Healing Combat Trauma

Best Recent Books on PTSD and Veterans

Top picks from the recent crop of books about veterans, PTSD and re-integration, coming from a number of diferent perspectives. There's a real wealth of good material here, on multiple subjects, from dealing with TBI and PTSD after war (and not having it wreck your marriage) to working out aspects of PTSD via guided writing exercises, delivered by a fellow veteran. Great stuff abounding! Check them out.

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Top 10 Films on PTSD and Veterans

Each of these films deserves its space on a "top 10" list about veterans, PTSD, reintegration and healing; or dealing with grief and loss. BUT, there's more, some of which aren't available as DVDs. For military sexual trauma, for instance, there are the "big three:" "The Invisible War," which is listed; "Service: When Women Come Marching Home," and "Justice Denied," both of which are available in other forms. Taken together, they give a very complete picture of the military sexual assault problem today, for men and women as survivors. There's also a good film called "The Welcome," about homecoming and reintegration in community that isn't available on DVD yet.

Favorite movie for understanding re-integration after combat? It's here. Best movie for understanding that women serve in combat today, and the issues that affect them? It's here too. Enjoy!

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Top 10 Books on PTSD and Healing

A post I've been wanting to do forever. Each book here heavily deserves its place on the list, but for different reasons. Maybe it's exceptional about talking about trauma, and how the body stores (and releases) trauma; or it covers the landscape of PTSD and treatments for it really well; or it talks about the effect on the family and techniques for improving relationships with a trauma survivor; or one man's journey making peace with his own "scars" from combat. It's all here! Enjoy...and if you can afford to, offer to buy one or more of these books for your local library. I'm sure they'd appreciate it.

Note: Amazon limits us to 10 choices only for this carousel effect. So "watch this space" for more selections like this to come!

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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

On the Shelf: Great Books on War Photography

A short list of great books on war photography, recommended by photojournalists, war correspondents and museum curators/consultants.

The items cover Civil War-era photography (Matthew Brady); through World War II (Robert Capa and the Magnum book); the Vietnam era (Requiem); and the wars in Iraq and Afghanistan (almost everything else).

Two are produced from museum shows, at the Museum of Fine Arts in Houston, Texas (finished earlier this year) and the Metropolitan Museum of Art in New York City (ongoing).

The recommended books, alphabetically:

"Deeds of War," by James Nachtwey;

"Here I Am: The Story of Tim Hetherington, War Photographer," by Alan Huffman;

"In the Wake of Battle: the Civil War Images of Matthew Brady," by George Sullivan;

"Magnum: Fifty Years at the Frontline of History," the story of the legendary photo agency, by Russell Miller;

"Photography and the American Civil War," by Jeff L. Rosenheim. (Metropolitan Museum of Art.)

"Photojournalism: 150 Years of Outstanding Press Photography," by Reuel Golden;

"Photojournalists on War: the Untold Stories from Iraq," by Michael Kamber;

"Requiem: By the Photographers Who Died in Vietnam and Indochina," by Horst Faas, editor; foreword by David Halberstam;

"Robert Capa: Photographs," by Richard Whelan;

"Robert Capa: The Definitive Collection," by Richard Whelan;

"Shooting under Fire: the World of the War Photographer," by Peter Howe;

"This is Our War: A Soldier's Portfolio: Servicemen's Photographs of Life in Iraq," by Devin Friedman;

"Unembedded: Four Independent Photojournalists on the War in Iraq," by Thorne Anderson;

"War/Photography: Images of Armed Conflict and its Aftermath," by Anne Wilkes Tucker. (Museum of Fine Arts, Houston.)

Editor's note:

For more on the Metropolitan Museum of Art's exhibit on "Photography and the American Civil War," which runs through September 2, click here. If you want to read about the Houston Museum of Fine Art's "War/Photography" exhibition, now over, click here.

 

 

 

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We appreciate your support as we continue to provide therapeutic resources to veterans with combat-based post-traumatic stress ("PTSD") and military sexual trauma ("MST"), their caregivers, healthcare practitioners and decision-makers. Thank you!

David Halberstam on "the Most Relentless of Forces, the Power of Memory"

In honor of the panel discussion on war correspondents and PTSD taking place at the National Press Club in Washington, DC today, some brief remarks by noted war correspondent David Halberstam, in the introduction to the coffee table book, Requiem, about the war photographers who died in Vietnam and Indochina:

"Our memories of Vietnam are too mixed, and there is altogether too much sadness in most of them; we have spent much of the last twenty to twenty-five year learning to forget or at least learning to soften those chapters in our lives. Saigon is mercifully distant, a place that belonged to the younger men and women we once were, the young, eager, scared journalists clad in Catinat fatigues, scrambling to get to Tan Son Nhut to get aboard the Hueys going into battle, terrified we might get there too late to get aboard, terrified we might get there in time to get aboard.

We are all older now, sedate men and women in our fifties and sixties living in civilized settings, leading ordinary, rather mundane lives. Yet for most of us, the memory is always there, just beneath the surface; when we open a book like Requiem and read it now in our handsome apartments in the Western cities in which we live, the past still lurks. And as we read, we are at first flooded by these images of the past, and then we are surrounded by a terrible stillness, a special silence produced by the most relentless of all forces, the power of memory. We are quiet as we turn the pages of this book, as befits a special act of homage to those we knew so well.

The silence stands in sharp contrast to the terrible noise that was a defining part of those days and accompanied so many of these very scenes: the racket of infantry weapons and artillery, the harsh clamor of the helicopters. We read it, of course, now safely distanced from our own terrible fear that was the constant of those days. But in some ways the remembrance of another time is more powerful than ever, not just because of the photos but, more important, because of the memory of the young men and women who women who took them, since they themselves, in the most final and terrible way, became part of what lay before them. Looking through Requiem, we remember not just what they did, but now we know, as well, the price they paid."

Ernie Pyle on Transformation in Soldiers about Killing

I've been reading a great book about Ernie Pyle's war correspondence in World War II lately, and have been struck by many of his observations. In this passage below, the book's author quotes Pyle describing the transformation he sees in the soldiers he's "embedded" -- a transformation he doesn't completely share, despite his genuine love for the men. It's a great passage about how even moral horrors can become what amounts to "just another day at the office."

Ernie Pyle "felt bonds of kinship tugging him toward these men...but he perceived a change in them that he had not undergone. Before Kasserine they had been merely civilians thrust into Army green. Now they were soldiers. He heard the transformation in 'the casual and workshop manner in which they now talk about killing. They have made the psychological transition from the normal belief that taking human life is sinful over to a new professional outlook in which killing is a craft. To them now there is nothing morally wrong with killing. In fact it is an admirable thing.' He didn't hear this sort of talk in the rear echelons, only among the rifle companies at the tip of the spear. The front-line soldier 'wants to kill individually or in vast numbers. He wants to see the Germans overrun, mangled, butchered...' It was a profound difference, shocking yet necessary. 'All the rest of us -- you and me and even the thousands of soldiers behind the lines in Africa -- we want terribly  yet only academically for the war to get over. The front-line soldier wants it to be got over by the phsyical process of his destroying enough Germans to end it. He is truly at war. The rest of us, no matter how hard we work, are not.'" 

Source: Ernie Pyle's War: America's Eyewitness to World War II, by James Tobin. 

 

 

War reporters, combat stress and Ernie Pyle

It's no surprise war correspondents also experience the two so-called 'signature wounds' of this era's conflicts -- PTSD and TBIs as well -- they're exposed like service members are, admittedly for shorter times, to the same stressors in the war zone. 

The McCormick Foundation is hosting a symposium this coming November in Washington, DC on war reporters and PTSD; the Dart Center for Journalism and Trauma ("a resource for reporters who cover violence") has already covered this ground exhaustively and well, even issuing a set of guidelines on how not to make the problem worse. Michael Samstag's documentary about combat reporters, "War and Truth," offers opportunities to see the toll embeds have taken on journalists in recent wars. Ashley Gilbertson, combat photographer and outstanding writer, is no stranger to the concept of PTSD, and has both shown and told about it compellingly. (His article, "The Life and Lonely Death of Noah Pierce," is one of the best articles about veterans, PTSD and suicide in print.) Kathy Dobie, who's written two of the best pieces about the same topic, above, here and here -- understands the concept on a personal level as well, which is perhaps how she can be so empathic in print. And favorite journalist -- and Iraq war vet himself -- Carl Prine wrote tellingly lately about his own head injuries suffered in combat, before needing to take a break from writing about it for while. 

