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PTSD Combat : Winning the War Within

Friday, August 18, 2006

Updated Vietnam Vet PTSD Numbers

The New York Times today explores the findings of a new study on the rate of PTSD in the Vietnam vet population. I've been doing a lot of reading on this issue this past summer, and can honestly say that another look and attempt to nail down a figure seems more than fair. The numbers are all over the place depending upon what book, account, or study you read.

Probable problems: 1) can we really get a plausible number at this point -- 35 years out, and 2) is this information going to hurt the PTSD care avlb to OEF/OIF vets coming back right now?

Click on 'Article Link' below tags for more...

The report, published in the journal Science and viewed by experts as authoritative, found that 18.7 percent of Vietnam veterans developed a diagnosable stress disorder that could be linked to a war event at some point in their lives, well under the previous benchmark number of 30.9 percent. And while the earlier analysis found that for 15.2 percent of the veterans the symptoms continued to be disabling at the time they were examined, the new study put that figure at 9.1 percent.

Although some may have a problem that the percentage of Vietnam vets diagnosed with a stress disorder such as PTSD has 'officially' dropped from 30.9% to 18.7%, that figure still represents a lot of people. Others agree:

Dr. Matthew J. Friedman, executive director of the National Center for Post-Traumatic Stress Disorder for the Department of Veterans Affairs, said the new study should establish beyond question that post-traumatic stress disorder is both a common and legitimate diagnosis in returning soldiers. “We can quibble about the numbers,” he said, “but the point is that it’s a lot of people,” and the potential demand on services is substantial. ...

The most important figure in the study, most agreed, was the rate of chronic mental suffering [which clocked in at 9.1% in the study]. ”War is not healthy for children, and what this shows is how unhealthy it is, and who has to pay for the lifelong consequences of that,” said Michael Gaffney, a lawyer in Washington who served in an artillery unit in Vietnam in 1968 and 1969. “And the meat grinder is still operating, in Iraq.”

What are the worries?

The findings come at a time of simmering debate over the emotional effects of service in Iraq which, with its lack of a conventional front echoes the Vietnam experience more than it does other wars. Politicians have clashed over the Department of Veterans Affairs’ budget, including its $3 billion annual bill for mental health, in part because of a suspicion that the estimated rates of post-traumatic stress, based on Vietnam veterans, were too high. Last year, the department commissioned a review of combat stress disability claims for evidence of exaggeration.

The debate has angered some trauma researchers, and infuriated veterans’ groups who say that as it is, mental health services too often fall short.

From Fox News:

In a rational world devoid of politics, Congress might reasonably restrict benefits to the small minority of veterans whose PTSD claims can be verified against their combat experiences. But in our very different -- sometimes surreal -- world, powerful veterans' lobbies pressure Congress to increase benefits with few if any restrictions, regardless of the relevant facts and science. Not many politicians are willing to be seen as saying "no" to veterans.

This has happened before in the cases of Vietnam, Cold War-era and Gulf War vets making scientifically questionable claims of health effects caused by Agent Orange, nuclear weapons testing, and depleted uranium weapons, respectively. In those cases, the process of science was misused and abused in order to justify broad health care benefits.

But then they say this in the very next paragraphs:

One possible solution is simply for Congress to provide that certain types of military service -- such as any service in theaters of combat, not just actual combat experience, and other forms of hazardous duty -- automatically qualify veterans for lifetime health benefits.

That way, scientific research involving combat veterans will be less politicized and results will be less likely to have been pre-determined and/or skewed by the hidden and not-so-hidden agendas of researchers and their funders.

More coverage:

Please read the whole NYT piece...

Wednesday, August 16, 2006

PTSD's Effect on the Brain

A quick audio program discussing PTSD's effect on the brain. From the Earth & Sky Radio Series. [listen | transcript]

PTSD Combat Featured in New Documentary

Back in June, I traveled to UMass-Amherst to take part in the Media Giraffe Project. A great thrill to represent ePluribus Media at a couple of panels at the conference (see my post and photos).

While there, I was interviewed twice regarding our and my work. Check out one interview (starting ~1/3 of the way into the show) ePM board member Cho and I gave to Rabble Radio. (Thanks Wayne MacPhail!) Next up, brief appearances in Project Documentary's interesting documentary (it's 15 minutes long, so give enough time for download) on citizen journalism, From Pamphlet to Blog.

Click on 'Article Link' below tags for more...

My understanding is that the documentary team for Cambridge Community TV shot a lot of video and needed to pare it down to 15 minutes. Really. That's the reason why my video footage wound up on the cutting room floor. Really. Really. So, although you can't see me in the documentary, you can still hear me. But you have to catch it quick in the intro as I say "I am a citizen journalist."

Woo Hoo! :o)

What's got me even more thrilled, though, is the brief on-camera appearance of a screenshot of PTSD Combat: Winning the War Within. Mixed in with other blogs, Harvard Professor John R. Stilgoe provides the voice-over:

Society is beginning to realize maybe every morning before breakfast, it might be nice to see how a particular blogger who is particularly smart and thoughtful has picked up on the previous day and night's news. ... Every local politician should not only be conscious of bloggers, but afraid.

Well, I'm not sure about afraid, but I'm happy to have had our little online area highlighted in this way -- even if ever so briefly.

And if you missed those brief 'appearances', don't bat an eye as the credits roll by. (And no, that's not me next to my name -- that's Bill Densmore, the brains behind the The Media Giraffe Project. :o)

Thank you to the whole Project Documentary team for covering the citizen journalism movement. Kudos to your work!

Jason Crow
Shaun Clarke
Darcie Deangelo
Amy Mertl
Buz Owen
Jason Ong
Matt Landry
Mayana Leocadio

The Longevity of War's Wounds

From today's Cleveland Plain Dealer:

Echoes of combat in Iraq are reverberating among veterans of bygone wars to the point where some are experiencing symptoms of post-traumatic stress disorder or PTSD.

A Department of Veterans Affairs study published in February found that reports of mental distress among VA patients aged 18-44 increased dramatically between 2000 and 2003 - when war in Iraq erupted. The study, based on an annual national survey by the Centers for Disease Control and Prevention, compared the physical and mental health of nearly 22,000 vets in 2000, and 31,000 veterans in 2003.

VA researchers said that although the increased levels of mental distress were highest among younger vets, many of whom served in Desert Storm, they also noted, "Vietnam-era VA patients [aged 45 to 64 years] reported particularly high levels."

Click on 'Article Link' below tags for more...

Many veterans, in another survey earlier this year said they feel that we didn't learn anything from Vietnam.

The Department of Veterans Affairs said PTSD disability-compensation cases have nearly doubled since 2000, to a record 260,000-plus, with the largest portion coming since the Iraq war started in 2003. Most of those claims (73 percent) are for Vietnam-era veterans, and Vasil isn't surprised.

Vasil said that as these veterans got older and sought treatment for physical health problems, caregivers "started finding that a lot of these guys are having trouble with PTSD. The war in Iraq just amplified it."

Wilson said that for some veterans now reaching or well into retirement, "facing the prospect of the end of their life brings them back to that time when they had to face death for the first time."

Please read the entire piece. Then consider thanking the Cleveland Plain dealer for their attention to this issue.


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Saturday, August 12, 2006

Therapies for Healing Trauma

A general run-down of trauma therapy techniques can be found in an article written by Dr. Bharati Vendgadasalam running in Sunday's Malaysia Star. Topics covered include:

  • Listening
  • Anxiety Management
  • Exposure Therapy
  • Cognitive Therapy
  • Creative therapy: sand-play therapy, art therapy
  • Medications
  • Holistic Health
  • Social Support
[N]ot everybody who experiences trauma will suffer from PTSD. In fact, when given adequate support, most people recover without needing specific psychotherapy. It is when the person’s natural recovery is disrupted that specialised trauma therapies are needed.

Professional help is indicated when the intensity of trauma symptoms do not subside over weeks or months, when symptoms cause severe distress or when a person’s socio- occupational functioning or daily functioning is compromised. Therapies ought to be tailored to suit the needs of the particular individual in that particular circumstance of trauma. In fact the therapy ought to be adapted to the individual, not vice versa.

Read the rest >>

Help Keep 1-800-SUICIDE Confidential, Independent

The personal is political.

