PTSD Combat : Winning the War Within: March 2006

The Oregonian Continues Its Excellent PTSD Coverage

Hot on the heels of its massive PTSD series on the 3rd anniversary of the start of the Iraq War, The Oregonian delivers more stats and important information to its readership on combat-related posttraumatic stress disorder.

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From the Oregonian:

Ron Cannon lost his right leg in a Vietnam minefield. Thirty-six years later, Luke Wilson lost his left leg in a rocket-propelled grenade attack in Iraq. They came together Monday in Salem with nearly 50 experts to say that while support for returning soldiers is broad, more must be done for Oregon's returning veterans.

Post-traumatic stress disorder is a top concern, along with high unemployment, underemployment and alcohol abuse, despite an unprecedented effort to reach returning vets and their families.

Although the President's 2007 VA budget calls for a 12.2% increase in funding, it still may fall far short of what's necessary to meet the need of our returning veterans.

[A]t the Oregon Veterans Summit hosted by the Oregon Army National Guard in Salem, Congresswoman Darlene Hooley, D-Ore., said that the $339 million increase in mental health spending in that proposal still won't be enough to serve the needs of new combat veterans and those who served in previous wars. "The Oregon Army National Guard has lost enough soldiers," she said. "I don't want to lose any more when they come home."

Hooley told a packed room at the Guard's readiness center that the story in The Sunday Oregonian about Sgt. Bill Stout and his family's struggle with his post-traumatic stress "perfectly embodies why we're here, why we have to focus significant resources on reintegration and give veterans the help they need."

Staff members at the Portland Veterans Affairs Medical Center and at the Oregon Army National Guard reintegration team pointed to increasing evidence that returning veterans face immediate medical and mental problems.

Among the statistics:

Nationally, one-third of veterans from Iraq and Afghanistan have sought mental health care, many of them for PTSD, drug abuse, depression and alcohol abuse.

At the Portland VA Medical Center, one-fourth of the 775 veterans of Iraq and Afghanistan treated have sought mental health care. Of those, 62 percent screened positive for PTSD and 52 percent for depression.

Roadside bombs have produced more than 430 cases of traumatic brain injury among U.S. soldiers, and many more soldiers who survived concussions in such attacks have suffered cognitive and emotional problems. ...

Sgt. Phillip Jacques, a member of the Guard reintegration team who has dealt with job, mental health and medical care problems for fellow veterans since he returned wounded from Iraq, reminded all of the war's cost. His team has intervened in at least four potentially life-threatening crises involving recently returned soldiers. "PTSD is a big ugly animal. It hits the guys you'd never expect, the real hard chargers," he said. "But for the most part, it's hit everyone."

Thank The Oregonian and/or reporter Julie Sullivan for continuing their important work to educate their local communities on PTSD. They're showing other media outlets how it should be done.

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Combat PTSD: General Sequence of Treatment

If you or a loved one are coping with posttraumatic stress disorder, you're sure to be curious about how it's treated. Here's a quick and general outline of the general treatment strategy for PTSD used by the author of The Post Traumatic Stress Disorder Sourcebook.

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From Courier Publications:

Glenn Schiraldi is a public-health educator on the stress management faculty at the University of Maryland and formerly on the stress management faculty of the Pentagon. He is author of “The Post Traumatic Stress Disorder Sourcebook.” ...

Schiraldi said there a number of ways of treating PTSD, most of them centered on talking therapies.

“You take this memory that's sitting there like an angry child in a playpen and you try to calm it so you can put it away,” he said. “You try to neutralize the memory, which is intruding, put the pieces together and then store it in long-term memory.”

He said therapy for PTSD patients usually follows a sequence, such as:

Educating the person - normalizing the symptoms and understanding the symptoms.
Stabilization phase - making sure they're not harming themselves.
Managing the symptoms.
Cognitive behavioral treatments - These include correcting unreasonable negative memories such as “I'm responsible for losing my squad members when we were attacked.” Various skills are used for expressing the memories and bringing the traumatic memory to awareness. Schiraldi said art therapy can be very effective. “If a soldier comes in with unresolved trauma from his earlier life, such as child abuse, they're more vulnerable to getting PTSD from combat duty,” Schiraldi said.
“Group therapy can be very helpful, especially for soldiers who feel that nobody but other soldiers can understand what they've been through,” Schiraldi said.
Serotonin enhancers that are used to treat depression such as Zoloft have been found to be effective medications to combat PTSD.
“Mental-health professionals have many more tools than they used to have and so the prognosis is much brighter,” Schiraldi said. “Individuals would be wise to seek a trauma specialist, not just a generic counselor. Sometimes just talking about it is not just enough.”

He said the Sidran Institute in Maryland keeps a registry of trauma specialists. “There is some evidence that you don't want to wait, that the sooner you get treated, the better your prognosis,” Schiraldi said. “Some people suffer for decades, not realizing that if they got treatment, their suffering would lessen quickly.” “The more you keep these memories secret, the more they will eat away at you,” he said.

Schiraldi said many members of the World War II generation masked their painful war memories by drinking, and not talking about them for decades. He said a U.S. naval veteran who was in a Kamikaze attack in the Pacific on a warship had all his memories flood back over him almost 60 years later when he saw the World Trade Center attacked by terrorists on Sept. 11, 2001.

So, the key here seems to be to seek treatment quickly rather than suppress. The faster you face and deal with your PTSD, the sooner you'll be able to check it and move on to the better things in life.

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PTSD Poetry: Power, Pain, and Progress

I recently received approval to reprint the following moving poem written by a soldier who'd served in Mosul, Iraq with the mighty 101st Airborne. Known as Mr. Sandman, he's been blogging on his experiences in Iraq, as well as his experiences with PTSD now that he's returned home to his wife, family, and friends. His blog, "The Iraq War", Through the Eyes of a Soldier is a highly recommended journey. Thank you, Mr. Sandman, for your service, for sharing your difficult experiences with others, and for allowing me to reprint one of your many fine poems. In my eyes, you're a hero through and through.

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Only For a Moment - © 2006 David Kerpash

For a moment...I was a part of something huge
I was invincible....strong....a powerhouse of a man
A soldier!!

For a moment I was part of a brotherhood....
that had been tested in time
Never believing I would ever have to kill.....
for a moment I dreamed of exotic locations and college
Naive to believe I was special.....I took the oath of a soldier

I try to be strong for my wife....a lover, and a husband....
and soon to be father
Hating the weakness I now show....as a vulnerable man
I hide away the decay inside me....buried deep....I pretend all is well
But in dreams.....they always find me....only to exhaust me, and drench me in guilt

Now I join the ranks of the forgotten....
a disabled veteran who has lost his sense of purpose
Longing to go back to the fight......
even though it brings me nighmares.....
I dream of making a difference
To put right what went wrong too many times in Iraq

I wish so much that I could get back to the person I was back then......before PTSD....before the war

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Update on President's Mental Health Commission Meeting

Wednesday, the New Freedom Commission on Mental Health regrouped on Capitol Hill to hear a variety of panels. One panel focused on the mental health of returning war vets. Kaiser Network webcast the event, and it's now available online.

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From UPI's Health Business Correspondent:

Social stigma and lack of funding are still preventing progress in the areas of veterans' health, suicide and mental health in the workplace, experts said Wednesday. Three years after President Bush convened the first New Freedom Commission on Mental Health, the commissioners met again to assess progress on the recommendations in their original report.

Progress has been made on the individual level they say, with people locally taking up the cause of improving mental health services even in the face of dwindling budgets. The problem arises on the federal level -- and they attribute that to a lack of leadership.

These were the specific findings regarding the current state of veterans PTSD diagnosis and care:

Stefanie Pelkey described the ordeal of her husband Michael, who began displaying symptoms of post traumatic stress disorder (PTSD) after he returned from fighting in Iraq. He had trouble accessing military mental health services, and his officers and wife -- who was also in the army -- did not realize the severity of his symptoms. He ultimately committed suicide by shooting himself in the chest, leaving behind his wife and a baby son. After her husband's death, Pelkey said she had trouble accessing benefits because her husband had not been diagnosed with PTSD by an official military psychiatrist.

The families of returning soldiers need to be better educated on the symptoms of PTSD, Pelkey said, and services need to be made more widely available and for a longer period after troops return from war. "I feel the lessons have not been learned," she said. "I have traveled and seen programs that work, but they are different from post to post and sometimes not available at all. It needs to be centralized so all soldiers can access them.

Pelkey added, "Until the senior leaders of our country start recognizing these deaths outside the theatre of operations, soldiers will not come forward with their own battles with PTSD."

Frances Murphy, deputy under-secretary for health and health policy coordination at the Department of Veterans' Affairs outlined changes the agency is undertaking to help the estimated 18 percent of soldiers who served in Iraq and the 11 percent who fought in Afghanistan who have PTSD. The steps include instituting face-to-face sessions for returning troops, longer term post-deployment screening, and a "no wrong door" policy that offers veterans many entry points to access the VA mental health system. But more expansion is needed, Murphy said, to treat the ever-increasing number of veterans who need help. In the past three months, the VA has seen a 30 percent increase in PTSD diagnoses, she noted.

To perform its mental health function well, said Joy Ilem of the Disabled American Veterans, the VA system needs to be better funded and better integrated with community and follow-up care options, and the period of eligibility for VA services needs to be extended from two to five years.

Last year, I wrote of Stefanie Pelkey's struggle to make sense of her husband's suicide after returning from Iraq.

Labels: advocacy, bush, community, funding, murphy, oversight, society, stigma, suicidal, va

Rep. Lane Evans, Veterans Advocate, to Retire

Sad, sad news on the veterans advocacy front today. Crain's Chicago Business reports:

Citing worsening health woes, U.S. Rep. Lane Evans, D-Rock Island, a prominent advocate for veterans' welfare, Tuesday announced that he will not run for re-election and will retire at the end of his current term. "When I announced in 1998 that I had Parkinson's Disease, my doctor said that this condition would not interfere with my work and that I would be able to perform at a high level for a number of years," Mr. Evans said in a statement released by his off ice. "That window of opportunity is now closing."

Mr. Evans has been in and out of the hospital for several weeks. He cast his last House vote on Feb. 14.

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Continuing from Crain's Chicago Business:

Mr. Evans was the ranking Democrat on House Committee on Veterans Affairs. A former Marine and staunch friend of organized labor, Mr. Evans won passage of a law that gives health benefits to children of veterans exposed to Agent Orange, a poison used during the Vietnam war.

To see one example of his recent work for our veterans, one need only look at his introduction of the Comprehensive Assistance for Veterans Exposed to Traumatic Stressors Act of 2005. The legislation was crafted with the aim of improving the mental health benefits given our returning veterans. (Read more on this bill and Evans' work here.)

Rep. Evans statement on his retirement:

This is a tough day for me. I am announcing that I will not run for re-election and will retire at the end of my current term in the U.S. House of Representatives.

When I announced in 1998 that I had Parkinson's disease, my doctor said that this condition would not interfere with my work and that I would be able to perform at a high level for a number of years. That window of opportunity is now closing.

I fully expected that I would continue my work for the foreseeable future following this current break from the office. But I have come to recognize that the time needed to address my health makes it difficult to wage a campaign and carry out my work as representative. I will return soon and to the best of my ability complete the important work of this term in my roles as representative and ranking member of the House Committee on Veterans' Affairs.

This decision is especially tough because this job means so much to me. I believe strongly in serving people and working to make a positive difference in their lives. Every day has been rewarding and I'm proud of what I've been able to accomplish and the fights I've made.

I thank my family and everyone who has worked with me - great friends, terrific colleagues, a dedicated staff, fellow vets. And I appreciate the support of people I never met before who would ask how I was doing and tell me to keep up the good fight. I'll be doing that in the weeks and months ahead and look forward to thanking every one of you personally for all you have meant to me."

To my constituents and veterans across this country, it is an honor and privilege to represent you.

Semper fi,

Lane

If you'd like to send your good wishes to Rep. Evans:

Contact information (no handy-dandy online contact form for us to use).

Email: lane.evans@mail.house.gov

Phone: Washington, DC
Voice - (202) 225-5905
Fax - 202-225-5396

Mail: Congressman Lane Evans
2211 Rayburn House Office Bldg.
Washington, DC 20515

Rep. Evans: I'm going to miss reporting on your many good works, miss hearing how hard you're fighting to set things right by our veterans and by your constituents. You've been a shining example of what a public servant should and could be. Thank you so very much for that. All of my best to you for comfort, happiness, and quality time spent with family and friends. Thank you for your service to our country -- in and out of uniform.

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President's Mental Health Commission Meets on Capitol Hill

On April 29, 2002, President Bush established the New Freedom Commission on Mental Health to study how good current public and private institutions were at providing mental health services to its customers. The Commission met 11 times publicly, and reviewed 2,500 comments from "consumers, parents, family members, advocates, service providers, educators, researchers, and other concerned individuals." It issued its final report on improving mental health services in July 2003.

The Commissioners are today returning to Capitol Hill to hear a variety of panels, the first focusing on the mental health of returning war vets. Presentations on this panel will be given by Frances Murphy, M.D., M.P.H. (Veterans Health Administration); Joy Ilem (Disabled American Veterans); and Stefanie Pelkey (former Army captain). Last year, I wrote of Stefanie Pelkey's struggle to make sense of her husband's suicide after returning from Iraq.

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Appleton Post-Crescent: President's Vet Health Budget a Shame or Sham?

Being more closely tied to and supported by their local communities, editorials from small-town newspapers are often a clearer indication of how 'average' Americans (if there is such a thing) feel about certain issues. Let's take a look at what Appleton, Wisconsin's Post-Crescent had to say about veterans health funding earlier this month.

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From the Appleton Post-Crescent:

Under the [President's 2007] budget proposal, the funding for veterans' health care would grow from $24.5 billion in 2006 to $27.7 billion in 2007. After that, though, it would be cut 3 percent in 2008 and stay below $27 billion in each of the following four years.

Now, consider that the average annual increase in the veterans' medical budget has been more than 10 percent since President Bush took office. Also consider that the needs will grow as veterans come home from Iraq, Afghanistan and wherever else they're sent.

Finally, consider that President Bush "is committed to honoring America's veterans who have sacrificed so much for our nation" and veterans' health care has indeed gained a better reputation. But veterans' eligibility requirements already have been toughened. Now, future funding will get cut. Or will it?

President Bush wants to cut the federal budget deficit in half by the end of his term in 2008. Cutting or holding the line on much domestic "discretionary" spending, such as veterans' health care, is how he plans to do it — at least on paper. According to the Associated Press, the White House "says the long-term budget numbers don't represent actual administration policies." In other words, they're numbers that might not mean anything, other than making the overall budget proposal look like it's reducing the deficit. The administration might not follow through on them.

So that leads us back to Edwards' analysis. Either the budget proposal will do serious harm to the health care of the veterans who have nobly served our country and we will further dishonor our commitment to them — or the whole thing is just a sham.

Either option is appalling.

Feel free to offer feedback to the Appleton Post-Crescent by filling out the online form found below the editorial page.

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Lifelines Online PTSD Video Series for Military Families

As our troops continue to stream home to us, families are having to deal with a variety of adjustment issues. Soldiers, sailors, airmen, and Marines are likely coping with combat stress or post-traumatic stress disorder; and so, Navy hospitals have been reaching out to help their service members and families via traditional counseling and online videos to assist families in understanding some of the reintegration issues they'll be facing.

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[UPDATE Apr 09 2007]: View videos below.

From AP:

Sgt. Milton Caples made it home to his wife and daughter after a year as a security convoy driver in Iraq, but thoughts of suicide bombers and mortar attacks haunted him, nearly costing him his former life. Driving on the rural roads near his home, he would flashback to the streets of Balad and Tikrit, speed up and try to out run other drivers. "I would know I was doing crazy stuff. It would seem like I was driving but I wasn't there. I was looking at myself doing stuff in a video game or something," he said. "In some cases, I'm glad the police didn't see me because they would have taken my license away."

He spent his nights doing security patrols of the family home - repeatedly checking to see if doors and windows were locked, if anyone was prowling around outside. His anger ate away his relationship with his wife and daughter, who struggled to reach the fun-loving man they once knew.

Three years into the Iraq war and almost five years after the invasion of Afghanistan, American families like the Capleses are increasingly becoming part of its collateral damage. Learning from the mistakes of Vietnam, the military has long encouraged returning soldiers to seek counseling. Now its leaders are trying something different - reaching out to the soldiers' families.

Although treatment and medication have evolved since Vietnam, the warrior mentality still prevents most returning soldiers from getting the help they need, said Rick Weidman of Vietnam Veterans of America. "Real men don't eat quiche and they don't have problems like this - hooah," he said, giving the shout soldiers make.

To counteract this attitude, Navy hospitals have begun advertising their counseling programs as well as pointing families to their online PTSD video series.

The videos were designed not for service members, but their families. "The goal was to bring in the family in hopes that if the individual wouldn't come in on their own, we would reach them through the family. We made thousands of copies and distributed them to all kinds of places," said retired Navy Capt. Jennifer Morse, the San Diego Naval Hospital psychiatrist featured on the videos. The Navy began producing the videos in 2004 and is releasing a re-edited version of the project in the coming months.

"The intent is to get people help, not to fix them over the Internet. (To tell them that) they shouldn't be ashamed of their feelings after they have served in these situations," said Bill Hendrix the Navy's Pentagon-based coordinator of the Lifelines video project. The videos have been so successful that the Air Force and the Army are also using them to encourage families to seek counseling for veterans of both Iraq and Afghanistan, Hendrix said.

Weidman, of the Washington-based Vietnam veterans group, applauded the efforts to reach troops by reaching out to families. "The military, under significant pressure, has made some significant efforts," he said. Vietnam Veterans of America has long pushed the Department of Defense to develop such programs, he said.

But Capt. Jeffrey Weyeneth, a psychiatrist at Pensacola Naval Hospital, estimates continued counseling programs still reach only 10 percent of troops returning from Iraq and Afghanistan. "A lot of guys, they see it as a nick in their armor, 'If I want to do 20 (years) or more, I don't want to be seen as a nut case'. And confidentiality is difficult with the military because mental health can affect your ability to function in the military so confidentiality is not as absolute as it is in the civilian world," he said.

Returning soldiers who go without treatment often hide their stress from co-workers to avoid ruining their careers and instead take their problems out on their families, Weyeneth said. "A lot of these guys come back from war but never get out of the combat, the enemy just changes. They direct their anger at other people," he said.

You may access the full Lifelines video series online.

[One technical note: For some reason, this link wouldn't open the video page in my Firefox browser; Internet Explorer, however, downloaded it just fine, making the programs available for viewing.]

The videos have been made available on YouTube:

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Maine Veteran? Combat PTSD Symposium Tomorrow

If you're in Maine, you may wish to plan to attend a public symposium for veterans and their families seeking to learn more about posttraumatic stress disorder. The program runs from 9 a.m. to 3 p.m. tomorrow (Saturday, March 25, 2006) at the Senator Inn in Augusta. Space is limited to 150 attendees; please call 778-7292 or 293-2580 to pre-register. Fee: $10 (may be waived for hardship) per person, lunch included. More details.

