Healing Combat Trauma

One Author (and Former Marine's) Attempt to Make "Darkness Visible"

I read the classic Darkness Visible: A Memoir of Madness, by William Styron, the other night.  It's a quick but melancholy read and takes about an hour. (What I didn't realize at the time -- and it's completely tangential to his story, which is really about a four year bout the well-known author had with clinical depression, and the closeness he felt to suicide -- is that Styron was a former Marine.)  Styron died of pneumonia in 2006, at 81 years old.

In an obituary printed about Styron on Martha's Vineyard where he had a home, the following information about his military service is revealed:

Following high school [Styron] joined the reserve officer training program for the United States Marine Corps, and enrolled at Davidson College. He was unhappy there and through the Marines transferred to Duke University in June of 1943. In October of 1944 he was called to active duty and in late July 1945 was commissioned a second lieutenant. He was assigned to participate in the invasion of Japan; a month later the atomic bomb attacks forced the surrender of Japan and he was discharged. ... In 1955 he published The Long March, originally a novella about his experiences in the U.S. Marine Corps.

The same obituary also makes clear the trajectory that led to Styron's depression, and the resultant book that introduced this highly personal experience of the author's to the American public:

[Styron] drank heavily and smoked cigars until the summer of his 60th birthday in 1985, when he decided that alcohol no longer agreed with him and gave it up. But the abstinence triggered mood disorders which required medication, and the drugs in turn brought on a deep, enduring and suicidal depression that required him to be hospitalized for more than two months. The experience prompted him to write Darkness Visible: a Memoir of Madness, after he had recovered.

The book earned Mr. Styron a whole new set of followers. "I think it causes people to realize two things," he told the Gazette in an interview in 2001. "That this is a pain that afflicts a lot of people; it's universal and if I could describe it in this way and people could relate to it, it meant they weren't alone; and the second thing - almost as important or more important - is stressing the truth that people can get well, and that it's not by any means fatal."

Styron's book is interesting, to a degree, mostly because of his prominence as an author at the time he wrote it, and because it is so uniquely personal: One person telling the story of his own descent into "madness." I wasn't a complete fan: it's a little hard to keep reading how marvelous Styron's life was, yet how unhappy he was within it -- true though that might be.  And the entire book, while short, is one continuous slog through the same miserable territory, until his case finally improves towards the end (mostly thanks to hospitalization, it would seem.)

However, there are some interesting parts.  One is near the beginning, where he quotes the French writer Albert Camus, "There is but one truly serious philosophical problem, and that is suicide."  In Styron's hands, the problem becomes more physiological than philosophical.  He tries to put off suicide, while coping with his depression -- but first, cataloging his depression fairly exhaustively for the reader (or himself, it's never too clear.)  He covers some standard themes, such as how self-medication with alcohol kept his demons at bay for years, until he cold turkey gave up drinking, and watched his depression take on form and substance.  He explains how the common response of depression is to be more interested in injuring self than others (small comfort, that).  And he mentions the unique aspect we discuss here from time to time, about how psychological pain can manifest as, or at least be accompanied by, physical pain.  In Styron's words, about his own case:

"What I had begun to discover is that, mysteriously and in ways that are totally remote from normal experience, the gray drizzle of horror induced by depression takes on the quality of physical pain.  But it is not an immediately identifiable pain, like that of a broken limb.  It may be more accurate to say that despair, owing to some evil trick played upon the sick brain by the inhabiting psyche, comes to resemble the diabolical discomfort of being imprisoned in a fiercely overheated room.  And because no breeze stirs this cauldron, because there is no escape from this smothering confinement, it is entirely natural that the victim begins to think ceaselessly of oblivion." 

(Hmmmn.)

Styron indulges in one of the book's only tiny moments of humor when he describes the loss of his libido, which he says happened pretty much as soon as the depression settled in.  Describing a conversation with a doctor he felt 'just didn't get it,' Styron writes:

"...I wondered if he seriously thought that this juiceless and ravaged semi-invalid with the shuffle and the ancient wheeze woke up each morning from his [sleeping pill-induced] sleep eager for carnal fun."

