Healing Combat Trauma

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.

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.

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.

Bombshell Lily Burana, Author of "I Love a Man in Uniform," on PTSD

Lily Burana is a lovely force of nature, and at this time of year when we celebrate veterans, it seems only fitting to celebrate their often long-suffering spouses as well. Burana wrote a great book a while back called "I Love a Man in Uniform," about her marriage to an Army veteran who was deployed. 

"Love is great," she jokes among friends, "but it ain't no match for PTSD."

Last week, in honor of Veterans' Day, she wrote a typically light, humorous and reflective article for the New York Times about "The Quiet Side of Being the Soldier's Other Half," linked here.

She also wrote on her blog:

"I've been blessed with an adventure-filled life that has taken me many places and transformed me in many ways, but nothing has moved and transformed me more than my experience as a military wife. The grit, ritual, passion, dedication, resilience, and sacrifice have left an indelible mark on me.

This Modern Love column may be my final word on my experience as an Army wife--though you never can tell. When I saw it online, I started shaking and cried, mostly out of a deep gratitude for being part of the military family."

More germane to our purposes around here, though, what's particularly refreshing about Lily Burana -- on top of her smarts and humor -- is her delightful candor about how she and her husband each struggled with their own forms of PTSD. And how that experience challenged -- but ultimately did not extinguish -- their marriage.

Burana's book is smartly subtitled, "A Memoir of Love, War and Other Battles." And while "I Love a Man in Uniform" isn't technically "about" PTSD, as with many servicemembers' marriages, PTSD can turn out to be the elephant in the room. Marriage is difficult, deployment takes its toll on both partners, and trauma -- even from other sources -- tends to be cumulative.

In "I Love a Man in Uniform," Burana talks about her experiences with EMDR, therapy, medication, and Neuro-Emotional Technique, a form of chiropractic. In subsequent conversations with her, she credits EMDR with doing much of the "heavy lifting" where PTSD was concerned. EMDR "gave me the will to live," she says, "It significantly improved my quality of life."

"I know what it's like," she says. "I felt worthless." "My story has an encouraging ending, so I'm happy to share it. I'm going to put a face and a name to it" -- what so many others go through. "I went about as low as you can go," she said, before EMDR started turning her life around.

Like many military spouses, she talks of the pride of seeming "capable on the outside," but "dying on the inside." She also talks about how as her husband got his own PTSD from combat treated, "it served him beautifully." It became "a better life for him, too."

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Editor's note: In addition to being an author, Lily Burana used her background as a burlesque dancer to create "Operation Bombshell," "the world's only burlesque school for military wives." (It doesn't involve nudity or a striptease.) According to the Operation Bombshell website, linked here, Burana started this light-hearted recreational program, "after enduring her own 'deployment blues'. 

"Burana's husband, then an Army Intelligence officer, was fighting in Operation Iraqi Freedom, and Burana longed for something to lift her spirits. Later, during a little "retail therapy" lingerie shopping, she found that the salesgirl was herself a sad, lonely military wife, and Burana wished she could offer her some cheer and healing distraction. In that instant, Operation Bombshell was born. The first Operation Bombshell class was held at Fort Hood, Texas in 2008."

For more about Operation Bombshell, click here. Or watch this endearing clip from Fox News about the program. (And for more on EMDR, click here.)

Photo credit: Laura Byrnes.

Quotable Quotes -- Larry Pence on Making a Difference

“There are people who go through their entire lives and never help another individual," says Larry Pence, adding "Don’t be one of them."

-- Pence is a retired Army command sergeant major who volunteers regularly with various veterans charities, including U.S. Army Caisson Platoon Equine Assisted Programs in Washington, D.C. (Read more about that, here.)

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

 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

PTSD and MST Affect Men, Women Servicemembers and Veterans Alike

A few months ago, I attended the week-long clinical training program in post-traumatic stress disorder (“PTSD”) at the National Center for PTSD in Menlo Park (Veterans Administration) as well as the “Brain at War” conference in San Francisco, put on by the Department of Defense. Both made clear how much money is being spent on research ($500 million) but as for success stories, they can be hard to find. PTSD affects veterans, their families and communities; it can also lead to suicide.

Current statistics show an active duty suicide every 36 hours, and that 18 veterans a day die by their own hand. Suicides are on the rise in every branch of the military that’s seen heavy combat in the current wars -– Marines, Army, National Guard -- and so far this year, there have been more suicides than combat deaths. 

The problem extends to women veterans as well. According to the American Psychiatric Association, “Women veterans are two to three times more likely to commit suicide than nonveteran women” -- and also die at a younger age, “between 18 and 34.” 

Clearly the problem is serious and troubling. But suicide is also the final step on a journey of misery, pain and despair that can potentially be halted earlier, by intervention that increases a veteran’s chances of survival and success.

Five years ago, after writing about integrative medicine for years, I created the nonprofit Healing Combat Trauma, a website devoted to therapeutic resources for veterans with combat-based PTSD. Today, that’s becoming an actual program to lead combat vets with PTSD through, using integrative medicine -- “the best of East and West” -- to help them recover from the scars of war. 

Two years ago last week, a combat vet, Marine, who’d served in Vietnam, and suffered TBI from explosions and a head wound, as well as 40 years of severe, chronic PTSD, flew out to meet me, and together we went around the country, experiencing specific therapeutic modalities in the hands of experienced practitioners that were targeted to address his PTSD. (Watch "A Veteran's Healing Journey," here, for more of his story.)

Initially actively suicidal, once his symptoms receded, so did his threats of suicide. He had gotten his life back, and was eager to stay involved in it. And the cost of helping him reverse his symptoms, and improve his quality of life? Under $10,000, including travel, lodging, and practitioner visits.

As much attention as PTSD receives in the media, military sexual trauma (“MST”) – which frequently leads to PTSD – receives even less. A more taboo subject, MST affects roughly the same number of men and women, approximately 60,000 each, between 2002-2008, despite their disproportional numbers in the services. 

According to the VA, “Approximately 1 in 5 female patients … reports MST,” and MST is associated with “increased risk for mental health conditions including PTSD, depression and substance abuse disorders.” VA reports the prevalence of MST among OEF/OIF veterans is 15.1% among females, but anecdotally the figures are much, much higher, typically under-reported because of shame and fear of reprisal.  And MST leads strongly to PTSD. Among Gulf War veterans, for example, women who suffered MST were at 5x higher risk of contracting PTSD.

But for a sense of the human toll, read how one young woman soldier expressed her misery, after multiple sexual assaults in a single deployment in Iraq, followed by a suicide attempt: 

“I remember so many things I want to forget. I remember once upon a time I was a real person. Then I was a soldier. Now I am a ghost.”

Earlier this summer, another young woman combat veteran, Angela, with whom I’ve become friends, spent time staying out here, around our both attending a local retreat for veterans and their families. Angela has MST and PTSD, and a service dog to help her manage her PTSD symptoms. 

Even in the brief time she visited, taking her to practitioners chosen to help her recovery, she was able to reduce her smoking by half, and said she couldn’t remember when she’d felt so relaxed – certainly not since she’d experienced combat. (A former Army sergeant, she’d been in Baghdad during the surge in 2003.)

A few years earlier, Angela had attended the VA’s “cutting-edge” program for women vets with MST. The program housed the women vets –- all of whom had experienced sexual assault -- in a men’s homeless shelter(!). The stress of that experience was so great, Angela said, that her fellow attendees all relapsed into substance abuse. She credited her own experiences with integrative medicine as what kept her, barely, on the path. Out here this summer, she was able to expand those options further, in positive ways that continued to help her heal. 

Now we want to offer that opportunity to more women veterans (and later, men) in a pilot program. Please help us do that.

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

 

When Is PTSD NOT PTSD? When Stubborn Pride Takes Control

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

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

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

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

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

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

 

The Sacred Brotherhood -- and Sisterhood -- of Those Who Understand

We read a few days ago Larry Heinemann's excellent quote about veterans after combat "carrying the darkness with us," linked here. And yesterday, in "War Creates Brothers," we learned about an historic gathering, a sacred ceremony of sorts, where Vietnam veterans like Heinemann met with Russian Afghansti veterans, at least a decade younger, and shared their stories with one another, bonding in the wet blood of brotherhood (and sisterhood, because it now applies to women veterans as well) from war. (That piece is linked here.) Now we synthesize the two together, with a quote from the article Heinemann wrote in 1989 in a national magazine, describing both the gathering mentioned above (lightly), and a much more extensive retelling of what the same Vietnam veterans' trip to Russia to meet with the Afghansti initially was like, a few months before.

Heinemann describes at great length the similarities and the bonds among the men that were formed, and tells the story of how the Russian veterans became involved in their own war in Afghanistan, leaving generally bruised and beaten "after nine years and 15,000 dead." Much of the article focuses on the stories of the Afghansti veterans they met in Russia, the grief of the devastated families of those who'd served, and the generalized indifference of the Russian government -- all of which he can compare, to one degree or another, to situations in our own country, after Vietnam. (As an aside, the bureaucracy of the VA seems to stand in for that of the Russian government in his analogy.)

As clearly as he paints the picture of the Russian veterans' suffering, and how it's mirrored in our own, one of the strongest descriptions he suggests is why the veterans on both sides of the conversation, separated by decades and culture, are nevertheless able to bond so strongly, through telling stories about their experiences, horrific and otherwise. This is the same principle we've been alluding to recently in the series about ritual, and the unburdening that can come from individual warriors when they meet up with one another, and have the safe "container" in which to share their suffering, confusion and grief. Here's Heinemann's remarkable quote:

"These stories and many others, came forward because the Afghansti finally had someone in their midst -- as we surely did not two decades ago [returning from Vietnam] -- who knew what they were talking about. We were fellow soldiers who could listen to the madness and know they were not mad; someone who could validate their worst blood-bath nightmares; someone who had an inkling of the brutality they had endured and inflicted; someone whom they could trust with stories about the deadest, darkest places in their hearts." -- Larry Heinemann.

Circling back around to Heinemann's earlier quote, mentioned a few days ago, we read in this article that it comes at the end of a longer declaration. As food for thought, I now include the full paragraph, in case it now adds fuller context, in light of the above.

"The Afghansti have caused a great many people a great deal of grief and have themselves suffered -- for a lie, let us not forget -- the same was we in the United States have caused much suffering in Southeast Asia, and have also suffered much in return, also for a lie. It was no small betrayal, no small lesson for a man to learn at the age of 19. Any soldier returning home must rediscover his humanity and establish a livable peace with the discovered, liberated, permanently dark places in his own heart --the darkness that is always with us."

Self-Image in Veterans with PTSD after Combat: Same as Before, or Different?

We wrote an article on this site more than a year ago that was read very heavily, entitled "A Combat Veteran Asks Himself, Who Am I, on the Inside?" linked here. His response at the time to the question, "What's your greatest problem right now?" was very direct, raw and hard to hear: "I'm an exploding ball of hate," he said.

As tough as that "conversation" was to absorb, it might be time for a rematch, but on a slightly different topic. How does -- or does it actually -- a combat veteran with PTSD's self-image change, after combat, from what it was before combat? (Or before and after PTSD. Really, either question would produce interesting results.) 

It does seem that even in the literature, very little attention is paid to how servicemembers and veterans view themselves after combat. What was their self-image before -- and then did it change, or HOW did it change, after combat?

(By way of definition, "self-image" is different from "self-esteem." Self-image is basically how you look at yourself, pros and cons -- your sense of yourself and who you "are." It can be as simple as, I'm so tall and weigh such and such; I'm a good student or I'm good at sports; I'm social or I'm a loner, etc. Self-esteem has more to do with how highly you regard yourself (e.g., belief in yourself and/or self-confidence). It's also not the same as "self-worth," which is the value with which we regard ourselves. It's more purely "just"" how we see ourselves: bad, good or indifferent.)

Our self-image is who we see ourselves are -- how we would describe ourselves to others. "I'm fundamentally a good person." "I'm fun to be around." "I'm responsible." Ways we describe ourselves to differentiate ourselves from others. 

The illustration at left may help. It's a drawing a combat veteran with PTSD made based on an instruction to "draw himself as he saw himself, right now." Meaning, at this point in his life, not necessarily right after combat. He drew what amounts to a split personality, a "bad" and a "good" self, about equally weighted. He saw himself as both, at the same time. 

(Example from non-combat-related psychology, to further define what self-image is, by taking a look at what distorted self-image is: When an anorexic woman looks at herself in the mirror and "sees" herself as overweight, though she is underweight, we say that she has a "distorted" self-image. In other words, her correct self-image would be accurately that she is too thin. Instead, she projects onto the accurate image the distorted image she carries of herself, and she is able to see herself, wrongly, as not thin enough.)

I'm torn about including several quotes about war and the warrior, to get the discussion going...but I don't want to tip the scales one way or the other here. It's probably best to just think of the actual question: How did I view myself before combat/PTSD, and how do I view myself now, after combat/PTSD -- and have those two views of myself changed?

Quotable Quotes: The Transition from Real Person to Soldier to Ghost

Every once in a while you run across a quote that just puts everything into perspective. Here's a combat vet, woman, with PTSD and MST, raped multiple times(!) in her deployment -- a form of hazing? A highly intelligent woman, coming to terms with what she's gone through, but it isn't easy, and it did involve unspeakable things. Here's how she describes it: 

"I remember so many things I want to forget. I remember once upon a time I was a real person. Then I was a soldier. Now I am a ghost."

Editor's note: For more on military sexual trauma, also known as MST, which affects equal numbers of men and women, despite their disproportionate numbers serving, click here. For more on PTSD, read the rest of this site :-)

An American Veteran -- After Combat, Unlucky in Love

"Ann," Eddie Livingston, the subject of our "An American Veteran" series writes to Ann Landers in the summer of '65, "you cannot possibly know how the help and comfort your column brings to people like myself. Many times I have found things in your column that seemed to apply to me, specifically." In characteristic Eddie fashion he adds, "I hope you are never alone, or lonely, Ann."