Robert Capa, the famous combat photographer who photographed in five(!) wars, and later went on to found the photo agency Magnum, shot photos during the D-Day invasion of Normandy, even under heavy fire. He was once quoted as saying, "If your photographs aren't good enough, you're not close enough." The same impulse is shared of course by war reporters; and whether you're photographing or writing about combat, you're liable to be deeply affected by it in many of the same ways that veterans are.

In the next few posts, we're going to look at someone who was exposed at length to combat in World War II -- the Pulitzer Prize-winning journalist Ernie Pyle -- and some of his observations about what he saw and how it changed him. It's more than a little ironic that he once wrote a friend, "If there's one thing in this world I hate and detest, it's writing about the Army" --  though he had published extensively beforehand, his columns written while embedded with the infantry in both theaters of World War II gained him a worldwide readership and a devoted following, along with a sense that nobody covered the little guy like Ernie did -- perhaps because he identified with him so much and so well.

As the Dart Center says, "Journalists who are sensitive to the suffering of others and understand the complexity of emotional trauma are often able to write about traumatic experiences in a way that is informative, engaging and often helpful to readers." This is the case with many of today's war reporters, and it was certainly the case with Pyle. A simple comment by Philadelphia artist George Biddle, who traveled to the war zone and sketched Ernie Pyle on assignment, testifies to his appeal across the years in a way nothing I've read elsewhere has done. If you've not read much of Ernie Pyle, it may not resonate with you; if you have, however, I expect that it will:

 "June 15. This morning I did a drawing in red sanguine of Ernie Pyle. I only put into it, I am afraid, a small part of his rare personality. He seems Yankee to the core, though hailing from Indiana farm stock. Ascetic, gentle, whimsical, shy.  Frugal in his habits. Like so many Americans, his expression is fundamentally sad, yet full of tenderness. Of course a stubborn, thin-lipped individualist, and probably hard as granite under his timid manner. I like to think of him as he sits on the beach toward sundown, a white and slender Gandhi, swathed in towels and wrappers, for he hates the cold as much as he fears the sun. He does not swim and dislikes bathing. He sleeps three hours each day; reads for three hours; and then, being at his wits’ end what to do, he sits down and writes a column. He puts his whole life into his column: his shy love of human beings, his tenderness, and his hard, salty, Indiana-farmer humor.” 

 

Quotable Quotes -- Sarah Ban Breathnach on Overcoming Adversity

Every once in a while we need to be reminded that there is some benefit to struggle. Here's a great quote about keeping perspective on that:

"Real life isn't always going to be perfect or go our way, but the recurring acknowledgment of what is working in our lives can help us not only to survive but also to surmount our difficulties." -- Sarah Ban Breathnach, author of "Simple Abundance."

It's Anniversary Time! Please Support Our Work...

Healing Combat Trauma turns six (6) years old this month!

That's 2,190 days, 52,560 hours, and over 3 million minutes of sustained focus on helping veterans with combat-based PTSD with therapeutic resources and information, focused on integrative medicine and that vital intangible {{{hope}}}. When we started this six years ago, there was literally NOTHING available on the Web on the topic. Hence this site.

If you feel it's helped you, please contribute to our effort by sending a donation. We're trying to get our IRS 501(c)3 designation as a nonprofit, and would appreciate any contributions to that end. Please donate here. Thank you so much!

Quotable Quotes -- Tori Amos on the Hidden Courage that Healing Takes

"Healing takes courage, and we all have courage, even if we have to dig a little to find it." -- Tori Amos, American singer and songwriter.

For more great, thought-provoking quotes about the healing process, read our "Tao of Healing" section, linked here.

Quotable Quotes -- American Poet Walt Whitman on the True Nature of War

Famous American poet Walt Whitman (1819 - 1892), author of "Leaves of Grass," volunteered as a nurse in the Civil War. He is reported to have been profoundly affected by what he saw, and wrote about it in an essay called "The Great Army of the Sick," published in a New York newspaper at the time, and also in a later book called "Memoranda During the War." He claims to have visited almost 100,000 wounded troops, though that claim is likely to be an exaggeration, and is thought to have sat at many wounded soldiers' bedsides, drafting letters home for them to their loved ones, among many other kindnesses he performed.

In the tone of Vietnam combat veteran Tim O'Brien who wrote "The Things We Carried," who famously said, "A true war story is never moral," Whitman wrote, "The real war will never get in the books."

Whitman had originally journeyed to find his injured brother, George, who had enlisted with the Union Army, traveling to battlegrounds and eventually to hospitals in Washington, D.C. Along the way he wrote his mother, tellingly:

"Now that I have lived for eight or nine days amid such scenes as the camps furnish … really nothing we call trouble seems worth talking about.”

Editor's note: This photo of Walt Whitman during his Civil War years is by the famous photographer Matthew Brady, and is in the archives of the Library of Congress. A collection of his work in the National Archives, online, is linked here.

Quotable Quotes -- Eleanor Roosevelt on the Human Cost of War

As a nation, we've been blessed to have had some wonderfully enlightened presidents -- and in this case, first ladies as well. (See previous quotes by Eisenhower on war, etc.) But in this case, we've got the prayer that Eleanor Roosevelt apparently carried around in her pocket during World War II, to highlight the sacred responsibilty of sending others off to war. It's both profound and true. Here's what it said:

"Dear Lord,

Lest I continue
My complacent way
Help me to remember
Somehow out there
A man died for me today.
As long as there be war
I then must
Ask and answer
Am I worth dying for?"

Unlike in Roosevelt's World War II era, where almost 25% of the nation served -- today just about 1% of the nation does. That means that hardly anyone understands the cost of war or the sacrifices military families make except those who serve and so have "skin in the game." This prayer is probably more relevant now that ever.

Editor's note: Illustration is the White House portrait of Mrs. Roosevelt.

Happy Veterans Day 2011 -- Joe Galloway on the Experience of War

"War is about men who love their country but even more than that love each other. I left that battlefield knowing that they will continue to sacrifice for me. There are some events that are so overwhelming you can't simply be a witness. You can't be above it you can't be neutral you can't be untouched by it. You see it, you live it, you experience it and it will be with you all of your days." -- Joseph "Joe" Galloway, from "Vietnam in HD" on the History Channel. 

Editor's note: Longtime journalist Galloway, who served as a war correspondent in the battle of Ai Drang during the Vietnam War, has been decorated for his bravery under fire. He's also the author of "We Were Soldiers Once, and Young" with Lt. Gen. Harold Moore (Ret.), which has since been made into a movie; and he's featured in the excellent Michael Samstag documentary about war correspondents in the current era, called "War & Truth." 

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

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

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

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

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

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

Quotable Quotes -- Life is a Journey Sometimes Walked in Light, Sometimes in Shadow

The book, "Keep Going: The Art of Perseverance," by Native American writer Joseph M. Marshall III, opens with an extended monologue by the spiritual Lakota Sioux grandfather to his grandson, attempting to help him deal with loss. Here's part of what he says:

"In life there is sadness as well as joy, losing as well as winning, falling as well as standing, hunger as well as plenty, badness as well as goodness. I do not say this to make you despair, but to teach you reality. Life is a journey sometimes walked in light, sometimes in shadow.

You did not ask to be born, but you are here. You have weaknesses as well as strengths. You have both because in life there is two of everything. Within you is the will to win, as well as the willingness to lose. Within you is the heart to feel compassion as well as the smallness to be arrogant. Within you is the way to face life as well as the fear to turn away from it.

Life can give you strength. Strength can come from facing the storms of life, from knowing loss, feeling sadness and heartache, from falling into the depths of grief. You must stand up in the storm. You must face the wind and the cold and the darkness. When the storm blows hard you must stand firm, for it is not trying to knock you down, it is really trying to teach you to be strong.

