The Singular Trails and Trials of Female Combat Veterans

Sharing a handful of recent news reports focusing on the unique military service and civilian reintegration experiences of our women veterans. A good intro for our purposes from Jayme Fraser, Montana Kaimin:

Military policies banning women from the frontline are disappearing as the number of female veterans in the United States nears 1.9 million.

“I think we’re growing up,” Army National Guard Capt. Dawn Gray said. “If you look at other countries, especially Israel, women are not excluded from any combat role if they can physically handle it.”

The role of women in war has expanded significantly since World War II, when women moved into the workplace void left by men going off to war.

“There are only a few places that women aren’t actively assigned and I expect that will change, too,” Gray said.

Female pilots fly combat missions for the Air Force and Navy. Though Army policy prohibits women from the frontline, temporary assignments and test programs, as well as changing dynamics of urban warfare in Iraq, have put more female soldiers into combat.

Combat Clips: A Selection of OEF/OIF Veteran Statistics, April 2010

Quick looks at the latest news containing statistics of interest to returning veterans, military families and their caregivers.

First up, Kristin M. Hall for AP:

Brig. Gen. Stephen Townsend addressed the 101st Airborne Division with military brusqueness: Suicides at the post had spiked after soldiers started returning home from war, and this was unacceptable.

"It's bad for soldiers, it's bad for families, bad for your units, bad for this division and our Army and our country and it's got to stop now," he insisted. "Suicides on Fort Campbell have to stop now."

It sounded like a typical, military response to a complicated and tragic situation. Authorities believe that 21 soldiers from Fort Campbell killed themselves in 2009, the same year that the Army reported 160 potential suicides, the most since 1980, when it started recording those deaths.

But Townsend's martial response is not the only one. Behind the scenes, there has been a concerted effort at Fort Campbell over the past year to change the hard-charging military mindset to show no weakness, complete the mission.

Does Guilt and Disillusionment Play a Role in Combat PTSD?

Yes.

A recent study confirms the role of guilt and the need to resolve meaning-of-life issues in those attempting to move beyond PTSD:

Combat veterans commonly report guilt and depression following stressful military experiences. More depressed veterans often report higher levels of posttraumatic stress disorder (PTSD; Dohrenwend et al., 2006). Guilt also appears to be a distress-related response, potentially increasing both avoidant coping and PTSD (Henning & Frueh, 1997; Street, Gibson, & Holohan, 2005), potentially worsening prognosis and treatment response (Kubany et al., 1995; Owens, Chard, & Cox, 2008). Understanding the multiple influences on PTSD is a pressing priority, particularly with current military deployments.

Cognitive restructuring models of coping (e.g., Park & Ai, 2006) may explain why PTSD develops in some trauma survivors and not others. Posttraumatic stress disorder is believed to result when a traumatic event shatters core beliefs that enable people to establish meaning in life (Janoff-Bulman, 1992). If people cannot cognitively restructure traumatic events, regain meaning in life, and rebuild core beliefs, depression and guilt may develop. ...

Veterans of various service eras (N =174) completed an Internet survey about combat exposure, posttraumatic stress disorder (PTSD) symptoms, depression, guilt, and meaning in life. Results of a hierarchical regression indicated that younger age; higher levels of combat exposure, depression, and guilt; and lower meaning in life predicted greater PTSD severity. The interaction between meaning in life and depression also was significant, with a stronger inverse relation between meaning and PTSD at lower levels of depression. Meaning in life may be an important treatment concern for veterans with PTSD symptoms, particularly at higher levels of functioning.

Source: "Posttraumatic stress disorder, guilt, depression, and meaning in life among military veterans," Journal of Traumatic Stress, Volume 22 Issue 6, Pages 654-657

VA Research: 'Improving Veterans Lives' Brochure Series on PTSD

The Veterans Health Administration as part of its VA Research: Improving Veterans Lives brochure series, has produced a six-pager on Posttraumatic Stress Disorder [pdf]. Written by the communicators at VA's Research & Development Department, the slant is on treatment modalities currently being developed and tested:

This brochure presents examples of VA’s recent accomplishments in PTSD research. These studies, it is hoped, will benefit veterans and many other Americans now and in the future and spare them from PTSD’s life-disrupting symptoms and complications.

One of nearly 10 other offerings to choose from (Iraq & Afghanistan Veterans [pdf], Mental Health [pdf], Rural Health [pdf], TBI [pdf] Women's Health [pdf] and more) -- all worth at least a glance.

