Badges of Honor and Integrity

This post is a comment on a question from a post on April 26, 2009, if you want to see the comment click here if not read on.

I wear my memorabilia to display a remembrance of a past war, my war, the Gulf War.

I welcome an open hearted question on the significant of the symbols I wear today. I am at a point in my life where I recognize the anger and animosity felt within and take responsibility for it. By doing so I do not project it onto other people or make others accountable for it, the consequence being acceptance. Today I wear symbols of integrity and character, to remind me that I can achieve my goals even in the face of great adversity.

There was a time that I wore them for other reasons, to immortalize the guilt I still carry today. I left my guys over there, we killed literally thousands upon thousands of Iraqi soldiers, and finally the 30 soldiers that were trying to surrender. The insignias were my badges of guilt and shame, nothing that I wanted to share in a positive way.

When I wrote this piece I was reminded of the anger and rage I felt that encompassed my being and perspective. I was ready to explode and any excuse was the ember that could spark an inferno. I remember that a well formed question could offset this demeanor and open a reverence and grieving process whereby I could speak of the emotional pain. I was both of these people along with many others.

I see the wisdom in your response and accept it as a reminder that most people want to seek answers that only a combat veteran could expound upon. Today I honor this responsibility too speak on the reality of war and the devastating effects upon the person, family and community.

Societal Norms Implore Expected Public Behavior: Implications for Veterans & Soldiers

I cross posted my last article over at A Soldier's Perspective (a totally different site that I contribute on combat PTSD) and recieved this comment:

I'm generally not a stupid guy, so I've never done anything like that kid. I'm not trying to condone it either.

But I wonder; with military gear/paraphernalia so much in style amongst civilians these days(at least here in NYC), isn't there a legitimate question whether the wearer earned the badges or not? Keep in mind that civilians can't tell between a real one and a copy.

How do you guys feel about the fashion trend in general?

My response:

...I personally do not have anything against people wearing military style clothing.

I would say that yes, there is a legitimate question as to whether the wearer earned a badge, ribbon, etc.

I quote myself;

"If you see a person in public with military clothes on, a hat or something that signifies that they were in the military. Do yourself a favor and do not ask him or her about medals, badges, or any insignia they may have displayed right away, especially in a negative way. Tell them welcome home, and then gauge their reaction and if they want to talk to you they may open up some. But, do not take this as an invitation to ask personal information. Our military experiences have an extremely sacred and personal compartment in our minds and hearts that we place them in. Many of us do not even tell our wives, family or friends about what we did or saw."

Men or women who have been in combat generally do not want to talk about their experiences. To them it is a deeply personal part of their lives that they do not wish to share, especially someone they do not know. Combat and killing another human being is the most intimate act one can have with another human. Probably more so than making love to your significant other. Do you talk openly to someone you do not know if they ask you do you have sex with them? Obviously no, the question is taboo.

A societal norm is expected behavior when out in public, and talking about your sex life is generally looked down on in polite company, and especially rude to ask when in passing company. The same holds true to asking someone, probably more so, if they earned their decorations or if they killed anyone.

My message here is that it is rude and insensitive to the soldier or veteran to ask them if they earned their military decorations. Many of us combat veterans have an extremely difficult issue with trusting anyone, even loved ones who we fully felt fidelity before combat.

The answer to your question is that your question would better be left unsaid. If you truly want to talk to a veteran or soldier about their experiences, broach the subject in an empathetic way. First tell them "welcome home" this will probably bring their guard down somewhat. When we come home many of us feel as though we have returned to a foreign land, as though we do not belong anymore.

If you come upon someone you feel as though they may not own the right to wear military decorations. Consider this, we have young soldiers and veterans who are 18 and 19 that have been on multiple tours and have seen more combat than most other wars, including WWII.

Upwards of 90-94% of our troops in Iraq have been shot at, seen someone killed or have been in a combat situation. 68% have actually engaged the enemy where only 40% of the people who actually have the job description of combat arms or killing. In this war we have women fighting and killing the enemy, over 100 women have been killed in combat.

So, when you doubt if someone is old enough or "looks" as though they did not earn their awards. I would suggest to ask yourself these questions pondered here

More Stupid Crap to Say to a Combat Veteran

I picked up a new Army Veteran hat that I just bought yesterday and hung it up on top of my Desert Storm hat. My desert storm hat has a Combat Infantry Badge (CIB) pin on the front of it, and I considered placing the pin on my new hat. As I was doing this a thought came to me of a time when I first came home, I had not been back long at the ripe age of 21. I went into a convenience store and was buying something at the register (probably gas) and as I was leaving this young guy maybe a little younger than me was coming in the door.

I had my BDU (Battle Dress Uniform) jacket on with a CIB patch on it. This young punk was coming in the door and looked at the patch on my jacket and said, "Did you earn that?" I immediately went into homicidal ideation, I thought about doing some serious harm to him. But, after what seemed like hours, I told him in as shitty a way that I could and almost screamed at him "YES!" I am pretty sure I had an intimidating posture to put an emphasis on my point. Guess what? Instantaneously he became extremely intelligent and did not say another word.

If you see a person in public with military clothes on, a hat or something that signifies that they were in the military. Do yourself a favor and do not ask him or her about medals, badges, or any insignia they may have displayed right away, especially in a negative way. Tell them welcome home, and then gauge their reaction and if they want to talk to you they may open up some. But, do not take this as an invitation to ask personal information. Our military experiences have an extremely sacred and personal compartment in our minds and hearts that we place them in. Many of us do not even tell our wives, family or friends about what we did or saw.

We do not wear our military memorabilia because we want people to ask us about them, we wear them to remind us of shit we will never be able to forget. If you cannot understand that then you have no business asking us about anything.

Reflections of Self: Self-Care, Healing the Healer

I have been battling my demons also; I have an intimate understanding of an overwhelmed and heavily burden soul. I have to constantly remind myself take my time, no hurry here in the journey of healing. I thought I was literally crazy until my education on my malady gave me a sense of normalcy. I learned about posttraumatic stress disorder (PTSD) and found that I was not alone in this “inner world,” I was able to begin building a foundation on which I could begin to face my inner demons. In educating myself I had finally discovered my particular pathology and that I could watch for triggers, use newly found coping skills and find a way to express my inner torment without self destructing.

