Trauma Therapist Podcast

Last week I had the very great pleasure of being interviewed by Dr. Guy MacPherson. Guy is a clinical psychologist and the moving force behind the West Coast Trauma Project, a website dedicated to raising awareness of trauma and helping trauma therapists thrive. “My goal with the West Coast Trauma Project,” Guy explains, “is to help other trauma therapists thrive – through providing actionable information, community building, inspiration and support.”

One of the resources Guy offers on his website is the Trauma Therapist Podcast, a series of recorded interviews with therapists in the field of trauma. My conversation with Guy provided me with an opportunity to share from my heart about my life and work. Follow here, to listen in.

Lost

Families of service members killed in the line of duty have suffered the ultimate loss of their loved ones. Their sons or daughters, husbands or wives, fathers or mothers, will never come home. Their loss and grief are real and tangible.

But many families of service members who do return from active duty also feel that they have “lost” their loved one. To a lesser degree – but still significantly – the service man or woman they knew before deployment has changed beyond their recognition.

Military families understand that the experience of combat changes people. They would be concerned if their loved one returned from deployment exactly as they used to be, as though nothing had happened to them. But many families and loved ones are unprepared for the stranger who at long last walks through the door.

Loved ones expect a time of transition. But when time goes on and on and their veteran doesn’t readjust – or is possibly getting even more troubled – they wonder what to do. They can feel pain for the lost relationship, frustrated over how to get help, and worn out at the burden of care placed on them.

Military personnel are changed by their service . . .

. . . physically – by wounds and injuries, and the lingering disabilities they may produce

. . . emotionally – by anxiety, depression, rage, terror, and shame

. . . mentally – by changed attitudes about the world and the people in it, or by the side effects of psychotropic and pain medications prescribed for visible and “invisible” wounds

. . . spiritually – by a loss of hope and faith, by anger at God, by shame for violating deeply held principles of conduct in a hellish theater of war

The Bernstein Institute for Trauma Treatment, with the support of nonprofit Sonoma Coast Trauma Treatment, is in the process of forming a support group for loved ones of veterans struggling with the traumatic effects of their service. If you or someone you know needs our help at this time, please get in touch.

Military Suicide and Military Families: Part 3

Military suicides happen far too often.  Alarming statistics from studies of suicide by active duty service members and veterans both paint a tragic picture.  The years of combat in Iraq and Afghanistan, the multiple deployments, have taken their physical and emotional tolls.  Over the last few months, I’ve kept this issue in the forefront of my blog posts.  Lately, I’ve highlighted a side to military suicide about which few studies have been done and statistics are largely unavailable: suicide by military spouses.

I’ve drawn heavily from the words of two military wives:  Ms. Deborah Mullen, wife of former Chairman of the Joint Chiefs of Staff and retired Navy Admiral Mike Mullen, and Kristy Kaufmann, wife of an Army soldier and executive director of the Code of Support Foundation.  I’ve reviewed the symptoms of post-traumatic stress (including suicide and suicide attempts), and the inadequate mental health treatment currently available to military spouses.  Today I’m going to go into more detail about the stresses experienced by military families.  I’ll conclude with Deborah and Kristy’s suggestions for ways the Departments of Defense and Veterans Affairs could better serve the mental health needs of military families.

In January, 2011, Deborah Mullen addressed the Military Health System Annual Conference.  She opened with a direct quote from a letter by a young military spouse.  “It is infinitely worse to be left behind,” she read, “a prey to all the horrors of imagining what may be happening to the one you love.  You slowly eat your heart out with anxiety and to endure such suspense is simply the hardest of all trials that come to an army wife.”

The letter’s young author?  Libby Custer, wife of General George Custer, writing in May of 1876.  “The nature of war changes,” Ms. Mullen observes.  “Weapons get smarter . . . tactics get sharper . . . breakthrough medical advances save more and more lives.  But the stress and the anxiety felt by those who are left behind NEVER changes.”

Besides the agony of waiting, other sources of stress for military spouses and families include reintegration and reunion challenges, Deborah explains.  “A combat tour may last a year, but the effects of that tour on the service member and family may last much longer.”  Spousal and child abuse cases are rising in military families.  Families of service members who’ve sustained serious physical injuries may endure long-term relocation to receive treatment, and children “may be left at home with family or friends”, breaking the immediate family apart.