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Marine Parents Conference Offers Community and PTSD Resources

Next month's Marine Parents Conference in Houston, TX offers its participants the "esprit de corps and the bonding atmosphere of United States Marine Corps and Navy families" in its three days of speaker presentations, breakout sessions, and workshops. Registration for the conference, which takes place April 21-23, 2006, is $195.00 and also includes entertainment and dinner on Friday, breakfast, lunch and dinner on Saturday and breakfast on Sunday.

Additionally, from the website: "All conference attendees will receive a copy of the book Down Range: to Iraq and Back. The book addresses PTSD (Post Traumatic Stress Disorder) for our military personnel returning from combat. Attendess will have an opportunity to attend a panel discussion with the authors Bridget C. Cantrell, Ph.D. and Chuck Dean on Saturday."

Please visit the conference website for more information.

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Insurance Money Available for Veterans with Traumatic Injuries

In a letter to Sgt. Shaft at Military.com, we learn of the VA's "new program for service members sustaining traumatic injuries, Traumatic Servicemembers' Group Life Insurance (TSGLI). [It] will help families focus on recovery, readjust to military or civilian life and ease worries about financial difficulties. The TSGLI benefit payments, ranging from $25,000 to $100,000, are made to service members who have suffered certain traumatic injuries while on active duty. The program became effective Dec. 1...[and b]enefits are also payable retroactively to Oct. 7, 2001, for service members and veterans who served in OEF and OIF."
Program Details | TSGLI Certification Form [pdf]

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Veteran with PTSD? Online Communities Offer Help

Are you a returning veteran coping with PTSD (or a military family member seeking help in supporting your troop with PTSD)? Getting answers to your questions can leave you stumped. Where can you turn? A good start is by looking at this list for ideas; another is to join an online community focused on combat-related PTSD.

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Here are a few good online PTSD communities to explore:

Be sure to check them all out. Each of them have their own vibe, so you're bound to find one that fits your own.

Labels: advocacy, community, linklists, online, resources

Acoustic Startle: Experimental PTSD Assessment Tool to be Studied in WI

The Wisconsin State Journal explores a new, experimental tool that researchers at Madison's Veterans Hospital are currently testing to gauge the effectiveness of posttraumatic stress disorder treatments. Called acoustic startle, the study will monitor eye flinch reactions, heart rate, and sweat production to sudden, loud sound to determine how severe the patient's PTSD is.

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From the Wisconsin State Journal:

Doctors at the Veterans Hospital are preparing for a new generation of veterans returning from Iraq and Afghanistan who might develop PTSD. They are researching new therapies for the disease that might make the condition more manageable for newly returned soldiers than it has been for many Vietnam veterans. The doctors are also looking at a new way of assessing the effectiveness of PTSD treatment.

The experimental assessment tool, called acoustic startle, is based on the flinch of a patient's eye muscles. It's a reflex to a sudden sound that can be measured by the contraction of the obicularis oculi, the muscle that gives people of a certain age bags under their eyes.

As with most psychological disorders, doctors now use questionnaires to rate symptoms of PTSD and determine whether medications or psychotherapies help patients get better. But sufferers of PTSD, many of them men who have been in combat, can be reluctant to acknowledge their symptoms, doctors say. Improvements in irritability, detachment, nightmares and flashbacks can be subtle.

In a study about to begin at the VA, electrodes will be placed below the eyes and on the arms and hands of veterans with and without PTSD. The subjects will wear headphones through which piercing tones will randomly ring. During 10-minute sessions of loud beeps, their eye muscle contraction, along with heart rate and production of sweat, will be measured. Some participants will have recently started detox for alcohol abuse.

The goal is to see if acoustic startle is a useful way of quantifying the severity of PTSD - and to learn if some patients, likely those who react most to sudden noise, "self-medicate" by drinking.

More clinical information on startle response from the National Center for PTSD:

Historical and contemporary records provide evidence that an important symptom seen in combat veterans diagnosed with Shell Shock, Combat Fatigue or Post Traumatic Stress Disorder has been, and continues to be, an exaggerated startle reflex. (6-9) Clinical observations of exaggerated startle in distressed combat veterans were so common by mid-century, some psychiatric authorities argued that increased startle was cardinal symptom of combat fatigue (10). While not considered the cardinal symptom of PTSD today, exaggerated startle remains tightly linked to trauma related psychological illness. In fact, according to DSM-IV, PTSD is now the only anxiety disorder in which hyperstartle is listed as a core symptom.

Investigators have had various motivations for studying the acoustic startle reflex in humans and especially in those suffering from PTSD. Some have been interested in finding out whether or not exaggerated startle is a marker (or sign) indicating, or helping to provide a reliable diagnosis of PTSD. The idea of an objective test for PTSD remains extraordinarily appealing to many clinicians and forensic specialists. It is felt that such a test would enhance discrimination between individuals who do and who do not have PTSD.

For other investigators, startle has been less interesting as test for PTSD, and more interesting as a probe in examining central nervous system reactivity in individuals with PTSD. Because so much is known about the neuroanatomical pathways of, and neurotransmitters involved in the startle reflex, several studies have used startle to gain an understanding of neurohormonal functioning in PTSD. Finally, several investigators have used startle as an objective measure of the emotional states of anxiety and fear and have used startle as a tool to elucidate the neural mechanisms involved in the learning and extinction of fear and anxiety.

The startle reflex is one that is shared by very nearly all animals. In basic terms, it is the rapid motor twitch or jump that occurs when an animal or human is exposed to a sudden stimulus (such as a touch, a noise, or a visual image or light). The term acoustic startle reflex refers to the startle response to loud or sudden sounds. In humans, the most consistent and easy way to measure the acoustic startle reflex is to record the speed and intensity of the eye-blink that occurs after someone hears the noise.

The Madison Veterans Hospital is also conducting other PTSD experiments, including:

"Imagery rehearsal therapy" to reduce nightmares - and, sometimes, other symptoms. "You practice a dream and change the ending," said researcher Tracey Smith.

The short-term use of steroids to boost cortisol, a stress hormone. Some patients with PTSD have low levels of cortisol, perhaps because a sudden rush of it following a traumatic event has blunted production. A two-week dose of steroids "could help normalize that system," said researcher Catherine Johnson.

Use of the drugs risperidone and quetiapine, both antipsychotics developed for schizophrenia, in addition to the antidepressants typically given to patients with PTSD.

Researchers are also testing the use of prazosin, a blood pressure medication that slows down the sympathetic nervous system, commonly known as the "fight or flight" response to danger.

Great to see these studies moving forward.

Labels: biological, clinical, diagnosis, hypervigilence, medication, studies

Troops Medicated, Returned to Combat

An unbelievable story from the San Diego Union-Tribune today. Troops are now returning to the field of battle carrying their own supply of antidepressant and anti-anxiety medicine; service members who are having mental health issues are routinely sent into combat for a second, third, or fourth tour. Is this safe? Is this sane policy?

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From the article:

The redeployments are legal, and the service members are often eager to go. But veterans groups, lawmakers and mental-health professionals fear that the practice lacks adequate civilian oversight. They also worry that such redeployments are becoming more frequent as multiple combat tours become the norm and traumatized service members are retained out of loyalty or wartime pressures to maintain troop numbers.

Sen. Barbara Boxer hopes to address the controversy through the Department of Defense Task Force on Mental Health, which is expected to start work next month. The California Democrat wrote the legislation that created the panel. She wants the task force to examine deployment policies and the quality and availability of mental-health care for the military.

“We've also heard reports that doctors are being encouraged not to identify mental-health illness in our troops. I am asking for a lot of answers,” Boxer said during a March 8 telephone interview. “If people are suffering from mental-health problems, they should not be sent on the battlefield.”

Stress reduces a person's chances of functioning well in combat, said Frank M. Ochberg, a psychiatrist for 40 years and a founding member of the International Society for Traumatic Stress Studies.

“I have not seen anything that says this is a good thing to use these drugs in high-stress situations. But if you are going to be going (into combat) anyway, you are better off on the meds,” said Ochberg, a former consultant to the Secret Service and the National Security Council. “I would hope that those with major depression would not be sent.”

The DOD doesn't keep track of troops returning to combat medicated for mental health disorders; however, Army and Marine Corps medical officers confirm that medicated soldiers and marines are returning to the combat zone.

Buttressing the idea that large numbers of service members are medicated, more than 200,000 prescriptions for the most common types of antidepressants were written in the past 14 months for service members and their families, said Sydney Hickey, a spokeswoman for the National Military Family Association.

Hicks said a Defense Department official gave her the information during a December briefing. She said the official did not distinguish between prescriptions for the troops and those for their family members. In addition, the Defense Department has not provided prescription totals for such antidepressants from before and after the United States invaded Iraq in 2003.

Politics and penny-pinching are part of the problem.

Mental-health care for service members and the Defense Department's efforts to keep the mentally ill in uniform are becoming national issues, said Steve Robinson, director of the National Gulf War Resource Center in Silver Spring, Md. Robinson said three Army doctors have told him about being pressured by their commanders not to identify mental conditions that would prevent personnel from being deployed.

“They are being told to diagnose combat-stress reaction instead of PTSD,” he said. “That does two things: It keeps the troops deployable and it makes it hard for them to collect disability claims once they get out of the military.” Robinson contends that the Pentagon is trying to control its spending on mental-health disabilities. ...

Overall, service members' mental health is a hot-button subject because it goes to the cost of the war in dollars and lives, said Joy Ilem, an assistant national legislative director for the organization Disabled American Veterans. “The (Department of Veterans Affairs) is very worried about the political implications of PTSD and other mental issues arising from the war,” Ilem said. “They are talking about early outreach and treatment, but they are really trying to tamp down the discussion.”

Medical practice and ethics questions loom large, too.

Cmdr. Paul S. Hammer deals with such issues daily. Hammer, a psychiatrist, is responsible for the Marine Corps' mental-health programs during this deployment rotation. He confirmed that Marines with post-traumatic stress disorder and combat stress are returning to Iraq, though he would not say how many.

Hammer said deciding who is deployed is often anguishing. Sometimes he has to tell Marine commanders that personnel they had counted on will not be deploying. In other instances, he said, “We'll hold some guy's feet to the fire and say, 'This is what you signed up for, and you have to go.'” Marines are “amazingly resilient,” Hammer added. “You've got people exposed to incredible violence, but they do entirely well.”

It's the tough calls that worry Adrian Atizado, a legislative director for Disabled American Veterans. “Currently, the services will deploy a service member if the person is medically stable and it is determined that the deployment won't aggravate (his) condition,” Atizado said. “How does one gauge that? This a gray area; this is asking a medical provider to make a decision based on the future. The medical providers are human beings. I have no doubt that they are looking out for the best interest of the service members, but they are under pressure to check off on their deployment.”

Ultimately, much is unknown about the rates of post-traumatic stress disorder among Iraq veterans, especially those who have been through more than one combat tour, said Matt Friedman, executive director of the U.S. Department of Veterans Affairs National Center for PTSD in White River Junction, Vt.

Friedman said that with time, “one of the things we are going to find out is how well people function who might have been on medication (during combat). This is a very important question and has all kinds of implications. “But remember, they are all volunteers. This isn't Vietnam, where people were drafted and sent to fight. Think of the ethical questions that would arise from sending draftees back to war on medications.”

If you'd like to thank the San Diego Union-Tribune for their coverage of this issue, please do.

NPR's Morning Edition: Looking at Multiple Tours

NPR's Morning Edition today briefly covered the difficulty of multiple tours on soldiers and their families. Full audio and transcript of the program are available online.

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Chicago Trib on PTSD: Interview with a VA Counselor

The Chicago Tribune presents an interview with Ed Klama, a social worker and PTSD program director at Hines VA Hospital at Maywood, IL. From WWII veterans dealing with late-stage PTSD to recently returned troops from OEF and OIF, the discussion deals with war's consequences and the role good counseling plays in Quelling War's Aftershocks. To accompany the print piece, they have the full interview audio available online. If you'd like to thank the Chicago Tribune for their PTSD coverage, please do.

Labels: audio, counseling, local, reintegration, va, vietnam

3 Years On, Combat PTSD Comes Out of the Closet

Yesterday's 3rd anniversary of the Iraq invasion found an interesting situation brewing: returning veterans coping with post-traumatic stress disorder [PTSD] are no longer being hidden away from our view. The media is beginning ever-so-slightly to lift the veil on this nerve disorder affecting at least 16,000+ of our troops who've served in Afghanistan and/or Iraq.

Since we have so very little else to celebrate as another year moves forward with no end in sight to war and its victims, I'm going to focus on the good reporting on this issue that is finally, finally seeing the light of day. And I celebrate the fact that rather than using this anniversary to glamorize and glorify the war, the media seem to have finally decided to use it to introduce this ballooning problem at last to the public.

Click on 'Article Link' below tags for links to yesterday's coverage...

A Partial List of Yesterday's Combat PTSD Coverage

Meehan: Help our heroes once they return home, MetroWest Daily News [Framingham, MA]
National Guard sheds its "weekend warrior" image and works to adjust to its changing mission, The Times Union [Albany, NY]
Veterans' group provides friendship to returning soldiers, Courier-Post [Cherry Hill, NJ]
The ties that bind -- Marines' fellowship forged in battle, The North County Times [Escondido, CA]
Building a new reality, Los Angeles Daily News
Profile: David Roby, The Cincinnati Enquirer
The Iraq effect, The Observer [UK]
Some troops headed back to Iraq are mentally ill, San Diego Union Tribune
The trauma of war Experts fear cases of veterans with PTSD could skyrocket, The Kalamazoo Gazette
Quelling War's Aftershocks, Chicago Tribune
Wounded Lives, The Oregonian
They're so very brave, New York Daily News op-ed
Our sacrifices - Working through the trauma, Santa Fe NewMexican
Our sacrifices - The Journey home and readjustment, Santa Fe NewMexican

There were many more reports that didn't find their way onto this list. Some were in local papers without online editions; others I haven't turned up, yet. If you know of any that I've missed, please drop them into comments; I'll be happy to add them.

The Oregonian Delivers Massive PTSD Story Today

Spanning an enormous 12 online pages, one explanatory editorial, and an introduction by the author, Julie Sullivan (assisted by Torsten Kjellstrand), the Oregonian delivers its readers a grand public service this morning. Through the experiences of the Stout family (who were extremely gracious in allowing reporters into their lives to record their story), America receives a detailed view of the struggle some of our veterans -- and their families -- are facing as they cope with post-traumatic stress disorder.

This important article is so exhaustive and detailed, that it is impossible to do it justice in any way here; please just take the time to read it. And after you've finished, please contact The Oregonian and commend them for devoting resources and taking great care in presenting this topic to their readership. You might also wish to contact the reporters, Julie Sullivan and Torsten Kjellstrand, to offer your personal thanks.

Labels: family, incidents, local, stress, suicidal

PTSD Documentary Airs Today

New England Cable News (NECN) is set to air a new documentary, Hidden Wounds, detailing the struggle of three local soldiers who've returned from Iraq with post-traumatic stress. If you're in the viewing area, you can catch it today at 10:00AM and 7:00PM. NECN will re-broadcast the special throughout the week [times/dates - scroll down]. For those not in the viewing area, the Boston Globe has an article out today and online clips are available.

Click on 'Article Link' below tags for more...

The pop of a firecracker in a parking lot was all it took to send Nate Fick back to Iraq. That sound had him ducking behind the nearest car, grabbing for the pistol holstered on his thigh. Except his gun wasn't there. The former Marine was in Maryland with his sister and it was July Fourth, about a month after his return from Iraq. "I stood up a few seconds later, and said, 'Man, I'm out of my mind,'" Fick said in an interview this week. ...

"Hidden Wounds," which debuts Sunday at 10 a.m. and 7 p.m., tells the stories of Fick, currently a Harvard graduate student, Sgt. Russell Anderson, a longtime military man from Norton, and Jeff Lucey, a Marine who killed himself several months after returning to Belchertown. "These are three very different men," said Iris Adler, the film's producer and writer. "In spite of their differences, they all come home with post-traumatic stress disorder."

About one in six soldiers from Iraq and Afghanistan are suffering from post-traumatic stress disorder and depression, according to studies cited in the documentary. The soldiers in the film believe that the percentage is much higher, but a stigma prevents others from admitting the struggle. "There's a lot more people out there than you think like me," Anderson, 55, said this week.

Anderson's and Lucey's experiences are briefly outlined before returning to Fick's story:

Fick, a Dartmouth graduate, joined the military to test himself and because he believed members of the privileged class should serve. In Iraq, he led a reconnaissance unit to Baghdad. Carnage became commonplace, and the pressure of making life and death decisions was relentless. When he returned home, Fick fell into deep depression. He found relief writing about his experiences, an exercise that became the book, "One Bullet Away."

Fick said he hoped telling his story makes post-traumatic stress disorder real to people who don't know a soldier. People returning from Iraq are going to have serious problems, he said, and society needs ensure they get proper care, unlike so many Vietnam veterans. "Their problems have endured the 30-40 years since they came back," Fick said. "I don't want to see that repeated."

Don't forget to view the online clips if you're outside of the viewing area; and take a moment to thank NECN for their efforts at getting more to understand the plight of those troops coping with PTSD.

Doctor of OEF/OIF War Wounded: "They Are So Brave"

The New York Daily News presents an op-ed piece written by Dr. Gene Bolles, "chief of neurosurgery from November 2001 to February 2004 at Landstuhl Regional Medical Center, America's tertiary hospital serving our troops." As we arrive at 20,000+ wounded and 2,600 killed in action, the physician remembers those he's crossed paths with these past three years.

Click on 'Article Link' below tags for more...

With the third anniversary of Operation Iraqi Freedom upon us, I am reminded of war's horrors, but also of the unparalleled sacrifice and loyalty of the men and women who serve this nation. During my time at Landstuhl, I evaluated hundreds of men and women. As a civilian not in their chain of command, the servicemen and women often confided to me that they were living in constant fear as witnesses to the agony of war — the smell and sounds of death; seeing their buddies mutilated, along with Iraqi men, women and children.

Most of those who are killed or wounded are under the age of 22. Those who are seriously injured (some with only one extremity remaining, some blinded and severely disfigured) frequently express a strong desire to go back to their units to complete their tour of duty and protect their buddies.

He tells the story of a 19-year old woman who came to him with severe back injuries; and he remembers the 21-year old man who'd lost two limbs, yet was still more worried about his buddies.

They are, every one of them, true heroes. And it is these heroes who pay the many human costs of war.

In addition to post-traumatic stress disorder (it is estimated that 35% are afflicted), there is traumatic brain injury (often disabling, unrecognized and untreated), chronic pain and spinal damage, blindness and the questionable effects of undepleted uranium. Instances of amputation in the Iraq War are reportedly double previous rates, and while the military medical care is the best in the world, there are still long-term problems with disability and chronic pain often requiring multiple surgeries.

I have the highest regard for the medical care offered by the Veterans Administration and our military. But there are many problems associated with the bureaucracy, which often stymies the efficiency of the delivery of care, which is paramount. After soldiers are discharged, they are dependent on our Veterans Administration, an overloaded and underfunded system. This system designates only 30 minutes per month for treatment of post-traumatic stress, and can take from six months to a year to provide treatment in various specialty clinics.

Unfortunately, our global war on terror is only going to add to the number of veterans suffering from war-related injuries.