(Click on the photo to read the letter in its entirety.)

A comment like that stands out because being alone and loneliness are clearly important to Eddie as well.

His niece, who's brought his writings to light, comments that Eddie believed "because of all of his problems stemming from the war and his POW experience [both creating his PTSD] that no one could ever love him."

Fortunately he found someone later who did, but in this letter you can clearly read the pain and frustration of the 41-year-old Eddie at striking out too many times in the same way, where other men with less baggage from the war are clearly succeeding. Eddie was 41 at the time but a recent combat veteran I ran into the other day, in his 30s, was able to use the experience of having several women break up with him in a row as his "wake-up call" -- that it was no longer all of their problems but it was his PTSD as the common denominator, and he started to go get help so that he could change his future. I commend his efforts but also Eddie's plaintive authenticity on this front. I'm no "Robert Taylor," he bemoans, citing a celebrity of the day, but knows that he's still worth loving. Veterans with PTSD may have rocky relationships (see the divorce rates) and plenty of alone time (see the series on living in the bunker), and these problems with others may stem from the difficulty they find in loving or accepting themselves. It's certainly true that I've recently seen spouses not have the easiest time with the experience, either. Difficult or hard to love? Yes, probably. Worth the effort? We believe so. Stay tuned for a very positive story on just this topic...

Editor's note: For a set of articles about the fuller topic of sexuality and intimacy in the combat veteran with PTSD's life, click here.

Resources on Military Sexual Trauma: VetWow's Short Podcasts for Survivors, Friends and Family

Military Sexual Trauma, like PTSD another "invisible wound," is unfortunately more prevalent in the military than we would want to believe, though little discussed officially. It's different though when combatants get together who have experienced it. Among female servicemembers in particular, it is all too often a common experience; and whether among male or female servicemembers, the after-effects can be devastating. 

At its root, it is a betrayal of trust -- the military is designed to be a "family unit," so assault within this context can feel to survivors like incest -- and many survivors describe the hazing by their command as more difficult in its own way than the actual assault (ugh). Civilians in particular have a hard time wrapping their brains around how prevalent the problem is, how light or nonexistent the penalties (despite official "policies" to the contrary), and how devastating the aftermath is for those who suffer -- who then have to navigate an often-byzantine system of claims and benefits for their care. (Fortunately, MST survivors are able to access VA in a very direct manner...it's worth watching Susan's discussion, linked here, to understand how.) Family and friends -- who may find themselves supporting the survivor -- also need education about how best to offer support, in ways that are constructive and not counter-productive or further traumatizing.

We've written about military sexual assault on the site before, here. "Military sexual trauma (MST) is the term that the Department of Veterans Affairs uses to refer to sexual assault or repeated, unsolicited, threatening acts of sexual harassment –- that occurred while the veteran was in the military."

Susan Avila-Smith, a former Army linguist who suffered her own sexual assault in the military, is now a formidable MST/PTSD advocate and the founder of VetWow, where she advocates for others who have experienced MST and PTSD, and focuses on resolving their claims. A settled claim can provide the MST survivor with financial independence, which is important also in healing. Avila-Smith does not charge for her services, though she does encourage the male and female survivors to pay this service forward in their own lives, once they have stabilized enough to do so, by contributing to others in various ways. 

Recently I got a chance to work with Avila-Smith on creating a "channel" on YouTube for short, one to three minute podcasts about various aspects of MST for survivors, their families and friends, their advocates and the media. The videos/podcasts are organized into the following categories. Please watch them, and share them with your friends and colleagues. Particularly let those in the military (active duty) and veterans know about this resource. As Avila-Smith herself says, it's important to get the word out about military sexual trauma, because "you can't tell by looking at someone" if they've ever been sexually assaulted. For those who have been, these resources can be tremendously reassuring, constructive and helpful.

For MST survivors:

• Symptoms of MST in Veterans;
  
• What PTSD Feels Like to the MST Survivor;
  
• Difference between "Traumatic Stress Syndrome" and "Post-Traumatic Stress" Syndrome; 
  
• For the MST Survivor: Thoughts of Death and Self-Harm;
  
• Interested in Becoming an MST Advocate?;
  
• For Female MST Survivors, Hoarding Can Be Typical;
  
• For MST Survivors: "Hitting the Wall";
  
• For the MST Survivor: Working with Your Therapist Effectively;
  
• For the MST Survivor: Working with the Veterans Service Officer ("VSO") Effectively;
  
• For the MST Survivor: Achieving Satisfaction with Your Advocate;
  
• MST Survivor May Fit VA's Expanded Definition of "Homeless";
  
• For the MST Survivor: Learn to “Pay it Forward";
  

For male survivors of MST:

• For Male Survivors of MST;
  

Self-care and healing resources:

• For the MST Survivor: Good Self-Care Habits;
  
• Alternative Therapies for PTSD.;
  

For friends and family:

• Welcome Friends and Family!; 
  
• What PTSD Feels Like to the MST Survivor;
  
• For Friends and Family: When an MST Survivor Wants to Share Their Story with You;
  
• For Friends and Family: How to Help and How Not to Help an MST Survivor;
  
• When the MST Soldier Comes Home: Best Practices for a Good Outcome;
  

For active duty:

• Why Active Duty Advocacy is So Important;
  
• Active Duty / Filing a Restricted Report;
  
• Active Duty / Filing an Unrestricted Report;
  
• Filing an Unrestricted Report: What GENERALLY happens;
  
• Filing an Unrestricted Report: What SHOULD happen;
  
• Unrestricted Reports: the Danger of "The McDowell Checklist";
  
• For Active Duty: More on the Administrative Discharge;
  

Dealing with the VA:

• Accessing VA Services as an MST Survivor;
  
• Guide to Navigating the VA;
  
• When You Get a Letter from the VA;

Filing and winning a claim:

• Why Filing the Claim Quickly is in the Veteran's Best Interest;
  
• How to File a Claim for Military Sexual Trauma: The Key Items Needed in Your VA Claim File;
• Winning an MST Claim, Part I;
• Winning an MST Claim, Part II: How Long It Takes, Strategies for Self-Care While You Wait, etc.;

For advocates:

• Interested in Becoming an MST Advocate?;
  

For prospective donors:

• For Prospective Donors;
  

For the media:

• For the Media: When You Want to Interview an MST Survivor;
  
• For Media Who Want to Interview MST Survivors and Veterans;
  

General interest:                                                   

• Why MST is a Problem and Why the Solutions Don't Work;
  
• Explaining a Few of the Myths Surrounding Military Sexual Trauma;
  
• Which is Worse for the MST Survivor: The Rape or the Command?;
  
• Why the Current System Needs an Overhaul;
  
• Strange Facts about MST and the VA: Offenders and Victims;
  
• What I Envision in a Perfect Future: Blue Sky Thinking on MST;
  

Editor's note: For more resources about military sexual trauma, particularly filing and winning a VA claim, head for Susan Avila-Smith's website, VetWow; to support (i.e., donate to) those who advocate for victims of military sexual trauma, go to PackParachute; or to follow the legislative progress on this issue, go to Service Women's Action Network for information on the legislative angle. Remember, this is a problem that affects both men and women in the military. And most of all, watch the videos linked above -- and share those with family, friends and veterans' advocates. Thank you.

From the Canadian Side of the Street: A Military Author's Take on Veterans Suffering from War and PTSD

One of the many blessings of the new media -- social media like Facebook -- are the interesting, talented people one meets within that. One such person is Bonnie Toews, a Canadian former journalist and novelist with a longtime background in writing about the military. I forwarded her an article from the Montreal Gazette last week about social workers quitting because of burnout in Canada, meaning that fewer will be available to serve returning veterans with PTSD, and this is what she wrote on her website in response:

Outrageous failure of government assistance to returning Afghanistan vets

"It is wonderful that we celebrate the lives and courage of fallen soldiers when they are repatriated to CFB Trenton and paraded down the Highway of Heroes, but the question that is never answered: who looks out for the returning vets? Especially those whose minds, bodies and spirits have been shattered on a continual rotation of tours through the past eight years.

It is disgusting and absolutely unacceptable to hear that Canada's Veterans Affairs is cutting back on social workers because WWI and WWII vets are dying off. 

Excuse me, but Canada has a whole new generation of vets who have served in Afghanistan for eight years. By next year it will be nine years. The war in Afghanistan has lasted longer than either world war in the 20th Century and soldiers have been repeatedly rotated through three and four tours because our forces aren't large enough to handle a deployment this long and this demanding. These vets and their families need help to mend their lives back together. 

Kevin Dougherty in Montreal's newspaper, The Gazette, writes that soldiers suffering from Post Traumatic Stress Disorder can wait up to four months before seeing a social worker, a necessary step to integrate them back into society and return them to the labor market. 

Why? Because federal social workers each have a caseload of 40 clients to their provincial counterparts, who carry a caseload of 20 clients each. There are not enough social workers to contend with the need, and under such strained resources, these caregivers burn out, depleting veterans' social services even further. 

People forget that soldiers returning home are not the only victims of the wars they've fought. So are their loved ones, families and friends. They need as much social assistance as the soldiers themselves. Those coming home are forever changed. They have experienced things the rest of us can't imagine. They carry this psychological burden for the rest of their lives. 

In 1994, in Rwanda, I was briefly introduced to that world of theirs. I was one of the few North American journalists covering the massive humanitarian effort following the genocide against the Tutsis and moderate Hutus in Rwanda. One peacekeeper after another told me what they saw, incomprehensible mass slaughter with no human respect whatsoever and they were forced to observe because the UN didn't give them the mandate or size of force to quell the madness. Soldiers trained to fight and defend forced to stand down. Can you imagine the helpless rage they experienced? Yet, when I came home, I faced the same apathy from friends, co-workers and the public as they did. My husband proudly explained that I had been in Rwanda and time and time again I was asked, "Did you go there on holiday?" 

People didn't even know what was going on, and were indifferent when I chose to explain. I, like so many soldiers, learned not to talk about it because no one really cared to listen. 

This time the public must get behind their vets and demand the social services they deserve and need. This is the most important tribute we can give our returning vets for the sacrifices they've made on behalf of our country."

 -- Bonnie Toews. A longtime journalist reporting for logistics and private security magazines and now a novelist, speaks out for the victims of genocide and war, from the peacekeepers and coalition forces trying to save suppressed peoples to the children and innocent civilians caught in the crossfire of opposing powers, ideologies and cultures. Current writing "Trilogy in Treason." Member of Military Writers Society of America, American Authors Association and ACFW. Her website is linked here.

Editor's note: Find us on Facebook, here; follow us on Twitter @HealingPTSD.

Provider Burnout among Combat Stress Healthcare Practitioners

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

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

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

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

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

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

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

Veterans, PTSD and Suicide: The Overlooked Element of Contagion

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

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

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

But to the point at hand...

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

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

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

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

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

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

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

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

He continued,

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

He added,

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

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

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

---

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

To the science on this.

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

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

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

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

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

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

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

Moyers said:

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

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

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

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

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

Virginia Not Just for Lovers This Summer: Also for Vietnam Veterans and Their Families

The Virginia Historical Society is pleased to offer free admission for everyone this summer! From June 6 to August 30, the VHS is displaying three exhibitions about the Vietnam era. The society is offering complimentary admission as a way to honor military personnel who served in the Vietnam War and their families.

On Display / Current Exhibitions:

• Soul Soldiers: African Americans and the Vietnam Era through August 30, 2009

Soul Soldiers: African Americans and the Vietnam Era explores the issues, actions, reactions, and expressions of life and culture of African Americans as they were affected by the Civil Rights Movement and the Vietnam War. Over 160 artifacts, photographs, audio recordings, songs, oral histories, and an original documentary on display in this award-winning exhibition show how events in the 1960s helped frame African American political and social perspectives that extended beyond civil rights. The roles of Dr. Martin Luther King, Jr., Colin Powell, Jimi Hendrix, and many others are explored, as well as the 9,000 women who served as nurses and in clerical and support positions during the war. Soul Soldiers was organized by the Senator John Heinz History Center in Pittsburgh, Pa.

• Marking Time: Voyage to Vietnam through August 30, 2009

Marking Time: Voyage to Vietnam features a cache of Vietnam War soldier art of striking importance and poignancy. Soldiers and Marines on the ship USNS General Nelson M. Walker, bound for Vietnam in 1967, inscribed graffiti phrases and images on the bottom sides of canvas bunks in the troop compartments. Men wrote their name and hometown, the date they expected to leave the service, and kept day-by-day calendars to mark the progress of the voyage. Original graffiti-covered canvases—discovered in the process of scrapping the vessel in 2005—display messages of patriotism, politics, humor, anxiety, and love. Marking Time was organized by the Vietnam Graffiti Project in Keswick, Va.

• A Vietnam POW's Story through August 30, 2009

Bring Paul Home: Phyllis Galanti and Vietnam War POWs is based on the collection given to the Virginia Historical Society by Richmond resident Phyllis Galanti. Her husband, Paul, was a lieutenant commander in the U.S. Navy when his plane was shot down over Vietnam on June 17, 1966. Mr. Galanti was a Prisoner of War (POW) until February 12, 1973. Pictures, letters, pamphlets, buttons, and posters from the donated collection show Mrs. Galanti's efforts, and those of the National League of Families of American Prisoners and Missing in Southeast Asia, to publicize the plight of their loved ones and to secure their release. "I think these exhibitions will be of interest to visitors, especially those who lived through the 1960s and 1970s, because they will be able to personally relate to the topics covered in all three shows," Levengood said. "It is the perfect opportunity for parents and grandparents to bring their children and grandchildren to learn about events that had a huge impact on American society, politics, and culture—and they can see it all for free!"

