Cannabis and the Veterans Suicide Tsunami

By 2014, waves of soldiers surged in the tides of our modern wars, with 2.7 million veterans lost in the detritus of conflict, as compared to Vietnam's 2.6 million. Both populations amplifying the undercurrents of the veteran suicide tsunami, inundating our communities. Post-traumatic stress disorder (PTSD), the third highest psychiatric diagnosis for returning veterans, erodes buoyancy and dulls surfing the edges of sanity. The veteran rates of PTSD are 9% when returning, with a sharp liquid curve up to 31% a year later.

Swimming in the undercurrents, therapists report higher rates where 50% seeking help, only half get minimum treatment, thus triggering a seaquake spraying untreated veterans across communities, prisons and institutions. Army vets wash up in 67% of PTSD cases, where 19% received a traumatic brain injury, and 7% have both. Preceded by the military suicide epidemic, add bias in reporting veterans accidental deaths, plus under-reported statistics and treatment, and no central data veterans ride the white-capped waves suffering in silence, through ineffective systems, pour in poor record keeping from institutions, sets a consummate storm.

In the deep-sea of misery, the re-experiencing of vivid and graphic memories take form, in and out of reality. Often no memories and sometimes we cannot forget, a deluge of fears, repeating disturbing intrusions, running from bombs and bullets the green ghosts skip across the periscope screen. Studies point to previous trauma with increased risk and severity deepens when the soldier killed, failed to save a comrade, handled the dead, and saw atrocities. Tumbling further for veterans incarcerated, victims of military sexual trauma (MST), multiple deployments, childhood traumatization and or have substance abuse issues, all increasing suicidal behavior and risk taking. Rising tides in women veterans issues, higher rates of childhood abuse, MST, domestic violence and assault combined with combat increases the stress response and plunges with amputees and prisoners of war, where 37% are more likely to succumb to suicide. To cope, many veterans self medicate, often leading to substance abuse and an exacerbated mental health.

Where 39% abuse alcohol and 3% harder drugs, an increasing number of veterans are turning to cannabis to quell the agitating flashbacks, regurgitating anxiety attacks, gushing nightmares and flooding dissociation. Veterans using cannabis to quell the storm, report higher coping and increased resilience, significant anxiety reduction and a better quality of sleep, plus a full range of emotions to include joy and happiness. The hypothalamus and amygdala mediate stress through the endocannabinoid and limbic systems, tripping or skipping over the flight or fight survival mechanism. Cannabinoids function in fear extinction, role switching, and regulating the neuroendocrine system governing behavioral responses, resetting the mind's ocean; with calm, deep and cool convections. To quell the veteran suicide tsunami claiming 112,000 lives in the last 14 years, make cannabis legal and available to veterans.

Darkness Visible, Depression, and Suicidal Ideation

By Anonymous

Him the Almighty Power
Hurld headlong flaming from th' Ethereal Skie
With hideous ruine and combustion down
To bottomless perdition, there to dwell
In Adamantine Chains and penal Fire…
As one great Furnace flam'd, yet from those flames
No light, but rather darkness visible
Serv'd onely to discover sights of woe,
Regions of sorrow, doleful shades, where peace
And rest can never dwell, hope never comes… 

~ from Milton’s Paradise Lost, Book One (1674)

Wikimedia Commons

In the passage from Paradise Lost above, Satan has launched his unsuccessful war against God and heaven and rightfully been cast down into the pits of Hell. He finds himself chained in unbreakable chains to the floor of a fiery pit without even the comfort of light from the flames. In “darkness visible” he sees only “sights of woe, / Regions of sorrow, doleful shades.” In the absence of God’s presence he flails about in pain, doomed to never know peace, rest, or hope again.

It was on a beautiful spring day—birds chirping, sun shining in through the window, adoring, four-legged friends at my feet—that I used the passage above to describe to my girlfriend how empty and defeated depression made me feel.

We have different names for these things now, but “sights of woe” sound an awful lot like intrusive thoughts; “doleful shades,” to me anyway, accurately described the synesthesia of strength-draining darkness that had creeped over me. With all promise of “rest” and “peace” dashed by medical science and the constant voices of doubt in my head, I had certainly lost hope.

Worst of all? The closest comparison I could come up with to describe myself was that of Satan. A lot of doctors would call that “a poor self-image.”

Fast forward a few months.

Not many people talk about suicidal ideation. It seems they’re either embarrassed, worried about alarming their loved ones, or afraid of being locked up. These reasons are all valid, of course. But I made a promise a long time ago to be open and honest about what I’m going through because I think it makes me stronger while helping those around me. So, again, here it goes.

The other night I was lying in my bed, completely in the dark, waiting to fall asleep. The self-effacing negativity and spitting of curses at myself ran rampant as it had for a while. It was something I’d grown accustomed to since quitting my medications in the spring. For me, not having medications is a tradeoff where I can better control my impulses at the expense of increased depression. When I’m alert, the dark thoughts are easier to push away. But when I’m tired, about to fall asleep, it is often a different story.

For me, as a man who experienced a suicide in his immediate family, it will never be an option. I realize on both an emotional and intellectual level that it only hurts the ones you love. But that doesn’t stop the theatre of the macabre from acting itself out my head. Thoughts and images of hurting myself flash before my eyes faster than I can stop them. I know I will never act on them. I know I am physically in control. Still—and I doubt I am alone on this—simply having the thoughts can be discouraging.