Or maybe the returning service member has suffered the signature wound of our Iraq and Afghanistan conflicts: an “invisible” wound from PTSD or TBI.  Spouses and children “don’t understand why their parent looks the same, but isn’t the same,” Deborah continues.  And “for those children whose mom or dad died – either by the enemy or by their own hand – this war will never really end.”

How can the DoD and VA better serve the mental health needs of military families?  Deborah Mullen and Kristy Kaufmann, writing for the New York Times, make the following key suggestions:

1. Really listen to military families, look at things through their eyes, to better understand their special needs and challenges.

2. Provide “home-centered” assistance for families in crisis, in which counselors and other assistance personnel come directly into the home to provide needed support.

3. Do a better job of following up on the results of programs currently in place.  New programs are being created all the time, but too often they aren’t reviewed and modified, as necessary, to become truly effective.

4. Develop a more holistic strategy that integrates military families and community support.  Society has a crucial role to play in helping keep military families strong and healthy.

“Ultimately,” Deborah concludes, “spouses tell me they don’t need another program, they don’t need more training.  What they need – what they want – is time.  Time with their spouses.  Time together with their family.  Time with a counselor or a doctor or a minister.  They want time to explore and understand what is happening to them . . . and the patience and understanding of loved ones, friends and the system itself.”

“If you have a broken family,” Kristy warns, “chances are you’re going to have a broken soldier – and vice versa . . . . It will take a nation working together to keep us strong.”

As a young Marine wife told Ms. Mullen, “It doesn’t matter if it’s the first day they’re gone, or the last day before they return home, you’re scared all the time.  You pretend to be happy, but you’re living in fear.”  And, Deborah urges, military spouses should not have to face that fear alone.

Through my work, I’m committed to the health and well-being of our nation’s service members and their families.  I don’t want them to be left alone to struggle with their issues of emotional trauma and post-traumatic stress.  I encourage you to join me, in whatever way you can.

Military Suicide and Military Families: Part 2

In my last post I sought to bring attention to an overlooked aspect of the current tragedy of military suicide – suicide within military families.  While hard statistics are unavailable at this time, anecdotal evidence indicates elevated levels of suicides and suicide attempts by military spouses, due to high levels of stress and secondary trauma.

I quoted two military wives – Ms. Deborah Mullen, wife of former Chairman of the Joint Chiefs of Staff and retired Navy Admiral Mike Mullen, and Kristy Kaufmann, wife of an Army soldier and executive director of the Code of Support Foundation – as they eloquently spoke out about this troubling issue.  Deborah pointed out that stigma still exists against military spouses admitting their mental health challenges and post-traumatic stress.  Depression, anxiety, sleeplessness, panic attacks, and self-medication with alcohol and drugs have become a part of military spouses’ lives, as well as the lives of their active duty and veteran partners.

I ended my last post with the question: What happens for the desperate spouses who do gather the courage to seek treatment within the Department of Defense and Veterans Affairs mental health services?  I draw my information here directly from Ms. Mullen’s address to the 2011 Military Health System Annual Conference.

The experience of spouses who seek help is “disappointing”, Deborah states.  “Misdiagnosis.  Lengthy waiting periods.  Red tape.”  Obstacles that “discourage and indeed damage the healing process”.

At the same military post hospital, she reveals, two spouses who sought treatment for help with classic PTS symptoms – one with suicidal thoughts – were prescribed five and seven medications each, with no followup appointments.  And, “Neither was ever referred for psychological help.”

I’m going to make a very strong statement here.  I believe a system that would allow a general practitioner to prescribe multiple, heavy-duty medications for psychological symptoms and then not see the patient again, is broken.  This is especially true for patients with suicidal thoughts.  Several prescription anti-depressants have been recently shown to create or intensify suicidal thought ideation.  I believe the actions of the doctors at this post hospital were unethical and unconscionable.

But there is even more going wrong for suffering military spouses within the mental health approach of the DoD and VA.  According to Ms. Mullen, spouses refer to it as the “15 and one rule”.

“It goes like this,” she explains.  “No matter WHAT may be bothering you from a health perspective, you are allowed to discuss only one symptom and only then for 15 minutes.  That’s it, no exceptions.  If we accept, as we have, that spouses suffer a PTS all their own . . . and if we know, as we do, that PTS manifests itself in many different ways in many different people, why would we not accept the need to treat the whole person?  Why would we fail to look at the totality of issues confronting a young spouse?  And why would we ask that young spouse not to confront them all herself?”

