This post all fits together in some fashion or another...dissociation. If you want to discover my perspective on the whole situation, you will have to read all of the roads herein to understand your war veteran.
Dissociation is best written about and described in short and choppy details, blocks really well, because it comes and goes in clarity and can and probably will be anywhere in between. So, now try and keep up. Because now you must check the information you told yourself to remember and now you cannot forget what you just told your self too forget which gets in the way of what you would like to remember, ad nauseum.
The best way I can detail what this means for someone who has combat PTSD is to filter it through my personal experience and hopefully a bit of my wisdom sprinkled on. Since May 7th I have been writing about different thoughts that I have to get back into the "this is my life, again..." to the reality show that is my life. Have you ever watched one? You may wind up in some situations that will require your next move to either save your life, someone else's or die and not necessarily in that order. Better have your shit jacked!
I was writing about the conversation that made me realize the Central Thesis of This Website. If we are not helping our veterans who scream for help, then we are criminalizing the treatment of combat PTSD (More on this to come, hmm cool epiphany). If we can save these mens lives, then we can begin to treat them. Even though they deserve to be saved before they are jailed, become institutionalized, kill others or die at their own hands or police-assisted suicide. If we did not help them, then who's fault is that?
If we were serious about the urgency in treating our modern combat veterans, NOW. We would at this moment be unveiling a massive and expansive vision to triaging the incoming PTSD invasion.Millions going to universities who could put together grant proposals for full federal block grants. Put together a top notched stand alone proposal and you will find an endowment for the best evidence-based solutions in the treatment of complex trauma based on a holistic perspective.
Three years ago I said it when no one else was, "So, does that mean that it will be ok to have a 30-40% PTSD rate for the Iraqi War? We are now, three years into this movement and we must act now to save as many as we can.
If I had a title for this post it would be "Massive Block Grants to Fund Treatment for Combat PTSD." If we are taking the plight of our veterans and soldiers who keep falling, falling from mental wounds seriously.
Then we are committed to them as they were to us! Really, must it be a perfect world for this to happen?
Massive Block Grants to Fund Treatment for Combat PTSD, tweet it, Facebook it, past it on!
Showing posts with label PTSD rates. Show all posts
Showing posts with label PTSD rates. Show all posts
February 7, 2009
More on PTSD Rates in the War On Terror
Most existing studies define cases of PTSD and depression using criteria that have not been validated, that are not commonly used in population-based studies of civilians, and that are likely to exclude a significant number of servicemembers who have these conditions (italics added for emphasis, Rand, 2008, p. 94).
Read that last part again, “…likely to exclude a significant number of servicemembers who have these conditions (p. 94). Which will increase the percentage of veterans and soldiers who will or have developed severe mental illnesses.
Stringent screening criteria will miss not only actual cases of PTSD and depression but also subthreshold cases, individuals with symptoms of PTSD or depression who do not meet the established case definition yet (italics added) who experience significant impairment. Identifying subthreshold cases of PTSD and depression is important, since interventions and treatment aimed at these cases can reduce symptomatology and prevent progression to full diagnoses (p. 95).
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 the mental wound to become entrenched into their psyche, further exacerbating their problems in living full productive lives.
Regardless of the sample, measurement tool, or time of assessment, combat duty and being wounded were consistently associated with positive screens for PTSD (p. 97).
Our servicemembers survive wounds that would have killed them in earlier wars. Coupled with the trauma of combat and killing, the trauma of surviving such devastation weighs heavily on the individuals mind.
…research conducted many years after previous conflicts, such as Vietnam…and the first Gulf War…have produced prevalence estimates equal to if not higher than those presented here, which may be due to the emergence of symptoms over time (i.e., a “delayed onset” PTSD) or increases in treatment seeking behaviors. We hypothesize that, regardless of its cause, the need for mental health services for servicemembers deployed to Afghanistan and Iraq will increase over time, given the prevalence of information available to date and prior experience with Vietnam. Policymakers may therefore consider the figures presented in these studies to underestimate the burden that PTSD, depression, and TBI will have on the agencies that will be called upon to care for these servicemembers now and in the near future (p. 105).
Heed the warnings, the research shows that as of right now PTSD rates are equal if not higher than previous wars and that the estimations “…underestimate the burden…” (p. 105). Given this information, I again, lay claim to the oncoming mental health epidemic that our soldiers, veterans and nation face.
January 31, 2009
Statistics, Effects and the Realities of Multiple Deployments
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I finally found the data that I have been looking for. I have been scouring the internet for raw statistics on how many deployments soldiers have been on. I actually found it by not looking for it. I was checking out the website Veterans for America (VFA) and came across some reports on the strains on the Guard units fighting in Iraq and Afghanistan.
For our WWI and WWII vets it was to suffer in silence, for our Korean and Vietnam vets the denial of such suffering, and for my generation of Desert Storm vets the myth of the "Jarhead" movie as a common experience and of the denial of the Gulf War Syndrome (which was recently acknowledged by the US government) and now with our modern veterans, the effects and realities of multiple deployments.
Preliminary self-reported rates of PTSD from OIF and OEF have reached 15% already according to Hoge et al. (with a 15-40% lifetime rate after combat; Hoge and Castro, 2005 para. 2) and we continue to have naysayers saying the problem could not be as bad as we say it is. How many times have our veterans been on the receiving end of this same kind of generational denial and recrimination?
Rand (2008b) reports,
[O]f the 1.64 million service members who had been deployed for OEF/OIF as of October 2007, 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 (p. xxi).These figures taken with the above place estimate levels of PTSD today in soldiers and veterans of our nations modern wars at 23%.
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. Quoted directly from the horses mouth, the Mental Health Advisory Team (MHAT) V, the military's own 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 (MHAT V, 2008, Sec. 2.2.2, No. 8).VFA reported on October 8, 2008 that 1,321,019 soldiers had been deployed to wars abroad, 796,483 (60%) had been deployed once, and that 469,095 soldiers had been deployed 2 to 3 times (36%), and 55,441 (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.
In the monograph, a truncated report, titled “Invisible Wounds of War,” recently published by Rand (2008a),
Early evidence suggests that the psychological toll of these deployments—many involving prolonged exposure to combat-related stress over multiple rotations—may be disproportionately high compared with the physical injuries of combat. Concerns have been most recently centered on two combat related injuries in particular: posttraumatic stress disorder and traumatic brain injury. Many recent reports have referred to these as the signature wounds of the Afghanistan and Iraq conflicts. With the increasing concern about the incidence of suicide and suicide attempts among returning veterans, concern about depression is also on the rise (p. iii).The report adds,
The pace of the deployments in these current conflicts is unprecedented in the history of the all-volunteer force (Belasco, 2007; Bruner, 2006). Not only is a higher proportion of the armed forces being deployed, but deployments have been longer, redeployment to combat has been common, and breaks between deployments have been infrequent (Hosek, Kavanagh, and Miller, 2006). At the same time, episodes of intense combat notwithstanding, these conflicts have produced casualty rates of killed or wounded that are historically lower than in earlier prolonged conflicts, such as Vietnam and Korea. Advances in both medical technology and body armor mean that more servicemembers are surviving experiences that would have led to death in prior wars (Regan, 2004; Warden, 2006). 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 (p. 2).The Psychiatric Times reports a “gathering storm” due to the estimate that 70% of soldiers and veterans will not seek help from federal agencies (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.