Our esteemed athletes in the NBA, NFL and NCAA receive medical care and appropriate testing almost immediately upon being injured. Our soldiers and their families deserve no less. If we can spend $7 billion to $10 billion dollars a month on a war, we must also afford to help rebuild lives impacted by this war.

Food for thought, indeed.

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Labels: disabled, fear, local, opinion, shortfalls, stats, tbi, tribute, va, wounded

Rep. Meehan: Working to Reduce Stigma, Provide Services for Veteran PTSD

Congressman Marty Meehan (D-MA), a senior member of the House Armed Services Committee, writes an important guest column in the Framingham, MA MetroWest Daily News today. He explains how the current post-deployment mental health screening and counseling programs are flawed -- and how legislation he is helping to craft aims to remedy many of the serious problems which result. Click on 'Article Link' below tags to read more...

In the interest of PSTD education, I am quoting the column in its entirety, adding links to provide access to related information at your fingertips:

On the third anniversary of the invasion of Iraq, it is important to reflect on the lessons learned and where to go from here. Many mistakes have been made, from poor prewar planning to a failed postwar reconstruction policy. Often overlooked, and just as alarming, are the inadequate resources available to help service members cope with their emotional and psychological scars when they return home. Post-war planning does not stop at Iraq’s border. We must provide the support our service members need to re-enter civilian life when they return stateside.

The current system is fundamentally flawed: it neither pays adequate attention to veterans suffering from mental health disorders nor dedicates sufficient resources to diagnosing and assisting them. A July 2004 New England Journal of Medicine study found that one in five of our troops involved in ground combat in Iraq suffer from Post Traumatic Stress Disorder (PTSD), symptoms of which include major depression and generalized anxiety.

Even more troubling is that service members at a significant risk of mental health problems have often resisted seeking help because of the stigma associated with treatment. Among returning service members, only between 23 percent and 40 percent of those who tested positive for a mental health disorder sought professional help. This alarming statistic illustrates the need to educate our soldiers on this issue, and to end the stigma surrounding a legitimate illness.

The war in Iraq is the bloodiest in a generation, with urban and close quarter combat that is bound to leave lasting emotional scars. The reality is, the longer we fight the war in Iraq, the more troops will return suffering from PTSD. Working to address PTSD continues to be one of my top priorities in Congress.

In the 2006 National Defense Authorization Act, I worked with my colleagues on the Armed Services Committee to include a Mental Health Task Force that will study how the Defense Department and the Armed Services can better identify, treat, and support mental health needs for service members and their families. While this is a good first step, we must dramatically increase the amount of funding for PTSD screening and treatment to adequately assess and care for the emotional wounds of our returning service members. It’s unconscionable to send our brave young men and women into Iraq and then not try to make them whole -- mentally as well as physically - when they come home.

Last spring I introduced the Help Extend Respect Owed to Every Soldier (H.E.R.O.E.S.) Act, which would create a peer support program to educate military personnel about PTSD. It would also create a Defense Department mass media campaign to raise awareness about mental health and substance disorders among service members and their families. This program, which was endorsed by Dr. William Winkenwerder, Jr., assistant secretary of defense for Health Affairs at the Department of Defense, will help remove the stigma and encourage people to seek treatment.

The H.E.R.O.E.S. Act also requires that service members undergo a thorough mental and physical examination before being sent home. The current mental health screening is just a form to be filled out, not a real exam. If an examination reveals the need for treatment, it would be provided when the service member is back with his or her family, so returning troops don’t need to be concerned that revealing symptoms during an examination would delay their reunions with their loved ones. By reducing the stigma of PTSD, screening soldiers for the illness, and providing treatment for those affected by the illness, the H.E.R.O.E.S. Act will help thousands of returning soldiers win their final battle in this war.

President Theodore Roosevelt once said that anyone "good enough to shed his blood for his country is good enough to be given a square deal afterwards." We have a responsibility to the brave men and women returning from Iraq to provide them with the care and services they rightly deserve.

If you support this work, contact Rep. Meehan and let him know you have his back, and contact your own representatives to ask them to support the above legislation. And if you wish to thank the MetroWest Daily News for running this important public service column, I think they'd appreciate hearing from you.

Finally, take a look at which other legislators are working tirelessly on behalf of our returning combat veterans.

Labels: counseling, dod, house, legislation, local, meehan, opinion, reintegration, roosevelt, screening, shortfalls, stats, stigma

Thank You Soldier: A Poetic Tribute

This weekend, as we remember the continuing sacrifices of our soldiers, sailors, airmen, and Marines involved in Iraq, I'd like to share a poem recently sent in by Chris Woolnough. You'll find her ode to our fighting men and women, a link to the writer's online bulletin board, and links to more poetry shared at PTSD Combat. Please send or post in comments any poems you'd like to share as well. And thank you, soldier.

Click on 'Article Link' below tags for more...

Thank you Soldier
By Chris Woolnough

Have you stopped to thank a veteran today?
For the price of freedom they had to pay?
Did you gaze into those distant eyes?
Did you see the ghosts he can't deny?
Did you think a soldier's heart was made of steel?
Because he was trained to kill, he couldn't feel?
Did you see the guilt written on his face,
For the loss of life he can't replace?
Did you know he mourns the lives he couldn't save,
And walks with comrades in their grave?
Did you remember the boy with innocence lost?
Do you really know war's ultimate cost?
Have you felt the blast of artillery fire?
Do you have the courage it would require?
Have you stood in trenches consumed with fear?
Felt the enemies breath so very near?
Have you walked with God on a battleground?
Seen your brothers dead or dying all around?
Have you stopped to thank a vet today,
Or did you just turn and walk away?
From the pain he'll carry for the rest of his life,
Did you consider his family, his children, his wife?
That watch him suffer in silence each and every day,
As he's haunted by memories that don't go away?
Did you care that the soldier is still pulling guard?
That his heart, mind, and soul will forever be scarred?
Do you know how he suffers from ptsd?
Or that our precious freedom is never free?
Do you care that he still hears the blood curdling screams?
Or that he returns to the war each night in his dreams?
Have you felt the sorrow of a combat vet?
Or would you rather just forget?
That war has pierced his hardened heart,
And torn this soldier all apart?
Would you rather our heroes just fade away?
Or will you stop to thank a vet today?

Please visit Chris Woolnough's online community at The Aftermath of War, Coping with PTSD. You'll find "a safe haven of support for those whose battles live on in The Aftermath of War." Thank you, Chris, for sharing your poetry with us and extending your services to so many appreciative people over the years.

Newsweek Covers Combat PTSD and Brain Trauma

Newsweek today runs a web exclusive (why it's not in the print edition, I'll never know...) dealing with the hard realities facing our returning troops coping with brain injuries coupled with PTSD. Take a glimpse inside their world through one soldier's experience.

Click on 'Article Link' below tags for more...

Newsweek offers us the story of Sam Reyes, a Marine who was severely wounded in a Fallujah suicide bomb attack in September of 2004. He was one of the fortunate ones to have survived that day (12 others weren't as lucky); but, injuries he most likely would not have survived in previous wars have left his life radically changed. Following a painful 18 months of recovery, he's still struggling to piece his life back together.

Although his physical wounds have largely healed—save for scattered scars across his forehead and his sense of taste, which has yet to return—the bomb blast left Reyes, now 21, with a less visible, but devastating injury to his brain. Like many Iraq vets who survive the concussive force of an improvised explosive device, or IED, Reyes is now sometimes unable to recognize his friends or family, to recall what he just read or heard, to concentrate or to read faster than the average second-grader. ...

Like more than 1,700 military personnel wounded in Iraq and Afghanistan in recent years, Marine Cpl. Samuel Reyes Jr. is suffering from traumatic brain injury, known in military jargon as TBI, which leaves survivors unable to perform the most basic cognitive functions. According to officials at the Walter Reed Army Medical Center in Washington, TBI affects more than 25 percent of bomb-blast survivors like Sam Reyes, making it the signature injury of the Iraq war.

In fact, military officials say that were it not for advances in body armor, helmets and drastically improved battlefield medicine, the majority of survivors being treated for TBI would not have even survived their injuries as recently as the first gulf war 15 years ago. The increasing number of TBI survivors and the vexing limitations they face has become an enormous challenge for both military medicine and for the Department of Veterans Affairs, which will treat these survivors for life.

"In the military, the question is 'are you battle ready?'" says Dr. Harriet Zeiner, a clinical neuropsychologist for the VA in Palo Alto, Calif., where Reyes is being treated. "Our criteria at the VA [are], are you going to be able to hold down a job, sustain a relationship, get married, have kids or do you have something that's going to impair you?"

For Reyes, and hundreds of others suffering from TBI, the answers to these questions are still far from clear. The diffuse but debilitating symptoms of traumatic brain injury—which sometimes are not apparent until months after the bomb blast—can leave veterans with festering psychological problems and anger that often lead to failed relationships and careers, substance-abuse problems and the inability to adapt to civilian life.

Many TBI patients, like Reyes, are also suffering from posttraumatic stress syndrome (PTSD), a psychological condition affecting many combat veterans and other trauma survivors that is marked by flashbacks, nightmares, anxiety and irritability. The combination of TBI and PTSD, says the VA's Zeiner, "is pretty deadly." Reyes suffered damage to the frontal lobe of his brain, the area that helps a person calm himself after a stressful or frightening experience and where problem-solving takes place.

When Reyes becomes anxious, he quickly escalates to a state of agitation. It's not uncommon, says Zeiner, for those suffering from TBI and PTSD to "either drink themselves into a stupor," in an effort to self-medicate, or to become agoraphobic, afraid to go out where they may have to contend with overwhelming stimuli.

Reyes goes on to explain how his memory loss frustrates himself and others around him. He also explains his journey receiving care for his PTSD.

Soon after he arrived at the brain-injury center, Reyes's doctors began trying to convince him to go for treatment at the VA's PTSD center in nearby Menlo Park, where Vietnam veterans work side by side with active-duty Marines and soldiers, trying to find ways to deal with the lingering trauma of their respective wars. At first, Reyes resisted, worried that his fellow Marines might think he was weak. Meeting the other men in the PTSD treatment center had a big impact on him.

"Some of them are real tough, big guys, real smart, and that made me feel better. It showed me I wasn't the only one in the whole world who would have it." Reyes says his fellow Marines who haven't gotten help are suffering. "I tried to let some guys know who I thought could use help, and they said, 'Nah, I don't need that. I take sleep medicine and I drink, so I'm doing pretty good'." Although the Marine Corps is sending some mental-health workers into the field, Reyes says he didn't have any discussions about combat-related stress.

He got a brochure about PTSD at one point, but says it didn't explain the symptoms. "It scares me that all these guys could be just like me, having the same problems, and they're getting ready to ruin a whole lot of their life."

As the population of wounded Iraq veterans increases, the military is also trying to raise awareness about TBI, especially the less severe cases like Reyes's, which can easily be misdiagnosed or overlooked in the chaos of battlefield medicine. The Defense Department is developing a training course for medics to teach them how to screen for TBI in the field. Any injured combatant who has lost consciousness is a candidate for TBI diagnosis.

The military is also making plans to station a TBI expert at medical facility in Germany where the U.S. wounded are first evacuated after leaving Iraq. "I'm sure people do get misdiagnosed , says Dr. Warren Lux, deputy director of the Defense and Veterans Brain Injury Center at Walter Reed. "That is why we are trying to get education out there."

Read the rest of the piece, and then let Newsweek know you appreciate the coverage on this topic -- and perhaps they might even run it in the print version next time, too.

House Bill Introduced to Allow Vets Legal Rep for VA Claims

Introduced by Congressman Lane Evans [D-IL], Ranking Democrat on the House Veterans' Affairs Committee and Congresswoman Shelley Berkley [D-NV], Ranking Democratic Member on the Committee's Subcommittee on Disability Assistance and Memorial Affairs, HR 4914 would "amend title 38, United States Code, to remove certain limitations on attorney representation of claimants for veterans benefits in administrative proceedings before the Department of Veterans Affairs, and for other purposes."

Click on 'Article Link' below tags for more...

From Veterans Today:

[HR4914] would permit veterans to hire an attorney when they disagree with a benefits claims decision of the Department of Veterans Affairs (VA). Currently, veterans are not allowed to hire an attorney until the end of the administrative appeals process, specifically, after the Board of Veterans Appeals has rendered a decision. "We recognize that many fine veterans service organizations have traditionally provided full representation to veterans and their families without cost and expect that these organizations would continue to represent most claimants. Nonetheless, we believe that in this day and age, veterans should not be prohibited from hiring an attorney if they choose to do so,"said Evans.

"I hear from Nevada veterans all the time who wish to hire an attorney to represent them in a VA matter, but cannot do so because of this needless restriction. There is no good reason why Congress should prevent veterans from exercising their choice to seek legal representation. We should have ended this outdated prohibition dating back to the Civil War ages ago," said Berkley...

The restriction on attorney representation dates from the Civil War era when concern for attorneys preying on sick and disabled veterans resulted in legislation which limited the fee attorneys could charge to $10.00. Although the $10.00 limit no longer applies, veterans are currently prohibited from hiring an attorney to appeal an initial VA decision.

Evans and Berkley said the "Veterans' Choice of Representation Act" responds to a January 22, 2006, Washington Post article which questioned: "If American soldiers are mature and responsible enough to choose to risk their lives for their country, shouldn't they be considered competent to hire a lawyer?"

Contact your representatives with your feedback.

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Labels: benefits, claims, evans, house, legal, legislation, va

Iraq War Costs and Casualties Tallied Up

See also the comprehensive The War List: OEF/OIF Statistics

As we get closer to the 3rd anniversary of the start of the Iraq war, contributor Al Huebner of the independent Vermont Guardian tallies up some of the costs, casualties, and consequences in a commentary today. PTSD is covered. And, for those interested, economic data is found in a comprehensive paper by Linda Bilmes and Nobel laureate Joseph E. Stiglitz.

Click on 'Article Link' below tags for more...

The piece opens exploring the number and nature of the wounded.

Statistically, eight soldiers are wounded for every one killed, about double the rate in Korea, Vietnam, and the Gulf War, according to recent studies. The percentage of soldiers who have undergone amputation is twice that of our past military conflicts; nearly a quarter of all the wounded suffer from traumatic head injuries, also at a far higher rate than in other recent wars.

Later, the issue of posttraumatic stress disorder is highlighted:

The unpredictable IED attacks, protracted urban combat, and high incidence of casualties produce an elevated rate of psychological illness — one soldier in six according to a study done last year — notably post-traumatic stress disorder (PTSD). Sufferers have harrowing flashbacks and alternate between emotional numbness and outbreaks of rage, guilt, and depression. They experience impaired memory, insomnia, and anxiety.

A recent issue of the British periodical New Scientist has pieced together new evidence on the effects of PTSD. It shows that affected veterans will pay the price of combat for decades to come. Recent and soon-to-be published research shows that those suffering from PTSD who fought in combat as diverse as Vietnam and Lebanon are twice as likely to develop cardiovascular disease, diabetes, and even cancer later in life.

Boscarino isn’t alone in his view that PTSD is a general threat to health. Last March, Yael Benyamini and colleagues at Tel Aviv University reported that among Israeli veterans of fighting in Lebanon in 1982, those who developed PTSD are now twice as likely to have high blood pressure, ulcers, and diabetes, and five times as likely to have heart disease as those who didn’t develop PTSD. According to Benyamini and his colleagues, “PTSD is the key mechanism that leads from the trauma to poorer health.”

Last year, a study by army scientists at Walter Reed Medical Center concluded that PTSD may affect as many as 18 percent of U.S. veterans from Iraq, or roughly 60,000 people given current troop levels. Timely psychological help might mitigate the problem, yet the Walter Reed group found that only a third of the Iraqi veterans with PTSD were getting help from a mental health professional a year after their return. In February, the U.S. General Accounting Office reported that the Department of Veteran Affairs had not fully met any of the recommendations its own advisors had offered to ensure better treatment of PTSD.

The commentary also looks at the economic costs of the war:

What is the cost of this armed conflict? There have been several attempts since the beginning of the war in Iraq, some serious, some deceptive, to answer that question. There is no way, of course, to put a dollar value on the lives ended by the war, and of the many more destroyed by horrible injuries and crippling PTSD. Nevertheless, economists have made some estimates of the cost of the war in Iraq. White House economic adviser Lawrence Lindsey was, in effect, fired for suggesting a few years ago that the war might cost up to $200 billion rather than the $60 billion claimed by the president’s budget office. The administration’s latest claim is that nearly $400 billion has been spent since the fighting in Afghanistan and Iraq started.

Now economists Linda Bilmes and Nobel laureate Joseph Stiglitz have calculated a much higher price tag. They found that the total cost could be between $1-$2 trillion, depending how much longer the troops stay in Iraq. This drastically larger amount includes the money for combat operations, but also what the government will have to pay for years to come for lifetime health care and disability benefits for returning veterans and special round-the-clock medical attention for the most seriously wounded.

Read the whole piece, and then feel free to offer your thanks to the Vermont Guardian for covering veterans health issues.

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Labels: benefits, funding, iraq, stats, studies, tbi, wounded

MN Community Reaches Out to its Troops

Little Cloquet, MN -- population 11,201 -- is making a name for itself. Last month, it began an outreach program to help 120 Iraq vets from the local Guard unit transition successfully back into the community. The local newspaper, the Pine Journal, got involved by publishing the first in a series of PTSD eduction articles that rival anything being done by the national media. Part I introduced the program and some of the veterans who'd served in Iraq; Part II reveals some of the barriers to a quick and easy transition into civilian life for these service members.

Click on 'Article Link' below tags for more...

I'll quote extensively from the Pine Journal:

“We want the community to come out healthy – and the soldiers to come out alive.” That was the straightforward statement made to local employers, business owners, law enforcement officials and members of the clergy last Tuesday by National Guard Chaplain John Morris. Morris went on to say that the jump from common citizen to “warrior” is a dramatic one – and one that takes months to learn.

“Our government takes our citizens and transforms them into warriors to execute the mission of the United States,” said Morris. “It took six months to flip the switch to transform some 2,700 Minnesota National Guard soldiers into warriors, but the question is, when they return, how do you flip that switch back? The road home is much longer, steeper and tougher.” ...

First, he pointed out, the community needs to understand how the “road to war” works. “We take our young men and women from citizens, to soldiers, to warriors,” Morris said, “from security to insecurity, from safety to danger, from comfort to discomfort, from order to chaos, from trust to mistrust, from ‘us’ to ‘me.’ They have to learn the hard way that nothing is predictable, and everything they once trusted in is turned upside down. Along the way, they become very self-centered. That doesn’t mean they’ve become evil people but that there’s been a transformation. And so, how can we help them go from that mistrust to trust once again? How can we convince them that the dead dog on the side of the road doesn’t have a homemade explosive device inside it?”

The Chaplain, a two-time veteran, went on to give an example of how behavior that works to protect on the battlefield quickly can create problems off. Standing in line one day at the airport, someone cut in front of him. He said, "This immediately threatened my sense of order," and a strong over-reaction to his frustration resulted in him directing strong words towards this person. A security guard quickly got involved to break it up.

