Thursday, July 18, 2013

PTSD, The Ongoing War.

Courtesy of the US Department of Veterans Affairs, the National Center for PTSD website
 When my friend's brother (I'll refer to him as Sam) returned from Iraq, he stayed in isolation in his room for some months, only leaving to meet infrequently with a few friends. He ate his meals in his room and watched TV and that was it. He rarely changed his clothes and he wore the same bandanna day in and day out. One day, his mom, my friend, said something about it. Sam, raged at her, screaming, "My buddy got blown up in front of me and it's his blood I'm wearing. Nobody washes this."

His mom said nothing more; she understood as did his siblings and his dad. He took off the bandanna when he was ready months later; it remained unwashed and blood soaked, hanging on a dresser mirror for over a year. Then he finally burned it on his own one night.

That first year back home, Sam was on the wrong medication, either too little or too much. The psychiatrist recommended to his parents by his family doctor did not completely understand PTSD. He didn't follow the best protocol for a returning vet. Sam was taking 10 meds with varying side effects that had to be counteracted by additional meds. It was a new situation for psychiatrists and their diagnosis at the time was spotty.  (It has since improved). He was physically ill and emotionally distraught, exacerbated all the more by those around him who could still smile and laugh and take pleasure in ridiculous things.

During that first year, Sam resisted counseling. His physical and mental condition worsened. He got into fights and during one of them, broke a bottle and threatened a group of young men in a parking lot. He was arrested and faced charges for fighting with a deadly weapon, though he was defending himself and the buddy who was with him. His family hired a lawyer and he pleaded guilty and paid fines and worked community service, his background figured in the sentence. Unable to  work, he found little purpose in his life, but unlike the soldier in the film, The Hurt Locker, he could never go back and serve in the military for another tour. He had seen enough.

Toward the end of that first year home, Sam met up with another returning vet who implored him to go to the V.A. for help. "They would understand," he said. It was a good thing. The V.A. doctor who examined Sam immediately took him off eight of the meds and told him his kidneys were in toxicity and if it wasn't stopped, he'd have to go on dialysis. Sam went into group, saw a therapist and joined other counseling sessions. Eventually after a few years, he was able to recover and find purpose in his life helping other returning vets. But the young, enthusiastic man who went off to preserve this country from terrorism vanished as if in a dream. He and his family will feel the impact of his time in Iraq for the rest their lives. But in this knowing, Sam is able to greatly help others who are returning to a culture that often doesn't understand and appears to be callous toward them in the extreme.

Oftentimes, the family suffers along with the veteran. Patrick Stewart in a poignant revelation discussed how his father, who fought during WWII, abused him and his mother. Years later Stewart was told by an expert in the field that his father was suffering from PTSD and because he was never treated, it never left him. In the 1940s, this severe physical and psychological condition was known by the benign euphemism as "shell shock," and vets were left to handle their condition on their own, as they "bucked up and were men." Because of Stewart's traumatized childhood in remembrance of his father he supports the non profit UK organization Combat Stress and for his mother, Refuge, a non profit organization which gives women and children a SAFE refuge from violent partners/ spouses.

As is suggested in Sam's story, when vets came back from the war in Iraq, they were dislocated and the culture and doctors outside the VA were widely clueless even inattentive about PTSD. As a result of celebrity media attention, films, unfavorable and alarming statistics, tragic events and many vets speaking out, there has been forward momentum in educating the public and the medical profession about the traumatic physical and psychological burdens vets face coming home. Currently, in the United States as in the UK, with the help of vocal veterans, family members and celebrities bringing funds and awareness, non profits and branches of the military have created initiatives and programs some of which are on the forefront of new strategies to help vets recover from PTSD. Some of the following initiatives and organizations you may have heard of. Others I introduce here are innovative approaches helping vets deal with PTSD, including one I recently became aware of this weekend.