The Virginia Historical Society is located at 428 N. Boulevard, Richmond, VA 23220 Tel.: (804) 358.4901. The Museum is open from Tuesday–Saturday 10–5 and on Sunday 1–5 (galleries & shop only).

The Story of Virginia, An American Experience, a 10,000-square-foot exhibition with more than a thousand objects covering all of Virginia history from prehistoric times to the present is featured in the Robins Center for Virginia History. Hours: Tuesday–Saturday 10 am–5 pm and Sunday 1 pm–5pm (Museum Galleries and Shop only). Admission: $5/adults, $4/seniors 55+ ($2/Tuesdays–galleries only), $3/children and students, free/members. Admission to the galleries is free on Sundays. For group tour information, call (804) 342-9652. For more information, please call (804) 358-4901 or visit www.vahistorical.org.

Editor's note: For further information about these and other exhibits at the museum, please click here. (And thanks, Merri, for letting me know about this!)

Upcoming Seminar on Warrior Health: PTSD, Depression and TBI

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

A Center for Deployment Psychology Training Program:

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

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

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

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

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

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

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

The Real Meaning of Memorial Day: Remembering the Sacrifice

For the real meaning of Memorial Day, remembering the sacrifices that have been made, there's a powerful essay written by a trauma surgeon in Iraq about the tragic death of one Marine he treated that might be worth your while to read.  Beware: it's completely gruesome, and spares no detail, though is done respectfully.  And it has an even doubly tragic ending (you'll have to read it to see what it is.) If you have been to war, you might not need to read this -- you're already plenty in touch with what carnage and sacrifice are all about.  If you haven't been, though, it might be a little more eye-opening about what those who serve go through and ultimately sacrifice.

The most impressive part of the story to me, besides the great care the trauma surgeon takes with every battlefield injury, is his love and respect for those he's working for -- and on, a love and respect shared by everyone involved in the course of his workday.  The sheer magnitude of what they go through, and its power to numb the human heart and psyche, is astronomical.  The fact that they fight through for it not to numb them is even more remarkable.  It's a complex human reaction, best expressed by the doctor himself, but it's also summed up centuries ago in the following quote, which we've used before on this blog:

"Anyone who looks with anguish on evils so great must acknowledge the tragedy of it all; and if anyone experiences them without anguish, his condition is even more tragic, since he remains serene by losing his humanity." -- Augustine of Hippo, quoted in One Bullet Away: The Making of a Marine Officer, by Nathaniel Fick.

If you want to read a gory but powerful reflection on the true cost of sacrifice, read "A War Surgeon's Perspective on Memorial Day," by John P. Pryor, M.D., quoted in full on the blog, The Kitchen Table. The reflection is linked here.  It's well worth reading, though completely sobering and sad.

Editor's note: For more material along the same lines, there's an OEF/OIF memoir by another doctor who served, "On Call in Hell: A Doctor's Iraq War Story," by Cdr. Richard Jadick, which is linked here.

Feel Like Just a Number / War's Psychic Toll

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Let's Hope This Isn't More "Blame the Victim" Thinking on Combat Veterans with PTSD, But...

A recent medical study, published in the British Medical Journal and reported on Friday, suggests that "the risk of combat-related post-traumatic stress disorder (PTSD) increased by two- to threefold in military personnel who had significant mental or physical problems before deployment, according to a study of 5,400 veterans."  In other words, those who were vulnerable beforehand, were even more susceptible to PTSD than their peers.  Hmmmn.

It's always interesting, and is going to stay interesting, to contemplate what, if any, predictive or predisposing factors there are for who develops later develops combat-based PTSD and why.  At the very least, this study throws yet more analysis into the mix, in a story that will continue developing for years.

According to the BMJ, the conclusion of the study was that:

"Low mental or physical health status before combat exposure significantly increases the risk of symptoms or diagnosis of post-traumatic stress disorder after deployment. More vulnerable members of a population could be identified and benefit from interventions targeted to prevent new onset post-traumatic stress disorder."

The study, which was supported by the U.S. Department of Defense, reported that:

"More than half of post-combat PTSD diagnoses involved veterans who ranked below the 15th percentile in mental or physical health at baseline, Cynthia LeardMann, of the Naval Health Research Center in San Diego, and colleagues reported online in BMJ.

"We have identified an at-risk population whose functional health seems to predict vulnerability to PTSD after combat deployment," the authors said. "In theory, such a population could be targeted for PTSD prevention programs, early intervention after exposures to stress, or even protection from stressful exposures, when possible."

The findings came from the Millennium Cohort Study, which has accumulated data on military personnel since 2001, before the wars in Afghanistan and Iraq. Investigators collected follow-up data from June 2004 to February 2006.

A previous report based on the study suggested that combat exposure -- as opposed to deployment -- significantly increased the risk of new-onset PTSD. Building on that observation, the authors examined the association between baseline mental and physical health and the risk of new symptoms or a diagnosis of PTSD.

The current analysis involved 5,410 combat veterans who completed baseline and follow-up questionnaires. The questionnaire includes a 17-item self-report measure of PTSD symptoms.

Baseline health status was determined by participants' scores on the mental and physical summaries of the SF-36V (veterans) health survey. A new PTSD diagnosis was based on DSM-IV criteria (derived from the questionnaires) or self-reported physician diagnosis.

The analysis showed that 7.3% of the participants had new-onset symptoms or a diagnosis of PTSD at follow-up by DSM-IV criteria. When self-reported physician diagnosis was included, the rate increased to 8.6%.

The authors stratified the participants into three groups according to mental and health status scores: below the 15th percentile, 15th to 85th percentile, and above the 85th percentile.

Combat veterans who scored below the 15th percentile of the mental summary had a relative risk of PTSD of 3.51 compared with those in the 15th to 85th percentile.

A score below the 15th percentile of the physical summary more than doubled the risk of PTSD (RR 2.22).

Overall, 58% of new PTSD diagnoses involved combat veterans who were below the 15th percentile for either summary.

Subgroups at increased risk for new PTSD symptoms or diagnosis included:

• ≥3 combat exposures during deployment, 2.60
• Women, 2.33
• Current smokers, 1.56
• Non-officers, 1.77
• Reserve/National Guard members, 1.85
• Army veterans, 2.04"

Editor's Note: The full reference is: LeardMann CA, et al "Baseline self reported functional health and vulnerability to post-traumatic stress disorder after combat deployment: Prospective U.S. military cohort study."  The full citation is: BMJ 2009; 339: DOI:10.1136/bmj.b1273. For the link to the full article, click here.

Wyoming Takes More Steps to "Guard" Mental Health

More good news from Wyoming.  NPR reports today in their show, All Things Considered, that Wyoming is "about to mobilize its largest deployment of National Guards in state history. Embedded with the troops will be a mental health professional who is a PTSD specialist. The commander of the Wyoming Guard believes treating the mental health needs of the National Guard troops is a priority and he has also worked to connect mental health resources in Wyoming communities to those in the military."

For a link to that story, entitled "Embedding Mental Health in the National Guard," and originally reported by Wyoming Public Radio, click here.

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

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

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

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

Investigative Report on Desperate Troops with PTSD Who Go AWOL

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

Upcoming Seminar: The Warrior's Journey: Healing PTSD (with Edward Tick)

The Warrior's Journey: Healing PTSD (6 CE hours)
Tuesday, April 28, 9 a.m. to 4 p.m.
Tuition: $150 general public; $130 Antioch alumni, faculty, staff

War's violence is so severe that it can cause the true self to become distorted or lost for life. Untold numbers of veterans from old and new wars suffer Post-traumatic Stress Disorder (PTSD). Newest estimates are that 20-40% of Iraq returnees come home with PTSD and its multitude of disabling symptoms. Countless more return with severe, disabling wounds to body and mind. Contemporary society and the institutions meant to serve veterans are in crisis and at a loss as to how to respond to this massive wounding.

In this workshop, gain insight into the psycho-spiritual approach to healing from war. Learn how PTSD is not just a stress and anxiety disorder. It is also an identity disorder, soul wound, interrupted initiation and social wound. Examine various forms of psycho-spiritual interventions and community activism that rebuild veterans' identities, shrink trauma and restore wounded dimensions of soul. Develop a deeper understanding of PTSD treatment philosophies and strategies that can bring hope and healing to veterans and their families. Explore the spirituality inherent in war and learn how to use it to heal veterans and society.

Instructor: Edward Tick, Ph.D., is a holistic psychotherapist, writer, educator, journey guide, activist and veterans' advocate. He has been working with veterans and survivors of war, violence and trauma since the late 1970s. He specializes in using psycho-spiritual, cross-cultural and international reconciliation practices to help veterans, communities and nations heal. He is founder and executive and clinical director of Sanctuary: A Center for Mentoring the Soul, and of Soldier's Heart: Veterans' Safe Return Programs. Tick is adjunct professor in both Communication and Global Studies at the Sage Colleges. Tick is the author of War and the Soul: Healing Our Nation's Veterans from Post-traumatic Stress Disorder.

Editor's note: for further information about the program, click here and scroll down until you see this particular seminar.

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

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

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

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

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

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

Free Yoga Sessions for Veterans - Of Any War

This is a nice gift, from the yoga community to veterans of any war.  Four free sessions.

Yoga has been shown to have some benefits for PTSD, and is often part of a good, stress-reducing lifestyle.

From their website: "Yoga For Vets was launched and is directed by registered yoga teacher and former Navy diver Paul Zipes in 2007. The yoga community is very concerned about our returning troops and prior war vets.  Giving 4 free yoga lessons  is a small way of saying welcome back to America.  At best, some vets are finding yoga helps symptoms of PTSD and trauma.  At the least,  yoga is fun and healthy.  If you are a war veteran from any era and have been helped by yoga or just want to share a positive yoga story, please go to our testimonial page.  Finally, we are always looking for ways to tell more military vets about yoga.  Please help spread the word and let us know if you want to help."

Read up on the actual offer to learn more, linked here.

For previous posts we've done on yoga and PTSD, click here.

"It Was Loyalty to Your Buddies That Kept Men Going" -- The Wet Bond of Blood, Civil War Style

A few months ago we blogged about an interesting, little-known WWI-era poem, written by Robert Graves for Siegfried Sassoon, called "The Wet Bond of Blood," about the brotherhood men forge in combat. (That post is linked here.)

From the news this past week comes a related story in the L.A. Times, talking about the work of Dora Costa and Matthew Kahn, a husband-and-wife research team at UCLA, who have been delving into 41,000 Civil War records of the Union Army to find out what makes some soldiers "stay and fight on a brutal battlefield," and others "desert and flee." Their new book is called "Heroes and Cowards: The Social Face of War."

According to the L.A. Times,

"The book's thesis is that serving in a homogenous Army company, particularly one of volunteers recruited from the same region, reduced desertion rates in the 1860s. Patriotism played a role in keeping soldiers at the front lines, according to the book, but more important factors were sticking with buddies of similar backgrounds and avoiding a bad reputation back home.

"Loyalty to comrades trumped cause, morale and leadership. But loyalty to comrades extended only to men like themselves -- in ethnicity, social status and age," the authors wrote."

For example,

"Through statistical analysis, the authors developed a formula in which group loyalty in those Union regiments was found to have counted twice as much in preventing desertion as a soldier's ideology, and six times as much as their unit leaders' popularity. For example, Company D of the 36th Regiment contained neighbors and relatives from Worcester County, Mass. The men, mainly mechanics and artisans, saw heavy action and no desertions.

In contrast, Company B of the 47th Regiment from New York was a more diverse lot, including men from cities and farms, along with laborers who were paid to substitute for conscripts. Its desertion rate was 16 percent."

"Cohesion" in military units is a topic even experts like Jonathan Shay, M.D., Ph.D. have spoken about as vital and essential for morale, and for the prospect of some form of healing taking place also in community.  As the article's author remarks, "Unlike the Civil War army, American units today are ethnically and geographically diverse. Yet the military has learned to reinforce the bonds gained in training, and usually rotates entire units in and out of war zones rather than fill in for casualties with new soldiers as it did during the Vietnam War, the professors said."

Interestingly, the book's authors are economists, not sociologists. The data they surveyed, and the ways they worked with the source material might also be useful for others to evaluate as well.  One of the recent, though debated, conclusions of PTSD research is that ethnic minorities are at risk for suffering from PTSD at greater rates than the general population.  There are various hypotheses proposed as to why, and no general agreement as yet about why this might be.  (See "PTSD among ethnic minority veterans," from the National Center for PTSD Research, linked here, for more on this subject. Also Professor Hedley Peach's research with the Australian Vietnam veterans studies as well, previously discussed on this blog.)

(Here's a look at the source material and their techniques for analyzing it, from the same L.A. Times article:)

"They used Internet databases as well as copies of antique paper documents written in the elegant penmanship of 19th-century government clerks. They applied the statistical tools of economic analysis to history, a cross-disciplinary technique increasingly popular in academia. Through those archives, the authors examined service records, ages, birthplaces, prewar occupations, battlefield deaths and prisoner-of-war interments among 35,000 white and 6,000 black Union soldiers. They also tracked census and pension information going back in some cases to 1850 and as far forward as 1910. Similar Confederate records were not available, they said. And to estimate pro-Union sentiment among the troops they studied, the researchers examined support for President Abraham Lincoln¹s elections in the soldiers' home counties."

Dora Costa, one of the book's authors called the source material they used, the Union Army's war records, "a fantastic laboratory for studying how do men behave under extreme stress." For that very reason, I hope other authors and scientists will mine this same trove of information.  The book's authors come up somewhat blank on one of the most fascinating themes of all.  During the Civil War, "the most ideological of U.S. wars," Costa remarked, "it was loyalty to your buddies that kept men going.id. "But we don't know why there was this loyalty."

