Healing Combat Trauma

Coming Out of the Shadows: Women Veterans and Homelessness

Recently we've been publishing a series of articles on women veterans and homelessness in the Huffington Post, which has been generating some much-needed attention on this deserving population who is poorly understood, marginalized in conversations about veterans and the homeless, and frankly, also very much under-researched. 

The reporting for the series was conducted under a Howard G. Buffett inaugural grant from the International Women’s Media Foundation, and there was an article in Military Times about it as the project was starting to kick off, as well as some foundation laid in an Op-Ed in the Texas Tribune.

There are more than two million women veterans in the U.S., and a growing percentage of them are homeless. In fact, they're the fastest growing group of homeless veterans, a fact many people are not familiar with. If you want to learn more about women veterans and their unique struggles in this area -- as well as the tie between military sexual trauma (MST) and homelessness -- here are a few places to start:

• “G.I. Jane Needs a Place to Sleep,”
• “Into the Gap: Women Veterans Describe Homelessness,”
• “Camaraderie Offsets Trauma for Women Veterans,” and
• “The Path Home for Women Veterans.”

Garnet News picked up the original story, and the Center for Women Veterans (VA) featured it on their home page. There's also an article about the project on the ACEs Too High website, the leading collection of resources about the Adverse Childhood Experiences study, which is foundational public health work on trauma and its aftermath.

The original survey research (n=400) on women veterans and periods of unstable housing after military service was presented at TexVets symposium, the Southwest Social Sciences Association, the fourth annual Military Social Work conference at University of Texas-Austin, and at the National Association of Social Workers (NASW) Texas state conference, all in 2016. The current, revised and expanded survey of women veterans about housing issues after military service is still open but has received more than 2,200 responses and 1,500 completions to date.

Other elements of the project include:

• An interactive timeline of how we got to this point,
• A radio show/podcast featuring Lily Casura, BriGette McCoy and Rosie Palfy talking about female veteran homelessness, and
• A data visualization showing the comments of 400 women veterans describing their experiences of unstable housing after military service.

Finally, there’s a website of state-specific housing resources for women veterans at risk for homelessness, where you can recommend additional resources.

And if you're a woman veteran or currently serving as a female reservist, please go ahead and take this brief, IRB-approved survey on housing issues after military service. If you're an advocate or you have women veterans in your social networks, please also alert women veterans and women reservists to the survey so that they also can have their voices heard. Thank you!

Women Veterans: Get Your Voices Heard!

There are more than two million women veterans today in the U.S., a good percentage of whom have struggled with or continue to struggle with housing issues after military service. We've written about the topic, here, but we're giving you an opportunity to have your voices heard on the subject. Tell us your own story. This is a link to a brief, IRB-approved survey on housing issues after military service. If you're a woman veteran, a woman currently serving as a reservist, or if you completed your military service as a woman, please take this survey. Please also share it with other women veterans you know. By doing so, you will help raise the profile of who women veterans are and substantially add to what's known about housing issues after military service. Thank you! http://bit.ly/hwvsurvey2b. 

Women Veterans and Oral History: Is It Time to Collect and Preserve Your Stories?

Recently I had the absolute pleasure to watch two women veterans, from very different eras, connect and thank each other for their service. The vets were a 92-year-old WAAC from World War II, who served stateside and also in Karachi, which was India at the time and would later become Pakistan -- and a 44-year-old Gulf War vet, who served in the Marine Corps as a combat correspondent. It was beyond heartwarming to feel the love that emanated from both of them, during this "chance" meeting in a big Midwestern VA healthcare facility, as they both exuded gratefulness and appreciation for what the other meant to them, symbolically and now in person.

If you're a woman who's served in the U.S. military, and you've been thinking about preserving your story -- or capturing someone else's before it's too late -- please do.

And especially if you know any World War II, Korean War or Vietnam-era veterans, the time is really now. 

"Our elder WWII sister vets will all be gone in a few years. Whenever you have an opportunity to spend time with one or more of them, relish the moments, sear them in your memory and share their contributions. An amazing and generous generation," says longtime advocate and woman veteran, Diana Danis.

Women veterans' stories have traditionally gotten much less play, but they're just as important -- maybe even more so because they're harder to find. Even where they're collected is somewhat of a hodge-podge of locations.

Here are a few places that collect them -- although further down in this post you will see that it's probably most efficient to think of doing it through the StoryCorps "app," which will get it to the Library of Congress seamlessly. (If you have an interest in getting it somewhere else, you can check out this list below.)

"There are a number of stories that have been collected over the years. Boston University did a bunch years ago with an oral history project as did the Minerva Project under the able guidance of Dr. Linda Grant DePauw. The University of North Carolina has an archive as does the National Archive, the Library of Congress, the VA has a number through the Women Veterans Center as does the Women in Military Service to America Memorial (WIMSA), the Women's Army Corps Association (WAC), the Women's Army Corps museum, the Women Marines Association, the Women Air Force Association and a few others right off hand," says Danis.

Sylvie Lubow, program manager for the Military Voices Initiative at StoryCorps, also mentioned several other sites of potential interest:

• "Always Coming Home Always Coming Home: The American Female Veteran Experience Archive" at the University of South Carolina -- which appears to collect digital stories and is an ongoing project (there are several dozen videos available at present, appearing to represent women veterans of multiple eras as well as women veterans of color);
• The "Bras & Boots" blog of American Women Veterans, which collects women veterans' stories.

There's also a collection of women veterans' stories in a special collection for the Women's Overseas Service League (WOSL), housed at the University of Texas at San Antonio. That collection can be viewed by special permission, and is not ongoing -- the project that collected the narratives is over but the results are housed there. To learn more about the WOSL collection at UTSA, go here.

StoryCorps, familiar to many from their excellent show on NPR, or their current podcast series, are in many ways responsible for popularizing a method of capturing others' stories through conversation in a recording booth. They created a military voices initiative to capture service members and veterans' stories. And recently, they've turned the whole StoryCorps method into something available to anyone, through a smartphone app. Take advantage of this (free) opportunity to start a conversation that captures history, while you still can.

Note: If you have suggestions for other archives that collect women veterans history narratives in the first person, please advise.

(This post is inspired in part, too, by a side conversation with Kristine Hesse, the fab women veterans outreach coordinator at the National Veterans Foundation, who feels strongly that older women veterans "telling their stories" will encourage generations of younger women veterans as well.)

 

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.

Intimate Survival: When the Veteran You Love Commits Suicide Anyway

Today is the 12th annual "National Survivors of Suicide Day." It's also a day of healing for survivors of suicide loss around the world.

Every day 18 veterans take their own lives; every 36 hours, an active duty soldier does. The pain is immeasurable, not only for the one who cannot bear it anymore and takes his or her own life, but also, importantly, for the ones they leave behind. They wait for time to heal those wounds; but it's almost impossible for time to do that; the loss is so great, particularly where there was also great love.

Because of how many veterans die each year at their own hand, affecting so many others in suicide's wake, we wanted to honor these relationships by asking a wonderful woman to tell the deeply true and deeply painful story of her own loss of her love to suicide. By telling the truth about these stories, and bringing this sadness into the light that truly so many share, we can embrace one another in the courage and compassion it takes to carry on. Marilyn has graciously shared her story, below. We are blessed to have her presence here.

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"The Language of Suffering and Healing: Lessons Learned from Loss and Life with a PTSD Vet"

Suffering has its own language.  Old words take on new powerful meanings, and some words that formerly brought up feelings of joy now are redefined with fear and terror.

When you live with and love someone with combat Post-Traumatic Stress Disorder, you develop a new vocabulary related to the disorder/the suffering.  The word “anniversary” used to be one associated with dressing up, going out to dinner, exchanging cards and gifts of love. Then it came to be associated with the anniversary dates of horrible, tragic events from the war -- i.e. the day a buddy was blown out of the air in his helicopter during a mission.  The word “trigger” has a common definition referring to a part of a gun -- now it referred to a smell, a sound, a sight, a verbal exchange, a situation that could set off rage, depression, anger, or isolating.

My late Vietnam vet husband, Denny, suffered with severe combat-related PTSD.  Truthfully, we both suffered from his PTSD.  Even though technically I wasn’t a soldier in Vietnam, it seems for a time, during the final ten years of our marriage, I became a prisoner of that war.

I feel I need to let you know right off that this story does not have a happy ending.  On December 9, 2009, my husband successfully completed suicide.   I say “successfully completed” because he had tried numerous times before in the last several years, but I had been able to save his life those other times.  Not so, this time. 

So now, in reality, I have my own set of “triggers” and “anniversaries” stemming from Denny’s PTSD behaviors and suicide.  I am sure these will be with me the rest of my life; but hopefully, with focused healing work they will hold less sway with my emotional well-being.

Countless articles, journals, blogs and books have been written about combat PTSD, each one with its own unique focus.  In this reflection piece, I can only do two things: I can share my own personal experience of living, loving a Vietnam vet who eventually committed suicide; and, I can share what I have learned from these experiences.  After all, isn’t that what it’s all about? What happened in your life, and what you learned from it.

Meeting Denny

The moment I met Denny, I knew my life had been forever changed.  I felt a connection with his soul I had never before experienced -- and I’m pretty sure, I never will again. 

He was a professional storyteller who came to my fifth grade classroom, to enhance the reading curriculum and increase the students‘ academic performance through an artistic approach.  He taught the students a love of story and characters through the sharing of folktales, fairytales, and the narratives of his own personal experiences.  And, oh, the personal experience narratives he had had in his life!  Denny told of sailing a boat during a Nor’easter, living in a tree house in Peru and hiking the Machu Pichu trail, fighting forest fires from a helicopter, hitchhiking across North America -- more adventures than most of us could ever dream of having.  And he told his adventures with a gleam in his eyes and a song in his heart.