As a professional in the mental health field, with over 40 years of experience, I’m appalled and angry at what I see as insensitive and unprofessional practice within the military health system.  Patients must have the time and opportunity to reveal an accurate picture of the issues they face and the symptoms they experience.  With suicide as a potential outcome for desperate patients, I would characterize the treatment protocols for military spouses as very irresponsible and dangerous.

Kristy Kaufmann has strong words of her own on an additional obstacle.  “The fact is,” she wrote in a New York Times opinion piece last fall, “even if everything in the Pentagon and the VA were working perfectly, the government simply does not have the resources – or culture, for that matter – to support the level of need after 10 years of war, and it never will.”

Are you angry yet?

Combat and active duty experiences create their own patterns of post-traumatic stress for our service members.  What are the special problems that enter the lives of military spouses and families, leaving trauma in their wake?  I will return to answer that question next week.

Military Suicide and Military Families: Part 1

Today I want to return to the topic of military suicide and discuss a different and sadly overlooked side to this tragedy.  Yes, active duty service members and veterans are taking their lives at alarming rates, but suicide within service member and veteran families – among spouses in particular – is happening as well.

Two voices have recently spoken up about this underreported issue.  Deborah Mullen, wife of former Chairman of the Joint Chiefs of Staff and retired Navy Admiral Mike Mullen, delivered an address to the Military Health System Annual Conference in early 2011 on the topic.  Kristy Kaufmann, wife of an Army soldier and executive director of the Code of Support Foundation (a nonprofit organization dedicated to bridging the gap between civilians and military America), published an opinion in the New York Times last November.

Both Deborah and Kristy point out that we have no accurate accounting of rates of spousal suicides within the military, due to privacy rules, and that this in itself is part of the problem.  Recent studies of military suicide have excluded the mental health of military family members, “effectively ignoring half of the problem”, Ms. Kaufmann stresses.

Only anecdotal evidence exists on the numbers of suicides and suicide attempts.  “Three Army wives I knew personally all took their own lives,” Kristy writes.  “Suicide attempts and completions among family members occur far more often than many realize or care to acknowledge.”  She adds that “suicide among service members, veterans and families is an indicator of the amount and duration of stress we continue to bear.”

“War comes home,” Kristy eloquently tells us.  “No soldier comes back the same, which means no family is ever the same.”

Deborah Mullen’s revelatory conference speech deserves to be read in its entirety.  She points out that there are many specific programs in place to help spouses with challenges such as the day-to-day demands of being a single parent or being a new caregiver to a wounded veteran.   But, “we are still discovering, still revealing, fissures and cracks in the family support system,” she observes.

The first “fissure” she mentions is “secondary post-traumatic stress”, and I see this as an extremely important and relatively misunderstood phenomenon.  Secondary post-traumatic stress, or secondary trauma, is the stress and trauma we are not directly exposed to but experience through someone else’s eyes and memories.  It is also the pain we feel as we watch someone we care about suffer and change from those first-hand experiences.  Kristy put it well: War comes home.

Suicide is the most extreme and tragic symptom of secondary trauma, but there are plenty of other symptoms as well. Ms. Mullen clearly identifies many of them.  “Families experience depression, anxiety, sleeplessness, and headaches,” she observes, as well as cold sweats, lost concentration, panic attacks, and dread of contact with the outside world.  Many spouses are “unable even to get out of bed, to get dressed, prepare meals, or leave the house.  Some won’t even get their children off to school, leaving the care of little ones in the hands of older siblings.”

“We shouldn’t be surprised,” Ms. Mullen continues, “to learn that some spouses turn to the same remedies that troops with PTS turn to – alcohol, prescription drugs, and some even contemplate suicide.”

The military branches have recognized for some time the stigma attached to mental health issues within the ranks.  Programs have been put in place to address the issue so that more service members can get the care they need and deserve.  But Deborah Mullen points out something I think most people are unaware of: the stigma against military wives seeking help for their own mental health challenges.

First of all, she believes, they’re “embarrassed” to seek help.  They also “worry that in doing so, they could negatively impact a husband’s or wife’s military career.”  As a final straw, “the service member even warns the spouse against getting help.”  “The services have worked hard to reduce mental health stigma in the ranks,” Deborah states, “but we need to continue to work to eliminate it from our homes as well.”

