Consider Yourself Slapped

Longer than usual post. Please forgive... but warm up the coffee and dig in.

The other day the House Committee on Veterans Affairs held a "Symposium" on PTSD. The speakers (besides all the members of the committee) included people from the Thought Field Therapy Center (ummm, tapping various pressure points on your body in a specific sequence and applied to a psychological problem the person is focusing on, "will eliminate the perturbations in the thought field, the fundamental cause of all negative emotions..." [ed. comment: including war??] and you apparently don't have to understand or believe for it to work! Yah.), National Council for Community Behavioral Healthcare (represents the interests of community behavioral healthcare organizations nationwide... conducts federal advocacy activities, representing the industry on Capitol Hill and before Federal agencies), American Psychiatric Association, Institute of Rural Health at Idaho State University (improving the health of rural communities in Idaho and the Intermountain Region, as well as throughout the nation and the world [ed. comment: nothing like a little over achievement to scream mentally healthy, huh?]), Wounded Warriors Project (assisting men and women of our armed forces who have been severely injured during the conflicts in Iraq, Afghanistan, and other locations around the world) and the American Enterprise Institute [for Public Policy Research] (a private, nonpartisan, not-for-profit institution dedicated to research and education on issues of government, politics, economics, and social welfare. [ed. comment: don't "government, politics & economics" actually preclude "social welfare"?]

I watched the last 60-90 minutes of this "symposium" and to say that I was less than impressed would be an understatement; to say that I was infuriated at times might be an overstatement. Aggravated, agitated (principally at the attitude) might be most accurate.

But what I know for sure is that many of those people DO.NOT.HAVE.A.CLUE about COMBAT-INDUCED PTSD's effect on those with the condition. And a few need to be slapped up side the head for their generally self-serving attitude. In the time I watched, I didn't hear one person actually talk about PTSD and it's effects on the Veteran. I didn't see one Veteran talk about it. Maybe that was earlier. Maybe.

So for the members of the Committee, their guests and the general public who might wander past this blog and actually make it to the bottom, and plagiarizing Dr. Satel (see below): Post-traumatic stress disorder is a real and painful condition. [I]t will afflict some men and women returning from Iraq. A humane and grateful country must treat them.

Those soldiers and Marines that suffer from PTSD truly suffer. Some of them live burdened with depression -- not just "the blues" -- but crippling thoughts of death and doom and hopelessness.

Some of them live with anxiety... sometimes debilitating and overwhelming anxiety that reduces them to fetal positions or sitting huddled in dark closets with hearts pounding and shortness of breath -- their minds and bodies convinced that their or a loved one's death is imminent and unable to convince themselves that such fears are unfounded. Even if it is not an extreme anxiety attack, the constant level of anxiety that hovers on them is exhausting mentally and physically.

Their sleep can be fitful and come only sporadically... and when it does come it is often interrupted by dreams and nightmares... adding to their exhaustion.

Some of these Veterans feel guilt -- survivor's guilt -- that they have lived and others -- sometimes many others - have not... unable to convince themselves that "coulda, shoulda, woulda" would only have meant one more death.

Most importantly, regardless of the number, complexity or severity of the symptoms those with PTSD experience, these individuals have lost their coping mechanisms: even with close, caring and supportive families, every nerve is raw and every stress -- even in daily living -- is a stress that cannot be accommodated. Like a sponge that has taken all the water it can hold, they can take no more stress and thoughts of putting themselves out of their misery obsess and consume them.

For the lucky, they have a command structure -- especially NCOs -- who encourage and insist that a Joe get help and the words, "Suck it up," never pass the Sgt.'s lips when one of his soldiers back from combat suggests that they might be f**d up.

For the even luckier, they recognize their peril and call a friend who comes over and takes the gun from his friend's hands, drives him to the hospital and tells his friend, "It's OK to get help."

No parent or spouse of a valued member of the military should ever have to receive a call telling them that their spouse or their child has attempted to take his or her own life. And no one should ever have to have the visit telling them that their loved one succeeded. People tell me that the culture is changing... not fast enough for this Mom. People tell me the stigma is changing -- I intend to help that change as much as I can.

The complexities of the brain and its attempts (both its successes and failures) to deal with trauma -- and, in the case of combat Vets, the daily pounding and unrelenting trauma that is war -- are as myriad as the Veterans who experience those traumas. If PTSD -- its affects, its diagnosis and its treatment -- were an exact science, we would be able to know why this event effects one but not another, or why this Marine has this symptom/response but not that one or why this combination of symptoms and not those. Conversely, we would know why this treatment worked for John but not for Charles. All we know for sure is what we do not know.