My oldest sister, the one with that gorgeous smile and heart of gold looking over my shoulder, committed suicide nearly 6 years ago. I miss her a lot. There are still times like today that I cry over the loss of this kind and sweet lady. But she's with me every single day. Literally.

Her lost battle has been the bridge to the empathy I have for others who lose family members to suicide. She's the reason I began writing about post-traumatic stress disorder [PTSD] in our returning troops after reading an August 31, 2005 Seattle Weekly article. She's the inspiration for the PTSD Timeline, and she's the inspiration for this online journal you're reading today, and the upcoming book, and everything else that's flowed from my reporting on PTSD.

Click on 'Article Link' below tags for more...

Yesterday, at midnight, the federal government wanted to take over the most successful non-profit, confidential suicide hotline available. They almost did it. The largest private non-government suicide hotline (the National Hopeline Network), working tirelessly the past 8 years to build up the 1-800-SUICIDE resource, will continue to operate for two precious weeks due to an enormous outpouring of support yesterday.

I'd like to think that many of those who responded to my call for help yesterday evening had a little something to do with it.

Please help 1-800-SUICIDE remain open and confidential.

Late yesterday afternoon, I came across this article from Taylor Marsh for Huffington Post:

If you've ever known anyone in the throws of deep depression, especially someone who is suicidal, you know that reaching out for help is not easy. Depression brings with it a lot of shame, especially when you're in the throws of the deepest, blackest heart of the illness. Just ask Mike Wallace if you don't think depression is real. ...

[Reese Butler is the founder of the hotline.] According to Butler's suit, the Suicide Hotline takes in over 1,000 calls per day, approximately 60% of which are crisis calls. Butler's current provider is now threatening to shut down the hotline as of midnight tonight. I received this press release this morning.

WASHINGTON, Aug. 11, 1-800-SUICIDE, the nation's best known, private and confidential suicide prevention hotline network, will be shut off at midnight tonight unless action is taken. The Substance Abuse and Mental Health Administration (SAMHSA), a division of HHS, has decided to end all funding for KBHC while continuing to owe them $266,000 from over 2 years ago. Instead of sending the funds that were already allocated, SAMHSA has gone on to create their own competing crisis hotline -- which gives them access to callers' private information through phone records. 1-800-SUICIDE does not disclose its phone records to the federal government. SAVE HOPE

I didn't know what to do. It was already late, there were just a few hours left. What good would it do? Could it do any good at such a late date? I had to make a judgement call.

Shook my head in silence (and anger) that I hadnt' heard a thing about this at all up until late yesterday. I began reading as much as I could about the problem from the press reports that were out there. The Huffington Post columnist quoted above especially seemed to have done her legwork, explaining in detail what types of investigations she made into this cause.

So, I made the call after thinking it over to move forward. Perhaps it might be valuable still to lend a hand. Kept digging.

I cross-posted in a number of my usual areas; others have emailed the diary out, too. I also called the 202 number at the Save 1-800-Suicide website but couldn't get through. It was past business hours on the east coast anyway. And so, I called the 800# itself as well and talked to the nice gentleman on the other end.

My understanding of the role this organization plays is that it's the umbrella around some 200 local help centers that answer the phones. For example, I spoke with somebody from the Will-Grundy County center when I called the 800#. He couldn't answer any specific questions I had; but was very nice and I didn't want to waste his time. He did say something along the lines that made me feel that I wasn't the first to call and enquire about this today.

Anyway, what Kristin Brooks Hope Center appears to be is the keeper of the information, the entity that brought all of these scattered help centers together under one brand-new 1-800 number 8 years ago. I mention this because this leads into what finally swayed me and put me into action.

From the FAQ page (which is highly recommended reading if you'd like to give to this cause; it will ease your concerns):

How did the government get involved [initially with this hotline program]?

The Federal Government got involved through the efforts of the late Senator Paul Wellstone after hearing the plea of 1-800-SUICIDE's founder H. Reese Butler II to Congress to help support the National Hopeline Network. Butler had called for the increase in funding to provide enhanced and expanded crisis center certification, training of crisis line workers, and support for the actual network and the organization that runs it. On June 28th, 2000 Congress appropriated (added to the federal budget) $3 million dollars to the SAMHSA annual budget to support and evaluate a national hotline network of suicide crisis lines and to train and certify crisis line workers.

So, this was a project that Sen. Paul Wellstone believed in.

SAMHSA plans to take over the hotline without having to pay anything for it. From The Raw Story:

[T]he government is hoping to direct callers to a new hotline, operated by the Department of Health and Human Services Substance Abuse and Mental Health Services [SAMHSA].

Even in light of an outpouring of support in favor of the Kristin Brooks Help Center [KBHC], SAMHSA won't budge:

A grassroots effort called "Save 1-800-SUICIDE www.save1800suicide.org" was created to enlist supporters' help in asking the federal government to make good on their commitment. This online effort sent over 2500 emails to SAMHSA and raised over $7,000 in the past ten days -- but fell short the $60,512 in over due phone bills to keep the line connected.

From the Save 1-800-Suicide website:

Substance Abuse & Mental Health Service Administration (SAMHSA), a division of Health & Human Services, has decided to create their own government run system where they would have direct access to confidential data on individuals in crisis. ...

KBHC network covers more than 200 crisis centers with 20 different distinct peer support hotlines such as the Youth America Hotline, veterans hotlines, postnatal depression moms hotline, etc... 1-800-SUICIDE stands firm in its commitment to provide the best hotline support network with complete confidentiality of the caller's identity.

"I created this hotline in honor and memory of my wife and wanted it to have the utmost in integrity to the caller and to their family. It is unfair that SAMHSA is simply not paying the bills from 2004. They punish not only me for not giving them access to the data -- but the calls that need help, will not get answered" stated Reese Butler, founder of KBHC.

These are the action items they have available to us:

  1. Tell the government to keep their commitment to 1-800-SUICIDE and send the $266,000 that was already allocated.

  2. Help Fund 1.800.SUICIDE. We need to raise $266,000 for our bills with AT&T to keep the Suicide Prevention Hotline running privately. Once we pay off AT&T for our old phone agreement We have to pay roughly $30,000 per month for the next 6 months in order to come out of debt.

  3. Keep Suicide Prevention Private and Confidential Petition. Our Government should not duplicate the efforts of the  Hopeline - but help with training of social works, education and awareness of the issues of mental health.

  4. E-mail your friends.


Help Save 1.800.SUICIDE

Update [2006-8-12 1:8:40 by ilona]: Damn, we're good!!

This just in, caught by sardonyx:

1-800-SUICIDE Gets 2 Week Extension - Thank You For Your Support!

TO ALL THOSE WHO SUPPORTED US A BIG THANK YOU!

The outpouring of support and donations was the largest we have ever received in our history in a single day. We received over 100 donations and the day is not done. We made our target of 10k to keep the line live for two more weeks. We received calls of support from people who credit the Hopeline with helping them through their most difficult times and now they wanted to help us in ours. We also received the most media coverage in our 8 year history. So many more people will learn of our service as a result of this campaign.

There is much work to be done to get our organization into a secure sustainable position but our all volunteer Board is dedicated to helping us to get there, and with the support of people like you this grassroots network of community based crisis centers can be even better and stronger than before. From all of us at the Kristin Brooks Hope Center and the members of the National Hopeline Network, we thank you for your continued support, faith in us to be stewards of the nation's suicide hotline network and belief in our mission to offer help and hope from unconditional and confidential crisis centers.

Best always,

Reese Butler, President and Founder

KBHC Board of Directors


Woo Hoo, this one is a clear victory, guys. THANK YOU ALL! We're not done. They still need our help. Please do what you can...

Wednesday, August 09, 2006

Cuts to Vet Brain Trauma Funding Planned

The issue of Traumatic Brain Injury (TBI) care for our returning veterans has virtually ignited the past couple of days. First came the opening installment of a TBI series over at Gen. Wes Clark's Community blog yesterday morning. In the afternoon, I added a TBI article to the mix to generate interest in the series.

Late last night, USA Today blew the issue wide open by posting a stunning article on its website. They reported that the House and Senate Appropriation Committees were poised to slash by half TBI funding used for research and treatment of war-related brain injuries in its 2007 Defense appropriation bill.

Traumatic brain injury is the signature wound of our nation's current wars. As of January 2006, 20% of those injured in Iraq had TBI. Cutting funding when it's most needed is reckless and immoral. My full analysis posted at ePluribus Media.