Combat Clicks: Military Science, Health and Technology News (April 2010)

Recent press reports on science, technology and health re: combat veterans and military. Edric Thompson, CERDEC Public Affairs via Army.mil:

Maj. Gen. Nick Justice, Research, Development and Engineering Command commanding general and key members of his staff traveled to Apple headquarters March 5. Apple officials gave the Army group tours of its laboratories and other facilities and talked about some examples of where the military is already using Apple technology. The Army's research and development command is evaluating commercial hand-held solutions such as iPad, iPhone, iPod, iMac, and MacBook platforms. ...

"We're continuing to leverage commercial technology for battlefield uses; we can't ignore that kind of existing knowledge," [Justice] said. "Our job, as stewards of the taxpayer's dollar, is to adopt and adapt appropriate commercial technology and offer the best possible solution to the warfighter."

The meeting was part of the Army's efforts to support "Connecting Soldiers to Digital Applications," an initiative to demonstrate the technical capabilities of hand-held devices and applications to the Army and gathering warfighter. The working group is tasked with looking at how commercial cellular technology - including devices, applications and networks - could be utilized in a tactical environment.

Latest Military Combat Veteran Suicide Statistics

Military suicide figures recently reported on in the press. First up, Mark Thompson asks in an article for Time magazine, Is the U.S. Army Losing Its War on Suicide?

From the invasion of Afghanistan until last summer, the U.S. military had lost 761 soldiers in combat there. But a higher number in the service — 817 — had taken their own lives over the same period. The surge in suicides, which have risen five years in a row, has become a vexing problem for which the Army's highest levels of command have yet to find a solution despite deploying hundreds of mental-health experts and investing millions of dollars. And the elephant in the room in much of the formal discussion of the problem is the burden of repeated tours of combat duty on a soldier's battered psyche. ...

[T]he service's suicide rate continues to rise (it doubled between 2001 and 2006) while remaining flat in the civilian population, even when adjusted to reflect the Army's age and gender. Last year, 160 active-duty soldiers killed themselves, up from 140 in 2008 and 77 in 2003.

Basic Training for the Mind: Ft. Jackson's New Mental Health School

One of the newest courses at Fort Jackson, the Army's biggest basic training and combat instruction outpost, is something called Master Resilience Training. The genesis for the course has been the rise of suicide in the military.

Yesterday, Army Chief of Staff Gen. George Casey, a vocal proponent of warrior resilience training, toured the South Carolina base and spoke about the novel 10-day program.

Joseph Kasko, New Channel 7-ABC:

Casey toured a new school where sergeants and young officers learn positive approaches toward mental health to reduce suicide and post-traumatic stress.

“It was clear to me after my time in Iraq that we’re going to be at this for a while,” said Casey.

“The human mind and body wasn’t made to deal with repeated combat deployments, one after the other. So we had to give every soldier the opportunity to and the skills to deal with those challenges,” he said. ...

Casey said the Army currently has 1,000 master resilience trainers and he hopes to [have] one in every battalion by the end of the year. He said, however, there is still resistance to mental health training in the military.

“We’ve been working very hard since 2007 to drive down the stigma for getting treatment for post-traumatic stress or mild-traumatic brain injury,” said Casey.

“My expectations for this, is that it is gradually embraced by the Army and becomes part of our culture.” ...

Casey said the Army has budgeted $125 million for the program over the next five years, which he called an “investment” in their soldiers. He said the Army has been working on the program for two years, after militarizing a similar program developed at the University of Pennsylvania.

Lots more background and details below the fold.

Chicago Tribune Reports on VA Claims Process Quandary

Headline splashed across the front page of today's Chicago Tribune: The Cost of War.

Analyzing more than 3 million VA disability claims (this figure equals the number of vets receiving such compensation in 2009 -- a jump of 24 percent over the 2003 total), it is the latest in a long line of government and private studies on problems at the VA. The Trib found:

The bulk of the increases didn't come from veterans of the current wars in Iraq and Afghanistan but from those who served years or even decades before. Veterans from the Vietnam and Persian Gulf eras accounted for roughly 84 percent of the rise in spending, which hit $34.3 billion last year.

The surge from past eras comes even as more soldiers than expected are returning home from Iraq and Afghanistan in need of care. With hundreds of thousands of troops still deployed, the VA already provides disability payments to nearly 200,000 veterans from the current conflicts, a number that is expected to balloon during the next 30 years.

The unanticipated crush of claims is exacerbated by the VA's antiquated compensation system, which hasn't been overhauled since 1945. Cumbersome and heavily bureaucratic, the system requires a mountain of paperwork, is based on diagnoses that lag far behind medical advances and runs on a computer system that is so outdated it can't accurately verify whether veterans were deployed.