Non Profit Organizations:
1. The Wounded Warrior Project
The WWP helps vets recovering from severe physical and emotional injuries. It has done much to inform and expose the maiming severity of PTSD as a soul and spirit injury for vets like Sam, some who may return without physical injuries. The Wounded Warrior Program has a number of programs.
Courtesy of the Wounded Warrior Project website
  • Combat Stress Recovery Program.  The "Combat Stress Recovery Program," helps returning warriors deal with mental health and cognitive needs. The beauty of the program is that it provides services at key stages during a warrior's readjustment process. The program approaches PTSD and combat/operational stress from the warrior's perspective. The "stigma" associated with mental health, access to care and challenges to interpersonal relationships is overcome by understanding the situation of war and combat that soldiers face in the field. 
  •  The "Restore Warriors" website offers immediate engagement and feedback online in the privacy of one's home. The site offers a brief self-assessment tool if warriors want to get in touch with where they are in their emotional present. An online help tool offers warriors proactive self-help exercises for each element related to the following: stress, relationships, loss, self-esteem, betrayal, shame and guilt, self-care. Professional help contacts are given on the site and a warrior is a click away from a Live Chat or phone call with another warrior. Videos of warriors are also given with their stories, impressions and struggles. They are feeling and heartfelt and tie warriors together as a band of brothers helping one another. 
  • Project Odyssey,  is a program which uses nature and the outdoors in a more holistic approach toward recovery. Project Odyssey offers outdoor, rehabilitative retreats that help vets foster connections with the peaceful beauty of natural surroundings. On these retreats vets are able to share activities and experiences with peers, the Odyssey staff and trained counselors. Outdoor, recreational activities include horseback riding, canoeing, whitewater rafting, kayaking, rock climbing, a high ropes course, fishing, skeet shooting, sled hockey and skiing at retreats held in various locations around the country. Vets have the time and opportunity to develop inner strengths and renew their courage to continue recovering and healing from the long war. It has been found that the experiences gained from Project Odyssey allow vets to face the challenges related to combat stress by helping them improve their mental attitudes and outlook. The environment is one of inspiration and encouragement for them "to build new skills, connect with peers, and find support for combat stress among Wounded Warrior Project® (WWP) staff and trained counselors."
Courtesy of Omega Institute in Rhinebeck, NY. website

2. Omega Institute in Rhinebeck, New York is a nonprofit center for lifelong learning.  The Omega Institute, dedicated to awakening the best in the human spirit (since 1977) offers workshops, conferences, R&R retreats and online learning in addition to other programs on their 200-acre campus in the heart of the Hudson Valley. For more than 20 years Omega Institute has supported individuals, vets and family members dealing with PTSD.  This year they are offering a handful of workshops/conferences to address the various needs of military communities, families dealing with PTSD, and professionals working with active duty soldiers or veterans of any war.  In April, Omega Institute hosted a 5-day retreat for vets living with PTSD entitled, "The Costs of War, Violence & Denial" to learn meditation techniques for improved well-being.
Courtesy of Omega Institute Workshops website (Veterans, Trauma & Treatment)

Courtesy of Omega Institute Workshops website
 Mark your calendar for upcoming workshops/conferences being held in October. On October 18-20 Omega will be convening a weekend conference for Health-Care Professionals working with vets and their families:  "Veterans, Trauma & Treatment: Best Mind-Body Practices." The conference is providing information on the cutting-edge mind-body modalities that the military is investigating as a complement to traditional drug/talk programs. From October 20-25, a 5-day workshop is planned for yoga teachers servicing military communities, entitled "Teaching Yoga in Military Communities: Advanced Teaching Skills for Addressing Combat-Related Issues." Additionally, from October 20-25, Omega is offering "Healing from Military Trauma: A Retreat for Military Women and Women Veterans." Tiered pricing and scholarships are offered for many programs.

