Showing posts with label PTSD. Show all posts
Showing posts with label PTSD. Show all posts

Thursday, June 9, 2016

Plan Ahead with a PTSD Alert Signal

Let’s talk about PTSD and triggers – and a way to communicate ahead of a full-blown anxiety situation.  As you become more familiar with what causes situations to move toward a negative situation, or a rising sense of foreboding, you’ll likely learn what triggers set off you or your family member.  Yes, it’s important to include you in this equation, since many caregivers also have accumulated symptoms of secondary PTS, and the resultant hypervigilance, mood changes, effects of insomnia, and stress.

Working together as a team, a family can learn to mitigate certain situations, such as crowds, loud and volatile situations, including family holiday dinners.  Creating a non-verbal signal puts you and your family member in charge of alerting one another.  Keep it simple, a tap on your wrist, a hand signal or perfect the Let’s-Get-Out-of-Here-Soon glance.  Demonstrating that you understand your family member (or you) are feeling rising anxiety, stress, or discomfort with the situation is helpful and allows you to more gracefully depart most situations promptly.  What a relief to avoid gutting out every difficult occasion! 

Recently, I heard a wonderful follow-up to this trigger signal by a smart and thoughtful caregiver named Lauren.  After these signals are given, departure is complete, when the next quiet moment comes, she and her husband engage in a short discussion.  Either one asks: First, are YOU okay?  Second, is the Situation okay now? And, Third and most important, Are WE okay?  This is a strong team effort that is kind and intuitive.


Take time this week to create your own PTS Alert Signal, practice it until the all feel united and comfortable, then consider asking those three key questions to keep the calm channels of communication open and willing. 

Linda Kreter & the
VeteranCaregiver Team

Thursday, February 11, 2016

Hormone Replacement Therapy for NED (symptoms of TBI and PTSD)

PTSD and TBI have physical symptoms that can be evaluated and treated if we ask our care teams about the newly emerging treatments that can help manage some of the symptoms.  Most of the time, the VA will guide a service member or veteran to CBT (Cognitive Behavior Therapy) or PET (Prolonged Exposure Therapy) as their first standard of care.  Yet, if you look at many of the symptoms of TBI and PTSD, these conditions may have resulted in reduced levels of important hormones.  These invisible injuries have a “neuro-endocrine” component; hence the psychological elements, but also the physical one.  Considering hormone replacement therapy is a complementary therapy option.

Physical injury to the brain with these (often) precipitous drop in hormonal levels, may contribute to many psychological and physical symptoms such as anger outbursts, depression, anxiety, mood swings, memory loss, concentration issues, learning disabilities and sleep deprivation. Many vets also experience high blood pressure, diabetes, loss of sexual drive, obesity, muscle weakness, and in women, menstrual changes. 

Hormones are powerful in our bodies, and may strongly impact quality of life for the veteran and their families.  It’s never fast enough for us, but studies are ongoing with hormone therapy to address the specific areas of reduced hormone production.  These hormonal deficits cover hormones regulating the thyroid, pituitary and adrenal glands, growth hormone, and the sex hormones, estrogen and testosterone. 

Researchers at the VA Puget Sound and the University of Washington found that up to 42% of veterans with blast injuries could suffer from low levels of pituitary hormones, causing some of the most troubling and lingering effects of mild TBI, such as fatigue, insomnia, lessened cognition, memory loss, sexual problems, depression, concentration and mood disturbances.  The primary investigating physician on the study said this:  “If PTSD does not resolve, it’s very possibly due to hormonal deficiencies”.

How many of you have heard the term “NED”?  DCoE for Psychological and Brain Health recommends screening for NED, or Neuro-Endocrine-Dysfunction in veterans with a history of TBI and symptoms lasting longer than 3 months, or which present within 3 years of injury. One example is with low levels of testosterone.  In the past, testosterone was delivered via injections, which caused spikes in blood levels, translating to the comments made by caregivers in two categories:  “too much sex drive, low energy, mood change” or “too little sex drive, aggressive, mood change”.  Newer administration is through pellet delivery (small as grains of rice) through a shallow incision in the buttocks or elsewhere for roughly 3-4 months in women and 5-6 months in men.  This delivers the bio-identical hormone in a steady fashion to the body; a blood test can determine if the levels have been optimized for each of the hormones (thyroid, adrenal gland, pituitary and gonads).  Sometimes, hormones are administered through oral supplements to complement the therapy an individual will require. 