This 'kinetic energy' -- a sense that they are in a commanding position, no matter where they are -- is one that is often misunderstood by the public.

The article continues:

National Guard Reserve units tend to have a tougher time making the transition back into society following an active combat assignment because, after their return, the unit splits up and its members go back into civilian life. “They are no longer with their comrades, their ‘battle buddies,’” said Morris, pointing out how the unit has become a support system that is often sorely lacking out in the community. “What they really need,” he said, “are employers, pastors, social workers and others who will take the time to try to understand them and support them.” In doing so, he stressed that community members must understand the challenges the soldiers face in that reintegration process.

First, they must strive to overcome alienation – from family, friends, co-workers and the community. He asked audience members to visualize going on a five-star vacation somewhere in the Caribbean where all they do is eat, drink, sleep and experience fun and excitement for an entire week, free from stress and responsibility.

“When you get home and go back to the office, the sudden return to routine, stress, and responsibility is hard enough to cope with,” he said. “And chances are, you’re also brimming over with stories to tell and photos to show off, but you can just about imagine how long your co-workers are going to be interested – about a minute and a half! You begin to realize that you have had an experience that you can’t share with anyone except those you were there with.”

Returning veterans have to cope with feelings of alienation, and worry they'll always feel different. These are the same factors that have driven many Vietnam veterans to homelessness and unsuccessfully coping with their mental health issues.

Solid suggestions for the community:

[S]ome 18 percent of the 82nd Airborne and 101st Airborne National Guard units are showing signs of mental health issues after returning from combat, and 30 percent of the soldiers still exhibit signs of mental health issues four to five months after demobilization. “We can’t afford to lose these people,” he stated. “As employers, you can help. Be respectful, welcoming and show hospitality to them until they get their feet on the ground.”

Secondly, the community must help returning soldiers move from simplicity to complexity once again, from letting others think for them to accepting responsibility. “In civilian life,” Morris said, “we live complex lives. We often make some 15,000 choices a day, compared to only about 800 a day in the military. The fact of the matter is that most soldiers are not responsible for much, and it feels good. They no longer have to balance the checkbook, or change the oil in the car or cut the grass. When they come home and are suddenly faced with all those choices and responsibilities once again, they often feel grouchy and overwhelmed.”

Thirdly, returning soldiers are faced with the challenge of how to replace war with some sort of other “high.” “War is an adventure, and nothing in civilian life matches the intensity,” Morris admitted. “When it comes right down to it, most soldiers who train with the National Guard actually want to go to war to put into practice what they’ve learned to do, and statistics show that some 72 percent admit they are glad they did it.” The “high” of war is often replaced by a need for speed and reckless driving, resulting in traffic tickets, accidents and, in some cases, death. Others turn to drugs, alcohol and gambling.

Many returning troops never find the same 'rush' in civilian life; this may be one explanation for the National Guards' record reenlistments -- these veterans want to get back into the war zone.

The real challenge, of course, is for returning soldiers to learn how to accept life as it is, because for them, everything else pales in comparison to what they have experienced in combat.

Fourthly, the returning troops are faced with rediscovering who and what they are outside of their military role. “They have to find meaning and purpose outside of combat,” Morris said. “They have to realize that they were someone before war – and that they can be someone afterward as well, or they will be stuck in Iraq forever. If they can learn to draw from their combat experience and apply it to their lives, they can actually be better off than they were before.” Morris went on to say that combat veterans who have successfully made it through the first 10 years following their return often become among the most productive members of the community.

Finally, returning soldiers must learn to make peace with themselves, God and others in the community. “They may have done, or not done, things that violate their moral code,” Morris explained. “They may have participated in the killing of other human beings, or they may be plagued with thoughts of whether they really did their part after a fellow soldier gets killed right next to them, or if they remain in a non-combat position in the Forward Operating Base while the others are out there fighting. After they return, where do they go in the community for confession and absolution? Someone needs to help them in the process.”

Families and employers can play a strong role in helping the returning soldier. First, they need to learn to understand what they've been through, what combat stress looks and sounds like. Second, they need to let the troop talk about their expieriences at their own pace. Finally, they need to be sympathetic and patient in allowing the soldier to ajust to the changes that have taken place at home since their absence.

Sadly, however, nine times out of 10, many returning soldiers end up going to bars, where alcohol breaks down their inhibitions and they are able to confess their “sins” to whoever will listen.

More and more, local media is pummeling the national outlets when it comes to PTSD reporting. If you'd like, email the Pine Journal a quick thank you for their coverage; being a small paper, they'll probably really appreciate hearing that their efforts are being recognized. Perhaps consider contacting your local officials to ask if your community has any plans to organize something like this, too (especially if you live near a base).

Related Resources

Department of Veterans Affairs (VA) - Seamless Transition
Hearts Toward Home - Turning Your Heart Toward Home Workbook
National Center for PTSD - A Guide for Military Personnel and Families
THRIVEnet - Guide to Listening to War Veterans for Family Members

Senate Republicans Vote Down $1.5B in Veterans Health Care

Yesterday, Senate Republicans voted along party lines against a Democratic budget amendment introduced by Senators Patty Murray (WA) and Daniel Akaka (HI) which would have:

Provided $231 million in transition assistance help for Iraq War veterans;
Increased support for PTSD and mental healthcare by providing an additional $321 million;
Expanded veteran support clinics by providing $81 million to expand Vet Centers around the country to provide daily support and assistance to veterans;
Eliminated new fees and co-payments by providing $825 million to roll back a Bush administration plan to raise fees and co-payments on veterans who seek VA healthcare;
Provided $42 million to expand residential rehabilitation services for veterans.

Feel free and contact your Senators if you'd like to voice your opinion on this issue.

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Unacceptable: National Guard Makes Post-deployment Mental Health Screening Optional

Haven't seen much of this anywhere else; but, the Boise [ID] Weekly has a disturbing report on the loosening of required post-deployment screening in the National Guard. This seems to be foolhardy. Rather than making once-required mental health screenings optional, we should be doing quite the opposite: increasing the amount of counseling our returning soldiers are required to complete. A more hands-on debrief process would go far in fighting back the stigma and fear which surely prevents many from getting the help they need.

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From the Boise Weekly:

When it comes to obtaining post-combat mental health services, the infamous "fog of war" appears to be following veterans of the 116th Idaho Army National Guard Combat Brigade Team back home to Idaho. With some experts estimating that up to one out of 10 soldiers returning from Iraq and Afghanistan suffers from Post Traumatic Stress Disorder (PTSD) and other emotional disorders, military officers are emphasizing increasing access to resources for those who need them. But other senior staff, spouses and state officials quietly complain that a key component of that system has been dismantled.

At issue is the procedure whereby returning vets are screened and informed of the services available to them. The first set of troops returning through Fort Lewis, Washington, were all given up to one hour of mandatory mental health assessments, performed by a team of Veterans Center counselors. Then, according to a confidential e-mail sent to Boise Weekly by a concerned public health official, "One person of influence made the in-processing screenings (along with many other important 'stations' to tell folks about their vet benefits) optional instead of mandatory."

The confidential email continued to say that now that the 'honeymoon period' has come and gone, 6 months out there is cause for concern. This email received by the paper is far from the only confirmation they have of the loosening of the counseling requirements. Guard Lt. Col. Heather Taylor has noted that the 3,000 soldiers of the 116th went through the following required debriefs:

Vet Center Brief
Veteran's Benefits Brief
Tricare Health Insurance Brief
Chaplain's Brief that focused on reunion with family and stress management

However, she states, "the only station that was made optional was the 'One-on-One Vet Center sessions' during Phase III. When it was made optional, attendance for that one station dropped off significantly."

The article continues:

The licensed professional also passed on a letter from a northern Idaho clinician who treats returning vets, observing that "The soldiers are experiencing 'post-traumatic stress' due to combat fears, morbidity, near death experiences and adjusting to a completely foreign culture," yet "the soldiers do not want to 'complain' or appear 'weak' about their deployment experience, and it is manifesting itself with anger management problems."

But the concern isn't just outside the Guard. An officer within the 116th told BW that the returning soldiers he had spoken with were "pretty pissed themselves, let alone the people in leadership who thought it was an insane order" to make screening optional. Another guard member insisted that "there would not be any written documentation about the order given to make the information and screening optional." The member added, "Lots of people out at the Guard are pissed about this too, but can't say anything."

One National Guard officer, reluctant to give his name, explained that "there's peer pressure and leadership pressure. The leadership's position is that 'We will have no problems.' There's even no tracking of the divorce rate, because they're afraid to." Soldiers deployed in Iraq "couldn't talk to those of us back home" about any emotional difficulties, the officer said, "even though some of us have been friends for decades."

Asked why so many were reluctant to make their concerns public, the officer stated, "It's hard to explain a whole culture in one paragraph. Basically, you don't talk to anyone outside the unit. You're not a team player if you do." And in the highest echelons of the unit, "their attitude is that they can do no wrong" in the area of policy-making.

Be sure to read the rest of the report; and thank Boise Weekly for their attention to this important issue.

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Labels: disillusion

Battlemind Brochure to Help with Troop Reintegration

Are you a returning troop whose combat zone reactions are standing in the way of fully easing back into civilian life? Common combat reactions help you to stay alive and well on the battlefield; but, they do the exact opposite to you out of uniform. If this is something you're struggling with, Walter Reed Army Institute of Research has a brochure for you. Download Battlemind Training: Continuing the Transition Home today [pdf file].

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PTSD Breakdown: We're Failing the American Military Family

Things are not all right at home.

Grandmothers enlisting, fathers speaking out. Mothers arrested while a Vietnam veteran (a minister, no less) chooses death over the pain of another war.

We are failing our military families. And we are failing each other.

The following is a heartrending entreaty meant to alert those Americans not directly touched by war. It is entirely brutal and not advised reading for those who are having a hard time with PTSD. I post it here only for those wishing to see the full war burden borne by our military service members and their families.

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PLEASE NOTE:The aim of this research is to shine a sliver of light on yet another burden placed on society by war. It is not to lay blame or demonize our veterans. In my eyes, they are victims, too.

I'm not interested in singling out our soldiers as if they are the only ones in society who commit crime. They're not. Violence exists in the general population -- not only amongst those suffering from combat-related PTSD. Additionally, not everyone with PTSD suffers to the same degree. Most return, folding back into society and family without harming themselves or others.
In an attempt to show respect for the veterans, I choose not to include names here or in the PTSD Timeline. This isn't about individual acts. Rather, it's meant to bring about a fuller understanding of what happens to the fabric of society when a nation sends another generation to war. And it's meant to give pause and reflect on the obligation we have to make sure those we've sent to war are well taken care of upon their return -- for their own good and ours, too.

This is the face of misunderstood, maligned, and under treated combat-related PTSD:

Fathers killed, children abused and dying -- too many dying. Wives murdered, wives strangled, wives drowned, wives stabbed. And strangled and choked again. Ex-wives and their boyfriends shot. Friends slain. War buddies murdered. Cousins shooting cousins over and over, sons overeating, and banks robbed all to keep from having to return to Iraq. Others going AWOL after returning home. Desertion.

Murder-suicides of husband and wife over and over and over and over again. Wives beaten, spared death, but forced to watch a husband kill himself. And himself. Girlfriends also the victims of murder-suicides. Children left behind. Mothers and fathers and brothers and sisters and spouses all affected. Forever.

Police officers killed, suicide-by-cop. Unintentional murder, and intentional. A suicide one day after a lonely Father's day spent in a foreign land at war. War buddies murdering war buddies 72 hours after coming home from Iraq. Stateside rape and foreign, too.

Our soldiers are returning home, and don't have to go through any mandatory counseling. The VA doesn't have money for that. And so, stores are held up while the manager is left to die. Neighbors beaten, employers killed. More girlfriends are killed, more assaulted, former girlfriends kidnapped, robbed, and raped. Double homicide. Aggressively overreacting to a group of Sisters from the Sacred Heart of the Monastery peacefully protesting. Shooting at unarmed police officers. A 3-hour armed police standoff. Injuring strangers, some shot dead, some stabbed to death -- all out of the fear and nightmares they brought home with them.

A suicide attempted by a blind, severely wounded Iraq veteran. Suicides faked and suicides accomplished. Too many accomplished. Some a mere day after getting home. Or 6. Or 30. Or 365. Suicided even while on Walter Reed Army Medical Center's suicide watch with a bed sheet or a bathrobe sash. Poison drunk in a lonely motel room to break away from the pain. An overdose. A bridge hanging. A soldier awaiting deployment checks out when he hears the news of his brother's KIA in Iraq. Another suicide as a 6-times decorated Army Reserve soldier who's returned from Afghanistan finds out he's lost his promised promotion at work.

All gone. Privates. Captains. Colonels. Brigadier Generals. Lance Corporals.

A Marine who'd personally been reenlisted by the Secretary of the Navy, Gordon R. England, at the peak of Mount Suribachi above Iwo Jima the year before. Another who only 11 days earlier was personally decorated with the Army's Combat Action Badge by Army Chief of Staff Gen. Peter Schoomaker himself following 15 months of combat duty in which he received a purple heart and bronze star.

18 years old. 22. 23. 24. 33. 37. 40.

500 homeless already. 40,000 returned troops showing signs of mental disorder.

::

All this, and we have an administration which refuses to even utter the term 'posttraumatic stress' -- and which also refuses to fully fund the VA. And just what type of treatment can our returning veterans expect from an administration whose key appointee to the National Advisory Council (NAC) for the US Center for Mental Health Services (CMHS) says the following:

Over the next few months, 130,000 American troops will return home from Iraq. Their arrival will bring joy to their families and gratitude from the nation. It will also renew a debate over post-traumatic stress disorder. The House Veterans' Affairs Committee, for instance, has scheduled hearings on the disorder next week, with a focus on soldiers returning from Iraq and Afghanistan.
Likewise, just as the press has spent a year comparing the invasion of Iraq to Vietnam, it has begun drawing parallels between today's troops and Vietnam veterans, who are believed to suffer from a high rate of war-related psychiatric disorders.
But as we try to help the soldiers of Operation Iraqi Freedom meld back into society, it would be a mistake to rely too heavily on the conventional wisdom about Vietnam. What is generally put forth as an established truth--that roughly one-third of returnees from Vietnam suffered psychological problems--is at best highly debatable. ...
[T]here is an economic incentive to claim suffering. A veteran deemed to be fully disabled by post-traumatic stress disorder can collect $2,000 to $3,000 a month, tax free. More important, perhaps, the syndrome provides a medicalized explanation for many unhappy, but not necessarily traumatized, veterans trying to make sense of their experience.
Psychological studies have shown that people tend to reconstruct the past in terms of the present--they often exaggerate the degree of earlier misfortune if they are feeling bad, or minimize old troubles if they are feeling good. Thus it is vital that researchers corroborate the battlefield events that veterans cite as causes of their post-traumatic stress. Unfortunately, researchers on the 1990 readjustment study did not do the archival legwork to verify the trauma that the veterans reported. Until a better study is done, the "facts" on post-Vietnam stress are simply speculation.
Some soldiers will return from Iraq and Afghanistan with severe psychological problems, and we must do everything in our power to help them. The vast majority, however, will be able to adjust on their own--and imposing on them the questionable legacy of Vietnam won't do them any service. As the British psychiatrist Simon Wessely has put it: "Generals are justly criticized for fighting the last war, not the present one. Psychiatrists should be aware of the same mistake."

That was written in 2004. After all that we've seen befall our military families since 2004, you'd think Sally Satel, MD would revise her comments. Hardly. Instead, she's sharpened the anti-PTSD crusade in another maligning NYT Op-Ed just this month -- one which received much deserved scathing feedback.

Read more about this issue in Blaming the Veteran: The Politics of PTSD.

::

An Introduction

What is the PTSD Timeline?

It's a collection of online news reports listing incidents related to returning combat veterans coping with PTSD. These are the most tragic of all incidents, of course, as mild cases of PTSD are hardly given a mention in our media. As a matter of fact, if it weren't for smaller media organizations and local outlets, we'd probably never even hear about these violent cases, either.

Can you remember the last time you heard of a soldier who'd recently returned from combat committing suicide? In the traditional press?
Can you remember the last time you heard of a marine committing armed robbery just so he didn't have to return to Iraq?
Can you remember the last time you found out that a recently returned soldier killed himself and his wife in a fit of uncontrollable rage?
Can you remember the last time you heard about a soldier going AWOL rather than return to the combat zone?
Can you remember the last time you ever even heard or saw a public service message on this mushrooming crisis?

If our national media fails to report on this issue, does that mean it's not important? Or do the people in pain and in harm's way of a soldier or marine spiraling downward still exist? Is their pain relevant? Do we as a nation have a responsibility to ensure that the VA is properly funded to help meet the needs of our military families hurting the most?

Pro war or against, a helpless child or spouse abused due to the the undiagnosed or untreated pain of a veteran returned home from battle should resonate with us all. And it should compel us to act in their defense.

The purpose of the PTSD Timeline is to:

Aid in our understanding of the magnitude of this all-encompassing problem
Record the incidents for future study and evaluation
Allow reporters and researchers to find OEF and OIF PTSD incident data quickly and easily

::

The Silence is Deafening

No traditional news organizations are tracking returning veteran PTSD-related incidents. The Pentagon isn't doing it. And neither is the cash-strapped Veterans Administration (VA).

Fortunately, most soldiers, sailors, aviators, and Marines return to civilian life without any major hardships -- at least the type that can be seen from the outside. They fold back into their home lives, into their communities. And the fickle public happily moves on and forgets about them. They're no longer warriors met with parades; they are simply citizens.

Then again, that's what they really were all along, anyway. Merely citizens of our country. Our brothers and sisters. Husbands and wives. Mothers, fathers, children, or cousins. How well they cope with PTSD affects not only their own future, but that of the loved ones who surround them. Their ability to function fully and well after their return home from combat also has an immediate and real bearing on the fabric of their local community. Their health also affects our larger society as a whole.

We leave them alone to deal with their wounds (either visible or invisible) at our own national peril.

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Labels: disillusion, family, incidents, opinion, politics, reintegration, society, suicidal, violence

OIF Vets: More in Line to Receive Veterans Preference

From the Office of Personnel Management:

More service men and women now will be eligible for veterans' preference according to a recent memo issued by the U.S. Office of Personnel Management to Chief Human Capital Officers and Veterans Service Organizations. OPM Director Linda M. Springer announced the Defense Authorization Act for FY 2006, recently signed into law by President Bush, contains two provisions which broaden the definition of a "veteran" for purposes of preference eligibility and clarifies eligibility for those released or discharged from active duty.

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It continues:

The first provision accords preference for those who served on active duty during the period beginning on September 11, 2001 and ending at the close of Operation Iraqi Freedom provided they meet other conditions. (The provision broadens the number of individuals who may be entitled to veterans' preference).

The second provision, clarifies veterans' preference eligibility for federal hiring as available to individuals "who are discharged or released from active duty service" provided these individuals meet other applicable veterans' preference eligibility requirements. This new language replaces the previous statement of "individuals separated from the armed forces." The revised section is consistent with OPM's long-standing policy pertaining to the application of veterans' preference for individuals released from active duty military service.

Director Springer said, "This is good news. These provisions recognize veterans for their service during a critical time in U.S. history. As a result, more eligible veterans who served on active duty during the designated period will be entitled to veterans' preference."