After the initial euphoria abated I discovered a false belief that I would find an inner peace upon the discovery of what ailed me, but nothing had changed except that I know more than before. I was let down, when I realized what was "wrong" with me I had an immense relief, but then it hit me that nothing had changed at all! That I did not anticipate, I was expecting this realization to have significant changes. Today I understand that nothing is wrong with me, I have yet to achieve a developmentally congruent stage that matches my age. According to Erikson’s lifespan stages I am currently battling through several stages at the same time; rapidly vacillating back and forth through stages one through seven.

It took me having to go through existential crisis’ to realize that I had an inner strength that has eluded me in the last twenty years. Subconsciously I use to feel that PTSD was a weakness, by my military training and the implications within the greater society. The stigma attached to mental illness impeded my recovery and instilled a deep sense of hopelessness that still troubles me today.

I have been considering getting involved with the Veterans Administration (VA) peer support program, but have yet to take that leap. I do know that what the expected individual involvement, but by placing myself in that role of the helper I may find my trust issues raging. I am not sure I would find that in the peer support program, but I will be making inquires soon as I have to do something different than I have lately.

To further expand my judgments and perceptions, trusting is a double-edged sword that can cut deep. So the possibly of a distorted perspective and warped sense of trust I can sometimes find fault in everyone that does not think like me. This does not mean that I have the correct assumption, my experiences in combat have vastly altered my value system, emotional make up, perceptions of others, and behaviors to name a few. I usually try and tend to my perceptions and intuitions as they can lead me in the right direction many times. Sometimes though, especially when I am more depressed than usual I cannot trust my judgment all the time. To combat this I have been seriously considering finding a male role model in the clinical field as a mentor so that he could be a model in which I could aspire to.

I will never give up on my lifelong process of healing, I have learned to better assert myself and have put away most of my outward aggression. I wish to find someone who can interact with me in a way that complements my personality, someone who can find the time and have a vested interest in my recovery and friendship. A male mentor in the clinical field would compliment and foster a sustainable growth in which I could use as a base for practicing therapy. By continuing therapy throughout the next couple of years and possibly beyond, I will be able to ensure a more balanced life and practice.

Reflections of Self: Bridging Differences with Similarities Between Clients and Myself

In the treatment of combat related trauma, the latest research reveals that a union of therapist and client can and will eventually bring about a healing process. Whereby upon establishing trust in the clinician, the combat veteran or soldier can begin to recover compartmentalized portions of the personality and regain a sense of normalcy. Prior trauma, such as childhood neglect, abuse and sexual abuse can and will have an impact on combat trauma (Van der Hart, Nijenhuis and Steele, 2006).

Seeing as how I have connected all of the dots here before inked, I will have to take great care in safeguarding myself from becoming triggered and interacting with the client on the outside of the therapeutic window. In doing so I will need to find a mentor who I can process with and who will be able to counteract any maladjusted behavior I may exhibit. Additionally, I am in the process of receiving exposure therapy in an attempt to reintegrate my childhood memories, my combat experiences and string together a more compete autobiographical history of self.

According to Tyson (2007), working with clients who have trauma based disorders can greatly impact and “transcend the mirroring of their client’s PTSD symptoms…” thus affecting the practitioner’s expressions of self-identity and leak into every aspect of their lives. With continuing therapy, I will find myself further integrating my past trauma experiences and finding breathing room upon facing the fires of facilitation within the realm of the treatment process. Should the field of combat trauma therapy consume too much of my psych, I must endeavor to find a different avenue to help my fellow veteran.

I have such a passion to help those who I fully identify with, to help them out of the dark and into the light of recovery. The closer I attend to receive my degree, I find myself having a growing apprehension and need to “fix” myself. I do recognize the false belief here, in that I am broken, or less than. These schemas and operational tendencies I face every day and take great measures to identify them as I live them. To alleviate these fears I have decided that if the stress is too great then I will help in other areas with our veterans, such as educational benefits. I received the help of a professional social worker in gaining the benefits that I attend school with today.

With a centered focus on self, self identifying in the moment, utilizing a mentor, engaging in continued therapy and further studying of trauma therapy I will be able to safeguard the clients well being and cause no further harm to an already fragile mind. I also plan on placing objects within my office that represent my principles and values that will shape my practice and ability to reflectively engage the client rather than defensively react. I behold the gift of cynosure and have viewed the revelation of my purpose; my faith and spirituality will be the sign posts to my continued journey.

Resources

Van der Hart, O., Nijenhuis, E. R., and Steele, K. (2006). The haunted self. New York, New York: W. W. Norton and Company.

Tyson, J. (2007). Compassion fatigue in the treatment of combat-related trauma during wartime. Clinical Social Work Journal, 35, 183-192.

Reflections of Self: Who I Am

Beginning today I will post three reflection papers that I wrote for my Practice II class. They reflect on who I am, identifying strengths and weaknesses, biases, and what I will do to guarantee the safety and integrity of the client.

I grew up all over the country and in some others as well. I am heading into my forties and have just begun to live life from the perspective of a more complete person. One would think that this would be as it should for someone my age. I am here to tell you that a miracle has happened to me to have afforded my rebirth at a late age, for my childhood was one of extreme abuse and excessive indulgence. We were not raised with any religious or principled upbringing, more like if it feels good do it, but do not get caught.

My father had his moments of vacillating between, father of the year, to bastard of the century. Today I can remember more good than bad for I have reconciled with my inner child. I remember the wrestling and tumbling about with my father into the late of night. Memories of working with him were some of the best, his paying homage and bragging of how hard we worked filling me with his praise. Taking long drives, talking of nothing in particular, to serious imparting of knowledge and engaging in the communion of son and dad.

Mom was a strong resolute individual, but I did not know this until she was gone. To live through all the heartache and pain she had endured, one would need a deep inner reserve. She was part Cherokee, Black Dutch, and some others I cannot remember. My grandmother, who had a considerable influence on me, was part German and her gruff exterior told the tale. I remember hearing of how she used to chase dad with a Louisville Slugger. I had all of these influences rolled into one, me. I was resentful of my father, I hated and loved him. I was ashamed of my mother who became an alcoholic, even though I followed in her shoes. I adored my grandmother and was always getting away with what I wanted, with her protection and admonishment. To say the least I was going in all directions.