This isn’t only about sex drive; it’s about quality of life with energy, mood, concentration, focus, and the potential to feel more like before deployment.  Note: this may be used as a complementary or alternative therapy, and no single therapy works for 100% for all taking it.  Research hormone therapy as a possibility with your primary care physician, since studies are showing real promise for improved quality of life.  More information is available through an Internet search or at the www.USMedicine.com website and search for “hormone replacement”. 

Linda Kreter & the 
VeteranCaregiver Team




Wednesday, December 9, 2015

What IS PTSD Really?

Many military family members (rarely the caregiver except in the beginning…) ask this question:  What is PTSD really?   

Post-Traumatic Stress Disorder, or PTSD, is the mind and the body's response to a traumatic event.  PTSD can is more commonly seen in combat veterans and first responders who experience and witness trauma doing their jobs.  PTSD is one of the Invisible Injuries.   Though PTSD is largely invisible, meaning that to a stranger, it wouldn't be apparent, the condition is often misunderstood by friends and family.

Symptoms vary and can be either subtle, or abrupt, leading family and friends to be confused.  It can also leave the veteran wondering if life will ever be the same again, and the family members unclear on what to expect each day.  One of the earliest signs to a caregiver may be that the service member or veteran is acting “differently”. 

The relationship can feel upside down, and there may be avoidance and isolation.  The vet may re-live the trauma through night terrors or flashback memories during the day.  This can be exhausting, and possibly alarming to the spouse who becomes the imagined enemy or situation in the dark.  Training kept them alive, but upon returning home, it’s hard to “turn off” the extreme vigilance, the hormonal cascade (testosterone and adrenaline) when PTSD is triggered by a scent, a sight, or even an anniversary.  It is not uncommon to see self-medicating to try to keep PTSD at bay.

With treatment, it is possible to anticipate possible triggers (prompts) such as a car backfire, or Fourth of July fireworks.   There may be a startle response, and hypervigilance which shocks children with its suddenness, and feels like rejection to spouses. There may be emotional numbness or increased aggression that feels as though it should go away now that he or she is safely home.     
The body needs time to recondition itself to the new safe environment and many effective treatments exist.  Since PTSD is both a psychological and neuro-hormonal response to perceived danger, newer treatments address both aspects and treatment, including complementary therapies for anxiety reduction, mindfulness, and communication help families to manage PTSD.   Know that treatment is necessary and the right “fit” can be found with persistence and the knowledge that life can become higher quality over time.

Linda Kreter & the
VeteranCaregiver Team

Thursday, August 6, 2015

Vietnam Era Caregivers - You Are Not Forgotten

PTSD is not only a condition of today’s troops, veterans, and first responders, unfortunately, it is a condition that affects our vets of much earlier conflicts.  When you consider the state of the country at the time of Vietnam, our troops came home to protests, rioting, and a very difficult adjustment for those serving. 

The stories were dreadful.  Like now, families felt somewhat isolated, but the country was far less respectful of those serving.  Today, even without full understanding of how to act or what to say, our troops are mostly warmly accepted and supported.  By contrast, my uncle was briefed to change out of his uniform immediately upon arrival in the States to avoid the chaos of the anti-war protests. Others were verbally and physically assaulted.  
The effects of coming home and working diligently to be invisible in the communities has also produced a long-term result – many of those from Vietnam did not receive treatment for their PTSD, nor did it have that name in the 1960’s, though the condition has been around as long as there has been trauma and conflicts. 

Another result is this aging population may come to seek VA care only in their later years, and they and their families have lived for decades with what is today openly discussed.  PTSD then and now will have many of the same symptoms of scent and sound triggers, sleep disorders, difficulty communicating and relationship challenges.  Add to this the possible loss of prime mobility, hearing loss, and aging issues, including presumptive conditions like Agent Orange, and we know we must actively communicate with the caregivers of each era.

It is less known, but very sobering that 80% of Vietnam veterans reported active PTSD symptoms 25 years after their service in a RAND study, with very high rates of depression and suicide.  These caregivers are hidden among you and please lend your support to them, include them in your peer groups, and learn from their experiences. 

PTSD may be a more familiar term these days, but our Vietnam era caregivers are only now coming out of the shadows.  To our Vietnam and earlier era caregivers, thank you for your quiet strength and service.