More information is available in the OPM's Vet Guide as well as their Delegated Examining Operations Handbook.

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Marine Corps Suicides Spiked 29% in 2004

The latest data made public by the Marine Corps shows a spike in Marine suicides in 2004 -- the highest amount recorded in ten years. Although service members generally commit fewer suicides than the general population, "Marine commanders say the rise...continues a worrisome three-year trend that is likely linked to stress from the sharply increased pace of war-zone rotations."

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From the Washington Post:

Thirty-one Marines committed suicide in 2004, all of them enlisted men, not commissioned officers. The majority were younger than 25 and took their lives with gunshot wounds, according to Marine statistics. Another 83 Marines attempted suicide. There were 24 suicides in 2003, and there have not been more than 29 in any year in the last 10. ...

It is "not only Iraq, it's just the ops tempo [operational tempo] in general, that's what I think," Gen. Michael W. Hagee, the Marine Corps commandant, told reporters at a breakfast meeting yesterday.

Hagee's remarks echoed a strong warning in a Dec. 13 memo that he issued on suicide prevention. "This problem is pervasive and is impacting Marines throughout the Corps, not just those who have been deployed in support of the global war on terrorism," the memo said. "The increased operational tempo that our Corps is experiencing may be affecting the ability of our Marines to deal with perceived overwhelming stresses associated with relationship, financial, and disciplinary problems."

Indeed, about 70 percent of Marine suicides over the past four years have been caused by problems in personal relationships, which can be exacerbated by heavy workloads, said Cmdr. Thomas Gaskin, a behavioral health specialist for the Corps' Personal and Family Readiness Division at Quantico. "That is the single biggest stressor," he said.

Even in the general population, people drowning in suicidal thoughts and behaviors find it hard to reach out for help. In the military, this may be an even more difficult hurdle to overcome:

Hagee warned that while some Marines have displayed obvious warning signs of suicidal tendencies -- such as a preoccupation with dying, risky behavior, withdrawal or giving away their possessions -- many do not. In his memo, he warned that some Marines feel stigmatized for seeking help.

"They may feel it is not acceptable to ask for help because they don't want to be labeled as 'weak' or 'defective' in the eyes of their subordinates, peers, or leaders," he wrote. Commanders, he emphasized, must redouble their efforts to make Marines feel comfortable in revealing problems that could lead to suicide.

Please read the entire WaPo piece. And if you're in need of help personally, please seek it out immediately. You have many places to turn and many resources available for taking.

Other helpful links

Leaders Guide to Managing Marines in Distress
Marine Corps Suicide Prevention Program

Suicide Prevention Info (from the Camp Pendelton website)

For the past 10 years suicide has been the second or third leading cause of death among active duty Marines and Sailors. Suicide is a result of the inability to deal with stress because of an underlying psychological problem, such as depression or alcohol abuse. Suicide thoughts and attempts are made by all ranks regardless of color or sex.

Common Signs of suicide risk:

* Previous Attempt
* Mental health problems or alcohol abuse
* Suicidal thoughts
* Social Isolation
* Impulsive Anger
* Relationship Problems
* Legal Problems
* Financial Problems
* Performance Problems

Marines are in the habit of taking care of each other. If you suspect a fellow Marine is at risk for suicide take action and A.I.D. L.I.F.E.

* A-sk, Don't be afraid to ask if the person is thinking of suicide
* I-ntervene Immediately -Take action. Listen to the person. Let them know they are not alone and that you and others are willing to help them.
* D-on't keep it a secret
* L-ocate Help - Seek out the officer on duty, chaplain, physician, corpsman, friend, family member etc. right away.
* I-nform the Chain of Command - The chain of command can aid the individual in finding resources for the long term. They can help monitor and assure the individual receives the help they need.
* F-ind Someone - Don't leave the person alone. Find someone to stay with them.
* E-xpedite - Get help right away. An at-risk person needs immediate attention.

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Labels: marines, stats, suicidal

Hidden Wounds: A New Combat PTSD Documentary

New England Cable News (NECN) is set to air a new documentary, Hidden Wounds, detailing the struggle of three local soldiers who've returned from Iraq with posttraumatic stress. The program will air on east coast stations starting on the 3rd anniversary of the start of Operation Iraqi Freedom, March 19, 2006. Friday's premiere, which included Sen. John Kerry and former senator Max Cleland, was held at Harvard's Kennedy School of Government.

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Details on Hidden Wounds:

The documentary profiles Nate Fick, a graduate of Dartmouth College who was drawn to public service, and joined the military to test himself in a rigorous way. He was a platoon commander in “Recon,’’ the elite unit of the Marines. He fought in Afghanistan, then Iraq, returning from war in June of 2003. Fick descended into depression for close to a year. To cope, he began writing. His resulting book, “One Bullet Away’’ has been met with wide acclaim and he is currently on tour in the U. K. He is also pursuing graduate degrees at Harvard’s Kennedy school and business school.

“Hidden Wounds’’ also tells the story of Sgt. Russell Anderson of Norton, MA who joined the Army in 1969, right out of high school. He served four years monitoring worldwide communications. He returned to civilian life, but kept re-signing with the reserves. Sgt. Anderson volunteered to go to Iraq in 2004, where he was assigned to a fuel transport unit, because he wanted to continue to serve his country. He returned in February 2005 angry, hostile, depressed, and he resisted counseling. He finally agreed to treatment when he “bottomed out,’’ but he continues to cope with the affects of PTSD.

And, it spotlights Jeff Lucey of Belchertown, MA who joined the Marine Reserves as a high school senior in 1999 to bring discipline to his life. He spent a year as a truck driver in Iraq, returning home in 2003. He drank heavily and became increasingly despondent. His parents tried to get the Veterans Administration to commit him and treat him for post-traumatic stress disorder, (PTSD) but the VA refused to do so until Jeff Lucey stopped drinking. He committed suicide at age 23. His parents are now activists trying to ensure adequate funding for PTSD treatment.

Senator John Kerry and former Senator Max Cleland (along with many other distinguished guests and speakers) attended Friday's premiere. From the Harvard Crimson:

“The first definition of patriotism back here at home for all of us is to keep faith to those who wore the uniform for our country,” [Sen. John] Kerry said. At the event, Kerry introduced a new funding push he is making in Congress to allocate $100 million to Veteran Centers for the screening and treatment of PTSD.

[Former Senator Max] Cleland, who lost both legs and half an arm in 1968 when he was serving in the Vietnam War, took the stage with Kerry before the screening. Cleland said that while he dealt with the physical wounds, for a long time, he was unaware of the “hidden wounds” of PTSD. He said that he was now in the kind of counseling which he should have sought out “ages ago” and stressed that PTSD is a legitimate diagnosis.

After the projection of the documentary, several veterans and military officials addressed the forum about PTSD. Kerry’s Swift boat comrade Del Sandusky, whom Kerry calls his “brother,” spoke among them. “PTSD is nothing to be ashamed of, but it’s something that we can’t control,” Sandusky said.

Kerry and Cleland are far from the only people working hard to protect veterans health; in the face of Bush administration underfunding of the VA, many Democratic leaders continue to speak out for what's right: honest and quantifiable support of our troops.

If you're fortunate enough to live in the NECN broadcast area, you can catch Hidden Wounds at the following dates and times:

Sunday 3/19 10:00AM and 7:00PM
Monday 3/20 8:00PM
Tuesday 3/21 11:00AM and 3:00PM
Wednesday 3/22 7:00PM
Thursday 3/23 2:00PM
Friday 3/24 4:00 and 10:00PM>
Saturday 3/25 6:00AM and 8:00PM

Take a moment to thank NECN for their efforts at getting more to understand the plight of those troops coping with PTSD. And if you're not in the viewing area, other movies have been made which deal with the topic of combat related PTSD.

Rep. Martin Meehan Works to Help Returning Veterans

Rep. Martin Meehan [D-Mass.] deserves the spotlight for his tireless efforts on the behalf of veterans -- and especially for those coping with PTSD. He joins a list of other hard-working elected officials trying their best to get the VA adequate funding, deliver top-quality health care to our veterans and their families, and protect other benefits our troops have earned for their service to our country.

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From Rep. Meehan's website:

Working to address Post Traumatic Stress Disorder (PTSD) continues to be one of Congressman Meehan's top priorities in Congress. Congressman Meehan has called on his colleagues to redouble the commitment to soldiers now returning home and those who defended our freedom in past conflicts, ensuring that we provide care not only for the physical wounds, but the emotional scars as well.

As it stands now, the government maintains an unacceptably flawed system that neither pays adequate attention to veterans suffering from mental health disorders, nor dedicates sufficient resources to diagnosing and assisting them. This allows too many veterans suffering from mental health disorders to fall through the cracks. ...

Congressman Meehan wrote legislation -- included in the House version of this year's National Defense Bill -- that would create a Defense Department mass media campaign to raise awareness about mental health and substance disorders among service members and their families. It would also create peer support programs to support and educate soldiers about PTSD. This legislation, which was endorsed by Dr. William Winkenwerder, Jr., Assistant Secretary of Defense for Health Affairs at the Department of Defense, will help remove the stigma and encourage people to seek treatment.

The legislation in question above appears to be HR2411:

To provide improved benefits and procedures for the transition of members of the Armed Forces from combat zones to noncombat zones and for the transition of veterans from service in the Armed Forces to civilian life.

Sponsor: Rep Meehan, Martin T. [MA-5] (introduced 5/17/2005)
Cosponsors: None
Committees: House Armed Services; House Veterans' Affairs; House Financial Services
Latest Major Action: 6/21/2005 Referred to House subcommittee.
Status: Referred to the Subcommittee on Military Personnel

As the bill appears to have no co-sponsors presently, perhaps those interested in supporting this work could take a moment to contact their district representative, asking them to consider co-sponsoring this important legislation.

More details:

U.S. Rep. Martin Meehan, D-Mass., has filed legislation that would require every returning veteran to undergo a thorough psychological and physical examination. Meehan also seeks to increase funding for treatment of veterans with post-traumatic stress disorder. "If you look at how much money we're spending in Iraq and the increase in the defense budget, surely a small portion of that could be used to take care of these kids coming back from Iraq," Meehan said.

Part of the reason for the mental stress when soldiers return could be the nature of this war, in which U.S. troops aren't fighting an army. Soldiers never know whether a civilian is the enemy. Troops rotate in and out of Iraq and return home to a country less accepting of the war. "It's one thing to hunker down in one area, but it's another to move around to a new unsecured area all the time," said staff Sgt. Robert Davis, a mental health technician with the Army's 883rd Combat Stress Control Company, a unit that offers psychological counseling to troops on the front lines in Iraq. "There's anxiety, battle fatigue, lack of sleep and they're miles from home. Any of those is difficult, but all of them together is bad," Davis said.

David Spiegel, a psychiatrist at Stanford University and expert in PTSD, said soldiers are immersed in a brutal environment, then just dumped back home among people who don't understand. "You have a society not prepared to deal with what these people have been through and done. It isolates them when they come back."

Many are reluctant to seek help. Veterans worry that getting counseling could hurt their careers or alter relationships, said a study last year in the New England Journal of Medicine by the Walter Reed Army Institute of Research. "A lot of the younger guys won't do that," said National Guard Staff Sgt. Joseph Nelson of Bloomingdale, N.Y. "They think it makes them into wimps."

Please take a moment to send a note of thanks to Rep. Meehan. He's got every veteran's back. Shouldn't we have his?

Labels: anxiety, benefits, dod, fatigue, funding, homecoming, house, iraq, legislation, meehan, reintegration, screening, self medication, shortfalls, sleeplessness, society, stigma, va, winkenwerder, wramc

Scientific American: A Look at the Work of Combat Psychologists

The February/March 2006 issue of Scientific American presents an informative piece well worth a read. Written by two frontline Army Captains/psychologists, Combating Stress in Iraq reveals the critical role their profession plays in supporting the emotional and psychological needs of our troops on the battlefield. Related article: Among Troops, New Efforts to Gauge War’s Emotional Casualties.

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Labels: army, caregivers, combat, iraq, psychology, stress

Lexington VA Hospital's One-of-a-Kind PTSD Program

As the VA struggles to find the resources it needs to deliver top notch care to our returning veterans, some programs rise to the challenge. Lexington, KY's VA Hospital offers a unique residential rehabilition program to help local veterans coping with PTSD.

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From WTVQ Action News (ABC-Channel 36):

The medical community admits it was slow to recognize the debilitating condition, but continues to catch-up to try to help Veterans of all wars. Part of that progress is a one of a kind residential rehabilitation program at the V.A. Hospital on Leestown Road in Lexington. Group and individual therapy teaches coping skills, adjustment skills, anger management, relaxation and all the things needed to try to help the Veterans dimish their PTSD symptoms.

The Veterans we spoke to in the program said it's successful, effective and in some cases life saving. "I've tried to commit suicide twice," said Vietnam Veteran Paul Louallen of Lexington. Like countless other Veterans, Louallen suffered in silence for decades, not knowing what was wrong. He couldn't control his anger, nightmares and irrational thoughts. "I'd go days without sleeping. I was afraid to go to sleep," Louallen said. He couldn't hold down jobs, alienated friends and couldn't manage a successful personal relationship with anyone. He, like many Veterans suffering from PTSD, turned to drugs and alcohol to numb the emotional pain.

The veterans being treated in this important program include those who served in wars from Korea to Iraq. They are very satisfied with the treatment they're receiving.

The Clinic Coordinator for the program is V.A. Hospital Psychologist Bruce Nerenberg. "These Veterans can sit around in a circle because they feel that the other Veterans are watching their back, there's that kind of trust and they talk and share and realize that they're not alone," said Nerenberg. There are an untold number of Veterans who may not realize they're suffering from PTSD or refuse to get help because of the stigma of weakness that society attaches to the disorder. Program coordinator Nerenberg said the courageous aren't those who deny they have a problem, but rather those who get help.

Veterans may be referred to this program by their primary care physician or VA doctor. Call the Lexington VA Medical Center for more details at 859-281-3949.

Labels: anger, counseling, iraq, korea, local, nightmares, numbing, reintegration, resources, self medication, society, stigma, suicidal, treatment, unemployment, va, vietnam

Online Meditation and Stress Reduction Video

If you're looking for free stress relief resources, we've one to share with you. Meditation Therapy for Stress and Change with Jyotish Novak is a free 36 minute online video from Crystal Clarity. Try it in the comfort of your own home, and begin applying these stress-busting practices right away...

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A Bit of Relaxation for the Soul

Labels: freebies, me, mind_and_body, online, relaxation, resources, stress, video

PTSD: Columbia University Encyclopedia Definition

Continuing to explore the various definitions of PTSD, today we'll look at what's found inside the covers of the Columbia University Encyclopedia. Other official definitions already examined in this series include those of the VA, the Army's Combat Stress Field Manual, as well as that found on the National Center for PTSD website. Seek knowledge, gain power...

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From the Columbia University Encyclopedia:

post-traumatic stress disorder (PTSD), mental disorder that follows an occurrence of extreme psychological stress, such as that encountered in war or resulting from violence, childhood abuse, sexual abuse, or serious accident. The stressful event is usually followed by a period of emotional numbness and denial that can last for months or years. After that period, symptoms such as recurring nightmares, “flashbacks,” short-term memory problems, insomnia, or heightened sensitivity to sudden noises may begin. In some cases outbursts of violent behavior have been observed. The usual treatment for PTSD is individual psychotherapy, including anxiety management, or group psychotherapy with others who have the disorder. Some antianxiety and antidepressant drugs are being studied for their effectiveness.

Citation:
"posttraumatic stress disorder." The Columbia Electronic Encyclopedia, Sixth Edition. Columbia University Press., 2003. Answers.com 10 Mar. 2006. http://www.answers.com/topic/posttraumatic-stress-disorder

ABC News: Returning Soldiers Not Getting Care They Need

Yesterday's ABC World News Tonight covered the important topic of veterans health issues. In Soldiers Back From Iraq, Unable to Get Help They Need, they covered the long waits, the long distances necessary to travel for VA care, and the recent Texas protest by veterans.

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From ABC's online transcript of its broadcast:

Eugene Simpson doesn't like to complain. Paralyzed in a bomb attack in Iraq, his initial care was excellent, but ever since then he has felt adrift. ... Getting to the nearest Veterans Administration hospital that can best treat his paralysis means a three-hour roundtrip, and the VA isn't paying for therapists closer to home. So he does without. ...

In Texas, a group of veterans staged a protest march covering the distance to the nearest VA hospital: 250 miles. "[It takes] four-and-a-half to five hours .. one way," said Vietnam War vet Polo Uriesti. Uriesti said his father, a veteran of World War II, suffers a greater hardship. But he said the headaches and flashbacks of post-traumatic stress still flare up without warning. "I just … it chokes me up," said Uriesti.

R. James Nicholson countered back, saying that last year "97 percent of veterans who came to us for a primary care appointment got that appointment within 30 days, and 95 percent of those who came for an acute care appointment got it within 30 days."

Unfortunately, those numbers are far from the last word on the matter, as ABC reported:

But an inspector general's audit found real problems with the way the VA has come up with those numbers. The audit found that some VA staff, feeling "pressured," actually fudged the numbers, and error rates were as high as 61 percent. In Atlanta, one veteran who the VA said got an appointment within a week actually waited nearly a year. Another veteran in Boston who reported seeing a VA doctor within hours actually waited 472 days.

And so, with ever more Iraq war veterans returning to the states needing post-deployment health care, many veterans groups are understandably worried. I applaud ABC News for covering this story last night; please contact ABC World News Tonight if you'd like to join in thanking them, too.

Labels: disabled, flashbacks, incidents, injustice, shortfalls, stats, va, wounded

Morning Sentinel: Wrong to Cut Veterans Health Care

Nice to see local newspaper editorial boards coming out to make strong statements in favor or taking care of our returning veterans. Monday, we heard from Nashville's Tennessean; today, central Maine's Morning Sentinel chimes in.

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From the Morning Sentinel:

More than 2,300 American soldiers have died in the war, and more than 17,000 U.S. service members have been wounded, according to the U.S. Department of Defence. Body armor does a great job of protecting the head and trunk, but legs and arms are vulnerable and there is no way to protect the psyches of soldiers from the stress of daily combat or the trauma of watching a friend die.

Wars have costs, some of which may remain hidden for years, even decades after the shooting has stopped. When our soldiers go to war, our nation incurs a debt, both implicit and explicit, to honor their sacrifice with more than words.

After every war, that debt is reflected in the health care we provide veterans. More wounded soldiers requires more money for veterans' care.

The paper goes on to explain that the President's '07 budget short-changes our veterans. The plan is to increase spending on veterans' health care next year, but decrease funding in 2008 and the four years that follow.

Smoke and mirrors are a normal part of the federal budget process, but rarely has an administration's clearly stated policy been so strongly contradicted by its own numbers. The cuts appear to be necessary to allow the president to claim he can to cut the deficit in half by the time he leaves office, as he has promised.

The Bush administration says it will make good on promises to care for veterans and points to previous increases in funding for veterans' care. That may be reassuring to some, but President Bush still needs to explain how he is going to pay for both the war and its aftermath and still cut the deficit.