At the website VA Watchdog, a reprint story on a Massachusetts commission found that veterans were not “receiving adequate treatment and readjustment assistance.” A summation of a member of the commission, 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 World War II or Vietnam (VAWatchdog.org).The much reported mental health screening process during processing from combat duty has little to no effect on reporting the actual numbers of soldiers who have received psychological damage.
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, Auchterlonie, and Milliken, 2006, p. 1023).Hoge et al. (2006) goes on to ponder 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 (p. 1030).Hmmmmm, let me take a wild stab at it. Take it from a combat veteran who had attempted to receive help for PTSD through the combative VA system 7 times over 15 years. The systemic denial of veterans 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.
Similarly, Hoge et al. [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 (Brit, Greene-Shortridge, and Thomas, 2007, p. 1).I witnessed this mentality of denial when looking into the eyes of my primary care and mental health personnel as I cycled through suicidal ideation, several episodes of psychosis, severe depression, addiction, homelessness, unemployability and complete disengagements from reality, society and loved ones. 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, 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 (Citizens for Responsibility and Ethics in Washington).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 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 becomes to much to bare, they take their own lives in alarming rates.
It is perplexing to realize that we keep having to do the same thing over and over again with the issues that our veterans encounter. To educate the public of the plight our veterans face on a daily basis, while combating the governments complete denial, as our veterans die each day.
December 15, 2008
The Modern Combat Veteran: Dissociative Posttraumatic Stress Disorder & Influences on Criminality
The following is a paper that I have completed for my Social Work Law class, parts of the paper I have been writing about in my blog. The paper ties together the evolution in my train of thought concerning the veteran or soldier consumed by the ravages of full blown PTSD.
The paper is long, but relevant to the plight of our returning combat soldiers and veterans. If you want to understand more about why a veteran or soldier runs afoul with law and society then you should read this.
Running Head: VETERANS, DISSOCIATIVE PTSD AND CRIMINALITY
Scott A. Lee
Kent School of Social Work, University of Louisville
November 3, 2008
The Modern Combat Veteran:
Dissociative Posttraumatic Stress Disorder and Influences on Criminality
Statistics
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). The USA Today (2008) reported that 68% of all soldiers have been deployed to a combat zone, 31% have been deployed more than once and 2,358 have had more than five tours of duty.
The United States Department of Justice (2004) reports that, “[t]he majority of veterans in State (54%) and Federal (64%) prison served during a wartime period….[that] Vietnam War-era veterans were the most common wartime veterans in both State (36%) and Federal (39%) prison.” The 57% majority of State prisoners were serving time for a violent crime compared to less than half of non-veterans who were serving less time for similar crimes. The report indicates the Iraq-Afghanistan era veterans comprise 4% of both prison populations (U. S. Department of Justice [USDJ], 2004).
Posttraumatic Stress Disorder: Dissociation and Other Considerations
PTSD is a life-long endeavor; there is no cure for it. The triggering traumatic event changes the landscape of the mind, it no longer works in the same fashion that it did before. The mind has been rewired; the neuropathways have been altered into a continuous loop. The PTSD triggering incident converts the fight or flight response in the primitive portion of our brain. Imagine having that scared feeling you get without the fear while keeping the bodily reactions; the tenseness, the adrenalin rush, the mind racing, heightened senses, and the hyper response reflex to react without thinking.
The incident that solidifies the mental wound of PTSD results in a mind numbing, or psychic shift. In response to the trauma of combat, the person needs to make a mental detachment to do what needs to be done. The survival mode of operation forgoes the higher levels of functioning and depends on the primitive reactionary portion of the brain. When this unconscious detachment has been activated to frequently or for extended amounts of time it becomes part of conscious processing and interferes with everyday interactions (Lee, 2006; and Cerone, 2006). According to Howell (2005), dissociation refers to,
A defined preconditioned set of beliefs and values, the combat schema enables the warrior to navigate efficiently through the adversity of combat without a detailed consideration of consequences. I propose a unique set of beliefs, Combat Values Theory (CVT), based on the survival of self in relation to the context of war and the “combat-othering”, for we must wholly demonize our adversary and in the process dehumanize ourselves. The combat veterans primitive fight or flight defensive mechanism has been repressed through the training in the military, conditioning the troop to take up the fight portion leaving a proclivity for violence without a concern for personal safety. Too engage in a mortal fight with the enemy this schema spells out the actions in a given situation without becoming preoccupied with survivability in the moment which could get a soldier killed.
The warrior with PTSD has grown accustomed to the value and belief systems of war and feels threatened when they become faced with having to let go of this security in an attempt to reintegrate back into society. Howell describes animal defensive and posttraumatic biological states,
The combat attachments born of blood do not leave us because we depart the battlefield; they become an empty feeling inside of us. The soldier develops a highly narrow functioning self-organization in conjunction with his or her other squad members. This organization, "troop-organism," becomes an extension of the combat-self, no different than an arm or leg. We do not will our arms or legs to move, we react from the expectations of intentional imagery based upon the combat values structure. It happens, such as the members of the "squad-herd" where each part of the troop-organism and acts in a homogeneous way, each troop becoming part of the others self-states.
These attachments to the other require a splitting within the interpersonal self-states where many such dissociated selves birth into existence, as each of the value system constructs do not match and out of necessity, develops into a complete compartmentalized persona while maintaining the "whole" sub-self organizations. Each of the self-states run parallel to one another and have the capacity of switching back and forth when the proper situation requires appropriate specialized skill sets. The interpersonal self of the civilian self becomes supplanted and filed away by the combat self due to the incompatibility of the value structures for survivability that requires a conforming from a civilian society to the norms of the combat environment.
Attachments can be considered the path to rigidity or vehicles of spontaneity; to become spontaneous the person must develop a mechanism for the free exchange of intimacy through beneficial interpersonal skill sets. Without a healthy development of attachments then disorganized attachments (d-attachments) form. The d-attachments become the mechanism to gauge interactions in the environment and in doing so they become rigid, an if this then that experiential existence. The d-attachment arraignment only allows for what can be controlled under a series of contingencies plans, or procedural knowledge, usually modeled after our parental attachments, an identification with the aggressor or other such negative role model. Becoming an identity of an exclusionary “personal culture” where the individual becomes estranged from regular society and defending their boundaries as they were national borders between two hostile countries (Howell, 2005; & Lee, 2006).
The cycle of procedural enactments play out in significant others that we allow in our lives, the reason why we keep having the same dramatizations and arguments while never finding a resolution. We enact our past roles and project them into our relationships cast from our childhood in an attempt to resolve the attachments constructively. Since we have not been shown healthy attachment enactments we reside in the cycle of d-attachments and further compound our disorders through retraumatization and or neglect, predisposing the person to develop trauma based disorders and or personality disorders (Howell, 2005).
Without a reintegration of the self and of attachments and d-attachments, a combat veteran can and will run afoul of friends, family and society. The returning combat veteran faces hurdles that they have not been trained to handle, the training and experiences they have navigated and survived will lead them to think a civilian life will be easy compared to the battle life. What they fail to realize is that they have replaced their civilian self with an operational combat value system and attachments, where in American society the individual has the utmost consideration further combining and compounding issues of integration. Little concentration on developing healthy attachment systems the untenable situation can lead the RCV with severely dysfunctional interpersonal skills and a mechanism of perpetual isolation.