Answering that question, we might want to turn to Graves' poem for Sassoon, mentioned above, or the thoughts of America's premier wartime journalist, Ernie Pyle, who we've also talked about at length on this blog.  From last summer -- the author of "Ernie Pyle's War," describing Pyle's authentic empathy for the soldier beside him, so well-conveyed in print:

"He knew, too, that it was neither God nor Flag nor Mother that impelled a pimply faced kid to risk, to lose his life in an obscene adventure.  He did it for the kid next to him; he couldn't let him down.  They needed one another so bad."

In "Heroes and Cowards," Costa and Kahn were surprised to learn that the average Union desertion rate was only about 10%, on average.  Says the L.A. Times, "Given the horrific conditions, it is surprising there was so little desertion," Costa said. That was especially true since fewer than one-half of those who deserted were caught, punishment often was not very harsh and execution extremely rare."

In the absence of any other, better sociological explanation, it just goes to underscore the "wet bond of blood" -- or what Pyle referred to as "the powerful fraternalism of the ghastly brotherhood of war."

Vietnam Veteran Turns to Acupuncture, Qi Gong and Yoga for Relief from PTSD

We've been discussing various forms of Complementary and Alternative Medicine, or "CAM" for short, which seem to have potential therapeutic usefulnessness for treating PTSD.  Here's a mention in a recent article in the Salt Lake Tribune of March 14, 2008, of other Eastern methods, including the energetic medicine, "Qi Gong," which appear to have brought some relief to one Vietnam war-era nurse.  From an article by Matthew D. LaPlante:

Mary Jane Shipley is a 62-year-old former trauma nurse who was stationed at a mobile Army hospital in Vung Tau, Vietnam. 

Shipley's "eyes well with tears," LaPlante writes, at the recollection of the young men she watched die there, burnt and broken and missing pieces of their bodies as they faded away." 

He continues, "Shipley says she knew almost immediately after returning home there was something wrong with her. In part, it was the helicopters. She could hear them, even smell them, ferrying patients to the Salt Lake City hospital where she worked - sometimes minutes before any of her associates could."

Her other symptoms are hallmarks of PTSD: "She had trouble relating to other people. She was restless. She was constantly afraid. Perhaps to the eyes of today's doctors and nurses, Shipley's illness would have been obvious. But back then, no one reached out."

In Shipley's case, according to LaPlante, "It took her 30 years to realize she wasn't alone. Now in treatment for post-traumatic stress disorder, the Western-trained nurse has found Eastern therapies to be most helpful. She practices yoga and qigong. And at least twice a week, she undergoes acupuncture. "It took me so long to figure out what works for me," Shipley laments, "and I still have so much trouble."

Writing Workshop Planned on "Trauma, Art & Writing" for June, 2009

Plan ahead for this writing workshop, June 15-26, 2009:

Sponsored by the William Joiner Center for the Study of War and Social Consequences and the Creative Writing Program of the University of Massachusetts Boston.

This workshop - open to writers of fiction and nonfiction, poetry, playwriting and translation - involves one or two weeks of working sessions and individual consultations with distinguished writers. The faculty includes Vietnam veterans and others whose lives have been altered by the experience of war, but applicants with diverse interests and backgrounds are encouraged to apply.

Visiting writers will join the teaching staff in a series of readings, seminars, and panel discussions. Special events held at UMass Boston and at other Boston locations will be open to both workshop students and the general public. This year's faculty reading series schedule will be posted.

Editor's note: Additional information about the writing workshop, including faculty bios, course schedule, accommodations, and application (as well as other materials) are linked here.

Why Soldiers Rape - Helen Benedict on Military Sexual Assault

If you've been following our recurring coverage on military sexual trauma (MST), here is an important addition to it: Helen Benedict, a professor at Columbia University's Graduate School of Journalism, currently on sabbatical, has a book coming out next year from Beacon Press called "The Lonely Soldier: The Private War of Women Serving in Iraq."  (You can pre-order the book at Benedict's own website, linked here.)

On Memorial Day weekend, she published an OpEd recently on the subject, in the New York Times. The piece, which was entitled "For Women Warriors, Deep Wounds, Little Care," is linked here.

A few months later, in August, she published another OpEd, called "Why Soldiers Rape," in a different outlet, which is linked here. Compared to the NYT piece, this one is more overtly politicized, both in thinking and in language.

While that strategy can have pros and cons, one positive is -- whether you agree with it or not -- that it's a useful stance to take to provoke thinking and/or discussion.  (Although I'd also like to compare the two essays side by side to see how Benedict treats the same material slightly differently, for different audiences.)

Decades ago, feminist authors and filmmakers were able to accomplish traction by taking on topics like rape (Against Our Will: Men, Women and Rape, by Susan Brownmiller) and pornography (Not a Love Story: A Film about Pornography, by Bonnie Klein, with Susan Griffin and others) as aspects of the culture that harm women substantially, yet are frequently overlooked.

(Benedict's website indicates that a previous article published in Salon last year, "The Private War of Women Soldiers," was awarded the James Aronson Award for Social Justice Journalism in 2008. That article is linked here.)

Some of the terms Benedict uses, like "misogyny" (literally, hatred of women) are very strong indeed.  How big a problem is this really? My hunch is less so than what Benedict suggests.  But by using such volatile language to communicate similarly incendiary thinking, Benedict succeeds in drawing greater attention to the problem.  Doubtless what she portrays, however, is not "everywoman" servicemember's experience in the military.  (The comments to the NYT piece make that abundantly clear.) But for those who are harmed by military sexual trauma, no doubt she makes some very good, and thought-provoking points -- even if you don't end up agreeing with everything she says, or how she says it. 

Another difficulty is the topic is so polarizing, based on individuals' own experiences -- that those who have suffered from it tend to see the pervasive nature of it; whereas those who haven't personally experienced also tend to believe their experience is the norm, and shut out the other point of view.  (See the comments section in the NYT piece for examples of this "all or nothing" thinking.) In this way, both sides run their own risk of illustrating the cliche that "when all you have is a hammer, you tend to see everything as a nail."

The following is an excerpt from that piece:

"Rape in civilian life is already unacceptably common. One in six women is raped or sexually assaulted in her lifetime, according to the National Institute of Justice, a number so high it should be considered an epidemic.

In the military, however, the situation is even worse. Rape is almost twice as frequent as it is among civilians, especially in wartime. Soldiers are taught to regard one another as family, so military rape resembles incest. And most of the soldiers who rape are older and of higher rank than their victims, so are taking advantage of their authority to attack the very people they are supposed to protect.

Department of Defense reports show that nearly 90 percent of rape victims in the Army are junior-ranking women, whose average age is 21, while most of the assailants are non-commissioned officers or junior men, whose average age is 28. . . "

Benedict ties rape to misogyny -- literally, hatred of women -- and what she suggests is the systematic, institutionalized degradation of women in the military:

"Two seminal studies have examined military culture and its attitudes toward women: one by Duke University Law Professor Madeline Morris in 1996. . . and the other by University of California professor and folklorist Carol Burke in 2004 . . . Both authors found that military culture is more misogynistic than even many critics of the military would suspect. Sometimes this misogyny stems from competition and sometimes from resentment, but it lies at the root of why soldiers rape. . .

Morris and Burke both show that military language reveals this "unabashed hatred of women" all the time. Even with a force that is now 14 percent female, and with rules that prohibit drill instructors from using racial epithets and curses, those same instructors still routinely denigrate recruits by calling them "pussy," "girl," "bitch," "lady" and "dyke." The everyday speech of soldiers is still riddled with sexist insults. . .

The view of women as sexual prey has always been present in military culture. Indeed, civilian women have been seen as sexual booty for conquering soldiers since the beginning of human history. So, it should come as no surprise that the sexual persecution of female soldiers has been going on in the armed forces for decades. . ."

Benedict then goes on to suggest why rape is under-reported in the military:

"Having the courage to report a rape is hard enough for civilians, where unsympathetic police, victim-blaming myths, and the fear of reprisal prevent some 60 percent of rapes from being brought to light, according to a 2005 Department of Justice study.

But within the military, reporting is much riskier. Platoons are enclosed, hierarchical societies, riddled with gossip, so any woman who reports a sexual assault has little chance of remaining anonymous. She will probably have to face her assailant day after day and put up with resentment and blame from other soldiers who see her as a snitch. She risks being persecuted by her assailant if he is her superior, and punished by any commanders who consider her a troublemaker. And because military culture demands that all soldiers keep their pain and distress to themselves, reporting an assault will make her look weak and cowardly.

For all these reasons, some 80 percent of military rapes are never reported, as the Pentagon itself acknowledges. . . ."

And then Benedict suggests two reasons, not exactly complimentary to recruiting, about how violence is perpetuated in and by the system.  Hmmmn.

"Misogyny has always been at the root of sexual violence in the military, but two other factors contribute to it, as well: the type of man who chooses to enter the all-volunteer force and the nature of the Iraq War.

The economic reasons behind enlistment are well understood. The military is the primary path out of poverty and dead-end jobs for many of the poor in America. What is less discussed is that many soldiers enlist as teenagers to escape troubled or violent homes.

Two studies of Army and Marine recruits, one conducted in 1996 by psychologists L.N. Rosen and L. Martin, and the other in 2005 by Jessica Wolfe and her colleagues of the Boston Veterans Affairs Health Center, both of which were published in the journal Military Medicine, found that half the male enlistees had been physically abused in childhood, one-sixth had been sexually abused, and 11 percent had experienced both. This is significant because, as psychologists have long known, childhood abuse often turns men into abusers. . .

Worse, according to the Defense Department's own reports, the military has been exacerbating the problem by granting an increasing number of "moral waivers" to its recruits since 9/11, which means enlisting men with records of domestic and sexual violence.

Furthermore, the military has an abysmal record when it comes to catching, prosecuting and punishing its rapists. The Pentagon's 2007 Annual Report on Sexual Assault in the Military found that 47 percent of the reported sexual assaults in 2007 were dismissed as unworthy of investigation, and only about 8 percent of the cases went to court-martial, reflecting the difficulty female soldiers have in making themselves heard or believed when they report sexual assault within the military. . ."

(Those last statistics are perhaps most troubling of all...)

Benedict also has an essay on her website that's worth reading, called "For Women Warriors, Deep Wounds, Little Care," which is linked here. (Same title as NYT piece, slightly different content.)  Watch for her book to come out in the Spring of 2009, from Beacon Press.

Go to War, Do Art - Afghanistan and Iraq Combat Art Show Opens in DC

You are invited to visit the new show opening on "Afghanistan and Iraq: Combat Art," from the United States Navy and United States Marine Corps Combat Art Programs.  

Pictured here is USMC Warrant Officer and Combat Artist Michael Fay, with his unfinished canvas for "Between Sunset and Moonrise, Wazir Pass, Afghanistan" (oil paint on gessoed watercolor paper). 

Fay is one of the combat artists featured in the exhibit, and we've written about his powerful work before on this blog: here,  here, and here, among others.  Marine Sgt. Kristopher Battles is another U.S. Marine Combat Artist whose work will be featured in the exhibit.  Both come from a long tradition of those told to "Go to War, Make Art" -- both in the Marine Corps and in the other branches of the military.

See the superb PBS series, "They Drew Fire," for more on combat artists.  Abbott Laboratories has its own magnificent collection of war art.  For more on the Marine Corps combat art program, and its permanent inclusion in the new Marine Corps Museum, click here.  For a look at Mike Fay's personal blog, Fire and Ice, click here.

We're going to assume that the combat art show is going to be in the same place the opening for it is: in other words, the (irony) Cold War Gallery, Building 70, at the Navy Museum, in the Washington Navy Yard.  My guess is it's moving later to the permanent digs at the new Marine Corps Museum. If this information later on turns out to be different, I'll update it when I know for sure.  In the meantime, here's a link to the Cold War Gallery: there does not seem to be a page up yet for the show itself (bummer).

In the meantime, at right is a look at Fay's finished work for "Between Sunset and Moonrise, Wazir Pass, Afghanistan."  His artwork, which the BBC and the Wall Street Journal have both profiled, contains any number of extremely moving images, particularly his sketchwork, and recently his bronzes.  Amazing stuff.  If you're in the DC area, do yourself the favor of catching this show, and acquainting yourself with the rich tradition of combatants who clarify through art what it's really like to be a veteran of war: the bad, the good and the ugly.

And while you're at it, be sure to check out our extensive collection here of links to art and war, and also art therapy -- a modality that doesn't work for everyone, but for those whom it helps, including combat veterans, a true blessing as a way to process the images lodged in the subconscious through a means that releases them therapeutically (i.e., catharsis).

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Pat Kemm Mann
Fruitland Mesa
Crawford, CO 81415

Between the Sheets: Healthy Sexuality for Combat Veterans

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

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

---

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

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

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

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

---

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

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

(To be continued...)

Military Sexual Trauma: A Sexual Violence That Injures the Soul

The other day a reader wrote to comment on her own experience of military sexual trauma:

"From my sorry experience, military sexual assault is a predatory crime of opportunity. ...  Victims are quite disposable... few perps are ever tried in court.  Yet the victim gets quickly processed out as a defective nuisance.  You suddenly become jobless & homeless for daring to report, no matter how good your daily job performance. The victim is subhuman and utterly alone and reviled, while the predator gets a promotion.  This is probably why military rape creates more PTSD cases percentage-wise than does combat.  In combat at least you are scooped up into the bosom of your band of brothers." 

"A couple of military stats," she continues: "Sexual assault is more likely in a command that encourages/allows harassing/misogynist behavior," and "Fifty percent of perps have a prior history of violence upon entering the military -again OPPORTUNITY to observe and select their prey in close confines."  Yikes.  True? Not true?  Either way, it's a hideous experience for the unwilling victim.

