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Monday, April 06, 2009

Sage Markers of Military Culture Change: Generals Continue Coming Forward to Share Their Stories of PTSD and Suicide

Wisdom. What is it?

Something forged out of experience, certainly. Usually that wisdom-forging insight stems from a walk down a challenging or difficult path, and combat experience would surely qualify here, one requiring either cognitive or physical effort (or both) to overcome.

Cognitive elements might include grappling with the events of one's own life as well as contemplating the greater meaning of those experiences. This avenue to wisdom will also eventually lead to a consideration of the greater forces on one's life or the existence of a higher power.

And what would the value of all of this wisdom work be if its product is not shared with others -- no matter the cost?

Cited in Richard Hawley Trowbridge's doctoral dissertation, "The Scientific Approach of Wisdom," [doc] social psychologist and Rutgers University professor Deirdre A. Kramer distinguishes five specific functions of wisdom: (a) finding solutions to problems that confront the self; (b) advising others; (c) management of social institutions; (d) life review; and (e) spiritual introspection.

One function, as noted above, of wisdom concerns its responsibility and ties to social institutions. Again, what benefit would wisdom have if not shared with larger society through organized (and other) means? Those in positions of power to enlighten and broaden the knowledge and understanding base of society and its institutions, especially when the activity might threaten one's career or image, are to be applauded.

Those who do this work are our modern sages and heroes.

When I say hero, it is as described by Franciscan priest and writer Richard Rohr in his book, Quest for the Grail:

The American Plains warriors, according to ancient legend, used to say in the morning: "It's a good day to do great things." To be able to say that and mean it was a magnificent ambition. Such an aspiration stirs something deep in the heart of any [striving] to be a hero. ...

A hero, for the record, is not a saint, much less a god.

In the great mythologies and legends, the hero is always an ordinary human being, with at least one tragic flaw. A hero is one who simultaneously keeps an eye on himself and a goal beyond himself.

Four Army generals of late have become my heroes.

In educational interest, article(s) quoted from extensively.

The latest, Army Maj. Gen. Mark Graham, entered this category last week when he shared his personal experience with the stigma of suicide after his son's 2003 suicide. In his efforts, which must be personally and professionally trying, we see the heroic elements of wisdom at work: desiring to find solutions to problems and advising others of that quest, etc.

More on his story in extended, but first a clip from a March 25, 2009, CNN interview with Graham:

Graham joins the ranks of at least four generals since November 2008 who have found the strength to try to destigmatize PTSD and/or suicide in the Army; Lily Casura of Healing Combat Trauma made note of the other three last month, and their stories and interviews follow.

In November 2008, Major General David Blackledge came forward to speak about his PTSD; his story literally helping others to find the strength to come forward to seek help as well. John J. Kruzel, Armed Forces Press Service:

Army Maj. Gen. David Blackledge is doing his part to reduce the social stigma attached to seeking mental health treatment for war-related stress. The general suffered from post-traumatic stress after surviving a near-death experience during his first deployment to Iraq in 2004. Now he willingly shares his tale of recovery and hopes his example will help others in dealing with war's invisible wounds.

"I felt it was critical that we had senior leaders experiencing [post-traumatic stress] come forward," Blackledge, the Army's assistant deputy chief of staff for mobilization and reserve issues, said in an interview at the Pentagon last week.

The wife of a military member suffering from war trauma used Blackledge's story to spur on her spouse to seek treatment, Blackledge said. "She said, ‘My husband was suffering from this, and when I showed him the article in the paper about you coming forward, he said that if a two-star general can get help, then maybe I can too,'" he said. ...

Last month, Gen. Carter Ham and Brig. Gen. Gary Patton spoke out about their own PTSD. They talked to CNN's Barbara Starr:

Tom Vanden Brook, USA Today:

Gen. Carter Ham was among the best of the best — tough, smart and strong — an elite soldier in a battle-hardened Army. At the Pentagon, his star was rising. In Iraq, he was in command in the north during the early part of the war, when the insurgency became more aggressive. Shortly before he was to return home, on Dec. 21, 2004, a suicide bomber blew himself up in a mess hall at a U.S. military base near Mosul and killed 22 people, including 14 U.S. troops. Ham arrived at the scene 20 minutes later to find the devastation.