Click on 'Article Link' below tags for more...

Today's reaction to proposed cutbacks from Veterans for America:

FOR IMMEDIATE RELEASE Contact: Jessica Love
August 9, 2006 (202) 628-7772
jlove@venturecommunications.com

CONGRESS WOULD LEAVE AN ESTIMATED 150,000 TROOPS AT RISK FOR SERIOUS BRAIN DAMAGE
House and Senate Would Cut Defense Appropriations Funding for
Traumatic Brain Injury Research and Treatment by 1/2

Statement by Jonathan Powers, Associate Director of Veterans for America,
And Bobby Muller, Chairman of Vietnam Veterans of America Foundation

Jonathan Powers, associate director of Veterans for America, and former Army Captain who served in Iraq, said:

“Cutting funding for traumatic brain injury is a moral outrage, and that’s the bottom line. As an Iraq War veteran, I believe there is no greater decision our country can make than to decide to go to war, so there should be an equally high priority for Congress and the American people to provide medical care for our soldiers both on the battlefield and when they return home.

Traumatic Brain Injury (TBI) is a signature wound of the Iraq War, and given the 10 percent of soldiers already suffering from TBI, it is on the path to becoming one of the most frequent injuries suffered by our troops in Iraq. Our men and women who bravely serve in the U.S. armed forces are our Nation’s number one most important military asset, yet Congress cannot find $19 million dollars in a defense appropriations bill that is likely to cost upwards of $370 billion?

How can members of Congress claim to be ‘supporting the troops’ while at the same time cut funding for one of the signature wounds of this war? When thousands struggle at this hour with a traumatic brain injury; when an estimated 150,000 will suffer a brain injury in this war, Congress should be increasing support, not decreasing it. America supports our troops – the priorities of this Congress are wrong.”

Bobby Muller, Chairman of Vietnam Veterans of America Foundation said:

“I am shocked and appalled to learn that Congress is not making the health of our soldiers fighting in Iraq a priority. The Iraq War is escalating, casualties are rising, yet Congress is on recess while their staff plans to slash desperately needed Traumatic Brain Injury research and treatment for our Nation’s men and women fighting on the front lines.

Since September 11th, 2001, 1.5 million service members have been deployed overseas to the Global War on Terror (GWOT). More than 3,000 have died. 50,000 have been wounded, injured or become sick with a physical or mental condition. The VA has reported that as of May, 2006, nearly 168,500 GWOT veterans have been treated, and the Veterans Brain Injury Center estimates that up to 150,000 veterans may suffer TBI from war. This budget cut is a serious moral outrage, and I call on Congress to explain to these 1.5 million men and women why the brain injuries they suffer in war are not a top concern for our country. This is the time for Congress to do the right thing and implement a comprehensive plan that addresses the needs of our veterans.”

# # #

Veterans for America, a new organization co-founded by the Vietnam Veterans of America Foundation and The Justice Project, is bringing together generations of veterans committed to advancing advocacy, education and humanitarian efforts around the causes, conduct and consequences of war. VFA is dedicated to addressing the needs of our veterans, service members and their families and their larger concerns about the impact of war.


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Veterans Feeling Alienated, Unsupported

Heartbreaking column by Bob Kerr from The Providence Journal:

He hears about the people who volunteer to go back to Iraq for second and third tours. He thinks he knows why. 'It's a sign of PTSD ... That's the last place life made sense. Here, they don't fit in. They're not part of anything.' ...

He left Iraq after nine hard months. 'We got back and nobody met us at the plane in Baltimore. I was carrying the bags of guys who had been sent home before us, and on the flight to Columbus, Ga., they wanted to charge us extra for the bags of the wounded. We ended up renting a U-Haul to drive it down.' At Fort Benning, there was no real welcome either. 'It's part of the PTSD problem,' he said. 'What I did didn't matter.' He took a day to go home and visit his children in another state and was berated for it by a superior officer.

So it happens again, only worse this time. Remember how we weren't going to repeat the mistake, how we were going to make sure that those coming home from Iraq were not met with the same cold, even scornful, rejection that awaited returning Vietnam veterans?

Well, don't look now but the PTSD clinics at veterans' hospitals are filling up with people who are coming home to find that their war isn't even on the far edge of awareness for many Americans. They go through the hell of it and see the carnage and then come home to a "ho-hum, where ya been?" reaction. They've darn near died and had friends who did and not a lot of people seem to care.

This is unacceptable, America. And you know it. What will you do to change it? Will you do anything to change it?

Tuesday, August 08, 2006

Protecting Our Troops from Traumatic Brain Injury

General Wesley Clark's Clark Community Network has just unveiled a new Troops and Vets issues blog, kicking things off today in fine form with the first in a series of articles on the signature injury of the Iraq War: traumatic brain injury (TBI).

You'll learn about one Marine's sister and the inspiring summer project she's taken up, advocating for Operation Helmet and for keeping all of our troops as safe as they can be.

Click on 'Article Link' below tags for more...

From the National Institute of Neurological Disorders and Stroke:

What is Traumatic Brain Injury?

Traumatic brain injury (TBI), also called acquired brain injury or simply head injury, occurs when a sudden trauma causes damage to the brain. TBI can result when the head suddenly and violently hits an object, or when an object pierces the skull and enters brain tissue. Symptoms of a TBI can be mild, moderate, or severe, depending on the extent of the damage to the brain.

A person with a mild TBI may remain conscious or may experience a loss of consciousness for a few seconds or minutes. Other symptoms of mild TBI include headache, confusion, lightheadedness, dizziness, blurred vision or tired eyes, ringing in the ears, bad taste in the mouth, fatigue or lethargy, a change in sleep patterns, behavioral or mood changes, and trouble with memory, concentration, attention, or thinking.

A person with a moderate or severe TBI may show these same symptoms, but may also have a headache that gets worse or does not go away, repeated vomiting or nausea, convulsions or seizures, an inability to awaken from sleep, dilation of one or both pupils of the eyes, slurred speech, weakness or numbness in the extremities, loss of coordination, and increased confusion, restlessness, or agitation.

TBI and PTSD
Traumatic brain injury can have a secreted, but cozy, relationship with post-traumatic stress disorder. Some TBI events lead to PTSD, but not all. It depends upon the specifics of the trauma.

When it does co-occur, PTSD and TBI together can be especially difficult to spot. The problem lies in the overlapping symptoms (increased anxiety, short attention span, limited concentration, problems with memory). This overlap muddies things up. The result? Detecting is difficult, making treatment and healing harder, too.

There's a great discussion of the TBI/PTSD relationship in an online chat with Dr. Catherine Mindolovich, Psychologist, Jamaica [New York] Hospital Medical Center. A few highlights:

TBI would be distinguished by such symptoms as increased processing time, problems with abstract thinking, muscle fatigue, loss of coordination, and problems with speech, hearing, vision etc. On the other hand PTSD would have associated cognitive problems but be marked by specific symptom profile. ... [For PTSD, following a traumatic] event, an individual may experience symptoms from three symptoms categories: 1 Re-experiencing; 2 Arousal; 3 Avoidance.

So, similar to TBI, an individual may become anxious, agitated, startle easily, be irritable... but also express symptoms such as avoidance of situations where the TBI was acquired. For example, it's not hard to imagine someone who was injured in a car accident avoiding driving. But that person may also avoiding walking along busy streets, or be hypervigilent when crossing a street. So, agitated arousal itself would not result in a diagnosis of PTSD, but that in combination with other symptoms might.

Are patients with a TBI more susceptible to PTSD symptoms?
It can go either way. If you have experienced a traumatic event in the past, you may be more vulnerable to experiencing PTSD after the TBI related event. By the same token, if you have TBI related PTSD, another, even less severe event may trigger a PTSD response, even if the event is not directly related. For instance, I often work with war veterans who have unresolved PTSD from the war, and who then experience an assault or accident and now have two life threatening events impacting on their well-being and functioning.

Read the rest of the interview here.

The Human and Financial Costs
So, why is preventing TBI important to all of us -- and not just the individual soldier or Marine who comes home with it? Although the human cost is obvious and by far gives reason enough to do what we can to prevent such violent and life-changing injuries, there are financial considerations as well for every American taxpayer.