I find that flashes of self-harm occur vividly and alongside waves of self-deprecation and doubt. The slightest slip-up or failure can trigger them. Those who know me well have learned that I vent this negativity through jokes and creativity. I used to be able to pop a VA-prescribed pill when I felt down or anxious. I used to be able to PRN-my-way through about any situation. But since going cold turkey I’ve been forced to find more and more behavior-based methods to deal with PTSD and its aftermath.

I’ve been grappling with this issue both intellectually and spiritually over the last couple of months. My goal has been to symbolically represent the causes of the condition through language and understand—beyond the limits of medical science—the role of my soul. But learning causes didn’t result in the ability to produce effects. So, each day I’d learn something new. Each night, I’d lie in the dark, struggling, waiting for that ability to come to me.

Suicidal ideation is like being strapped to a chair and forced to watch a really graphic movie of your own death. Here’s the catch: You’re both the protagonist and the antagonist—literally your own worst enemy. The voice you hear, the one screaming that you’re “pathetic” or “weak” or “disgusting,” it’s your own voice. And, after a while, you become convinced that you are the one doing the talking. Why wouldn’t you? It’s your voice. Your brain. You are the one conjuring up these thoughts because you are “sick,” right?

I’m no longer convinced.

On the night in question, I looked up. There hung my trusty shotgun—the one that PTSD tells me to keep ready for intruders at all times. Then came a flash of me shooting myself and collapsing on the bed. It lasted less than a second. But it was so disturbing and graphic that it wounded me. It was like being punched in the gut.

In its shocking repetition, suicidal ideation makes you feel very much like a victim of abuse. But you’re the abuser. What gives?  I was in control, but the thoughts weren’t going away. I felt like I was losing the battle—that it would just get worse and worse until I wasn’t in control. That was what knocked the wind out of me.

I said to myself, “You know...if you’re thinking about blowing your head off, the responsible thing to do would be to lock the gun up in your safe.”

“Yeah, I don’t want to do that. What if someone breaks in?”

I tried to be rational. It dawned on me that the safest alternative to locking up the weapon would be to crawl over to the corner of the bed and sleep there. That was the furthest spot away from the gun. I wouldn’t have to risk getting near it but could if someone broke into my house. Then it hit me that I’d just told myself to curl up in the fetal position on the corner of the bed.

“How did it get to this point? Listen to yourself!”

In the background during all of this, that vile, contemptuous voice kept talking. It had been telling me to “do it” and reinforcing its previous points about my being weak, pathetic, and disgusting. In my mind’s eye I stepped back for a minute and asked myself something I hadn’t before:

“If I’m listening, who’s doing the talking?”

I created a representation of the scene the best I could in my brain. I saw myself stepping away, outside of a circle of white light. Inside the circle, crouching and holding a severed head like a puppet, was the thing that had been talking. It was black like venom with skin the texture of a smoky-ink. The head it was holding, and by extension the voice, was my own. But I was clearly on the outside of the circle. I was listening.

“There you have it.” It wasn’t me talking at all.

I’d describe what happened next as an epiphany, but it wasn’t really that. It was more like something remembered—something I used to know but had forgotten. I paid particular attention to the voice: it tapered off; its tone described someone who’d just been caught. And it muttered something to the effect of “this doesn’t change anything.”

But I knew better. I made one conscious decision to listen and, for the first time in months, the voice shut its mouth.

What ensued was astounding: my head and face tingled. I felt a distinct crunching feeling in the tip-top of my brain—as if the folds of my cerebral cortex where tightening and strengthening themselves. I’m used to getting headaches, but a new, different one presented itself at my forehead. I welcomed it. I knew something big was happening. That some new—or old and forgotten—pathway was being opened up and I was (re)learning how to use it.

In “darkness visible” I opened my eyes.

Since then, I’ve come to call that voice the “Puppet-Master.” It was like he had his hand in the back of my neck, making me spout off terrible obscenities and lies about myself. The sound of my own voice did a lot to convince me. But so did the constant message that there was something wrong with me.

There might be something wrong with my brain. There might be something wrong with the way I live my life or the decisions I’ve made. There’s definitely something wrong with the things that have happened to me. But those things are not and have never been me. I held somewhere deep down inside the view that there was something defective with my soul—that I deserved the constant torment. It was a lie, and now that I’ve learned to put a muzzle on the liar, it’s one that makes me burn with a healthy anger rooted in self-respect.

I’m sure that the Puppet-Master reinforced that lie. He still likes to catch me unawares and slip in self-hate and violence when he gets the chance. But I’m onto his game now. When I catch him, I get angry. I step out of the circle, locate him, and drag his wretched ass to a nice box I constructed in the corner of my mind. I borrowed the box metaphor from my fellow veterans. Now I know what to put in there.

What should you make of all of this? I don’t know. You might think I’ve lost my mind or that I’ve used too many psychedelic drugs. To me, it seems like a lot of veterans and people struggling with mental illness believe lies about themselves. What I’ve done, in my best estimation, is find a way to represent the source of the lies—a Puppet Master—and a way to control it. Some people achieve this through medication and therapy, others through exercise, and still others through religion and service. My journey has been a combination of all of these things and it isn’t over. But I just won a major battle.

For now, I’ll just keep listening. I’d encourage you to take the time to listen to yourself, too. You might be surprised at what you learn.

Seconds Away From Suicide: Readily Will I Display...