Indoctrination
Combat alters and modifies the value system, a preconditioned set of beliefs, entailing a value-orientated constitute of definitions of situation in terms of direction of solutions and action dilemmas, formulating a culture of killing, stripping the combat vet of the niceties that lubricate society’s interactions, which in combat would result in death. In combat the fluidity of boundaries becomes awash in the relational adaptation to an integral cohesion with their battle buddies, a devolution of survival mindset develops and provides a sense of safety; the germination of base natural selection process by successful integration of the combat value system. With a disproportionate 56% of Army veterans incarcerated, the Army culture seems to generate people more prone to violence (USDJ, 2004).
The war zone recons the birthing of the “trooper organism,” where the firing squad becomes integrated with one other with a culture of survival. The individual boundary of the soldier submerges within the organismal boundaries of the trooper organism while shedding the individual identity. The troop organism allows for the diffusion of immense responsibility over all involved making the transition to an evolution of survival more manageable wherein the herd mentality brings forth the primitive instinctual remnants and the decentralization of obligation. Military culture portrays the combat arms military occupational specialty (MOS) as having more cultural capital and esteem. The infantry MOS with combat decorations increases the rate of promotion, rank and respectability while non-combat soldiers tend to be over looked (Lee, 2006; and Howell, 2005).
Situational Imprisonment
Military enculturalization subsumes CVT into an identification born of survival and dependent on the assimilation of the “firing squad mind set”, where one troops thoughts relates to an extension of his battle buddies. The fluidity of boundaries births the “troop organism” and forever impairs the RCV to return home without his “other selves.” Now the RCV has to try and interrelate without his relational attachments and attempts to reintegrate back into the civilian world where nothing makes sense anymore, where boundaries cross without attachments as a normative experience triggering perceived threat-states. This leads RCV to become his own “isolated island organism,” or an identity incomplete without the other part of the firing squad, that thinks, feels and acts as they do. The RCV becomes unable to interrelate with family and community in a meaningful way, impeded by the fluidity of boundaries.
As their safety has been compromised, a feeling of abject detachment has arisen from the conditioned reality of the combat organism that depended upon the battle buddy “having his back.” Therein leading to a sense of safety, the combat vet needed only to worry about their own personal “line of sight” in a battle field environment requiring a 360 degree threat radius. On his own in society this burden becomes an impossibly overwhelming sense of danger engulfing the RCV, leading to a susceptibility to triggers. A culture of 360 degree radius in the battlefield and shackled intimately with the culture of combat values, hereinto relying on the troop attachments and the evolution of survival, the RCV becomes stuck on the troop-organism functionality.
The troop-organism capacity becomes problematic to the integration of the “civilian-self” as it now has become supplanted by the “combat-self.” An attachment of the self to the self that is the identity of one whom sufficiently succeeds in suffering, completing the veteran and familial rift. The fluidity of boundaries in an intimate relationship with a loved one becomes a threat to the RCV due to the misidentification of signals between the two, one having adapted an independent perspective and the other a dysfunctional dependent state. The crossed-signals of the significant others has complicated the adaptation from independent relational skills verses over dependence and the perceived threatening self states with both parties expectations of returning to “the way it was.”
Compounding the issue, the RCV has now been conditioned to the “culture of killing” and the relational fluidity of boundaries between the two have become incompatible, further given rise to the RCV’s sense of threat as he where in combat. In combat a registering between non-compatible boundaries would be reconciled by a reflexive reactionary exercise of survival, triggering the culture of killing (Kirmayer, Rousseau, and Lashly, 2007). “Those supporting the use of culture as a defense argue that is it intrinsically unfair to judge someone exclusively by the rules and values of a society that he or she does not know” (p. 98). The above goes to the creation of a Veterans Court, where culture competency would require a special understanding of combat vets cultural “shaping.”
Criminal Behavior, Context and Responsibility
“[T]rauma exposure and symptoms of PTSD are prevalent among incarcerated veterans….[e]xposure to combat was the trauma most likely to lead to PTSD among males in a general population survey of 5, 877 individuals, [totaling] 19 percent” (Saxon, A. J., Davis, T. M., Sloan, K. L., McKnight, K. M., McFall, M. E. and Kivlahan, D. R., p. 962, 2001). Saxon et al. indicated a higher prevalence for PTSD in incarcerated veterans than the general population. Additionally veterans who screened positive for PTSD had significantly higher numbers of childhood trauma, indicating a possible correlation between peritraumas, military culture and past traumatization.
With our modern soldiers averaging two to three tours of combat, we will begin to see an increasing epidemic of incarcerated veterans. In the next 10 to 15 years the American public will see a sharp rise in veterans suffering from Post-Traumatic-Stress-Disorder, to the point of epidemic proportions. You see, never before in war have our troops been subjected to such prolonged exposure to combat and life threatening situations. In World War II our troops were fighting a defined enemy while engaging real objectives with sufficient downtime in between engagements. Most of the troops to see combat were infantry soldiers fighting on a distinct front, not the ones "in the rear with the gear". With a real threat to our sovereignty and way of life soldiers of this era were less affected by the trauma of war.
The significant political interference of the Vietnam War generated little to no tangible objectives for our soldiers solidifying and branding their levels of anxiety and forever troubling their minds. Guerrilla warfare, an inherently cognitively damaging military action compounded the neuropathic damage experienced by our troops in Vietnam. Even with the troops having regular downtime in between engagements the cognitive fractures of these veterans were enhanced by more intense combat and the rejection of our returning soldiers.
The soldiers in the Iraqi war have been sent on multiple deployments with an average of two or three tours of duty with little time in between. While in Iraq, there are no friendly countries or areas to spend leave time to relieve stress while residing on constant alert and most, even non-combat soldiers, see combat or threats on a daily basis. Now combine this with the most intensive warfare possible, guerrilla warfare in an urban environment. We get troops that are overextended and overexposed to life threatening situations within unprecedented levels of combat. Our troops in Iraq have no respite from danger, further entrenching the effects of PTSD through the hyper levels of neurotransmitters (Lee, 2008).
Dissociated attachments reenact combat trauma somatically and between interstates within the RCV resulting in a “civil war” amongst oneself. A seemingly supra-intelligent guidance of the unconscious, this device of PTSD that engages in the survival defensive mechanisms that has sustained the combat veterans life on a persistent basis. Thus becoming the protector and a “conceptualization of hostile self-states in ‘personified narcissistic and sociopathic defenses’ that defend against dependency, vulnerability, and guilt…[and]…applies just as well to pathological narcissism” (Howell, 2005, p. 224). The ‘diminished capacity’ rule would apply when dissociative episodes result in a “psychotic” break, whereby a thought disorder could be ascribed.
Diminished capacity resulting in a thought disorder would be split between two categories; one being “disturbances in the content of thinking and perceiving (hallucinations and delusions), and… [the second would be]…disturbances in the form of thinking (formal thought disorder)” (Young, 2003, para. 7). Procedural memory becomes disengaged from experiential memories where reactionary encoding enables the maladaptive somatic response encoded reactions needed during survival in the moment situations. Multiple self-states dissociate and boundaries within boundaries abound.
I am just now starting to sift through the sea of case law and journal articles on the considerations of PTSD and criminality; unfortunately I think that there will be an ever increasing need for individuals well versed in the pitfalls of combat trauma and difficulties in reintegration. I feel as you do that something needs to be done to address this issue head on, such as a Veterans Court much like the one just established in Minnesota. Additionally, we have only begun to see the tide of returning veterans with psychological troubles facing criminal charges.