That brought to mind some healing words of Britta Reque-Dragicevic, but first, the bracing truth: "Military sexual trauma is a crime, not a misfortune of war," writes Reque-Dragicevic in her book, Close to Home: A Soldier's Guide to Returning from War.  The e-book is available here for the very affordable price of $10.  Buy it :-)  Because it's a download, you can have it within minutes.The following is Reque-Dragicevic's thoughts on sexual trauma in war. 

As with the rest of her very worthwhile book, they are soothing, sane and reasonable, and will comfort the afflicted.  This book should be a must for veterans and their families; and at its very reasonable price would also make a thoughtful "Welcome Home, Veteran!" gift for veterans in your life or in your community.  She writes:

An increasingly common trauma far less talked [than PTSD] about is military sexual trauma—which is experiencing sexual assault or harassment while you are in the military. This is not just a women’s problem. In fact, the VA reports that fifty-five percent of women and thirty-eight percent of men in the military have experienced military sexual harassment. While military sexual trauma is more common in women, over half of all veterans with military sexual trauma are men.

War has historically seen an increase in sexual assault and rape incidents for both military and war-zone populations. It’s become more publicly recognized in war-zone civilian populations (mass gang rapes were widely reported during the Bosnian war and rape has traditionally been a way to violate an enemy population), but rarely do we hear about sexual assault among our own soldiers.

If you have experienced a sexual violation during war that has left you ‘just not feeling the same’ since, please know that you are not alone. Most victims of military sexual trauma will never report it. Whether or not you call it rape doesn’t matter. What happened to you wasn’t right and it wasn’t your fault; and no, you couldn’t have prevented or stopped it. Rape is always an issue of power, not sex. Unfortunately, rape in war happens too often as people deal with overwhelming feelings of god-like power, lowered inhibitions, excessive anger, lack of usual sexual release and the devaluation of human life—sexual force is often used with little outward consequence to the perpetrator. But the consequences to the victim are life-changing.

If this has happened to you, you may develop PTSD from this alone, but be too embarrassed or humiliated to tell anyone why. This may be the hardest part of your war experience to deal with and one that strangles you in secrecy, shame, and embarrassment. After all, with fellow survivors coming back with missing limbs and mental shock, how can having been sexually violated compare to that? No one would believe you, would they? What would loved ones think? Soldiers are supposed to be tough; how could you ever admit that you weren’t strong enough to keep someone from forcing sex on you? Yet, for you, what happened has become your war. A war that no one will ever know anything about.

Please stop. Stop and take a deep breath. Forget the fact that it was a war environment for a moment and realize that no matter where it happens, when, or to whom, being sexually violated always leaves a person feeling powerless, doubtful of themselves, uncertain, unable to believe it really happened, and feeling very, very small inside. Why? Because sexual assault is about taking away your power. Sex is our most intimate and most powerful interaction with another human being. And when someone overpowers us physically and enters our bodies without our consent, we are deeply ashamed and shocked at how powerless we were.

Sexual violence injures the soul. The shame, humiliation, loss of control, and shaken self-esteem affect both men and women even though each gender experiences them differently because of what we are conditioned to believe about our masculine or feminine roles in life.

Sexual violation impacts our self-image, sexuality, and our future, safe sexual experiences. The overwhelming sense of vulnerability and shame can lead to suicidal thoughts and actions.

For war survivors who have been violated by one of their own, the confusion and uncertainty, not to mention potential repercussions to your military career or even survival, lead most victims to never tell anyone. Keeping your mouth shut may be the only way to survive and get back home. But once you are home, please realize that if this has happened to you, you have been affected and it’s not just going to go away. It takes feeling safe to get yourself to the point where you can admit to someone that it happened. And for a lot of people, finding someone safe seems almost impossible.

Even if you tell no one else in your life, please call the National Sexual Assault Hotline at 1-800-656-4673 or visit them online for an anonymous chat at www.rainn.org. You can remain anonymous, and at least you will be able to talk with someone who deals with this trauma every day and can start to give you the resources you need to find healing. The VA also reports that it has counselors at every hospital trained to assist veterans with this issue. You can also visit www.ncptsd.va.gov, search for “military sexual trauma”—and a number of fact sheets will come up where you can learn additional information.

Remember, what happened to you was a crime, not just a misfortune of war. The person who assaulted you did not have the right to do this to you under any circumstances.

One of the hardest parts about having been sexually traumatized can be sharing that information with a spouse or partner. It’s normal to worry about how they will accept you once they know what has happened and to wonder how it will impact your intimate life together. Even though this trauma may loom large before your eyes, your partner loves you for who you are—not just your ability to have sex. You may find far more love and acceptance than you imagine. You are still attractive, beautiful, desirable, virile, and your partner still longs to experience sexual intimacy with you. You may struggle with feeling that you are not worth loving which is one of the ways sexual violation diminishes your own sense of power. But feelings are not facts. You are a human being worth being loved, enjoyed, and you deserve to experience sexual intimacy in a safe and caring relationship.

Partners of sexual assault survivors may feel a sense of rage, powerlessness, guilt for not having been able to protect your loved one, and a natural reaction to want to get even with the person who has hurt the person you love. Counseling individually and as a couple can be a safe place to express what you are feeling. You can also call the Sexual Assault Hotline—it’s not just for survivors; they can assist family and friends.

Remember, as long as you don’t tell your partner what happened, he or she will have no way of knowing what you are feeling, worried about, remembering, or associating with your current sex life. You may have no desire to have sex because of the trauma, but how will your partner know that? If you don’t share, he or she may assume that they are no longer desirable and that you’ve lost interest. They may easily blame themselves or you. Don’t lose your relationship because you are too ashamed to share what happened. Seek a counselor who can help you decide how to share this information. Don’t shut out what may be the only true source of love and support in your life. Loving partners can be incredibly patient when it comes to sex and trauma, but you have to give them the chance to understand what you are going through.

If you have been sexually traumatized, it may seem that that experience now defines who you are. Shame, guilt, self-blame, denial, rage, depression, lack of self-worth, fear of being intimate again, aversion to being touched or approached without warning, doubts about whether or not you are still desirable, or if having been raped effects your sexual orientation (it doesn’t) are all normal reactions. Just remember the trauma is real and intimate, but you are not defined by what has happened to you. You are a whole person who has experienced vulnerability and powerlessness; but that experience did not change who you really are: still strong, still powerful, still in control and still able to move toward healing. Deciding to move toward healing may be the only justice you ever get for what happened. You owe it to yourself, your partner, and your children to make sure that this trauma does not take you away from them any more than it already has.

Talk to a counselor. Sexual trauma is humiliating, but counselors deal with it everyday. Nothing bad will happen to you by just talking. It doesn’t mean you have to take legal action or that everyone will find out. You are not alone. Don’t let the one who took your power from you keep it.

You deserve a lifetime of being sexually loved and enjoyed.

Reprinted with permission from Close to Home: A Soldier's Guide to Returning from War, by Britta Reque-Dragicevic.  The e-book is available here for the very affordable price of $10.  Buy it :-) 

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

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

According to the Courant's website:

 

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

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

(The series was first published in May 2006.)

---

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

 

Mentally Unfit Soldiers

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

Army Sees Record Number Of Suicides In Iraq

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

Special Report: Mentally Unfit, Forced To Fight

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

'Jeffrey Was Really Messed Up'

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

Slipping Through The System

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

Potent Mixture: Zoloft & A Rifle

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

Amid Patriotism, Anger And Questions

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

Still Suffering, But Redeployed

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

Use Of Unfit Troops Blasted

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

Twice Betrayed: Women Veterans and Military Sexual Trauma

It's my deep-seated belief that women veterans who suffer military sexual trauma risk being twice betrayed: once by their perpetrator in uniform, once by the system itself, which should be doing a much better job of protecting them from a problem that's too apparent, widespread, and part of the actual culture to pretend that it doesn't exist.

 

See Jeff Benedict on this:

"But an occupation that thrives on a unique capacity for aggression among participants runs the risk of being a home for troubled men who cannot contain their rage against the opposite sex." -- Jeff Benedict, author of "Public Heroes, Private Felons"

Preventing Psychological Injury, Betrayal and Trauma: The Real “Costs” and “Treatment” of Military Sexual Trauma

 

Sometimes I think I miss the point on some of these blog posts: I’m too busy trying to set the stage and establish the “milieu” so that a thoughtful person can absorb it all and come away with a new outlook or two on a “same old” problem.  But maybe I’m failing to come right out and say what I’m really thinking, and God knows enough people are floundering around on this topic who shouldn’t be, so maybe I just will.  Here goes the suddenly editorial portion of our program:

 

We heard Jonathan Shay, M.D., Ph.D., pretty much the foremost expert nationally on veterans and PTSD, talk the other day about the “psychological injury” that troops are exposed to from lack of sleep, before and after combat, and how that sets them up for significant problems.  True; agreed; understood.  What we’re talking about here with women in the military and military sexual trauma is a similar thing: preventing and treating what is a grievous psychological injury. It's a situation like the one Shay talks about, something where the proverbial “ounce of prevention” is worth the “pound of cure.”  Shay is remarkable: he’s one of a kind.  There’s probably no better advocate for veterans in the country, although anyone who works with veterans from the heart is worthy of great honor.  It’s a pretty much unsung, undervalued calling.

 

However, we can’t really expect Dr. Shay, as amazing as he is, to come out and have much to say about military sexual trauma.  He’s got his hands full already with what his topics are; and, his main “demographic” has always been Vietnam veterans, most of whom…the vast majority of whom…are men.  That’s who served for the most part in Vietnam. That is not the composition of the military today; or even the contracting world that “supports” (using that term somewhat loosely) the military and the Department of Defense.

 

So we need to find some new experts, and some new paradigms; put in place some new safeguards, establish and deliver some new training; and, in general, get a radically new “outlook” on this problem.

 

That’s why I bothered to link in the passage from Jeff Benedict’s book about pro athletes who commit crimes against women, and how they are protected, in part, by the very environment in which their crimes take place.  So too with the military: it’s as good an analogy as you’re going to get right now, and frankly, we’re in need of one.

 

It’s a crying shame that women victims of military sexual assault are being murdered (they are) by their perpetrators to prevent their coming forward; and killing themselves (they are) because they’ve anticipating a double betrayal: the military that failed to protect them in the first place – and allowed the assault to happen – and the betrayal they expect to take place, when they muster up enough strength, courage or hope to try to “fight the system” and report the crime.  In the clutch – feeling desperate, forsaken and very much alone -- some of these women just give up, and take their own lives, because they’ve so lost hope that the system will get them the justice they deserve.

 

If you read the literature on suicide – something that plagues veterans with PTSD, and military sexual assault causes and is associated with PTSD in women – it’s not that hard to see the link.  People kill themselves when they give up hope; and when they anticipate from looking around that their situation isn’t going to be handled any better (any more sensitively, well or effectively) than the last person they heard about who had the same issues.

 

Listen to a world-renowned expert on suicide, Edwin Schneidman, for a moment on this.  A person goes from being troubled (perturbation) to doing something final about it (lethality) when they give up hope.  "Lethality, when coupled with elevated perturbation," writes Schneidman in his book, The Suicidal Mind, "is a principal ingredient in self-inflicted death.  Perturbation supplies the motivation for suicide; lethality is the fatal trigger."  He continues:

 

"Lethality -- the idea that "I can stop this pain; I can kill myself" is the unique essence of suicide.  Anybody who has ever switched off an electric light deliberately to plunge a hideous room into darkness or, with equal deliberation, stopped the action of an annoying engine by turning the key to OFF, has, for that moment, been granted the swift satisfaction the suicidal person hungers for.  After all, the suicidal person intends to stop the ongoing activities [including their highly personal traumas] of life."

 

What's the relationship to this topic?  Do I need to make it explicit?  Well, then, I will: if you set people up in a situation where they will fail (be assaulted) and then furthermore not address their condition compassionately, seriously, effectively or well -- the torment they feel (perturbation) is enough to create a sense that there is truly "no way out" (lethality) and no one who cares.  I think we have all the ingredients here.

 

Said another way, let's turn to Kathie Costos.  Chaplain Kathie Costos, who’s been caring about PTSD issues and the military for years now, signs her personal emails with a great quote, allegedly from George Washington.  It says:

 

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

Well, let’s just snap our fingers and bring that comment current, collapsing it with the material we’re talking about right here.  It still applies:

 

“The willingness with which women who have suffered sexual assaults in the military are to come forward is directly proportional to how they perceive other women veterans who have been victims of military sexual assault have been treated.”

And it seems they would have good reason to be concerned. You see women who came to horrible ends because their predation wasn’t understood for what it was (Maria Lauterbach and Cesar Laurean, but there are plenty more cases like that in the news, not just them); those whose situation was wrongly classified as “suicide” when it was way more clearly murder (see the case of Army Private LaVena Johnson, profiled in Salon and elsewhere, linked here); outrageous sexual assault situations against women contractors (see Jamie Leigh Jones' allegations against KBR, linked here); and well, the list goes on and on. Justice delayed = justice denied. 

 

It's just human nature/common sense: Fewer women come forward to report problems when they can see that the last situations they knew about weren’t handled well by the overarching authority, the military, and represented just more hell for the women involved.  That seriously needs not to happen.

 

(The Sacramento Bee, following up on my lifetime theme about good journalists pushing the culture forward, recently completed an exhaustive, and interesting, investigation about troops with criminal backgrounds, and what the effect on their subsequent service is.  Unfortunately for our purposes it didn't go far enough, because it didn't highlight or single out crimes against women.  If that were studied, and the results were significant -- that's two "if's," we realize -- those findings could go towards screening those potential recruits out of the military.  In a highly-charged aggressive environment with lots of boredom and little oversight, the last thing someone needs is more sexual predators in the midst, in uniform.)

 

In general, though, the focus shouldn’t just be on “reporting” or “treating” women who have suffered military sexual trauma.  It should be on prevention primarily, with a secondary emphasis on the others – or a sense that together, all three of those cords braid into a very strong rope, the kind that women will need to pull themselves up out of a very bad situation.