On the 5th of April, I burned my wrist pretty badly while making some home-brew. My wife had the car at the time, but, before I would even call for help, I had to clean the wort off the floor (wort is beer before yeast is added). I saved all of the wort so I could finish that batch. The Ranger creed may seem like a silly mechanism to discuss suicide, but the Ranger creed is what saved my life when I had loaded gun in my hand. This example of me cleaning up my mess before even calling someone in order to go to the emergency room illustrates just how the sixth stanza of the Ranger is webbed into fabric of my being. It is what prevented me from taking my own life.

Readily will I display the intestinal fortitude required to fight on the the Ranger objective and complete my mission, though I be the lone survivor. Rangers lead the way.

After I came home from the Surge, I could no longer conceal the problems I had for years. In crowds, I got so overwhelmed that I would almost pass out. I had to stop driving because I almost ran off the road twice, when I thought there were IEDS. Panic attacks almost made me lose consciousness. The mTBI symptoms were worse then, limited spatial awareness and vertigo characterized my life. When my neurologist recommended an inpatient program, my battalion executive officer told the personnel officer that he did "not have time to deal with a Captain with PTSD and mTBI," while I sat outside his office. I was the most battle tested officer in that battalion, and I felt like Boxer from Animal Farm: once I was used up, my battalion was happy to ship me off to the glue factory. My doctor stuck to his guns and I went to an inpatient program in Richmond, Virginia, and then in Salisbury, North Carolina. During my hospitalization my ex-wife decided that her chemistry professor was a better choice.

Needless to say, life was not going well and I was leaving the Army just days after getting out of a hospital. I was packing up my home to put it on the market when I looked at a Beretta pistol. Why not end it all right now? The unit I fought in for years thought I was a piece of shit, my family had not even seen me after I came home, and my wife was shopping around for a replacement. I still had the hospital bracelet on and now I was about to be on the street alone. No pay, no purpose, no family, no support at all. Just alone in my thoughts. I cocked the gun, but before I could lift it up my Ranger brain took to action.

The flood of the, stress chemical, cortisol, was something I had become accustomed to using in combat. In most cases you use the surge of cortisol to fight or fly, but as an officer I employed it to think through outcomes. When I held that gun in my hand I thought through what would happen. The Army would do nothing... I would just be another number. Maybe friends might find out, and be more sensitive when they had soldiers struggling with PTSD.  Probably not though, they always had their soldiers' best interests at mind. My mother would be devastated, but my father would just write my suicide into his latest narrative of war making me a sinner, and turning me against God.

Serendipitously, my boots from Ranger school were in my eye-line and reminded me of what I was capable of handling. Sure I wanted all of that to end, but I felt that way in Ranger school too. I used to say to myself, "I don't want to quit, I just want this to end." When you're walking in the middle of a swamp no one is coming in with a jungle penetrator to take you home. I would just make it to the next rest halt. This was the same, but what was the point? What was my purpose anymore? I left the Army because I wanted to make a difference with my pen. All of my "disabilities" were going to make that nearly impossible. So you're saying there is a chance. I was never a smart Ranger anyway, I was always a tough one. Everyday I was at sick call getting something drained, taking crazy low distribution antibiotics, getting all the skin taken of the bottom of my foot, yet everyday I would smile while humming the Ranger school hymn, "I'll Fly Away."

I knew how to find my way in misery; without thought I dropped the magazine, removed all the rounds and threw them into the woods. At the time I had no idea of what my mission was, but I was damn sure going to fight onto that objective. The whole world seemed to have turned on me, but, so what, just hum that hymn, drive on and somewhere in the process I will figure out how to get better, or learn how to enjoy the suck. I kept one Ranger school boot on my desk and one on my dresser so I would always be able to remember what I was capable of overcoming.

I can't tell you why things got so bad for me, but what I do know is that I did nothing to cause it or deserve it. I certainly am not weaker than I was before. If anything I am tougher mentally than my body is physically, and I should take it easier when my body is giving me queues like "Hey stupid, your wrist has second degree burns on it... someone else can clean the floor later on."  More importantly, when you have stepped up to save your own life, every milestone gets a little sweeter. My relentless mission focus is, more often, an annoying characteristic that pushes me way too  hard, but it also brought me through the most difficult time in my life. A time when I had no support at all. Now when I hold my wife, play with my dog, drink with my friends, and work with my colleagues, I am so grateful for the man that pushed on when there was no indication that I could never make a positive impact on the lives of others again.

You can see my burn and Darby's awesomeness

When we were kids we never think that, "seconds away from suicide," would end up on our bucket list, but I am so happy that I had the courage to live on unashamed. I have been lucky enough to put more on my bucket list after that day than I would have had the courage to dream of as a child. I hated Ranger school, but, like in combat, its ideals have never let me down when the world becomes dangerous or chaotic. It is often said that the Army never trained us for coming home, and that is generally correct, but it did teach us values. Learning to translate core values into a life out of uniform saved my life, and I would be lost without things like the Army Values, Warrior Ethos, and the Ranger creed. The road home is not easy and it sucks more often than not, but that doesn't mean that its is not something you can't enjoy or find fulfilling. It certainly beats Ranger School.

Suicidal Thoughts: Recovering From the Darkness

NOTE: I am in therapy and have an appointment in an hour and thirteen minutes and will be discussing the below. I have a safety plan called Smoke Break if the thoughts become persistent. When I can think of nothing else, it's time to check myself in to the local VA, for the 7th time if necessary.

If a veteran admits they have thought about killing themselves, then they mean yes, hell yes, too much and maybe even all the time. We talked about the compulsions to kill myself in the last post. Now I want to address the buildup to compulsive behavior; the compulsive thinking and the many reasons not to live rolling around in my head.