So, to piss everyone off, I joined the Army, knowing full well I would not be sent to war. In 1989 I was shipped off to a foreign land for my country; I still face those demons today. I also knew that I would never become my father. It seems that everything I thought I knew was just the exact opposite. I became my father, albeit to a lesser degree, but the same none the less. The trauma of my childhood was compounded by my crushing guilt of having survived and killed in a war of my own, both inner and in the past. I turned this anger and vehemence toward everyone who was close to me. I raged for 15 years before I received help, I have complex-PTSD, Gulf War Syndrome (undiagnosed), dysthymia, hearing impairment and tinnitus from my military service.

Today I have found that living a principled life leads to integrity, character, honor and humility. My sons have returned to my life and I am now a role model for them, something I was not in a past life. In the quest for a life without the madness that mental illness can bring, I have discovered an inner peace that I never thought was there. In my journey to wellness I have gained more friends than I thought I could ever hope to have, I have mended the fractures in between my family and myself. I have found my former anguish to be strength today; people who go through the fires of hell develop a unique set of skills.

My chosen profession will be combat trauma therapy, I feel that my experience of going through the therapies myself, I can have a greater empathy and compassion for the combat veteran. I will be able to guide them without the judgments that I experienced from the Veterans Administration (VA), and use my intuition as a tool to assist in integrating the dissociative mind of the combat veteran. My hope is that the unique perspective of my personal experience and education will help advance the cause of trauma therapy and the healing of shattered minds.

The thing that makes me distinctly qualified can also be considered an impediment, due to the likelihood that I will be triggered by my clients. To combat this I have completed stage two of Phase-Oriented Therapy and moving toward stage three, exposure therapy. I have found an MSSW therapist to work with that I trust and hope to have completed most of this in the next two years. I will be addressing this with my psychiatrist and therapist when I start my employment with the VA, so as to dispel any backlash and personal tension. An integration of all our skill sets, beliefs, values and potentials entails a lifetime journey, the sooner we accept, the sooner we can embark.

Information Can Lead to Knowledge But Not Necessarily to Wisdom

Early in my recovery I had many thinking errors, or mental actions based on a false belief system. I had a thinking dichotomy that reflected an "either or" proposition, an "If this then that" codification and a black or white opposition. A mind mostly grounded in defensive mechanisms.

When I had the realization of my condition, that a name could be assigned, I felt an immense relief. But then it hit me that nothing had changed at all! I expected this awareness would have a greater impact than it did. What I did find in this new perception, a deep profoundness and discernment which had escaped me before, I finally found myself to be no longer alone.

I thought with finally learning what I had, or what was wrong with me (PTSD), it would be more helpful than it actually was. In the back of my mind I believed I was literally crazy until I learned about my malady. I had the thought that by knowing what was "wrong" with me, that in someway I would get better. I assumed this knowledge would somehow cause a shift in my thinking. I had expectations of my enlightenment to be more profound than it was, nothing changed except that I now knew more than I did before. My mind at this time could not fathom that I had become a member of the walking wounded.

It hit me just recently that; information can lead to knowledge but not necessarily to wisdom.

Government and Private Service Providers: Soldiers & Veterans Stuck in Between

Government and Private Service Providers:

Soldiers and Veterans Stuck in Between

Scott A. Lee

University of Louisville,

Kent School of Social Work

Statistics, Effects and Realities of Multiple Deployments

As of August 27, 2008, according to the Congressional Research Service (2008) 4,726 soldiers have lost their lives in combat and 32,977 troops were wounded in action, with 8,089 suffering from Traumatic Brain Injury (TBI). Veterans for America (2008) reported that 1,321,019 soldiers had been deployed to wars abroad, 796,483 or 60% had been deployed once, and an unprecedented 469,095 soldiers had been deployed two to three times a 36% of the total, and 55,441 around 4% had been deployed 4 to 6 times. With multiple tours our modern veterans will become exponentially more vulnerable to join the ranks of the walking wounded. “Department of Defense [DOD] studies prove that with each deployment Soldiers are 60% more likely to develop severe post-combat mental health problems” (italics and bold type added; Veterans for America, n.d.).

Never before in the history of American warfare have we seen such high numbers of soldiers who have been under such unimaginable stress. In World War II (WWII) only 18% of our soldiers engaged in combat, with Vietnam it was 30 to 40%, in today’s wars a stunning 68% have actually engaged in combat (Veterans for Common Sense & Veterans United For Truth, Inc vs. Veterans Administration [VA], item 54, & National Center For PTSD Fact Sheet, Aftermath of Violence sec., para. 2). Not only have more soldiers engaged in combat, they have been in combat longer with an average of 2 to 3 tours of duty. Many have been on 5 tours and some as much as 6. A summation from a member on the commission, Massachusetts state Rep. Harold P. Naughton said,

the public also should understand that the operational tempo of the current wars has exposed troops to combat for upward of 200 days at a time, far longer periods of uninterrupted combat exposure than most troops experienced in (WWII) or Vietnam (italics and bold type added; Telegram and Gazette, n.d.).

The data on multiple tours was quite disturbing, due the fact that soldiers and veterans who have more than one deployment have significantly higher rates of mental health problems. The Mental Health Advisory Team (MHAT) V, the military's research arm reports, “Soldiers on multiple deployments report low morale, more mental health problems, and more stress-related work problems. Soldiers on their third/fourth deployment are at particular risk of reporting mental health problems” (Sec. 2.2.2, No. 8). Preliminary self-reported rates of PTSD from Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) have reached 15% already, with an approximated 15 to 40% lifetime rate after combat. As high as 80-90% of our soldiers have seen someone get killed, or been in a combat zone, we have reached combat saturation (Hoge & Castro, 2005; Hoge, Auchterlonie, & Milliken, 2006).

Rand (2008) reports, of the “…1.64 million service members who had been deployed for OEF/OIF as of October 2007 (italics added), we estimate that approximately 300,000 individuals currently suffer from PTSD or major depression and that 320,000 individuals experienced a probable TBI during deployment” (italics and bold type added; p. xxi). Today 15% of our soldiers and veterans have been diagnosed with posttraumatic stress disorder and or depression. Comparatively these figures although similar in number when weighed against past wars, where in Vietnam we had 30% PTSD rates, in WWII an estimated 15% estimated in and 15 to 20% of veterans from the first Gulf War have been reported to have PTSD. It took Vietnam veterans up to 10 to 15 years before their symptoms reached the point of becoming incapacitating. The implications for our modern veterans will have monumental deleterious effects in the next 10 years, it has been projected that PTSD rates in today’s wars will reach 50 to 60%. We will be inundated with mentally ill veterans who have few options and nowhere to turn and they will run afoul with society without proper mental health interventions (Lee, 2006; Rand, 2008).