What happens for the desperate spouses who do gather the courage to seek treatment within the Department of Defense and Veterans Affairs mental health services?  Deborah Mullen’s insider assessment paints a bleak, disturbing picture.  I will begin with that distressing portrait when I return next week.

Surprising Findings on Postwar PTSD

A recent op-ed piece in the New York Times by Anthony D. Mancini reported surprising and disturbing preliminary findings from a military PTSD study soon to be published in the British Journal of Psychiatry.  Mancini, an assistant professor of psychology at Pace University, and his colleagues set out to examine the stress responses of over 7000 United States service members, pre- and post-deployment to Iraq and Afghanistan.  The verdict?  “Fewer than 7 percent showed signs of PTSD following deployment”, and “among those with multiple deployments . . . only 4 to 5 percent” suffered from PTSD.

I don’t buy it.  Those numbers are way too low.

While we must wait for the full study to be published before drawing firm conclusions, Mancini’s contention that “the prevalence of PTSD among veterans” is “substantially lower than is commonly believed” should be a cause for concern. 

I want to see how the researchers set up the study, look at the guidelines and approach they used, and examine how they interpreted their data.  Researchers always go into a study with a goal, something they hope to prove, and possibly even additional agendas they are not fully conscious of.  These agendas can color the findings they report.  The study results quoted in Mancini’s piece on the low prevalence of PTSD among returning service members are so counter to what I’ve seen in my work that I suspect some bias crept in.

Mancini states that “many assume that humans are inherently vulnerable to trauma”, but that “a growing body of scientific research is telling another story”.  Only the first part of that statement is true.  Our nature as human beings, our biology and psychology, program us to respond to traumatic events in patterns that ensure our survival.  Almost everyone has heard of the “fight, flight, or freeze” responses, arising from our sympathetic and parasympathetic nervous systems.  These responses to danger make it possible for us to survive and then learn from threatening experiences.

Trauma, short-lived or lasting, arises when we fail to complete our natural trauma response.  Because we can bury and refuse to deal with the painful and overwhelming events of our lives, the intense emotions aroused by trauma (leading to that fight-flight-freeze) may never be released.  This happens all the time.  We can go back and resolve past trauma, but we are always “inherently vulnerable” to it, and our vulnerability to trauma increases the more we bury our previous “invisible wounds”.

The authors of the British Journal of Psychiatry study defend their results by characterizing their respondents as “not seeking treatment” and “representative of the military as a whole”.  They add that “[the participants’] reports were confidential and had no bearing on their military careers”.

I want to make a couple of points here.  First, and most importantly, why didn’t the study include service members who were seeking treatment?  How could the researchers’ study be “representative” without them?

Secondly, confidentiality is certainly an essential factor in getting accurate disclosure, but did the researchers take into account the lingering mindset of stigma within the ranks attached to a diagnosis of PTSD?  Most service branches have campaigns in place to de-stigmatize the invisible wounds of combat, but that message hasn’t yet been fully embraced by the military culture as a whole.

Mancini reports that “about 83 percent of respondents showed a pattern of resilience: they exhibited a normal-range ability to cope with stress both before and after deployment”.  What I want to know is, how did the study’s researchers define “normal-range ability”?  I have first-hand experience with government agencies who work with veterans, and I can absolutely state that their baseline definitions of good coping function are set appallingly low.  Their “good enough” is far from what I consider healthy, as a professional in the psychotherapy field for over 40 years.  I believe the average person would agree with me, and wouldn’t want to see the men and women who have served our country limited to life on such unsatisfactory and unfulfilling terms.

I am particularly suspicious – convinced, even – that the study’s parameters or methods were flawed due to their finding that service member resilience went up with multiple deployments.  This is absolutely counter to everything I’ve witnessed in my work and what many other professionals in my field have seen as well.

I also “do not want to stigmatize those with the disorder” of PTSD, as Mancini cautions.  But I also don’t want to minimize or mislead the military or the public about the true dimensions of what I and many of my colleagues believe will be a hidden epidemic.  I give Mancini credit for stressing that “even an estimate of 1 in 10 represents a public health issue of the first magnitude, requiring our full attention and resources”.  How much more, then, will be required if the real prevalence of PTSD is closer to 30 percent, which is my opinion?

Mancini closes his piece with a truly alarming statement.  He starts well by saying that “PTSD is a treatable condition and a realistic and informed understanding of our inherent coping abilities can only assist treatment”.  But he goes on to propose that “perhaps one day, even prevention of this debilitating disorder” will be possible.  That Mancini could make such a proposal betrays a profound misunderstanding of the nature of human beings and our innate, invaluable trauma response.