But another story was being written during his time in my classroom, and that was our story. We fell in love, got married, and between the two of us raised seven children (from previous marriages) and four grandchildren.  Our marriage was far from fairytale perfect, even in the beginning.  We had both been married and many hearts were broken in our coming together.  But we endured and learned and clung to each other through the good and the bad times. 

PTSD Enters

At about the 12 year point in our relationship, a new entity/force entered the picture.  This was an uninvited presence, unrecognized at first – but the behaviors it produced and the unwanted consequences it set in motion seemed to have a life of their own.

On September 11, 2001, when the planes crashed into the towers in New York, and the war ensued with Iraq – for Denny, this was the final unleashing of his own, internal war. He had been battling this war privately for years, but now, his inner battles consumed him.  At this time, “our” war with PTSD began in earnest. PTSD was the new entity in our marriage, and 9/11 was the trigger.

Within two weeks after 9/11, Denny was in a mental hospital due to suicidal ideations.  I had never even heard that term, “suicidal ideations,” before, but my vocabulary education was just beginning.

Denny was depressed and despondent.  After his release from the first of many behavioral hospital stays, he felt somewhat better for a while and the depression meds seemed to help. 

But periods of happiness and calm were short-lived and mostly non-existent.  He began canceling his performances due to severe anxiety attacks.  Much of his time was spent on the couch under a sleeping bag watching certain movies over and over.  The movies -- Gladiator, Fly Away Home, and SeaBiscuit -- all had the same theme, personal triumph over adversity and challenge.  But they also had a lot of sadness and tragedy embedded within them.

It was also an extremely confusing time for me. 

Denny had been such a force of talent and admired by many.  He performed before audiences of thousands, but now, he was a shell of his former self.  He had also been my rock of strength, my touchstone for love and sanity in life.  Now, he struggled just to survive each day.  He once told me during his intense depression times, that he felt like he was walking through life with a heavy rubber suit on.  Very sad. 

Waiting for the diagnosis

Denny still had not been diagnosed with combat PTSD.  The doctors we were seeing were on the civilian side, and they missed the combat connection to his present day state of being.  His diagnosis was “severe chronic depression and anxiety.” Under their care, he received some therapy, numerous anxiety and depression meds, and even 15 rounds of electric shock therapy – at Denny’s own request.  He so desperately wanted to feel “normal” again.

Over the next several years, his behaviors escalated to include: alcohol abuse, drug abuse, repeated suicide attempts (always by taking meds), extramarital affairs, physical abuse, severe anxiety attacks, night tremors, rage, isolation, and flashbacks. 

Each of these were ongoing and extremely painful events to deal with and live through, for both of us. 

Eventually our local doctor suggested we take Denny to the VA, suspecting his combat experience was in play with his ever-increasing risky and damaging behaviors.  After a 45 minute intake interview, I learned the term that seemed to define our current situation and the outlook for our future: combat-related Post Traumatic Stress Disorder.  Denny had it and he had it bad.  His time in Vietnam as a helicopter pilot had damaged him mentally, emotionally and spiritually.  And it seemingly had returned to completely claim its victim.

The VA knew more about his PTSD, but for Denny their attempted therapies, meds, support groups, etc. did not work.  He was spiraling down and I knew if I did not get help for myself, I would go right down with him.

Starting to take care of myself

I had joined Al-Anon (a 12-step program for people who loved someone with addiction) when it originally seemed like Denny’s problems stemmed from alcohol and/or drug addiction. 

It was not easy to join a support group because I had always believed I could fix or handle any problem that came along in my life.  Only it was obvious my methods were not doing any good in this situation, and if anything, I was only getting into a depression myself.  In those Al-Anon meeting walls/rooms, with those other suffering people, my first ray of hope began to appear. 

I started to learn and accept some critical information to save my own sanity:  I did not cause Denny’s problems, I could not control his behaviors, and I could not cure him.  The people in my Al-Anon group, my sponsor, the readings, the meetings were the beginning of my effort to find my own peace - no matter what was happening with Denny and our marriage.  Before I felt hopeless, confused, angry, out-of-control, and frustrated trying to get him the help he needed and trying to fix him.  Now I was beginning to feel some peace.

Love and loss

I also learned in these meetings about loving detachment -- that I could still love Denny but detach myself personally from his actions.  In other words, his choices were not about me  -- no matter what he said or did.  It was never about me - it was always about him and his suffering.  His pain had begun long before I met him even though the drastic behavioral manifestations did not appear until much later in his life -- about 30 years after the war.

After Denny was diagnosed by the VA, I was asked to join a support group for women married to or living with a vet with combat PTSD.  This group met weekly at the VA and was facilitated by a woman counselor.  The other ladies that attended these meetings have become dear friends through the years.  Their marriages were practically cookie-cutter versions of my own.  The same issues, the same behaviors, the same frustrations, and ultimately the same sense of loss -- for that was the bottom line for us all.  We all felt that we had lost the man we fell in love with.  That man did not exist anymore.  It seemed we lived with a man/child made of ice -- frozen emotions, feelings frozen in a time and place inaccessible to any of us.  Ultimately, whether Denny could not heal or chose not to heal, I will never know.

The beginning of the end

In the first few days of November 2009, Denny and I had an argument that set off a trigger for him.  He went into a severe rage and physically attacked me.  I was lucky to get out alive.  I left our home of 20 years, as I had three times before when it was not safe, but this time felt eerily different.  It felt
“of the end,” somehow.

I moved into an apartment and after a few weeks passed, I began returning Denny’s almost hourly phone calls and innumerable texts and email messages.  He was not doing well, to say the least.

 He could not remember the attack fully but he did feel “shame” from it.  He begged me to come home but I told him I could not until he committed to serious long-term mental therapy and it was safe for me.  One of the last emails he sent me said, “I want to be loved so desperately, yet have no patience for love”.

On December 8, 2009, he called me two different times and threatened suicide as he had so many times before.  I called the VA suicide team and the sheriff’s department to tell them what he had said.  They checked on him twice that day, both times he was able to convince them he was fine – remember, he had been a professional storyteller. 

But sometime that night, he decided he had had enough suffering.  I cannot speak to what went through his mind at the end, but I know he swallowed many bottles of VA prescription meds and the next morning, he was gone.

It is too painful to describe seeing him in our bed that next morning, so I won’t .  I can tell you this, after the medical examiners took his body, they handed me gloves and bags and told me I had to dispose of the “hazardous waste” of our  bedding due to the contamination of his bodily fluids.  That scene, that experience is now one of the triggers/anniversaries that haunt me.  As I continue to choose to heal, I know the pain will be lessened, but that memory will never be erased.

Denny’s suffering ended that day – and mine took a new turn. Attempted suicide is horrible; completed suicide is devastating.

Turning to healing

But there is a new language and a new vocabulary I am learning now.  And that is the one of healing. 

During the worst times of his PTSD and my resultant confusion, I began to understand through support groups the difference between adjusting and adapting.  Whenever I had tried to “adjust” -- i.e., Denny’s behavior, circumstances -- my life only became more frustrating and out of control.  When I learned how to “adapt” -- I began to have more control over my life and emotions.  By learning how to adapt, I became proactive instead of reactive.  I sought out the help I needed through understanding friends, family, but most critically, through the hard work of consistent participation in support groups of my peers.

Through all of these experiences, I believe I have become a more compassionate person.  I have learned not to have expectations of others -- only of myself.  That does not mean I cannot have boundaries for acceptable and unacceptable behavior -- and I do.  However, I find I do best when my focus is on my own behaviors and setting realistic expectations for myself.

I have learned we are all on our journey together and alone.  When we are together, we must do all we can to love, support and help ease the suffering of those we are with; and when we are alone, we must find ways to do this for ourselves.

The most significant lesson I learned -- above all else -- is the importance of reaching out and accepting help.  We all need to be able to let go of our egos -- to realize we don’t have all the answers and that there are others out there who share in our suffering and trials.  When you can dedicate yourself to getting the help you need in these situations, there will still be pain, but you need not suffer.

My suggestions would be to find support groups in your area, through the VA or the Vet Centers.  Read related articles, books, online resources, blogs, websites that offer wisdom and support.  Whatever you do, remember you must take care of yourself before you can be of any good to others, and that includes your vet.

I am so grateful to have known and loved Denny.  I am so sorry for all the pain he endured and I am hopeful he has found the peace he could not find here on this earth, in this life.  And I miss him every day more than I could ever have imagined.

My wish for those reading this is the following: If you recognize yourself and your loved ones in any of this writing, that you will reach out, seek out, and accept the help that is available for you.

May you learn the lessons you need that will guide you on a journey of compassionate love for yourself and all those in your life.

Namasté.

-- Marilyn.

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Editor's note. In addition to being grateful to Marilyn for sharing her story so graciously and courageously, we also need to share some resources. The American Foundation for Suicide Prevention has a well-stocked website filled with resources, linked here, including a section on "Coping with Suicide Loss," linked here. Their website is well worth a look. There's also the "Fierce Goodbye" website, a faith-based perspective on suicide, based on a documentary (put together by the Mennonites), linked here. And on the military veteran side, the American Widow Project, most of whom have been widowed by war -- and yet a few by suicide -- is linked here, with the stories of suicide linked here. For more material from our website here on suicide, as it relates to veterans with PTSD, click here. Additionally, crisis and hotline phone numbers are listed here. With love to all concerned...

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

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.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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.

---

 

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

 

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

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

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

Here is Helen's story:

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

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

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

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

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

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

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

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

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

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

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

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.

A Cheerful Heart Does Good Like a Medicine: The Struggles of Living with PTSD...in Your Spouse

I went to a retreat recently for combat veterans and their families. The retreat is in its third or fourth year of existence, and did a fine job with its core mission, which was providing community for veterans who had lost the camaraderie they'd experienced with other vets in combat. In theory it would also have been a supportive experience for family members who ordinarily might not find anyone else to talk with about living with and loving a combat veteran. PTSD wasn't the focus by any means -- it rarely came up -- but of course because of the demographic, many of the people at the retreat were struggling with the experience of having, or living with, someone with combat-based PTSD. And since the focus of the retreat was building community, not therapeutic counseling, the PTSD topic was somewhat of the elephant in the room, at least to me. So many people experiencing it, on one side of the aisle or another (veteran or spouse), yet few addressing it directly and certainly no one officially. 