Linda Kreter & the
VeteranCaregiver Team



Tuesday, July 22, 2014

How is CAM Helping Our Veterans & Caregivers?

Greetings!

CAM, the acronym for Complementary and Alternative Medicine is gaining recognition for helping veterans adjust and heal after combat mental health injuries (Post Traumatic Stress/PTS and Traumatic Brain Injury/TBI), and for pain management and addiction.  Complementary methods are used with traditional, evidence-based therapies, and Alternative methods are used in place of standard medical practice. 

PTSD (mild to severe) is a complicated condition estimated to effect 20-60% of today’s veterans, and TBI (mild to severe) may overlap in 19% of all veterans.  While there is debate over the condition prevalence and diagnoses, additional treatments for symptoms such as hyper-vigilance, insomnia, anger, social isolation, depression and anxiety are better understood. 

Most CAM therapies are sought by the veterans themselves or family members when traditional, evidence-based VA treatment is ineffective or inadequate.  Newer therapies are slow to mainstream to the VA, yet most practitioners acknowledge there is no “one size fits all” care plan.  Veterans seeking augmented help often feel empowered by taking action, and will then blend traditional methods with their additional therapies. 

If you or someone you know is struggling with the symptoms of PTSD or TBI, researching alternative programs may be of help.  The following is a partial list to explore:

Service Dogs:  Many programs exist that pair a SM/Vet with a dog suited and trained to support their specific needs, ranging from dogs who can alert an impending seizure to those that provide solace and companionship.  Service dogs become part of the household and add a sense of purpose to the vet.

Equine Therapy:   Riding programs assist PTSD and those with physical disabilities that negatively affect their emotional health.  For many, being mobile away from a wheelchair or walker, and in tune with a large animal is a turning point for hope and acceptance.

Outdoor Retreats:  Opportunities for veterans provide not only the peace of the outdoors, but add a renewed camaraderie among their peers.  Retreats may provide learning a new skill (fly fishing, rock climbing, sailing), and others pair outdoor activities with group therapy.  Retreats may also include separate sessions for family members and children, who also benefit from the experience.

Yoga:  Yoga has proven very helpful in easing chronic pain, providing physical focus, and beneficial through adding a spiritual element through movement and breathing awareness.  A growing number of programs are taught by vets or family members who understand the aftereffects of combat, and the essential mind/body connection is nurtured through this practice.

Meditation & Mindfulness:   These practices restore many focusing on both physical and spiritual elements that elicit emotional stability and well-being and are used mainly for decreasing anxiety and depression symptoms and improving overall wellness.

HBOT (Hyperbaric Oxygen Therapy):  HBOT has proven life-changing for many veterans with TBI (and/or PTSD).  This treatment places an individual in a highly pressurized oxygenated environment that stimulates cell growth.  These highly oxygenated red blood cells move through the body, facilitating the repair of bruised and damaged tissue for faster recovery.  Brain scans are showing visible improvement and the VA offers HBOT at most facilities upon request.

Acupuncture:  This ancient practice of thin needles placed in the qi (“chee”) points of the body facilitates calm, promotes peace of mind for better sleep patterns, and is also a help for chronic pain.  Acupressure utilizes the same premise, but uses manual pressure on the qi points instead of the insertion of needles. 

Therapeutic Massage:  The soothing element of touch can be very helpful for emotional health, and is often used for pain management, anxiety, insomnia, depression, and physical conditions. 

Art, Music, and Expressive Writing Therapy:  Through personal expression through these mediums, veterans have found emotional relief and improved wellness.  These attentive sessions are often in a group setting, which adds the peer support to those expressing and releasing painful or negative emotions in a non-judgmental environment. 

Many other complementary and alternative therapies exist, and the key element is finding one that fits the veteran’s personal situation most closely.  The symptoms of PTSD and TBI can usually be managed once the correct blend of therapies is followed, and is crucial for the best possible medical outcomes. 

Linda Kreter & the VeteranCaregiver Team

Wednesday, November 20, 2013

What Non-Caregivers Need to Consider...

Greetings,

Lately we’ve been noting how many times people are surprised at a comment or statistic about Caregivers of veterans.  It made us think that compiling several of them might make more of you aware of what people don’t know, and therefore they cannot offer to help you.  So, in the spirit of hoping others may read this (or you can send it to them), here is a brief and incomplete listing – feel free to add to the list!  This just might make your family holidays a bit easier?