The rate of deployments to Iraq and Afghanistan will go down in infamy as we will begin to see an exponential growth in our servicemembers succumbing to the ravages of insanity. Our relatively low death rate has given more soldiers and veterans a life that most would not want to live. The progression of technology in our body armor and medical advances has produced a historically lower rate of casualties when compared to other extended wars such as Vietnam and Korea. “However, casualties of a different kind—invisible wounds, such as mental health conditions and cognitive impairments resulting from deployment experiences—are just beginning to emerge” (italics and bold type added; Rand, 2008, p. 2). Moreover, a true perspective on the soldier’s receiving the brunt of the combat duty, active-duty Army Brigade Combat Teams (BCTs) and Armored Calvary Regiments (ACRs) have been cycled through frequent deployments, in excess of 42% of the killed in action have come from BCTs and ACRs (Veterans for America, n.d.).

The Veterans Administration System is Broken
Arline Kaplan of the Psychiatric Times (2008) reports a “gathering storm” and estimates that 70% of soldiers and veterans will not seek help from federal agencies such as the DOD or the VA, placing an undue strain on private facilities and practitioners. With this in mind the public sector of mental health has little to no preparation for the oncoming onslaught of help seeking veterans and soldiers. Monahan (n.d.) reported on a Massachusetts commission that found veterans were not receiving sufficient treatment and reintegration assistance compounding the effects of successfully coping and interacting with family and within society.

More than 50% of those referred for a mental health reason were documented to receive follow-up care although less than 10% of all service members who received mental health treatment were referred through the screening program (Hoge et al., 2006). Hoge et al. ponders the reasons for such high numbers of non-diagnosed veterans,

This study shows that approximately one third of OIF veterans accessed mental health services in their first year after deployment, 12% per year received a diagnosis of a mental health problem, and an additional 23% per year were seen in mental health clinics but did not receive a diagnosis. It is not clear why there was such high use of mental health services without a mental illness diagnosis (italics and bold type added; p. 1030).

The systemic denial of veteran’s benefits has a strong bureaucratic resistance to give any compensable diagnosis coupled with “protecting the budget.” Compounding the issue for veterans and soldiers receiving help for mental health issues is the stigma attached to such help. Stereotypical views within the military culture still hold a pervasive foothold in the minds of soldiers as to the nature and problem of psychological wounds. Too many times our veterans have been on the receiving end of this same kind of generational denial and recrimination (Lee, 2006).

Similarly Hoge, Castro, Messer, McGurk, Cotting and Koffman (2004) found that of the soldiers and Marines who met the criteria for being diagnosed with a mental health problem, only 38 to 45% indicated an interest in receiving help. Furthermore, within the previous year, only 23 to 40% reported actually receiving professional help. Proof positive of this phenomenon, quoted from the infamous email from a VA hospital’s PTSD Program Coordinator, Norma Perez, “Given that we are having more and more compensation seeking veteran [sic], I’d like to suggest that you refrain from giving a diagnoses of PTSD straight out. Consider a diagnosis of Adjustment Disorder, R/O [rule out] PTSD” (Veterans for Common Sense, 2007).

Many of the studies being conducted on soldiers and veterans define cases of PTSD and depression by using invalid screening criteria not commonly used in civilian evidence-based studies, “and that are likely to exclude a significant number of servicemembers who have these conditions” (italics and bold type added; Rand, 2008, p. 48). Subthreshold cases of PTSD and depression left untreated will in all probability develop into full blown cognitive pathology and severe maladaptive symptomatology, warranting a diagnosis of a severe mental illness. Soldiers and veterans who do not receive treatment run a high risk of a mental wound becoming entrenched into their psyche, further exacerbating their problems in living full productive lives (Hoge et al., 2004; Rand 2008).

Research on past wars has generated prevalent assessments of equal or greater percentages of PTSD to our modern wars, when taken in perspective could be considered a reasonable conjecture. Except, when we consider the time frame in which these figures arose from; we must consider the phenomenon of “delayed onset PTSD” and their additive effects to the overall burden on mental health services both in private practice and the government sector. Further hypotheses calls for an increased awareness of policies and agencies and how we can meet the oncoming mental health epidemic that our soldiers, veterans and nation face (Lee, 2006; Rand, 2008).

Not only do we have this gap in services between the government and private sector, we do not have a treatment modality based upon the most up to date research, and as if this was not enough of a hill to climb, we have unfilled mental health positions in the military and at the Veterans Administration. The government system (DOD and VA) have become inundated with an ever increasing caseload of mentally ill combat soldiers and veterans. Compounding this problem, approximately 80% of military psychology positions have been filled, along with 80% of the VA positions (DeAngelis, 2008; Statement of the Honorable Patrick W. Dunne, 2007). The figures above do not reflect on other mental health service practitioners.

In a monograph report titled “Invisible Wounds of War” recently published by Rand (2008), preliminary studies indicate that protracted exposure to combat over multiple deployments will intensify the psychological stress upon our soldiers and the signature wounds on the modern battlefield; namely PTSD and TBI’s. As the suicide rates keep racking up, a growing concern over depression has been mounting and further research is needed to explore this additional pandemic. In the coming years we are going to see a growing trend in veteran suicides. On November 13, 2007 CBS reported that veterans between the ages of 20 through 24 have the highest suicide rate when compared to all other veterans in the War on Terror, almost four times higher than civilians of the same age. The suicide rate for non-veterans is 8.3 per 100,000, while the rate for veterans was found to be as high as 31.9 per 100,000.

Repeated deployments will have unforeseen consequences for our veterans and soldiers. Never before in the history of warfare have we exposed our soldiers to such prolonged combat and sustained deployments and redeployments with little to no down time needed for decompressing stressed out psyches. Combine this with the governments slow to respond, cavalier attitudes and dismissal of the magnitude and scope of the problem, our veterans and soldiers suffer in silence and when the killing, death and deprivation become too much to bear, they take their own lives in alarming rates. A perplexing and vexing realization; that we have too repeatedly educate the public and our government officials on the plight our veterans and soldiers face on a daily basis, while combating the government’s complete denial, as 120 of our veterans kill themselves every week (Keteyian, 2007; Rand, 2008).