Being strong means taking one more step toward the top of the hill, no matter how weary you may be. It means letting the tears flow through the grief. It means to keep looking for the answer, though the darkness of despair is all around you. Being strong means to cling to hope for one more heartbeat, one more sunrise. Each step, no matter how difficult, is one more step closer to the top of the hill. To keep hope alive for one more heartbeat at a time leads to the light of the next sunrise, and the promise of a new day.

The weakest step toward the top of the hill, toward sunrise, toward hope, is stronger than the fiercest storm. Keep going."

Photo is of Sitting Bull, the Lakota Sioux chief who defeated Custer. 

For more from our "Tao of Healing" series, click here. For more on our series on Native Americans and healing, click here.

Comparing Risk of Suicide in Veterans to Non-Veterans

Periodically I wish we were doing a section on this site called "What We Knew, When" because the unfortunate tendency in the world at large, for whatever reason, is to suggest that so little is known about PTSD and combat veterans that we can keep re-discovering it, at great expense and to the detriment of the veterans affected themselves (and their family members, who also have to cope with this).

One case in point that I ran across the other day is this. Back in 1986, before some of the servicemembers in the current war climate were even born, the New England Journal of Medicine reported in a study that veterans were "65% more likely to die from suicide and 49% more likely to die in a motor vehicle accident than non-vets of the same age."

The article's authors affirmed, "We conclude that the most likely explanation for these findings is that military service during the Vietnam War caused an increase in subsequent deaths from suicide and motor-vehicle accidents." (N Engl J Med 1986; 314:620–4.)

I bring this up because even the other day, a civilian wondered -- on hearing the statistics of how many suicides are being reported in the Army -- how the rate of suicide in those who've served compares to the civilian rate. The short answer? It's much higher. The current figures for servicemember suicides are one every 36 hours; for veterans, an also-shocking 18 every day -- and those figures have been valid for a while. (If you want to learn about civilian suicide rates, you'll have to do your own homework here, but the NIMH is a good place to start. The figures are a bit old but periodically update.) As a general point of reference, in 2007 it was known to be twice that of the civilian population.

Periodically new studies arise that make different claims -- a recent one says there's no difference at all, but perhaps their window of "in the past year" was too small -- but as a general rule of thumb, it's higher than civilians and the NEJM reference cited above is an interesting metric about how much higher. It also makes mention of motor vehicle accidents, which have a certain overlap with suicide in terms of method. 

Another recent study which seems to have gotten no traction in the news is that suicide is also higher for veterans who've suffered traumatic brain injuries ("TBI"). (The figure they mentioned is 1.55% the rate of non-veterans.) And of course TBI and PTSD frequently go together in recent veterans. This isn't to impugn the current veterans' sturdiness level in some manner, but rather to remind us all perhaps of the higher costs of serving. Let's all keep an eye on this issue, and exercise both compassion and interest as it develops over time.

Editor's note: Over the years, we've written quite extensively on suicide on this site, so there's lots of good information if you want to delve into it further -- from personal essays to suicide maps across the U.S. to even what seems to help forestall or prevent suicide. And of course this section also includes some worthwhile wisdom from the acknowledged "father of suicidology," Edwin Shneidman, M.D., whose words are well worth knowing and remembering.

A Nutritional Clue Offers Hope for Military Suicides

It's not often enough that we get to report some good news about suicide and the military -- for months now, the numbers have been climbing in the wrong direction, with few notable exceptions to the trend.

However, just recently, a development from a most unusual quarter shows some true promise for the future. And for those unfamiliar with the effect that nutrition has on brain and emotional health, the results may truly surprise.

Maybe you've never associated C-RATs, MREs, or even meals served in base dining halls, in the U.S. and in the war zone, with impressive nutritional credentials -- but that may be the wave of the future if the military takes steps to improve servicemembers' mental health through a closer attention to nutrition's effect on the brain and the emotions.

A study published in the August 23, 2011 issue of Journal of Clinical Psychiatry online links military suicides to a low level of docosahexaenoic acid (DHA), an Omega-3 essential fatty acid found in fish and flax seed, but which the body doesn't manufacture -- in other words, which needs to be supplemented through diet.

According to the press relase about the study from the Uniformed Services University of the Health Sciences:

"Scientists at the National Institute on Alcohol Abuse and Alcoholism (NIAAA) led by Capt. Joseph R. Hibbeln, M.D., teamed with researchers at the Uniformed Services University of the Health Sciences (USUHS) in Bethesda, Md., to analyze a sample of suicide deaths among U.S. military personnel on active duty between 2002 and 2008. The researchers compared levels of omega-3 fatty acids of 800 individuals who committed suicide with those of 800 randomly selected controls — service members who were matched with the suicide cases by age, sex, and rank. They found that all the service members had low omega-3 levels, and that suicide risk was greatest among individuals with the lowest levels of docosahexaenoic acid (DHA), the major omega-3 fatty acid concentrated in the brain. The new study is reported online in the Journal of Clinical Psychiatry." 

The study, entitled "Suicide Deaths of Active-Duty US Military and Omega-3 Fatty-Acid Status: A Case-Control Comparison," "found that service personnel with higher levels of DHA in their blood were less likely to take their own lives," according to Military.com, continuing "Servicemen whose medical records showed they had low levels of DHA in their blood were 62% more likely to have been suicide victims than those with the highest levels."

The background -- a fish story

An earlier study, from 2004, sets the stage for our understanding:

"Even though the brain is materially an organ like any other, that is to say elaborated from substances present in the diet (sometimes exclusively), for long it was not accepted that food can have an influence on brain structure, and thus on its function. Lipids, and especially omega-3 fatty acids, provided the first coherent experimental demonstration of the effect of diet (nutrients) on the structure and function of the brain."

Quickly, omega-3 fatty acids, in particular DHA from fish oil, swept the nutritional world with promise of their remarkable benefits. According to one expert, quoted in an article called "Omega Medicine," from "Nutrition Action," the newsletter for the Center for Science in the Public Interest, in October, 2007, "it's one of the biggest success stories in decades," with "downsides ... so minimal that the burden of proof for a benefit doesn't have to be that high." 

Familiar television personality and heart doctor Mehmet Oz, M.D., calls Omega-3 one of the five critical nutrients to take, and says that "It's good for your joints, skin, vision, brain, heart, helps lower bad cholesterol levels and even boosts fertility. It's ... good for just about every single part of your body."

With this kind of versatility -- and publicity -- suddenly DHA the superstar food additive started being introduced to many items on grocery store shelves, from bread to milk to cereal. Then there were the nutritional supplements as well (e.g., fish oil capsules) which were sold over-the-counter in health food stores, probably gratifying the generations of mothers who attempted to push daily spoonfuls of cod liver oil on their unsuspecting, and frequently ungrateful children :-). 

But DHA has always been in its most effective form, apparently, when sourced directly from food itself -- primarily fatty fish from cold-water regions -- so Atlantic salmon, mackerel, and sardines are frequently mentioned as particularly good sources. Omega-3s are also found in flax seed, nuts and even certain kinds of algae, but DHA is sourced predominantly from fish and fish oil.

Science takes a closer look

A study published in the Journal of Nutritional Health and Aging in 2004 stated that "dietary omega-3 fatty acids are certainly involved in the prevention of some aspects of cardiovascular disease...and in some neuropsychiatric disorders, particularly depression."

An earlier French study from 2003 on lipids, depression and suicide reports as part of its literature review that "Some epidemiological data support the hypothesis of a relation between lower depression and/or suicide rates and a higher consumption of fish." While focusing on the ratio of fatty acids to one another in the blood, it reported, "In major depression, all studies revealed a significant decrease of the polyunsaturated omega 3 fatty acids ... In addition, two studies found a higher severity of depression when the level of polyunsaturated omega 3 fatty acids or the ratio omega 3/omega 6 was low." 

