogel, profiles the efforts of Army Major Steven Gventer and others to encourage the injured troops under his care to get the help they need, and most importantly, to help take care of one another.  It's an interesting story about what amounts to proactive case work being done by the military, with their injured soldiers undergoing treatment at Walter Reed, and it represents very much of an improvement -- seemingly something to be replicated elsewhere.  Read the story.  It's rare to find some encouraging news on this front -- this really qualifies.  The article is linked here.