Cuts in the Bush budget would force staff cuts and delay investment in new medical equipment needed to take care of those veterans now in the system. ...

Sending our soldiers into combat means more than paying for bullets and tanks and armor, it is also means paying for medical care decades after the war is over. The Bush administration must come clean with both veterans and the American people on the real costs of the Iraq war and how it intends to pay for them.

Veterans deserve to know if the Bush administration is willing to put its promises down on paper. The rest of us deserve to know how much those promises will cost, if not 10 years from now, at least two, three, or four years in the future.

If you agree with this, please take some time today to thank the Morning Sentinel. You can do this by visiting their website, scrolling to the bottom of the page, and clicking on the 'Questions/Comments?' link provided.

Let's keep these types of editorials coming!

NJ Assemblyman, Mayor Help Homeless Vets

Two local New Jersey officials have determined to do whatever they can to help our veterans. Fourth-district Assemblyman David Mayer and Assemblyman and Washington Township Mayor Paul Moriarty have introduced a bill benefitting the Veterans Haven Program, located in Winslow Township. Veterans Haven is a facility that provides assistance and shelter to up to 54 homeless veterans a night. Let's take a look at how these two fine gentlemen are supporting their troops where it counts most -- at the local level.

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Coming on the heels of Tuesday's news that 25% of New Jersey's returning veterans are struggling with PTSD and other mental health problems, we see two gentlemen who are trying their best to alleviate one outcome linked to PTSD: homelessness.

Before winning the Assemblyman title, both men ran on the following veteran-friendly platform:

Recognizing, as General George Washington did that, “the willingness with which our young people are likely to serve in any war, no matter how justified, shall be directly proportional as to how they perceive the Veterans of earlier wars were treated and appreciated by their country,” Assembly candidates Paul Moriarty and David Mayer released their Veterans platform. ...

All Veterans in New Jersey would benefit from David Mayer’s plan to create a cabinet level position for Veterans in government. “Our Veterans need a voice at the table. Our government is pushing too much on one plate with military affairs and Veterans’ responsibilities in the same department,” said Mayer (D-Gloucester Township). “We need to make government more efficient and attentive to our Veterans’ needs.”

Listen to them discuss this issue.

Well, now that they're in office, they're getting busy:

The proposed bill would permit residents to contribute voluntarily to the Veterans Haven Program on their state income tax returns, according to Mayer.
"You and I, as taxpayers, will be able to check off a box that says, 'please make a donation to Veterans Haven.' That money will be earmarked for the program," Mayer said. That money, in turn, would go toward expanding the services provided by Veterans Haven. Currently, the facility acts as the core place in which homeless veterans seek and find shelter.

Right now, there aren't enough beds or rooms to accommodate those in need, according to Mayer. "They're at capacity all the time. We just can't place them," he said. ...

"I've noticed a tremendous need for resources to be dedicated to homeless veterans. These are individuals who have fought for our country," he said.
As it stands now, it is estimated that 8,300 veterans will be homeless tonight, according to the New Jersey Health Care System Homeless Veterans Programs. ...

Bruce Tornari, vice commander of Washington Township's VFW Post 6332, said that other programs designed to assist veterans have been stretched since the start of the recent war in Iraq. "Take the V.A. (the U.S. Department of Veteran's Affairs)." Before the Iraq war they were under-staffed, under-funded and overworked. Now it's 10 times worse." The new legislation, A-2663, will help those as deserving as our veterans, Moriarty indicated.

"New Jersey Veterans deserve an opportunity to pursue a life that is
productive and happy. We owe a special debt to our veterans and there are so many falling through the cracks in our society." Moriarty said. ...

They go on to say that a lot of their veterans are returning with PTSD and need the services that Veterans Haven provides all the more. Program details:

After first being medically evaluated at a VA medical center, candidates for aid at Veterans Haven must agree to a long-term program focusing on psychological, social and vocational rehabilitation. Veterans Haven is a drug- and alcohol-free program. Residents must abide by this zero tolerance rule while enrolled. There is random testing for each, with violators being immediately discharged from the program.

Furthermore, Veterans Haven is divided into three phases: Treatment (TR),
Self-Reclamation (SR), and Community Reintegration (CR). Each phase lasts
three to six months and is tailored to individual treatment needs and vocational interests. Veterans completing the program return to vocations, which will support them in years to come. Veterans Haven program participants have a 75 percent success rate

If you'd like to send accolades to either New Jersey official, please do. More information on Veterans Haven can be found in their brochure [pdf].

Labels: advocacy, audio, community, donations, homelessness, legislation, local, shortfalls, society, va

House Reps, Dems Push Bush Admin to Increase VA Staffing

From Knight Ridder:

Congressional leaders from both parties have begun pushing the Bush administration to boost staffing for its veterans' disability compensation program, now mired in a growing backlog of cases and beset by increasing delays. At the same time, Democratic lawmakers are writing legislation to increase funding and enrollment in a pension program for poor veterans and their widows. In December, Knight Ridder revealed that the program was overlooking the vast majority of people who could participate - an estimated 2 million veterans or widows who collectively aren't getting as much as $22 billion a year. ...

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The column continues:

Although the Bush administration expects the backlog to continue rising, its 2007 budget proposal calls for decreasing the staff that directly handles such cases - 149 fewer workers, from the current year's 6,574. The VA has long wanted to reduce its backlog to less than 250,000 claims. But the department's most recent projections have it rising to nearly 400,000 by the end of 2007. In addition, the average time to process claims, which the VA had said would drop to 145 days, or 125 days, or even 100 days, is projected to increase this year and next, to more than 180 days. ...

Rep. Steve Buyer, R-Ind., chairman of the House veterans committee, said in a Feb. 23 letter that his committee "strongly recommends" adding 200 VA claims workers into the president's budget, slightly increasing the level over the current year's. Buyer "definitely is dissatisfied that the backlog is going back up," Brooke Adams, a committee spokeswoman, said this week. "The goal is to significantly reduce the backlog."

Democrats and Republicans on the committee say the administration also needs to beef up its appeals division, generally the source of the longest waits for veterans. In 2005, the average response time for a board decision was 622 days - well above the department's goal of 365 days.

Please contact your representatives and ask them to support an increase in VA staffing.

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Labels: benefits, bush, buyer, claims, funding, house, politics, va

Military Family Resource: MarineParents.com

A great resource for military families, the non-profit MarineParents.com offers a Recovering from Combat Page filled with resources "for new vets, parents, spouses, family & friends." You'll find a brand new PTSD bulletin board, an impressive collection of post-war coping links, as well as information on their upcoming conference featuring an incredible line-up of speakers.

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New Jersey: 25% of Troops Returning with Problems

More local PTSD data, this from the state of New Jersey:

New Jersey's top military officer said yesterday the state Department of Military and Veterans Affairs more than doubled its budget this year to treat veterans for post-traumatic stress disorder.

[A]djutant general, Maj. Gen. Glenn Rieth, said his department budgeted $800,000 this year -- up from $300,000 the previous year -- for post-traumatic stress disorder treatment for veterans, some of whom fought in Iraq or Afghanistan. He said he may seek more funding in the next fiscal year, which begins in July. "About 25 percent of the kids are having some problems," Rieth said. "It's not just New Jersey's problem. It's America's problem."

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[T]he agency provides services to New Jersey's 600,000 veterans. He also commands the 5,900 soldiers and 2,400 airmen of the state National Guard. State-funded treatment for veterans with post-traumatic stress or other mental health problems supplements wider programs run by the federal Department of Veterans Affairs, which is responsible for the bulk of veterans' medical care. ...

Lt. Col. Roberta Niedt, a military and Veterans Affairs spokeswoman, said the state mental health program is handling 1,125 cases of post-traumatic stress disorder. The number includes New Jersey National Guard troops and other service members who have returned from combat zones over the past two years, as well as veterans of previous wars. The numbers are on the rise. In 2004, the state handled 118 new cases, and the number increased to 268 last year. There have been 82 new cases since January, including 26 National Guardsmen or reservists who served in Iraq. "At this rate, there's potential to have 400 by the end of the year," Niedt said. "You can see the potential for this to continue to increase."

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Labels: community, funding, guard, local, stats, va

At the Movies: Film and PTSD

Movies have the power to present difficult social or personal problems, offering the viewer an educational benefit alongside the usual entertainment value. Movies can bring the viewer closer to topics that are often hidden away from the general public's gaze.

Think: Philadelphia (HIV/AIDS discrimination); Boyz 'N the Hood (poverty/crime); A Beautiful Mind (mental illness); Dead Man Walking (capital punishment); I Know Why the Caged Bird Sings (child abuse); or Rain Man (autism).

By exploring these issues in provocative -- even entertaining ways -- filmmakers go a long way in educating us.

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This page was updated on July 28, 2007.

Combat post-traumatic stress-related films allow us to examine PTSD through the cinematic lens, often offering therapeutic qualities to the viewer. From Psychiatric Times:

Theater, film, literature and poetry are forms of expression that allow artists and their audiences to explore the compelling issues of their lives. On a very basic level, the various forms of art are windows into the emotions and impulses that populate the human unconscious. Furthermore, art, both in its creation and its enjoyment, can be as healing for the psyche as psychotherapy. The themes explored in literature allow us to understand, from a different perspective, the difficult issues with which our patients grapple in therapy. Of all of the medical specialties, psychiatry may have the greatest affinity for the humanities. Psychiatry is inherently about the human psyche, a topic addressed by all of the arts in one way or another. Thus, psychotherapy and art are merely different approaches to the understanding of the human experience.

While some of the following movies may be too disturbing for the post-deployed veteran to watch, they may have educational value for those seeking to better understand the inner turmoil of a loved one with PTSD.

Vietnam-era Films Presenting PTSD

Taxi Driver (1976)
Coming Home (1978)
Apocalypse Now (1979)
The Deer Hunter (1979)
Return of the Soldier (1982)
Birdy (1984)
Born on the Fourth of July (1989)
Heaven and Earth (1993)

These movies unleash the inner mindset of combat veterans trying their best to cope with the trauma of war. Characters clearly exhibit classic symptoms of PTSD such as uncontrollable anger, emotional numbing, denial, keyed up startle responses, an interest in recreating traumatizing events, and substance abuse.

OEF/OIF PTSD Documentaries

The current crop of documentaries revealing the post-war issues troops returning from Afghanistan and Iraq are coping with include:

The Ground Truth: The Human Cost of War by director Patricia Foulkrod is probably one of the better films to date on the subject, allowing the stories to unfold through interviews and strong footage. Currently, it is available at Google Video. Trailer:

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Labels: art, films, reintegration, society, video

NPR's Diane Rehm Show: Discussion on Troop Mental Health

A big, hearty thank you goes out to The Diane Rehm show which today devoted one full hour of programming to the topic of Mental Health and Military Service in Iraq. The show discussed the "types of problems [our combat troops] are experiencing, the help available, and long term cost to individuals, their families, and the nation."

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Guests included:

Charles Sheehan-Miles, executive director of Veterans for Common Sense and a veteran of the first Gulf War (and who just last week left a comment right here at our fledgling PTSD Combat blog)
Col. Dr. Charles Hoge, director of the division of psychiatry and neuroscience at the Walter Reed Army Institute of Research and author of a ground-breaking study on troop health released last week to front-page headlines
Chaplain John Morris, chaplain for the Minnesota National Guard
Craig Smith, served as a Specialist in Operation Iraqi Freedom from April to November 2003

Listen to the full program [Real Audio - Windows Media], and then send your thanks to Ms. Rehm for devoting such a large portion of her program to this important topic today.

And a Personal Thank You

A personal 'thank you' goes out to a tireless Vietnam vet with the biggest of hearts, Jim Starowicz. Jim (who has his own very fine blog) has been one of my strongest allies in collecting interesting PTSD-related information to pass along to you. Thank you, Jim. Oh, if there were more like you in the world! But, I'm glad we have you.

Labels: audio, family, guard, gulf, incidents, iraq, reintegration, society, wramc

The Tennessean: Support Troops Long Term

Today's much-recommended editorial in Nashville's Tennessean:

The good news in a study of soldiers returning from active duty is that they seem to be more willing than ever to seek evaluation for their mental and emotional state. The discouraging news is that one in every eight soldiers coming back from service in the first year of the Iraq war has been diagnosed with a mental illness, including post-traumatic stress disorder.

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The editorial continues:

Just as soldiers often have trouble adjusting after harrowing experiences in war, the military has come to grips with the fact that such problems should be expected and addressed. It remains a compelling obligation for government to help those veterans when the need arises. Sometimes, the problems may come much later than anticipated after the return home. ...

Mental problems from war experience are not new. The illnesses were once called names such as shell shock or combat fatigue. What has changed over the years is that society has begun to understand the problem better and that the stigma associated with such ailments is subsiding. Soldiers should be no more hesitant to ask for help in coping after battle than they are in seeking medical help when physically wounded. Tragically, this nation did not embrace such understanding when soldiers returned from the Vietnam War. Some lessons have been learned, as evident in utilizing soldiers' contacts with families through the Internet or telephone when away.

Veterans have a wide array of needs far after their battle experience. It is important that the nation stand at the ready to meet those needs long after their service is over. That's a way to truly support the troops, whenever they need it, not just in the heat of battle.

Please join me in saying thanks by contacting The Tennessean, letting them know you appreciate their strong show of support for our troops. We need to see much more of this in our newspapers, far and wide.

Labels: advocacy, editorial, iraq, local, psychology, reintegration, society, stigma, studies, vietnam

PTSD Combat: 'Blog of the Week' at Genetics and Health

A quick thank you to Genetics and Health (an incredible blog edited by Hsien-Hsien Lei, PhD in epidemiology from Johns Hopkins University), for showering us with featured blog status for the week. Thank you for your positive nod and help in educating others to the plight of some of our returning veterans.

Labels: biological, blog_milestones

Combat PTSD: What are the Symptoms?

If you're a returning combat veteran having some difficulty readjusting to civilian life, you may be wondering what's going on. Why am I angry all the time? Why am I feeling detached?

If this sounds like you, you may want to review the following list of some of the general symptoms associated with post-traumatic stress disorder (PTSD).

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The following is a composite of PTSD symptom descriptions culled from the Journal of Clinical Psychology Expert Clinical Guidelines Series; the always informative National Center for PTSD website; and the Vietnam Veterans Association of Australia.

What You Need to Know

Traumas happen to many competent, healthy, strong, good people. No one can completely protect him- or herself from traumatic experiences.
Many people have long-lasting problems following exposure to trauma. Up to 8% of individuals will have PTSD at some time in their lives.
People who react to traumas are not going crazy. They are experiencing symptoms and problems that are connected with having been in a traumatic situation.
Having symptoms after a traumatic event is not a sign of personal weakness. Many psychologically well-adjusted and physically healthy people develop PTSD. Probably everyone would develop PTSD if they were exposed to a severe enough trauma.
When a person understands trauma symptoms better, he or she can become less fearful of them and better able to manage them.
By recognizing the effects of trauma and knowing more about symptoms, a person is better able to decide about getting treatment.

PTSD Symptoms/Signs

So, let's take a look at the symptoms or signs of combat-related PTSD. They generally fall into 3 main categories:

Intrusive - Re-experiencing of the traumatic event(s)

Distressing recollections
Flashbacks (feeling as if you're back in combat while awake)
Nightmares (frequent recurrent combat images while asleep)
Feeling anxious or fearful (as if you're back in the combat zone again)

Because trauma survivors have these upsetting feelings when they feel stress or are reminded of their trauma, they often act as if they are in danger again. They might get overly concerned about staying safe in situations that are not truly dangerous. For example, a person living in a safe neighborhood might still feel that he has to have an alarm system, double locks on the door, a locked fence, and a guard dog. Because traumatized people often feel like they are in danger even when they are not, they may be overly aggressive and lash out to protect themselves when there is no need. For example, a person who was attacked might be quick to yell at or hit someone who seems to be threatening.

Re-experiencing symptoms are a sign that the body and mind are actively struggling to cope with the traumatic experience. These symptoms are automatic, learned responses to trauma reminders. The trauma has become associated with many things so that when the person experiences these things, he or she is reminded of the trauma and feels that he or she is in danger again. It is also possible that re-experiencing symptoms are actually a part of the mind's attempt to make sense of what has happened.

Avoidant - Drawing inward or becoming emotionally numb

Extensive and active avoidance of activities, places, thoughts, feelings, memories, people, or conversations related to or that remind you of your combat experiences
Loss of interest
Feeling detached from others (finding it hard to have loving feelings or experiencing any strong emotions)
Feeling disconnected from the world around you and things that happen to you
Restricting your emotions
Trouble remembering important parts of what happened during the trauma
Shutting down (feeling emotionally and/or physically numb)
Things around you seem strange or unreal
Feeling strange and/or experiencing weird physical sensations
Not feeling pain or other sensations

Because thinking about the trauma and feeling as if you are in danger is upsetting, people who have been through traumas often try to avoid reminders of the trauma. Sometimes survivors are aware that they are avoiding reminders, but other times survivors do not realize that their behavior is motivated by the need to avoid reminders of the trauma.

Trying to avoid thinking about the trauma and avoiding treatment for trauma-related problems may keep a person from feeling upset in the short term, but avoiding treatment means that in the long term, trauma symptoms will persist.

Hyperarousal - Increased physical or emotional arousal

Difficulty sleeping
Irritability or outbursts of anger
Difficulty concentrating or thinking clearly
An exaggerated startle response (triggers bring you back to a certain combat zone event)
Hypervigilence, being overly angry or aggressive (feeling as if you need to defend yourself from danger)
Panic attacks

Triggers can include any of the following:

Specific scenes - crowded streets, sunsets, sunrises, familiar clothing
Movement - someone rushing towards the individual
TV - even if the story is unreal, the subject or the environment may cause thoughts which act as a trigger
Sound - helicopters, songs, unexpected loud noises
Smell - jungle or bush, rain, smoke, blood, cordite or explosives
Reading - or discussion about subjects of trauma
Touch - gun metal, webbing, blood
Situational - being crowded, walking across open spaces, feeling vulnerable or not in control

Just Remember

Although you may be overwhelmed by your symptoms, you do have many resources available to you. Please make use of them. If you need immediate help, please get it. If you'd like to talk to someone about what you're going through, there are a lot of people and organizations you can turn to you may not be aware of. If you'd like to learn more, there are a wide variety of PTSD resources waiting to be explored by you.

And if you're seeking professional help, you've a lot of options to help you find relief and resolution to your PTSD.

Labels: avoidance, clinical, definition, diagnosis, disillusion, flashbacks, hypervigilence, psychology, reintegration, sleeplessness, triggers

Poetry in Motion: Using Art to Process PTSD

Art has the ability to broach topics that are often more difficult to process head-on. Poetry is one such vehicle. Last month I posted a poem written by leftvet along with a link to a resource for veterans who happen to enjoy writing. Tonight, I'd like to post a few more lines of verse that will provoke and elucidate, make you cringe and perhaps even weep. Feel free to share your own creations in comments if you'd like.

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The following poem was written by the tireless Vietnam vet and advocate Sarge Lintecum. It is a brutal and frank piece of work. When I asked for permission to reprint part of the poem (I intended to leave off the last three stanzas not wishing to offend others), Sarge explained, "I'm going to guess that you are not a veteran because the verses you want to omit are very important to my poem." He went on to gently educate this writer.