When Ham returned from Mosul to Fort Lewis, Wash., in February 2005, something in the affable officer was missing. Loud noises startled him. Sleep didn't come easily. "When he came back, all of him didn't come back. … Pieces of him the way he used to be were perhaps left back there," says his wife, Christi. "I didn't get the whole guy I'd sent away."

Today, Ham, 56, is one of only 12 four-star generals in the Army. He commands all U.S. soldiers in Europe. The stress of his combat service could have derailed his career, but Ham says he realized that he needed help transitioning from life on the battlefields of Iraq to the halls of power at the Pentagon. So he sought screening for post-traumatic stress and got counseling from a chaplain. That helped him "get realigned," he says.

"You need somebody to assure you that it's not abnormal," Ham says. "It's not abnormal to have difficulty sleeping. It's not abnormal to be jumpy at loud sounds. It's not abnormal to find yourself with mood swings at seemingly trivial matters. More than anything else, just to be able to say that out loud."

The willingness of Ham, one of the military's top officers, to speak candidly with USA TODAY for the first time about post-traumatic stress represents a tectonic shift for a military system in which seeking such help has long been seen as a sign of weakness.

Jim Garamone, Armed Forces Press Service:

For Army Brig. Gen. Gary S. Patton, the dreams are the worst. Patton, now the Joint Staff’s director for personnel, served as a brigade commander with the 2nd Infantry Division in Ramadi, Iraq, in 2004 and 2005. As a colonel, he commanded 4,100 soldiers who deployed from Korea to Iraq, and then redeployed to Fort Carson, Colo.

“It was a very tough neighborhood,” he said during an interview. “It was a very active terrorist threat.”

Patton calls the dreams “sleep disturbances,” and said that was one of the reasons he sought mental health help. “I’ll wake up in the middle of the night with a loud explosion going off in my head,” he said. “Not only do you have the sound, but the recreation of the smell and taste that you get from being right there in an [improvised explosive device] explosion.

“That effect has diminished, but it’s disturbing nonetheless.”

One of the dreams centers on Army Spc. Robert Oliver Unruh. Patton was observing actions on the north side of Ramadi when Unruh, a 25-year-old combat engineer, was hit in the torso by small-arms fire.

“We put him in an armored vehicle to [medically evacuate] him to our aid station,” the general said. “I was the last person to talk to Specialist Unruh because he died before my eyes there.”

Calling the sleep disturbances dreams doesn’t really give them their due. The incidents unroll as they happened, he said. He smells the cordite, he feels the blood, he hears the conversations, and he sees the young specialist die.

Patton wears a bracelet with Unruh’s name on it as part of remembering the 69 soldiers from his brigade who paid the ultimate sacrifice over a year in Iraq.

No one is immune from the stresses of combat,” Patton said. “It affects everyone, in all specialties.” ...

Patton found that counseling and conversation helped. “One of the best things for me is just communication with others who went through the same thing,” he said. “Our family members, who love us dearly, have a hard time relating to what we went through. My greatest relief was just through talking over the experiences with others who had been there. I gained coping skills just by talking to other soldiers.”

Counseling helps, but there are other treatments as well. The disorder often comes in tandem with traumatic brain injuries and military and Veterans Affairs researchers continue to make progress in treatments.

But this won’t help if personnel don’t seek aid. “My advice is to go seek mental health care as you would for a physical ailment,” Patton said.

Last week another general, the fourth to discuss sensitive topics not usually discussed so openly by such high-ranking military officers, shared how depression and suicide took the life of his own son. Yochi J. Dreazen of the Wall Street Journal:

Maj. Gen. Mark Graham is on the frontlines of the Army's struggle to stop its soldiers from killing themselves. Through a series of novel experiments, the 32-year military veteran has turned his sprawling base here into a suicide-prevention laboratory.