Here are a few observations, based on the experience of spending almost five days with the group. The observations are my own; your mileage may vary. 

In addition to the things done well -- community-building, family support (particularly for the children), recreation opportunities, good food, and neat opportunities for bonding among the participants and creative expression -- there were some difficulties, which I think speak to the topic as a whole these days, or the state of affairs on PTSD and the military. Despite the numerous initiatives addressing the topic of PTSD and the military, based on what I saw and experienced, I questioned how much was really getting through. Family members seemed to be living in the midst of PTSD but not being really aware of what PTSD was or how it could affect their relationship. 

Civilian spouses, predominantly women, talked about their husband's unpredictable violent tendencies, unwillingness to communicate, or withdrawal, sleeping and crying, without being aware that those were elements of the PTSD he suffered from combat. 

Younger spouses appeared justifiably frightened and unsure of how to "read' the signals -- often fearing that they were now bookended by two violent men in their lives -- the father they'd grown up with and left young to marry their husband, and now their husband, returned from combat but without enough progress under his belt in addressing his own PTSD, either through medication or therapy or any other means. The experience was highly raw, and still unfolding. The dominant theme among these young women seemed to be FEAR and CONFUSION, as well as a certain amount of co-dependency. Fear over not understanding their husband's PTSD and confusion over how to interpret the signals or how best to manage the chaos. And co-dependency in contributing their reaction as part of the problem. Their best solutions? My guess: love, support, and EDUCATION -- primarily about the main topics of concern to them. What PTSD is, and issues around co-dependency and safety (domestic violence, safety planning, communication skills, etc.)

Older, theoretically more "mature" spouses, who had endured decades of their husbands' military service and repeated deployments, were sadly not much to look up to for the younger women. The primary theme of their communication seemed to be RESENTMENT. And a pronounced tendency to locate all their problems externally: the slacker husband, his terrible family, the town they lived in to be close to his family, etc. If you were looking for a genuine sense of love and appreciation for the combat vet, despite his shortcomings, well, that appeared to be in short supply. (Which is not to gloss over the exceptional difficulties of living, for years, with someone unpredictable, violent, or withdrawn -- or having to cope single-handedly with the considerable demands of keeping the family on track by yourself. However...)

The trouble with resentment is that it festers, and is a good emotion/reaction to address/move through/and move on -- not a great place to camp out, somewhat indefinitely. It's a short hop from resentment to bitterness, and neither of those are about communication and growth. Prescription? A growing focus, daily, on GRATITUDE -- things to be thankful for and appreciative of, not things to pick apart. Wherever your focus is...that's what you get more of. So why tempt fate with only criticism, when gratitude is also an option? Even the book of Proverbs talks about a "cheerful" (or joyful) heart being "good medicine," but a "crushed spirit dries up the bones..." (Proverbs 17:22.)

(Years ago, when Oprah was doing her "Remembering Our Spirit" segment, one of her consistent tools was the gratitude journal...and the challenge to every day, before bed, find one, two or three things to be grateful for. Many people found the (corrective) experience had the power to change their lives. That on top of addressing the legitimate issues and concerns? Much more positive...Here's a link to what's involved in keeping a Gratitude Journal.) 

---

I remember two years ago when the subject of the "Eyewitness to Combat" series contacted me through this site, and shared that his own family (in his opinion) were frustrated with him and his search for healing, and basically tired of listening to him on the subject. I remember him saying a version of this, that in their opinion, "You were only in combat for two years...how is it possible that you're not OVER it yet...how has it dogged you all these years?" But the reality is, it had. It's not what we want, sometimes, it's the hand that we're actually dealt. And that was his hand...and that was theirs. The same is true today.

What I wish for these spouses is comfort, understanding, good communication, and ultimately JOY. I think of the great women I know, like Kathie Costos, who DO get what it's like to be married to a combat vet with PTSD, and who have excelled, not crumpled, under the strain, and who do what they do with LOVE. (Here's a link to her downloadable book about living with and loving her husband, "For the Love of Jack.") I think of the woman spouse who wrote the post several years ago, linked here, and used with her permission, which absolutely taught some truths about being married to a vet who you still LOVE and BELIEVE IN, but who is suffering on his own path with PTSD. I think of Britta Reque-Dragicevic, who I've written about before on this site, who wrote the wonderful (and real) book, "Close to Home: A Soldier's Guide to Returning from War," available here. I think also of the great resources in Patience Mason's work and Aphrodite Matsakis', and how their work has helped all of us to understand the dilemma of what a combat veteran struggles with, from the spouse's perspective, so much better. I think of the ongoing guidance I get from people like Kathie Costos (mentioned above), who has such a great understanding of the communication skills needed to interact with a combat vet with PTSD, but from the important perspective of loving them for who they are. And don't forget the resources on this site: communication skills, caring for the caregivers, sexual intimacy, and a fabulous resource list of books and articles for military spouses and family, broken down by topic, linked here.

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

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

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

REFERENCE LIST: Military Families 

Children

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

Communities of Support

 

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

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

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

 

Culture

 

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

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

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

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

 

Death

 

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

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

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

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

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

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

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

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

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

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

 

 

 

Deployment

 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

           

 

 

Grandparents

 

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

 

 

Intergenerational Transmission of Trauma

 

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

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

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

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

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

           

 

 

Interventions 

 

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

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

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

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

 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

           

Maltreatment 

 

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

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

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

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

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

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

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

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

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

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

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

           

 

Marriage        

 

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

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

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

 

 

Military Families        

 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

           

 

 

Military Service Members

 

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

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

 

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

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

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

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

           

 

Moving Relocation     

 

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

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

           

 

National Guard Reserves

 

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

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

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

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

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

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

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

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

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

 

Policy

 

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

 

 

Posttraumatic Stress Disorder/Mental Disorder

 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

            

Psychological Toll      

 

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

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

           

 

Reference Handbook 

 

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

 

 

Schools

 

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

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

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

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

Secondary Traumatization

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

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

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

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

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

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

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

           

Single Military Parents

 

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

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

 

Spouses          

 

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

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

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Quotable Quotes -- Helen Keller on Overcoming Suffering

"Although the world is full of suffering, it is full also of the overcoming of it." -- Helen Keller

Honoring Women Veterans Who Served and Suffered

October 12th through 16th is "Military Rape Awareness Week." In observation of that, the story of Colleen Mussolino, as retold by veterans advocate Susan Avila-Smith:

In Memory of Colleen Mussolino, Women Veteran Trailblazer

"I wanted to be an aviation engineer," Mussolino said.  "The recruiter said I could get into the program, but I found out that was closed to women." Instead she became a cook.  Soon the young WAC would find out just how differently women were regarded in the military.  On December 29, 1965, Colleen was raped by four men and left for dead.  She spent one night in the hospital and was sent right back to her barracks.  Colleen was treated like a prisoner of war, interrogated and was blackballed on the post trying to force her to sign a paper that she would not prosecute. Threatened with a dishonorable discharge, Mussolino signed the paper and was honorably discharged in March 1967.

For the next 20 years, Mussolino raised two sons, and lived her life.  But as time went by, the traumatic assault that was supposed to be covered up and forgotten began to take its toll.  "I was getting more and more short-tempered," Mussolino said. "My temper was just bad."  One day, while fishing with a World War II veteran, he told her she was entitled to veterans benefits.  She applied and began to receive benefits. She also joined a women's support group at the Brooklyn, N.Y. VA Medical Center.  "I was looking for other women who went through what I went through," Mussolino said. "Your civilian counterparts have no clue."

Women Veterans of America
With talk of the war breaking out in the Persian Gulf, she realized more women would be involved in combat than ever before.  In response, she co-founded Women Veterans of America to offer support and attention to the issues facing women in the military.  "The transition from military to civilian life is difficult," Mussolino said. "Once the uniform goes on, it never comes off." Their mission: Information and support for women veterans; liaision to government agencies; obtaining veterans' benefits and health care; advocacy in local and national isues affecting women veteran and women serving in the military. Pressure on Congress and the Department of Defense to cahnge the Uniform Code of Military Justice to include a fair avenue for victims of assault and rape to be able to report their cases and get their day in court. Punish those who perpetrate such crimes and offer protection from intimidation and threats for women who report the assaults. "The repercussions from the way the victims are treated only adds to the problem and can cause severe PTSD symptoms," the statement reads. "The UCMJ does not protect the victim, but instead rewards some perpetrators with promotion, and does not punish except with a slap on the wrist and a finger shaken in the face it continues.  It is difficult for many to fathom the emotional and physical turmoil that the men and women of the armed forces are put through.  To add sexual assault to the burden is unconscionable."

In November 1996, reports of sexual harrassment and sexual assault against women at the Army Proving Ground in Aberdeen, M.D., prompted "20/20" to put together an investigative piece on the military's handling of sexual assault.  A member of Women Veterans of America wrote to 20/20 about her own experience. "She was afraid to be interviewed because she had been given death threats," Mussolino said.  Instead, Mussolino agreed to share her own story of sexual assault and cover-up in the military with Peter Jennings. "I figured if anything came out of it, women would know they are not alone, and there is help," Mussolino said.  "Not only women are raped, but men are raped. The story seemed to validate them, too." During the show's airing, the Department of Veterans Affairs made a toll-free number available for women to call in for counseling.  "Over 3,000 women called that night from all diferent wars and branches of service," Mussolino said.  "The Department of Veterans Affairs realized more had to be done for women veterans." "A lot of Vietnam veteran women in this country don't come forward," said Mussolino.  They don't talk about it.  Those are the ones I want to reach. There is help. There is therapy by talking to a brother or a sister."