Styron helpfully delineates his personal symptoms and by so doing, provides an example for others about what depression can look and feel like.  He describes his sensations of pain, his loss of libido, his weakness, his weak and distant voice that made him sound much older than his years, etc.

He also describes his troubling experience with several doctors (he calls them "careless") who overprescribed medications to him, including sleeping pills, at levels that were dangerous and could have provoked suicidal thoughts. It's unclear whether Styron ever considering a malpractice lawsuit against these doctors, but what he describes doesn't sound good -- and it sounds like he just took it in stride and was thankful he wasn't harmed, but didn't pursue any further action.  Ironically, eventually it's medication that helps him get well, once he is hospitalized.  Before he commits himself, however, he reaches the end of his rope and contemplates suicide.  When he finally realizes how sick he is, he heads for the hospital, and, there removed from other distractions, is able to (in his opinion) concentrate on his cure.From other things I've read since, it sounds like Styron continued to battle depression off and on for the rest of his life, and probably had struggled with it for many years beforehand, also.  At no point in the book is there any indication about his military service having an effect, pro or con, on his depression.  In fact, it sounds like his depression was both genetic and environmental -- but had nothing to do with being a Marine.

By page 84, the last page of the short book, there is finally a ray of at least faint light.  Styron is getting better, and he sums up -- neatly mentioning Dante, the subject of a previous post here on this blog:

For those who have dwelt in depression's dark wood, and known its inexplicable agony, their return from the abyss is not unlike the ascent of the poet [Dante], trudging upward an upward out of hell's black depths and at last emerging into what he saw as "the shining world."  There, whoever has been restored to health has almost always been restored to the capacity for serenity and joy, and this may be indemnity enough for having endured the despair beyond despair."

And then he concludes with a quote from Dante, mirroring the optimism that is finally able to see in his own situation:

"E quindi uscimmo a riveder le stelle.

And so we came forth, and once again beheld the stars."

Editor's note: If you want to read more about Styron's later work, referencing this book as well, there's a good article from 2003 in the Guardian, linked here.

The Vietnam Veteran as Exile: Missing in America, But Hidden in Plain Sight

My friend the veteran artist John Paul Hornbeck made this flag -- I just love it.  It carries forward the whole issue of POW/MIA into the present day, by asking in effect why the veteran is "still" Missing in America (that's the "MIA" part these days.)  He mocked up this flag, using the old and familiar symbol, to highlight the cause of homeless veterans in America -- a cause worth addressing.

I'm broadening the point, though, to something else:

Why ARE Vietnam veterans, in particular, still exiles in their own land?

And what should we, as a country, be doing about that?

Because failing to address that, failing to welcome back these warriors into their own land, perpetuating their exile both from what they've seen/done/experienced and how they were received when they returned -- has left a gigantic, gaping gash in the "fabric" of the American psyche; and decades worth of not addressing it has not resulted in any pain being healed.  Sure there are sporadic attempts made here and there, but they're relatively weak, lackluster, or involve too few people to really make a difference.

If you read Pat's "Welcome Home" story, or Claude Anshin Thomas', just to use the names of two representative Vietnam vets among thousands -- you find out that they are STRIKINGLY similar, almost verbatim copies of each other (and the rest who haven't written them, I suppose).  The hopes, the dreams, the flat-out fantasies (under the circumstances) of how they were to be received -- combined with the completely dashed, rejected and really shattered realities of how they were -- aie, the mind boggles.  It's surprising the whole generation of warriors didn't go postal, not just a few.  It also explains why so many of them are still living in pain to this day.  Turned into exiles by what they lived, that they had no possible means of integrating -- and shunned by the country they fought for.  If that woudn't give you issues, I'm not sure what would.