Iraqi and Afghanistan veterans have been exposed to unprecedented levels of sustained combat. Never before in the American history of War have our soldiers seen three and four tours of combat as a common experience. Penny Coleman, author of Flashback: Posttraumatic Stress Disorder, Suicide, and the Lessons of War testified before the House Committee on Veteran’s Affairs on December 12, 2007,

My name is Penny Coleman. I am the widow of Daniel O’Donnell, a Vietnam veteran who came home from his war with what is now known as PTSD and subsequently took his own life. I use the term PTSD grudgingly—it is the official term, but it is deeply problematic. My husband did not have a disorder. He had an injury that was a direct result of his combat experience in Vietnam. Calling it a disorder is dangerous; it reinforces the idea that a traumatically injured soldier is defective, and that idea is precisely the stigma that keeps soldiers from asking for help when they need it (Statement of Penny Coleman, 2007).

She goes on to report that more than 6,200 veterans commit suicide each year. In Washington D.C. the Vietnam Memorial wall has over 58,000 names emblazon its back granite wall. Taking the figures above we can calculate more than 180,000 veterans has committed suicide since the Vietnam War ended more than 35 years ago. The VA system is poorly underfunded and not ready to take on such a high level of veterans needing mental health care as we will see in the next 10-20 years (Fischer & Reiss, 2006; Frosh, 2005; Keteyian, 2007).

Kentucky holds two major military bases where many soldiers need help but cannot or will not seek help. Further widening the barriers to care, private practitioners do not have adequate integrative therapeutic skill sets based on the latest up to date research to engage this population.

Government and Private Service Providers
Soldiers and Veterans Stuck in Between
National Defense Authorization Act of 2008, Public Law 110-81, language was added that requires a study of the clinical qualifications of Licensed Professional Counselors (LPCs) and outline regulatory policies to provide guidance on private practice. LPCs can practice under the umbrella and scrutiny of TRICARE, a triple option benefit plan available for military families. The crux of the issue with serving our servicemembers and families lies in obtaining independent practice authority. The policies as they stand today effectually block service members from receiving proper mental health care. The oppressive doctrine of the DOD and TRICARE leaves servicemembers vulnerable to repeated post-traumatic decline while wading through a sea of authorizations, regulations, and additional fees stemming from physician appointments to receive sanctions for mental health care (Kieffer, M., personal communication, February 22, 2009; American Counseling Association (ACA), Access, 2009).

The governmental bureaucracy inhibits and discriminates against LPCs in that they have similar training and education as other clinical professionals who practice on a master’s level. They must work under direct supervision of a primary care physician who has not received specialized training to adequately oversee mental health services. Further, to access TRICARE the soldier must receive a referral from their primary care physician and even then approval of such allocates only 10 sessions before they must go back and achieve approval for additional help. With a shortage of specifically skilled practitioners in mental health, the soldier suffering from post-combat stress faces hurdles that he or she may not be able to cope with. With the convoluted system of today we miss out on access to over 100,000 qualified mental health counselors on a national scale (Kieffer, M., personal communication, February 22, 2009; ACA, Access, 2009; ACA, Progress, 2009).

Recently a bill was introduced, H.R. 952: Combat PTSD Act of 2009 that establishes the definition of,

‘combat with the enemy,’ for purposes of proof of service-connection for veterans’ disability compensation, as service on active duty: (1) in theater of combat operations during a period of war; or (2) in combat against a hostile force during a period of hostilities.

In designating a succinct criterion for activities in a war zone, the Act lifts the burden of proof from the servicemembers or veteran. In doing so, the veteran or soldier can expedite service-connection compensation and receive treatment conducive to their symptomatology.

Harvard University (2007) dispensed a report with conclusions that (a) the Veterans Health Administration (VHA) has been overrun with help seeking veterans and will not be able to meet the increasing needs of combat veterans without a substantial increase in funding. (b) The Veterans Benefits Administration (VBA) has been struggling with a high volume of pending claims and do not have the capability to process the current pending claims. A tsunami of returning veterans will inundate the capacity of the VBA and will jam up the system further. (c) A budget of $350 to $700 Billion expenditure will be required to cover treatment over the course of the Iraqi and Afghanistan veterans lives. “Key recommendations include: increase staffing and funding for veterans medical care particularly for mental health treatment; expand staffing and funding for the ‘Vet Centers’ and restructure the benefits claim process at the [VBA]” (Harvard University, 2007, p. 1). The VA has acknowledged that “waiting lists render that care virtually inaccessible.” When the projected 700,000 veterans reach an already overwhelmed VA, the care will considerably drop and possibly leading to more suicides.

Joshua Omvig Veterans Suicide Prevention Act of 2007 recognizes the urgency of establishing new training initiatives and programs to combat the veterans and soldiers taking their own lives can and should be avoided with proper interventions. The Act designates a comprehensive program for suicide prevention; including Suicide Prevention Counselors, best practices research, sexual trauma research, establishes a 24-hour hotline and mental health care, outreach and psychoeducation for veterans and families and a peer support program. “The high rate of using mental health services among Operation Iraqi Freedom veterans after deployment highlights challenges in ensuring that there are adequate resources to meet the mental health needs of returning veterans” (Hoge et al., 2006, p. 1023).

Resources
American Counseling Association, Office of Public Policy and Legislation. (2009).
Access to Counseling Department of Defense’s TRICARE Health Services Program (Position Papers). Washington, DC, February 2, 2009 (No. 02.02.09). Atlee, P.

American Counseling Association, Office of Public Policy and Legislation. (2009). Progress on Implementation of New Veterans Affairs Law (Position Papers). Washington, DC, March 20, 2009 (No. 03.20.09). Atlee, P.

Harvard University: John F. Kennedy School of Government. (2007). Soldiers returning from Iraq and Afghanistan: The long-term costs of providing veterans medical care and disability benefits. (Issues Brief No. RWP07-001). Chicago, Illinois: Bilmes, L.

Brook, T. V. (2008, August 12). Report: 57% of troops sent on combat tours. USA Today. Retrieved October 12, 2008, from http://www.navytimes.com/news/2008/08/gns_deployments_081108/

Congressional Research Services (2008). United States military casualty statistics: Operation Iraqi Freedom and Operation Enduring Freedom. CRS Report RS22452. Retrieved on October 29, 2008, from http://assets.opencrs.com/rpts/RS22452_20080909.pdf

Combat PTSD Act of 2009, H.R. 952, 111th Cong., session 1 (2009).