One reason: Fort Carson has seen nine suicides in the past 15 months. Another: Six years ago, a 21-year-old ROTC cadet at the University of Kentucky killed himself in the apartment he shared with his brother and sister. He was Kevin Graham, Gen. Graham's youngest son.

After Kevin's suicide in 2003, Gen. Graham says he showed few outward signs of mourning and refused all invitations to speak about the death. It was a familiar response within a military still uncomfortable discussing suicide and its repercussions. It wasn't until another tragedy struck the family that Gen. Graham decided to tackle the issue head on.

"I will blame myself for the rest of my life for not doing more to help my son," Gen. Graham says quietly, sitting in his living room at Fort Carson, an array of family photographs on a table in front of him. "It never goes away."

Suicide is emerging as the military's newest conflict.

The article also looks at some of the factors the Army believes are driving the increasing rate of suicide:

Teasing out the underlying causes is difficult, since it is impossible to fully understand just what prompts someone to commit suicide. Military officials point out that one-third of the soldiers who took their own lives last year had never been deployed to Iraq or Afghanistan, though they say that the soldiers might still have felt the stresses of constant training and pending overseas tours.

Defense Secretary Robert Gates and other senior Pentagon officials believe that the suicide rate is being pushed higher by the Army's rising divorce rate. Repeated deployments to Iraq and Afghanistan are pushing Army relationships to the breaking point, and many military marriages are buckling under the strain.

Some Pentagon officials believe that military drug and alcohol use is also contributing to the increase in suicides. Growing numbers of soldiers take antianxiety medication like Prozac and Xanax after they return to the U.S., and some commanders worry that the combination of drugs and alcohol is upsetting many soldiers' emotional states.

The poor national economy also adds to the strains facing many soldiers and their loved ones. Foreclosures in towns with large military facilities are rising at several times the national average, and hundreds of military families have lost their homes in recent months. The civilian spouses in many families are also struggling to find work, adding to the financial pressures facing modestly paid military personnel.

Army officials acknowledge that many soldiers are reluctant to seek help because of the stigma around mental-health issues. A survey last year by the American Psychiatric Association found that 75% of military personnel felt that asking for assistance would reduce their chances for promotion. Others worried about appearing weak in the eyes of their peers.

It's vital for leaders to begin leading on this issue. They must continue to find ways to engage in these heroic examples of wisdom-sharing for a higher purpose of bringing relief to the struggles of those serving below them.

It should have come sooner. More could have been done to help save those who have been struggling and lost all of these years. But, the change in openness on this topic is greatly welcomed.

In previous wars, there was very little discussion of the psychological aspects that flow out of the experience of combat; stories of the personal effects of combat stress and PTSD coming from the higher ranks were virtually nonexistent. Many years after the Vietnam War ended, with the steady stream of its veterans seeking help for their symptoms at the VA, discussion of PTSD finally began to emerge.

In 1980, the condition was officially recognized when it was included in the APA's Diagnostic and Statistical Manual. At the opposite end of the decade, in 1989, the VA's National Center for PTSD was created by Congressional mandate (PL 98-528) to "address the needs of veterans with military-related PTSD ... with the ultimate purpose to improve the well-being, status, and understanding of veterans in American society."

The relative calm of the '80s afforded us the opportunity to explore and discuss the topic of PTSD In fact, a popular song at the time, "19," is one example of this:

As the song explains, almost a decade after the Vietnam War's end, many of its veterans were still battling the consequences of their having fought in it. We need to continue to push to make sure this isn't the fate of our current vets.

The generals (alongside countless others both inside and outside our military organizations, as well as recently returned OEF/OIF veterans themselves) who are coming forward today with their stories and wisdom are doing vital work to change military culture and the stigma of PTSD. The forthrightness will be a balm for current and previous generations of veterans.

What's fascinating is that this work is finally being done even as the wars continue. That is significant. Starting to chip away at this thing from 'the inside' hopefully will have an enormous effect on how we help move our veterans toward resolution.

The sooner understanding of and care for the normal psychological aftershocks is available, the sooner our veterans can focus on the next chapter in their lives.

They've certainly earned that right.

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