From a Jan. 2006 paper, The Economic Costs of the Iraq War: An Appraisal Three Years After the Beginning of Conflict [pdf] by Linda Bilmes and Nobel Prize-winning economist Prof. Joseph E. Stiglitz:

"There is a special category of health care expenditures that go beyond those included in the above calculation -- for those with brain injuries. To date, 3213 people - 20% of those injured in Iraq - have suffered head/brain injuries that require lifetime continual care at a cost of $600,000 to $5 million. The government will be required to commit resources through intensive care facilities, round-the-clock home or institutional care, rehabilitation and assisted living for these veterans.

For the conservative estimate, we have used a midpoint estimate of a net present value of $2.7 million over a 20 year expected survival rate for this group, which is about $135,000 per year, yielding a cost of $14 billion. This amount seems low for brain-injured individuals who will require round-the-clock care in feeding, dressing and daily functioning. For the moderate estimate, we use a higher cost estimate ($4m) and assume a longer life duration for a total cost of $35 billion. In both cases we assume that the number injured will rise in a manner consistent with the duration of the conflict."

Here's What You Can Do
To help protect our troops in the field, Operation Helmet sprang into action because the DoD has been deathly slow in providing the very best head protection equipment available. A $100 upgrade of our current helmets is all that stands in the way of better protection. Here's a bit on how Operation Helmet came to be:

March, 2004: My grandson, Justin, was in a convoy-escort training program as a combat engineer student at Camp Pendleton and learned from a Marine gunny just back from Iraq of the benefits of installing a protective upgrade kit to his helmet. We sent Justin a couple for his rifle team. They tried them and loved 'em, but called an said that they couldn't keep them unless his entire Company of 100 could get them too. We researched the upgrade kit at Oregon Aero's Website and found it to be a very worthwhile product, capable of converting fatal impacts to ones that might daze a body, but would leave them alive and fighting.

We also spoke to Navy Explosive Research docs, demining professionals in the US, Sweden and France, and to a group of doctors in France doing helmet studies. Once we were satisfied the solution was viable and worthwhile, we started Operation Helmet, initially to outfit Justin's Company. From a start of 100, we have shipped over 9,000 as of June, 2006.

The helmets currently in use by the Marines as well as those projected for the future are engineered to protect against 'ballistics' (bullets) and have only fair protection from blast forces and fragment impacts from IED's and other types of newly appreciated combat dangers. Both the old PASGT and new Marine helmets depend on a strap suspension system to 'float' the helmet over the head to maintain helmet/cranium separation. A shock-absorbing pad suspension system is far superior in providing helmet/cranium separation ('standoff') and protection from blast waves and fragments. The shock-absorbing pad systems area available commercially for just under $100.00 each!

The Marine Combat Equipment Team tells me they have a limited budget and can't afford to retrofit all the existing PASGT helmets (cost $99.06 per kit), while at the same time purchasing the new LW helmets. It was my decision to act, rather than just write letters to Congressmen. The troops need this protection right now, not when the rather cumbersome Governmental process deems.

Please consider pitching in a couple of nickels in the Operation Helmet bucket. And if you're a service member currently deployed, be sure to request your free helmet upgrade kit.

CCN's Troops and Vets
Future articles in the TBI series are in the pipeline (I've seen two upcoming installments, and they'll make for a good primer on the issue). PTSD will then take over with a series of its own; and I've been humbled to have been invited to contribute to them as the newest member of the Clark Community Network's Troops and Vets team.


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Monday, August 07, 2006

CA East Bay Stand Down Days 2006

From the Oroville, CA Mercury Register:

"East Bay Stand Down 2006 is set to pitch its tents next week at the Alameda County Fairgrounds in an effort to reach out for homeless, downtrodden veterans. 'We pride ourselves as a one-stop shop,' said Jerry Yahiro, director of East Bay Stand Down. 'One-third of all the homeless you see in the Bay Area are veterans. Nationally, there are over 250,000 homeless veterans.'

The biennial event, which will run Aug. 10-13, will turn the fairgrounds into 'Tent City,' where homeless veterans and their relatives will be bused in throughout the Bay Area. Participants will receive free drug and alcohol counseling, dental care and medical attention. Judges will be present to settle warrants and other legal problems. There also will be job and benefits counseling."

Here's a full list of Stand Downs across the country. Pitch in any way you can, and make a vet's day!

Daily Press: Improve Returning Vet Health Care

Important editorial in today's Hampton Roads, VA Daily Press:

"The casualties of war are not always the obvious ones, and the wounds brought home are not always visible until after they've begun to affect families and entire communities. Recent studies suggest that soldiers and Marines returning from Iraq are seeking mental health services at a very high rate. Whether it is post-traumatic stress, anxiety, suicidal impulses, alcohol and drug abuse or marriage and family problems - all of which can manifest themselves in the aftermath of combat duty - these are needs that must be taken very seriously.

Most alarming is the situation faced by many reservists and National Guard members, whose military insurance benefits cover only those problems diagnosed within 180 days after returning from combat. Those two groups now comprise about 40 percent of the front-line forces in Iraq and more than half in Afghanistan, the highest percentage for any war in U.S. history. They are doing more tours of duty, and longer ones, than anticipated, and when they return home - not to military bases, but to their families, communities and workplaces - it is imperative that they receive any counseling or mental health care they need."

Read the rest, then consider emailing thanks to the Daily Press for standing up for our returning veterans.

Saturday, August 05, 2006

Missing OH Iraq Veteran

From Channel 5 Cincinnati News:

Mother, Police Search For Missing Iraq Veteran
Man Last Seen Saturday Morning, July 29

HAMILTON -- Hamilton police are asking for the public's help in finding a missing Iraq War veteran.

Police said Sgt. Garry Jones, 24, was last seen Saturday morning [a week ago] leaving American Self Storage on Eden Park Drive in a late 1980s maroon Chevy Cavalier. Janice Jones said her son has not been the same mentally since returning from duty in Iraq last year. Jones said her son has never disappeared like this before.

Updates in comments.

Thursday, August 03, 2006

Iowa Sens Support Vet Suicide Prevention Bill

From the Des Moines Register:

"Iowa's senators teamed up today to introduce a bill that would require the federal government develop a better program to prevent suicides among veterans returning from Iraq.

Sen. Tom Harkin, a Democrat, and Sen. Charles Grassley, a Republican, said too many tragic stories are cropping up of veterans who come home only to deal with continued anguish over their service. 'Veterans don't simply have physical ailments--often they are struggling mentally,' said Grassley. Harkin said that 'the stress our servicemen and women endure in combat is enormous and can trigger severe mental health issues after they have returned home.'

Under the legislation, the Department of Veterans Affairs would be required to provide suicide prevention education for staff members, ensure 24-hour access to mental health care for veterans deemed at risk of suicide and create a family education program, aides said.

The bill is named for Joshua Omvig of Grundy Center. Omvig, 22, suffered from untreated post-traumatic stress disorder following an 11-month tour of duty in Iraq."

The House version of the Joshua Omvig Suicide Prevention Act was introduced by Iowa Rep. Leonard Boswell.

Gen. Wesley Clark Talks About PTSD

From the New Jersey Jewish Standard:

"Addressing veterans’ issues [at the American Legion Post in Rochelle Park, Gen. Wesley] Clark said that America’s security relies on its armed forces and those forces need more than they are getting, in the field and at home. He told of a soldier whose mother he had recently met. The young man came home from Iraq without visible wounds, although he’d witnessed comrades die. One day he left a note for his mother, pulled the trigger on his gun, and committed suicide.

Clark, who had suffered from post-traumatic stress after his service in Vietnam, said that the Israelis have psychologists and psychiatrists for every man in the army, and the United States owes 'it to our men and women to take better care of them.'"

30% of Ft. Irwin OIF Vets Show Signs of PTSD

From the Barstow, CA Desert Dispatch:

"Approximately 30 percent of Fort Irwin soldiers who have returned from Iraq are experiencing some symptoms of post-traumatic stress disorder, said Lt. Col. Valvincent Reyes, the senior social work officer at Fort Irwin's mental health department.

Reyes said the symptoms for soldiers vary but usually include nightmares, problems sleeping, anger, anxiety, detachment from the outside world and intrusive thoughts or flashbacks. 'Five different belief systems are impacted in war,' he said, citing the ideas of safety, control, a belief in power, self-esteem and trust. 'That's changed once they run into IEDs and mortars.'