Courtesy of the Guardians of Rescue website

 3. The Paws of War is a holistic program that provides treatment for the whole person through an intangible relationship with another being. This therapy dog program has been developed by the New York-based group Guardians of Rescue. GoR rescues dogs that either are strays or dogs that have to be left behind by deployed soldiers. The group then trains the dogs to become "buddies" for soldiers returning from the war zone with PTSD. Therapy dogs have been shown to help those with combat stress. The dogs provide comfort, unconditional affection and love. They offer a more potent connection than the isolating human interactions from those in a peacetime culture that little understands warfare and military society,  as has been indicated by vets' increased suicide rates and violent events, some enacted by vets who were attempting to deal with PTSD.
How the program works is the dogs received from shelters are evaluated prior to training to make sure they qualify. Each dog is carefully matched up with their vet/owner and follow up help and training is provided by GoR as well as free transportation and delivery. GoR gives a 100% guarantee with their buddies and will take a dog back if things don't work out. All Paws of War PTSD dogs are certified service dogs. Their certification qualifies them to travel in all public venues (including airlines, taxis, restaurants, etc.) with their military veteran owner as protected through the ADA (Americans with Disabilities Act). Because Guardians of Rescue relies solely on public donations, there is no cost to the veteran.
Courtesy of the Guardians of Rescue website
These rescued dogs rescue their owners by helping restore their connections to civilian life through their love, support and enthusiasm. Vets find their relationship with their dog and caring for their dog makes it easier to get out of the hell of depression, sleeplessness and even pain from disabling physical injuries. Guardian volunteer U.S. Army Corporal John Walis, recovering from PTSD after serving in Afghanistan attests to the healing power of these therapy dogs in his testimony on the Paws of War website.
Courtesy of the Warrior Writers website
 4. Warrior Writers  is a national non-profit to promote recovery from PTSD and other issues military personnel have faced through their writing. Warrior Writers creates a culture that articulates veterans’ experiences. It provides a creative community for artistic expression. Most importantly this organization bears witness of the lived experiences of warriors. Click for Brochure
Courtesy of the Warrior Writers website
 This weekend I had the good fortune to attend "Smashing the Stigma: Female Veterans Take the Stage," which was a one night performance as part of the Women Center Stage Festival at The Culture Project in NYC. Five veterans, members of Warrior Writers from various branches of the military, presented their incredible work, expressing the truth of their experiences: their pain, their struggles, their scars, their triumphs. Five women told their individual stories about war, trauma, rape and motherhood. Most discussed how they are coping with PTSD. The women, Jenny Pacanowski, Susanne Rossignol, Nicole Goodwin, Jennifer Cole and Marie Delus shared personal moments. They revealed how their writings in workshops and in the community of Warrior Writers have enabled them to move forward in their lives, make sense of their journeys and embrace the hardships and the healing, never forgetting the loss, the sacrifice and the selves they left behind in the military and the war they continue to face at home.

Courtesy of the Culture Project /Women's Center Stage Festival website
 It was obvious to me from this performance that the program, Warrior Writers, connects a community of male and female warriors which has reached deep within to a soulful humanity. In the talk back after the performances Sunday night, no one in the audience wanted to leave. Their writings had touched  us in a way that the hollow writings of civilians could never do. It resonated and struck deep into common feelings of life battles along our human travels. Though we may not understand the terrors of combat, we as civilians can empathize with the loneliness, fear and brokenness of the human condition. The recovery they've achieved is ongoing and through their writings they are giving voice to that which has been unspeakable.
 US Military's Innovative Initiatives to Help With PTSD

Because of the mediocre success rate of giving active soldiers meds to cope or sending vets home with bottles of pills and a few therapy sessions to "cure" PTSD, the military, the VA and others have had to rethink such strategies. There are no quick and dirty answers, no facile cures. Many have come to believe that PTSD can be mitigated but never cured. To be effective and deep, the restoration must be gradual, the therapeutic process affirming, empathetic and uplifting. This takes time. There will be set backs. There must be a strong emotional component delivered by like minded individuals who have experienced trauma and who perhaps are farther along in the process to guide, offer a hand when needed and know when to back off when the anger comes until it breaks into the underlying sorrow and eventual reaching out for solace.

Soldiers in active duty who face PTSD need tools to help them regroup emotionally, de-compress and handle high levels of stress more effectively. Holistic and wellness practitioners who employ techniques like yoga, meditation, healing touch, craniosacral therapy, healthy, clean food and cleanses, guided spiritual principles even music therapy,  suggest that these techniques can enhance and restore the broken mind-body connections and return soldiers and vets to a state of increased well being. The military has come to realize the truth of this and has embraced holistic approaches to encourage recovery for active soldiers and for veterans.