I've included Sarge's explanations in the hopes that it will bring about a deeper understanding as well with other non-vets who are trying to get their heads around this issue. Not having gone through the experience of war myself, I appreciated the extra time Sarge took with me, explaining things fully. Thank you, sir.

P.T.S.D. Love Poem - © Sarge Lintecum 2003
(Post Traumatic Stress Disorder Poem)

I love you through my anger,
In between my fits of rage.
I want us to be happy,
But I just can't turn the page.

I see in you the answer
To every time I've prayed.
Then I get mad; you leave the room;
I wish that you had stayed.

My love just wants to hold your hand,
But my anger doesn't care.
I feel the weight you carry.
It really isn't fair.

I gave our country everything
The day I went to war.
I thought the cost would be my life,
But it turned out to be much more.

I look into my child's eyes,
And I see a child burned
By Napalm lying on the ground,
Without a lesson learned.
Without this verse the veteran will think his PTSD causing memories are worse than other vets.

So now they send the young folks
To act like war is fun,
Without a thought of how they'll feel
When their killing job is done.
Without this verse you would leave out the lack of help from the government that was a bigger slap in my face than "Charlie" (Viet Cong) ever gave me.

When folks go fill their gas tanks
I think they all should know,
A veteran's future happiness
Is drowning in the flow.
Without this verse you would leave out the underlying reason for the war that is easily hidden from the public but not the veteran.

Please visit Sarge's website, PTSDHelp2000.com, and read of his own struggle with PTSD. If I may share one more bit of his advice:

One more thing I'd like to pass on that has helped me gain control of every day of my life, rather than having PTSD control my life, is this -- Somewhere along the way, I realized that the tortured life I was leading was ripping off my brothers on the Wall because they gave up their lives and I was throwing mine away. It was then it hit me that if I were to spend my entire after-Nam life torturing myself, feeling bad about myself, and making life miserable for the ones I love, I am dishonoring my brothers on the Wall.

So think of how you'll feel when you tell them all about the life you had after Nam, because that's the first thing they're going to want to know about when we see them again. They're going to want to hear that we all had happy, wonderful lives, just like the life they had imagined having if they had made it home and, I for one, am going to have a hell of a fun story to tell them.

If you'd like to join in and thank Sarge for his work in PTSD education and assistance, please email Sarge and say 'thanks'...

And check out Sarge's 'day job' as a master blues harmonica player. He and his wife, Leslie, do student outreach in the Arizona/SW California area, helping kids cultivate their love of music and poetry; Sarge also travels the country performing at veterans' events and blues concerts.

Thank you for your service to our country in and out of uniform, sir.

PTSD Defined: Dept. of Veterans Affairs Center for PTSD

We've already looked at the VA's official definition of post-traumatic stress disorder; now we'll expand on that by taking a look at the VA's National Center for PTSD definition. The more ways we look at PTSD, the better.

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Much of the information at the National Center for PTSD website is in the public domain, giving everyone the right to share the information with others elsewhere. The following is from their What is Posttraumatic Stress Disorder? fact sheet:

Posttraumatic Stress Disorder, or PTSD, is a psychiatric disorder that can occur following the experience or witnessing of life-threatening events such as military combat, natural disasters, terrorist incidents, serious accidents, or violent personal assaults like rape. Most survivors of trauma return to normal given a little time. However, some people will have stress reactions that do not go away on their own, or may even get worse over time. These individuals may develope PTSD. People who suffer from PTSD often relive the experience through nightmares and flashbacks, have difficulty sleeping, and feel detached or estranged, and these symptoms can be severe enough and last long enough to significantly impair the person's daily life.

PTSD is marked by clear biological changes as well as psychological symptoms. PTSD is complicated by the fact that it frequently occurs in conjunction with related disorders such as depression, substance abuse, problems of memory and cognition, and other problems of physical and mental health. The disorder is also associated with impairment of the person's ability to function in social or family life, including occupational instability, marital problems and divorces, family discord, and difficulties in parenting.

Understanding PTSD

PTSD is not a new disorder. There are written accounts of similar symptoms that go back to ancient times, and there is clear documentation in the historical medical literature starting with the Civil War, when a PTSD-like disorder was known as "Da Costa's Syndrome." There are particularly good descriptions of posttraumatic stress symptoms in the medical literature on combat veterans of World War II and on Holocaust survivors.

Careful research and documentation of PTSD began in earnest after the Vietnam War. The National Vietnam Veterans Readjustment Study estimated in 1988 that the prevalence of PTSD in that group was 15.2% at that time and that 30% had experienced the disorder at some point since returning from Vietnam.

PTSD has subsequently been observed in all veteran populations that have been studied, including World War II, Korean conflict, and Persian Gulf populations, and in United Nations peacekeeping forces deployed to other war zones around the world. There are remarkably similar findings of PTSD in military veterans in other countries. For example, Australian Vietnam veterans experience many of the same symptoms that American Vietnam veterans experience.

PTSD is not only a problem for veterans, however. Although there are unique cultural- and gender-based aspects of the disorder, it occurs in men and women, adults and children, Western and non-Western cultural groups, and all socioeconomic strata. A national study of American civilians conducted in 1995 estimated that the lifetime prevalence of PTSD was 5% in men and 10% in women. A revision of this study done in 2005, reports that PTSD occurs in about 8% of all Americans.

How does PTSD develop?

Most people who are exposed to a traumatic, stressful event experience some of the symptoms of PTSD in the days and weeks following exposure. Available data suggest that about 8% of men and 20% of women go on to develop PTSD, and roughly 30% of these individuals develop a chronic form that persists throughout their lifetimes.

The course of chronic PTSD usually involves periods of symptom increase followed by remission or decrease, although some individuals may experience symptoms that are unremitting and severe. Some older veterans, who report a lifetime of only mild symptoms, experience significant increases in symptoms following retirement, severe medical illness in themselves or their spouses, or reminders of their military service (such as reunions or media broadcasts of the anniversaries of war events).
How is PTSD assessed?

In recent years, a great deal of research has been aimed at developing and testing reliable assessment tools. It is generally thought that the best way to diagnose PTSD-or any psychiatric disorder, for that matter-is to combine findings from structured interviews and questionnaires with physiological assessments. A multi-method approach especially helps address concerns that some patients might be either denying or exaggerating their symptoms.

How common is PTSD?

An estimated 7.8 percent of Americans will experience PTSD at some point in their lives, with women (10.4%) twice as likely as men (5%) to develop PTSD. About 3.6 percent of U.S. adults aged 18 to 54 (5.2 million people) have PTSD during the course of a given year. This represents a small portion of those who have experienced at least one traumatic event; 60.7% of men and 51.2% of women reported at least one traumatic event. The traumatic events most often associated with PTSD for men are rape, combat exposure, childhood neglect, and childhood physical abuse. The most traumatic events for women are rape, sexual molestation, physical attack, being threatened with a weapon, and childhood physical abuse.

About 30 percent of the men and women who have spent time in war zones experience PTSD. An additional 20 to 25 percent have had partial PTSD at some point in their lives. More than half of all male Vietnam veterans and almost half of all female Vietnam veterans have experienced "clinically serious stress reaction symptoms." PTSD has also been detected among veterans of the Gulf War, with some estimates running as high as 8 percent.

Who is most likely to develop PTSD?

Those who experience greater stressor magnitude and intensity, unpredictability, uncontrollability, sexual (as opposed to nonsexual) victimization, real or perceived responsibility, and betrayal
Those with prior vulnerability factors such as genetics, early age of onset and longer-lasting childhood trauma, lack of functional social support, and concurrent stressful life events
Those who report greater perceived threat or danger, suffering, upset, terror, and horror or fear
Those with a social environment that produces shame, guilt, stigmatization, or self-hatred

What are the consequences associated with PTSD?

PTSD is associated with a number of distinctive neurobiological and physiological changes. PTSD may be associated with stable neurobiological alterations in both the central and autonomic nervous systems, such as altered brainwave activity, decreased volume of the hippocampus, and abnormal activation of the amygdala. Both the hippocampus and the amygdala are involved in the processing and integration of memory. The amygdala has also been found to be involved in coordinating the body's fear response.

Psychophysiological alterations associated with PTSD include hyper-arousal of the sympathetic nervous system, increased sensitivity of the startle reflex, and sleep abnormalities.

People with PTSD tend to have abnormal levels of key hormones involved in the body's response to stress. Thyroid function also seems to be enhanced in people with PTSD. Some studies have shown that cortisol levels in those with PTSD are lower than normal and epinephrine and norepinephrine levels are higher than normal. People with PTSD also continue to produce higher than normal levels of natural opiates after the trauma has passed. An important finding is that the neurohormonal changes seen in PTSD are distinct from, and actually opposite to, those seen in major depression. The distinctive profile associated with PTSD is also seen in individuals who have both PTSD and depression.

PTSD is associated with the increased likelihood of co-occurring psychiatric disorders. In a large-scale study, 88 percent of men and 79 percent of women with PTSD met criteria for another psychiatric disorder. The co-occurring disorders most prevalent for men with PTSD were alcohol abuse or dependence (51.9 percent), major depressive episodes (47.9 percent), conduct disorders (43.3 percent), and drug abuse and dependence (34.5 percent). The disorders most frequently comorbid with PTSD among women were major depressive disorders (48.5 percent), simple phobias (29 percent), social phobias (28.4 percent), and alcohol abuse/dependence (27.9 percent).

PTSD also significantly impacts psychosocial functioning, independent of comorbid conditions. For instance, Vietnam veterans with PTSD were found to have profound and pervasive problems in their daily lives. These included problems in family and other interpersonal relationships, problems with employment, and involvement with the criminal justice system.

Headaches, gastrointestinal complaints, immune system problems, dizziness, chest pain, and discomfort in other parts of the body are common in people with PTSD. Often, medical doctors treat the symptoms without being aware that they stem from PTSD.

How is PTSD treated?

PTSD is treated by a variety of forms of psychotherapy (talk therapy) and drug therapy. There is no definitive treatment, but some treatments appear to be quite promising, especially cognitive-behavioral therapy, group therapy, and exposure therapy. Exposure therapy involves having the patient repeatedly relive the frightening experience under controlled conditions to help him or her work through the trauma. Studies have also shown that medications help ease associated symptoms of depression and anxiety and help with sleep. The most widely used drug treatments for PTSD are the selective serotonin reuptake inhibitors, such as Prozac and Zoloft. At present, cognitive-behavioral therapy appears to be somewhat more effective than drug therapy. However, it would be premature to conclude that drug therapy is less effective overall since drug trials for PTSD are at a very early stage. Drug therapy appears to be highly effective for some individuals and is helpful for many more. In addition, the recent findings on the biological changes associated with PTSD have spurred new research into drugs that target these biological changes, which may lead to much increased efficacy.

Related Fact Sheets

Epidemiology - Information about rates of PTSD in the United States among different populations

Help for veterans with PTSD - Answers to some questions about PTSD and service-connected disability that are frequently asked by veterans and their families

Risk factors - A fact sheet about the risk factors for adverse outcomes in natural and human-caused disasters

Treatment - Information on availble treatments for PTSD

Be sure to spend some time exploring the entire National Center for PTSD website; it will be time well spent.

University of Illinois Supports Its Veterans with Free MBA's

[UPDATE December 2, 2007]:

This post has been one of the most contentious on PTSD Combat, and I'm planning (as soon as time can be found) to do a follow-up on the controversy that has erupted re: the program outlined below. For the time being, I have green-lighted every comment, no matter how severe, in the interest of having a forum to air grievances.

I ask that commentors please steer clear from libelous, personal attacks against any of the individuals who may or may not be involved in one way or another. After doing my update, I will return to comments and delete those that are found to be inappropriate.

Well, the fine state of Illinois has just upped the stakes in the 'Best Freebies for Veterans' category. They join Washington State; the towns of Cloquet, Minnesota and Oakridge, Tennessee; and a whole slew of local media outlets who are walking the walk when it comes to talking about, advocating, and supporting our troops. While GI Bill delays are hampering timely veteran tuition payments, the state of Illinios and the University of Illinois have decided to cut out the middle-man for 110 lucky resident veterans.

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The incredible news was released yesterday:

The College of Business at the University of Illinois at Urbana-Champaign (UIUC) has partnered with the State of Illinois to award up to 110 new academic scholarships for Illinois-based military veterans and active-duty military personnel. The scholarships offer veterans an unprecedented opportunity to receive free tuition while earning an MBA degree from one of the top universities in the US.

By combining the University's Military Scholarship Program with the Illinois Veteran Grant (IVG), the program offers qualified and eligible applicants an opportunity to earn an MBA tuition-free through the College's 20-month Executive MBA Program located at the Illini Center in downtown Chicago or the MBA Programs offered in Urbana-Champaign. ...

"This is a unique opportunity for the citizens of Illinois and our university to honor our men and women in uniform," said van der Hooning. The University wants to help soldiers and veterans put their career on a fast track without the burden of student loans. I recently met with a returning group of marines from the 2/24th Battalion who fought on the front lines in Iraq and Afghanistan. The enemy named them the Mad Ghosts for their fighting prowess and bravery. The experience was overwhelming. At that moment, I realized that saying 'thank you' was not enough. We had to do something tangible and significant, and this program is a step in the right direction." ...

This program builds upon a partial financial scholarship that was first offered to Illinois veterans by UIUC in 2005, and was expanded to cover full tuition based on the demand. "The men and women of our military are the best trained in the world. They can now combine that training with the knowledge that they will receive from this program," said Lt. Governor Pat Quinn. "I would like to salute the University of Illinois College of Business for introducing this program that will make these brave Service members the best in the nation."

Resources and Info to Get You Started:

UIUC's Executive MBA Page
Military Scholarship FAQ's [pdf]
Pre-Application Checklist for Veterans [pdf]
UIUC's College of Business (programs available)

Or call van der Hooning at 312-575-7905 for more information.

Labels: disillusion, educational, freebies, local, state

Upcoming Job Fair for California Vets

MilitaryStars is hosting the Western Regional Career Expo on March 6th from 12pm - 5pm at the Hilton Burbank Airport 2500 Hollywood Way, Burbank, CA. From the website: "Participating employers range from Fortune 500 companies to the nation's fastest growing local businesses with positions available in Management, Operations, Logistics, Sales, Technology, and much more." Registration [pdf] | Agenda

And before you go, you might want to take a look at these job search resources. Good luck!

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Related Posts

Labels: events, jobs, local, resources

Veterans and PTSD: A Video by Kathie Costos

This one comes entirely from the heart. The video quality may not be straight out of a movie studio, but the information and sentiments expressed are top notch.

The video's creator and author of For the Love of Jack, Kathie Costos, says, "With the figure of veterans from Iraq and Afghanistan already topping 70,000 diagnosed cases, there is no better time than now to unite behind our veterans. This is a new piece I did in an attept to explain PTSD, how it changes the veterans and their families. It also address[es] how so many of them end up homeless. Hope you like it but I hope it helps more. Pass it on at will."

Watch Veterans and PTSD. Then thank Ms. Costos for her work.

Labels: afghanistan, homelessness, iraq, stigma, video

Scientists Racing to Ease Painful PTSD Memories

Scientists are using their growing knowledge of brain chemicals -- and the role they play in saving and accessing memories -- to find ways to help people better cope with one symptom of PTSD: the painful replay of traumatic memories. We'll review today's Chicago Tribune article, Drug Eases Pain of Bad Memories, to get an update on progress in this somewhat controversial area; and we'll take a look at results of studies conducted by the National Institute of Mental Health (NIMH) on the role the brain plays in PTSD.

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From the Chicago Tribune:

There is no definitive treatment for PTSD and no cure, and the number of cases is only expected to grow as a result of U.S. military action overseas. This week, published research found that 12 percent of soldiers returning from Iraq were diagnosed with post-traumatic stress disorder, depression or another serious mental illness.
Brain scientists think they have found a way to help by using a drug called propranolol to alter traumatic thoughts. It appears that the drug, a beta blocker used to treat high blood pressure, interferes with stress hormones in the brain to defuse the impact of horrific memories.

While use of the drug for this purpose has not been approved, some psychiatrists already have begun to prescribe it to patients with PTSD. (Other beta blockers do not seem to affect the brain the same way.) Researchers emphasize that the drug can lower the intensity of a bad memory--but not erase it. "It's not that people will no longer remember the trauma, but the memory will be less painful," said Alain Brunet, a psychologist at McGill University in Montreal, where experiments on human subjects are under way.

An interesting part of the new research and findings is that it's been a century's old scientific view that memories are fluid only for a matter of a few hours (the article says 6), and then following that period of time become fixed. They're stored in the fixed state, and can't be changed in any way in the future.

But Karim Nader, a pioneering McGill psychologist, was able to show that long-term memories aren't nearly as hardwired as scientists had thought. When we retrieve a memory, Nader found, it again enters a vulnerable state where it could be manipulated or even lost. "It was formerly thought that once a memory is fixed you can't mess around with it," said Nader. "That was scientific dogma for 100 years."

The brain's wiring changes each time something goes into long-term memory, but not all memories are equal, he said. "You remember the day of your wedding better than three Tuesdays ago when there was nothing important going on."

Emotional memories, Nader explained, activate a second process that ups their intensity. This is called a "gain switch" and can be thought of as the volume control on a radio. Studies have shown that emotionally arousing events cause stress-related hormones such as adrenaline to be released by the brain's amygdala, which is involved in emotional learning and memory. PTSD may develop when the event is so emotionally powerful, and so much adrenaline is released, that the "gain switch" is set too high.

As the National Institute for Mental Health (NIMH) explains:

NIMH and the VA sponsor a wide range of basic, clinical, and genetic studies of PTSD. … Studies in animals and humans have focused on pinpointing the specific brain areas and circuits involved in anxiety and fear, which are important for understanding anxiety disorders such as PTSD. Fear, an emotion that evolved to deal with danger, causes an automatic, rapid protective response in many systems of the body. It has been found that the body's fear response is coordinated by a small structure deep inside the brain, called the amygdala. The amygdala, although relatively small, is a very complicated structure, and recent research suggests that different anxiety disorders may be associated with abnormal activation of the amygdala.

What appears to happen each time a memory is retrieved by the brain is that the amygdala releases more hormones, the painful memories being all the more intensified with each recall. This is where the drug propranolol comes to the rescue; it has been shown in lab experiments to desensitize the subject of expected fear-producing memories.

Trials are now underway on men and women and seem to reflect the results of lab research showing that those taking the blood pressure pill propranolol have a milder reaction to traumatic memories than those taking a placebo. Additionally, propranolol may help to ease the painful memories immediately after a traumatic incident, the Chicago Tribune explains:

Dr. Roger Pitman, a professor of psychiatry at Harvard Medical School, wondered if giving propranolol as soon as possible after a traumatic event could prevent indelible, terrifying memories from taking hold.

He tested the idea on 41 people who had experienced car accidents, assaults and other events that brought them to a Massachusetts emergency room. They received the drug within six hours of their mishaps. The results were dramatic. Three months later, 22 of the victims listened to audiotapes on which they had described their traumas. None of those who took propranolol showed strong responses to the tapes, but eight of the placebo patients were obviously shaken by reliving their experiences. Their heart rates increased, their palms sweated, their muscles twitched--all signs of PTSD.