 

Women who suffer military sexual trauma are twice betrayed: once by the rapist, once by the system.  It’s time to put an end to that problem.

 

Some recommendations?

Create an atmosphere in which military sexual assault is not tolerated.  Where prosecution is expected and justice is swift.  Take women’s concerns seriously.  Raise the standard of investigation and prosecution to be on a par with the civilian world.  Expect, demand, and reward parity with the civilian police departments (good ones) and criminal justice system on this topic.  No more lost rape kits or botched, semi-competent investigations.  If you don’t know how to do this, go learn from the people who do, in the civilian world.  Call them in to be your speakers at your conferences, not the dipsticks who can simply restate the problem to you and offer nothing more than singing “Kumbaya” together as a solution. If you don't have the experts in-house, and my guess is that you heavily don't, go find them, because they are out there: many are specialists in a parallel situation in the civilian world. 

 

Call in some cutting edge thinkers, who can help you re-evaluate the situation as it already stands, and think some new thoughts on it.  People who have some competence in the civilian world, and are sensitive to the issues and concerns that surround women who have been traumatized by aggressive men in a culture that rewards it, but can’t seem to manage mitigating those qualities when they’re not called for – off the field.  The closest analog is actually pro sports: and both Jeff Benedict and Victoria Vreeland (incidentally, both attorneys) who we wrote about the other day on this, if they’re willing, might have copious insights to provide, based on their work with women who have been traumatized by sexual predators.  (Heck, I even know of one combat veteran and ex-cop, ex-police chief, ex-criminal justice teacher, who's getting his Ph.D. in psychology, and intimately understands PTSD, because he has it from combat. He might be willing to help you think through the problem, and create some solutions: or help train the trainers.  That's Rob Honzell.)

 

Want to know the scope of the problem?  Listen to Paul Reickhoff on it, who is once again pushing for change in a key area of importance to veterans.

 

Want to learn how to screen for potential offenders, or protect and keep women secure from it? Get in touch with Gavin de Becker, author of The Gift of Fear, and Protecting the Gift, and have him talk to you about what better security looks like for people who need the assist (women) in a dangerous environment.  A senior consultant to the Rand Corporation, and an international expert on security and threat assessment, he’s very familiar with concepts like unwanted pursuit, and predicting violent behavior – two topics that ought to be of concern to the military infrastructure on this problem.  Thankfully, he’s also very sensitized to the whole topic of women and assault, which is a rarity. 

 

Want to learn how the law and the medical system can work in conjunction to intervene effectively, and bring hope back to survivors?  Study things like the innovative “Passageways” program, a medical-legal partnership between Harvard Law School’s Legal Services Center and Boston’s equally eminent Brigham & Women’s Hospital that offers domestic violence intervention for women. Sarah Boonin is the person who knows most about this program: her bio is linked here. (The Passageways program even has a cool little book that might be helpful for survivors as they work through some of their issues.)  And spend some time thinking about how to keep women warriors safe in an environment where their sexual safety is a) not a priority, and only poorly understood as a need; and b) where prosecution and treatment of offenses can be poorly handled, botched, or doubly victimizing.  Enlarge your minds, call in the real experts, not the supposed experts, ask the good questions, shake up the paradigm; rethink the problem, and come up with better solutions.

 

As good ol’ Albert Einstein is alleged to have said, in some vague quote I’m botching as I paraphrase, “no real problem can be solved at the same level of thinking that was in place when it was created; you always have to go one level up from it.”

 

That is…if you really want it to be solved.

 

It’s always possible – we like to look at every side of a topic, to better understand the 360 of it – that really nobody wants to solve this problem, or they’d be doing a better job of it.  Is it a way to shuffle women out of the military, which some feel they never should have been a part of in the first place?  Would it take too much wise screening of potentially felonious recruits, to start cutting down on the types of potential predators who are donning uniforms?  Is the longtime military focus on just one aspect of “flipping the switch” – the switch that trains men to be killers, but doesn’t help them re-integrate after combat, and resume their ordinary lives – part of the problem?  Men in combat are a finely-tuned killing machine, with women warriors in their midst – and the whole psychology is attuned to the enemy as the opponent.  Sometimes, women inadvertently become the opponent as well.

 

Seriously – who knows?  Certainly not I.  But one thing I do know for sure: this situation cries out for better handling.  And every week that goes by that it isn’t, women are being assaulted, dying and being killed – at their own hand, and at the hands of others.  And worst of all, by the system’s neglect.

 

It’s great that they’re out there – VA programs like the National Women's Trauma Recovery Program for Women Veterans, which we've blogged about here, and the Women's Mental Health Center for Women Veterans, which we've blogged about here -- programs devoted to helping women heal from military sexual assault.  But those programs are in their infancy, there aren’t enough of them, and the women who suffer these invasive tragedies and horrors by those with whom they serve – have a hellaciously tough time putting their lives back together again.  It’s in their honor that I’m even talking about this, which is a little off the topic of the main theme here on this blog, combat trauma and PTSD.  Really, though, military sexual assault of women warriors is just “another form of combat trauma.”

 

In wartime, “betrayal,” which means to have trust broken by one of the parties, in a horrific way that affects the one who relied upon it, and causes them by implication great harm – is a called “treason” – a crime punishable by death.  That is, when it’s the servicemember betraying the military.  When it’s the military betraying the servicemember?  What do we call that?

 

Let’s hope what we don’t call it is...business as usual.

When the Sexual Predator Wears a Uniform: Athletes, Warriors, Women and MST

Editor's Note: This lengthy passage, excerpted with permission of the author, is linked to the previous blog post, "Unchecked Aggression: Women Servicemembers, Contractors and Military Sexual Trauma," linked here.  Read that first to get a sense of why this passage is being introduced.

 

The author introduces the problem that a few athletes (like a few servicembers) are sexually predatory, in a subculture that rewards aggression.  He writes, in the chapter called "When Women Are the Opponent":

Despite the ever-increasing number of sexual assaults and domestic beatings reported to police annually the mainstream press affords little attention to such crimes.  One exception occurs when a prominent individual, particularly an athlete, an unique blend of role model and celebrity, is linked to such an incident.   The increasing frequency of accusations of abuse against sports figures has stirred unprecedented interest in a pervasive social problem that for decades has stirred little.  Although the widespread mistreatment of women clearly transcends the playing field, the attention and popularity enjoyed by sports figures has brought the sports culture under intense scrutiny by researchers looking for links between competitive team sports and the violence that occurs away from the field.  As a result, a perception is growing that the aggressive nature and competitive atmosphere of male athletics can lead to criminal aggression against women.

 

Although the attitudes associated with male sports can reinforce sexist attitudes towards women, the suggestion that sexism is the dominant influence behind the rash of violence by athletes against women both overstates and oversimplifies the relationship.  Participation in athletics does not cause men to abuse women, but it can help to incite transgression in those athletes who are predisposed to such acts.  And certainly the culture of male athletics (using sexist locker room dialogue; rewarding aggressiveness, legitimizing violence) helps to sustain negative attitudes towards women.

 

….

 

“A stronger link between male athletes [sexual predator  servicemembers] and the criminal abuse of women is the socialization process that takes place away from the playing field…”

 

“Operating under an increased sense of power [armed combat] and the mantle of public trust [patriotism, and the unwillingness to question what goes on when we’re fighting a war], athletes [servicemembers] inclined to sexual and physical violence have ample opportunity to exploit women who often misperceive them as respectable citizens [fellow servicemembers; sometimes their superiors].

 

“Among men who harbor violent tendencies toward women, athletic success may accelerate the exhibition of abusive attitudes, increasing the frequency of violent incidents.  Nonetheless, that is less a function of athletics per se than a reflection of the modern athlete’s [warrior’s] status as an icon of pop culture.”

 

…

 

But an occupation that thrives on a unique capacity for aggression among participants runs the risk of being a home for troubled men who cannot contain their rage against the opposite sex.  Because of the physical nature of athletics [combat]; the aggressive, confrontational, super-macho attitudes surrounding them; and the social approval afforded to celebrity-athletes, the sports industry has in effect embraced those men who demonstrate a disdain for women through repeated acts of criminal violence.”

The author then introduces the example of Cincinnati Bengals and Green Bay Packers cornerback Lewis Billup:

“Although he took advantage of his exceptional access to women, Billup’s desire to control them had little to do with his athleticism.  Rather, a much more complex set of factors was contributing to his routine violence.  “It has to do with power and control and hate…a disdain for women,” said Victoria Vreeland, co-counsel for Victoria Alexander, who sued Billup for rape. 

 

As the former president of King County Rape Relief in Seattle, and an assistant to Washington’s Attorney General in drafting the state’s Victim’s Rights Bill, Vreeland was quite familiar with the mentality of men who acted like Billup. “The person [the victim of abuse] isn’t a person anymore, they’re an object.  To that extent, if you  have some societal sense or your grew up with a lack of power or control, or that you weren’t as good, this offers power and control.  “I wanna be in charge.” 

 

It is similar to children who lack a sense of power.  Their feeling of powerlessness somehow gets twisted around in their minds and so the way to be powerful is to pick on somebody else.  If you grow up with crime and objectification, making people objects, then killing them or harming them doesn’t matter.  They are not human.”

---

Then he discusses Mike Tyson's problems with women in depth, writing:

“Greg Garrison, the special prosecutor who successfully prosecuted Mike Tyson for raping [18 year old Desiree] Washington, concluded that Tyson’s violent tendencies toward women, like those of many other abusive athletes, were exacerbated by his sports career.

 

“Professional athletics has become such a megagod that it is sometimes unresponsive to the morals of a community,” said Garrison.  “Sometimes it just doesn’t matter what a superstar does, it’s OK.”  This is a particularly dangerous scenario when men who are prone to violently abuse women get involved and are thrust into an environment where their contact with women increases.”

---

“Professional sports leagues and individual teams are in a more influential position to discipline and deter players from this type of behavior, yet they often decline to do so.  Off-the-field criminal violence is repeatedly tolerated as long as players perform on the field.  Clearly … countless male athletes live and work in a similar environment without ever engaging in criminal mistreatment of women.  Nonetheless, the fact that predators … are playing professional sports demonstrates the degree of indifference exhibited by owners, managers and coaches.”

 

“As in most case of abuse against women, the majority of women who are assaulted by athletes are their acquaintances.  Those few players who are inclined to violate women enjoy almost  limitless opportunity to meet, and ultimately victimize, women.”

 

“Athletes use their celebrity as their billyclub to gain the superior position [with women],” Garrison said.  “Tyson knows he forced Desiree, but he doesn’t care, because that’s what he does.”

 

“One NFL player who has seen the way Tyson interacts with women supported Garrison’s position.  “You can’t imagine,” said the player, on condition of anonymity.  “I’ve been to social functions with him.  He walks in there and goes, “I’ve got to get some pussy, got to get some pussy.”

 

“Now I’ve been around a lot of people, but nobody comes in there with the proudness that they’re that macho that they can just …  It’s like a drink, an item, there’s no feeling behind it.  It’s just something that he’s got to physically conquer.  He’s a product of his environment.”

 

Tyson developed a proclivity toward the abuse of women at a young age – a habit that mushroomed with his rise as a boxer.  As a child he witnessed numerous incidents of violent abuse inflicted on his mother by boyfriends.  As a young teen, demonstrated a disdain for young girls who repeatedly made fun of his high voice and chubby fame.  After the renowned boxing trainer Cus D’Amato rescued Tyson from a life of violent street crime, handlers honed Tyson’s exceptional strength and fury into a relentless fighting machine.  They used his distrust and anger toward others to motivate him and elicit his aggression in the ring.

 

D’Amato once presented Tyson with a baseball bat, prompting Tyson to ask, “What’s this for?”

 

“For the women,” the trainer explained, “When you’re the champion, you’re going to need something to beat them off you.”  Although tactics such as this were designed to strengthen Tyson’s damaged ego, the message they conveyed bolstered an already dangerous attitude toward women.

 

A champion before his twentieth birthday, Tyson indulged in countless sexual liaisons with women.  Yet, his contempt for them only increased.  He confessed to fellow fighter, Jose Torres.  “You know something, I like to hurt women when I make love.  I like to hear them scream with pain, to see them bleed.  It gives me pleasure.”

 

“Well, did it ever occur to you that men who behave that way probably hate women, that deep down they simply don’t like them?” responded Torres.

 

“You may be right,” said Tyson.  “You’re the first person to tell me that.  You know, you may be [expletive] right.”

 

Bitterly aware that women’s interest in him was based solely on his high profile, Tyson nevertheless used that profile to his advantage in his quest to obtain sexual gratification and domination over women.  Through repeated encounters with multiple women, often prostitutes or so-called groupies, Tyson developed an insatiable appetite for sex. …

 

Garrison saw Tyson’s training as a boxer as a lethal trigger mechanism that unleashed his disdain for women. When his sexual advances met with resistance, Tyson approached the unwilling woman much as he would an opponent in the ring. “The wife of every lawyer says, ‘Don’t get into an argument with them [their husbands], because they do it for a living.  You may be right, but you’ll never win,” Garrison said.

 

“What about a boxer?  Boxers are masters of physical deception; at moving in one direction, but actually moving in another; at feigning left and going right; at appearing to be at a disadvantage when in fact they are poised to strike when somebody sees and is sucked into the apparent deception.  Boxing is lying for a living.  You don’t not be a boxer when you leave the ring.  What I wanted to do was to show the jury that this guy will deceive because he’s good at it.”

More on the Tyson assault and ability to accompolish same:

 

“The cordial small talk he had made at the Expo and in the limousine soon turned to sexually suggestive dialogue.  The abrupt change in Tyson’s manner left Washington totally unprepared for what was to follow.  “Desire struggled real hard with, “How could he be like that? He’s Mike Tyson.  My dad idolizes him,” said Garrison.