The findings of the current study, according to one of its authors, "add to an extensive body of research that points to a fundamental role for DHA and other omega-3 fatty acids in protecting against mental health problems and suicide risks." As the press release regarding this study notes:

"Previous studies have associated low levels of omega-3 fats or low dietary intake of seafood, with suicide, thoughts of suicide, and depression. Many, but not all, treatment studies also have reported mental health benefits of supplemental DHA, including reduced anxiety, depression and risk of psychosis."  

The benefits conceivably extend beyond suicide to general emotional wellness. Capt. Joseph R. Hibbeln, M.D., acting chief, Section of Nutritional Neurosciences, NIAAA Laboratory of Membrane Biochemistry and Biophysics remarks,

"... a previous placebo-controlled trial demonstrated that 2 grams of omega-3 fatty acids per day reduced suicidal thinking by 45 percent as well as depression and anxiety scores among individuals with recurrent self-harm. In a prior study we found that low blood levels of DHA correlated with hyperactivity of brain regions in a pattern that closely resembles the pathology of major depression and suicide risk. While omega-3 fatty acids are generally recommended by the American Psychiatric Association as an adjunctive therapy for mood disorders, more research is needed to establish a definitive role for their use in the stand alone treatment of depression."

With suicides up, the military looking for reversible risk factors

Generally speaking, DHA levels seem low in servicemembers, if this study is any indication -- which points to a deficiency of fish in their diet, and little supplementation in the form of fish oil capsules, for instance. From Army Col. (Dr.) Michael D. Lewis, lead author on the study, and assistant professor in the Department of Preventive Medicine and Biometrics at the UHSU:

“We were surprised to find just how low the levels of omega-3 fatty acids were in the entire sample. There still was a significant suicide risk when we stratified the population. When we compared the 1,400 samples with the lowest levels of DHA to the remaining 200, there was a 62 percent increased risk that the samples were from a documented suicide. We need to continue to evaluate these results with a well-designed interventional study, but this represents a potential simple nutritional intervention that warrants further investigation.” 

The takeaway for us from this study is that if supplementing with DHA -- in the form of an increased amount of dietary fish, of the right kind -- improves the situation for depression and suicide -- it sounds like it's a change very worth making. The upside is so large, and the downside so low that truly, what's the risk? (And the rest of the literature on omega-3 fatty acids and DHA suggest so many other phsyiological positives -- from heart health to joint pain -- that it only adds to the attractiveness of this option.)

Again from Capt. Hibbeln:

"The U.S. military invests a great deal of funds and effort to ensure that its troops receive optimal nutrition, especially in combat and deployment situations. This study presents new information on the potential usefulness of omega-3 fats in reducing risk for suicide and optimizing mental health, which can be taken into account when designing U.S. military diets." 

Anything that improves the situation with mental health and combats suicide -- even if it makes only a fraction of a difference -- seems to be worth doing. Let's hope the military tests this as an intervention to see how well it works, and ends up making a "dietary difference" in the ongoing fight against suicide.

Quotable Quotes -- Dietrich Bonhoeffer on Suffering and Sorrow

Dietrich Bonhoeffer was a Christian theologian, author and martyr, who was executed in a German concentration camp during the Second World War. Among his powerful writings are these two short sentences about suffering and empathy/compassion in action:

"Some of us suffer a great deal from having our senses dulled in the face of all the sorrows which these war years have brought with them."

- and -

"It seems to me more important actually to share someone's distress than to use smooth words about it." -- Dietrich Bonhoeffer.

Karl Menninger, M.D. on PTSD (Combat Stress) in WWII Veterans

We've briefly quoted Karl Menninger, M.D., before, here. But in scouring a book he wrote almost 50 years ago, we came across this extensive retelling of what he observed with World War II veterans and combat stress -- what we know today as PTSD.

It's interesting to read because there is both not much material readily available before the Vietnam War brought post-traumatic stress disorder into the common awareness, and also because the phenomenon of PTSD does seem to slightly "mutate" over time, perhaps because of the difference in the types of combat with each significant war. Menninger, a world-famous psychiatrist, brings up many important points in this passage -- and we wonder how many of them would still be considered true today.

(The context for the original work that he's citing here was performed when he was a member of a commision to study combat exhaustion in World War II veterans, appointed by the Surgeon General and his brother, Brigadier-General William C. Menninger.)

“In our studies of reactions to combat stress in World War II previously referred to, we were very much impressed with the way in which a set of forces began a phase of great stress and simultaneously aroused certain opposing forces which helped to maintain a balance. Then came more stress and more defense. Gradually the stresses seemed to become greater than the defenses, so that there occurred a lowering of achievement level, a partial retreat, the employment of emergency regulatory devices, evidences of threatened disorganization, and then, usually a recourse to medical aid.

With sedation and a few hours of rest many of these individuals were able to resume their former efficiency and return to the battle. Heroic and admirable as it was, this was not too difficult to explain. But other individuals had the same treatment and were not able to return to the front lines. Their symptoms persisted. This too we could understand. More time was required, more rest, more recuperation, further removal from the imminence of renewed combat stress.

But now comes the enigma. Many of these patients were sent back to the base hospital for care, nursing, protection, rest, and treatment. We saw some of them there, later. Many had improved or were improving; some had returned to duty (but usually not to combat duty). What impressed us most was that some of them were not better; they were under treatment of sorts, but they were worse. There was, for them, no more battle stress, no more physical exertion and prevail, no more threat of death. There was not even any considerable probability of further duty assignment. Bright, or at least safe and comfortable, situations lay ahead for them. Why did not the symptoms disappear?

In analyzing the nature of the stress they had undergone, we began to realize this was different from what would appear on the surface. In the beginning these men had experienced fear, fatigue, resentment, hunger, cold, and other things. But they were sustained, there, by many things, too: self-respect, pride-idealism, courage, devotion to duty, training, and habituation to routine. Moreover, there was a strong support from relations with comrades and officers and units. The sudden increment of stress which precipitated these symptoms was frequently the loss of one of these human supports by death or transfer. In other instances cumulative fatigue seemed to be the most important factor.

For these men, then, who did not respond to battalion aid-station treatment, the nature of the stress had changed; but it did not diminish quantitatively as the casual observer might have assumed. The threat of danger was gone, true, but so were the excitement and the routine activity. The weariness was gone, true, but so was the companionship of fellow soldiers. The unpleasant physical conditions were corrected, but in their place was the guilt feeling of abandoning one’s comrades and the fear of accusation of cowardice. Painfully disturbing was the dilemma that if one mastered his distress he would be sent back to duty, but if one admitted it he would be retired. A retirement could be cleared of all tincture of suspected cowardice only if it took the form of something called sickness. Efficient warfare and humane medical science are antithetical and sooner or later the antithesis shows up in the individual.”

-- Karl Menninger, M.D., “The Vital Balance: The Life Process in Mental Health and Illness.” New York: The Viking Press (1963).

Editor's note: The photo illustrates Polish soldiers involved in the Warsaw Uprising.

A Remarkable Quote from General Dwight D. Eisenhower about Who PTSD Affects

"You mustn't think of these people as just some sort of unfortunates . . . They are not — they are one of you. I saw a major general, one of the finest athletes of his time, definitely break — break because he could no longer sustain the agonies of combat. He could not talk to me without shaking, and he had to go home. This cannot be dismissed as not touching you personally." -- General Dwight D. "Ike" Eisenhower, U.S. president and five-star Army general.

Quotable Quotes -- Karl Menninger on Hope and Suicide

"Hope is the major weapon against the suicide impulse." -- Karl Menninger, M.D., psychiatrist.

For what it's worth, even though we've been posting a number of quotes lately, intending to provoke deeper thought and reflection, there's also an enormous archive (~1,000 articles) on this site, on topics such as suicide and the Tao of healing. Enjoy.

Quotable Quotes -- Eckhart Tolle on the Benefits of Suffering

"Is suffering really necessary? Yes and no. If you had not suffered as you have, there would be no depth to you, no humility, no compassion." -- Eckhart Tolle, author of "The Power of Now."

Quotable Quotes -- Elisabeth Kübler-Ross on Struggle Perfecting People

Swiss-born physician Elisabeth Kübler-Ross, famous for her seminal work on the emotional progression associated with dying, also had something wonderful to say about the benefit of hardship for improving who we are.