The Committee's after-action press release on the Symposium states, "Ideas for improved mental health service delivery to veterans included immediate screenings for all veterans upon their return from deployment, a “de-boot” camp to decompress from the stress of deployment, and more effective electronic medical records transfer between the Department of Defense and the Department of Veterans Affairs."

Well, except that soldiers are already screened and, to use an old adage, "if you know the system -- you can beat the system". 'nuff said... and military (regular, Reserve, Guard) have been away from home for 12, 15, 18 months and you want them to stay a little longer to decompress? How long do you think it will take to "decompress" from the physical, sensory and psychological stresses of WAR? A week? A month? Y'all will have to work on that one...

The whole records thing should just get DONE. Give them friggin' thumb drives or iPods or whatever with their records... hell, give me my son's records and I can scan them all in an afternoon, upload them to any one of a number of storage devices, encrypt and protect the info... and somebody just MAKE the services and the VA use the same software or storage medium. Whatever it takes, whatever it costs -- it's a one time investment and then it's done. I figure using one year's House and Senate retirement plan contributions ought to cover it. This has been a problem since the services and the VA computerized... Git it dun.

From comments made late in the discussions, I assume that representatives of the Veterans' Administration were actually present at some point, but not only is the VA not mentioned in the after-action press release from the Committee, neither is the content of the VA's testimony, and late in the Symposium when the Committee Chair asked for ideas -- no holds or cost barred -- the VA reps were already gone, so I have no clue what (if anything) the VA contributed to the discussion.

During this late exchange, I listened to Dr. Satel, a "resident scholar" for AEI [ok, what exactly is that?] and a psychiatrist who apparently works in a public [drug rehab?] clinic; her biography doesn't list any work with veterans in or out of a clinical setting although she references work at a VA in some of her testimony before Congressional Committees. She spent much of her time at this Symposium reiterating her thoughts contained in her 2006 paper in which she posits that there is little reliable evidence supporting claims that the current war is responsible for a surge in disability compensation among veterans' ranks and that there are more plausible explanations (read here) and her 2004 testimony before this same House Committee -- strongly suggesting (concluding?) that the percentage of Vietnam Vets with PTSD from the 1990 National Vietnam Veterans Readjustment Study (The Research Triangle Institute) and considered the benchmark for estimating the PTSD levels of OIF/OEF Vets are highly inflated and unreliable and should not be used to estimate the number of Iraq Vets who will have PTSD. She suggests, in fact, that there will be far fewer soldiers with PTSD than people are touting:

But the most informative glimpse at what is happening now come from a report released just two days ago. The VHA Office of Public Health and Environmental Hazards, Report #4, (March 9, 2004) states that 436 soldiers out of 107,540 separated from active duty in Iraq have thus far been diagnosed with PTSD. This is about .4% of veterans who returned. According to adherents of the NVVRS, we can expect to see a seventy-fold increase in PTSD over the next decade? This is an astounding (and unrealistic) amplification.

[ed.note: not only is that data for less than 12 months in Iraq, but I don't buy that number: 1,500,000 guys through Iraq and Afghanistan... 0.4% (remember to move the decimal when you pull out your calculator)... and just 6,000 will have PTSD? Or is that the number the military or VA was "forced"(in 2003?) to compensate because they couldn't get away with denying service-connected conditions?] Also keeping in mind that combat conditions in 2003 were far different than those chronic conditions that set in in 2004 to the present. (Please don't think I mean that conditions were not terrible in 2003; war really is always Hell.)

I also listened to a number of these "experts" say that we do nothing to help our Vets by "paying them to have PTSD" and that somehow paying them disability stipends is a disincentive to "getting well"... and in their experience getting these people [I think the reference was actually to recovering addicts] back to work gives them validation, improves their self-worth and serves to heal them... if not direct quotes, to that effect. In fact, Dr. Satel reiterated this from her 2004 testimony:

Once a patient gets permanent disability payment, motivation to ever hold a job declines, the patient assumes--often incorrectly--that he can no longer work, and the longer he is unemployed, the more his confidence in his ability for future work erodes and his skills atrophy. He is trapped into remaining “disabled” by the fact that he was once very ill but by no means eternally dysfunctional. (If disability benefits are unequivocally indicated, lump sum payments with or without a financial guardian might make better sense than monthly installments.)

and

If work is often the best therapy (it structures one’s life, gives a sense of purpose and productivity, provides important social opportunities and a healthy way to get one’s mind to stop ruminating about problems), then ongoing disability payments can be the route to further disability and isolation.