1.      The VA takes care of all medical care for your veteran and you, what are you complaining about?”  (The VA takes care of the Vet’s care and Caregivers receive CHAMPVA or TRICARE depending on service status, caregiver program, and other factors, but not all care is covered for the caregiver.  It can be very hard to find a doctor who takes CHAMPVA or who understands PTSD, so don’t assume life is “easy”.)

2.      As a Caregiver, you are paid for your work.”  (Not in every case and not at market pricing for commercial caregivers. It is very challenging to explain to others what a "typical" day looks like, but the pay is not why you do what you do, but it helps meet the bills that stress you.  Ask that person to accompany you on your next set of doctor visits; it may open their eyes and their hearts.)

3.      Besides, s/he’s your husband/adult child, you should take care of them just because you love them.”  (Judgment by others not familiar with your days of constantly being on edge, dealing with a large bureaucracy, trying to apply logic to an illogical system, scheduling countless appointments, juggling 20 medications carefully, and being bone-tired has nothing to do with paybacks for love.  Visible and invisible injuries take a great deal of patience and work to manage with the care team. It’s hard to keep the train on the tracks.  This is why there is a Caregiver program at VA that covers at least some of your needs because it’s fairly obvious that if you all dropped off your vet at the VA that the system would crumble rapidly.  These may be people you don’t need in your life…)

4.      You should get a therapist if you are stressed or not sleeping.”  (That might be the case, but being a Caregiver is draining and stressful at times, and only a clinician can advise you.  Having said that, talking with your peers or a professional might lighten your load. We bristle when we hear the words "you should"...)

5.      Never continue the conversation if the Caregiver is in tears.”  (We disagree.  We think this is a perfect time for active listening and compassion.  If you can’t let down with those you’re close to or who need you, they miss out on an opportunity for support.  Be a safe haven for them.)

6.      Don’t discuss talk of suicide or suicidal thoughts if the Caregiver brings it up.”  (This is an excellent time to compassionately listen, and to also ask if they need other resources and professionals to discuss this serious topic.  If they are seemingly a danger to themselves or others, call emergency services.  If you are unsure, a call to the VA Lifeline would be appropriate to ask what to do for support.  Sometimes, though, just providing a shoulder and a kind ear calms the anxious moment and the almost-crisis moment passes.  However, when in doubt, always reach out for help!)

7.      PTSD and TBI are excuses for acting like a jerk!”  (Perhaps, but unless you’re a physician and know the background and medical record of the veteran, the symptoms of either PTSD or TBI may not be managed well, or needs may have changed.  Educate yourself on both, and know what to look for when medications are changed or someone is in denial over needing help.  Great resources exist on both conditions, and alternative therapies may work when traditional first-line therapies aren’t working.  No two vets are alike.  No two Caregivers are either.)

8.      You’re not the one with PTSD – s/he is!”  (Potentially false.  Secondary PTSD or Generational PTSD are the terms used for the cumulative effect of being around those with PTSD and having to alter your normal way of living to accommodate the veteran with PTSD.  Insomnia, hyper-vigilance, walking on eggshells, avoiding surprising someone, isolation, and altered communication may indicate that the Caregiver needs supportive clinical care also.  Again, it helps to educate yourself and your family so they don’t inadvertently trigger a situation unwittingly.)

9.      S/he’s been back for two years, what’s the problem?”  (War is hell.  People come back from war changed, and they change those around them.  Physical loss doesn’t get easier and invisible injuries are still misunderstood.  There are Vietnam vets who have suppressed their emotions and experiences for 40 years and they suffer still.  There is not a timeframe for “getting better”.  Please do not judge Caregivers or veterans on their issues; judgment is not yours to make.  Offer resources, a gentle ear, and recognize that everyone heals at their own pace and with appropriate care.)

10.   You need to make time for yourself – you’re running yourself ragged!”   (We think that each and every Caregiver has probably heard this at one time or another.  And, if you have run yourself ragged by always putting others first, then please, ask for and access respite care, a half-day off, or even begin seizing 15-minute intervals to breathe.  Consider that if you fall down, the entire family structure will wobble.  Don’t underestimate your critical role; you are the heartbeat of the family and you matter, so taking care of yourself is critical.  To family members, please keep offering help proactively so that the Caregiver knows you really mean it.  Caregivers are an independent, resourceful group, so coax them to lean on you and be there when they do.)

There are many more, but this posting is long enough.  We wish you a Happy Thanksgiving, and may you have a calm and peaceful holiday.