DeAngelis, T. (2008). Psychology’s growth careers [Electronic version]. Monitor on Psychology, 39(4), 64-7.

Fischer, C. & Reiss, D. (2006). Battle at home. Registered Nurse: Journal of Patient Advocacy, 102(8), 14-21.

Frosh, D. (2005, January 6). Soldier’s heart: Thousands of Iraq War veterans will come home to face serious psychological problems and a system that may not be ready to help them. Tucson Weekly, Feature Article. Retrieved April 15, 2009, from http://www.tucsonweekly.com/tucson/Currents/Content?oid=64343

Hoge, C. W., Castro, C. A., Messer, S. C., McGurk, D., Cotting, D. I. & Koffman, R. L. (2004). Combat duty in Iraq and Afghanistan, Mental health problems, and barriers to care. The New England Journal of Medicine, 351(1), 13-22.

Hoge, C. W. & Castro, C. A. (2005). Impact of combat duty in Iraq and Afghanistan on the mental health of U.S. soldiers: Findings from the Walter Reed Army Institute of Research Land Combat Study. In Human Factors and Medicine Panel Symposium: Strategies to maintain combat readiness during extended deployments – A human systems approach (pp. 11-1 – 11-6). Neuilly-sur-Seine, France: RTO.

Hoge, C. W., Auchterlonie, J. L., & Milliken, S. M. (2006). Mental health problems, Use of mental health services, and attrition from military service after returning from deployment to Iraq or Afghanistan [Electronic version]. Journal of the American Medical Association, 295, 1023-1032.

Joshua Omvig Veterans Suicide Prevention Act of 2007, Pub. L. No. 110-110, § 121 Stat. 1720F (2007).

Kaplan, A. (2008). Untreated vets: A “Gathering Storm” of PTSD/Depression [Electronic version]. Psychiatric Times, 25(12).

Keteyian, A. (2007, November, 13). Suicide epidemic among veterans. CBS News. Retrieved on April 15, 2009, from http://www.cbsnews.com/stories/2007/11/13/cbsnews_investigates/main3496471.shtml

Lee, S. A. (2006). Effects of combat on returning veterans. Unpublished manuscript, Jefferson Community and Technical College at Louisville Kentucky.

Mental Health Advisory Team [MHAT] V. (2008). Operation Iraqi Freedom 06-08. Office of the Surgeon Multi-Nation Force Iraq and Office of the Surgeon General United States Army Medical Command.

Monahan, J. J. (n.d.). Panel finds vets not seeking help: Hidden wounds unreported. Telegram and Gazette. Retrieved April, 13, 2009 from http://www.telegram.com/article/20090115/NEWS/901150680/1116

National Center for PTSD (n.d.). The unique circumstances and mental health impact of the wars in Afghanistan and Iraq. Retrieved December 23, 2008, from http://www.ncptsd.va.gov/ncmain/ncdocs/fact_shts/fs_iraqafghanistan_wars.html

Powers, R. (2005). Deployment rates, United States military. About.com. Retrieved on December 26, 2008, from http://usmilitary.about.com/od/terrorism/a/deploymentrates.htm

Rand Corporation (2008). Invisible Wounds of War: Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery. Retrieved December 23, 2008, from http://www.rand.org/pubs/monographs/2008/RAND_MG720.pdf

Statement of the Honorable Patrick W. Dunne, Rear Admiral, U. S. Navy (ret.), Assistant Secretary for Policy and Planning, U. S. Department of Veterans Affairs: Hearing before the Subcommittee on National Security and Foreign Affairs, Committee on Oversight and Government Reform, U. S. House of Representatives, 110th Cong., 1 (2007).

Statement of Penny Coleman, Author of Flashback: Posttraumatic Stress Disorder, Suicide, and the Lessons of War: Hearing before the Committee on Veteran’s Affairs, U. S. House of Representatives, 110th Cong., 1 (2007).

Veterans for America (n.d.). Talking points: The consequences of churning & weekend warriors to frontline soldiers. Retrieved October 29, 2008, from http://www.veteransforamerica.org/wp-content/uploads/2008/04/talking_points.pdf

Veterans for America (2008). The Alaska Army National Guard: A “Tremendous Shortfall.” Retrieved April, 2009, from http://www.veteransforamerica.org/wp- content/uploads/2008/10/vfa-alaska-ng-report.pdf

Veterans for Common Sense & Veterans United For Truth, Inc vs. Veterans Administration, C- 07-3758-SC, 2007 U.S. Dist.

This is What I Thought to Say as He Walked Away

As some of you may know, I attend college at the University of Louisville. I park my car at the stadium parking lot and have to ride the bus to classes and back. When I climbed on the bus, in front of me I noticed a young man that had a Marine lanyard hanging out of his pocket. I wanted to tell him welcome home brother...But, I did not do so. Instantly my mind went to what I would say if he said his brother or sister was a marine...



This is what I thought to say as he walked away...

To all who lost a brother, sister, mother, father, son or daughter. Thank you for your sacrifice. Your continued devotion is not a hallow loss. You sustain their honor, to carry the torch of service to this great nation. By doing so you illuminate their enduring service to this country.

Your servicemember died for a cause they once believed. Carry this cause for they have laid down their lives so that you may battle on.

I will never forget you.

Somatoform Disorders, Service-Connection Compensation and Fill in the Blank

I received this comment on my companion site over at A Soldier's Perspective on an article titled "Magically on November 17, 2008 after 17 years, Gulf War Syndrome Does Exist." The commenter was acknowledging my astute observations into my physiology and some research to back it up. I thought my comment had some prevalence in other matters, such as filing for disability, service-connected compensation and SSDI. So fill in the blank on your particular subject and well...read on.

I am also a Gulf War vet, was exposed to the PB pills, Anthrax, Oil-burning fields, a scud missile was also intercepted by a patriot missile over my compound. I am 40 years old, and have been suffering from Chronic Fatigue, Muscle and Joint pain throughout my whole body, Sleep Disorders, Depression, Anxiety and Panic Attacks which all of these symptoms occurred shortly after my return from the Gulf; for years I've been told that it was all in my head, recently I places a claim with the VA and was originally awarded only 20% for Muscle and Joint Pain, they categorized this under Fibromyalagia, I went for an Upgrade and was awarded for 40%. To this day, I am unsure if I have been diagnose properly and would like to know what I should do now? I suffer everyday from pain throughout my body, I have been through 2 failed marriages and sometimes I just don't want to go on. I can't afford to file for SSDI, because my family will suffer as well. WHAT DO I DO?????