She wrote:

"The most beautiful people we have known are those who have known defeat, known suffering, known struggle, known loss, and have found their way out of the depths. These persons have an appreciation, sensitivity, and an understanding of life that fills them with compassion, gentleness, and a deep loving concern. Beautiful people do not just happen." -- Elisabeth Kübler-Ross, M.D., author of "On Death and Dying."

The House of Four Rooms: How Are Yours Doing?

I first learned about this concept from a fairly philosophical Marine officer who was serving in Ramadi in '05, while he was there. He shared the concept with me, and it's a great one -- one I need to return to more frequently for that all-important and oh-so-easy-to-lose balance in life.

The quote:

"There is an Indian belief that everyone is a house of four rooms: a physical, a mental, an emotional and a spiritual room. Most of us tend to live in one room most of the time, but unless we go into every room every day, even if only to keep it aired, we are not complete." -- Rumer Godden, "House of Four Rooms."

Freeing Yourself from the Pain in Your Soul: Writing and Trauma

Everyone who writes, it's safe to say, has different reasons for writing. "Every writer primarily writes for the back of his own head," says British author Jonathan Raban. But when it comes to trauma, one of the key reasons people write -- or more informally, journal -- is to attempt to make sense of their own experience, and process successfully what's happened to them. I thought about that this morning, when I read this passage in a book: 

"One author said, 'I can get rid of anything by writing about it,' meaning that the process of externalization could liberate him from the pain in his soul. That realization produced a delicious dichotomy: to free himself, or to hold on to both joys and tortures by remaining silent about them."

That last line is particularly striking: is the choice really between freeing yourself -- by expressing what you've been through, even to yourself -- or holding on to a potentially richer experience, by not sharing what you've been through with anyone? Seems like a difficult choice to have to make. What of it?

Quotable Quotes -- Joseph Campbell on Joy Overcoming Pain

"Find a place (inside) where there's joy, and the joy will burn out the pain." -- Joseph Campbell

Quotable Quotes -- Victor Frankl on Pushing Through the Pain

"What is to give light must endure burning." -- Victor Frankl, concentration camp survivor, psychotherapist, and author of "Man's Search for Meaning."

 

Quotable Quotes: Steven Pressfield and Lao Tzu on Love and Courage

Two interesting quotes, that share a certain amount of symmetry across the centuries:

‎"Courage is inseparable from love and leads to what may arguably be the noblest of all warrior virtues: selflessness." -- Steven Pressfield from "The Warrior Ethos"

-and-

"Being deeply loved by someone gives you strength, while loving someone deeply gives you courage." -- Lao Tzu

May you have your fill of both love and courage...

Quotable Quotes -- Bruno Bettelheim on Wounds Need to be Talked about

"What cannot be talked about cannot be put to rest. And if it is not, the wounds will fester from generation to generation." -- Bruno Bettelheim, from "Surviving and Other Essays." (Bettelheim was a renowned child psychiatrist and concentrate camp survivor who later committed suicide as an elderly man.)

Quotable Quotes -- Carl Rogers on How the Patient Knows Where the Pain Is

"The client knows what hurts, what directions to go, what problems are crucial and what experiences have been buried." -- Carl Rogers, American psychologist, founder of client-centered therapy.

Celebrate with Us: Healing Combat Trauma Turns Five Years Old

"HHappy birthday to us:

We're an amazing five (5) years old today! Almost 1,000 entries about veterans, PTSD and the possibility of recovery. Over 200 recommended books and experts. And a lovely three-minute film, documenting one veteran's healing journey. 

Along the way we've gotten some great training, involved some wonderful practitioners, and touched some veterans and their families' lives with an improved quality of life. We've also built a thriving community on Facebook, gotten some awards and accolades, created some merchandise about how "healing happens," and published an awful lot of good material (much of it by other contributors) about what possibilities there are for getting better, not giving up.

To give you a sense of what was going on five years ago when this started, here is what we wrote in that very first post, on February 23, 2006:

"Welcome. No time like the present to begin a blog dedicated to the resources for healing combat trauma. This blog is intentionally apolitical. War happens. Veterans deal with the aftermath of going. Let's make sure they get the resources, help and support they need. And let's get started on that...yesterday.

Just to be clear, this blog's focus is: Resources for and about healing combat trauma. The focus is on effective medical and psychological care, and the slant is apolitical."

Well -- some things stayed the same over the last five years. The intention, for one, which continues to be huge -- that veterans find some healing that they're unlikely to find through conventional means. 

At the time we started this, it was the very first website devoted to PTSD and veterans on the Web. Truth. We searched and searched, and there was literally nothing out there -- though there were some good books from the past on it, and some experts here and there with their valuable guidance. But nothing on the Web, and veterans and their families would soon be desperate for any constructive help getting healed.

With that as a landscape, we started this. The name itself was carefully chosen to reflect the most core concept, that healing was possible -- and that healing from the trauma of combat was possible. We intentionally did not use the "PTSD" moniker in the title, preferring instead the three most important words we could envision to represent the problem and its solution, other than the veterans themselves.

After a while, other sites sprang up, covering different aspects of the problem -- most often simply rehashing the news or telling personal stories of their own war experience (both have value). Now, there are dozens of sites devoted to PTSD and veterans, of varying quality. The goal here has always been to be original, to provide resources veterans and their loved ones need to make decisions about how to recover, and to keep reminding readers about the importance of hope, without which it's very difficult to heal.

Over time, we were able to drop covering aspects of the issue (such as the legal and medical) because those were being covered capably elsewhere (not so in the beginning, when the landscape on this topic on the Web was quite barren). Today, we focus mainly on one aspect of the topic: how integrative medicine (the so-called "best of East and West") can help a veteran recover; and of course we keep talking about hope, because even the Bible says, "without vision (hope) the people perish." If you don't believe you can get better, it's very difficult to put one foot in front of the other to walk that path.

We also take pains to not endorse any one type of treatment over another, and we stay away from the hype -- preferring to research the validity of claims being made. That's been our practice and it will always be our practice. We also don't find it necessary to rehash what the mainstream approach is, because that can be found very easily through official channels. The VA itself, for instance, has an enormous PR budget, which it can use to tell you what a great job it's already doing (and in many cases, it is.) But you're less likely to find out about other options unless you come to a site like this, which contemplates many different choices, tries to focus on the ones which have potential for good and not harm, and isn't selling or promoting any of them, despite how many requests we get almost daily to do the same. 

Over the last five  years, the website has transitioned from being "just" an -- by now, enormous -- informational resource, to becoming an actual program, where veterans access opportunities for healing, delivered by qualified practitioners. We need your help making this dream a reality, so as always we appreciate your donations.

The short film, referenced here, shows how healing became a reality for one combat-hardened veteran with decades of severe, chronic PTSD. With over 18 suicides a day by veterans, and one every 36 hours by an active duty servicemember, it's clear to see that the "problem" won't be going away anytime soon.

And while the conventional system relies on the old, gold standards of talk therapy and pharmaceuticals, the need to continue to look for other solutions outside the box continues. That's what we're about here, and we appreciate your devoted interest over the last five years. We want you to help us make our dream a reality -- that any veteran who wants healing from PTSD can find it. Thank you.

The Heart-Ship of Loving Veterans with PTSD

Valentine's Day -- and coming up next week, five years of writing this site -- are making me think about holding the space of loving veterans with PTSD in my heart, and the "heart-ship" sometimes of doing so.

I was warned early on about this, by none other than Kathie Costos, who I esteem highly to this day. A few years into it, she wrote me in response to some problem I was bringing up, "I told you in the beginning when we first started corresponding that they would break your heart while you did this thankless job but the rewards would be worth millions for your heart. I told you they were magnificent! I am so happy they are starting to tell you how much you mean to them. That's really wonderful and even more important they are opening up. That is a big compliment to your work. They have a hard time opening up to anyone."

Well, open up they have...especially in a forum linked to this, which is the Healing Combat Trauma site on Facebook, and all the different relationships that have come out of that. 