---

So let's think outside the box on this, FAR outside the box.  (If the box is the status quo, that is, because that's not particularly impressive.)  What prevents us from giving veterans, in every city across America, down EVERY Main Street -- a true, genuine, and long-overdue "WELCOME HOME"?!

Couldn't we use that psychic energy we'd gain back as a nation -- from repairing the rent in our actual psyche -- to surge forward, and embrace our combat veterans from here on out, with all the services and the help they so desperately need?  We've seen the problem: it's been well-documented.  But even to go forward successfully, in this case, I think we also need to go backwards -- make use of the "invisible bridge" -- and welcome the group of veterans who are STILL waiting, 40 years out, for America to acknowledge their return.

---

I learned a long time ago, that even in personal relationships, there's a big difference between the crappy/weak/self-serving apology -- "sorry IF I hurt your feelings" -- and an actual, gut-level, authentic and genuine apology, that takes responsibility, asks for forgiveness from the injured party, waits for the answer, or renegotiates the situation -- and then moves on, healed.  In the Bible, that's even called the difference between "worldly sorrow" (sorry I got caught) and "godly sorrow" (sorry that I did it, because I know it was wrong).  Without making a point about religion here, I'm merely trying to show that many traditions understand there's a difference between a heartfelt apology, a lame one, and none at all.  It's like the Oliver Wendell Holmes line from a few blog posts back, that "even a dog knows the difference between being kicked, and being tripped over."

---

Let's harness or leverage the momentum from the current groundswell of public "enthusiasm" for veterans' rights, exemplified by support for passage of the new GI bill, and the continuing emphasis on not settling for less in healthcare, particularly PTSD and TBI.  Let's expand that, though, to other issues of concern to veterans, before the "mood" passes -- as it surely will -- to be eclipsed by other different, pressing concerns.  Let's settle our largely unspoken national shame with how we treated Vietnam veterans, while a few of them are still alive to appreciate that our apology is genuine, and acceptance would heal us all to be able to move forward.  What we don't want to do is to create two different classes of veterans: the ones we care about, who get the right treatments for the right reasons; and the ones we don't, because we frankly made such a mess of it it's just easier to overlook it than apologize and move on.  It's time to make things right for ALL veterans.  Let's have those Welcome Home parades NOW...

Editor's note: John Paul Hornbeck is the artist (and veteran) who made "Shattered Soldier," the lifesize scultpture of a veteran with PTSD, that we blogged about earlier, here.  He is the child of an American Vietnam war veteran Army father, and a Vietnamese mother.

Would Expanding Awards of the Purple Heart to Include PTSD Help End the Stigma?

A few months ago, a debate began in military and veteran circles that may continue for years: Whether the Purple Heart, traditionally reserved for awarding to those killed or wounded in battle, should be extended to include also "invisible wounds" of battle, like PTSD.  There are no easy answers.

Said an article at the time, in the Wall Street Journal:

"The dispute reflects a broader question roiling the military: Can psychological traumas, no matter how debilitating, be considered equivalent to devastating physical wounds?

Supporters of awarding the Purple Heart to veterans with PTSD believe the move would reduce the stigma that surrounds the disorder and spur more soldiers and Marines to seek help without fear of limiting their careers.

“These guys have paid at least as high a price, some of them, as anybody with a traumatic brain injury, as anybody with a shrapnel wound,” Dr. John Fortunato, who runs a military PTSD treatment facility in Texas, told reporters recently. Absent a policy change, Fortunato told reporters, service members will mistakenly believe that PTSD is a “wound that isn't worthy.”

Opponents argue that the Purple Heart should be reserved for physical wounds, as has been the case since the medal was reinstituted by Congress in 1932. Military regulations say the award should go to those with injuries “received in action with an enemy.” Some opponents also note that PTSD can be faked, which can't easily be done with a physical wound.