 

When Washington showed no interest in his sexual advances and tried to flee, Tyson quickly moved to snatch off her clothes and overpowered her with brute force.  Despite her pleas that he stop, Washington became the object of Tyson’s unchecked sexual desires.  “[Tyson’s training as an athlete] certainly plays a role when you realize that any [professional] athlete is possessed of such incredible physical gifts,” said Garrison.  “Guys that get cut from [pro teams] are physical geniuses by comparison to the man on the street. And the players at the top of their profession?  Could O.J. Simpson kill two people with the same knife?  Of course he could, and neither one ever even know what hit them.  You watched him run.  How many guys did you see tackling air?  Laundry was all over the field.  And these men are as good as him.  He was quick as smoke.  Tyson’s the same way.  He looks like he’s going someplace else and bam!  You’re gone.”

Then the author concludes:

A subtle but important distinction is that athletics did not train Tyson to be a rapist; rather, his athletic training became a dangerous weapon in his misguided conception of what qualified as appropriate treatment of women.

“If I want it, I get it,” is the mentality that they’ve trained him to believe,” said Garrison.  “If I want to knock you out, then you’re going to be knocked out.”  Unfortunately, it’s persuasive in many of the wrong directions.  The reason that Mike Tyson won’t admit rape is not because he didn’t do it or because he didn’t think he did it, but because he didn’t think there was anything wrong with it.”

 

The disparaging attitudes toward women held by Billups and Tyson are consistent with those of the small number of athletes who are repeatedly associated with allegations of rape and battery.  While there is no shortage of men who commit crimes of violence against women, few rapists and batterers combine exceptional physical superiority and with an aura of public trust, as deviant athletes do.  Within the confines of the revenue-producing sports, men who are inclined to abuse women are left to inflict their abuse without punishment or the stigma usually attached to sex crimes and domestic battery.”

-- Excerpted with permission of the author, from Public Heroes, Private Felons: Athletes and crimes against women,” by Jeff Benedict.  Boston: Northeastern University Press (1997).

Unchecked Aggression: Women Servicemembers, Contractors and Military Sexual Trauma

The local news today showed another woman servicemember, 34, dead in Iraq of a non-combat wound.  Just days away from a planned, 18 day leave back to the States, she's no longer going home to see her devastated family - or anyone else, for that matter.  The investigation into her unexpected death is still pending, but really -- how many people die accidentally, or worse, kill themselves just before they're liable to get out of hell?  It's a little...ironic, if not completely counter-intuitive (that's, the complete opposite of what you'd normally think, for the non-academic types out there reading this.) It's also particularly tragic, and all the more so if something like military sexual trauma is involved in her death: it has been in a number of others.

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While I haven't done a count lately of how many women have been dying non-combat deaths in Iraq or Afghanistan, however high or low the number happens to be, a percentage of those deaths will turn out to be murders that are botched or intentional attempts to cover up sexual assault; and another percentage will turn out to be suicides by women who have been sexually assaulted or raped, whether by peers or superiors.  In the "bubble" of living and working for the military, whether as a servicemember or a contractor - women place themselves in an environment where men are the majority, where calculated, strategic violence is the goal (we call that, "combat"), aggression (directed toward the enemy) is the norm, weapons are ubiquitous, and boredom, opportunity, and mixed feelings about being there in the first place create an explosive brew.  Just like KIA versus WIA statistics, for every woman killed or suicided, many more are injured and sexually exploited.

That's the bad news -- but it has to be balanced against the fact that these crimes, and the predators who commit them, are the minority.  Many women pass through the military without becoming victims of sexual harassment or predation; but for those who do, it's often a life and psyche-destroying event.

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Paul Reickhoff wrote about military sexual trauma today and women in the military in an excellent post, published on the IAVA Blog, linked here.  According to statistics he cites, "Women make up 20% of all new recruits and more than 11% of the forces deployed to Iraq and Afghanistan."  Then he tellingly adds:

"The rates of assault are shocking.  Almost one-third of women veterans say they were sexually assaulted while in the military. (In the general population, one out of every six American women has been a victim of a sexual assault.)  Already, 15 percent of female Iraq and Afghanistan veterans who have gone to the VA for care have screened positive for Military Sexual Trauma.  But even these troubling figures may not be telling the whole story; experts estimate that half of all sexual assaults go unreported..."

All too true.  We've written about Military Sexual Trauma (MST) before on this blog, several times.  It's a hot topic right now, not the least because there just aren't many answers out there about what to do for women who have been affected by it.  What we do know is that it's a potent terror: women who are victims of MST often develop PTSD, the frequent theme of this blog -- and of those who do, the MST is often considered worse than even their usually concomitant PTSD.  Yikes.  That gives you an idea of how horrific the experience is for these tough, trained, formidable and admirable warrior women.

I can also tell from who's searching this blog for answers, and what they're looking for, that there's not much out there that specifically addresses the needs of women veterans who have been sexually traumatized by other servicemembers.  Fortunately, there are a few programs at the VA that are attempting to address this problem, but sometimes I see them searching here, too, for answers.  The answers that would help put these women's broken lives back together may simply be lacking, at present.

In lieu of "answers," what I'd like to offer here is another way of looking at the same problem.  With the permission of Jeff Benedict, I'd like to quote at length from a chapter in his book, "Public Heroes, Private Felons: Athletes and Crimes Against Women," published in 1997 by Northeastern University Press (Boston, Massachusetts).  Benedict, a longtime journalist, is now an attorney in private practice in Connecticut. The chapter is called "When Women Are the Opponent."  As you read the lengthy excerpt from this chapter, try to absorb the great similarities (not perfect as an analogy, but as close as we're gonna get, for the present) between two arenas in which men are systematically trained and rewarded for aggression. 

As Benedict repeatedly points out, and I will have to add as an obvious caveat too, the majority of men who are involved in either pursuit -- professional sports or the military -- can behave appropriately towards women in their midst.  The problem is not with the majority; it's with the minority, who for one reason or another cannot. 

As you read this passage, I've highlighted what I find the biggest issues to be.  Every time Benedict mentions, "athlete" think "warrior" instead, and see if the analogy doesn't work.  Again, we're not talking about MOST men who are in this situation; we're talking about the minority who are the problem.  But the problems these few create are so horrifically soul-destroying to the women who experience them, whether servicemembers or contractors, that much more needs to be done on the part of those who watch over women in the military, to protect them from predation from the few who seek to harm.  The consequences to the women who are affected's lives and psyches are just too great to ignore or overlook or neglect any further.  It's definitely a case where "prevention" of this type of suffering is far more effective than a nebulous "cure" that seems sadly, at this hour, out of reach.

Editor's Note: Given the length of the excerpt, I'll go ahead and create it as a separate blog post, linked here.

Shaking Off the Blues: Two New Books Help Veterans and Others Get "Unstuck"

A well-regarded psychiatrist who thinks there are other-than-pharmaceutical antidotes to biochemical depression?  Rank heresy!  Oops, actually we meant -- how very refreshing indeed. 

A soulful journalist who's lived and worked in war-torn countries, and knows what it's like to be a survivor -- who then turns her attention to helping veterans and their families come home from war and rebuild the pieces of their often-shattered psyches? Again, a wonderful suggestion.

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NPR the other day published a great interview with none other than James S. Gordon, M.D., author of the new book called "Unstuck: Your Guide to the Seven-Stage Journey Out of Depression." Depression is an important topic, because many people who are risk for suicide have depression as an underlying state.  According to one psychiatry textbook for medical students, "A majority (60% to 80%) of people who commit suicide carry a diagnosis of depression."   

If you remember, we've talked about Dr. Gordon on this blog before.  He has an impressive, very talented background academically (Harvard College, Harvard Medical School), and is the founder of the Center for Mind-Body Medicine in Washington, D.C., as well as a frequent lecturer at the Smithsonian, and the former chairman of the White House Commission on Complementary and Alternative Medicine, also known as "CAM."  (We've blogged about CAM, also known somewhat misinformedly as natural medicine, and its opportunities for treating PTSD here on the blog, at length here; and also about the varieties of mind-body medicinethat might show some promise for treating combat trauma and PTSD, here.)

To listen to the NPR interview, or to read the accompany material on getting unstuck -- in Dr. Gordon's words -- click here.  To read Dr. Gordon's bio -- click here.  To read our previous posts about his work on "Healing the Wounds of War," click here; on "Healing the Troops," click here; and on his and the Center for Mind-Body Medicine's annual conference, planned for October 25-29th in Minneapolis, Minnesota this year, click here.  The topic of this year's conference is the highly-appropriate "Integrating Mind-Body Medicine into Clinical Practice, Medical Education & Trauma Healing."  As Dr. Gordon's website says, "We're teaching thousands to heal the world's millions." Indeed -- and what a noble task that is; and how very, very vital.

If I had ONE RECOMMENDATIONfor the Pentagon, the DOD, the VA, the various branches of the military (Army, Air Force, Navy, Marines, National Guard) that frequently comb this site, looking for answers to the questions they have -- it's that they would get to know Dr. Gordon's work, and send representatives to this conference in late October, 2008.  Check into mind-body medicine, with a credible expert, and somehow who's already worked with, and proven his work with, the war-torn and traumatized (troops and civilians) here and abroad.  Broaden the outlook on how to treat PTSD and combat trauma, by returning people to themselves, and helping them to learn to manage their own stress in creative and supportive ways.

Dr. Gordon says his book, Unstuck, goes into many of the same principles that his trauma work does. I can't wait to start reading my copy, which his office promises to send.

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In the meantime, I hope Dr. Gordon gets to cross paths professionally with Minnesotan Britta Reque-Dragicevic. I have read her book-- devoured it in one sitting is the more accurate description -- and think it has lots of potential to comfort, support and nurture returning veterans and their families in putting the pieces of the puzzle back together.  (One thing I love about both Dr. Gordon and Britta Reque-Dragicevic -- they both "get" it.  They've had a personal experience with what they're talking about; it's not just academic.  And they're both driven to help others heal from their suffering -- the not exactly unspoken single purpose of this blog: there's synchronicity.)

Reque-Dragicevic has written a completely soulful manual on getting unstuck herself, and with her profound understanding of the needs of trauma survivors, as a longtime journalist in post-war Saravejo and Bosnia, I sense a little (**magical?!**) professional matchmaking going on that would only serve to increase the amount of healing and overcoming in the world, especially among trauma survivors and veterans with PTSD.  If you want to read more about Reque-Dragicevic's marvelous book, Close to Home: A Soldier's Guide to Returning from War, click here.  Her book is endorsed and recommended by Dr. Edward Tick, among others.  At a mere $10 as a download on the Web, you really can't go wrong.  (We'll be quoting from Reque-Dragicevic's book on this blog in the future, with her permission, because it's wonderful stuff and she really "gets" it. Veterans and their families need to experience this.)

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If you have $10 to spare, or as a gift for someone else, buy Britta Reque-Dragecivic's book.  It's a download, and you can have it in your hands within minutes, from anywhere in the world, and start the healing process today.  If you have about $18 and shipping, buy Dr. Gordon's book, and start the healing process when it arrives in the mail -- or at your local bookstore.  If you have about $40, buy them both :-)

Kanye West and MTV Share the Glow - And Help Some Struggling Veterans

"Dedicate some of your life to others.  Your dedication will not be a sacrifice.  It will be an exhilarating experience because it is an intense effort applied toward a meaningful end." -- Dr. Thomas Dooley

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Wow -- just wow.  It is thrilling to be here and watch this happening.  I hope it's even half as good as it looks, but it looks very, very good -- even wonderful.  Superstar entertainer Kanye West and MTV, along with MTV host Sway Calloway, team up to address with truth and candor some of the needs of hurting OEF/OIF veterans with PTSD today, in real time, while it's still happening - and it's possible to do something constructive about it. How cool is that?!

The MTV documentary special titled 'Choose or Lose & Kanye West Present: Homecoming,' will air this Monday night, July 28 at 10 p.m.  It seems like a "Don't Miss" piece of "appointment television."  (Be sure to watch the video linked below -- it's well done and, in places, riveting -- thanks to the vets themselves, and Kanye's candor and concern, which are clearly genuine.)

According to the article on AOL Music's website, linked here:

"The stories of the veterans from the wars in Iraq and Afghanistan are important and worth telling." MTV's Executive Vice President of News Dave Sirulnick said, saying that the network and West "felt it was time to listen to them and show them the same interest by giving something back."

This is just GREAT.

Sure he's gonna give them stuff -- sort of Oprah-like in that regard -- and help them get back on their feet -- and that's wonderful (though some might argue they shouldn't be in the position of needing to be rescued, anyway -- we should be taking better care of veterans as a country, and as a military.)  But it's not the handout or the hand up that's so impressive here: it's the veterans, it's MTV, and its Kanye.

The veterans have great stories to tell, and you want to see them succeed.  MTV deserves props for putting their resources behind getting this show made.  And Kanye, well, he impresses. He talks to survivors like another survivor, with warmth, empathy, care and concern - and you can tell the veterans feel, equally importantly, helped AND heard. 

"I've had a lot of struggles in my life this year," he says to one of them (I'm paraphrasing), and continues, "I know you have, too."  "I came here to encourage you and do something about your problems," he adds in another section (again, my paraphrase); "but you've encouraged me," he says to the vet, "you've inspired me to be a better person, and make better decisions."  This is good stuff, and has so much power to heal.  (The old Paul Tillich line we've blogged about here before: "The first duty of love is to listen.")