Never before in the history of American warfare have we seen such high numbers of soldiers who have been under unimaginable stress. In WWII 18% of our soldiers actually engaged in combat, with Vietnam it was 30-40%, today 68% have actually engaged in combat (Veterans for common Sense & Veterans United For Truth, Inc v. Veterans Administration, item 54, & National Center For PTSD Fact Sheet, Aftermath of Violence section, paragraph 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. As high as 80-90% of soldiers (Hoge, C. W., Auchterlonie, J. L., and Charles S. M., 2008, results section, paragraph 5) have seen someone get killed, or been in a combat zone, we have reached "Combat Saturation."
Today 15% (300,000; Rand Corporation, 2008) of our soldiers and veterans have been diagnosed with PTSD and this seems like it may be a smaller number compared to other wars. 30% PTSD rates in Vietnam, 15% estimated in WWII and 15-20% of Gulf War I vets reported to have PTSD. It took Vietnam veterans up to 10-20 years before their symptoms reached the point of becoming debilitating. 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 50-60%. We will be inundated with mentally ill veterans who have few options and nowhere to turn and they will run afoul with the law (Lee, 2006).
Today we have become faced with a growing trend of soldiers and veterans becoming enmeshed in the court systems. In direct conflict with the perception in the media I propose the theory that our veterans and soldiers face an insufficient mental health care which has a major impact to their lives, families and communities. The problem is not individualistic but systemic requiring major changes in how we view and treat PTSD. The care of our soldiers and veterans is not being met and we have just begun to see the aftereffects of the mind shattering results of combat trauma. Untreated PTSD can destroy the lives of many, not only the soldier and veteran. We send our soldiers to war for our freedom and then lock them up when they are broken and of no use anymore (Lee, 2008).
Suggested Guide to Help Your Veteran or Soldier Diagnosed with PTSD
and Charged With a Crime
To whom it may concern,
I would suggest that you start researching about PTSD right away. The mind-body connection and interactions, the psychology of PTSD, defensive mechanisms, how the mind responds to trauma, the symptoms of PTSD, how extended combat (such as multiple tours served) effects soldiers and veterans, legal ramifications of criminal behavior and PTSD, the processes of the psychic split from reality and past combat experiences, how anxiety plays an everyday part of our lives, how ordinary stress can lead to higher levels of stress and extreme responses and flashbacks, the nature of flashbacks, the nature of triggers and how they apply to PTSD, and the mental compartmentalization that happens to a PTSD survivor. This is by no means a comprehensive list, but should give you some kind of idea of where you might want to start.
Like it or not, this has consumed your life by no choice of your own, instead of letting that energy overwhelm you and feeling helpless, turn that energy into a useful endeavor and focus it toward finding out as much as possible about PTSD and the effects of combat. You have more passion about this subject than anyone, use this as an opportunity to help your loved one get a fair trial and to force the courts to consider his/her mental illness as a contributing factor in their actions.
Do not take no for an answer from his/her lawyer as to your wanting to get involved in your significant others case, jump into his/her pocket and become the "paralegal" and find them the information that needed for fair consideration of the case. Most lawyers will resist this from you, again do not take no for an answer. I am guessing that the lawyer will probably be a public defender; they are overloaded with cases and cannot really give the appropriate attention that their caseload needs. So, you need to assume that role of "defender" and information detective, this can greatly impact the outcome of the trial.
Consider trying to find a high profile lawyer who will take the case on pro bono; this type of case has become a hot topic in the news and media. A lawyer might take a case for this reason and could benefit the outcome. Go to the clerk’s office and get a copy of the court case file, this will help you by becoming familiar with the states perspective on the case and what exactly is being done. Educate yourself in Miranda rights (If they violated his rights here, this could have a considerable impact on the outcome), federal constitutional law concerning 1st, 4th (emphasis here), 5th, 6th and 8th amendments, along with state constitutional law. Educate yourself on how the court works, the proceedings, when and where evidence can be brought, the questioning of witnesses and how that process is different in every aspect of the trial.
Educate yourself on case law concerning PTSD and other mental illnesses where a consideration or precedent has been set, this can be used in your case and can greatly influence what happens. Look into your state laws first as they will have the most sway, because state law guides state cases first, then look to federal law to find precedents and findings where PTSD was considered in the sentencing phase. Concentrate on first on the main trial part where the evidence and witnesses will be displayed then on the sentencing. Both of these parts of the overall court proceedings will be the most important part, your soldier or veteran’s fate will be decided between these two proceedings.
Educate yourself on and things to do:
You were born to do this; this may be your purpose in life, to be the freedom fighter for all veterans and soldiers who will face similar tribulations. You have more vested in this than anyone else, you have more to lose, do not stand by and be a spectator. Get involved and later you will not have the guilt of "I wish I had done something". A most important issue to face would be finding a support group that you feel safe with and trust. You cannot do this alone, enlist the help of as many people that you can. Contact your congressperson, senator and your local VFW, AMVETS, DAV or American Legion. This is only a suggestion for what to do. I have compiled this list and information as a suggested guide for personal empowerment.
Thank you for listening and God bless,
Scott Lee
References
Appelbaum, P. S., Jick, R. Z., Grisso, T., Givelber, D., Silver, E., and Steadman, H. J. (1993). Use of posttraumatic stress disorder to support an insanity defense [Electronic version]. American Journal of Psychiatry, 150(2), 229-234.
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/
Bourget, D., and Whitehurst, L. (2007). Amnesia and crime [Electronic version]. Journal of the American Academy of Psychiatry and the Law, 35(4), 469-480.
Buchanan, A. B. (2006). Psychiatric evidence on the ultimate issue [Electronic version]. Journal of the American Academy of Psychiatry and the Law, 34(1), 14-21.
Cercone, K. (2006). Brain based learning. In E. K. Sorensen (Ed.), Enhancing learning through technology (pp. 293-322). Hershey, PA: Information Science Publishing.
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
Hoge, C. W., Auchterlonie, J. L., and Charles 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.
Howell, E. F. (2005). The dissociative mind. Hillsdale, NJ: The Analytic Press.
Kimayer, L. J., Rousseau, C. and Lasley M. (2007). The place of culture in forensic psychiatry [Electronic version]. Journal of the American Academy of Psychiatry and the Law, 35(1), 98-101.
Lee, S. A. (2006). Effects of combat on returning veterans. Unpublished manuscript, Jefferson Community and Technical College at Louisville Kentucky.
Lee, S. A. (2008). Combat veterans and institutions: A systems analysis. Unpublished manuscript, Kent School of Social Work at the University of Louisville.
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
Mezey, G. (2006). Post-traumatic stress disorder and the law [Electronic version]. Psychiatry, 5(7), 243-247.
Poortinga, E., and Guyer, M. (2007). Criminal responsibility and intent [Electronic version]. Journal of the American Academy of Psychiatry and the Law, 35(1), 124-125.
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
Robinson, C. L. (1999). Observations on cognition and insanity [Electronic version]. American Journal of Forensic Psychology, 17(4) 63-75.
Saxon, A. J., Davis, T. M., Sloan, K. L., McKnight, K. M., McFall, M. E. and Kivlahan, D. R. (2001). Trauma, symptoms of posttraumatic stress disorder, and associated problems among incarcerated veterans [Electronic version]. Psychiatric Services, 52(7), 959-964.