Linda Kreter & the VeteranCaregiver Team

Friday, October 25, 2013

Mental Health Support - Individual/Group & Moral Injury/PTSD

Greetings, friends,

We've been talking about Moral Injury on the American Heroes Network radio broadcast lately (15Oct), and a new discussion yesterday has provoked new thinking.  

[An example of moral injury would be a fierce firefight that resulted in the inadvertent killing of innocent civilians that haunts a veteran afterward. This has gone on as long as war has been waged.]



Two issues are provided for your thought here today.  

When a unit experiences a trauma together that goes against personal values and creates a moral dilemma, service members are forever changed.  In past eras, it was very hard to reconnect with members of a unit, especially if the war fought was considered an Unjust War (Vietnam).  With today's Social Media capabilities, we learned a great deal from a wonderfully articulate Marine who has found 80% of his unit.  This online effort has now grown to include annual reunions that are highly significant and meaningful to them.

This unit/peer connection appears to be a growing phenomenon and began years ago with Facebook pages for a specific unit, and has morphed into using GPS geo-locators for identifying other veterans (POS REP). The action of organically connecting to prior unit members is showing positive outcomes for many, including finding some semblance of peace and improved mental well-being.  

Interestingly, most mental health care is administered to each individual. Which works best?This is a tough question to answer since everyone is different, but research appears to be saying that for combat vets, a shared experience and peer connection may be an excellent way to heal.  

Secondly, is Moral Injury separate or a component of PTSD?  Moral Injury is under study to discern whether it is separate from PTSD, even though many symptoms may be the same. Is moral injury defined by guilt and a moral disagreement with personal values and PTSD more a danger response (with biological, psychological symptoms) coupled with a spiritual outlook?  Does this help explain drone operators who are not in physical danger, but suffer greatly as we now know.

This topic will be discussed more fully on the American Heroes Network (www.AmericanHeroesNetwork.com) on 05 November at 11am EST and archived afterward on iTunes and the AHN website.  Let us know what you think of the group versus individual approach to Moral Injury and/or PTSD may be?

Linda Kreter & the VeteranCaregiver team

Friday, October 11, 2013

Moral Injury & PTSD - One Story

Greetings,

We will be talking Tuesday with two cutting edge researchers on the American Heroes Network about Moral Injury:  PTSD and Suicide in the U.S. Military. This term is not often heard, but the stark truth written below may help with greater understanding of our troops' sacrifices and invisible injuries that linger after they return home.  This story was written in 2005 and rings true today (link: http://www.commondreams.org/headlines05/0615-08.htm.

Wednesday, May 04, 2005

IT WAS STILL DARK...
--by Sgt Zachary Scott-Singley

 


It was still dark. I got dressed in that darkness. When I was ready I grabbed an MRE (meal ready to eat) and got in the truck. I was going to go line the truck up in preparation for the raid we were about to go on. The targets were three houses where RPG attacks had come from a few days prior. Sitting there in that darkness listening to the briefing on how we were to execute the mission, I let my mind wander from the briefing and said a prayer. "Just one more day God, let me live one more day and we will go from there..." It was the same prayer I said every day because every day I did the same thing. I left the base. With a small team I would go out each day on different missions. I was their translator.

There were different people to meet each day. There were some who would kill you if they could. They would look at you and you could see the hate in their eyes. I also met with people who would have given me everything they owned. People, that were so thankful to us because we had rid them of Saddam. Well, this day was not really much different from all those other days so far. After the briefing we all got into our assigned seats and convoyed out to the raid site. I was to go in directly after the military police that would clear the building.

The raid began without a hitch. Inside one of the courtyards of one of the houses, talking to an Iraqi woman checking to see if her story correlated with what the detained men had said, I heard gunfire. It was automatic gunfire. Ducking next to the stone wall I yelled at the woman to get inside her house, and when the gunfire stopped I peeked my head around the front gate. I saw a soldier amongst the others who was pulling rear security by our vehicles. This soldier I saw was still aiming his M249 (a fully automatic belt fed machine gun) at a black truck off in the distance. His was the weapon I had heard.

I ran up near his position and overheard the Captain in charge of the raid asking what had happened and why had this soldier opened fire. The soldier kept his weapon aimed and answered that he was sure he had seen a man holding an AK-47 in the back of the black truck. I was amongst the four (along with the soldier who had fired on the black truck) who had been selected to go and see what was up with that truck.