Long after the war ends, the battle still rages. First of all, welcome home brother. Keep fighting, do not give in too the pain and madness. You are worth every battle fought, including the day to day struggle of daily living.

You say you have a family, right? They do not care how much money you make. They do not assign your worth to them in the form of dollar bills. They want their father or mother. They want you to be as healthy as you can.

Call the VA and get some help with your feelings of hopelessness. If you do not like the therapist assigned (try at least 4 sessions, unless they are totally insensitive), you can fire him/her and get a new one. Ask for the form to change therapists at the front desk.

If you are on antidepressants they can sometimes lose their effectiveness after several years, go back to your psychiatrist and start a new regimen of medicines and keep trying until you find the medicine that works. I tried 9 different medications over 18 months until I found a medication that would work.

Fibromyalgia, an illness that has a psychiatric component connected to physiological symptoms–meaning it is not all in your head. I used to think that somatic disease, which fibromyalgia is classified as, was a way for the doctors to discount my PTSD. But, after much research I have found that is no the case. Here is a paper I found on the subject:

Narrative Review: The Pathophysiology of Fibromyalgia

Here is a resource that has many traditional and nontraditional remedies. The author of this site has Chronic Fatigue Syndrome and through many years of research and treatments she has devised an approach that has put her symptoms almost completely at bay. You can contact her through her website and email her, she would be happy to give you advice.

Healing Combat Trauma

If you have to file for social security, then do so. You have probably worked for most of your life. I am pretty sure that fibromyalgia is a condition that qualifies to receive early retirement from social security, not SSDI. I have a friend that just recently received early retirement from social security for bi-polar, full retirement benefits, $1,300 a month for my friend.

If your claim has been within a year you can appeal the award and could quite possibly receive more. almost 90% of all appeals are won, the rating system has the same mandate as the VA bureaucracy, PROTECT THE BUDGET. Even if you are awarded service connection, you can still appeal it for a higher percentage.

Another suggestion, if your 40% rating has been over a year, go to a civilian doctor and have him/her assess your condition and use that as new evidence to open a new claim. Show this doctor your medical file and he/she should be able to better assess your condition. You can get your complete file from the records office at your nearest VAMC, then separate all the information that does not pertain to your fibromyalgia C and P exams and your treat for this condition since then. If you have two or more C and P exams from the separate ratings then include these documents for the civilian doctor.

My last suggestion, do research, type this into your Google search, without the brackets [fibromyalgia filetype:pdf] and you will only receive PDF files on the subject. You will find more peer reviewed research doing this, you can substitute any key words in place of fibromyalgia. You will find both sides of the argument, for and against as is with any point of research. Combine terms to narrow your search, such as [fibromyalgiatreatment filetype:pdf], or any other words such as antidepressants.

National Former Prisoner of War Recognition Day

Yesterday was proclaimed to be National Former Prisoner of War Recognition Day, by our new and honorable President Barack Obama. May God bless their hearts, souls and troubled minds, for I know that I could never completely understand what they face in pursue of daily activities since their captivity. Your continuing sacrifices have finally been recognised as a tribute to your fortitude and resilience. I will never forget.




NATIONAL FORMER PRISONER OF WAR RECOGNITION DAY, 2009

- - - - - - -

BY THE PRESIDENT OF THE UNITED STATES OF AMERICA
A PROCLAMATION

American prisoners of war exemplify the courage and sacrifice that define our men and women in uniform. These brave warriors have paid a massive share of the costs of freedom, and our Nation will be forever in their debt. Today we honor all prisoners of war by recognizing the tremendous sacrifices made and the hardships endured by those who fight for our freedom.

American prisoners of war have experienced extreme conditions across the world and many have made the ultimate sacrifice. Sixty-seven years ago, in the midst of World War II, nearly 12,000 Americans and 76,000 Filipinos were captured while defending positions on the Bataan Peninsula in the Philippines. As prisoners of war, they endured the Bataan Death March, suffering starvation, torture, and unspeakable conditions. Thousands were randomly executed and many perished on this journey. During the Korean War, more than 1,600 Americans died under grave conditions at the Pyok Tong camp. In Vietnam's Hoa Lo Prison — the infamous Hanoi Hilton — Americans endured torture and other forms of inhumane treatment.

There are countless tales of the bravery of American prisoners of war — of the burdens borne, of the acts of heroism. These individuals have made great sacrifices and have demonstrated an enduring faith in themselves and in the United States. Their commitment calls out to all Americans to live up to our Nation's highest ideals and to serve our fellow citizens with equal selflessness and honor. We will never forget their sacrifices. Their spirit of service will inspire the American people for generations to come.

NOW, THEREFORE, I, BARACK OBAMA, President of the United States of America, by the authority vested in me by the Constitution and laws of the United States, do hereby proclaim April 9, 2009, as National Former Prisoner of War Recognition Day, and I urge all Americans to observe this day of remembrance with appropriate ceremonies and activities.

IN WITNESS WHEREOF, I have hereunto set my hand this ninth day of April, in the year of our Lord two thousand nine, and of the Independence of the United States of America the two hundred and thirty-third.

BARACK OBAMA

A Cocktail of Therapies, Does It Help Our Soldiers and Veterans?

A cocktail of therapies. The thing is that many practitioners themselves stop at coping strategies and basic psychotherapies. Chronically traumatized persons will respond to these therapies and receive much needed relief from major--presenting--symptomology. By not addressing the underlying dissociated parts of the personality that drove the presenting symptoms, the survivor will be left with forever coping with and managing the structural dissociation and intrusive mental machinations.

Without appropriate interventions and therapies to address the structural dissociation, such as the Phase-Oriented approach, this can lead to post traumatic decline and periodic relapses of crisis and revictimization. The Phase Oriented Treatment modality concentrates on first, the aspects of cognitive restructuring and attaining the necessary skills to weather the stresses and resistance of reintegration of the personality.

A diagnosis of PTSD, or complex PTSD, becoming a diagnosis and broaching on borderline personality disorder. The chasm has left us with a dissociated understanding of the underlying processes driving the insanity of the one with PTSD, and branded by a fragmented trauma terminology base within the profession further impedes treatment.

