June 24, 2009

Consider that War, Combat and Killing Most Would Find Abhorrent

Imagine the effects of combat, killing and war might have a repulsive air.

Imagine the perception of killing feeling like an odious gust we must breathe.

Imagine this life sustaining element having this abhorrent component, as you try and refrain from breathing.

But know that eventually you must. For without it, you will expire.

Consider that war, combat and killing most would find abhorrent.

June 23, 2009

Reconciling our Combat Past with our Present Presense

Today I received an email from a reader who had some questions. She has a Iraqi veteran friend who had returned in 2007 from back to back deployments. Just recently he had opened up and sent her an email of some pictures he had of his Humvee after it had hit an IED, he was the only survivor. She asked these questions,
Any advice what to say or not say? Do you agree him showing me the pictures was important? Why now two years later does he send the pictures?
Below, my email in response,

When you said,
I simply told him thanks for sharing the pics, that I am really glad he is still here, and clearly he is still meant to be here.you expressed a heartfelt answer. I do not know if I could have scripted a better response.

I do agree that his showing you the pictures is of significant importance. When your veteran shared the pictures with you he opened the door for an interpersonal exchange on the subject. That being said, I would reserve talking to him about the pictures and shared revelations until the right moment. I have been talking about this "right moment" for the last month or so with my sons, girlfriend, family and friends. Your questions on when to talk or broach the subject of combat experiences reaffirms a divine presense in my life.

The right moment will arise and become recognizable when it materializes. It will be more of a 'feeling' or emotional response to something said, done or expressed. It may be when he further shares his mindfulness and opens his heart to you. I would reserve bringing the subject up due to his emotional stability may not be at a high enough level to respond positively. If you remain in the moment or feel an empathetic resonance between the two of you, you will know when the right moment appears.

As for his waiting two years later to show you the pictures. When we go to combat it changes us completely; we have attained a different operational system based on a combat values structure, we have bonded with our battle buddies on a closer level than we ever thought possible and potentially more so than we know ourselves. A brotherhood born of blood.

Additionally, while in the battlefield we have this fantasy of life back home and hold to it as though it has not changed. We come home having expectations of our significant others, wives, husbands, children and family to be as they were. Yes we have been told to expect these changes. But, coming home with our new perspective of life we find that we have stepped off into an alien world where everything looks as it did before but now seems distant even though we are near.

Everyone that depended on us has grown accustomed to filling this void with others or have grown to be independent. We now try and fit back into the shoes we once filled only to find that they fit uncomfortably and cause us pain. It takes time to adjust back into our lives and make peace with what we have seen and done while reconciling it with our present.

We miss our past selves and past lives, our brotherhood and our sense of security.

June 12, 2009

Review: Eye Movement Desensitization and Reprocessing (EMDR) in the Treatment of War Veterans

Silver, Rogers and Russell (2008) outline EMDR as an “eight-phase therapeutic approach” based on the Adaptive Information-Processing (AIP) model to treat combat veterans. The foundation of EMDR resides in the clients “neurologically based information processing” (Silver, et al., 2008, p. 948) center and employs an “adaptive resolution” mechanism from the neuroprocessor to resolve traumatic memories by utilizing the two underlying cognitions of adaptation; accommodation and assimilation. Accommodation involves the modification of our internal representations to adapt our normal operating schema. Assimilation involves utilizing an old schemata in a novel way.

When the individual traumatic experience such as combat, the mind begins to lose concordance with the internal operating system and equilibrium begins to unravel into trauma induced sequelae. EMDR seeks to reconcile the traumatic memories into a more collective consciousness within the individual by unblocking the portion of memory that has become entrenched. The combination of EMDR coupled with the AIP model corrects maladaptive behavior and cognitions through an adaptive resolution of the triggering stressor and the unprocessed memory that cause abreactions within everyday living.