We were out of breath when we got to the gun-truck nearest to the black civilian truck (a gun-truck is a HUMMWV or sometimes called a Hummer by civilians, with a .50 caliber machine gun on its roof). There was a group of four Iraqis walking towards us from the black truck. They were carrying a body. When I saw this I ran forward and began to speak (in Arabic) to the man holding the body but I couldn't say a word.

There right in front of me in the arms of one of the men I saw a small boy (no more than 3 years old). His head was cocked back at the wrong angle and there was blood. So much blood. How could all that blood be from that small boy? I heard crying too. All of the Iraqi men standing there were crying and sobbing and asking me WHY? Someone behind me started screaming for a medic, it was the young soldier (around my age) who had fired his weapon. He screamed and screamed for a medic until his voice was hoarse and a medic came just to tell us what I already knew. The boy was dead. I was so numb.

I stood there looking at that little child, someone's child (just like mine) and seeing how red the clean white shirt of the man holding the boy was turning. It was then that I realized that I had been speaking to them; speaking in a voice that sounded so very far away. I heard my voice telling them (in Arabic) how sorry we were. My mouth was saying this but all my mind could focus on was the hole in the child's head. The white shirt covered in bright red blood. Every color was so bright. There were other colors too. The glistening white pieces of the child's skull still splattered on that so very white shirt. I couldn't stop looking at them even as I continued telling them how sorry we were.

I can still see it all to this very day. The raid was over there were no weapons to be found and we had accomplished nothing except killing a child of some unknowing mother. Not wanting to leave yet, I stayed as long as I could, talking to the man holding the child. I couldn't leave because I needed to know who they were. I wanted to remember. The man was the brother of the child's father. He was the boy's uncle, and he was watching him for his father who had gone to the market. They were carpenters and the soldier who had fired upon the truck had seen someone holding a piece of wood and standing in the truck bed.

Before I left to go back to our base I saw the young soldier who had killed the boy. His eyes were unfocused and he was just standing there, staring off into the distance. My hand went to my canteen and I took a drink of water. That soldier looked so lost, so I offered him a drink from my canteen. In a hoarse voice he quietly thanked me and then gave me such a thankful look; like I had given him gold.

Later that day those of us who had been selected to go inspect the black truck were filling reports out about what we had witnessed for the investigation. The Captain who had led the raid entered the room we were in and you could see that he was angry. He said, "Well this is just great! Now we have to go and give that family bags of money to shut them up..." I wanted to kill him. I sat there trembling with my rage. Some family had just lost their beautiful baby boy and this man, this COMMISSIONED OFFICER in the United States Army is worried about trying to pay off the family's grief and sorrow. He must not have been a father, otherwise he would know that money doesn't even come close... I wanted to use my bare hands to kill him, but instead I just sat there and waited until the investigating officer called me into his office.

To this day I still think about that raid, that family, that boy. I wonder if they are making attacks on us now. I would be. If someone took the life of my son or my daughter nothing other than my own death would stop me from killing that person. I still cry too. I cry when the memory hits me. I cry when I think of how very far away I am from my family who needs me. I am not there just like the boy's father wasn't there. I pray every day for my family's safety and just that I was with them. I have served my time, I have my nightmares, I have enough blood on my hands. My contract with the Army has been involuntarily extended. I am not asking for medicine to help with the nightmares or for anything else, only that the Army would have held true to the contract I signed and let me be a father, a husband, a daddy again. 

Thursday, June 20, 2013

Heart Cracks ...

Today it's about perspective.  It’s not the heart-wrenching stories that drain us the most. It's the overall indifference.

There are hundreds of very tough stories, with just a few here: 
  • -       A father of three dying of early onset dementia brain lesions after an FOB is set up directly over a 500 gallon fuel spill in the desert
  • -       A daughter who will forever re-live the systematic rapes and abuse for three years by her CO
  • -       A son who drove his car into a tree at over 120 mph to die, but gratefully who lived and continues to fight his PTSD
  • -       A family that lives on edge awaiting the rages/destruction/fierce silence of PTSD in a husband and Dad who won’t seek help, but whom they still love

What hurts us (and our nation) the most is the numbness of bureaucratic indifference.  In just the last three days, we guided four caregivers to official contacts to improve their specific long-term situations (overdue expense reimbursement, foreclosure/eviction, cancelled utilities, change of physician).  We made 17 calls of our own to try to break through the logjam.  