If you are feeling suicidal or homicidal, the National Suicide Prevention Lifeline has helped me several times over the years, so call 1-800-273-TALK.

I have few close friends locally and family comes around every so often; my dog and a few friends, that's it. I do not want to keep feeling this pain in isolation. Been fantasizing about how ending it would 'show them' or how 'they wouldn't care' while stoking my resentments and devising a list of who cannot come to my funeral. The obsessive thoughts of self assisted doom have been patrolling my mind to seize upon my life. There's no loved one or caregiver here, or resources for assistance for a non-Post 9/11 and undeserving veteran. I don't have a plan, just unmet needs fueled by distorted and delusional thinking leaving me vulnerable to the compulsions to kill myself. But, such is life.

Along comes detachment and numbness to replace the physical and mental pain, a different kind of anguish that makes us relish the void and can last for as long as life for some. It's another kind of hell to be cut off from the out going person I used to be, that deep down my desire to be among loved ones out in the world is buried under the fears of loosing my reality to the past, cyclical thoughts fueled by petal to the metal emotions raging on and on to loose myself. Or yourself if you are stuck in this pattern thinking. Below is how I get through moments of utter inner panic, most do not see it. But, those in the know do.

If you need a therapist in person or over the phone, click the Give an Hour picture above to get you in touch with mental health practitioners in your area free of charge.

Chronic traumatization causes our survival mechanisms to become hard-wired into our neuropathways; a veritable surgical steel Swiss Army Knife of fight, flight or freeze. A constant threat assessment on the battlefield was a lifesaving skill to master, at home it can manifest in distorted and delusional thinking, a major component of chronic Combat PTSD. The entrenchment of our evolutionary and primitive defensive mechanisms makes us prone to reactionary and compulsive behavior in civilization. The evolutionary defensive mechanism confound us with cyclical and repetitive thinking that may or may not be grounded in reality. Over time I have been able to become less reactionary by learning coping skills, education on my condition and triggers along with treatment. I can attest to the plasticity of the brain as per becoming a completely different person from 7 years ago, it has been exhausting most days but well worth the hard work.

Accept that you cannot prevent all of your triggering events and see them as a window into your suppressed self. 

The compartmentalized part of the mind acts as projections into the environment as seemingly inconspicuous triggers such as the unconscious sensory stimuli exchange of a tailpipe backfire for a battlefield bullet discharge. The damaged subconscious suppresses the ability to consolidate past and present memories thus giving birth to the dissociative features of Combat PTSD; a phenomenon we experience most days. It will make you question your own reality. During PTSD moments our arguments may have paranoid and delusional components set within circular arguments and backed by defensive mechanisms. As we learn our triggers, defensive mechanisms and look into what our subconscious is trying to communicate to us we begin to see a perspective from the out side of the chaotic, we begin to see more options. When we get caught up inside the circle and the battle is on. Anxiety and panic attacks can be coped with to where they pass without making us freak out. Meditation and pray have been my greatest tools to work through mine.

Meditation and mindfulness exercises like guided imagery can give you the sense of letting your thoughts go, or clearing your mind.

How? Imagine a body of water representing and matching your emotional level from raging seas to the calming stillness of a pond. Start with was an open body of water with the waves matching the level of your stress and anxiety. Visualize the waves calming to the point of stillness. This tool can be used to gauge internally your stress level and as a way to self sooth during these moments. Where there was no emotional gauge before, now if I am out of touch with my emotions accessing this image helps me gain perspective again. Coping skills such as guided imagery and other mindfulness techniques help by giving us a visual representation of our emotions so that we may better self sooth our anxiety and stress levels. Keep practicing and remember is not about perfection, it's about addressing our dangerously detached and compulsive behavior.

I ask God to take the power of it and practice letting go rather then holding onto.

Part of Prayer is asking God's blessing, an oft looked over piece is the sharing of the burden. We do not have too onerously endeavor, a trick of the Defensive State of Mind is to believe that we are alone. The sharing of the burden is living a prayerful life, venting to God and all who will listen is doing His work. Do you think the Apostles and saints talked calmly to God? By sharing your experience, you are the change you wish to see in the world. Your footsteps blaze the path where many will follow

Maybe it's time for us all to begin healing, if in your heart you feel the welling sense of hope beginning. Please, do not squelch this; you will be happy again given time. Also, accompanying may be apprehension and a sense of foreboding. This is a normal response, you were meant for more than you have been living and your being resonates this. You will become what you dream, if you dare to accept what is in your heart and act soon, if not now.

Mental Health Emergencies

An overwhelming sense of hopelessness may lead a person to think of only one way out. I want to say that we all have errant thoughts of others being better off without us, but that's probably a symptom of something in me. Obsession is an often overlooked component of the hypervigilance portion of PTSD, coupled with the delusional aspects of traumatization cause the suicidal thoughts to be seen as a way to escape the emotional and physical pain.

Upon percolation the overwhelming and despondent thoughts often lead us too constantly resist compulsions to drive head on with a truck or off an embankment. Picking up a sharp knife to chop veggies for dinner becomes an ominous dilemma or looking out the window makes me wonder if the second story is high enough. When the higher thought processes shut down and give way to base emotional states we become susceptible to reactionary and compulsive behavior. In our hearts and minds we are torn between the vast chasm of the macabrous to spiritual enlightenment, of which in war we felt simultaneously.

Get help now, for your mental health emergencies. Don't sit alone waiting for months on end. Your life depends on getting treatment and reducing these obsessive thoughts.