1. The Warrior Resilence Center in Fort Bliss, Texas is the Army's premiere PTS treatment facility. It uses alternative medical practices and holistic approaches which have been found to be more effective based on objective data that the Warrior Resilence Center keeps and monitors. There are 14 similar facilities across the Army, including resilience centers in the war zone like The Freedom Restoration Center at Bagram Airfield, the largest U.S. military base in Afghanistan.

However, each program differs because of available local resources and counselors' insights into what appears to be most helpful based upon the individual participants.  The program is four weeks. Soldiers in the program remain assigned to their current units. However, their duty station for four weeks is the Warrior Resilience Center, from 7:30 a.m. to 4 p.m. The goal is to expose them to a little bit of everything so that, at the end of the four week period, they can help come up with an after-care program.  After  participants have tried all of the alternative treatments, they select which ones they prefer, which ones appear to work best as tools they can rely on to treat the symptoms of PTS and move forward.

The staff of 13 clinical social workers, psychologists, reiki master teachers, licensed massage therapists, an acupuncturist, and a yoga, tai chi and qigong instructor work together as a team to help the Soldiers. In addition to the various alternative treatments which participants select as the most effective, they also receive intensive therapy sessions. They have individual therapy twice a week and group therapy four times a week. According to social workers it is common to hear families praise the program and hear soldiers say the program saved their lives. The tools help soldiers return to their careers in the military where they are able to assist other soldiers. It is hoped that using these new techniques will also aid them in preserving their well being so they will continue the practices and better adapt to civilian life after their military service has ended.

Military Websites - The Department of Veterans Affairs

Meanwhile, until soldiers and veterans acknowledge that they are injured emotionally and psychologically, there are online sites which can bring soldiers toward the journey of realization.

1.Make the Connection is a personalized site helping vets and family connect with other vets and family going through similar experiences. They are able to share experiences and discover others' stories as well as share their own concerning a range of life issues from the loss of a family member to homelessness, addiction, employment and financial issues and relationship problems to name a few. Throughout the site, there are links to PTSD categories which direct the vets or family for help.

2. The Veterans Affairs National Center on PTSD offers public and professional information about PTSD. On the "For Public" section, soldiers stories are presented. There are category links "just for women," self-assessment, self-help, treatment, therapies, PTSD communities, types of trauma, common problems, etc. The site also informs about current research initiatives on PTSD. For the"Professional" section one finds links like Co-occurring problems and treating specific groups to name a few. Links to assessment are in both the public and professional sections.

It's Never Too Late For Citizens to Become Involved

This year The Veterans Affairs designated June 2013 as PTSD awareness month. The month has passed but the statistics about vets with PTSD, TBI (traumatic brain injury) and their suicide rates continue (In 2011 200,000 soldiers returned with PTSD the numbers have increased since then.) The programs listed here and many others in individual states help. But such programs aid only those vets who seek treatment. According to the same statistics, 50% of the vets who return after deployment never seek help though they have PTSD. More must be done to assist warriors mitigate PTSD.

Courtesy of Policy Mic website
What have some individuals done? James Gandolfini was a proponent for supporting vets with PTSD and he remained on the front lines speaking out and raising money. Using his notoriety and connections, he drew attention to the vets' culture clash after returning home by producing two documentaries. In Alive Day: Home from Iraq (2007) Gandolfini personally interviewed 10 survivors of the Iraq War on the challenges they faced returning to civilian life. In 2010 he produced another documentary called Wartorn 1861-2010 (It won a Prism Award for Best Documentary) which focused on vets with PTSD from the Civil War to the present.

What can we do? We must expand our awareness and sensitivity toward returning vets and deployed soldiers. We must support all veterans, encourage them, be prayerful and hopeful. We can also petition our representatives ensuring that if any programs are to be cut, the last ones to be cut should be those supporting vets, their families and those still deployed in the Middle East. No family member upon welcoming their returning loved one home after agonizing months fearing for their safety should have to experience their suicide or other terrible event because their loved one's PTSD was left untreated.

Until then though the wars may end and the troops return home, their fight goes on. Keep them in remembrance and donate when you can to the Wounded Warrior Project and these other non profits.

Theirs is a cause worth supporting.

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