To prevent PTSD we would have to rid the world of cruelty, abuse, violence, and evil.  Or we would have to develop into one of two kinds of people: impervious automatons, able to turn off our feelings at will; or psychological super-humans, able to easily experience and quickly and completely resolve every shock, crisis, and horror, from the cradle to the grave.

My take on this?  Won’t happen anytime soon.

Military Suicide and Unemployment

Many factors contribute to the current unacceptably high rates of military suicide.  I’ve written before about a recent policy brief by Dr. Margaret Harrell and Nancy Berglass of the Center for a New American Security, “Losing the Battle: The Challenge of Military Suicide”, which identifies several causes and recommendations for this unfolding tragedy.  Combat injuries, including such invisible wounds as PTSD and traumatic brain injury; mental health issues such as depression and anxiety; other symptoms of trauma such as sleep disturbances, substance abuse and addiction, and high-risk, adrenaline-fueling behaviors – all can play a role.  Harrell and Berglass also observe that the relative absence of three protective factors – belongingness, usefulness, and an aversion to pain or death – are crucial predictors of a service member or veteran’s likelihood of succumbing to suicidal tendencies.

In a New York Times op-ed piece responding to Harrell and Berglass’ study, Peter D. Kramer, a clinical professor of psychiatry at Brown University, proposes another factor overlooked in the policy brief: relatively high unemployment rates among young veterans of Iraq and Afghanistan.  In “The Best Medicine Just Might Be a Job”, he cites an astronomical unemployment rate of 28 percent for male veterans 18 to 24 years old.

Kramer respects the “comprehensive” brief but expresses his concern about the omission of unemployment among the list of causes identified.  While he characterizes himself as “hardly an expert”, he reveals that “study after study correlates unemployment with suicide”.  “When soldiers leave the military,” he continues, “they lose what service provides: purpose, focus, achievement, responsibility and the factor the CNAS report calls ‘belongingness’.  The workplace can be stressful, but especially for the mentally vulnerable, there is no substitute for what jobs offer in the way of structure, support and meaning.”

High unemployment rates among veterans have no one simple cause.  In “As Wars End, Young Veterans Return to Scant Jobs”, Shaila Dewan of the New York Times (who cites unemployment rates for veterans aged 20 to 24 at 30 percent) lists several issues and challenges for both employers and potential veteran employees.  Employers “fear the aftereffects of combat or losing reservists to another deployment”, and veteran job-seekers need to learn basic interview skills while often still “overwhelmed by the transition from combat to civilian life”.

Veterans can be characterized as mature for their age, disciplined, and possessing valuable skills transferable to the marketplace, Dewan emphasizes.  But employers aren’t so sure military service training and experience really translate to civilian industry.

And the competition for jobs is high.  Veterans often serve as reservists or in the National Guard and Dewan points out that this can impose a particularly heavy burden on companies.  Employers of reservists potentially face losing their valuable staff to deployments of up to 12 months in length, while being required to guarantee a job on the reservist’s return.  Even though it is illegal to discriminate in hiring based on military service and status, these requirements can make it nearly impossible for small companies to survive and compete in our difficult economy.

And, in my experience with veterans, both characterizations mentioned above are true.  Former service men and women are more mature and disciplined.  They are skilled, purpose-driven individuals with the kind of values I respect.  But they can also be very troubled individuals, still reeling from their traumatic, combat-related, employment-complicating experiences.  They are often in need of help to work through their lingering psychological invisible wounds.

I assist service members and veterans in this kind of healing.  I hope to do even more when our non-profit, Sonoma Coast Trauma Treatment, begins accepting veterans into its planned comprehensive, case-managed treatment program, which will include providing job-readiness training and skills.  Another promising development to address veteran unemployment is the creation of entrepreneurship programs specifically tailored for vets.

The Wall Street Journal recently reported on several of these programs in “Military Veterans Prepare for a New Role”, by reporter Sarah E. Needleman.  Independent-minded veterans who want to start their own businesses, but lack business start-up know-how, are starting to have a resource in “business accelerators”. Accelerators are programs offering everything from cubicle space and peripherals like Internet and copy/fax services, to expert guidance with business plans, financing, and marketing.