Despite her disabilities which have put her in a wheelchair, she would be at every significant event for MST and Vietnam vets, and was the primary point of contact for the media since the early 1970s.  Since Colleen's terminal illness, Women Veterans of America "decided that WVA is taking too much time on the issue of MST, and has dropped it from their services."

PTSD from Military Sexual Trauma (MST) is caused by sexual harrassment, rape and intimidation, or any improper sexual behavior.  Perpetrators often go unpunished, and have no "record" in an effort to play down the prevalence of assault and harrassment.

Editor's note: There's a "fan page" for Colleen Mussolino on Facebook, linked here.

Two Retreats for Veterans This Summer and Fall in Upstate New York

For our 650th post -- my, how time flies! -- an item about two upcoming retreats that may be of interest to veterans and their families -- both to be held in upstate New York later this summer and early fall.

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For women veterans only, in mid-August, The Adirondack Women Veterans’ Reintegration Retreat 2009 will be held from Monday, August 10th to Wednesday, August 12th, 2009, at the Wiawaka Holiday House (a retreat center for women) on Lake George, New York.

Their program says, "The Adirondack Women Veterans’ Arts & Reintegration Retreat is open to any woman who has served our country in any branch of the military at any time. The retreat will focus on reintegration issues arising out of military service. We will provide a safe space to share experiences, learn from others who have served our country, gain skills that will enhance quality of life,  enrich a sense of self and sense of community and build a network with other women who have served our country.

Our retreats have become known as a place where women can connect with others and their inner selves. In many sessions, we have had people from the same community meet each other for the first time and discover new friends and support that they can maintain after they leave."

Click here for a link to that program or to register. Scholarships are available -- hurry! -- and the campus is drug- and alcohol-free.

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In mid-October, the Omega Institute in Rhinebeck, New York will be hosting "The Costs of War, Violence and Denial" -- subtitled "A retreat open to veterans and their families" -- with Claude Anshin Thomas, who we've written about on this blog frequently.  Thomas is a Vietnam combat veteran, now Zen Buddhist monk, and the author of "At Hell's Gate: A Soldier's Journey from War to Peace," linked here. The retreat runs from Wednesday, October 21st through Sunday, October 25th. 90% of the cost is being underwritten for veterans and their families; the remaining 10% is the price of registration, and in some cases that may also be able to be waived.  The Institute asks that you register for the retreat by September 25th.  Click here for a link to information about the program and registration.

The Omega Institute notes: "This 5-day retreat with Claude Anshin Thomas is substantially funded. Scholarships cover up to 90% of tuition, meals, and accommodations. No one will be turned away. Complete scholarship details are available online or call 800.944.1001."

Editor's note: We've talked about Claude Anshin Thomas and his book before on the blog, here, here, here, here, and here. And thanks to all who let us know about these events -- Susan, Sue and Frances.

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

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

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

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

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

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

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

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

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

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

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

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

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

Pulling the Pin: Combat Vets, PTSD and Troubled Personal Relationships

Combat veterans with PTSD often have tremendous difficulty with their closest personal relationships: marriages and families.  Divorces, multiple marriages, and short-term relationships that end unhappily are very common: All situations that compound the pain and suffering that already exists with PTSD.

While there are a few books out there that provide some helpful advice about the difficulty of combat vets with PTSD sustaining good relationships, some insight is also in order.  While many obstacles could be mentioned, we'll stick to just a few important ones.

1.    Needing to have a constant enemy. Combat veterans will tell you that their training requires a constant enemy for alertness, vigilance, what amounts to staying alive. Once combat ends -- or between episodes of combat -- that "role" needs to be filled by somebody.  The most obvious candidate to fill that role?  The combat veteran's usually unwitting, and unwilling, partner. If the spouse or partner isn't available, the next best candidate is a child. The combat veteran is often unaware that he or she is using this tactic at all, and the one victimized by it can often tell "something is wrong," but isn't always clear on exactly what that is.

2.    Pestering and teasing doesn't feel like love, but it does feel like irritation. Let's say the coast is clear.  It's a sunny day, everything seems (temporarily) all right in the combat veteran's world. But he or she teases and pesters a spouse, partner or family member (e.g., a child) incessantly, until that person gets fed up and walks away.  "But I was just teasing!" says the combat veteran.  Yes, but the frictional nature of the allegedly good-natured teasing has a predictable effect: it drives close others away, much like bad behavior also does. Now the combat veteran can be left alone: But is that what he or she really wanted?  Perhaps.  Perhaps not.  The main thing, combat vets say informally, that inspires this strategy, even on an unconscious level, is that too much peace and calm is off-putting, and creating (or re-creating) a little "chaos" in interpersonal relationships puts the combat vet with PTSD back where he or she is more likely to be comfortable.

Now factor either (or both) of these two behavioral patterns (among several others that could have been discussed) with the combat veteran's periodic desire for intimacy -- and imagine the realistic toll that such behavior, even if unintentional, takes on the spouse or partner's desire for intimacy.  More likely, either one or both of these behaviors is more likely to shut down or numb the spouse or partner, who then is more tempted to resist attempts at intimacy.  Is turning down intimacy the problem?  Is it the only problem, or even the central problem?  Probably not, if either of these fairly typical behaviors are an issue.

Combat Veterans, PTSD and Domestic Violence - A Sometimes Deadly Combination

Domestic Violence a Growing Problem for Veterans

“The increasing number of veterans with posttraumatic stress disorder [PTSD] raises the risk of domestic violence and its consequences on families and children in communities across the United States,” says Monica Matthieu, Ph.D., an expert on veteran mental health and an assistant professor of social work at Washington University in St. Louis. “Treatments for domestic violence are very different than those for PTSD. The Department of Veterans Affairs [VA] has mental health services and treatments for PTSD, yet these services need to be combined with the specialized domestic violence intervention programs offered by community agencies for those veterans engaging in battering behavior against intimate partners and families.”

Matthieu and Peter Hovmand, Ph.D., a domestic violence expert and an assistant professor of social work at Washington University, are merging their research interests and working to design community prevention strategies to address this emerging public health problem.

“The increasing prevalence of traumatic brain injury and substance use disorders along with PTSD among veterans poses some unique challenges to existing community responses to domestic violence,” says Hovmand. “Community responses to domestic violence must be adapted to respond to the increasing number of veterans with PTSD. This includes veterans with young families and older veterans with chronic mental health issues.”

VA research shows that male veterans with PTSD are two to three times more likely than veterans without PTSD to engage in intimate partner violence and more likely to be involved in the legal system.

— Source: Washington University in St. Louis

The Woman's Bill of Rights to Sexual Intimacy and Pleasure

Periodically we revisit the all-important topic, "Healthy Sexuality for Combat Veterans."  In this installment, we include a "bill of rights" that's essentially written for the woman partner, from Gina Ogden, Ph.D., author of "The Heart and Soul of Sex," and, most recently, "The Return of Desire." The author of five books, Ogden is a marriage and family therapist and a sex therapist.  In a conversation directed primarily to women, she says:

"It's important for you to know what your sexual rights are -- no matter what your age or sexual orientation or physical ability.  Some of us seem to know our rights instinctively and are able to set effective boundaries and ask for what we want.  But many of us have never thought about our rights to intimacy and pleasure -- or even imagined that we had such rights.  When we're unaware, we're extra vulnerable to being taken advantage of by others, whether they intend to take advantage of us or not."

The following advice comes from a guide by Ogden for women about "how to say "yes" to pleasure and "no" to unsafe sex."

My Rights to Intimacy and Pleasure:

1.  I have a right to my own body and all of its sensations, including pleasure and pain;

2.  I have a right to think my own thoughts, whatever they may be;

3.  I have a right to feel the full range of my emotions – excitement, joy and anger, sorrow and depression, love and fear – whether or not my feeling them is acceptable to others;

4.  I have a right to acknowledge my memories, whether they are memories of delight or of abuse, and to base present relationship decisions on them;

5.  I have a right to be – or not to be – a sexual person at all ages and stages of my life, and a right to chose how I define what I mean by sexuality;

6.  I have a right to expect that my partner respect my body, thoughts, feelings, and general well-being, and a right to insist on respect, if necessary;

7.  I have a right to ask for what I want;

8.  I have a right to say “no” to any sexual encounter that feels unsatisfactory or threatening – physically, emotionally, spiritually, or sexually;

9.  I have a right to say “yes” to pleasure that is physically, emotionally, spiritually and sexually safe; and

10.  I have a right to feel good about saying both “yes” and “no.”

-- Source: "The Heart and Soul of Sex," by Gina Ogden, Ph.D.

Military Sexual Trauma Increases Likelihood of Mental Health Problems, VA Says

From a press release, this fairly obvious conclusion:

Military Sexual Trauma Associated With Higher Rates of Mental Health Problems.

According to preliminary research results from the VA, approximately 15% of recently returned female veterans utilizing the VA healthcare system report experiencing sexual trauma during military service.

The cross-sectional study, presented at the American Public Health Association’s 136th Annual Meeting & Exposition in San Diego, examined healthcare screening data of over 100,000 veterans of Operation Enduring Freedom in Afghanistan and Operation Iraqi Freedom who utilized medical care at any Veterans Health Administration facility during a six-year period.

Along with the more than one in seven women, 0.7% of males also reported having experienced military sexual trauma. Both males and females reporting military sexual trauma were more likely to be diagnosed with a mental health condition than patients who did not report military sexual trauma.

“These data highlight the importance of the VA’s universal screening policy,” said Joanne Pavao, MPH, a VA researcher on the study, “as well as early intervention among veterans who have experienced sexual trauma, to prevent long-term consequences.” Veterans Health Administration policy requires that all male and female veterans are screened for experiences of military sexual trauma and that free treatment for military sexual trauma-related conditions is provided at all VA healthcare facilities.