Are Veterans Who Kill in Combat More Likely to Get PTSD?

Yes. (Not a very surprising conclusion, is it?) Recent research shows this to be true for Iraq War veterans:

[A study led by Shira Maguen of the San Francisco VA Medical Center and University of California-San Francisco] examined the mental health impact of reported direct and indirect killing among 2,797 U.S. soldiers returning from Operation Iraqi Freedom. Data were collected as part of a postdeployment screening program at a large Army medical facility. Overall, 40% of soldiers reported killing or being responsible for killing during their deployment. Even after controlling for combat exposure, killing was a significant predictor of posttraumatic disorder (PTSD) symptoms, alcohol abuse, anger, and relationship problems. Military personnel returning from modern deployments are at risk of adverse mental health conditions and related psychosocial functioning related to killing in war. Mental health assessment and treatment should address reactions to killing to optimize readjustment following deployment. ...

Military personnel who have killed may experience significant shame and/or guilt and need to know that they will be allowed to explore the impact of killing in a safe and supportive environment (e.g., Veterans Affairs). They also may have received criticism or been subject to insensitive questioning by acquaintances, friends, or family members that cause them to be weary of speaking to others about this sensitive issue, especially when they fear others will not understand or judge them for their actions.

Source: "The impact of reported direct and indirect killing on mental health symptoms in Iraq war veterans," Journal of Traumatic Stress, Volume 23 Issue 1, Pages 86 - 90

An earlier study by the same research team shows a similar correlation between killing in combat and increased incidence of PTSD in the Vietnam War veteran population.

Problems Accesing Content?

Sorry for the state of the website right now.

I'm putting the finishing touches on a long-needed template update. So, I'm working quite a bit in the background, which will cause some hiccups for anyone attempting to access the site.

In the next few days, you'll find some discontinuity between a number of pages (the sitemap and alternate home page at ptsdcombat.com, for example, won't integrate smoothly with the rest of the site until I finish cleaning them up and bringing them in line with the rest of the blog).

If you're having problems, please check back later.

Thanks for your patience.

A Basketful of Simple Stress Solutions

I recently came upon a beautifully-filmed and presented set of stress management videos created by Joy of Ritual author Barbara Biziou.

Geared toward a general audience (and not specifically for those with PTSD), yet just about as colorful as a basketful of Easter eggs, I thought I'd share them with you (be sure to check in extended for parts 2 + 3).



Here's to a relaxing yet 'hoppy' holiday!

Is There Anything 'Good' About Traumatic and/or Intense Life Experiences?

Yes.

Studies suggest posttraumatic growth can be a significant, positive outcome of surviving and even thriving following a traumatic event. Controversial in some quarters, at this juncture the data shows such life experiences may be character-building:

That which does not kill us makes us stronger. — Friedrich Nietzsche

In contrast to Nietzsche’s well-known quote, life-threatening experiences may lead to psychiatric conditions such as posttraumatic stress disorder (PTSD; Kessler, Sonnega, Bromet, Hughes, & Nelson, 1995). Furthermore, greater exposure is usually linked to more severe symptoms (Brewin, Andrews, & Valentine, 2000). Psychopathology nevertheless occurs only among a minority of those exposed to such events, leaving open the possibility of other outcomes, including benefits (Bonanno, 2004). Tedeschi and Calhoun (1995) identified the positive psychological changes that can occur following a potentially traumatic event as posttraumatic growth: improved relationships with others, openness to new possibilities, greater appreciation of life, enhanced personal strength, and spiritual development. ...

How are strengths of character related to growth following trauma? A retrospective Web-based study of 1,739 adults found small, but positive associations among the number of potentially traumatic events experienced and a number of cognitive and interpersonal character strengths. It was concluded that growth following trauma may entail the strengthening of character.

Source: "Strengths of character and posttraumatic growth," Journal of Traumatic Stress, Volume 21 Issue 2, Pages 214 - 217

Finding Balance and Resilience 101: Free Workbooks and Guides for Veterans, Military Families and Counselors

Last summer, I crossed paths with Pamela Woll, MA, CADP.

A Chicago-based author and consultant in writing, training, and instructional development, Woll works on getting individuals and organizations to "recognize and build on resilience; understand the nature, neurobiology, and effects of stress and trauma; and promote successful recovery from the effects of embodied stress and trauma."

While her entire Human Priorities website is well worth more than one visit (so much good information to be found there), I'd like to point you to two sets of resources she's created specifically with veterans, military families and counselors in mind.