“The Purple Heart was meant to be a badge of honor to show you were wounded in battle,” said Bob Mackey, a retired Army lieutenant colonel who fought in the first and second Iraq wars. “I've been in combat three times. There's stuff I've had to deal with. But it's substantially different from being physically hurt.”

Mackey said the biggest difference is that some veterans may be diagnosed with PTSD even if they never saw combat or fought an enemy – requirements, historically, for receiving a Purple Heart."

Military.com also conducted a poll on its website about the issue (see graphic), and only about 1/3 (33%) of the respondents voted "yes" to awarding the purple heart for PTSD.  58% voted "no," and another 9% rode the fence, saying "perhaps" -- but only if PTSD were diagnosed in the war zone, which really affects far fewer people.

The IAVA's Ray Kimball wrote a good op-ed piece at Military.com in favor of expanding the award -- that's linked here.

---

The more you talk with veterans who have PTSD, the more you realize how long the effects can be -- vets who are still struggling mightily with events that occurred 40, 50, sometimes even 60 years before (as well as a lot more recently than that.)  The sheer extent of the suffering, to me, puts this allegedly "invisible wound" on a par with ones that can be more clearly seen.  Though seriously, I bet if you ask a knowledgeable spouse or family member, the so-called "invisible" wound of PTSD is fairly easy to "see" in the the effect its had on the life of the veteran, and his or her family.  Studies like the one conducted on Vietnam veterans in Australia even shows residual effects on family members of veterans with PTSD into the second generation.  It may be "invisible," though I don't think it particularly "is," but it's certainly also "the gift that keeps on grieving," as one veteran so aptly put it.

It's weird and a tad unpleasant to see a divide developing (or perhaps the divide was always there, and is just now being articulated) between those with external and internal injuries -- especially since the ones injured externally seem to be the ones "pooh-poohing" the validity of the more internal injuries. Then, of course, there are those who've suffered both kinds.  Max Cleland comes to mind, the former Secretary of the VA, who decades after Vietnam learned he had PTSD, in addition to his obvious physical wounds as a triple amputee -- we blogged about him, here -- as do some other veterans who have unfortunately passed on.  Perhaps we need to hear more from those veterans who understand both types of injuries, and learn which side they argue in this debate. 

Typically, suffering begets compassion -- people can be fairly un-feeling about topics they've yet to have experienced personally, discounting motives and pain quotients alike -- so who better to understand which types of wounds really "count" than those who have cruelly suffered both? My guess is it's going to be from this corner that the rest of us learn how to more properly weight the stunning, substantial and frequently lifetime effects of this so-called "invisible wound" we refer to as PTSD.

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.

---
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.

What the VA Needs Is "The Odwalla Effect"

[If this blog were a newspaper, which it isn't, this particular blog post would be an editorial -- found in the opinion section, separate from the rest of the paper.  The editorial section is where the editor "puts together" what the news means to him or her, and sets out a point of view, about what we should do or feel, think or believe about something, based on what else has been in the news lately, that they've been keeping people up to speed on.  It's the opinion section, essentially -- but from the editorial management's point of view.]

Here's ours:

Kathie Costos has a great series of posts over at her blog, linked here, but there's one in particular we'd like to talk about - and we'll leave you the link to it in a minute, so you can read it for yourself.  First, the discussion.  Kathie is conducting a question and answer session with Paul Sullivan, head of Veterans for Common Sense, clearing up "rumors" about the veterans' lawsuit against the VA.  Sullivan's answers are clear and to the point, and contain some fairly galvanizing statements, pro or con.