Not a single time was a solution provided.  Of the two people who answered their phones, they sympathized, but were also unable to help.  We were cordial, asked for further guidance, thanked them, and yet, it is the ones that will not answer or respond to calls and email who could ultimately help.  At least that is what we hope, for there is always a solution when people want to help.


We who support our veterans and their families do not have compassion fatigue.

We have Bureaucracy Fatigue.  Lord, please help us to continue to press forward despite the weariness, indifference, and malaise. These caregivers, families, and veterans matter!

Amen,

Linda Kreter & the VeteranCaregiver Team   

Monday, October 8, 2012

Response to Military Suicide Article



The Pentagon's "Quick" Fix is NO FIX to Military Suicide

By:  Rev. Dr. Chrys L. Parker, J.D., PTSD specialist

It's an unfortunate irony that the Defense Department apparently believes that its proposed ban on servicepersons' privately owned guns will serve as a "silver bullet" that will prevent or reduce suicide among service members. 

Such a proposal, while no doubt well intended, is reflective of the Pentagon's misguided and ineffective search for quick and simplistic answers to complex problems of the human psyche, which are the inevitable product of war.  While the military is undoubtedly skilled in marshalling men and regulating the use of arms on the battlefield, the ongoing battle within the mind of the traumatized and suicidal soldier is of a very different kind.   The skills needed for the first kind of battle are ineffectual in fighting the second. 

The military was designed to fight wars, and does so with competence.   But as an institution, the military was never designed to be the curer of wounded souls.  When confronted with the alarming psychological byproduct of war,  the military seeks to employ "default" solutions which, in its estimation, will fix a problem through the issuance of orders.

 Soldiers do not become suicidal simply because they possess weapons.  And they will not avoid suicide, based on an order not to possess them.  After all, suicide may just as easily be accomplished with a service weapon, and frequently is.  If possession of private weapons is (erroneously) deemed to be the factor which initiates suicide, then we must be led to the ludicrous conclusion that a ban on all weapons, including service weapons, would be in order if we are to really get serious about reducing the rate of military suicide.

 Obviously, the Pentagon is not logically thinking this problem through to its thoroughly illogical conclusion.  In a desperate move to find a quick "fix" that can be implemented by legislation and M.P.'s, instead of through appropriate, empathic and personally rendered care, the military is firing without aiming first.  It seeks to control the means of suicide, without bothering to examine the reasons that warriors adopt those means in the first place. 

And, to be sure,  there are plenty of means that remain available to the suicidal serviceperson, whether private firearms are banned or not.   It is patently obvious that the nameless "senior Defense Department officials," who have concocted the suggested ban on private weapons,   spend little or no time whatsoever actually talking, working, or counseling with REAL suicidal warriors, like the ones I see and counsel every day.  

In coming to illogical conclusions about what drives suicide, or by what means it is accomplished, the Pentagon appears not to learn from its own reports. For proof of that, one may look back at the DoD Epidemiological  Report on Suicide for  the year 2009, which references the number of suicides accomplished by hanging. 

Would the Pentagon therefore propose that we inspect the house of every warrior for rope and seize the household clothesline, as an "effective" plan for suicide reduction?   Having begun with private weapons, and moved on to rope,  should we also plan on banning razors, kitchen knives,  motorcycles,  and automobiles,  which are also prominent instrumentalities of suicide? 

The additional suggestion that prescription drugs be removed from households by spouses of "at risk" soldiers is irrational and ineffective.  It presumes, first, that "at risk" soldiers can be systematically identified.  Suicidal soldiers will be the first to tell you that if they are truly serious about taking their lives, they will deliberately evade identification.

Assuming, however, that a soldier is identified as genuinely "at risk" of suicide, that soldier ought to be in treatment, NOT left sitting in his bathroom contemplating the contents of the medicine cabinet.  Having failed to make adequate treatment accessible, the military is shifting the burden of care to spouses, who are not the proper persons upon whose shoulders the psychiatric management of soldiers should be foisted. 

I am sure that the good intentions of Dr. Jonathan Woodson,  Assistant  Secretary of Defense for Health Affairs, are not to be doubted… only his ability to grasp the obvious.  The "obvious" is that (l) removal of prescription drugs may also serve to defeat the administration of bona fide medical treatment;  (2) removal  of the drugs of one person would  extend to removal of  ALL drugs for  ALL family members ;  and  (3)  a suicidal soldier may obtain lethal drugs from many sources outside the home ,  including the $3.00 bottle of acetaminophen (Tylenol) from the local drug store. 