— Source: American Public Health Association

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

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

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

Sarah Haley - Psychiatric Social Worker, PTSD Pioneer, Friend of Veterans

Gerald Nicosia's book Home to War: A History of the Vietnam Veterans' Movement, is fascinating reading, if only to keep in mind the wisdom of the George Santayana quote, "If we do not learn from the mistakes of history, we are doomed to repeat them."  Nicosia goes into much detail about how the PTSD diagnosis was first determined and included into the DSM, and along the way he paints the picture of many of the key participants, including Sarah Haley, in first treating Vietnam veterans for combat trauma and the resultant PTSD.

Whenever we look at history like this, it becomes apparent that whoever is impressive today in this work owes so much to pioneers like Haley (who Nicosia discusses) and Lawrence Kolb, M.D. (who Nicosia oddly does not).  "Standing on the shoulders of giants" is the semi-cliched expression about what present practitioners owe as a debt to the pioneers of the past, and it is certainly true about Haley's work: she was a true giant.

Here I'm going to excerpt, with Nicosia's permission, parts of the many passages about her work so you can see three important things: what her background was, which gave her a special compassion for the truth the veterans first presented with; the extent of her rapport with and trust established with the veterans themselves, which allowed her to help them; and some of her more intuitive leaps about what PTSD really meant from the lives of veterans with whom she consulted.  What a truly remarkable person; and what a shame she's no longer with us, so that we can continue to benefit from her truly outstanding work with veterans.  (Few of these quotes are continuous; most skip around from important part to important part, with the gap indicated by the ellipses)

Haley's background:

"It was a woman .. a psychiatric social worker named Sarah Haley, in the big VA outpatient clinic in Boston, whose research into veterans’ stress disorder literally blew the existing psychiatric definitions to pieces and began to put a whole new definition on the map.

"Sarah Haley [initially] seemed the least likely person in the world to make waves…

Her friends all warned her that the VA’s psychiatry program was “fifth-rate,” that she would find herself treating ‘chronic schizophrenia and passive-dependent men with bleeding ulcers,’ and that her career would surely go down the tubes.  But despite the fact that she entered upon her new VA job with the meagerest of expectations, she couldn’t help being ‘shocked at the low caliber of the general run-of-the-mill health person there.’  As she recalls, ‘These were not mental health people that you would want anybody in your family to get near.’"

 

Haley's first astounding discoveries:

"One day, a young man in a highly agitated state was brought into the clinic by his parents.  He had only been home from Vietnam for three days, and his parents had no idea what to do with him.  He was having total body tremors and exhibiting ‘startle response’ every few minutes.  If a car backfired or a door slammed, he would dive under the nearest table.  After much rambling, the young man told her he had been at a place called My Lai, that terrible things had happened there, but that it was difficult to piece it together.  He was confused and experiencing a lot of amnesia, but he did remember seeing the bodies of women and children and vomiting into the bushes.  He also remembered that he could not shoot anybody himself, that he had thrown his gun down.  The American soldiers who did the killing had sought to intimated him and the others who didn’t shoot: ‘If you ever tell anybody, we’ll come get you.  Or we may come get you anyway.’

 

…

"Indeed, any other intake worker might have dismissed [this recent Vietnam veteran] as delusional, but Haley had reason to believe him.

(Her father had been on special operations with the OSS in North Africa during World War II, a self-admitted ‘assassin for the government.’  He had told her about seeing a truckload of German prisoners who were led out and made to kneel in front of a ditch, where an American officer shot each one of them methodically in the back of the head.  Then the Americans dumped their bodies in the ditch and shoveled it over.  Thus Haley, as she puts it, had “no illusions about war.”)

 

How Haley worked with veterans and understood their particular trauma:

"Haley had nothing to go on but a big hunch, but she decided to follow it.  It seemed to hear that a lot of mental health professionals – especially those at the Boston VA clinic – had great difficulty in listening to the recital of trauma: as a defense, they either disbelieved it off the bat, turning it into the less threatening notion of “delusion,” or else withdrew from the patient as quickly as possible so as not to have to hear more about it. 

 

The other horn of this troubling dilemma was that the traumatized person, especially if he was a Vietnam veteran, would almost never come in and spill his guts to a perfect stranger.  Trauma patients need to establish trust with a therapist, and the Vietnam veterans coming into the VA clinic were never being given the chance to do this.  It was by the merest lucky chance that the My Lai veteran had seen something in Sarah Haley that made him believe he could confide in her, thereby opening the door not only to his own dark secrets, but also to possible help for a whole generation of trauma victims.

Haley perceived correctly that the reason the My Lai vet could not remember all the details of his trauma was that much of the most painful material had been repressed.  In the coming years, she would encounter the same phenomenon in hundreds of Vietnam veterans, some of whom could only recall five or six months of their 12- or 13-month tours of duty.

 

More insights into how Haley worked with veterans, and uniquely modified the approach for dealing with combat trauma:

"She further realized that the stuff was eating away at them would have to be brought slowly and steadily to the surface – that there were no quick fixes, like ‘5 mg. Stelazine daily.’  Equally ineffective, she would soon discover, was ‘the sort of non-authentic treatment’ where the professional would talk about family issues or other daily matters that were troubling the patient, but never bother asking about the existence of trauma in his past; for if the professional didn’t ask, the trauma victim would seldom bring it up on his own. Haley was aghast to learn, for example, that an analyst friend of hers had “successfully” treated a Vietnam veteran solely on the basis of working through the rivalry with his father and never even asked the veteran about his [combat experience.]

"Most of the Vietnam veterans Haley found were coming in to see a VA psychiatrist merely so that they could get their next month’s supply of Valium.  Haley would go to the psychiatrists and inquire whether they had ever asked these veterans about their Vietnam experience; the usual reply from the shrinks was that they had stopped asking because the veterans didn’t want to talk about it.  Haley was flabbergasted that none of the VA psychiatrists – with the exception of two notable women, Lillian Rodriguez and Constance Hartwell – evinced any interest in learning the cause of the tremendous anxiety for which they were blithely prescribing shelves of medication.

Unique problems to Vietnam veterans that Haley noted:

"During those first few years at the VA, Haley encountered a great many vets who talked about participation in atrocities.  she found most of them to be ‘terribly guilty, feeling unclean, and not worthy to be back in the world.’

…

 

"… Instead of hearing, “Doc, I have a bellyache,’ or “Doc, I’m seeing visions,” or “Doc, I’m terribly depressed,” what Haley would hear time after time was, “Doc, I think I’m a murderer… I slaughtered innocent civilians.”

 

And finally, Haley's substantial impact:

"Working with these men and the material they brought up was so painful that it took Haley almost two years to complete her article…which was immediately recognized as a landmark work.  By precise delineation of the symptoms of several veterans she had treated, Haley established that the Vietnam veteran who had witnessed or taken part in atrocities could not be handled merely as a traditional case of traumatic war neurosis, but presented a completely new challenge to psychotherapy."

Sarah Haley was indeed a remarkable woman, and a great Friend to Veterans.  So much of the unique and compassionate approach to understanding PTSD's impact on veterans comes directly from this woman's work, and for that we are deeply appreciative and honor her in memoriam.

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

(From a press release)

Helping Military Families Help Themselves

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

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

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

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

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

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

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

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

Unhealthy Sexuality: A Bond That Is Strong, But Lack of Desire - We Just Gave Up

Here's an item from a woman I admire to the hilt, who has been the wife of a Vietnam veteran since she was 24.  Her husband, more or less 10 years older, fought in Vietnam, and has suffered from PTSD ever since. She ended up writing a book about how she came to learn about PTSD and how it affects the family, and since then has done exceptionally kind, warm-hearted and great work on behalf of veterans and their families with PTSD.  In her case, she found that being married to someone with PTSD presented unique relationship challenges, which didn't always work out to her satisfaction.  On balance, she still accepted and took comfort in the relationship, but the sexual aspect was hard to work through, and painful to talk about.  With her permission, we have excerpted the relevant passages from her book (these passages offer a look at a slice of life from decades ago, but they are very accurate nonetheless, as hard as this stuff is to share):

Some general information about the situation:

It is amazing what changes happen to a person. Facing Jack’s problems and sticking it out made me realize something about myself that had to be changed. It was time to make the same commitment to my current job and stick it out. All the other jobs I had, I ran away. I would quit the job and move on to another one. I was always good at what I did and tried to give 100% but I never felt that my effort was appreciated. I was always taken for granted and devalued. I was feeling the same way about my current job. I didn’t want to run away this time and end up learning a job all over again. I didn’t want to start from scratch. I was just going to make my attitude different and stick it out.

It took five years of going to the VA for help before Jack eventually dropped out of

treatment. The denials were like a knife in his back. He couldn’t take it any more. It was causing us financial hardship and he lost time at work going to the appointments along with the times he couldn’t function at all. There were so many times that he couldn’t bring himself to get up off the couch. There were times when I saw it coming. He would become edgy, agitated and quick to anger, then silent, motionless holding his head in his hands. I was losing the battle. The fight had gone out of me and I was looking for a reason to stay with a man who could no longer be a husband or a father. I was in all respects a single parent. I had stress at home and a stressful job.

It tore at me knowing that no matter what I did, I would not be happy. If I left him, I would have felt guilty for turning my back on part of my family. If I stayed I knew that I wouldn’t be happy knowing what I would never have again. I didn’t know if I could do it. I didn’t know if I could keep looking in the mirror as the years left their mark on me, knowing that I would never feel desire or passion again.