Misinterpretations and a misconstrued understanding of the nature of Trauma Based Disorders, which lies on a spectrum where simple PTSD (primary structural dissociation), Complex PTSD (secondary structural dissociation), Dissociative Disorder Not Otherwise Specified (DDNOS, a more elaborated form of secondary structural dissociation) and Dissociative Identity Disorder (tertiary structural dissociation) which comprise the diagnostic criteria in relation to the Theory of Structural Dissociation of the Personality. Feeding into this confusion, the DSM-IV schedule separates the diagnosis’ in differing categories with seemingly no associations or connections.

Intrinsic in this spectrum of maladaptive behavioral defensive complexes, the true nature of combat or complex PTSD rests in a structure of adopted defensive mechanisms from the evolutionary primitive portion of the brain which becomes fragmented, thus limiting the individual from accessing differing aspects of identity and complicated further by prior trauma as precipitating factors.

Why Do Soldiers and Veterans Seem Reluctant to Seek Help?

I have thought about this for a couple of days and did not know what to say for a minute. But then I started thinking about why I was not persistent with receiving help. My initial help seeking came from the insistence from ex-wives, on a conscious level I did not believe that I needed help even in the face of my insanity. It took many years of my flailing about to become convinced of my need for assistance.

I believe the reason for many veterans reluctance to receive help, on the internet or in the office has to do with the inherent denial of PTSD coupled with the stigma attached. We survived the most intensive environment that a human can endure; combat, killing and mayhem. How can we succumbed to an unseen foe? Unimaginable and enduring ghosts that chase us unrelenting, a perfect machination for denial.

If I do not acknowledge it, I will not have to deal with it. Except that when we do not fully realize a part of our selves then we run the risk of being led by an unrecognized part of self that now becomes an entity within, influencing our thinking and behavior. A self perpetual and elusive presence populating the mind.

Another key issue we have, trust. We have an aversion with trusting anyone that do not think like us. In combat we formed the most intense bonding that a human can experience, a total and unrelenting commitment to a guardianship between squad members. I refer this as the "troop organism", we feel great pain in the loss of our appendages, both in a KIA and in going home without the "rest of us".

The mystifying experience of posttraumatic decline involves a sense of confusing reexperiencing and intrusive thinking from a disowned side of the personality. The part of us that we do no accept as our own, we deny its existence, we cannot accept that we have a killer inside of us. This disassociated self, the combat self, insists on interjecting itself into our daily life. In a battle with no solid enemy and no apparent battleground the warrior having been trained to combat the physical comes in contact with a foe that can overshadow the imagination. A pitched battle between denial and acceptance can rage for many years.

Even after many attempts to receive help, I was not equipped to begin therapy, so I would quit before a diagnosis could be assigned. In the VA before a service connection can be determined the veteran must endure many forays into the stressors that caused the posttraumatic stress reactions. Doing so without many months or even years of psychoeducation and cognitive restructuring therapy can be detrimental and harmful to the veteran, exacerbating their condition.

Combat Rage and What We May Do With It

I want the reader of this post to know that I am writing about the combat veteran with a severe form of PTSD. Not every combat veteran will fit this category, as a matter of fact most combat veterans do not fit this category. Even though most combat veterans will not experience this degree of symptomology, many will feel several of these symptoms and feelings.

To put a finger on what combat rage feels like and the disconnection between the veteran is problematic in that the separation from such disables the feeling of this affect. Try and imagine a time when you felt an extreme distance to your own feelings and envision, then expand it to a gulf. Now, the anger or rage we all have in us takes a matter of triggering by an extreme stress situation to disengage and embark on evolutionary defensive mechanisms; a survival fight or flight defense. Suppress the flight part and you are coming closer to the realization of fight or die, this switch goes off and now the training kicks in and you become guided by your warrior self, a world of black and white, a dichotomy of kill or be killed. Fueling this fire is the consumption of rage, anger multiplied, like an electromagnetic coil holding the boiling and broiling plasma of fear, rage and humanity in such a precise way as to be utilized to do what needs to be done. Kill or be killed without consideration of another's life other than yourself and your squad.

Now remove this person from the battlefield and look through his/her eyes and tell me of the total ambiguity and discord in society you see and now feel the fight within self to let loose the rage and exterminate all that does not fit the afore mentioned narrow field of forgotten battlefield schemata. Now the real battle begins, fighting for your life when you know the simple rules of kill or be killed verses and weighed against societies norms, now you can do nothing but feel the rage, fear and your humanity. But what do you do with it? Where do you put it?

In combat you project it into the enemy and forgot instantly as you spray lead through the use of controlled anger, rage and fear into a 'combat othering.' Othering is simply the development of placing oneself above another, the mechanism of wielding the tools of oppression in society, or death and destruction in the killing fields. In combat we place the supposed deserving of hot lead into the enemy, we place upon them the responsibility of our actions, we wholly demonize them to save our battle buddies and ourselves. Back in society we no longer have that repository to dump into, we now turn this shell we call a body into the demon, we become the demon, we are the demon. Now we perceive many threats everywhere, including the demon hosted by the facade of me. This conglomeration of selves is inadequate and maladjusted in regular society and can lead to chronically dissociating from self, community and society.

With chronic cycling through anger, rage, hyperarousal, and fear by a misattuned self regulator within the person, we can find ourselves succumbing to the demon without knowing why or how. Our world has been turned upside down and in combat we surrendered to this perspective, but back in society we still have this perception of the world that looks and feels "wrong" and having already adopted this vision in the battle zone, we still operate from this intense sense of right and wrong which triggers in us the demon. On the surface where we now reside we see only the ripples of a foreboding tsunami of emotions. The momentum of such a wave sends us roiling along until we hit the shallow end of coping and then seemingly out of nowhere the hundred foot wave rises above and rolls out over everything and everyone.

The veteran battling this probably does not understand it themselves. With regards to the rage and anger, this disconnect happens on several levels. One level we can feel it welling up and the fear entangles with it, which we can suppress most of the time, except that our loved ones will notice a difference in our demeanor and behavior. A deeper level we feel it slipping, sliding off uncontrollably, succumbing to an even deeper level, where all emotions and affect leaves and we switch over to our combat selves. We have checked out, no longer in command of our facilities and we have returned back to the killing field in all sensory levels except in body. Our mind smells, sees, hears, tastes and feels the acrid pending doom of combat, we have left our body and given over to the demon.

Hope this helped, it seems that the best way to describe it was through metaphors.