Now Pitman's group is pursuing a study in which patients with chronic PTSD are treated repeatedly with propanolol. "If we get positive results, there are many potential applications for people with PTSD from a variety of sources, including Hurricane Katrina and the Iraq War," Pitman said.

These treatments are not without controversy as some ethicists are concerned that by trying to numb the pain we may be setting ourselves up to be less capable of handling psychological pain in the future. But the brain researchers counter back:

"Many people have thought of these as amnesia drugs: `I would like to get rid of the memory of a horrible experience I had with another person; I'll just take propranolol and get rid of it,'" said James McGaugh, a neurobiologist at the University of California at Irvine whose work on learning and memory paved the way for research by Pitman and others. "Well, propranolol does not remove memories."

The day after Nader's first study was published, a woman called and asked whether she could have the memories of her abusive first husband erased.

"The idea of erasing memory is just silly," Nader said. "We can't do it; nor do we want to. But if we can turn down the intensity of the memory sufficiently that these patients can respond to traditional treatments, that's the goal, I think."

Be sure to read the whole Chicago Tribune piece, and visit the NIMH website if you'd like to learn more on this issue -- and PTSD in general.

JAMA's Iraq Combat Mental Health Study: A Review

Note: Details on JAMA's Nov 2007 follow-up study here.

A 'perfect storm' of events (Zogby International's poll of Iraq combat troops and a study of today's current military population appearing in the Journal of the American Medical Association) has come together to bring combat-related PTSD into the forefront this week. Both of these barometers of troop health and opinion are ground-breaking. I've already touched upon the Zogby data; here I'll take a look at what the JAMA study reveals.

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Background

A month following the start of combat operations in Iraq, the Department of Defense (DOD) implemented a post-deployment survey program of its combat veterans. Each service member was (and is still) required to complete the Post-Deployment Health Assessment (PDHA) form. At the same time, troops would also receive a face-to-face assessment by a physician, physician assistant, nurse practitioner, or independent duty corpsman/medical technician.

From the Deployment Health Clinical Center website, the purpose of the screening is to:

review each combat veteran’s current health
study the mental health or psychosocial issues commonly associated with deployments
track special medications taken during the deployment
make note of possible deployment-related occupational/environmental exposures
discuss deployment-related health concerns

It continues:

Positive responses require use of supplemental assessment tools and/or referrals for medical consultation. The provider will document concerns and referral needs and discuss resources available to help resolve any post-deployment issues. The original completed DD Form 2796 will be maintained in the individual's permanent medical record. A copy (paper or electronic) will be sent to the Army Medical Surveillance Activity (AMSA).

The data collected by AMSA is then integrated into the Defense Medical Surveillance System (DMSS) database – and that database is the source of data for the Hoge study.

Study Authors

The March 1, 2006 Journal of the American Medical Association (JAMA) article outlining the results (Mental Health Problems, Use of Mental Health Services, and Attrition From Military Service After Returning From Deployment to Iraq of Afghanistan) was written by the much respected Charles W. Hoge, MD (Division of Psychiatry & Neuroscience, Walter Reed Army Institute of Medical Research); Jennifer L. Auchterlonie, MS (US Army Center for Health Promotion and Preventative Medicine); and Charles S. Milliken, MD (Division of Psychiatry & Neuroscience, Walter Reed Army Institute of Medical Research).

Value and Goal of Study

The authors explain the reason and value for the unprecedented study (never before has population-based study been possible so immediately or fully after or even during combat ops – today's computer databases now make this possible) stating, “Such studies are an important part of measuring the mental health burden of the current war and ensuring that there are adequate resources to meet the mental health care needs of veterans returning from Iraq and Afghanistan.”

Study Participants and Window

Dr. Hoge and his colleagues used the data available from the records of 303,905 Army soldiers and Marines who’d completed a PDHA between May 1, 2003, and April 30, 2004 and had served in either Operation Iraqi Freedom (OIF), Operation Enduring Freedom (OEF), or other locations such as Bosnia or Kosovo. Of this population of service members, 50,611 have been detached from the military.

Study Questions and Analysis

Two questions were used to determine risk factors for depression: one examining depressed mood (“felt down, depressed, or hopeless”), the other anhedonia (“little interest or pleasure in doing things”).

Four questions were included to screen for PTSD of the key domains of PTSD (re-experiencing trauma; numbing; avoidance; and hyperarousal); an affirmative response to 2 out of the 4 questions was taken to mean the troop was considered to be at risk for PTSD. Additionally, four more questions were proffered exploring suicide, interpersonal relationships, and interest in receiving care. [See the PDHA form for more detail.]

Study Results

Not surprisingly, rates of mental health problems are higher for those deployed to OIF vs. those deployed to OEF or other locations. [One note: All statistics below are for combat soldiers and Marines. The authors explain, “Although Air Force and Navy personnel also serve in the combat environment, the majority of ground combat units are Army and Marine.”]

Soldiers and Marines meeting the risk criteria for mental health concern:

OIF: 19.1%
OEF: 11.3%>
Other: 8.5%

The study states, “The 8.5% compares closely with baseline data from another study of soldiers surveyed before they deployed for the first time to Iraq and Afghanistan.”

Soldiers and Marines scoring 2 or more on the 4-item PTSD scale:

OIF: 9.8%
OEF: 4.7%
Other: 2.1%

Soldiers and Marines referred for a mental health problem:

OIF: 4.3%
OEF: 2.0%
Other:0.9%

The 4.3% translates to 42,506 OIF veterans screening positive. Of these, 18.3% (7,797) were referred for a mental health problem.

Cross-component prevalence of mental health problems (screening positive for 1 of the mental health concerns) in OIF troops:

Active: 18.4%
National Guard: 21.0%
Reserve: 20.8%

Of 14,777 veterans who were hospitalized, 35% reported a mental health problem. Other mental health care stats for our OIF veterans:

Documented to have at least 1 outpatient mental health care visit within one year post-deployment: 31%
Annualized rate of utilization of mental health services: 35% of persons per year
Episodes of care per person per year: 3.4 visits

A few cautionary notes borne out by the data that do not bode well for the current mental health assessment process and our ability to diagnose and treat combat-related PTSD:

Among OIF veterans who’d listed mental health concerns on their PDHA form, only 20% were referred for such care.
Of those who accessed mental health care within a year after deployment, only 7.6% (5,216) has a referral for such on their PDHA form.
60% who screened positive for PTSD, generalized anxiety, or depression did not seek treatment.
Rates of mental health care use has been increasing with each year since 2000, “providing further evidence that the war is burdening the health care system at large.”

Selection of Press Coverage Given Study

Additional Screening Program Implemented by DOD

As already reported at PTSD Combat last month, an additional mental health screening program for our returning troops is being rolled out by the DOD: the Post-Deployment Health Reassessment (PDHRA form). Service members will participate in the health screening three-to six months after arriving home.

Join Operation Homefront in Sending Softballs to Our Troops

The Northwest Illinois Chapter of Operation Homefront has launched its Operation Softball program. From the website: "The original goal was to collect 1,016 softballs to build a pyramid of support for our soldiers. For months, softballs were distributed to area businesses, churches, and schools for people to sign and write words of support for our troops. Because of the tremendous outpouring of support, the program has been continued through April 15, 2006 and extended to the national level. The goal has now been raised to collect 10,000 softballs and baseballs for our soldiers.” Signed balls can be mailed to: Operation Homefront, 1204 South Maple, Freeport, IL, 61032. For more information, contact Mike Brinkmeier at (815) 579-8436.

Labels: donations, events, iraq

Army Field Manual: Combat Stress Control Scope & Definitions

Another exploration of official definitions and standards regarding PTSD. This one comes from the Army, FM 22-51: Leaders' Manual for Combat Stress Control. This post looks at stress terminology definitions provided in the manual, and reviews what the Army considers the scope of combat stress control -- from the battlefield all the way through to post-deployment family and VA support.

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Chapter 1. OVERVIEW OF COMBAT STRESS CONTROL

1-3. Scope of Combat Stress Control

Combat stress control is much more than just a few stress reduction techniques which busy leaders are supposed to learn from books or mental health workers and use now and then when the stress seems intense. Army combat stress control activities must be a part of everything the Army does. Combat stress control must be a natural part of the three continuums of Army life: responsibility, location, and Army mission. Note that a weakness or gap anywhere in these three continuums can cause weaknesses, overloads, or breakdowns in other aspects of Army life.

a. Responsibility. Responsibility for combat stress control requires a continuous interaction that begins with every soldier and his buddies. It also involves the soldier's family members. The interaction continues through the small team's combat lifesaver (when there is one) and the combat medic. Stress control requires special involvement from direct(small unit) leaders. The responsibility extends up through the organizational leaders and their staffs (both officers and noncommissioned officers [NCOs]) at all echelons. Appendix A describes combat stress risk factors and prescribes leaders' actions to control them. Leaders, staffs, and individual soldiers all receive assistance from the supporting chaplains, the medical personnel, and combat stress control/mental health personnel (see Appendix B for information pertaining to combat stress control units). If any link in the chain of responsibility is weak, it is the responsibility of the other members of the chain to strengthen it.

b. Location. The location for combat stress control extends continuously --

From the site of battle, disaster, or rigorous duty.>
Through the unit's forward and rearward support areas.
Through the communications zone (COMMZ), if present.
To the continental United States (CONUS).
To the unit's home station.
To the rear detachment.
To the family support group.
To the Army hospitals and medical centers.

The location even extends to the Department of Veterans Affairs and veterans organizations after the soldiers' discharge, medical separation, or retirement. Preventive efforts, and also treatment for stress dysfunction, should be actively accomplished at each location. If stress control is weak at any one location, this can cause stress and breakdown not only there, but elsewhere in other locations.

Section I. STRESS TERMINOLOGY AND THE STRESS CONCEPT

2-1. Introduction

The understanding of the stress process has been refined over time by research and experience, leaving some terms obsolete. This chapter establishes how the Army's combat stress control concept currently defines and interprets stress terminology.

2-2. Understanding of Interactions

a. Stressors. A stressor is any event or situation which requires a nonroutine change in adaptation or behavior. Often it is unfamiliar or creates conflict among motives within the individual. It may pose a challenge or a threat to the individual's well-being or self-esteem. Stressors may be positive or negative (for example, promotion to new responsibilities or threat of imminent death).

b. Combat Stressors. Combat stressors are any stressors occurring during the course of combat-related duties, whether due to enemy action or other sources. Combat duties do not necessarily involve being shot at and may be carried on even in "safe" areas far from the enemy. Many Stressors in combat duties come from the soldier's own unit, leaders, and mission demands. They may also come from the conflict between mission demands and the soldier's home life.

c. Stress. Stress is the internal process of preparing to deal with a stressor. Stress involves the physiological reflexes which ready the body for fight or flight. Examples of those reflexes are increased nervous system arousal, release of adrenaline into the bloodstream, changes in blood flow to different parts of the body, and so forth. However, stress is not synonymous with arousal or anxiety. Stress involves physical and mental processes which, at times, suppress arousal and anxiety. Stress also involves the accompanying emotional responses and the automatic perceptual and cognitive processes for evaluating the uncertainty or threat. These automatic processes may be instinctive or learned.

d. Stress Appraisal. Stress may or may not involve conscious awareness of the threat, but the stressor must be perceived at some level to cause stress. The amount of stress experienced depends much on the individual's appraisal of the stressor and its context, even if that appraisal is wrong. The stress process includes psychological defenses which may filter the perception and appraisal to shield the individual from perceiving more threat than he is ready to tolerate.

e. Physical Stressors Versus Mental Stressors. A distinction can be made between those Stressors which are physical and those which are mental.

(1) A physical stressor is one which has a direct effect on the body. This may be an external environmental condition or the internal physical/physiologic demands of the human body.

(2) A mental stressor is one in which only information reaches the brain with no direct physical impact on the body. This information may place demands on either the cognitive systems (thought processes) or the emotional system (feeling responses, such as anger or fear) in the brain. Often, reactions are evoked from both the cognitive and the emotional systems.

f. Stress Behaviors. These are stress related actions that can be observed by others; for example, moving or keeping still, speaking or not speaking. The behaviors may be intended to overcome and turn off a stressor, to escape it, or to adapt to it. They may simply reflect or relieve the tension generated by the internal stress process. Any of these different types of stress behavior may be successful, unsuccessful, or not influence the stressful situation at all. They may make the stressor worse. They may resolve one stressor but create new stressors.

g. Combat Stress. This is the complex and constantly changing result of all the stressors and stress processes inside the soldier as he performs the combat-related mission. At any given time in each soldier, stress is the result of the complex interaction of many mental and physical stressors.

I'll have more bits and pieces from the Army Leader's Manual for Combat Stress Control in future posts. Feel free and take a look at it yourself if you'd like to learn more.

Related Posts

Labels: army, combat, definition, stress

Military Families: Preparing for Your Troop's Return Home

Hearts Toward Home International is the brainchild of Bridget C Cantrell, Ph.D. She is a leading clinical psychologist specializing in the area of combat-related PTSD, and has set up a workbook/counseling program which supports families supporting returning troops. A free chapter of the Turning Your Heart Toward Home program is available online. I'll share some of the ideas found in this excellent resource with you today.

Click on 'Article Link' below tags for more...

From the Hearts Toward Home website:

Perhaps we now have the opportunity to make up the ground we lost when our troops came home from previous wars. “Turning Your Heart Toward Home” is a course that utilizes many lessons learned from the past. It provides tools for warriors to reintegrate with their loved ones upon returning from their military assignments.

The combination of educational skills and experiences have structured this powerful course entitled “Turning Your Heart Toward Home”. This vital information addresses and resolves many of the destructive issues surrounding relationship reintegration when soldiers return home from war. During the course, war veterans and family members alike are directed to the core concerns that work against healthy reconnections. Using step-by-step inventories participants are guided toward rebuilding healthy relationships.

The excerpt that I'll share with you today answers the question every military family member struggles with: What can I do to prepare for the return of my troop?

The very first thing you need to do is prepare yourself mentally for the changes and differences that will prevail for a while in your relationship. As much as we all want things to go back to the way they were before deployment, realize this is an unreal expectation. To think that you and your loved [one] can go back to square one and pick up where you left off is setting yourself up for a loss. Time has passed, lives have changed. Be progressive and stay focused in the here and now.

Here are some ways to prepare. Discuss them as a group and list out productive coping methods:

For marriage partners: Plan to start the dating process all over again. Rekindle the friendship and romantic aspects of your relationship, and sort out the responsibilities afterwards.
For family members: Plan to view the relationship in the present and avoid trying to re-live childhood activities, remembrances, and/or dreams. (After engaging in wartime activities, dreams and innocent notions of life may have been shattered and most likely the furthest thing from their mind. Bringing [up] the memories of their past life can remind them too much of what they have lost.)
Plan for ways to be sensitive to your loved one's idiosyncrasies. For example, it is considerate to ask them where they would like to sit in a restaurant. Refrain from demanding that they go shopping in crowded malls. Do what you can to keep the kids from crawling on them too much (remember the 'perimeter wire'?). Do not take it personal if your loved one does not hug as much as you would like. If you give them space by understanding and respecting the 'wire' principle, hopefuly they will draw closer in time.

Download your own copy of the first chapter to find more helpful advice. And be patient with your troop -- and yourself.

Friday, March 31, 2006

The Oregonian Continues Its Excellent PTSD Coverage

Thursday, March 30, 2006

Combat PTSD: General Sequence of Treatment

PTSD Poetry: Power, Pain, and Progress

Update on President's Mental Health Commission Meeting

Tuesday, March 28, 2006

Rep. Lane Evans, Veterans Advocate, to Retire

President's Mental Health Commission Meets on Capitol Hill

Monday, March 27, 2006

Appleton Post-Crescent: President's Vet Health Budget a Shame or Sham?

Saturday, March 25, 2006

Lifelines Online PTSD Video Series for Military Families

Friday, March 24, 2006

Maine Veteran? Combat PTSD Symposium Tomorrow

Thursday, March 23, 2006

Marine Parents Conference Offers Community and PTSD Resources

Wednesday, March 22, 2006

Insurance Money Available for Veterans with Traumatic Injuries

Veteran with PTSD? Online Communities Offer Help

Tuesday, March 21, 2006

Acoustic Startle: Experimental PTSD Assessment Tool to be Studied in WI

Monday, March 20, 2006

Troops Medicated, Returned to Combat

NPR's Morning Edition: Looking at Multiple Tours

Chicago Trib on PTSD: Interview with a VA Counselor

3 Years On, Combat PTSD Comes Out of the Closet

Sunday, March 19, 2006

The Oregonian Delivers Massive PTSD Story Today

PTSD Documentary Airs Today

Doctor of OEF/OIF War Wounded: "They Are So Brave"

Rep. Meehan: Working to Reduce Stigma, Provide Services for Veteran PTSD

Saturday, March 18, 2006

Thank You Soldier: A Poetic Tribute

Friday, March 17, 2006

Newsweek Covers Combat PTSD and Brain Trauma

House Bill Introduced to Allow Vets Legal Rep for VA Claims

Iraq War Costs and Casualties Tallied Up

MN Community Reaches Out to its Troops

Thursday, March 16, 2006

Senate Republicans Vote Down $1.5B in Veterans Health Care

Unacceptable: National Guard Makes Post-deployment Mental Health Screening Optional

Wednesday, March 15, 2006

Battlemind Brochure to Help with Troop Reintegration

Tuesday, March 14, 2006

PTSD Breakdown: We're Failing the American Military Family

Monday, March 13, 2006

OIF Vets: More in Line to Receive Veterans Preference

Marine Corps Suicides Spiked 29% in 2004

Hidden Wounds: A New Combat PTSD Documentary

Sunday, March 12, 2006

Rep. Martin Meehan Works to Help Returning Veterans

Saturday, March 11, 2006

Scientific American: A Look at the Work of Combat Psychologists

Lexington VA Hospital's One-of-a-Kind PTSD Program

Friday, March 10, 2006

Online Meditation and Stress Reduction Video

PTSD: Columbia University Encyclopedia Definition

ABC News: Returning Soldiers Not Getting Care They Need

Thursday, March 09, 2006

Morning Sentinel: Wrong to Cut Veterans Health Care

NJ Assemblyman, Mayor Help Homeless Vets

Wednesday, March 08, 2006

House Reps, Dems Push Bush Admin to Increase VA Staffing

Military Family Resource: MarineParents.com

New Jersey: 25% of Troops Returning with Problems

Tuesday, March 07, 2006

At the Movies: Film and PTSD

Monday, March 06, 2006

NPR's Diane Rehm Show: Discussion on Troop Mental Health

The Tennessean: Support Troops Long Term

PTSD Combat: 'Blog of the Week' at Genetics and Health

Combat PTSD: What are the Symptoms?

Sunday, March 05, 2006

Poetry in Motion: Using Art to Process PTSD

Saturday, March 04, 2006

PTSD Defined: Dept. of Veterans Affairs Center for PTSD

University of Illinois Supports Its Veterans with Free MBA's

Upcoming Job Fair for California Vets

Friday, March 03, 2006