[I should insert the caveat here, in an effort to be balanced, that I DON'T believe the VA is "all bad," nor do I imagine Costos or Sullivan does.  Every once in a while you DO read about people who are extremely thankful and grateful for the care they're received through the VA - I read an item the other day where a veteran was reminding us that they have one of the best healthcare systems in the world.  True.  But that also brings up a question of which metric you're using, since while they are succeeding in some areas, they are clearly failing in others (and those are the areas which are making the news, frustrating veterans and families, and where they're being sued.)  Highly competent, concerned and caring individuals DO work for the VA -- many of the leading lights of care in the PTSD segment in particular have come from, or worked with, or still do work with, the VA.  People who are tremendously significant in the history of caring for veterans in an extremely high quality, enlightened, empathic way -- so people like that DO work for the VA, and always have.  Look through the "Experts" section on this blog, and see how many people have an affiliation with the VA, past or present: Ray Scurfield, Shad Meshad, Jonathan Shay, as well as others, all come to mind. (For the record, these people were probably "born" (wonderful) not "made" (wonderful) by their association with the VA as caregivers, but still -- they worked there and in some cases, still do.  And God knows, the VA heavily reads this website -- even at odd hours -- including very late at night, on weekends, on national holidays -- times when the rest of America is out grilling a hotdog with their family, throwing a ball in a park, or just snoozing the night away -- so clearly there are some very dedicated individuals there, trying to learn all they can in order to deliver better care to those who are suffering.  (Though they may also be reading to keep up with public opinion, to see which way the wind blows...)

I do sometimes wonder when I see what the VA is searching for, on this site, because it either seems kinda elementary (like they should know about it already), or a little "weak" in the efficacy of treatment department (like things that are waaaaaaaaaaay down the totem pole or triage pile of things to actually try with a demographic of patients who are suffering greatly). To give you an idea of what I'm talking about, frequent searches -- and the topics change regularly -- by the VA include such things as "spirituality for PTSD," "does recreation help?" and things like that, where, really, yes, even if they do -- they're only adjuncts and pretty far down the list at that, compared to more likely things that seem worth trying or are known to have some benefit.  But maybe I should just be patient, and it's more a case of "if you build it, they will come."  Maybe there's a huge lag time afoot, where if the information is laid out there, eventually the searches will catch up -- on the VA's part, that is.]

(Huge digression -- but the point is, the VA's not all bad, and that's NOT the point of suggesting they change, which it certainly seems like they should.)

---

Deep in the Q&A between Costos and Sullivan is this exchange, with the comment of importance highlighted:

Do you know about the Freedom of Information request to the VA by CREW and VoteVets?(Which we blogged about earlier here, by the way.)

Yes. It is too bad that VA still plays games with FOIA. VA should be forced to turn over the information. Embarrassing information is never a reason to deny a FOIA, as VA frequently does.

Alrighty now.  That was the warmup (the foregoing).  Here's the pitch:

If the VA wants to control the flow of embarrassing information about it -- such as the Katz and Perez emails have provided us with -- there's one extremely simple way to do it.  It's NOT hiring a PR firm that specializes in crisis management and controlling the spin.  That's morally and ethically disgusting -- when contrasted with the concept of just changing -- and, it's ridiculously expensive -- a true waste of money that could be better spent on taking care of veterans and their families, with the needs the VA already knows about. And by promoting good works, like those of combat veteran Jay White, at the VA Center in Hartford, Connecticut, which we blogged about here.  Those ALSO make the news and contribute to public opinion, though everyone knows, and it's unfortunate that it's true, bad news travels first.  (And bad news here is definitely the Katz and the Perez emails, and the lack of putting patients first they describe, not to mention the rash of veterans suicides, etc.) Denying patients adequate care?  There's just no way to put a positive enough spin on that.  And the extent of the media coverage has been such, yup, we pretty much all know about it by now, if we even remotely care to.  Game over.  What needs to happen next is what happened with the Odwalla juice company -- what the VA desperately needs is the Odwalla effect.