I’m familiar with the business accelerator model.  In my community, my good friend Dr. Michael Newell heads up Sonoma Mountain Business Cluster, an excellent “incubator” program for emerging technology start-ups.  Michael and his team of talented mentors, with the financial backing of local businesses, support aspiring men and women with innovative ideas by providing the best possible opportunity to transform their ideas into jobs and income through facilities, services, and training.  The business school of Sonoma State University also gets involved, helping incubator members create high-quality business plans.  A program of this sort would be an excellent resource for returning veterans in our community and I would love to see one get established.

I recognize the causes and solutions for veteran unemployment are complex.  Nevertheless, I also believe, with Dr. Kramer, that veteran unemployment is a factor we need to consider in addressing our tragedy of military suicide.  We must do a better job of providing employment-related “structure, support, and meaning” for returning vets.  Meaningful work is essential in the process of restoring our service members and veterans, who have sacrificed so much for us, to health and wholeness, and to a place of value in their families and communities.  We owe them nothing less.

Military Suicides: Part 1

Today marks the first in a new series of posts about an appalling reality in our culture: the heart-breaking frequency with which United States military personnel are taking their own lives.  What I have to say about this topic will be serious and challenging; the number of recent service member and veteran suicides and suicide attempts should be absolutely unacceptable to every American.  I plan to not only share facts and statistics with you, but also to enlighten you about the underlying causes of this tragic epidemic from my over forty years of experience helping people resolve emotional trauma.

I recognize that this is a heavy subject.  Please stay with me on this one.  I’m going to primarily focus on suicides among combat troops of Iraq (OIF) and Afghanistan (OEF).  I firmly believe this topic must be addressed.  The men and women serving our country in our armed forces deserve to be heard before they use suicide to blast their way to our attention.

First, let me say that suicide attempts and completions are a symptom.  This ultimate act of self-destruction is a symptom of emotional trauma, or what has come to be called “invisible wounds” in our post-9/11 world.  As symptoms, suicide completions and attempts usually happen only after the development of other symptoms or warning signs, such as depression, reckless behavior, or substance abuse.  I’ll go into this later in more detail.  For now, I want you to understand that to effectively treat the symptom of suicide, we’ll need to comprehensibly address and heal our military’s invisible wounds.

The suicide statistics for veterans are truly alarming.  I’m going to start with data from a Department of Veterans Affairs study completed in 2010.  In his article for the Army Times, staff writer Rick Maze reported the following:

• 18 veterans of all wars and conflicts commit suicide every day (that’s one suicide every 80 minutes)
• 950 veterans in treatment with the VA attempt suicide every month (that’s 31 suicide attempts per day)
• 98 veterans of OIF and OEF committed suicide between October 2008 and September 2009 (that’s one suicide every four days)
• 1,868 OIF/OEF veterans attempted suicide during that same time period (that’s five attempts every day)

Let me tell you why I think these numbers don’t fully represent the magnitude of our veteran suicide problems.

First, this study is limited to information about veteran suicides that the VA knows about.  These statistics cover veterans receiving some type of treatment within the VA system combined with statistics the VA has been able to collect from other sources about veterans outside the system.  The VA’s internal data may be accurate, but many veterans outside the system can “fly under the radar” and their suicides and suicide attempts may not be measureable in any truly precise way.  For this reason, I would bet the VA numbers are low.

Second, I firmly believe that many suicides don’t end up looking like suicides or being reported as suicides.  An example of this that’s been in the news lately is the phenomenon of “suicide by cop”.  In suicide by cop, an individual acts in such a way as to present a flagrant danger to himself or others, in an effort to be shot and killed by peace officers.  Police responding to a scene of domestic violence, or burglary, or assault may find themselves face-to-face with a veteran desperate to end his suffering but unable to complete the act of taking his own life.  The veteran acts in an aggressive, threatening way to the officers, who necessarily shoot in defense of themselves and/or innocent bystanders.

Another example of disguised suicides and suicide attempts are deaths from reckless behavior.  A veteran feeling there’s “no way out” climbs on his motorcycle and speeds past control into a fatal crash on a winding country road.  Another veteran combines prescription medication with alcohol and no one really knows whether he slipped away by mistake or design.  Many incidents like these are masked suicides and not all of them will find their way into our statistics and awareness.