Most soldiers, he said, can never prepare for the amount of physical bodily damage done by an improvised explosive device, or IED. The images of destruction stay with the soldiers long after they leave the war zone. Fort Irwin soldiers are no exception."

Read the rest of Adrienne Ziegler's piece here.

Wednesday, August 02, 2006

Vermont to Receive Funds for Vet Readjustment Program

From yesterday's Barre/Monteplier Times Argus:

"The Vermont office of the U.S. Veterans Affairs Department is getting an extra $1 million to continue building a network that helps service members and their families adjust to life after being deployed to Iraq or Afghanistan.

The money is contained in the Defense Department budget, which has passed the U.S. House and is likely to pass the Senate, said Vermont independent Rep. Bernard Sanders, who introduced the legislation that led to the appropriation.

'The problem of post-traumatic stress disorder, and of difficulties in adjusting back to civilian life, is very, very real,' Sanders said Monday during a Burlington news conference. 'Social support is the number one predicator of successful readjustment, which means that working with families and communities is extremely important.'"

Editorial: Military, Troops, Families Under Stress

A hard-hitting editorial from the Beaver Valley/Allegheny Times today expresses frustrations with the Iraq war and the problems flowing from "botched" decisions stressing and taxing military readiness, equipment, personnel, and families.

Click on 'Article Link' below tags for more...

The U.S. military, especially the Army and Marines Corps, is paying a terrible price for the Bush administration's botched occupation of Iraq.

In a letter to President Bush, U.S. Rep. Ike Skelton of Missouri, the top Democrat on the House Armed Services Committee, reported that nearly two-thirds of the Army's combat brigades are not ready for wartime missions, largely because they are hampered by equipment shortfalls. They're also having trouble filing their ranks with qualified personnel.

It's important to note that Skelton, like fellow Democrat U.S. Rep. John Murtha, is a staunch supporter of the military. When Skelton speaks, people ought to listen because he, like Murtha, often reflects the views of those in the military. He also was not leaking secrets. The documents he and his fellow Democrats cited in their letter and at a press conference were unclassified.

He was backed up by the Army chief of staff, Gen. Peter J. Schoomaker, who released a statement the same day saying, "I have testified to the facts about our readiness and I remain concerned about the serious demands we face." The general added that the Army needs more than $17 billion in 2007 and up to $13 billion a year until two or three years after the war in Iraq ends.

Money can fix the equipment problem.

However, it isn't just materiel that is being worn out in Iraq. Personnel are, too. The constant combat rotations without adequate recovery time are taking a terrible toll, and not just on the combatants. Their families are under an incredible amount of stress, as well.

A first-class military organization is being ground down in Iraq because of this administration's blunders. Even worse, the quagmire in Iraq has limited the options the Unites States has in dealing with rogue states such as Iran and North Korea.

The time has come to withdraw our forces from this mess and retool and refit the Army and Marine Corps as quickly as possible so that they can do what their mission calls on them to do: to defend the nation against real enemies, not ideologically and politically convenient ones like Saddam Hussein.

Tuesday, August 01, 2006

Study: Higher Memory, Attention Lapses for OIF Vets

From AP, Iraq vets may have memory lapses:

"Veterans of the fighting in Iraq are more likely than other U.S. soldiers to suffer mild memory and attention lapses back home, but they also tend to have better reaction time, at least in the short-term, a study found. ...

The study involved 654 soldiers who took mental-function tests a few months before going to Iraq in mid-to-late 2003 and within three months after returning in 2005. The researchers noted subtle changes in their scores. If the changes persist, "that's where you have to worry about people developing stress-related emotional problems like post-traumatic stress disorder," Vasterling said.

Thursday, July 27, 2006

PTSD Combat News Roundup: July 14-27, 2006

Haven't had a roundup in a while, so there's a lot to catch up on including a snippet of a DoD briefing answering a question on PTSD (they fell a bit short at it, imho); the VA's battle to stay on top of the rising cases of PTSD in our returning vets; virtual reality and fly fishing therapy for PTSD; a story of one vet's successful battle to win PTSD benefits from the VA; figures on Japanese troops coping with PTSD...and more.

Click on 'Article Link' below tags for more...

PTSD Combat News Roundup: July 14-27, 2006

July 14, 2006 - DoD News Briefing with Col. MacFarland from Iraq:

Q. Colonel, I'm Carl Osgood with Executive Intelligence Review. There's been a number of stories recently about troops coming back from Iraq and Afghanistan with mental health problems. I'm wondering, how much of an issue is combat stress for you and your troops, and what kind of measures are you taking to deal with it?

COL. MACFARLAND: Well, well, thanks for that question. Combat stress is something that we are very concerned about, and whenever a unit suffers a loss -- which occurs all too frequently, unfortunately -- we immediately put a combat stress team, which -- we have organic teams of brigades down with that unit. They spend a few times, and they talk to the soldiers and work with them. And, of course, we all have our unit chaplains as well who do a terrific job.

So we do the immediate, on-the-scene counseling and working with the units, helping them to overcome the stages of grief and get them back into the fight, and at the same time setting the long-term conditions for their sustained mental health. More >>

July 15, 2006 - Stars and Stripes:

Military health officials trying to keep pace with war’s mental toll

As an Army computer specialist, Brian didn’t expect to find himself in combat in Iraq. But two months after arriving in Baghdad, while on patrol with a cavalry unit, he faced his first of many brushes with death when a makeshift bomb exploded near his vehicle. “That scared the [expletive] out of me,” said Brian — which is not his real name. As a member of Alcoholics Anonymous who recently completed mandatory treatment for alcohol and drug abuse problems, he spoke on condition he wouldn’t have to give his name.

Brian didn’t realize his clashes on the battlefield had mentally scarred him, but memories of what he went through put him in a state of perpetual anxiety. After returning from Iraq, he dealt with his anxiety the same way many Vietnam veterans did and still do: He turned to alcohol and drugs.

Substance abuse often goes hand in hand with post-traumatic stress disorder, a psychiatric condition that affects roughly 15 percent of Vietnam veterans and perhaps as much as 17 percent of Iraq veterans — including, doctors say, Brian. The condition often occurs after experiencing or witnessing life-threatening events. ...

Having slipped through the PTSD screening process, Brian dulled his anxiety with a self-prescribed regimen of alcohol and drugs. His heavy drinking and risky behavior got him two charges of drunken driving in less than seven months. “It wasn’t until I got my second DWI that I was ready to admit I had a problem,” he said.

He was about to get promoted to sergeant, but instead was busted down to private, sentenced to 45 days of extra duty and restriction, and had to forfeit pay. He was also ordered into the Army Substance Abuse Program. It was only after his mental health had thrown his career on the rocks that doctors said he likely suffered from PTSD.

After the diagnosis, he was enrolled in a six-week in-patient treatment program at Landstuhl Regional Medical Center in Landstuhl, Germany, that helped him deal with his dependence on alcohol and drugs and identify the events that had driven him to substance abuse. More >>

July 17, 2006 - Worcester Telegram & Gazette:

War on terror revives old battles

Stationed in South Korea in the 1970s, Army veteran Randy Della Penna had his share of disturbing experiences. As the war in Iraq becomes more controversial and the deaths of American soldiers continue, Mr. Della Penna has had a recurrence of these memories. Diagnosed a year ago with post-traumatic stress disorder, he believes those memories are the reason he’s jobless and now living at the Massachusetts Veterans Shelter.

Attention is slowly being focused on the sharp increase of PTSD suffered by American servicemen and women who have served in Iraq and Afghanistan. The New England Journal of Medicine reported two years ago that 15 percent to 17 percent of the returning GIs were exhibiting PTSD symptoms, depression or other mental health problems.

Not documented, but obvious to counselors who work with vets and several veterans organizations, is a similar increase in the incidence of nightmares, flashbacks and delusional thinking — all symptoms of PTSD — among soldiers who served in previous eras, particularly Vietnam. They are convinced it is a result of memories of their own experiences provoked by news accounts and images of the combat and suffering in Iraq and Afghanistan. “You see these veterans watching the news, angry or shouting at the television,” said Denis M. Leary, executive director of the veterans shelter on Grove Street. “They find themselves getting anxious again when they see a veteran in combat, guns firing, like on CNN these days.”