Young, D. W. (2003). Varieties of thought disorder in the criminal context. Washington State Bar Association. Retrieved October 29, 2008, from http://www.wsba.org.media/publications/barnews/2003/mar-03-young.htm
United States Department of Justice. (2004). Veterans in state and federal prison system, 2004. Retrieved November 20, 2008, from http://www.ojp.usdoj.gov/bjs/pub/pdf/vsfp04.pdf
Veterans for America (n. d.). Talking points: The consequences of churning and weekend warriors to frontline soldiers. Retrieved October 29, 2008, from http://www.veteransforamerica.org/wp-content/uploads/2008/04/talking_points.pdf
Veterans for Common Sense and Veterans United For Truth, Inc v. Veterans Administration, C-07-3758-SC, 2007 U.S. Dist.
The paper is long, but relevant to the plight of our returning combat soldiers and veterans. If you want to understand more about why a veteran or soldier runs afoul with law and society then you should read this.
Scott A. Lee
Kent School of Social Work, University of Louisville
November 3, 2008
The Modern Combat Veteran:
Dissociative Posttraumatic Stress Disorder and Influences on Criminality
Statistics
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). The USA Today (2008) reported that 68% of all soldiers have been deployed to a combat zone, 31% have been deployed more than once and 2,358 have had more than five tours of duty.
The United States Department of Justice (2004) reports that, “[t]he majority of veterans in State (54%) and Federal (64%) prison served during a wartime period….[that] Vietnam War-era veterans were the most common wartime veterans in both State (36%) and Federal (39%) prison.” The 57% majority of State prisoners were serving time for a violent crime compared to less than half of non-veterans who were serving less time for similar crimes. The report indicates the Iraq-Afghanistan era veterans comprise 4% of both prison populations (U. S. Department of Justice [USDJ], 2004).
The incident that solidifies the mental wound of PTSD results in a mind numbing, or psychic shift. In response to the trauma of combat, the person needs to make a mental detachment to do what needs to be done. The survival mode of operation forgoes the higher levels of functioning and depends on the primitive reactionary portion of the brain. When this unconscious detachment has been activated to frequently or for extended amounts of time it becomes part of conscious processing and interferes with everyday interactions (Lee, 2006; and Cerone, 2006). According to Howell (2005), dissociation refers to,
the separation of mental and experiential contents that would normally be connected. The word dissociation is laden with multiple meanings and refers to many kinds of phenomena, processes, and conditions. Dissociation is both adaptive and maladaptive, both verb and noun, both cause and effect….Dissociation is often psychologically defensive, protecting against painful affects and memories, but can also be an organismic an automatic response to immediate danger….Dissociation can be understood as taxonic or, varying in degrees….It is both occurent and dispositional….It refers to such psychical events as spacing out, psychic numbing, and even experiencing oneself as floating above one’s body. Dissociation has been thought of in spatial metaphor, as acts of ‘keeping things apart’ as well as ‘vertical splitting’ (p. 18).The mind can develop into split affective regions where multiple self-states dissociate incompatible values systems and set up residence along with establishing a unified substructure within matching internal guidance systems. The dissociated subsystems run parallel to other self-states and emerge when a particular skill set needs asserting pertaining to situational interactions. Here trauma based disorders may lead the symptomology to further entrenchment and compartmentalization that may lead to personality disorders. “A war veteran with PTSD might have more significant structural dissociation, involving the sequestration of more and larger portions of experience” (p. 22).
A defined preconditioned set of beliefs and values, the combat schema enables the warrior to navigate efficiently through the adversity of combat without a detailed consideration of consequences. I propose a unique set of beliefs, Combat Values Theory (CVT), based on the survival of self in relation to the context of war and the “combat-othering”, for we must wholly demonize our adversary and in the process dehumanize ourselves. The combat veterans primitive fight or flight defensive mechanism has been repressed through the training in the military, conditioning the troop to take up the fight portion leaving a proclivity for violence without a concern for personal safety. Too engage in a mortal fight with the enemy this schema spells out the actions in a given situation without becoming preoccupied with survivability in the moment which could get a soldier killed.
The warrior with PTSD has grown accustomed to the value and belief systems of war and feels threatened when they become faced with having to let go of this security in an attempt to reintegrate back into society. Howell describes animal defensive and posttraumatic biological states,
The human animal may have a repertoire of discrete behavioral states that are adaptive to conditions of predation….[t]hese animal defense states may underlie different dissociative parts of the personality….[t]his begins a neurophysiological alarm reaction…[and]…a tendency to over read cues as threatening, which can increase the probability for violence (p. 29).The ambiguity inherent in social dynamics can lead to mixed feelings or even a lack of feelings depending on the degree of interpersonal relatedness to the returning combat veteran (RCV). We rely on our parental figures to shape healthy personality and values structures through attachments with significant others, the attachments become avenues of exchange, a distillation of proper interactions and expectations according to society norms. When this exchange becomes distorted to the point of the child becoming a repository of negative energy, instead a healthy exchange solidifying proper boundaries, then the nature of our attachments may become warped and disorganized further compounding the RCV’s reintegration.
The combat attachments born of blood do not leave us because we depart the battlefield; they become an empty feeling inside of us. The soldier develops a highly narrow functioning self-organization in conjunction with his or her other squad members. This organization, "troop-organism," becomes an extension of the combat-self, no different than an arm or leg. We do not will our arms or legs to move, we react from the expectations of intentional imagery based upon the combat values structure. It happens, such as the members of the "squad-herd" where each part of the troop-organism and acts in a homogeneous way, each troop becoming part of the others self-states.
These attachments to the other require a splitting within the interpersonal self-states where many such dissociated selves birth into existence, as each of the value system constructs do not match and out of necessity, develops into a complete compartmentalized persona while maintaining the "whole" sub-self organizations. Each of the self-states run parallel to one another and have the capacity of switching back and forth when the proper situation requires appropriate specialized skill sets. The interpersonal self of the civilian self becomes supplanted and filed away by the combat self due to the incompatibility of the value structures for survivability that requires a conforming from a civilian society to the norms of the combat environment.
Attachments can be considered the path to rigidity or vehicles of spontaneity; to become spontaneous the person must develop a mechanism for the free exchange of intimacy through beneficial interpersonal skill sets. Without a healthy development of attachments then disorganized attachments (d-attachments) form. The d-attachments become the mechanism to gauge interactions in the environment and in doing so they become rigid, an if this then that experiential existence. The d-attachment arraignment only allows for what can be controlled under a series of contingencies plans, or procedural knowledge, usually modeled after our parental attachments, an identification with the aggressor or other such negative role model. Becoming an identity of an exclusionary “personal culture” where the individual becomes estranged from regular society and defending their boundaries as they were national borders between two hostile countries (Howell, 2005; & Lee, 2006).
The cycle of procedural enactments play out in significant others that we allow in our lives, the reason why we keep having the same dramatizations and arguments while never finding a resolution. We enact our past roles and project them into our relationships cast from our childhood in an attempt to resolve the attachments constructively. Since we have not been shown healthy attachment enactments we reside in the cycle of d-attachments and further compound our disorders through retraumatization and or neglect, predisposing the person to develop trauma based disorders and or personality disorders (Howell, 2005).