I’ve treated many OIF/OEF veterans and I’ve seen that they don’t want to draw attention to themselves.  When I ask the veterans I’ve been able to help how I can find and reach out to other hurting veterans in the community, they all say, “They don’t want to be found.”  This tells me the magnitude of our veteran suicide problem is probably significantly greater than we know, even with the most careful and conscientious reporting efforts.

What we do know is alarming enough.  Next week, in Part 2 of this series, I’ll present the results of another, recent military suicide report by the Center for a New American Security.

We’ve Got a Bad Connection

This week I want to return to a disturbing statistic, taken from a recent Pew Research Center survey of veterans and the American public, which I quoted in my last post.  Only about half of our civilian population feels that our armed forces’ sacrifices have been greater than their own, post-9/11.  I want to repeat that, as I repeated it last week – only about half.  I think this reveals a bad connection, an enormous disconnect between our veterans and our communities.  Of those civilians who do believe the military and their families shouldered greater burdens with their combat service, about 26% believe it to be unfair, while 70% consider it “just being part of the military”.  I find that attitude very disturbing as well, and I will get back to it later in this post.

First, some good news.  The survey results indicated that 96% of veterans are proud of their service, 93% say the military helped them mature, and 74% say their military experience has helped them get ahead in life.  Over 80% would recommend a military career to a young person close to them.  Also on the positive side, as reported by Tom Bowman of National Public Radio, the general public holds the military in “highest regard.  It towers above organized religion, big business, and Congress”.  The negative?  Only 40% of civilians surveyed would advise a loved one, friend, or acquaintance to join the armed forces and bear the heavy burdens of military service.

Now, some bad news.  Of the veterans surveyed, 44% experienced a difficult adjustment back to civilian life, 50% reported signs of post-traumatic stress, and 75% live with nightmares and flashbacks from their combat experiences.  And, of the general public, only 25% say they follow the progress of our wars in Afghanistan and Iraq closely, down from about 50% just a couple of years ago.  Marine Sergeant Jon Moulder, interviewed in Afghanistan by NPR’s Bowman, didn’t need the Pew survey to tell him that people back home are losing interest.  “We’re starting to fall by the wayside,” he feels.  “This has been going on for so long.  It’s America’s longest conflict running to date.  Kind of like the bastard children of our generation.”

What’s happening?  Why don’t these wars feel like a national experience?  Paul Taylor, editor of the Pew study, observed, “We’ve never had sustained combat for a full decade, and we’ve never fought a war in which such a small share of the population has carried the fight.”  According to Taylor, just one-half of 1% of the population has served on active duty in the past decade, while 9% of Americans were in uniform during World War II.

Having such a small fraction of the public in uniform this time, according to Martin Cook, a civilian professor of military ethics at the Naval War College, makes it “much more easy to deploy U.S. forces in tough environments for long periods of time because the vast majority of Americans don’t feel they have any skin in the game.”  “I’ve often speculated,” Cook continues, “could we have fought wars for 10 years if this was a draftee army and I doubt it.”

These Pew Research Center survey statistics leave me with a lot more questions than answers.

Are the sacrifices of our veterans – and their families – really “just being part of the military”?  Have recruits been fully able to anticipate the potential physical and psychological health risks of combat?  Did they know just how bad warfare conditions would be in Afghanistan and Iraq?  Did they expect multiple deployments?  Did they realize how menacing it would be to police terrorists embedded within a civilian population?  And, if their “job-related” stress has become debilitating, can service members “quit” – like civilians can – without long-term consequences, such as a less-than-honorable discharge?

Here are some more uncomfortable questions: Do we all agree that the 9/11 attacks – which killed thousands of innocent Americans, and targeted not only our nation but our way of life – required an armed response?  Do we all believe that without our Homeland Security and foreign military commitments post-9/11 more innocent lives would have been lost on American soil?  Haven’t these battles been deemed necessary by politicians on both sides of the aisle?  Hasn’t our involvement in Afghanistan and Iraq in fact benefitted all Americans?

Does the military serve our government, or do they serve us?  Aren’t they fighting on our behalf, for our sake?  Isn’t whatever happens to them in country more than “just being part of the military”, more than just their tough luck?  One of our greatest presidents, Abraham Lincoln, declared in his Gettysburg Address that ours was a government created “of the people, by the people, and for the people”.  Are we willing to uphold this long tradition, sharing in the decisions, commitments, and obligations of our elected representatives?

I believe, as “the people”, that the government’s promise and obligation to restore veterans’ physical and psychological health post-service is our promise and obligation as well.