Mark Twain once said (in 1907) something that's relevant to us here: "Praise is well, compliment is well, but affection--that is the last and final and most precious reward that any (wo)man can win, whether by character or achievement."

Twain is (was?) right, of course, and in addition to the "symbols" of veterans' affection, I have to say that it's their trust that means the most to me. Young or old, recent or quite a while since they've seen combat, it means the most how much trust they seem to put in me. I have no idea why, but I'm thankful for it. A common refrain is that they've told me things that no one else knows about them; that they wouldn't even think about telling their closest friend. Why is a mystery to me; but I'm thankful for the trust they put in me, I guess, and I do what I can to honor that and preserve it.

In the past five years I've learned a lot -- seen a lot -- been exposed to a lot, and in some ways I feel like I'm still scratching the surface of what there is to be learned. Not about what helps veterans -- that's almost simple by comparison to find out. And it does very much start with listening and caring, though perhaps not in that order. The largest lesson seems to be how no one came back from war unchanged; and the variations in how combat affected them are as different as individuals. But the underlying expectation to start with is that nothing is the same as it was before; and that very many veterans long for...and need help getting to...how they were before, an "earlier" version of them that seems to have all but vanished.

While I appreciate the conversations I've had with Vietnam-era veterans whose humility, vulnerability, and long-suffering are to be commended (may they get the help they need and deserve!), I also hear the same sentiment from younger veterans. From an Iraq veteran, Marine, just the other day: "What wouldn't we give to feel 'alive' again?" The disconnect with their former selves is real; and frankly, psychotherapy and medication isn't doing enough to return them to the selves they've lost. If that's the gold standard for care these days, and it is, things need to be added to it to flesh out the whole picture, so that care is broader, deeper, richer and more satisfying (and effective) to the veterans. I would also argue that there's things other therapies can do for veterans with PTSD that perhaps even lessen the need for talk therapy and medication. Not eliminate it, but lessen the need for it; or work hand-in-hand with it for a more effective combination of solutions.

Young veteran or old, male or female, short time or long time -- these are some amazing people -- very deserving of our love and respect -- and creativity in finding solutions to help them on their path back to wholeness. Five years into this, MUCH more needs to be done. And not enough is being done, because too many veterans are feeling not themselves, to this day, after combat and its aftermath.

Editor's note: For more on Kathie Costos and her wise words about veterans and their families, one sample here, with links to others.

Quotable Quotes -- Pearl Bailey on Facing the Truth

Self-awareness in healing turns out to be key; it's a little difficult to hit a moving target otherwise. While practitioners, particularly those with an Eastern orientation, might espouse the saying that "when the student is ready, the teacher will appear" -- healing also takes a willingness to look at your life squarely and realize what about it isn't working. That turns out to be the first and most necessary step along the path to wellness.

Another way of saying that is:

"You never find yourself until you face the truth." -- Pearl Bailey, American actress and singer.

Steven Pressfield on the Passive-Aggressive Nature of Being a Victim

Periodically we raise the specter here that there's little to be gained, in the long run, by overly identifying with the victim role -- and in hinting so, it never fails to offend someone. Well, it's been six months since the last time we mentioned it so it must be time to bring it up again. (You can tell it's not a main point if so much time has elapsed since the last time.)

And it's not at all to imply that all, or even most, or even a significant some of those who suffer do so because it's in their (often unconscious) best interests to do so. Yet we've all met -- and sometimes even been -- those who are seemingly unable to get well/happy/better, even when it would obviously be a better choice to do so.

So it's worth raising the question as to WHY we don't, and whether there is some pay-off in staying ill. (Even if you disagree with this point in general, consider the portion of it you do realize is within your control -- the temperature, as it were, you can raise or lower at will.)

Ironically, reading a book on creativity the other day by Steven Pressfield -- an author who's apparently also been a Marine -- this passage about the payoff from staying a victim popped out. His focus in the book is on the battle between creativity (good) and resistance (bad), and how the mind plays tricks on us, especially when we want to accomplish something great, to keep us in a rut. What Pressfield has to say about our ability to manufacture illness in service of "resistance" is blunt, and while most of it may not apply to PTSD, there's a great likelihood that some of it will.

Combat veterans most definitely don't give themselves PTSD...but PTSD can still be a very useful "mask" to wear or barrier to position between the self and others. Combat veterans themselves will tell you that. Here's Steven Pressfield on the dangers of victimhood. The material on passive-aggression seemed particularly relevant:

“Doctors estimate that seventy to eighty percent of their business is non-health-related. People aren’t sick, they’re self-dramatizing…

The acquisition of a condition lends significance to one’s existence. An illness, a cross to bear…Some people go from condition to condition; they cure one, and another pops up to take its place. The condition becomes a work of art in itself, a shadow version of the real creative act the victim is avoiding by expending so much care cultivating his condition.

A victim act is a form of passive aggression. It seeks to achieve gratification not by honest work or a contribution made out of one’s experience or insight or love, but by the manipulation of others through silent (and not-so-silent) threat. The victim compels others to come to his rescue or to behave as he wishes by holding them hostage to the prospect of his own further illness/meltdown/mental dissolution, or simply by threatening to make their lives so miserable that they do what he wants.

Casting yourself as a victim is the antithesis of doing your work. Don’t do it. And if you’re doing it, stop." -- "The War of Art: Break Through the Blocks and Win Your Inner Creative Battles," by Steven Pressfield.

Quotable Quotes -- A 5th Century Mercenary on the Warrior's Life

"It is one thing to study war and another to live the warrior's life." -- Telamon of Arcadia, mercenary of the fifth century B.C.

If you want to have a clearer picture of what it takes to live the warrior life -- and the ongoing attempt to integrate and embody those experiences into one's current life -- be sure to watch the remarkable documentary starring Rudy Reyes which we wrote about recently, here. The documentary, by In Their Boots, is entitled, "The Way of the Warrior."

I think of all the warriors I have known, and they're all still integrating what they've learned and been into who they are right now. It isn't easy, and it never stops. But healing does and can happen.

"Healing Happens" -- Support Our Work at Healing Combat Trauma

Are you a combat veteran with PTSD, a family member, caregiver, or healthcare provider who believes -- as we do -- that "healing happens"?! Then purchase some beautiful gear at CafePress that shows the world you believe in healing.

We've got T-shirts, hoodies, coffee mugs, even a baby bib and an awesome-looking messenger bag that all share the same message of healing and hope. A portion of the proceeds from the sale goes to benefit our work. We hope you'll take a look, at our Healing Combat Trauma store on CafePress, linked here.

And thank you in advance for your support of our work.

Drug-Free Breathing and Relaxation Study for Veterans with PTSD

Here's a study that may be of interest to veterans with PTSD who are in the Bay Area (San Francisco). Biofeedback is a useful technique in the stress-management toolkit. It's hard to say whether it will really help with PTSD but learning it will help with stress levels in general; and there are other ways to learn it/practice it even if you can't be part of the study. More on that separately.

From the study description:

Have you experienced a traumatic event? Do you experience:

• Recurrent dreams or memories of the event?
• Avoidance of people, places, or things that remind you of the event?
• Hypervigilance or are easily startled?
• Difficulty falling or staying asleep?

If you have any of these or similar symptoms, you may be suffering from Post Traumatic Stress Disorder (PTSD).

You may be eligible to participate in a drug-free Breathing and Relaxation Therapy study using a biofeedback device at no cost.

The study is conducted by researchers at Stanford University and the VA Health Care System, Palo Alto. Services provided to participants include free psychiatric and physiological evaluation. Financial compensation also provided. To participate in the study you must be between ages 18-65

For general information about participant rights, contact 1-866-680-2906

For further information, please contact (650) 493-5000 ext 69995 or [email protected].

Eddie's Place on Facebook Chronicles the Story of an American Hero with PTSD

If you've been following our "An American Veteran" series the past year on this site about Eddie Livingston -- the World War II veteran and POW who wrote powerfully and simply about the trials of being a veteran with untreated PTSD -- we've set up a "page" for him on Facebook where you can learn more about him and read some of his writings. The page is called "Eddie's Place," and you can click here for that link.