Without a reintegration of the self and of attachments and d-attachments, a combat veteran can and will run afoul of friends, family and society. The returning combat veteran faces hurdles that they have not been trained to handle, the training and experiences they have navigated and survived will lead them to think a civilian life will be easy compared to the battle life. What they fail to realize is that they have replaced their civilian self with an operational combat value system and attachments, where in American society the individual has the utmost consideration further combining and compounding issues of integration. Little concentration on developing healthy attachment systems the untenable situation can lead the RCV with severely dysfunctional interpersonal skills and a mechanism of perpetual isolation.
Combat alters and modifies the value system, a preconditioned set of beliefs, entailing a value-orientated constitute of definitions of situation in terms of direction of solutions and action dilemmas, formulating a culture of killing, stripping the combat vet of the niceties that lubricate society’s interactions, which in combat would result in death. In combat the fluidity of boundaries becomes awash in the relational adaptation to an integral cohesion with their battle buddies, a devolution of survival mindset develops and provides a sense of safety; the germination of base natural selection process by successful integration of the combat value system. With a disproportionate 56% of Army veterans incarcerated, the Army culture seems to generate people more prone to violence (USDJ, 2004).
The war zone recons the birthing of the “trooper organism,” where the firing squad becomes integrated with one other with a culture of survival. The individual boundary of the soldier submerges within the organismal boundaries of the trooper organism while shedding the individual identity. The troop organism allows for the diffusion of immense responsibility over all involved making the transition to an evolution of survival more manageable wherein the herd mentality brings forth the primitive instinctual remnants and the decentralization of obligation. Military culture portrays the combat arms military occupational specialty (MOS) as having more cultural capital and esteem. The infantry MOS with combat decorations increases the rate of promotion, rank and respectability while non-combat soldiers tend to be over looked (Lee, 2006; and Howell, 2005).
As their safety has been compromised, a feeling of abject detachment has arisen from the conditioned reality of the combat organism that depended upon the battle buddy “having his back.” Therein leading to a sense of safety, the combat vet needed only to worry about their own personal “line of sight” in a battle field environment requiring a 360 degree threat radius. On his own in society this burden becomes an impossibly overwhelming sense of danger engulfing the RCV, leading to a susceptibility to triggers. A culture of 360 degree radius in the battlefield and shackled intimately with the culture of combat values, hereinto relying on the troop attachments and the evolution of survival, the RCV becomes stuck on the troop-organism functionality.
The troop-organism capacity becomes problematic to the integration of the “civilian-self” as it now has become supplanted by the “combat-self.” An attachment of the self to the self that is the identity of one whom sufficiently succeeds in suffering, completing the veteran and familial rift. The fluidity of boundaries in an intimate relationship with a loved one becomes a threat to the RCV due to the misidentification of signals between the two, one having adapted an independent perspective and the other a dysfunctional dependent state. The crossed-signals of the significant others has complicated the adaptation from independent relational skills verses over dependence and the perceived threatening self states with both parties expectations of returning to “the way it was.”
Compounding the issue, the RCV has now been conditioned to the “culture of killing” and the relational fluidity of boundaries between the two have become incompatible, further given rise to the RCV’s sense of threat as he where in combat. In combat a registering between non-compatible boundaries would be reconciled by a reflexive reactionary exercise of survival, triggering the culture of killing (Kirmayer, Rousseau, and Lashly, 2007). “Those supporting the use of culture as a defense argue that is it intrinsically unfair to judge someone exclusively by the rules and values of a society that he or she does not know” (p. 98). The above goes to the creation of a Veterans Court, where culture competency would require a special understanding of combat vets cultural “shaping.”
Taking culture into account means that the purposes of the criminal justice system—which include prevention and rehabilitation—can be achieved more effectively. Cultural awareness must be coupled with an equally astute political awareness that traces the consequences of clinical or forensic consultations out into the larger society (Kirmayer et al., 2001, p. 101).Before the Insanity Defense Reform Act of 1984, questions of the “ultimate issue” when a defendant plead insanity in federal court was whether he lacked “the substantial capacity either to appreciate the wrongfulness of his conduct or to conform his conduct to the requirements of the law” (As cited in Buchanan, 2006, p. 14). After the bill was enacted, the question now goes to whether he “appreciated the nature and quality or the wrongfulness of his acts” (p. 14). “Case law and the Rules’ legislative history suggest also that in less clear cases an issue’s ‘ultimate’ status hinges on who has the authority to decide it…because it amounted to an ‘ultimate opinion’” (pp. 14-15). Psychiatric expertise falls under the Civil Procedure Rules (CPR), Part 35, whereby the duty of the assessor, in an expert capacity, is to help the court. A mental defense with the question of competency will rely on the weight of cognitive capacities.
With our modern soldiers averaging two to three tours of combat, we will begin to see an increasing epidemic of incarcerated veterans. In the next 10 to 15 years the American public will see a sharp rise in veterans suffering from Post-Traumatic-Stress-Disorder, to the point of epidemic proportions. You see, never before in war have our troops been subjected to such prolonged exposure to combat and life threatening situations. In World War II our troops were fighting a defined enemy while engaging real objectives with sufficient downtime in between engagements. Most of the troops to see combat were infantry soldiers fighting on a distinct front, not the ones "in the rear with the gear". With a real threat to our sovereignty and way of life soldiers of this era were less affected by the trauma of war.
The significant political interference of the Vietnam War generated little to no tangible objectives for our soldiers solidifying and branding their levels of anxiety and forever troubling their minds. Guerrilla warfare, an inherently cognitively damaging military action compounded the neuropathic damage experienced by our troops in Vietnam. Even with the troops having regular downtime in between engagements the cognitive fractures of these veterans were enhanced by more intense combat and the rejection of our returning soldiers.
The soldiers in the Iraqi war have been sent on multiple deployments with an average of two or three tours of duty with little time in between. While in Iraq, there are no friendly countries or areas to spend leave time to relieve stress while residing on constant alert and most, even non-combat soldiers, see combat or threats on a daily basis. Now combine this with the most intensive warfare possible, guerrilla warfare in an urban environment. We get troops that are overextended and overexposed to life threatening situations within unprecedented levels of combat. Our troops in Iraq have no respite from danger, further entrenching the effects of PTSD through the hyper levels of neurotransmitters (Lee, 2008).
Dissociated attachments reenact combat trauma somatically and between interstates within the RCV resulting in a “civil war” amongst oneself. A seemingly supra-intelligent guidance of the unconscious, this device of PTSD that engages in the survival defensive mechanisms that has sustained the combat veterans life on a persistent basis. Thus becoming the protector and a “conceptualization of hostile self-states in ‘personified narcissistic and sociopathic defenses’ that defend against dependency, vulnerability, and guilt…[and]…applies just as well to pathological narcissism” (Howell, 2005, p. 224). The ‘diminished capacity’ rule would apply when dissociative episodes result in a “psychotic” break, whereby a thought disorder could be ascribed.
Diminished capacity resulting in a thought disorder would be split between two categories; one being “disturbances in the content of thinking and perceiving (hallucinations and delusions), and… [the second would be]…disturbances in the form of thinking (formal thought disorder)” (Young, 2003, para. 7). Procedural memory becomes disengaged from experiential memories where reactionary encoding enables the maladaptive somatic response encoded reactions needed during survival in the moment situations. Multiple self-states dissociate and boundaries within boundaries abound.