What Keeps Me from Killing Myself Today

This answer keeps changing over the last 20 years, it used to be various family members and friends. This becomes too much for our caregivers if they alone bear that burden as I learned the hard way.
Today varying by degree this sacred duty I charge to select few friends whom I try and educate beforehand. But, the brunt falls to my dog Smokey. I've had him for almost four months an 80lb, 10 month old black lab. I am learning to train and looking for trainers to help me train him as a psychiatric service dog.

Unspoken High Cost of War No More: Public Acknowledgment of Veteran Suicides

WASHINGTON (AP) — The White House says that families of service members who commit suicide are now getting condolence letters from the president just like families of troops who die in other ways. http://www.whas11.com/news/national/125047909.html

Photo by Scott Lee

It is sad that this issue has to reach critical mass for veteran issue to be acknowledged but, this is a good thing. The character of our country depends on actions that advance our cause. We teach our children to do what is right, especially if they have put it off.

We cannot ignore the work and struggle of the Vietnam Veteran, since the end of the war, over 200,000 veterans have killed themselves. In 1980 our brothers and sisters were on point for those of us today, they forged the path that we follow today. They fought and won a diagnosis for their troubles, then it was to work on the treatment side. We know that story, we live it today.

It has taken our government 30 years to do what is right; acknowledge that our veterans sacrifices were not in vain. This is a victory for the Vietnam Veteran who took their life after suffering in silence. Today his family has the President of the United States with a public acknowledgement of their struggle, their honor has been restored.

It just dawned on me that I was 7 years old when the Vietnam War ended.

Suicide Bomber

A thundering explosion rocks downtown Baghdad, your body recoils at the deafening sound, adrenaline courses through your veins driven by a heart suddenly hammering within your chest. No time to react; the air expands with punishing force as the concussion of a devastating shock wave races through the afternoon air. It roars in your ears, slams you to the ground, snatches the breath from your lungs shaking every structure, and blowing out every window in its unstoppable path.

As you struggle to your feet a searing rush of heat sends you back to your knees scalding your skin with its suffocating cloak. No time to think; shrapnel flies through the air like a million angry bullets simultaneously fired in every direction. Twisted chunks of white hot metal violently crash to the ground like meteors hurled toward the earth by angry gods punishing all in their path. Your ears are screaming, a ringing so loud you cry out but are unable to hear your own voice.

Now on your feet, all around is burning; acrid smoke chokes the air and burns the soft membranes in your nose and throat. In a surreal moment, a gentle Baghdad breeze momentarily clears the scene… are those charred and grizzled shapes within the mangled wreckage human beings? Before you comprehend the horror of what you're seeing, another gust sends a curtain of black smoke across the morbid sight as though to shield the burning corpses from your gaze.


Your hearing slowly returns to the sound of frantic Arabic voices, police and locals swarm onto the street to load the dead and dying into the back of ramshackle pickup trucks. Just how many misguided Iraqis offered up their lives in Allah's name that afternoon? You count the legs, the arms... but the bodies have melded, intermingling in the inferno of the blast. Who knows how many deadly human weapons conspired to sacrifice themselves in that monumental act designed to kill you and as many of your fellow soldiers as possible.

You may not have lost your life that day, but back at home in the US these horrific recurring events have caused you to sacrifice your way of living.

I wrote this based on an account of just one of the suicide bombing missions my husband was caught up in. He says it's an accurate description but rightly pointed out unless you have been through something as horrific as this you cannot possibly convey to others the true force of the impact, explain the indescribable carnage, and the accompanying sounds and sickening smells.

Suicide Prevention for Combat Veterans

“Every day, five U.S. soldiers try to kill themselves”(CNN.com).

HEALING SUICIDAL VETERANS: Recognizing, Supporting and Answering Their Pleas for Help (October 2009, New Horizon Press) is written by Victor Montgomery, III, MAEd., CMAC, RAS, who has worked with thousands of veterans and families as a former crisis intervention therapist at the National Veterans’ Suicide Prevention Lifeline and as an addiction therapist in outpatient clinics.


In HEALING SUICIDAL VETERANS, Montgomery provides,

• Tips and effective strategies for veterans to cope and heal.
• Checklists to identify symptoms of depression, post-traumatic stress disorder, traumatic brain injury and substance abuse.
• Twelve real-life stories featuring veterans from the Iraq, Afghanistan, Gulf, Beirut, Vietnam and Korean wars.
• Resources for veterans to seek the help they need.

HEALING SUICIDAL VETERANS is a vital guide for any veteran struggling with suicidal impulses.

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

Government and Private Service Providers:

Soldiers and Veterans Stuck in Between

Scott A. Lee

University of Louisville,

Kent School of Social Work

Statistics, Effects and Realities of Multiple Deployments

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Just as No One Event Can be Attributed to a Suicide, Neither Can One Crisis be Excluded

To say that war does not have any influence on suicides would, in my opinion, be an ignorant statement and assumption.

When we see no other way out of a bad situation, we have exceeded our capacity to cope and manage our personal pain. I understand the consideration for taking ones life comes from an overwhelming sense of hopelessness. I comprehend this from a personal perspective and a deep realization to "know" the thought of "if I just pull the trigger, the relief I would feel" to ease my emotional agony.

Generally, no one factor precipitates the killing of ones self, to say otherwise would probably be foolish. To discount a soldiers or veterans taking of their own life because the last thing to happen to them was the death of their dog, would be to dishonor their service and sacrifice. Just as no one event can be attributed to a suicide, neither can one crisis be excluded.