I know my calling: to provide health and healing for veterans and their families.  To restore them to full participation in life and in their communities.  To say, “Thank you for your service”, in the most practical, effective way I can. And I‘m asking, can we – can you – make a commitment to be better aware of the pressing needs of our returning veterans?  Can we all make a commitment to care?  A commitment to stop the disconnect?

Your Neighbor, Your Co-Worker, Your Friend

Last week, I offered my take on the top two sources of stress in our lives today – “wealth”, or our lingering financial downturn, and “health”, the toll that downturn is taking on our physical and emotional well-being.  Today, I want to add what I see as the third major source of stress, and I’m going to call it “stealth”.

Why “stealth”?  Because too few of us recognize it exists, or, when encountering it, prefer not to acknowledge it.  So what am I talking about?

I’m talking about, possibly, your neighbor or your neighbor’s son or daughter.  I’m talking about your classmate, your co-worker, the person you used to see at Starbuck’s, the movie theater, or church.  The one who’s been away for several months now.  The one who’s coming home sometime soon.  In uniform.

I’m talking about our country’s servicemen and women, and veterans.

The wars in Iraq and Afghanistan have been going on now for almost a decade.  Hundreds of thousands of Americans have served in some of the most physically and psychologically intense battlefields in our history, served repeatedly over multiple deployments, and none of them will come out of their stressful combat experiences without deep and lasting personal changes.  Those changes will be both positive and negative.

Along with the combat stress our returning service members and veterans have endured, they’re experiencing health and financial stress in disproportionately greater numbers than our general population.  Technological advances in personal and vehicle armor have increased the ability of service members to survive attacks both in battle and from improvised explosive devices.  The downside to this is that more veterans come home with significant wounds and physical health limitations that will follow them the rest of their lives.  Whether it’s the challenge of losing an arm or leg (or both), loss of sight or hearing, or loss of mental clarity and memory from repeated concussions, the stress from physical health restrictions is and will continue to be a very real part of many lives.

Studies of post-traumatic stress (PTS) rates in returning veterans vary, but I’d estimate maybe half will suffer some kind of emotional and psychological stress as a result of their service.  Symptoms can run from mild – sleep disturbances, short tempers – to extreme – drug and alcohol addiction, paranoia, and suicide attempts and completions.

Financial stress for veterans runs extremely high, as well.  Statistics show that the unemployment rate for former servicemen and women is well over 20%, more than double the rates for the rest of the country.  Individuals who have prided themselves on their abilities and contributions to society are finding themselves without purpose or value in our stagnated job market.

I’ve also seen a kind of spiritual stress in the returning veterans I’ve treated: a crippling self-loathing because of the acts they committed in country, some necessary and some beyond the stipulated rules of engagement.  Men and women, who left the States with a strong set of ethics for their thoughts and behavior, return having violated their innate personal code.  Along with the bullets and IEDs, they find their personal honor and worth have exploded as well.  In some ways, I feel that this loss is the most tragic.

About that word, “stealth”.  I believe that the combat stress of returning American service members and veterans, and their families, can be characterized as stealth because of my own experience and because of a recent survey by Pew Research.  In an article in USA Today, “Veterans Proud but Struggling in Civilian Life”, reporter Gregg Zoroya summarizes some of the survey results from about 1800 veterans and about 2000 members of the public.  One question throws an extremely disturbing light on the different ways the public and service members see the sacrifices our military has made on the battlefields of Iraq and Afghanistan.

Only about half of the general public surveyed believed that American troops and their families made more sacrifices than all other citizens, post-9/11.  Only about half.  Eighty-four percent of service members, however, say that “the public has no idea of the problems incurred as a result of wars demanding multiple deployments”.

I’ve seen this myself, even in my own, much-loved hometown.  There seems to be some kind of irrational disconnect between the community and our veterans who are coming back devastated from the wars, having faced atrocities we can’t even begin to imagine.  There doesn’t seem to be real recognition by enough of us that we’ve been at war, and there’s a lot of good people – service members, their extended families, and neighbors – who are truly traumatized and suffering.  I’m a veteran of the Vietnam War era, and still I’ve never seen such a complete disconnect between the community and our military and the wars that are being fought.  This hits very close to home for me; it almost breaks my heart.

The Pew Research survey included many other significant findings, some encouraging and some disturbing.  I’ll return to share more of those results, and more of my perspective, next week.