The authors provide a brief overview of each phase in relation to the clinician’s main goals and expectations of the combat veteran. The treatment begins with a client history centering on the presenting problem(s), expressively the history of stressors and triggers. During the second phase the clinician prepares the client by educating her in what to expect, the clients role in treatment, information of EMDR and stress reduction techniques. An assessment follows in the third phase, concentrating on a goal-directed triggering of the patient’s affect through the client talking about the major stressors. The client has been given directions to deliberate on imagery, negative emotions and thoughts, and corporal sensations thus leading to the desensitization process.

During this step the practitioners expound on a key tenet of the procedure; the patient controls the therapy sessions and can at anytime halt the treatment. The fourth phase represents a fluid exchange between the client and the clinician where initially the patient is directed to speak of experiences shared in the history and assessment phases. The client has been informed that they do not need to disclose detailed dissections of the memories; a superficial discussion of the memories holds enough salience to stimulate eye movement. The practitioner employs a technique known as bilateral stimulation; a combination of eye movements, sounds and physical tapping to induce information processing to combine associated memories. This process proceeds until a complete resolution has been achieved. In phase five the helper helps the consumer to consolidate a new self affirmation in relation to the original stressors and formulate a novel experiential connexion to replace the trauma driven script.

The next step seeks to check bodily sensations to explore the need to reverse direction in phases or to go forward. Phase six involves a “body scan” whereby the client is directed to concentrate on the presenting problems and the newly associated positive perceptions. Bilateral stimulation can be implemented during this phase when bodily sensations do not match congruently with the recently identified cognitions. As with all therapies a closure needs to be ensured. The seventh phase addresses unfinished processing, covers the use of stress reduction and the probability of possible processing between sessions. The eighth phase includes a reevaluation and assessment to see if additional sessions would be needed to continue unprocessed memories, sensations, emotions and imagery.

In the article the authors chose to leave out two of the techniques in bilateral stimulation, the use of sounds and physical taps. I found this to be concerning, but not surprising as to the historical handling of the bastard child of psychological etiology of somatic disorders and related sequelae. Other considerations I encountered were their conclusions that EMDR therapy was “especially useful during combat situations” (Silver, et al., 2008). The article spent much of its time explaining the therapy and only one paragraph to state the argument in one of the main points in the abstract; that homework would not be necessary for using EMDR and would prove useful in a combat zone.

Considered an evidence-based practice, EMDR has weathered the storm of critics and naysayers and has attained the approval and endorsement of governmental and private entities including but not limited to the Veterans Administration, the Department of Defense and the American Psychological Association. Since the treatments inception in 1989, the efficacy has been proven to a high standard. Silver et al. (2008), reports of research on combat veterans has resulted in remission rates as high as 77% of PTSD patients. After 3-month and 9-months follow-up testing were reported to maintain the positive effects of the treatments.

One of the most interesting aspects of EMDR was the capacity to treat concurrent diagnosis such as depression and anxiety disorders in the same sessions with no distinctions made. Another feature I found that entice my interest to learn and master this therapy was empowering the client to control the procedure, mirroring a fundamental principle in social work, the strengths perspective. The final characteristic that has attracted me was the ability to maintain a safe distance from vicarious traumatization and avoid compassion fatigue that permeates the treatment of trauma based disorders.

Silver, S. M., Rogers, S., and Russell, M. (2008). Eye Movement Desensitization and Reprocessing (EMDR) in the Treatment of War Veterans. Journal of Clinical Psychology: In Session, 64(8), 947-957.

June 10, 2009

America's Heroes at Work

I received an email the other day and was trying to come up with a synopsis to post, but then I decided to quit hurting my brain and just cut and paste. But then I had to deal with all the garbage html codes that do not compute in blogger. Blah, so I used a pdf converter and then cut and pasted. Had to go back and put the links in but it was better than decoding thousands (hundreds? probably) html garbage. So as you are wondering "What the hell does this have to with anything?" Well this is my website and if I want to ramble on then, well, you are not the boss of me!