 

It was like living on a roller coaster. I would start to relax when Jack would level off and he would be easy to live with, then just when I was getting over the bad days, they would come again. It was as if he couldn’t stand being emotionally close to me. There were times of the year that seemed worse for him. November was bad, the month he went to Vietnam and the month he came home. It was also the same month that Camp Evans had the 122mm rocket and mortar attack. February was a bad month for him. So was April. The other months were bad but those three months seemed the worse for him. I suppose I could have become an angry, bitter woman. I could have taken out the unfairness of my life on others. I could have but I didn’t. I credit God and Jesus, as well as an understanding of the Bible for providing me with the strength and courage to stay true to who I was.

---

About their honeymoon, and subsequent relationship:

We went to Niagara Falls but it was not romantic. We had a king-size bed and I am sure that he didn’t sleep in it for more than a few hours. I’d wake up in the morning and Jack was sitting in the chair watching TV. I think that we made love once, maybe twice on our honeymoon. During the day it was romantic and we were happy. We kissed a lot, held hands and held each other. At night it was as if he couldn’t stand me near him. Sex was never really that important to us. I already had a marriage where sex was too important. That didn’t bother me as much as the fact that he didn’t want to hold me or be near me. I thought there was something wrong with me. It hurt. I understood quickly that to wake up Jack was like waking a grizzly bear. He was ready to attack but stopped himself.

We continued to visit his friends and enjoy life. I got over the hurt of his lack of desire and realized that he was older than I was. I thought that maybe his sex drive wore down with age. We still hugged and kissed a lot. We both worked hard, so when we did get to “fool around” it was enough. It was at least once a week and that was enough for me.

 

Once in a while we would end up down the beach and make love in the car even though we were married and finally had a place to be alone. He said it brought back memories. It felt good to just be in his arms.

 

There were still times when I wondered how this happened and I will probably wonder for the rest of my life. I wondered what it would have been like if the first time I left him, it ended. I listened to the experts on TV when they talked about marriage. They could only give advice on a limited basis to the “normal” side of society.

 

The experts never had much to say about a family like mine. I laughed knowing that a marriage could survive without sex, without the partnership. Children could thrive in a dysfunctional home if there is love there. An illness did not have to mean the end of everything. It was hard. Don’t get me wrong. There are families with alcoholics who in the process of their illness hurt the only ones who should matter to them. I believed that they feel so terrible about themselves that they strike out at the ones they are letting down unable to face the truth. The families are left to pick up the pieces of shattered lives and emotions. A father is supposed to love us and protect us. A mother is supposed to support us emotionally and nurture our souls. Husbands and wives are supposed to complete each other, keep us grounded when we get too full of ourselves and build us up when we feel pulled down. Home is supposed to be a place of refuge from the craziness of humanity and obligations. A place where we feel we are able to be ourselves and be loved despite ourselves.

I did have a place to be myself and I tried to give Jack a safe haven, a place where he didn’t have to worry about the outside world and his past. At times it seemed impossible but still there was a bond between us that existed before the illness was into full swing, before all the tragedies happened. We are not married in many senses of the word but the one that matters most of all to us, a bond that is strong.

The woman who wrote this is tremendously compassionate and knowledgeable about PTSD and veterans.  She is warm, caring, and selfless about sharing what she knows with others, and openness like this is only part of her "secret sauce" for helping veterans and their families cope with the many unforeseen difficulties of PTSD.

Unhealthy Sexuality: Unable to Touch Intimacy - "You Don't Want to Degrade Your Wife to That Level"

In our continuing, semi-regular series on "Healthy Sexuality and the Combat Veteran," we need to take a look at three or so "unhealthy" variations on a theme.  The first, here, is "inability to touch intimacy" -- there's plenty o' sex (promiscuity), just not with the wife.  The material is quoted from a Vietnam veteran participating in a program with Jonathan Shay, M.D., Ph.D.:

 

Nantucket in the summertime was a fucking playground.  You meet broads, we’re stationed there, we don’t know what the fuck we’re stationed there for.  A different broad every night, twosomes, threesomes, it was a liberal fucking place.  It was just fucking crazy, but it was a relief for a short period of time.  It worked better than booze.  In my mind it had intimacy.  With booze, I didn’t have intimacy.  You’re fucking someone you don’t even know; but you know that you’re fucking.  I wouldn’t even call it lust.  It’s what I’m supposed to do and I feel good doing it, but then you get up and leave.  After you’re done you couldn’t wait to get the fuck outta there.  Also on Nantucket.  Once you’re done everything popped back up [i.e., intrusive memories and emotions related to Vietnam.]  But for that five minutes you forget everything.  Then you get up and leave.

You know you’re walking down the street [today] and you see a guy with his wife, holding hands, and you wonder “why can’t I do that? Why can’t I hold hands like that?”  I want to, but I don’t know how.  It seems like there’s a process to it, but we don’t know the process.  You know, people hugging and shit like that?  We do it in different ways.  We take care of our wives, we give them what they want.  We make sure they’re not afraid of anyone – we’re there if anything fucking happens.  We have intimacy in that way.

You’re drunk, you’re slobbering over some broad – I touched it [intimacy].  I didn’t touch it with the person I want to [i.e., his wife], but I touched it.  Back then I didn’t know what it was for.  It felt good, and not too many things felt good lately and this is one of them.  You know I can drink till I drop.  Booze and fucking has a lot to do with our scenarios, booze would lead to sex.  Half of us don’t drink anymore.  The pact between booze and sex fucking ended.

And when I went home – you know, I think I still have a problem, I still have a problem today, approaching my wife for sex.  I don’t know if she wants me to approach her.  I don’t know the steps.  Every once in a while it’s okay, but most of the time it ain’t.  I won’t say it’s the punishment, but I’d say for us it’s the way it’s supposed to be.  We don’t put a lot of stock in it.

You’ve got a wife and a family, and you can’t abandon them, so, you just fuck.  There’s nights you don’t come home.  The wife, she figures you’re out on a drunk again.  And most of us did weird things, really, but we always left the money at home.  Like, “That’s for you, because this part of me isn’t good.”  [I would] fuck nasty, but you couldn’t do that kind of thing to your wife.  That’s a whole different thing.  That’s the woman who nurtures you, and puts you back together, and puts up with your bullshit.

If you look at a lot of us, we had solid women, the women were strong, they were solid.  That’s what we lost.  We were in the fucking jungle while they were going to their prom, the holding hands.  You know, the high school sweetheart, we gave that up.  Willingly, we gave that up.  We didn’t know it.  But we gave it up willingly and said, “I’m going to do this [fight a war],” so we can’t capture [what was lost], don’t know how to.  Before Nam, I remember going out with girls in high school, not fuck or anything, but making out all night, kissing and – I remember doing that.  [Before Vietnam] not really fucking.  It was that time in the early 1960s, you went home and took a cold shower half the time.  But the intimacy was there, the hugging and the kissing and you could put your arm around the girl you went out with.  These weren’t sluts…”

…

You don’t want to degrade your wife to that level.  [Like a slave?]  Yes.  There’s times when she approaches me, and you know what?  You’re very careful making love.  You’re very careful in your mind.  In your mind you don’t want to get dog-fucking dirty.  This is my wife, the mother of my kids.  She’s the one who holds the family together.  I supply [the family’s livelihood].  That’s a whole different thing.  I don’t have a word for it.

It has a type of relief that’s good for a while, sure as hell better than any booze.  Some of us ain’t drinking anymore so it’s harder.

The way we are, amongst ourselves, look at it is it’s just another price we pay.

Healthy Sexuality for Combat Veterans: The Tao of Healthy Sex

The topic of healthy sexuality for combat veterans that we started talking about yesterday, here, is so huge, and is going to have to be covered in so many ways, over quite a bit of time, in order for it all to sink in, and make sure it's all covered.  Unfortunately, before we get to the "good stuff," as they say, we still have to cover the "bad stuff," because there's quite a lot of that. And by "bad" we're not even meaning, the criminally bad stuff -- military sexual trauma, already covered, here; and domestic violence, already in progress -- how to leave someone with PTSD when you've really gotta go, no matter how much you love the veteran, because your safety and life are at risk.  That's another thing we're gearing up to talk about on the blog, and then we'll be "done" with this overall, comprehensive topic of "things related to sex and the veteran, both bad and good." 

However, all we mean for the moment by "bad" is the stuff that plagues combat veterans' lives, and that of their partners, and shuts them down, and kills off the potential for great, nourishing, healthy, supportive, mutually affirming sex.  Which of course is one of the very currencies of existence, and without which people's lives, and psyches, essentially begin to wither up and die (true, not just poetically speaking.)  Combat veterans bring an awful lot of baggage to this equation; but their partners sometimes do as well.  Or their partners develop some resistance, based on the other things that are going on in the relationship with the veteran. The unhappy "dance" of abstinence, rejection, emotional numbness, resentment and neglect (among others) can be a sad waltz that both partners know too well, and from which there seems very little chance or hope of freeing themselves.

That said, it's not surprising that if we step away from the whole "landscape" of inadequate, inferior, and ultimately unsatisfying sexual experiences, fraught by the problems combat veterans and their partners can experience (other people can too, but we're talking about them right now) -- that we have to look "elsewhere" to get a cleansing breath of "fresh air" about what healthy, balanced sexuality could look like.  Not sexuality that's based on compulsion, addiction, or effective bargaining tools: but sex as an affirming life-force between two mutually consenting, and non-addicted personalities.  From Den Ming Dao's beautiful book once again, 365 Tao, and as you reflect on it, consider how many filters he's saying that we view healthy sexuality with, that ultimately serves to ruin it for the participants.  Of course, it doesn't have to be that way: What we put into love determines what we get out of it.

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 :-) 

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.”

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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.”

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“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 :-)

Just Remember Our Sacrifices, Veterans Plead

 

A quote about sacrifice:

"When we come home, either standing or dead, to know you remember we fought and we bled is payment enough, and with that we will trust. That we mattered to you as you mattered to us." --  quote from USMC OIF/OEF combat veteran, perhaps quoting someone else (and perhaps not!).