God, The Things Our Minds Omit When We Thought We Could Never Forget

When I was in basic training we had a soldier kill himself while on bivouac training, two weeks away from graduation. He put his M-16 to his forehead and blew out the whole side of his skull.

We woke that morning to what I thought it was another blissful dawn where Drill Sergeants would detonate flash-bang grenades or fire M-16 rounds off because they forgot their alarm clocks. We all started looking around at each other when we heard all the commotion that would have gotten us in huge trouble otherwise, and knew something was wrong.

The news spread fast through the encampment, I went to go look and saw his brains all over the place. God, the things our minds omit when we thought we could never forget.

Janurary 2009, Not The Month of the KIA-The Month of Killed at Your Hand

In light of the most recent shocking statistics on military suicides, we have had more suicides in January than killed in combat. When will we begin to do something about our soldiers and veterans killing themselves?

They fought hard to keep themselves and their battle buddies alive. Should we not do the same for them?

As a nation we should be ashamed of our inaction to prevent this self administered massacre. Do we go on and keep letting down the people who gave us the right to ignore them?

How many of our modern warriors will become one of these statistics before you act?

Why Are Our Soldiers and Veterans Killing Themselves?

I received this comment today on an older article that I wrote back on April 17, 2008. This comment compliments a recent post from February 8 on the VA Mental Health System,

Its not only the VA - but the lack of support from the military. When soldiers try to go to the military to get help for PTSD and other war combat related injuries - they are brushed aside... and told that they need to suck it up.

Regardless of what the Army says to try to cover this up - its obvious by the amount of suicides that are still going on today... if the proper help was given to those coming back to war, suicides would not be on the rise.

My husband is a combat wounded soldier at Fort Bragg. The Warrior Transition Unit is ran by National Guard - by many who have not even been to war. There are less than 100 combat wounded soldiers in the Warrior Transition Unit with almost 600 soldiers total. Guys who have broken legs from training are put in with combat injured soldiers - the mix is not working.

The Warrior Transition Unit needs to separate the combat wounded from other soldiers and treat them with 1. RESPECT 2. DIGNITY 3. COMPASSION.

It does not take a rocket scientist to figure this out. Why all of the red tape?

 My original post,

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:

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 veterans commit suicide each 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.

Statistics, Effects and the Realities of Multiple Deployments

Image via Wikipedia

If you found this site looking for combat PTSD statistics you have hit the jackpot! Please take your time and read the post, vote in the poll and I encourage you to give your feedback. I will respond later with the results in another article.

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.

The Combat Veteran and Police Assisted Suicide

The Blood Runs Thick as The Bonds of Brotherhood 
On November 8, 2008, I wrote an article about identity and dissociation and the relationship between the two. Since then I have struggled with writing more, actually I have been having difficulties writing in the last month as I have only composed 7 articles this month so far. Granted some of the issue has to do with my having to write butt loads of papers for school about crap I do not want to write about. Uhh, professor(s) (they say that they have been here), if you happen to read this then I did get something out of the writing assignments, but I still did not want to.

So, anyway. Identity, dissociation and a connection to some kind of topic. Yeah, ok. Here it goes.

I was just reading about Sgt. Travis Triggs again, for those that do not know who I am talking about he was the soldier who had 5, yes FIVE tours of combat, that shot himself and his brother in the head after a police car chase. He went to Iraq 4 times and Afghanistan once. He had never been in trouble before that day even though the media had portrayed them both as having violent criminal histories. Sgt. Triggs volunteered for the extra deployments,

My symptoms went away. After all, I was going back to the fight, back to shared adversity, where the tempo is high and our adrenaline pulses through our veins like hot blood (as cited in Times Online, November 23, 2008).

The article gives an account of a lost soul that had left everything over in a far away land where the blood runs thick as the bonds of brotherhood. He had assumed a culture of killing and the persona of a "combat self," a subsumption of the "Soldier's Heart," shedding all of the remnants of his civilian identity and connections to self and home. He had become the perfect soldier, much to perfect.

There is disconnection between everything that is human and the necessities of killing and what has to be done in combat. Imagine being in an unimaginable situation and having to do the unthinkable. How can this be done? A disconnection between everything human and having to do the unimaginable resounds in combat. For we must wholly demonize our adversary and in the process we dehumanize ourselves, whereas the monster must die. A neurological reprogramming engaging dissociative states and a compartmentalization splitting. In doing so some veterans and soldiers lose their way, not only on the inside of our mind but now they become outsiders in society. Everything at home had become foreign to him, he had become lost within a once comfortable environment.

The parallel contrasts to my article on identity and dissociation and Sgt. Triggs? On the night where I had lost myself into psychosis, if the police had shown up, or if someone had confronted me on my abnormal behavior, it would had became real and the psychotic break would have been complete. I was convinced that everyone was out to get me and I would have responded with violence to "protect" myself due to a warped conception of a perceived threat.

I ran out of that house and jumped into my car and drove away; drunk, high and out of my mind. Easily I could have been in an incident that probably would have resulted in a similar outcome. My death, an innocent bystander and possibly the police.

To survive war is not a relief, it is a sentence of guilt and shame from killing and surviving.

PTSD, Combat and the Guilt of a Nation Mediated by the Media's Lip Service

I had recently posted an article over at A Soldier's Perspective that I had originally posted here on September 6, 2008 about the attachments that soldiers develop during combat. A commenter informed me of her belief that our soldiers were getting the proper help with psychological issues and addressing PTSD, that all they had to do was ask. It seems as thought she is trying to assuage her conscious and justify her beliefs that all will done to help our soldiers and veterans.