I am just now starting to sift through the sea of case law and journal articles on the considerations of PTSD and criminality; unfortunately I think that there will be an ever increasing need for individuals well versed in the pitfalls of combat trauma and difficulties in reintegration. I feel as you do that something needs to be done to address this issue head on, such as a Veterans Court much like the one just established in Minnesota. Additionally, we have only begun to see the tide of returning veterans with psychological troubles facing criminal charges.
Never before in the history of American warfare have we seen such high numbers of soldiers who have been under unimaginable stress. In WWII 18% of our soldiers actually engaged in combat, with Vietnam it was 30-40%, today 68% have actually engaged in combat (Veterans for common Sense & Veterans United For Truth, Inc v. Veterans Administration, item 54, & National Center For PTSD Fact Sheet, Aftermath of Violence section, paragraph 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. As high as 80-90% of soldiers (Hoge, C. W., Auchterlonie, J. L., and Charles S. M., 2008, results section, paragraph 5) have seen someone get killed, or been in a combat zone, we have reached "Combat Saturation."
Today 15% (300,000; Rand Corporation, 2008) of our soldiers and veterans have been diagnosed with PTSD and this seems like it may be a smaller number compared to other wars. 30% PTSD rates in Vietnam, 15% estimated in WWII and 15-20% of Gulf War I vets reported to have PTSD. It took Vietnam veterans up to 10-20 years before their symptoms reached the point of becoming debilitating. 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 50-60%. We will be inundated with mentally ill veterans who have few options and nowhere to turn and they will run afoul with the law (Lee, 2006).
Today we have become faced with a growing trend of soldiers and veterans becoming enmeshed in the court systems. In direct conflict with the perception in the media I propose the theory that our veterans and soldiers face an insufficient mental health care which has a major impact to their lives, families and communities. The problem is not individualistic but systemic requiring major changes in how we view and treat PTSD. The care of our soldiers and veterans is not being met and we have just begun to see the aftereffects of the mind shattering results of combat trauma. Untreated PTSD can destroy the lives of many, not only the soldier and veteran. We send our soldiers to war for our freedom and then lock them up when they are broken and of no use anymore (Lee, 2008).
and Charged With a Crime
To whom it may concern,
I would suggest that you start researching about PTSD right away. The mind-body connection and interactions, the psychology of PTSD, defensive mechanisms, how the mind responds to trauma, the symptoms of PTSD, how extended combat (such as multiple tours served) effects soldiers and veterans, legal ramifications of criminal behavior and PTSD, the processes of the psychic split from reality and past combat experiences, how anxiety plays an everyday part of our lives, how ordinary stress can lead to higher levels of stress and extreme responses and flashbacks, the nature of flashbacks, the nature of triggers and how they apply to PTSD, and the mental compartmentalization that happens to a PTSD survivor. This is by no means a comprehensive list, but should give you some kind of idea of where you might want to start.
Like it or not, this has consumed your life by no choice of your own, instead of letting that energy overwhelm you and feeling helpless, turn that energy into a useful endeavor and focus it toward finding out as much as possible about PTSD and the effects of combat. You have more passion about this subject than anyone, use this as an opportunity to help your loved one get a fair trial and to force the courts to consider his/her mental illness as a contributing factor in their actions.
Do not take no for an answer from his/her lawyer as to your wanting to get involved in your significant others case, jump into his/her pocket and become the "paralegal" and find them the information that needed for fair consideration of the case. Most lawyers will resist this from you, again do not take no for an answer. I am guessing that the lawyer will probably be a public defender; they are overloaded with cases and cannot really give the appropriate attention that their caseload needs. So, you need to assume that role of "defender" and information detective, this can greatly impact the outcome of the trial.
Consider trying to find a high profile lawyer who will take the case on pro bono; this type of case has become a hot topic in the news and media. A lawyer might take a case for this reason and could benefit the outcome. Go to the clerk’s office and get a copy of the court case file, this will help you by becoming familiar with the states perspective on the case and what exactly is being done. Educate yourself in Miranda rights (If they violated his rights here, this could have a considerable impact on the outcome), federal constitutional law concerning 1st, 4th (emphasis here), 5th, 6th and 8th amendments, along with state constitutional law. Educate yourself on how the court works, the proceedings, when and where evidence can be brought, the questioning of witnesses and how that process is different in every aspect of the trial.
Educate yourself on case law concerning PTSD and other mental illnesses where a consideration or precedent has been set, this can be used in your case and can greatly influence what happens. Look into your state laws first as they will have the most sway, because state law guides state cases first, then look to federal law to find precedents and findings where PTSD was considered in the sentencing phase. Concentrate on first on the main trial part where the evidence and witnesses will be displayed then on the sentencing. Both of these parts of the overall court proceedings will be the most important part, your soldier or veteran’s fate will be decided between these two proceedings.
Educate yourself on and things to do:
- Do not talk with the police or anyone else until you have talked with your lawyer, what you say will be used against you
- learn your rights and assert them, you do not have any rights if you do not know your rights
- get a copy of court case file
- get a copy of VA file and military file
- jump in your lawyers pocket
- try to find a pro bono lawyer
- individual rights, Miranda and if they were violated
- legal proceedings, structure of court formalities and rules of law
- psychology of PTSD
- case law, state and federal, concentrating on the main trial and sentencing process
- constitutional law
- legal responsibilities of the judge, your lawyer and the prosecutor
- find a support group
- contact your senator, congressperson
- contact your local VFW, AMVETS, or veterans associations
You were born to do this; this may be your purpose in life, to be the freedom fighter for all veterans and soldiers who will face similar tribulations. You have more vested in this than anyone else, you have more to lose, do not stand by and be a spectator. Get involved and later you will not have the guilt of "I wish I had done something". A most important issue to face would be finding a support group that you feel safe with and trust. You cannot do this alone, enlist the help of as many people that you can. Contact your congressperson, senator and your local VFW, AMVETS, DAV or American Legion. This is only a suggestion for what to do. I have compiled this list and information as a suggested guide for personal empowerment.
Thank you for listening and God bless,
Scott Lee
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/
Bourget, D., and Whitehurst, L. (2007). Amnesia and crime [Electronic version]. Journal of the American Academy of Psychiatry and the Law, 35(4), 469-480.
Buchanan, A. B. (2006). Psychiatric evidence on the ultimate issue [Electronic version]. Journal of the American Academy of Psychiatry and the Law, 34(1), 14-21.
Cercone, K. (2006). Brain based learning. In E. K. Sorensen (Ed.), Enhancing learning through technology (pp. 293-322). Hershey, PA: Information Science Publishing.
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
Hoge, C. W., Auchterlonie, J. L., and Charles 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.
Howell, E. F. (2005). The dissociative mind. Hillsdale, NJ: The Analytic Press.
Kimayer, L. J., Rousseau, C. and Lasley M. (2007). The place of culture in forensic psychiatry [Electronic version]. Journal of the American Academy of Psychiatry and the Law, 35(1), 98-101.
Lee, S. A. (2006). Effects of combat on returning veterans. Unpublished manuscript, Jefferson Community and Technical College at Louisville Kentucky.
Lee, S. A. (2008). Combat veterans and institutions: A systems analysis. Unpublished manuscript, Kent School of Social Work at the University of Louisville.
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
Mezey, G. (2006). Post-traumatic stress disorder and the law [Electronic version]. Psychiatry, 5(7), 243-247.