To hear Mr. Leary tell it, the good news about PTSD is that given the right treatment the symptoms can be eliminated or at least controlled through cognitive or behavioral therapy or medication. But he says the Veterans Administration system is overwhelmed and cannot handle its backlog. “They have a long waiting list at the VA center on Lincoln Street because they can only do so much with the force of clinicians they have up there,” he said. “And treatment makes a huge difference.” More >>

July 18, 2006 - SF Bay Area Independent Media:

Iraq Vet and NJ Native Tells His Story

War means something different to those of us that have looked through the sights of a rifle at another human being’s face. Collateral damage means something different to those of us that have seen the lifeless body of a 9-year-old girl caught in the crossfire. Or for those of us that have struggled to save the life of a 7-year-old boy with parts of his face and neck blown off while his father screams in agony to just let him die and concentrate on saving his other son.

I’ve only mentioned a fraction of what still haunts me from Iraq. I’ve been diagnosed with PTSD and, for about a year, I’ve been going to therapy for two hours a week. I suffer from nightmares, insomnia, flashbacks, and panic attacks. I suffered ligament damage in my knee and ankle while on a mission in Iraq that will require two surgeries to repair. I also have hearing loss from explosions and gunfire. I’m currently using private health insurance to get care, because the treatment that I have received at the VA has been offensive. A huge strain has been placed on my marriage, and at times I don’t think that it will survive. Ultimately I’m left asking, for what? More >>

July 19, 2006 - Waterloo/Cedar Falls Courier:

Iraq vet wins battle for benefits

A Courier story in mid-May related the former Iowa National Guard soldier's battle with post-traumatic stress disorder and his ongoing fight, at that time, to get disability pay to support his family. The story was part of a series of articles about the disorder --- everything from history to prevention --- and the toll it is taking on Northeast Iowa veterans and their families.

Nolan's struggle with the Veterans Administration is apparently over. A VA psychiatrist concurred with the Waverly resident's mental health counselor and family doctor that he does have the disorder and is entitled to disability pay. Early last month he received his first monthly check for about $1,400.

The 23-year-old said the money will go a long way toward recovery, knowing now he can better support his wife and five children. More >>

July 22, 2006 - The Daily Yomiuri (Japan):

Stress haunts returning troops / No fatalities, but GSDF moves to tackle post-conflict trauma

In the United States, 9,154 soldiers, or 5 percent of the about 180,000 involved in combat operations in Afghanistan and Iraq in the three years after October 2001, developed PTSD symptoms such as nightmares or personality disorders, according to the Government Accountability Office. Although similar data is not disclosed in Japan, the GSDF's study shows nine GSDF members, or 0.9 percent of about 4,000 who returned from Iraq, were hospitalized or treated for depression between one and five months after returning home.

Meanwhile, among those who were sent to Iraq, five GSDF members including security personnel who were placed in relatively more dangerous frontline positions, committed suicide two to 17 months after they returned to Japan.

According to the Defense Agency's figures, of every 100,000 Self-Defense Forces members aged between 20 and 59, 38.6 SDF members commit suicide compared with 43.3 in the general male population. However, among those who were sent to Iraq, the figure jumps to 78.9. "The suicide rate of those who were dispatched to Iraq is twice as high as that of other members," said a Democratic Party of Japan House of Representatives lawmaker at a Diet session on June 22.

Hiroshi Kato, head of research at the Hyogo Institute for Traumatic Stress, said suicide rates and other statistics concerning stress among SDF members should be made public. "[SDF] members are suffering from extreme stress, and it's necessary to provide them with some care," Kato said. "Maybe the SDF decided not to disclose data regarding suicide and depression because it didn't want to spark anxiety among their families. But this data should be properly analyzed and disclosed after SDF members complete their mission." More >>

July 24, 2006 - Bangor Daily News:

3 wounded veterans experience restorative power of nature

James Stuck and two other wounded soldiers - Christopher Short, 24, of Little Rock, Ark., and Russell Martin, 26, of Dover, Del. - arrived at Bangor International Airport on Friday. They enjoyed a fly-fishing weekend on Moosehead Lake thanks to Project Healing Waters, a volunteer-run charity that helps service personnel recover from injuries by introducing or rebuilding their fly-fishing and fly-tying skills. ...

The deep wounds

Tim Trafford watched the three soldiers carefully from across the Legion hall. As a constituent service representative for U.S. Rep. Michael Michaud, his job involves working with veterans like Short, Martin and Stuck to ensure they get the government services they require.

As a Vietnam War veteran who served as an Army helicopter pilot in 1968-69 and eventually retired as a lieutenant colonel after 24 years of service, Trafford was glad the soldiers received such a warm welcome. "The vets from Vietnam did not have the support that these guys have had," Trafford said, "so when the vets were forced to make that choice whether to go on with their lives or give up, they had no support system whatsoever. So they gave up."

That feeling helped fuel the warm greeting the soldiers met in Greenville, Trafford said. "All of us don't want them to go through what we went through," he said. "Every veteran has a choice. They can feel sorry for themselves or they can go on with their lives, and the more support we show them, the easier it is for them to go on with their lives. That's why events like this are so important."

Still, even today, combat-scarred veterans can be their own worst enemies, Trafford said. "They have been taught by the Army, by its culture, that they don't want to admit that they have problems," Trafford said. "When they lose a limb, they have to come to grips with the fact that they are vulnerable. That's difficult."

Trafford dealt with an Iraq war veteran from Maine who suffered 40 percent disability from combat wounds and post-traumatic stress disorder, but his doctors were prepared to discharge him with a 10 percent disability, which would have been disastrous.

Trafford argued until he realized the doctors didn't know of the soldier's problems because the soldier didn't tell them. A heart-to-heart talk with the soldier eventually led him to seek proper treatment and to get the disability rating he deserved, Trafford said. "The issue is," Trafford said, "at what point are they willing to accept treatment. Some kids with PTSD won't admit that they have it and won't seek treatment. "You have to look at their eyes," he added. "Their eyes will tell you a lot about what's going on in their heads. Always look at the eyes." More >>

July 24, 2006 - Vallejo Times Herald (letter to the editor):

The third war

Everyone is aware of our brave men and women fighting in Iraq and Afghanistan. The Bush administration has extended the tour of duty of our soldiers over and over again, pushing our troops to the point of exhaustion and into the real problems of Post-Traumatic Stress Disorder, or PTSD and multiple physical injuries.

But are you aware of the third war our troops face when they get home? This is the war against the Veterans Administration.

These are the people who are supposed to help our injured soldiers, your father, mother, brother, sister and others. Help them with physical and mental disorders. But it seems that the Veterans Administration is more interested in saving money by not giving our men and women the ratings they deserve to receive the benefits from fighting in these unpopular wars.

I served in Vietnam in 1967-68. It took me four years to receive my ratings. This was 40 years ago. The VA has not changed one bit. I have an opportunity to work with veterans and I hear the same stories from them that the Vietnam veterans faced.

The Veterans Administration still drags its feet in issuing ratings. The Veterans Administration is requiring our brave men and women who have been in Iraq and Afghanistan to document their experiences before they receive any kind of rating.

You do not have to be a military strategist to realize the war in Iraq and Afghanistan is unconventional. So if you drive a supply truck or you're a combat medic, infantry, etc., you are at high risk of injuries and death. If you are in a combat zone you face countless dangers. But the Veterans Administration seems to think that our brave men and women are on some kind of vacation with weather and scenery.

Please contact Sen. Boxer and U.S. Rep. Miller and ask them to investigate the VA's antiquated rating system and help our returning veterans from the stress they will face when they apply for their VA ratings.

Ask them to start with the Oakland Veterans Administration office, since this is the office that rates our veterans in this area. We must stop the arrogance, incompetence and mismanagement at the VA. We must fight for our troops on many fronts - this is just one.

Gary Belem, Vallejo

July 24, 2006 - Oregon Public Broadcasting:

Military suicides on the rise

The rate of suicide among US military personnel is on the rise.

Defense officials say they are committing new resources to detecting and preventing suicidal behavior in soldiers, including those fighting in Iraq and Afghanistan. But watchdogs -- and a recent government report -- suggest the Pentagon may not be doing enough to make sure at-risk personnel get treatment once they get home.

No legislation has been passed, but Oregon lawmakers are pushing the military to do more. Terry Gildea reports from Capitol Hill.

-----------

It was nearly a year ago that the Army awarded Specialist Leslie Fredrick of Fort Lewis, Washington the Combat Action Badge for his service in Iraq. Two weeks after getting the honor, Fredrick shot himself.