Here is her comment,

I agree that combat experience will bring soldiers together. These soldiers will often share things and feel an attachment like none that they have probably experienced in their life. However, the military does not view PTSD as a weakness and goes a long way trying to identify soldiers that have problems and get them the necessary help to allow them to continue to soldier or become responsible productive citizens. The choice to become a citizen or continue to soldier on is the soldier's choice. Initially the Army was not prepared to deal with PTSD or with traumatic brain injuries. Recently that has changed. You cannot sign into a new unit or Army School without going through medical screening and part of that screening is psychological screening. This screening is done in private so that soldiers can feel free to disclose any concerns without feeling ashamed. PTSD is not a weakness but an illness like any other condition you can develop over time. Additionally, the band of brothers that develop in combat owe it to each other to ensure that they are looking out for one another. Part of that is making sure any brother in arms receive treatment if you think they might have a problem. As brothers, you have to make sure your brothers are not suffering needlessly. If a brother is having trouble make sure we get him the treatment he needs and not allow him to try to grit it out. You can get help in private and not have your career affected. The Army is doing a better job of providing help we just have to make sure those who need it get it. Take care of each other and be safe. This is my own opinion and does not represent the Army's point of view.

to which I commented,

To the Common Masses,

Are you a mental health provider in the military, the VA or in civilian world? It sounds as if you have bought into the media portrayal that everything that can be done has become the norm. I know that the military has become more aware of problems associated with psychological trauma and have begun to implement some changes. But not on the scale of making significant changes in the soldiers and families lives that have been impacted by psychological trauma. Do you really think that our soldiers have a choice in becoming a citizen or soldiering on? This is the EXACT kind of thinking that alienates and stigmatizes our soldiers and veterans. "Hey you are the one who signed up for this! Suck it up soldier and drive on!"

This is EXACTLY what we face as a nation in overcoming PTSD and enriching our soldiers and veterans lives, people who believe in the benevolence of our nation to help the "heroes of war" (those of us who survive war do not consider ourselves a hero, just lucky. By calling us heroes all we can think about are the ones who did not make it home). The trouble becomes perfectly clear to the veteran or soldier who faces the daunting task of recovery from PTSD when they seek help. The nation does not dispense much needed education and treatment of PTSD, the institutions of bureaucracy weigh the task of defending the budget verses helping "those bastards who do not deserve help, suck it solider!" I can still see the look of disbelief on the VA therapists faces when I tried to get help, many times did I stare into that penetrating mask of "you are lying to get benefits" before I could get through the rigorous process of getting a diagnosis of PTSD which you need to receive treatment. Most of the times I was suicidal or homicidal when I was on the other end of the scorn and skepticism of the VA doctors, nurses, therapists and practitioners who were supposed to treat the veterans.

Go ask a veteran how or if they were helped, most will say it was like pulling their own damned teeth so I gave up.

If you want a true accounting of what a soldier goes through with this "enlightened" process of psychological screening you believe so much in, go read the harrowing account of Colby Buzzell, an author and a veteran diagnosied with PTSD. In his article in Esquire who had to go through the ordeal of being reactivated and sent back to Iraq after being out of the military for almost four years: The Army Wants You...Again! (Yes, Really.). The article is long, but soldier on if you really want to give some attention to the problem you believe is being taken care of.

What they have done is not enough to break the stigma behind the thinking in the military of PTSD being a weakness. This belief has been ingrained into the mindset of generations of soldiers and cannot be overcome by a screening or the CO standing up in front of the troops and saying it is OK to have PTSD and to get help for it. Decades of indoctrination have to be overcome; the only way to do that would be to implement training and education on the psychological impact of war on the mind and the possible ramifications they may face.

Hell, even before the troops enlist they have been taught that PTSD is a problem of moral fiber. Look at what we have done as a nation to our Vietnam brothers and past veterans, how many of them have become homeless because of trauma that has overwhelmed them? 200,000 veterans are homeless on the streets of America on any given night. Half of them have a mental illness, a third of them have been to combat. Tragically we throw away good people who need extensive help in getting their life back together. We venerate and honor the soldier but betray the veteran.

The culture of the military, the Army and Marines especially indoctrinates soldiers to become and believe that no one can oppose them with an air of invincibility. Soldiers have been trained to think that they can overcome any obstacle. But how does he/she defeat a problem without any substance other than mental manifestations that get in the way of normal functioning and affect life in general. In a battle with no solid enemy and no apparent battleground the warrior having been trained to combat the physical comes in contact with a foe that can over shadow the imagination.

The soldier usually does not understand or recognize the changes that have transformed them into a different person than the one who left and came back. They have just survived the impossible situation of combat, how can they troubled by some little problem of thinking or behavior? The biggest trouble of screening in the military does not take into account of the issue of longevity and accumulative effects of psychological troubles. Most veterans with PTSD can function enough to convince themselves, usually not their families though, that they do not have a problem until they accumulate to proportions that disable and debilitate them possibly taking years to decades.

The lip service in the media today talks as if the programs they report on has national impacts on our soldiers and veterans. Do not believe the hype; the programs being discussed have only begun to address a problem that has plagued our veterans and soldiers since the founding of our country. In the last five years different programs have been developed to treat PTSD sporadically across the nation, and the high demand for these services pale in comparison to the soldiers and veterans who need them. 300,000 war veterans and soldiers from the current conflicts have been estimated to need psychological help and treatment; this does not take into account of the veterans already in the system or the ones who do not have the capacity to go through such a rigorous process.