Poortinga, E., and Guyer, M. (2007). Criminal responsibility and intent [Electronic version]. Journal of the American Academy of Psychiatry and the Law, 35(1), 124-125.
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
Robinson, C. L. (1999). Observations on cognition and insanity [Electronic version]. American Journal of Forensic Psychology, 17(4) 63-75.
Saxon, A. J., Davis, T. M., Sloan, K. L., McKnight, K. M., McFall, M. E. and Kivlahan, D. R. (2001). Trauma, symptoms of posttraumatic stress disorder, and associated problems among incarcerated veterans [Electronic version]. Psychiatric Services, 52(7), 959-964.
Young, D. W. (2003). Varieties of thought disorder in the criminal context. Washington State Bar Association. Retrieved October 29, 2008, from http://www.wsba.org.media/publications/barnews/2003/mar-03-young.htm
United States Department of Justice. (2004). Veterans in state and federal prison system, 2004. Retrieved November 20, 2008, from http://www.ojp.usdoj.gov/bjs/pub/pdf/vsfp04.pdf
Veterans for America (n. d.). Talking points: The consequences of churning and weekend warriors to frontline soldiers. Retrieved October 29, 2008, from http://www.veteransforamerica.org/wp-content/uploads/2008/04/talking_points.pdf
Veterans for Common Sense and Veterans United For Truth, Inc v. Veterans Administration, C-07-3758-SC, 2007 U.S. Dist.
November 27, 2008
PTSD Rates: Part One
 |
| Image by The U.S. Army via Flickr |
I am just now starting to sift through the sea of case law and journal articles on the considerations of PTSD and criminality, unfortunately I think that there will be an ever increasing need for individuals well versed in the pitfalls of combat trauma and difficulties in reintegration. I feel as you do that something needs to be done to address this issue head on, such as a Veterans Court much like the one just established in Minnesota. Additionally, we have only begun to see the tide of returning veterans with psychological troubles facing criminal charges.
Never before in the history of American warfare have we seen such high numbers of soldiers who have been under unimaginable stress. In WWII 18% (Flashback, 2006, p. 73, War Psychiatry, n.d., p. 15; Grossman, 2007) of our soldiers actually engaged in combat, with Vietnam it was 30-40%, today 68% to 86% have actually engaged in combat (Veterans for common Sense and Veterans United For Truth, Inc, 2007, item 54, National Center For PTSD Fact Sheet, n.d., paragraph 2, and Hoge, 2004). Not only have more soldiers engaged in combat, they have been in combat longer with an average of 2 to 3 tours of duty (Boston.com, 2005, Veterans for America, 2008). Many have been on 5 tours and some as much as 6. As high as 80-90% (Journal of the American Medical Association, 2006, paragraph 5) have seen someone get killed, or been in a combat zone, we have reached "Combat Saturation."
Today 15% (300,000; Rand, 2008) of our soldiers and veterans have been diagnosed with PTSD and this seems like it may be a smaller number compared to other wars. 30% PTSD rates in Vietnam, 15% to 25% of combat soldiers "...nonfatal battle casualties...[were] neuropsychiatric" as reported in WWII by the Surgeon Generals report (as cited in War Chronicle, 1944) and 15-20% of Gulf War I vets reported to have PTSD.
It took Vietnam veterans up to 10-20 years before their symptoms reached the point of becoming debilitating. 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 50-60%. We will be inundated with mentally ill veterans who have few options and no where to turn and they will run afoul with the law.
August 5, 2008
Iraqi War Mental Health Epidemic
Image via WikipediaIn World War II our troops were fighting a defined enemy while engaging real objectives with sufficient downtime in between engagements. Most of the troops to see combat were infantry soldiers fighting on a distinct front, not the ones "in the rear with the gear". With a real threat to our sovereignty and way of life soldiers of this era were less affected by the trauma of war.
The significant political interference of the Vietnam War generated little to no tangible objectives for our soldiers solidifying and branding their levels of anxiety and forever troubling their minds. Guerrilla warfare, an inherently cognitively damaging military action compounded the neuropathic damage experienced by our troops in Vietnam. Even with the troops having regular downtime in between engagements the cognitive fractures of these veterans were enhanced by more intense combat and the rejection of our returning soldiers. Now that being said, I know a guy that did 5 tours in Vietnam which was uncommon, most soldiers did their two years and the ones that survived went home.
The soldiers in the Iraqi war have been sent on multiple deployments with an average of two or three tours of duty with little time in between. While in Iraq, there are no friendly countries or areas to spend leave time to relieve stress. They are on constant alert and most, even non-combat soldiers, see combat or threats on a daily basis. Now combine this with the most intensive warfare possible, guerrilla warfare in an urban environment. We get troops that are overextended and overexposed to life threatening situations within unprecedented levels of combat.
Our troops in Iraq have no respite from danger, further entrenching the effects of PTSD through the hyper levels of neurotransmitters. This information should be the on the forefront of discussion and conversation in the news and in the public arena. This is what is not being said about whats going on with this war.
The reason we don't have 20,000 soldiers dead compared to the Vietnam War 5 years into the war? Our medical knowledge and technical experience gained from another unpopular war.
What we do have are veterans that would have died in the Vietnam War or World War II that are going home with their bodies and minds shattered. The amputation rates have risen to twice that of previous wars. What will be the result of such unmitigated multiple traumas that the Iraqi veterans will be facing?
Some of the current thinking have postulated the PTSD rates of this war to be in the range of 30-50%. Come on America WAKE UP! Your freedom is due to the sacrifice of our soldiers lives, both in mortality and the possibility of becoming a meaningful and productive human being.
April 17, 2008
PTSD Rates Part Two
Image via WikipediaWhere do you think this is going? Maybe somewhere around double the incident rates of PTSD from the VW? Thats close to 50%, ok, lets say that would be impossible.
Do you really think that we will have the same PTSD rates as the VW? Even with the above factors tabulated in? Probably not. So, does that mean that it will be ok to have a 30-40% PTSD rate for the Iraqi War? I do not think so.
Like I have said before, we will not know until 10-20 years later what the impact will be. It will take years for PTSD to become debilitating.
Who is Killing our Veterans?
In the coming years we are going to see a growing trend in veterans suicide. On Nov. 13, 2007 CBS reported:
Over 30 years have passed since the Vietnam War ended, since then more than 180,000 veteran deaths have been attributed to suicide. 300,000 Iraq and Afghanistan veterans suffer from mental illness. 58,000 names emblazon the black granite in Washington D.C. at the Vietnam Memorial Wall, one third of the amount of veteran's deaths attributed to suicide.
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.
Veterans aged 20 through 24, those who have served during the war on terror. They had the highest suicide rate among all veterans, estimated between two and four times higher than civilians the same age. (The suicide rate for non-veterans is 8.3 per 100,000, while the rate for veterans was found to be between 22.9 and 31.9 per 100,000.)"
This is just the beginning, the Iraqi 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 Veterans’ 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."She goes on to report that more than 6256 veteran commit suicide a year.
Over 30 years have passed since the Vietnam War ended, since then more than 180,000 veteran deaths have been attributed to suicide. 300,000 Iraq and Afghanistan veterans suffer from mental illness. 58,000 names emblazon the black granite in Washington D.C. at the Vietnam Memorial Wall, one third of the amount of veteran's deaths attributed to suicide.
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.
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