Gordon Smith: "It's a tragedy to ever lose a soldier for any cause, but it just seems extra cruel when the cause is suicide. They're defending our country, America's interests and if we can't give them mental health assistance when they're in harm's way, we're really falling down on the job." Preventing suicide is a very personal issue for Oregon Senator Gordon Smith -- his own son Garrett committed suicide.

88 active duty soldiers killed themselves in 2005, a number that was up 13% over 2003 and more than 70% over 2001.

Paul Rieckhoff, executive director of Iraq and Afghanistan Veterans of America, calls the figures alarming. And he says an overstretched military and repeat tours of duty are taking a toll on soldiers. Paul Rieckhoff: "The last rotation, roughly 40% were there for the second time. Many are there now for the 3rd or 4th time. Divorce rates are going up, the violence continues to increase, and roughly one in three are coming home with mental health issues or Post Traumatic Stress Disorder, so our people are really showing signs of wear." More >>

July 26, 2006 - BusinessWeek:

A Dose of Virtual Reality

Dr. Dennis Wood takes patients on what some might consider an odd journey. He starts off leading them to a military compound in Fallujah, Iraq. He then guides them through an Iraqi marketplace before they accompany a patrol through Iraqi homes. And if he thinks they're up to it, he may even take them onto a battlefield, in the midst of explosions and aircraft flying overhead.

But neither Wood nor the patients is anywhere near Iraq. The therapeutic conflict is part of a virtual reality program developed at the Virtual Reality Medical Center in San Diego and funded by the Office of Naval Research (ONR). It's designed to help personnel returning from the wars in Iraq and Afghanistan cope with so-called acute post-traumatic stress disorder, or PTSD. Brought about by distressing experiences like those in war, PTSD can lead to flashbacks, other psychological ailments, and social problems.

COPING STRATEGIES. A therapist at the Naval Medical Center in San Diego, Calif., Wood monitors patients' heart and breathing rates and even how much they're sweating to see the effect of the virtual environments. The aim is to get patients to draw on their meditation training to regain perspective—and stay calm—when a stimulus causes an emotional response. "The idea being to be in the high-stimulus environment for a long period of time, maintaining low psycho-physiological arousal," Wood says. "The person then can take that learning in the therapeutic environment and transport it out or generalize it to day-to-day life." More >>

Financial To-Do List for Returning Reservists

Here's a list of 7 financial to-do's for returning reservists offered by Bankrate.com. Actually, these tips are a pretty handy reminder for all vets coming back from duty:
  1. Check your credit.
  2. Take a look at your insurance.
  3. Undo any powers of attorney.
  4. Talk to your creditors.
  5. See your lawyer.
  6. Pay your taxes.
  7. Review your situation.
Check out the details for each tip here.

Monday, July 24, 2006

Action Item: Contact House and Senate Reps Today

Important action to take this week. Veterans for America has made it easy for us to get armed with info and ready for action in support of 3 vital amendments to the National Defense Authorization Act (NDAA) for 2007.

Click on Steve Robinson's picture to listen to this week's legislative update. Then head over to their online action form to really show you support the troops.

Click on 'Article Link' below tags for details...

Before the NDAA comes up for a vote, it's hammered out in a joint House-Senate conference. To be sure the following three amendments make it through this process, we need to contact the House and Senate leaders involved -- Representatives Duncan Hunter (R-CA) and Ike Skelton (D-MO), plus Senators John Warner (R-VA) and Carl Levin (D-MI). You can use this online action form to make contact quickly and easily.

Here are the 3 amendments that need our support (via Veterans for America):

Amendment S. 4224 sponsored by Senators Barak Obama (D-IL) and Bill Frist (R-TN) requiring that traumatic brain injury (TBI) assessments be included as part of post-deployment health care assessments for service members deployed to Iraq or Afghanistan involved in improvised explosive device incidents (road side bombs). Serious brain injuries can have long-term effects if not diagnosed and treated quickly.

Amendment S. 4466 sponsored by Senators Barbara Boxer (D-CA), Joe Lieberman (D-CT), Hillary Clinton (D-NY) and Dick Durbin (D-IL) improving mental health care screening before deployment of our troops, establishing a minimum standard requirement and further evaluation by a qualified health care professional if a mental health condition is detected during pre- or post- deployment screening. Soldiers are committing suicide while deployed and after returning home. This screening may help save lives now.

Amendment S. 4409 sponsored by Senators Barak Obama (D-IL) and Kit Bond (R-MO) requiring a report from DoD on the feasibility of providing secure electronic medical and military records to service members when discharged to assist with expediting veterans’ medical care at Department of Veterans Affairs medical centers and private physicians. By providing full sets of records, this amendment allows veterans to choose when and where they go for medical care, and it provides an historical account of their military duty.

And don't forget to thank Veterans for America for providing this service to us, either by dropping them a nice line or two or tossing a few nickels into their bucket.

Thank you for taking action today!

Sunday, July 23, 2006

DSM's Definition for PTSD

To celebrate the Institute of Medicine's report for the VA in support of the American Psychiatric Association's definition for PTSD in its Diagnostic and Statistical Manual of Mental Health Disorders (DSM), I thought it might be a good idea to take a look at the DSM-IV's definition.

Click on 'Article Link' below tags for more...

The current definition for PTSD in DSM-IV:

309.81 DSM-IV Criteria for Posttraumatic Stress Disorder

A. The person has been exposed to a traumatic event in which both of the following have been present:

(1) the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others (2) the person's response involved intense fear, helplessness, or horror.

B. The traumatic event is persistently reexperienced in one (or more) of the following ways:

(1) recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions.
(2) recurrent distressing dreams of the event.
(3) acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur upon awakening or when intoxicated).
(4) intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.
(5) physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.

C. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by three (or more) of the following:

(1) efforts to avoid thoughts, feelings, or conversations associated with the trauma
(2) efforts to avoid activities, places, or people that arouse recollections of the trauma
(3) inability to recall an important aspect of the trauma
(4) markedly diminished interest or participation in significant activities
(5) feeling of detachment or estrangement from others
(6) restricted range of affect (e.g., unable to have loving feelings)
(7) sense of a foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span)

D. Persistent symptoms of increased arousal (not present before the trauma), as indicated by two (or more) of the following:

(1) difficulty falling or staying asleep
(2) irritability or outbursts of anger
(3) difficulty concentrating
(4) hypervigilance
(5) exaggerated startle response

E. Duration of the disturbance (symptoms in Criteria B, C, and D) is more than one month.

F. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.



 Related Posts


PTSD Criteria Review Complete for VA, DSM Stands

Characterizing the process as having gone smoothly, the Institute of Medicine (IOM) has completed its government-ordered study to "review the scientific and medical literature related to the diagnosis and assessment of PTSD, and to review PTSD treatments (including psychotherapy and pharmacotherapy) and their efficacy."

The report supports the existing definition for PTSD in the current Diagnostic and Statistical Manual of Mental Health Disorders (DSM). The IOM says there's "no need to change DSM-IV criteria for diagnosing posttraumatic stress disorder when evaluating veterans for the disorder."

Click on 'Article Link' below tags for more...

From Psychiatric News:

DSM-IV criteria for posttraumatic stress disorder (PTSD) are well-founded and should remain the standard for diagnosis, the Institute of Medicine (IOM) reported in June. The report had been requested by the Department of Veterans affairs in response to concern about increasing numbers of veterans applying for PTSD disability compensation.

Diagnosis should be carried out by experienced clinicians familiar with DSM-IV standards, added the IOM group, chaired by Richard Mayeux, M.D., M.S., a professor of neurology, psychiatry, and epidemiology at the College of Physicians and Surgeons at Columbia University. "The committee strongly concludes that the best way to determine whether a person is suffering from PTSD is with a thorough, face-to-face interview by a health professional trained in diagnosing psychiatric disorders," Mayeux said.

"In asking the IOM to evaluate and confirm the DSM-IV criteria, the VA was not seeking to challenge the criteria but to provide validation of those criteria to those who did challenge them," said Ira Katz, M.D., Ph.D., deputy chief patient care services officer for mental health at the VA. "The goals were very well met." ...

Separating diagnosis from treatment and disability was a good choice because the latter two issues probably lay more at the heart of the VA's concerns, said Regier.