Years ago, Odwalla was a new company with a great product: fresh juice, delivered nationally.  I knew someone whose three college friends had started it, and because of that, I guess I paid attention to what it was, and when I had the chance, tried the juice.  It was great, and for a while, everybody I saw who wasn't carrying some bottled water, seemed to be carrying a container of their juice.  They had, and still have, a number of blended juices, as well as the straight-up orange and apple.  And they had a novel, and in hindsight quite unwise, approach.  Their juice was unpasteurized, which they felt was needed to keep the juice as fresh-tasting and delicious as possible, but which also carried some known health risks, because pasteurization kills bacteria.  Children (particularly babies) and the elderly, as well as a few other groups (those recovering from illness and surgery, etc.) have weaker immunities -- in other words, are more susceptible to bacteria.  And I don't remember that Odwalla plastered their juice labels with big warnings about: "Warning! Our lack of pasteurization makes this juice likely unsafe for children and the elderly!".  They probably just made their juice, concentrated on getting it to market, and hoped people toasted each other with its deliciousness.  But over time, the inevitable happened: a few people who tasted their fresh, delicious (and unpasteurized) juices got sick - and, horribly - died.  And some of the affected were children, which the American public finds of course especially heartbreaking, and worthy of media attention.

In an instant, it seemed -- everyone turned on Odwalla, the juice and the company.  It went from being a media darling, to an object of abhorrence and fear.  How could they have let their juice kill people -- young children, even?  Horrifying...  Based on the immediate and complete backlash in the press and public opinion, I easily imagined Odwalla going under, and my friend's three college friends being put of work, and skulking away in public disgrace.

What happened next was amazing, though: and it shows you the power of good, and of doing the right thing.  (There's a conflicting story on the Web, but if you read the date on it, it's from 1999, which is ridiculously old news -- before the Odwalla success story of managing its PR happened, and before the company was later sold to Coca Cola - another evidence of its success. Plus, the guy who wrote it is by no means is a PR specialist, nor does he even seem to understand how PR works. I did work in PR, though I'm no expert on crisis management - I do get how it works.)  Odwalla didn't go bankrupt, didn't go out of business, didn't leave the marketplace in shame and disgrace.  What DID they do?  Simple as could be, and oh so powerful:

They accepted responsibility.  They apologized and paid the families' bills.  And they changed their process, so more people wouldn't be hurt by it.  They were wrong; they admitted it; they did what it took to make it right; and they changed.

In other words -- EXACTLY what the VA needs to do.

By now, we all know what the problems are, if we've cared at all to listen and learn.  They're kinda obvious.  And no amount of re-spinning the truth is going to make the problem go away.  All the media attention and lawsuit has done is show us the gaps in the system, the problems with care.  And because most caring, compassionate, fair-minded Americans care MORE about their veterans - we "get" the price they've paid -- than we do about hearing excuses and spin -- there's only one real solution here.  Admit the problem(s), apologize to those you've affected (veterans, their families, and the rest of us, who while less directly involved, are nevertheless put off by what we've learned), and fix the process.  Let tomorrow be vastly different from today, because you're starting to work -- really work -- on the problem, now.  The problem that we -- you, me, veterans, their families, the media, Veterans for Common Sense, the IAVA, the Disability Rights Project, Paul Sullivan, Kathie Costos -- all know exists.

Lack of pasteurization, denying veterans care -- and, if you'll allow me -- O.J. Simpson have all have been linked to killing people.  But in a contest between two kinds of OJ -- Odwalla and Simpson -- please, VA, we beg of you: show yourselves to be more like Odwalla, and less like Simpson. Fess up, come clean, do what's right by veterans and their families, make it right.  Now more than ever, what the VA seriously needs to re-create good public opinion is not denial, spin and blocking legitimate FOIA requests, in case something embarrassing gets revealed -- it's a simple thing called "the Odwalla Effect."  Also known as, doing the right thing, for the right reason, makes public opinion bounce right back.

---

Editor's note: Kathie Costos' Q&A with Paul Sullivan of Veterans for Common Sense about the veterans' lawsuit is linked here. Kathie Costos' blog, "Wounded Times," is linked here. Veterans for Common Sense is linked here.