Artwork done by proud Marine wife Christie, whose husband just got back from yet another deployment, days ago.  This is her artistic vision, created with photo imaging software, of an imaginary building facade she'd like to see, somewhere in America.

Sacramento Bee's Article Series on "Suspect Soldiers" - How and Whether Servicemembers' Criminal Backgrounds Affect Their Military Service

In these days of newspapers downsizing and widespread layoffs, investigative series -- because they chew up so much time and effort -- are getting significantly rarer and less likely to happen.  That's a real shame, because we've learned some great things from deep and wide-ranging investigative pieces over the years -- the work of the Boston Globe's "Spotlight" team comes to mind, as well as that of the Washington Post. On that level, it's great to see that the Sacramento Bee invested major resources in their series being published this week, starting last Sunday with the initial installment, "Suspect Soldiers: Troubled Histories Follow Some Troops to Iraq War," linked here.  (There are multiple other installments -- follow that first link to find the others.)   Here's what the SacBee says it took to pull off their series:

In reporting "Suspect Soldiers," Bee reporter Russell Carollo focused primarily on people entering the military since the Iraq war began in 2003 and on those linked to incidents in Iraq.

He also examined cases of returning veterans whose crimes were believed linked to post-traumatic stress disorder, and found that several had pre-Iraq criminal records that offered another explanation for their subsequent criminal behavior.

His interviews spanned 30 states, including 200 people ranging from police officers and court officials to soldiers and Marines – and their families. He filed more than 100 public records requests, yielding millions of computer records and thousands of pages of courts-martial files, military investigative reports and civilian court and police records.

A prodigious, considerable, commendable effort on the part of the SacBee.  Now here's the part I don't like.  I read the first installment, and as hungry as I am for news on this topic, I don't think I'll go back and read the rest.  Why?  Several reasons:

1.  Not really their fault (the reporters), but what was found, didn't really seem that significant after all, proportionally speaking. A few arrests here and there beforehand, some incomplete disclosures of recruits' backgrounds before enlisting or re-enlisting, a percentage of troubled histories after the fact.  But none of this was super compelling.  Had the offenses been larger, and with a greater link established to the same types of offenses being committed after enlistment -- or a greater percentage of prior offenders re-offending, I would have been more impressed.  Again, not the reporters' fault -- they asked the questions, they mined the data, they're purely dealing with what they found.  No one wants them making things up just to get a better outcome.  However, it does make me wonder -- why exactly weren't those links stronger?  Could be for any number of reasons, but here are two:

     a.  They're actually ahead of the trend they're trying to analyze; and if they're on the right path, it may just be the timing that's off -- and if they check back in a few years or even a year, using later data, they may find stronger linkages or stronger patterns to report.

     b.  The military may not be doing a good enough job of investigating crimes on its watch, so the back end and the front end aren't effectively tied together enough.  There may be -- let's face it, there are -- servicemembers dying and being injured by one another where the crime isn't being investigated for what it is.  If this side of the data is weak, no matter how great and/or thorough a job the SacBee reporting team did, there's a limit to what they're going to find.

2.  There's a different project I wish they'd done instead, now that I've seen the results of the first. One particular issue of concern to me, after reading about the "double whammy" of Military Sexual Trauma (MST) that we've talked about before on this blog -- is whether a different/better study could have been done, restricting the scope to crimes against women servicemembers.  This seems to be a whole subset of crimes committed while in the service that could seriously use deeper, further study.  Just the way that historically medical research dollars were spent almost exclusively on studies on male patients (look it up, it's true) and women were considered, when it came to medical studies, for years to be nothing more than "junior men;" perhaps the same institutional prejudice is happening here.  

There are some very troubling stories in the news -- if you look around, you will find them -- and there certainly are concerned parents, friends and spouses who know the stories as well -- about women servicemembers and contractors who have been greatly harmed or even murdered, and whose deaths or sexual assaults have not been investigated fully, comprehensively or well.  Not "all," but a significant "some" -- where even one is too many.  See cases of Army Private LaVena Johnson, profiled in Salon and elsewhere, linked here; and Jamie Leigh Jones'allegations against KBR, linked here.  And then there are the random cases we learn about in the news -- various creepy guys in the military (hey, they have them too) murdering their often also active duty military girlfriends. (Marine Cpl. Cesar Laurean and fellow Marine Maria Lauterbach, but they're only one example.  There are at least three more in the news just this week; and try a Google search for "soldier murders girlfriend" or words to that effect, and you'll be tripping over results -- it's really unfortunate.)

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Okay: long buildup for short point: how about just studying in a focused way, crimes against women in the military by other servicemembers?  And then see what relationship, if any, the accused's background has on the likelihood of his committing a crime against women while serving?  I hate to cry gender bias, because it's often so institutional that no one even notices it's there -- but all the more reason to think about it.  The main Sacramento Bee reporters on this series do seem to be men.  One thing we know for sure -- the effects of Military Sexual Traumaare devastating -- worse than PTSD, and often coupled with PTSD, according to reports.  So if the damage is that severe -- can't we work backwards from that and concentrate on prevention?  And part of that might be a good study or three to determine if there IS any relationship between male servicemembers' criminal pasts, where they exist, and crimes against women in the military -- especially crimes of a sexual nature. 

It does seem that some of unexplained deaths of women servicemembers -- which the military sometimes calls suicides, even when faced with evidence that would seem to contradict this claim -- are actually murders to cover up rapes and the like.  Of course men commit sexual crimes against other men in the military, too -- but predominantly, we're talking about women in this instance.  Given the severity of the consequences to the women who are harmed (read up on Military Sexual Traumaif you don't at first agree), it would be well worth investigating better methods for preventing this degree of harm, from one servicemember to another.  Those are some "suspect soldiers" it would really be great to weed out. Women servicemembers signed up to serve their country -- they shouldn't need to worry about harm coming from their fellow servicemembers.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Hey Mama: Celebrating Mother's Day for Veterans

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

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

Kathie Costos, Chaplain

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

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

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

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

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

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

Women Veterans and Military Sexual Trauma

A study reported in the Journal of General Internal Medicine in 2006 compared rates of Post-Traumatic Stress Disorder (PTSD) in female veterans who had Military Sexual Trauma (MST) with rates of PTSD in women veterans with all other types of trauma.  (The full title of the article is "DSM-IV Diagnosed Posttraumatic Stress Disorder in Women Veterans With and Without Military Sexual Trauma.")

Women subjects were recruited via health appointments and/or a mailing, and completed questionairres about their military service and their health and trauma history.  The results were shocking: Ninety-two percent (92%) reported at least one (1) trauma. Forty-one percent (41%) had experienced MST, either alone or with other trauma, and 90% had other trauma, with or without MST. Overall, 43% of subjects with trauma had PTSD. And most importantly, those women veterans who had endured military sexual trauma had higher rates of PTSD.  Sixty percent (60%) of those with MST had PTSD; 43% of subjects with other traumas (with or without MST) had PTSD. Military sexual trauma and other trauma both significantly predicted PTSD in regression analyses (P = .0001 and .02, respectively) but MST predicted it more strongly. Prior trauma did not contribute to the relationship between MST and PTSD.

The study concluded, "Findings suggest that Military Sexual Trauma (MST) is common and that it is a trauma especially associated with PTSD."  To read the article itself, click here.  (The citation for the study is: J Gen Intern Med.  2006;21(S3):S65-S69.)

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(Quoting from the study):

Rape is a violent crime with long-lasting consequences that is often perpetrated against women. At particular risk are women working within male-dominated environments such as the Armed Services, which, despite a recent influx of women, continue to be composed mainly of men.

National surveys found 13% to 30% of women veterans experienced rape during their military service. What is only beginning to be understood is the long-term impact that military sexual trauma (MST), such as rape, has on the lives of women veterans.

Posttraumatic stress disorder (PTSD) is one of the known consequences of rape. In fact, rape is the trauma most highly correlated with the development of this disorder. Posttraumatic stress disorder associated with rape is long lasting. Further, PTSD itself can cause impaired physical and social functioning. Most of what is known about rape and PTSD comes from the literature on civilian sexual trauma. Much less is known about the relationship between PTSD and MST. Previous studies examining the link between PTSD and MST have identified symptoms suggestive of PTSD or have created models connecting MST with the development of PTSD.

There is only one (1) study, to our knowledge, that examined rates of DSM-IV PTSD diagnoses in women veterans with MST. Suris et al., using a sample of female Veterans Administration (VA) patients, compared rates of PTSD related to 2 types of civilian sexual trauma with PTSD rates related to MST. They found that MST was more frequently traumatizing than civilian assault. Thus, the literature indicates that MST is more predictive of PTSD than are other types of military trauma or civilian sexual trauma.

Women's Mental Health Center ("WMHC") for Women Veterans

The VA Palo Alto Health Care System (VAPAHCS), widely recognized for its innovative treatment and research pograms, introduced the Women's Mental Health Center (WMHC) in October, 2002.

The Center was created in recognition of women veterans and their right to gender-sensitive, high quality mental health care.  The Center's mission, to promote the psychological well-being of women veterans, is advanced via provision of individual and group therapy, and delivery of psychoeducational classes and seminars developed in response to the unique needs of the women we serve.  A few important links:

• The Women's Mental Health Center Home in Palo Alto, CA, linked here.
• A gallery of photos showing the campus and typical attendees, linked here.
• A brochure about the program, downloadable as a PDF, linked here.

National Women's Trauma Recovery Program ("WTRP") for Women Veterans

More than a decade ago, the Department of Veterans Affairs opened the National Women's Trauma Recovery Program (WTRP) as part of the National Center for PTSD at Menlo Park, CA. The WTRP, designed to treat women veterans with post traumatic stress disorder (PTSD), is the first residential program of its kind and is open to women across the country. Many of the women who are referred to the program were sexually assaulted during their military service and suffer what is now referred to as Military Sexual Trauma (MST). The WTRP is intensive 60-day residential program with a strong emphasis on interpersonal skills. The initial two weeks of treatment involve psychological and psychosocial assessments in order to develop comprehensive treatment plans. Women come into the program in classes, or cohorts, and work together to problem-solve, learn effective communication, and better manage their PTSD/MST symptoms.