Operation Warrior Quest & Battlemind Training

I have talked about how the military needs to start programs for soldiers reintegrating back into society. Well it seems that they took my advice, ok maybe it was not quite my advice. But possibly the vibrations of my good intentions were felt?

Over at A Soldier's Mind, a blog worth checking, out they have chronicled the starting of programs to aid in the reintegration process.

The pilot program, called Operation Warrior Quest, will combine sports that are considered “high adventure sports,” such as skydiving, paintball, ropes courses, rock climbing, mountain biking, stock car racing, skiing, and others, with the Army’s Battlemind Training. The program is designed to help the Soldiers readjust to the calmer pace of life back in garrison or “at home.” The idea is that the high adventure sports will be a way to attract Soldiers to participate in the program, as well as serve as a release mechanism that will allow them to obtain the adrenalin rush they’re craving, yet at the same time, do so in a controlled environment.
Here is the link to the full article: Readjusting To Life Following Deployment

Lower Recruitment Standards Contributing to Military Suicide Rates?

Are you kidding me?

I was checking out the Army's Stand-To website to see what tabs were being kept on the blog world. I clicked on a link about military suicides and found a whooping flaming red flag of ignorance and decided to Try and put it out.

When I read the question of whether lower recruitment standards were contributing to higher military suicide rates, I immediately wanted to react negatively and harshly. But I had to think about where it came from and I had to deduce that it was from ignorance of military life and the nature of combat.

The military way of life provides strong attachments through a communal approach to every aspect of interactions between soldiers and their families. Whether through a support network for the spouse of a soldier to help one another or to the training of our troops.

This interconnectedness brings a sense of herdness into the human fold centered around the soldier. Developing and enveloping the individual perspectives while opening them to a cohesive togetherness usually not felt before enlisting.

I am describing the level of bonding that occurs on a military post before a war has been brought into the picture. Now add in a military conflagration and this level of interpersonal commitment and associations have become welded to each others identity.

Bonding through blood and battle takes the soldier to a whole new level of raw humanism forged through survival and fight or flight defensive mechanisms. The psychology of killing alters the terrain of the mind disabling the rational machinery and enabling the ancient reflexive responsive unconscious.

When combat takes away the soldier who has became the centerpiece of an intimate community it breaks down. Whether he has been buried or she has become a prisoner of her own mind; war fractures the body, mind, spirit and the community that once knew cohesion.

The troops who do make it out of the theater of combat have been changed in body and mind. They have lost substantial parts of their mind, soul and community. Psychological trauma devastates the battle buddy, spouse, children and splinters everything that once was the bedrock of the American Soldier.

Add it all up and what do you think the equation equals?

Mental Health Field Unprepared for Epidemic of PTSD

I received this email today and it touches on the topic of how unprepared our nation and mental health field is to handle the cases of PTSD we have right now. What will our veterans do when we have become inundated with the hundreds of thousands of combat vets seeking help in the next 20 years? Suicide rates have begun to climb on a continuous rate since the inception of the war. This trend will only increase in the next couple of decades, as of right now over 6,000 veterans kill themselves each year.

Email from a reader:

I will be reading your blog in detail. I am a counselor in [your nearest town], I have counseled 3 former soldiers, all with varying degrees of combat stress. I wish I could say that I have helped them. There is really no training information for civilian counselors that has satisfied me. The VA is little or no help to me, but I realize that I have to get more savvy about how it can help them. [The nearest base] is little or no help to civilian counselors. They didn’t even have a PTSD group on base until the 7th soldier killed himself in 2007 and received national attention b/c his widow insisted to national news that he was not helped appropriately. That was one who was credited as suicide. I know of a soldier who killed himself and the Army hushed it by giving his widow death benefits by listing it as a combat injury.

Anyway, I have applied for Tricare approval to become a provider and been denied on bogus grounds (last time they said there was no evidence that [my college] is an accredited institution – of course it is) twice despite the horrible mental health needs of the soldiers that any Joe Shomoe can read about online. I’ve appealed a third time. It all sickens me. However, as word spreads that I am open to helping and I have no military ties, they will come. AND they will pay out of their own pockets to get some relief. I want to be more prepared. Maybe you can help me to help them.

I’ll be in touch.

My response:

Thank you Joe (name changed) for your compassion towards veterans with PTSD. This insidious mental injury is all the rage in the news at this time, due to the perseverance of families with soldiers suffering from PTSD and the resulting suicides. I say all the rage because the media puts the face on this issue like things are being done to help, when in reality we are just beginning to touch on the topic and have little research on the complexities of PTSD or the resources to help our veterans. In addition we have insufficient training programs in our colleges and for practitioners already in the field. I will have to take an independent study course to be able to include trauma therapy geared toward PTSD at U of L, so I can be prepared to give our veterans the specialized care they need. We will be facing a mental health epidemic of proportions never seen before in the history of American Warfare. With the unprecedented levels of sustained combat and extended multiple tours our veterans will be facing the crippling effects of PTSD with their families as well as the public with generational consequences.

Thank you again, for your concern and commitment, I will do what I can to help you in your endeavors. I can only offer my experience as it relates to me and my life as I am not yet in the capacity of a therapist. I can answer your questions and give you insights as it pertains to my intuitions and knowledge that I have acquired.

I would like to put your email and my response in my blog as it covers and underscores the issue of how little prepared we are to handle the ensuing issue of PTSD.