A little bit more about who Eddie is:

A sharecropper's son from Alabama, Eddie enlisted in Army at 15 years old. He joined the 82nd Airborne and volunteered to be part of the "Pathfinders," a small group who parachuted into Normandy ahead of the Allied invasion. He was later captured, and spent a year as a prisoner of war (POW). Eddie fought in five campaigns in Salerno, Sicily, Cassino, Anzio and Normandy, and was a POW at the infamous Belsen-Buchenwald. He received seven purple hearts, three bronze stars with combat "V" for valor, two presidential unit citations, and was awarded, but never received, the distinguished service cross for his valor at Normandy.

There's a movie about the Pathfinders, in which Michael Connor Humphries, himself an Army vet, who played the young Forrest Gump in the movie of the same name, plays the part of Eddie. The movie, "In the Company of Strangers," has just been released overseas. You can watch it via download on the Web, here, or learn more about its production in links on "Eddie's Place" on Facebook.

Despite Eddie's valiant service, he spent most of the last three decades of his life living in abject squalor in Alabama, in a broken-down home without running water or electricity. The letters that he typed to everyone who would listen -- Life magazine, U.S. presidents Kennedy and Johnson, Ann Landers, newspaper editors and of course the VA -- are a powerful testament by a simple, humble man about the pains and perils of being a veteran with untreated PTSD, and so much more. A few sample quotes from Eddie:

"People tell me to forget the war, telling me it is over. Their advice is sound and well-intentioned but impossible to follow. Simply because my mind is not a faucet that I can turn on and off and at will. I am working on it."

and

"Although the war is long over, the experiences of war especially that P.O.W. (experience) still bother me very much at times. I have periods of nervousness and fear in which I am frightened and suspicious of almost everyone."

and

"After four years, seven wounds, a year as a P.O.W., World War II ended for me. I did the best I could, and no man should feel ashamed of his best. I have always known that war is our ultimate failure. But war is an addictive thing. I became addicted, and now I am addicted to agitation. I have no way of knowing how crazy I am. I doubt if the psychiatrist would (even) know. I made the fatal mistake of staying in combat too long. I had no choice; I had to stay. What we know does hurt us. It is what I know that has made me the way I am."

For more about this unsung American hero, read the "An American Veteran" series here, and follow him on the "Eddie's Place" page on Facebook, linked here.

Quotable Quotes -- Chief Dan George on the Necessity of Love

It's not always easy to love a combat veteran with PTSD. Heck, it's not even easy to BE a combat veteran with PTSD and manage to love yourself, or those around you the way that you want to.

But part of healing is getting back in touch with how important love is, and even respecting its own form of therapeutic, healing power. Listen to these words from a very wise sage about just how important love is, in the natural order of things:

"Love is something you and I must have. We must have it because our spirit feeds upon it. We must have it because without it we become weak and faint. Without love our self-esteem weakens. Without it our courage fails. Without love we can no longer look out confidently at the world." -- Chief Dan George, Canadian First Nations chief, poet, author and Academy Award-winning actor.

Martin Luther King Jr Had a Dream for Combat Veterans, Too

Martin Luther King Jr., from a speech delivered exactly one year before he was assassinated in Memphis, Tenn.:

"This business of burning human beings with napalm, of filling our nation's homes with orphans and widows, of injecting poisonous drugs of hate into veins of peoples normally humane, of sending men home from dark and bloody battlefields physically handicapped and psychologically deranged, cannot be reconciled with wisdom, justice and love." -- Martin Luther King Jr, speech at Riverside Church in New York City, April 4, 1967. 

Editor's note: A link to the online text and audio of his full speech is here.

Quotable Quotes -- Vulnerability, Trust and the Breakthrough

“We're never so vulnerable than when we trust someone - but paradoxically, if we cannot trust, neither can we find love or joy." -- Walter Anderson

Quotable Quotes -- Helen Keller on Suffering Refining Character

It's not easy to find any true benefit to suffering, but occasionally, a wise person offers some. Here's what Helen Keller -- someone who surely endured much of what the rest of us would consider suffering -- had to say:

"Character cannot be developed in ease and quiet. Only through experience of trial and suffering can the soul be strengthened, ambition inspired, and success achieved." -- Helen Keller.

Marine Recon Rudy Reyes in "The Way of the Warrior" Documentary from "In Their Boots"

The documentary series "In Their Boots" does a great job at showcasing important aspects of the servicemember, veteran, and family member experience in short films on subjects as varied as the participants themselves. Every single one of the episodes is worth watching and taken together, they represent an entire educational arc about the OIF/OEF veteran experience. Periodically we highlight one of the documentary series' new episodes here.

Rudy Reyes, former Marine recon sniper, star of "Generation Kill," and author of "Hero Living" is the star of the recent "In Their Boots" episode entitled: "The Way of the Warrior." The charismatic and exceptionally authentic Reyes carries the entire show himself, making crystal clear the conflicts within and without that the warrior faces. Reyes, not unlike many other veterans, has been fighting serious battles on and off his entire life. The way of the warrior has always appealed to him; and he speaks with powerful candor about the costs, as well as the camaraderie, this life has brought him.

Confucius wrote, "He who conquers himself is the mightiest warrior." Rudy Reyes is on that path. His level of honesty is not typical, is not ordinary, and does not come without a very high price; but you honor it with your attention. So many other warriors cannot be this clear or this forthright about articulating their inner struggles. While we give warriors points for subduing others in combat, those who watch this territory know the hardest battles are fought and won within. Rudy Reyes continually finds, and challenges, this personal edge. In this way, he truly embodies "the way of the warrior."

Editor's note: The link to the film is below. The photo pictured below is not Rudy Reyes.

Quotable Quotes -- Smedley Butler, Maverick Marine, on the True Costs of War to Veterans and Their Families

USMC Major General Smedley Butler wrote a remarkable and well-known piece of work called "War is a Racket," originally delivered as a stinging speech. In it, he takes the war profiteers of World War I and beyond to task for forgetting who it is who fights the battle, and who bears the ultimate price of war. His words are, of course, as relevant today as they ever were. In fact, it's intriguing to read his words and quiz ourselves how alike -- or different -- are conditions today.

So many people want to say, "Oh, we're just finding out about PTSD, that's why the system lags behind in treating vets." But in fact, this is not the case at all. The phenomenon of combat-wounded bodies, minds and spirits has been around as long as there's been war, irrespective of what name we've used to describe the malady. "Shell shock"? "Soldier's Heart"? "Post-Traumatic Stress"? Ultimately, it's all the same thing. And documentaries from "Hidden Wounds" and "The Soldier's Heart" back in 2006, which I wrote about here almost five years ago now, to HBO's recent "Wartorn" all make this point quite eloquently.

But back to Smedley Butler, a two-time Medal of Honor winner who served more than 33 years on active duty in the Marine Corps. Here's a sampling of his direct comments on what happens to the wounded and their families, and we quote it at length because there's just so much material here to really chew over and decide how "new" the struggles we're facing really are, re-integrating veterans after combat. His words:

"But the soldier pays the biggest part of the bill.

If you don't believe this, visit the American cemeteries on the battlefields abroad. Or visit any of the veteran's hospitals in the United States. On a tour of the country, in the midst of which I am at the time of this writing, I have visited eighteen government hospitals for veterans. In them are a total of about 50,000 destroyed men -- men who were the pick of the nation eighteen years ago. The very able chief surgeon at the government hospital; at Milwaukee, where there are 3,800 of the living dead, told me that mortality among veterans is three times as great as among those who stayed at home.

Boys with a normal viewpoint were taken out of the fields and offices and factories and classrooms and put into the ranks. There they were remolded; they were made over; they were made to "about face"; to regard murder as the order of the day. They were put shoulder to shoulder and, through mass psychology, they were entirely changed. We used them for a couple of years and trained them to think nothing at all of killing or of being killed.

Then, suddenly, we discharged them and told them to make another "about face" ! This time they had to do their own readjustment, sans [without] mass psychology, sans officers' aid and advice and sans nation-wide propaganda. We didn't need them any more. So we scattered them about without any "three-minute" or "Liberty Loan" speeches or parades. Many, too many, of these fine young boys are eventually destroyed, mentally, because they could not make that final "about face" alone.