Someone else suggested that maybe we need to give these Veterans just "temporary" disability -- like SSA does -- and then they have to get jobs and go to work. [pause... breathe in... breathe out... clench teeth... calm... calm...]

To his credit, John Melia from the Wounded Warriors Project reminded those present that Veterans who receive disability payments are not being paid "not to work" but were, in fact, being compensated for their loss -- whether it was a limb or appendage or the invisible but real wounds of PTSD -- and that while a Veteran with PTSD might very well be able to function (and work) in society, he was being compensated for the part of him that prevented that Veteran from being WHOLE... that PTSD is a permanent diagnosis and condition (treatable but not curable). He also rightfully noted that it was unlikely that Veterans diagnosed with PTSD -- who rarely are given a 100% rating for PTSD absent other debilitating conditions -- could live on the resulting small stipend. These statements only brought a smattering of unenthusiastic nods and "uh-huhs" from the others assembled.

I listened to committee members use the "symposium" as their personal opportunity to pontificate on the terrible state of CIVILIAN health care and the lack of national insurance... and that perhaps the lack of PRE-service mental health care could be why some of our soldiers are developing PTSD while in combat... [pause... breathe in... breathe out... clench teeth... calm... calm...]

and another member go on about how therapeutic one Iraqi Vet found it to write a few plays (he thought the plays were excellent) and how this Vet is now encouraging other Vets to perform in these plays and why couldn't this Vet be using [some college's?] [a VA Center's?] two theatres and maybe expanding this program could be useful in treatment... [pause... breathe in... breathe out... clench teeth... calm... calm...]

In all fairness -- given my generally trusting nature (hope no one got coffee out their nose) -- I'm assuming that all of these individuals actually want to help our Vets... that their motives really aren't political or grandstanding and the non-committee members appearing have no professional or personal motives... and that the committee members' statements about how much the ill-advised war is costing per day and the anti-CURRENT administration statements really didn't mean to leave out their party's administrations for the lack of Tricare and VA funding, the attempted dismantling of the military, the stripping of funds, the neglect of facilities... [pause... breathe in... breathe out... clench teeth... calm... calm...]

As the parent of a Soldier with chronic PTSD, here are my humble suggestions:

(1) Treatment for a member of the military with a competent diagnosis of PTSD should not be optional - it should be mandatory and immediate. The only question allowed would be, "Where do I go?" Let's take this out of the hands of those least able to determine whether they need help. There would no longer be any stigma attached in "asking" for assistance nor would the unenlightened be able to persecute those that need treatment for it could no longer be considered a weakness nor "permitted" at the whim of an NCO -- treatment would be an ORDER. And immediate treatment would prevent the problems long-term neglect of an illness begets and return a member of the military to productive, active status sooner (when possible) -- one who would otherwise be discharged because treatment came too late to help.

(2) Congress and the American taxpayer need to put their money where their mouths (and outrage and concern) are. The American public, Congress and the military need to invest in infrastructure and support at military and veterans' facilities NOW to treat mental health issues. Thirteen in-patient beds in the psychiatric ward at a Fort with 40,000 soldiers and 100,000 dependents and contractors that has sent its infantry division on its 4th deployment to the Middle East is SHAMEFUL. Having veterans wait months for appointments is SHAMEFUL. Knowing that if 20% of the 1.5 million members of the military that have/are serving in OIF and OEF may need treatment at some point for the mental ravages of war -- even if they don't meet Dr. Satel's criteria of a diagnosis of "PTSD", there will be approximately 300,000 Veterans -- who volunteered when 99% of the American public would not -- that will seek counseling at a Veterans' facility somewhere at some time -- and we need to plan and fund for those needs NOW. America is the greatest country on Earth with the best military on Earth and we should be the Gold Standard for their treatment. Rather than the whipping boy for failures to take care of our Veterans, wouldn't it be nice to be held in esteem for their treatment -- just this once? The military and Veterans are serving and have served us, now it's our turn to serve them.

So I'll repeat myself: What I learned watching the Symposium is that some people DO.NOT.HAVE.A.CLUE about COMBAT-INDUCED PTSD's effect on those with the condition and have no idea how to help. And to those that need to be slapped up side the head for their generally self-serving attitude: consider yourself slapped.

Copyright 2007 Some Soldier's Mom. All rights reserved.