The IOM committee will also review evidence for PTSD treatment and prognosis and for determining standards of disability related to the disorder. Those two reports are expected by the end of the year.

Although the primary diagnostic tool for PTSD is the knowledge and experience of the clinician, the report also suggested that use of structured or semistructured interviews such as the Clinician-Administered PTSD Scale (CAPS), the Structured Clinical Interview for DSM-IV (SCID), the PTSD Symptom Scale—Interview Version (PSS-I), can complement clinical interviews.

While some of these interviews might take time to administer, they can provide indications of presence and severity of symptoms. ...

The IOM also noted that PTSD was a true disorder because it met standards for validity, having distinct clinical features that had been consistently documented in a variety of settings and cultures, longitudinal stability, and some evidence that genetic factors accounted for about one-third of PTSD symptoms.

Back in February, the VA-ordered review create a lot of controversy.

At committee hearings in February, several speakers suggested that many veterans applying for disability compensation for PTSD through the VA were not suffering from the disorder, but looking for a government pension. clinicians should be aware of the potential for malingering and should consider discrepancies in the patient's reports, lack of cooperation in evaluation or treatment, and evidence of antisocial personality disorder in their evaluation, said the committee, echoing APA recommendations.

"Part of the reason for asking that clinically well-trained people evaluate patients is to avoid overdiagnosing people faking PTSD," said Regier. Several psychometric tests, like the MMPI-2 or the Impact of Event Scale–Revised, do a good job of detecting fakery, he added. Other speakers at the February hearings presented evidence that there were few instances of malingering among Vietnam War veterans studied. although the impetus for the IOM report arose from concern about veterans of earlier wars, Katz said that about 30 percent of returning veterans of Iraq and Afghanistan come to the VA for medical care. Of those, 33 percent have mental health concerns, and 15 percent of that group have at least some symptoms of PTSD.

Nothing specific in the report should cause the VA to change its approach to diagnosing PTSD, but the department is continually seeking to improve its services, said Katz. "The issue isn't business as usual, but enhancement as usual," he said. "The VA views the best diagnosis as an evolving process, guided by empirical-research evidence and accumulating evidence."

The IOM report also did not presage any developments for PTSD criteria that might appear in DSM-V, said Regier. Research over the next several years may generate new information that could confirm present standards or guide new ones, he said.

Saturday, July 22, 2006

Advice for OEF/OIF Vet Employers and Co-Workers

The Minneaplis-St. Paul Star Tribune and the Minnesota National Guard are doing a great job in both educating their local communities on returning veteran issues and ensuring their troops have as successful of a reintegration as possible. Read their solid advice for employers and co-workers.

Click on 'Article Link' below tags for more...

From the Star Tribune:

For a veteran, there is no such thing as coming back to the same job he or she left, according to Maj. John Morris, deputy state chaplain for the Minnesota Army National Guard. There is no company on the planet that can really let any job go undone for two years -- and even if it could, no job would freeze unchanged over that time, Morris said.

The flip side is that no veteran is the same when coming back to a job from combat areas such as Iraq and Afghanistan, he said. The changes spread wide across not only the soldiers' personal and family lives, but also their work lives.

Morris is conducting a 'webinar' course on Tuesday sponsored by the Employee Assistance Professionals Association of Arlington, Va. This group provides counseling services for many companies to their employees.

Besides the small percentage of post-traumatic stress disorder, Morris said, there are less dramatic but more common "residuals," including hyper-vigilance, sensitivity to loud noises, fear of crowds, and a combat-zone version of defensive driving that can be unnerving.

Some veterans find themselves simultaneously bored and overwhelmed by the jobs they come back to, Morris said. Some young veterans have burned through four or five jobs in six months, sometimes complaining that the boss is dumb and sometimes complaining that the boss thinks they're dumb. Nothing can compare to the thrill and the test of combat.

Morris' advice to employers is to start preparing before the veterans come to work. When soldiers are returning to the workplaces they left, they will come with a reservoir of trust if an employer has made an effort to stay in touch with the solider and the family left behind. That's the kind of employer they'll feel comfortable asking for help, he said.

On arrival, start things off with an official welcome back -- not a grand event, "but let's not act like it's no big deal," he said. Then some mutual understanding during the period of adjustment goes a long way.

Co-workers should brace for a strong indifference from veterans, Morris said, an attitude along the lines of, "I've been at the center of world events, and everything I've been doing is more important than what you've been doing."

On their side, co-workers can stop asking the kind of troubling questions veterans now get. "You do not want to ask, 'Did you kill anybody?' " Morris said. "Or, sometimes people ask, 'Do you think we should be there? Do you think we're winning?' Then they use that to go into their own politics, and that is not appreciated."

Instead, Morris suggests showing interest with open-ended questions, so veterans can go only as far as they're comfortable, questions such as:
  • What was your experience like?
  • How was it coming home?
  • What would you like to share about your time in Iraq?
  • Got any pictures you want to show us?
Employers often are in a good position to spot problem signs -- withdrawn or too kinetic -- and steer the veterans to help, he said. Morris suggests weekly check-ins for a while, for encouragement or intervention.

Some honest advice. Please thank the MSP Star Tribune for their great coverage on this issue.


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10,000 Unique Visitors Reached


PTSD Combat has just had its 10,000th unique visitor!

Although the comments areas are usually pretty quiet, there's always a lot going on behind the scenes. I thought I'd share just a few of the incredible names and organizations that kicked the tires around here the past 10 days. To commemorate, I've tweaked the site design somewhat, too. Thanks for visiting!

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Education: Universities of North Carolina, Indiana, Southern Illinois, California-San Diego, Portland State, South Dakota, Texas at El Paso, New Mexico, Pennsylvania, Washington, Northwestern, Harvard, Stanford, Emory, Stephen F. Austin, North Carolina A & T, Western Washington, and Loyola; Saint Joseph College; San Diego City Schools; San Bernardino County Superintendent of Schools.

Government: From across the pond, the Houses of Parliament and the Cambridgeshire County Council; closer to home, the U.S. House of Representatives and U.S. Senate Sergeant at Arms (I'm not sure if this is a good or bad thing :o); the States of Minnesota and Maryland, Cities of Philadelphia and Madison; and the Town of Norwood Light Department.

Military/Veteran: Department of Defense (DOD); United States Army Corps of Engineers; United States Naval Academy; National Defense University; Forts Belvoir, Carson, and Leonard Wood; Camp Liberty in Moldova; US Army Garrison-Michigan; Reese Air Force Base; 377 Communication Squadron; Vietnam Veterans of America Foundation; and the Department of Veterans Affairs (VA).

Health: The National Academy of Sciences; Loma Linda University Medical Center; Connecticut Center for Health; the Children's Hospital of Pennsylvania; and Baptist Memorial Health Care Corp.

News Organizations: CBS News; Tribune Company; Milwaukee Journal-Sentinal; Mankato Free Press.

Miscellaneous:
The Boeing Company, Ford Motor Company, Land O'Lakes (this one was great to see :o); General Electric Company; United States Postal Service; United Steelworkers of America; Alliance Capital; Avalon Publishing; and Simon & Schuster.

...and these were just a few of the visitors in the past 10 days. Thanks again, for your support and interest -- one and all!

Friday, July 21, 2006

What Do OEF/OIF Vets Have to Say? Check Out MTV Tonight.

Just received this in my email box:

IAVA will be on MTV tonight! Tune in to see IAVA's Executive Director Paul Rieckhoff featured on MTV's special, "Iraq Uploaded", tonight at 8pm EST.

"Iraq Uploaded" will be hosted by Gideon Yago and will explore how the personal videos and blogs from Troops in Iraq are informing the American public about the war. It is a powerful and fast-paced show that IAVA supports fully. "Iraq Uploaded" will highlight unfiltered videos and military blogs that have been coming straight from Iraq through sites like www.iava.org. ...

If you miss the show tonight, it will continue to air on MTV over the next few weeks. Check MTV's schedule for more dates/times.

I had the pleasure of meeting Paul Reickhoff last month, and can't rave enough about what he and his organization are doing to get the voices of our returning vets out there. We need to hear more from them -- and IAVA is helping to make it happen. Please consider donating to their organization. And I heartily recommend reading Paul's new book, Chasing Ghosts: A Soldier's Fight for America From Baghdad to Washington. Sample chapter here.

Want more news? Check Archives in the right-hand column. ==>>