Well, and if you're a celebrity, it's phenomenal, and surprisingly (shockingly?!) rare, to actually use your public persona and clout (plus cash!) for good.  For years, among women celebrities at least, Oprah has been a rare and shining light of socially-conscious giving that calls others higher, but few seem to follow.  And socially-conscious giving as opposed to a welfare-y handout or cash prize for having a desperate situation, riddled with plugs from sponsors.  From her "Remembering Your Spirit" segments from the 1990s to Oprah's Angel Network and beyond, she has set such a good example of digging down deeply into the difficult, troubling areas, and bringing up something that has the potential for catharsis -- in the subject, and often the viewer as well. 

Is Kanye following Oprah on this path?  For the extent of this documentary special, if nothing else, he seems to be -- and that in itself is fantastic, and refreshing. Converting pain into breakthroughs and overcoming adversity with help and courage -- wow -- who wouldn't be a fan of that?  I certainly am.  It's both a generous, and an inclusive, gesture, that draws the viewer in.

Even the title, "Homecoming," is well-chosen.  You can see from reading Pat's story yesterday, linked here, that "homecoming" isn't always what it's cracked up to be. The pain from his, gone wrong, has followed him for decades -- and his story is typical. Homecoming is the celebration that starts a veteran's transition back into the community he left.  It can go well or badly: he or she can be embraced, neglected, or shunned.  It sets the pace for the decades afterward and we can see from a story like Pat's what happens when it goes horribly wrong. 

But the word, "homecoming" SHOULD mean, "Welcome Back!" "We're thrilled to have you; we're very glad you're home."  "Thank you for coming back to us; let us help you to be whole."  What does the (erm) Good Book say? "Bind up the wounded" -- and not with needless bureaucracy and red tape, but with warmth and love, care and concern.  Will Kanye and MTV, even with their great resources, be accomplishing all that?  Nah, but they're making an impressive start.  Kudos to Kanye for using his celebrity for good, in a very tough (his mom's unexpected death) and very successful (his "Glow in the Dark" tour, which has been eclipsing all expectations) year.  And heartfelt thanks to him and MTV for not forgetting veterans.

[Editor's note: Kanye West's foundation in honor of his mother, Dr. Donda C. West, is linked here.  It does not, however (at least not yet) contain information about this veterans effort with MTV.]

<p>&lt;p&gt;&amp;lt;p&amp;gt;&amp;amp;lt;p&amp;amp;gt;&amp;amp;amp;lt;p&amp;amp;amp;gt;&amp;amp;amp;amp;lt;p&amp;amp;amp;amp;gt;&amp;amp;amp;amp;amp;lt;p&amp;amp;amp;amp;amp;gt;&amp;amp;amp;amp;amp;amp;lt;p&amp;amp;amp;amp;amp;amp;gt;&amp;amp;amp;amp;amp;amp;amp;lt;p&amp;amp;amp;amp;amp;amp;amp;gt;&amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;p&amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;a href="http://www.mtv.com/news/" target="_blank"&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;Kanye West and Choose Or Lose Presents: Homecoming&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;/a&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;/p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;&amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;/p&amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;&amp;amp;amp;amp;amp;amp;amp;lt;/p&amp;amp;amp;amp;amp;amp;amp;gt;&amp;amp;amp;amp;amp;amp;lt;/p&amp;amp;amp;amp;amp;amp;gt;&amp;amp;amp;amp;amp;lt;/p&amp;amp;amp;amp;amp;gt;&amp;amp;amp;amp;lt;/p&amp;amp;amp;amp;gt;&amp;amp;amp;lt;/p&amp;amp;amp;gt;&amp;amp;lt;/p&amp;amp;gt;&amp;lt;/p&amp;gt;&lt;/p&gt;</p> <p>&lt;p&gt;&amp;lt;p&amp;gt;&amp;amp;lt;p&amp;amp;gt;&amp;amp;amp;lt;p&amp;amp;amp;gt;&amp;amp;amp;amp;lt;p&amp;amp;amp;amp;gt;&amp;amp;amp;amp;amp;lt;p&amp;amp;amp;amp;amp;gt;&amp;amp;amp;amp;amp;amp;lt;p&amp;amp;amp;amp;amp;amp;gt;&amp;amp;amp;amp;amp;amp;amp;lt;p&amp;amp;amp;amp;amp;amp;amp;gt;&amp;amp;amp;amp;amp;amp;amp;amp;lt;a href="http://www.mtv.com/news/" target="_blank"&amp;amp;amp;amp;amp;amp;amp;amp;gt;Kanye West and Choose Or Lose Presents: Homecoming&amp;amp;amp;amp;amp;amp;amp;amp;lt;/a&amp;amp;amp;amp;amp;amp;amp;amp;gt;&amp;amp;amp;amp;amp;amp;amp;lt;/p&amp;amp;amp;amp;amp;amp;amp;gt;&amp;amp;amp;amp;amp;amp;lt;/p&amp;amp;amp;amp;amp;amp;gt;&amp;amp;amp;amp;amp;lt;/p&amp;amp;amp;amp;amp;gt;&amp;amp;amp;amp;lt;/p&amp;amp;amp;amp;gt;&amp;amp;amp;lt;/p&amp;amp;amp;gt;&amp;amp;lt;/p&amp;amp;gt;&amp;lt;/p&amp;gt;&lt;/p&gt;</p>

Kanye West and Choose Or Lose Presents: Homecoming

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.

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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.

There's a Revolution Going On: Users Rate Their Drug and Non-Drug Treatments for PTSD

We're just about to wrap up our series here -- a cycle of blog posts about the various treatments available for PTSD from the pharmaceutical, Complementary and Alternative Medicine ("CAM"), and mind-body medicine worlds. We've talked about bodywork therapies that show promise. Heck, we've even talked about street drugs like marijuana and ecstasy that appear to have some beneficial effects as well! (Sheesh -- we're not recommending them, per se -- we're just trying to do a comprehensive look at everything reasonable that's out there, that might help sufferers.)

We started this cycle of blog posts back in the beginning of June, with one about how the military was expanding its concept of treatment options to include some "revolutionary" non-drug approaches, linked here.  (We'll add to the cycle of posts over time as the need indicates, but the bulk of it is already done on this topic. This post also builds on a previous post, which talked about how a layperson can learn more about the effects and side-effects of medications prescribed, as well as where to learn about possible warnings when used in combination with other medications.  That post is linked here.) 

One of the most interesting developments is something I get to share with you now -- that a year or so ago when I first learned about it, was not robust enough to be of much value to PTSD sufferers.  Perhaps by now it really is.  The "it" I'm talking about here is something called "Revolution Health," the brainchild of AOL co-founder and marketing genius Steve Case, a project he began in 2005, after he left AOL.

Revolution Health is a number of things, but particularly for our purposes here's it's an online "community" of other patients who give their impressions, pro and con, of the treatments they're using for various illnesses and conditions -- including PTSD -- and not just of all the popular pharmaceutical medications, but also the non-drug therapies as well.  Finally, in one place, patients can check out what other people's experiences of the same drugs or therapies they've been prescribed, along with more straightforward information about the treatments themselves, the possible side-effects.  Clearly, for something like this to work, there need to be a LOT of people checking in and providing their impressions. 

When I first checked out the site, those numbers just weren't there.  It's not so exciting, interesting, or frankly even helpful to learn what three people think of a medication or a non-drug treatment like acupuncture or craniosacral therapy -- it gets a LOT more interesting as more people participate.  Such seems to be the case these days (no pun intended) -- but act quickly -- the site has been experiencing layoffs, and with Web businesses, even those founded by geniuses like Steve Case, you never really can count on how long they'll be around.  So be sure to check out what interests you while you still can.

This is what the site said a year ago about itself, which is still good advice:

This service is in its infancy, but our philosophy is that if millions of people participate, it will emerge as a useful tool for people as they consider their treatment options. Please note that treatments include a mix of some that are designed to directly treat a condition, some that treat side effects, some that provide symptomatic relief.

While individual real-life experiences can be a valuable health resource, they must be viewed in the context of evidence-based data and are not a substitute for medical advice. You should always consult a qualified health care professional before beginning, changing or stopping a treatment.

Now let's get down to business:

Want to learn how other participants rank, rate and review the various treatments for PTSD, both drug and non-drug? (Currently there are dozens suggested!), say, Duloxetine? Click here, for a list of the various, searchable treatments. (Better yet, click herefor them ranked by users in order of effectiveness!)  Want to take a look specifically at the pharmaceutical drugs for PTSD? Click here.  How about the various non-drug treatments for PTSD?  They're there, too, by name.  (You can sort either set of results by "most helpful," "most recent," and "highest effectiveness" on any individual treatment (of the 363) or on the category as a whole.)

Note: Be aware that not everyone who's weighing in with their opinion on what treatment they're loving or hating for PTSD has combat trauma-induced PTSD.  They may have PTSD from some completely other cause.  However, as far as relatabilty goes, this is the best we're gonna get for now -- a "Revolution Health" for veterans only does not appear to be in the works.  Ahhh, but we can dream, can't we?!

To reinforce the warning, though -- given the fact that nothing's permanent on the Web, especially "revolutionary business models," get in -- get your information -- and get out -- in case the website goes away, and/or the company goes out of business.  We sincerely hope that Revolution Health sticks around, because it's performing a useful AND innovative, visionary function --  but even more than that, we want YOU to get the information you're looking for, while you still can.  Oh, and if you sign up to be a member -- I believe that it's free -- you can also contribute your ratings to the user-generated rankings.

There's a Revolution going on...in health care.  Get yours now, while it lasts.

Editor's note: The usual "yada."  Be sure to consult with a qualified health care practitioner before changing or implementing a course of treatment, to make sure that the choices you make are appropriate and best for you.  We are presenting this material as information only, and it's not to be construed as medical advice.  If we could, we would; but we can't, so we won't.  There, we've said it.

Doing My Time in Hell - War Just "Dirt, Death, Misery and Guilt," Not Glory - Say Veterans

This photograph of an American soldier displaying his ink about combat is by the noted photographer Zoriah, and is used with permission of the photographer.  (Zoriah's blog is linked here.) 

The tattoo reads: "Walk peacefully on heaven's streets,You've done your time in Hell."

Ahhh, if it only were that "easy." 

I've been keeping one eye on Zoriah's situation lately -- he's the embedded humanitarian war photographer whose iconic images of the true horrors of war apparently got him kicked out of Iraq -- and the other on some writing of Vietnam veterans, all of them Marines (but not for any particular reason), about what it was really like to "be there."  The outcome of my faux research?  Sounds like up close and personal, war can be plenty of "guts," but not necessarily all that much "glory."

"The flashbacks and the hallucinations manifested themselves while I was still in [combat], says one Vietnam veteran, adding, "They have stayed with me for the last forty years." (Rob Honzell, 1st Recon Marines. Rob Honzell's memoir is "First Person: Combat PTSD.)

Another Vietnam veteran questions why Americans reflexively call servicemembers who die in combat "heroes."  He writes,

"Heroes?!! I served two tours in Vietnam including the Tet Offensive of 1968. I killed someone -- a NVA solider -- I was elated -- but years later, I can still see my round hitting this guy. I never see any heroism in war -- just death, dirt, misery and guilt. I have never met a soldier or Marine who felt heroic. We do our jobs to protect our buddies and we want to get home and live our lives as ordinary men not as heroes. When you smell death you no longer have a glorified sense of war. There is honor and duty, but to kill or be killed does not make you a hero. I feel for these young people and their families -- but war and combat are not heroic actions -- they are doing a job and getting home."

(Or hoping to.)

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I've been reading voraciously the accounts of the Marines who survived the ferociously fought battle for Hill 881, part of the battle for Khe Sanh in 1967 -- a particularly vicious conflict.  (You'll find out why, in a few posts, but not right now.) 

One Marine captain writes about his guys, from there:

"As far as the individual Marine goes, I think I learned to respect the individual Marine -- the 18-,19-, 20-year-old, more in this one particular battle than any other time that I've been in the Marine Corps. He was given a job; he went up in the fact of danger, in the face of just being blown away, more or less, and he went up and did his job. To see the faces of the Marines dragging back their dead buddies, their wounded buddies, you could see how close the Marines really were with each other. It was true brotherhood, and I was really proud at the conduct of the Marines." (Capt. David G. Rogers, C Battery, 1/12 Marines.)

Says another Marine, reflecting on his part in the vicious battle for Hill 881 -- "I should have cried" (at the time), but I didn't.  I didn't have time.  I would cry later, and when I did - the tears would never completely stop..."

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It doesn't sound like war has changed all that much.  Remember Ambrose Bierce, Civil War era journalist and soldier, who we talked about a few weeks ago?  He wrote at the end of his highly-charged battle memory / short story, a line -- speaking about himself, after what he'd observed and taken part in -- "the life I should have thrown away, at Shiloh." (Bierce went on to stir things up for a few more years, though...)

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A current veteran and fellow fan of Zoriah, now studying social work in an attempt to ease the burden of his fellow PTSD sufferers, has this to say about combat trauma, on his blog, "PTSD - a Soldier's Perspective," linked here:

"We tell a soldier or veteran of war "welcome home" because the battle never leaves us, as we return from conflict everyday of our lives. This is my story and struggle with PTSD, it affects every aspect of my life. I want people to know what a combat veteran goes through after the media and people forget."

And later:

Taking another's life in the name of freedom, patriotism and because of your job description profoundly changes the person. How do we reconcile the killing of another human being and still maintain our principles and values? Someone who has not done so can say all they want about what they think or believe. When a soldier goes home to his or her family, friends and community, how do we relate to people who expect the person that is no longer us? How do we tell them that each time we took a life that, we too died in spirit a little more? They congratulate us on a job well done and we tell ourselves that we did our job, what we were trained to do. They tell us how proud they are, and we cannot make them understand how we feel guilty for that pride. How do we tell them that we cannot get those faces or images out of our mind?

Dirt, death, misery and guilt -- that's a heavy, heavy burden for any one person to share.  Let's hope we shoulder it with them, and NEVER forget.