Anywho, America's Heroes at work looks like a credible attempt to help our soldiers and veterans with invisible wounds.

e-News, Spring 2009

Dear Friends of America's Heroes at Work:

The Office of Disability Employment Policy (ODEP) and Veterans' Employment and Training Service (VETS) are pleased to update you on news related to the America's Heroes at Work initiative - an employer-focused, U.S. Department of Labor project designed to help veterans with Traumatic Brain Injury (TBI) and/or Post-Traumatic Stress Disorder (PTSD) succeed in the workplace.

  • Announcing updates to the America's Heroes at Work Web site
  • Ready-to-publish articles on TBI, PTSD and employment now available
  • Hands-On Employment Pilot matches employers and veterans with TBI and/or PTSD
  • Join the America's Heroes at Work LinkedIn group
  • Please link to America's Heroes at Work
  • Partner News: Introducing DCoE's Real Warriors campaign
  • Event Alert: National Brain Injury Employment Conference
  • Wanted: Veteran candidates for corporate mentoring program
(Full news briefs below)

Announcing updates to the America's Heroes at Work Web site

Perhaps you've noticed some changes to the America's Heroes at Work Web site, located at www.AmericasHeroesAtWork.gov. Additions include new presentations and training tools, an updated online News Room, new links to resources and more success stories about veterans with TBI and/or PTSD and the employers who hired them. Please check the site often and encourage your colleagues and stakeholders to do the same.

Ready-to-publish articles on TBI, PTSD and employment now available

One addition to the America's Heroes at Work Web site is an enhanced library of "drop-in" articles that we encourage you to customize and publish in your own newsletters, e-blasts and other publications. Article topics include how to support employees with PTSD and brain injury, as well as a veterans-focused article on finding a job and achieving success in the civilian workplace. Please check them out and consider publishing or sharing these helpful articles.

Hands-On Employment Pilot matches employers and veterans with TBI and/or PTSD

America's Heroes at Work has embarked on a new hands-on endeavor - an Employment Pilot designed to coordinate successful employment experiences for veterans with TBI and/or PTSD, while studying individual experiences. DOL's Office of Disability Employment Policy (ODEP) is managing this "learning lab" concept with support from workforce development professionals and a steering committee comprised of representatives from key federal partners. Through the Pilot, DOL will study, validate and disseminate best practices related to helping employees with TBI and/or PTSD succeed on the job. The initial phase of the Pilot will concentrate on employers and veterans located in the Greater Washington, D.C. area, all of whom will benefit from hands-on support. Workforce development professionals on the team will consult with organizations interested in employing veterans with TBI/PTSD, match them with qualified veteran workers, provide ongoing support; and monitor experiences and track best practices. For more information, visit the America's Heroes at Work Web site.

Join the America's Heroes at Work LinkedIn group

America's Heroes at Work is now on LinkedIn - the business-oriented social networking Web site. Members of the new America's Heroes at Work LinkedIn Group include employers, HR professionals, veterans and other individuals interested in connecting online to discuss TBI, PTSD and employment issues. DOL will be using the group to update members on America's Heroes at Work news, while individual group members are posting discussion topics related to employment challenges and solutions. You can join the group by visiting this link. Or, you can visit www.LinkedIn.com and search for "America's Heroes at Work" under "SEARCH GROUPS." You must have or sign-up for your own LinkedIn account to participate. (Note: LinkedIn is a non-federal Web site. The Department of Labor does not endorse; takes no responsibility for; and exercises no control over the LinkedIn organization or its views, or contents, nor does it vouch for the accuracy or accessibility of the information contained on the LinkedIn server.)--------[same goes for me to here at PASP]

Please link to America's Heroes at Work

We make it easy for you to establish a link to America's Heroes at Work on your own Web site. To do so, simply send the following link to your Web master:www.americasheroesatwork.gov/linktous.html. We provide HTML code that can easily be copied-and-pasted into your Web site. The result? A linked America's Heroes at Work logo that will enhance cross-promotional efforts and highlight your support of our initiative. Thanks for helping us spread the word about our project.