Here's a list of key links:

• An overview of the Women's Trauma Recovery Program (WTRP), linked here.
• A statement about who's eligible to attend, linked here.
• The application itself, linked here.

The WTRP progam is headed by Darrah Westrup, Ph.D.  She has some positive, uplifting things to say about the program itself, including this quote: "our program is all about helping women reclaim their sense of worth and personal power." For more of her remarks, click here.  For more about Darrah Westrup, Ph.D., click here.

Special VA Programs Geared to Women Veterans

It's a little late for International Women's Day (March 8th) and a little early for Mother's Day (May 11th), but it's time to talk about the special needs and concerns of women warriors, and how they're affected by combat trauma.  The most recent issue of the Disabled American Veterans' magazine has an article on women combat veterans.  The public service poster graphic in particular (see left) is impressive, as is its slogan: "War is Hell: Being a [Woman] Veteran Shouldn't Be."  Click on this link to download the March/April issue as a PDF; the article begins on page 19.

It's good news that the VA is becoming more attuned to the special needs of traumatized women veterans, either through PTSD or sexual trauma, or both.  Here's a section of the main VA website that addresses VA Programs for Women Veterans.  Click here for that link.  The programs cover several important areas, including mental health and sexual abuse counseling; medical services for women veterans; education and training; research; compensation for women veterans; national cemetery administration; and demographic trends.  According to the VA's own website, women veterans should be able to get help by contacting the nearest VA center, and asking to speak to the women's program manager, who will be able to refer them to the right help.  To review the briefly-noted information on the VA website, click here.

There's also a physical facility at the VA Palo Alto Health Care System devoted to women's recovery from trauma, both combat trauma and military sexual trauma (MST).  That program is known as Women's Trauma Recovery Program, or WTRP, and it's housed in a facility, called the Women's Mental Health Center Home.  This program is open to women from all wars, with programs being developed to focus on OEF/OIF veterans.  For more from the VA about women veterans with MST, click here.

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Statistically speaking, according to the VA:

The estimated population of women veterans as of 2001 was 1.6 million, or about 7.2 percent of the total veteran population.  10.26% of the 22.8 million veterans who use VA for healthcare are women.  Currently, women make up 14.8 percent of the active duty military force and approximately 22.8 percent of the reserve force.  By 2010, they are expected to represent over 14 percent of the total veteran population.  Fifty-six percent of women veterans who use VA are less than 45 years of age.  Sixty-two percent of women veterans are less than 45 years of age.

When it comes to women veterans and Military Sexual Trauma, though, the figures are worse.  We've done a blog post about that separately.  To read that, click here.

Making a Fractured Heart Whole Again - Military Sexual Abuse and Women

The Buffalo News has an excellent feature story in today's paper about a residential program at the VA for women who are survivors of military sexual abuse, among other forms of trauma.  The residential program profiled in Batavia, NY is one of four such programs the VA runs in the country.  Others will be profiled in future blog posts.  The article is entitled, "Female Veterans Find Help with Emotional Wounds at Batavia Facility."  Go here and read the story.  For a somewhat generic link to the VA's position on women veterans with military sexual trauma (MST), click here.  For a link to the actual VA residential program for women veterans in Batavia, NY, mentioned above, click here.

On the West Coast, there is the Women’s Trauma Recovery Program (WTRP), opened by the Palo Alto, CA VA in 1992 as part of the National Center for PTSD. It is an intensive 60-day residential program with and emphasis on interpersonal skills and a focus on war-zone related stress as well as MST (Military Sexual Trauma).  For a link to a blog post discussing that in greater depth, click here.

There's also a residential program for women at the VA in Tyler, Texas.  And apparently there is a fourth program as well, but an hour plus surfing the VA's inscrutable website doesn't clarify where that is.  When I find out, I'll include the information.  For a link to the Central Texas program, click here.

Helping Families to Recognize Veterans' PTSD

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

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

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

Commander Beverly Dexter, Military Psychologist

Commander Beverly Dexter, Ph.D., is an Active Duty U.S. Navy Psychologist who has served three tours with Marines in the U.S. and Iraq.  She is a warfare qualified former Navy Special Operations Officer (salvage diver and ship driver) and former Navy Supply Corps Officer.  She completed operational tours on four Navy ships and frequently gives professional military presentations on leadership, resilience building for military families and prevention and treatment of trauma.  CDR Dexter has lived military life as a single person, double active duty couple, "dependent" wife and mom, deployed mom, stationed overseas and deployed to a combat zone.  She is the Founder and Chairman of the EMDR International Association Military Special Interest Group and the ISTSS Military Special Interest Group.  Dr Dexter is a leader in the effort to improve trauma treatment for Active Duty, Reservists, and National Guard returning from combat and for their families, and has considerable experience serving Army National Guard troops in Iraq.  Dr Dexter is EMDRIA Certified in EMDR and a Fellow and on the Speaker’s Bureau of the American Academy of Experts in Traumatic Stress.  Author of the forthcoming book, No More Nightmares:  How to Use Planned Dream Intervention to End Nightmares (scheduled for release in 2008), she has taught her original theory of Planned Dream Intervention to thousands of individuals who have experienced rapid resolution of recurring dreams and nightmares.

Loving Someone with PTSD - How It Affects You

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

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

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

Military Psychologist Faces Own Combat Trauma

The military publication, the Voice of America, has an article today called, "Combat Psychologist Treats Trauma, and Deals with Her Own," about Heidi Squier Kraft, who served as a Navy psychologist at the combat hospital in Al-Asad, Iraq, and has recently published a book about her experiences called, Rule Number Two: Lessons I Learned in a Combat Hospital.  Here's what the basic information about the book is:

Book Description
When Lieutenant Commander Heidi Kraft's twin son and daughter were fifteen months old, she was deployed to Iraq.A clinical psychologist in the US Navy, Kraft's job was to uncover the wounds of war that a surgeon would never see.She put away thoughts of her children back home, acclimated to the sound of incoming rockets, and learned how to listen to the most traumatic stories a war zone has to offer.One of the toughest lessons of her deployment was perfectly articulated by the TV show M*A*S*H: "There are two rules of war. Rule number one is that young men die. Rule number two is that doctors can't change rule number one." Some Marines, Kraft realized, and even some of their doctors, would be damaged by war in ways she could not repair. And sometimes, people were repaired in ways she never expected. RULE NUMBER TWO is a powerful firsthand account of providing comfort admidst the chaos of war, and of what it takes to endure.

About the Author
Heidi Squier Kraft spent nine years as a psychologist for the US Navy before leaving active duty in March 2005. She lives in San Diego with her husband and children.

Click here for a link to the article in the Voice of America.  The article is a little surfacey, but still worth reading, about the special considerations of a trauma care provider who's also exposed to the same trauma in combat.  If you want to read more about women troop's experiences in the Iraq war, try also Band of Sisters: American Women at War in Iraq, by Kirsten Holmstedt.  And if you want to read a book about a combat doctor's time in Iraq, read the aptly-titled, On Call in Hell: A Doctor's Iraq War Story, by Cdr. Richard Jadick, or A Doctor Looks at War: My Year in Iraq, by Michael C. Hodges.  Those books aren't necessarily going to focus much on combat trauma, but at least they're tangentially on the topic.  And if you just plain miss M*A*S*H, there are a couple of cool items on YouTube: a tribute to the show, with a great choral version of the theme song, Suicide is Painless, playing in the background; and a straight-up acoustic guitar version of the song which is also wonderful, below: 

Who Bears the Burden of Care Most?

The short answer is, as a society, we share it.  But the brunt of it is often felt, as we see in the Washington Post piece from this weekend, most directly around home and hearth.

In the front matter of Aphrodite Matsakis, Ph.D.'s original book, Vietnam Wives (she has a new book out this year, which we've recently mentioned), she writes this in the dedication of the book:

"From the beginning of time, men have fought each other and have suffered greatly as a result. Their women, children and other family members have also suffered.  To the "forgotten warriors" -- the wives, children and other family members of Vietnam veterans afflicted with Post-Traumatic Stress Disorder -- this book is sincerely dedicated."

As the recent video from the Norfolk County (Massachusetts) District Attorney's Office demonstrates, when a veteran comes home from combat, he (or she) needs time to re-adjust to the family, workplace, friends, hobbies, neighborhood, community, school and/or place of worship that he (or she) left behind.  Each of those environments and each of those relationships can be a source of friction and frustration, or ideally, and ultimately, some form of refuge.  But the adaptation is real, and so are the difficulties the returning veteran encounters.  What is often left out of the equation, also, is the difficulty encountered by the veteran's primary relationships, who are also affected by what the returning vet is suffering.  In some ways, we don't want to highlight this too much, because one of the triggers of suicide seems to be a sense of being a "burden" on others; but the reality is, the hardships of PTSD and combat trauma weigh on a veteran's loved ones, as they do on the veteran.

Fortunately, a certain amount of supportive material is targeted to a vet's close relationships.  The books of Aphrodite Matsakis, Ph.D. and Patience Mason speak to these needs directly (see booklist in sidebar), as do a few of the resources available through other sources.  Over time, we hope that more and more attention is paid, not just to veterans and what they're suffering as a result of combat trauma, but also to their famiies and friends, who may encounter new pressures, demands and hardships, as they care for their returning veterans.

Women Vets' Experience of Sexual Assault in Combat Adds to PTSD Woes

An article in today's Cleveland Plain Dealer addresses a topic rarely discussed: sexual assaults against women military in combat, which of course are another cause of PTSD for women veterans (and some men).  Sometimes these sexual assaults also trigger previously suppressed or repressed memories among the victims, adding to the trauma.