In the government hospital in Marion, Indiana, 1,800 of these boys are in pens! Five hundred of them in a barracks with steel bars and wires all around outside the buildings and on the porches. These already have been mentally destroyed. These boys don't even look like human beings. Oh, the looks on their faces! Physically, they are in good shape; mentally, they are gone.

There are thousands and thousands of these cases, and more and more are coming in all the time. The tremendous excitement of the war, the sudden cutting off of that excitement -- the young boys couldn't stand it.

That's a part of the bill. So much for the dead -- they have paid their part of the war profits. So much for the mentally and physically wounded -- they are paying now their share of the war profits. But the others paid, too -- they paid with heartbreaks when they tore themselves away from their firesides and their families to don the uniform of Uncle Sam -- on which a profit had been made. They paid another part in the training camps where they were regimented and drilled while others took their jobs and their places in the lives of their communities. The paid for it in the trenches where they shot and were shot; where they were hungry for days at a time; where they slept in the mud and the cold and in the rain -- with the moans and shrieks of the dying for a horrible lullaby.

But don't forget -- the soldier paid part of the dollars and cents bill too.

Up to and including the Spanish-American War, we had a prize system, and soldiers and sailors fought for money. During the Civil War they were paid bonuses, in many instances, before they went into service. The government, or states, paid as high as $1,200 for an enlistment. In the Spanish-American War they gave prize money. When we captured any vessels, the soldiers all got their share -- at least, they were supposed to. Then it was found that we could reduce the cost of wars by taking all the prize money and keeping it, but conscripting [drafting] the soldier anyway. Then soldiers couldn't bargain for their labor, Everyone else could bargain, but the soldier couldn't.

Napoleon once said,

"All men are enamored of decorations . . . they positively hunger for them."

So by developing the Napoleonic system -- the medal business -- the government learned it could get soldiers for less money, because the boys liked to be decorated. Until the Civil War there were no medals. Then the Congressional Medal of Honor was handed out. It made enlistments easier. After the Civil War no new medals were issued until the Spanish-American War.

In the World War, we used propaganda to make the boys accept conscription. They were made to feel ashamed if they didn't join the army.

So vicious was this war propaganda that even God was brought into it. With few exceptions our clergymen joined in the clamor to kill, kill, kill. To kill the Germans. God is on our side . . . it is His will that the Germans be killed.

And in Germany, the good pastors called upon the Germans to kill the allies . . . to please the same God. That was a part of the general propaganda, built up to make people war conscious and murder conscious.

Beautiful ideals were painted for our boys who were sent out to die. This was the "war to end all wars." This was the "war to make the world safe for democracy." No one mentioned to them, as they marched away, that their going and their dying would mean huge war profits. No one told these American soldiers that they might be shot down by bullets made by their own brothers here. No one told them that the ships on which they were going to cross might be torpedoed by submarines built with United States patents. They were just told it was to be a "glorious adventure."

Thus, having stuffed patriotism down their throats, it was decided to make them help pay for the war, too. So, we gave them the large salary of $30 a month.

All they had to do for this munificent sum was to leave their dear ones behind, give up their jobs, lie in swampy trenches, eat canned willy (when they could get it) and kill and kill and kill . . . and be killed.

But wait!

Half of that wage (just a little more than a riveter in a shipyard or a laborer in a munitions factory safe at home made in a day) was promptly taken from him to support his dependents, so that they would not become a charge upon his community. Then we made him pay what amounted to accident insurance -- something the employer pays for in an enlightened state -- and that cost him $6 a month. He had less than $9 a month left.

Then, the most crowning insolence of all -- he was virtually blackjacked into paying for his own ammunition, clothing, and food by being made to buy Liberty Bonds. Most soldiers got no money at all on pay days.

We made them buy Liberty Bonds at $100 and then we bought them back -- when they came back from the war and couldn't find work -- at $84 and $86. And the soldiers bought about $2,000,000,000 worth of these bonds!

Yes, the soldier pays the greater part of the bill. His family pays too. They pay it in the same heart-break that he does. As he suffers, they suffer. At nights, as he lay in the trenches and watched shrapnel burst about him, they lay home in their beds and tossed sleeplessly -- his father, his mother, his wife, his sisters, his brothers, his sons, and his daughters.

When he returned home minus an eye, or minus a leg or with his mind broken, they suffered too -- as much as and even sometimes more than he. Yes, and they, too, contributed their dollars to the profits of the munitions makers and bankers and shipbuilders and the manufacturers and the speculators made. They, too, bought Liberty Bonds and contributed to the profit of the bankers after the Armistice in the hocus-pocus of manipulated Liberty Bond prices.

And even now the families of the wounded men and of the mentally broken and those who never were able to readjust themselves are still suffering and still paying."

-- Smedley Butler, "War is a Racket." (1935).

Editor's note: You can read "War is a Racket" in full at several places on the Web. It's well worth reading. And, if you'd rather hear key parts of it delivered as a speech, which was its original form, check out this link from YouTube.

Quotable Quotes -- Epictetus on Living in the Present Moment

"Caretake this moment. Immerse yourself in its particulars. Respond to this person, this challenge, this deed. Quit evasions. Stop giving yourself needless trouble. It is time to really live; to fully inhabit the situation you happen to be in now." -- Epictetus, Stoic philosopher.

Quotable Quotes -- Ralph Waldo Emerson on a Positive Daily Mindset

Good advice for today and following: "Write it on your heart that every day is the best day in the year." -- Ralph Waldo Emerson

Ralph Waldo Emerson on Life, Death, Loss -- and the Compensations of Calamity

For everyone who's lost anyone -- and for veterans, that means their brothers and sisters in combat; for family members, their veteran -- there's obviously nothing good to be said about the tragic loss. But reading American luminary Ralph Waldo Emerson over the New Year's weekend, from an essay called "Compensation," we see him point to some positive things that loss brings forth. Not anything that lessens the original loss; but growth of a new kind, made possible because of that very loss.

Because it's almost impossible to find something good to say about something otherwise completely bad -- and because loss (and blame) tend to hang around for years, even decades longer than they "should" -- it seemed important to reprint Emerson's words here, in case they comfort any.

"We cannot part with our friends. We cannot let our angels go. We do not see that they only go out that archangels may come in. We are idolators of the old. We do not believe in the riches of the soul, in its proper eternity and omnipresence. We do not believe there is any force in to-day to rival or re-create that beautiful yesterday. We linger in the ruins of the old tent where once we had bread and shelter and organs, nor believe that the spirit can feed, cover, and nerve us again. We cannot again find aught so dear, so sweet, so graceful. But we sit and weep in vain. The voice of the Almighty saith, “Up and onward forevermore!” We cannot stay amid the ruins. Neither will we rely on the New; and so we walk ever with reverted eyes, like those monsters, who look backwards.

And yet the compensations of calamity are made apparent to the understanding also, after long intervals of time. A fever, a mutilation, a cruel disappointment, a loss of wealth, a loss of friends, seems at the moment unpaid loss, and unpayable. But the sure years reveal the deep remedial force that underlies all facts. The death of a dear friend, wife, brother, lover, which seemed nothing but privation, somewhat later assumes the aspect of a guide or genius; for it commonly operates revolutions in our way of life, terminates an epoch of infancy or of youth which was waiting to be closed, breaks up a wonted occupation, or a household, or style of living, and allows the formation of new ones more friendly to the growth of character. It permits or constrains the formation of new acquaintances and the reception of new influences that prove of the first importance to the next years; and the man or woman who would have remained a sunny garden-flower, with no room for its roots and too much sunshine for its head, by the falling of the walls and the neglect of the gardener is made the banian of the forest, yielding shade and fruit to wide neighborhoods of men."

-- Ralph Waldo Emerson, from an essay called "Compensation," published in 1841.

Quotable Quotes -- Ralph Waldo Emerson on the Patience of Nature

"Adopt the pace of nature: her secret is patience." -- Ralph Waldo Emerson.