Partner News: Introducing DCoE's Real Warriors campaign

On May 21, our partners at the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE) launched a public awareness campaign to combat the stigma associated with seeking care and treatment for psychological health concerns. Conveying the campaign theme "Real Warriors. Real Battles. Real Strength," the Real Warriors Campaign Web site is located at www.realwarriors.net. The Web site features articles and resources on a variety of psychological health issues, as well as video interviews with service members, their families and others dealing with psychological health or TBI issues. America's Heroes at Work encourages you to visit the Web site and support this important campaign. In addition, the DCoE Outreach Center, available 24/7 by dialing 866-966-1020, provides information on the care and treatment of these invisible wounds.

Event Alert: National Brain Injury Employment Conference

DOL's own Ron Drach, director of Government and Legislative Affairs for the Veterans' Employment and Training Service, will be speaking at the third annual National Brain Injury Employment Conference June 17-18, 2009 in Denver, Colorado. To learn more about this conference, visit the conferenceWeb site.

Wanted: Veteran candidates for corporate mentoring program

American Corporate Partners (ACP) is on the lookout for transitioning service members and veterans to participate in its nationwide mentoring program. ACP is a mentoring initiative dedicated to helping veterans transition from the armed services to private enterprise through career counseling and networking. Currently, ACP has more than 300 mentors across the country available to work with veteran proteges. Mentors are employees of leading U.S. companies including GE, PepsiCo, Verizon and others. To learn more, please visit: www.acp-usa.org.

This issue of e-News brought to you by America's Heroes at Work--www.AmericasHeroesAtWork.gov.

June 5, 2009

To Buckle Under the Burden

A friend of mine sent this message to me on Facebook. It expounds an enlightenment on how our veterans fare from war and healing.
I'm setting up at VA last night and fixing to head back this morning. My best friends dad is in there very sick. I look into all these old soldiers and wonder why do we have to fight in war...put scars on our men that will never go away. I feel that the mental thing you all have went through is worse then any psychical trauma. I know your more religious then me so can you put (him) in your prayers. He is ready to meet his maker, but his kids and I are not.
I am sorry to hear about your friends dad. I love you my friend and hope that you and your friend find Gods loving embrace as you journey through the ritual of passing. Know the scars that we bare in our hearts and on our bodies were endured as a service to you, our community and nation. Your veteran is a testament to the resiliency of a people who give freely and embrace higher ideals with valor and an inner reserve that only God can fill.

The whole US should walk through their nearest VA and see what war does to the body, mind and soul. I go to the VA regularly and see the newest veterans from the wars in Iraq and Afghanistan. I often see them in wheel chairs, in the waiting rooms or walking around with the scars of war visible or not from traumatic brain injury (TBI), amputations, PTSD, depression, and feeling that familiar tenseness in their bodies and mind.

One particular veteran I saw had no hair due to excessive scarring on his head that radically altered his appearance. He had a leg amputated which I had overlooked due to his healed head wounds. He was not interacting with anyone, just sitting in his wheelchair and looking off into space. His parents were there with him, he could not have been older than 21 or 22. I wondered what kind of life does this man have? Does he interact at all with his loved ones, and how does he do so?

Instantly I felt an immense sense of grief and almost buckled under the burden that he and his family carry. I only imagined the worst probably because of a bias that I carry in rememberance of our modern veterans. This rage I feel is in direct conflict with the pride I feel in me and our veterans; a cold raw anger and resentment of our government that has shattered our minds and bodies. I sense the pain of our modern disabled veterans and have thoughts that diminish my experiences or think that it should shrink my suffering. I love them and feel a kinship, a closeness that I have never experienced before, a connection to someone I have never met but know all to well.