The illogic of these proposals, not to mention their unconstitutionality, is astonishing.

"Orders" are things the military knows well.  Orders lend, to the military, both the internal feeling and the public perception that  things are "under control."   Orders are calming, because they make it appear that a problem has been put to rest.  But "orders" are also utterly ineffective to salve the deep wounds which cause many warriors to lose all sense of meaning and all desire to live.  The only thing which this proposed order will put to rest, are the lifeless bodies of soldiers who have ended their lives, in countless other ways,  despite the military's "orders" that they not commit suicide by firearm.

 As a mental  health provider,  as a Chaplain in service to military members and veterans, and as a contract military trainer,  it pains me to see the military utilize its time, resources, and talented personnel in continually avoiding the nature of the suicide problem, instead of addressing its underlying realities.

Suicide is not a weapons problem, or a drug problem, any more than it is a rope or razor problem.  It is an existential problem… a deep wound to soul and psyche of incalculable depth, which creates an absolute belief in the mind of the warrior that his or her existence is absolutely of no value or worth.  This is what drives suicide.

What is actually of no value or worth in preventing suicide is the use of weapons bans, prescription bans, or digitized slide shows which attempt to "lecture" despairing soldiers into  living against their will, rather than by providing them the relational care they need.

For some, suicide is the only means of escaping the unremitting terrors of gruesome and horrifying battles that are continually re-enacted in flashbacks which medication cannot remedy.  For others, suicide feels like the only "adequate penance" for intense guilt over having survived when one's buddies did not.  For others it is a reflection of the inability to "occupy" a body or soul that has become soiled by the brutalities of war, or the deaths of others caused by the performance of one's duty. 

Every warrior who suicides has his or her reason.   But whatever the reason, all suicides constitute a "final solution" for  people whose deep personal pain is fed not  by guns, but by mental, social and spiritual isolation, exclusion,  and the knowledge that the relational support  which they experience in the combat theater is no longer present for them when they return to the rear. 

It was my privilege to go to the Iraqi theater in 2010.  Now I understand why warriors are at lesser risk of suicide in theater than they are at home.  There is not a single suicidal warrior whom I counsel who would not willingly return to the war overseas, where men and women are kept alive by the close relational bonds connecting those who live, work and fight together and have a shared sense of life's meaning.  Society, however, often defines meaning in wholly different terms, into which some returning servicepersons no longer fit in the light of what they have experienced.   As a result they quickly feel unfit to be a part of the society they risk so much to defend. 

 Sadly, where some servicepersons they believe they DO "fit" is in deep, black emotional chasms into which warriors fall soon after they return to a life that is full of material comforts, but bereft of meaning.

 No private weapons ban will instill the will to live in warriors whose lives have been stripped of meaning.  Stripping them of weapons will only encourage them to look for other available exits from life. 

 Better that our military and our entire society focus our attention less on the false comforts of quick fixes, and more on providing empathic care, rendered shoulder to shoulder and face to face.  The hope that defuses suicidality is not found in a military "no weapons" order, but in the eyes of  other human beings who truly care.


Rev. Dr. Chrys L. Parker is co-author, along with Harry Croft, M.D., of the book I Always Sit with My Back to The Wall. She is a clinical chaplain, pastoral counselor and trauma therapist who has provided care for over 2,500 traumatized persons.  Harry Croft M.D. is a former Army doctor and psychiatrist who has evaluated more than 7,000 veterans with PTSD.  Visit www.mybacktothewall.com




Friday, May 4, 2012

Ahh, PTSD Awareness & Compassion Shown!


Greetings, friends,

One of my favorite Caregivers called today with a story of a great out-in-public experience.  Her husband, a veteran with moderate to severe PTSD wanted to go to the midnight showing of the new movie, The Avengers last night.  She was surprised, and also glad.  How very normal!  She immediately began mentally considering the environment:  they knew the building, the exits, the parking, the ticket line, but surely the crowds on opening night would be daunting?  Quick discussion: he really wanted to make the effort, so on they went.

The theatre and surrounding area was packed with people and after she’d bought the tickets, her vet started to become fairly agitated.  Since she’d been planning in her mind for the past hour, she easily located the manager and explained that her husband was a combat veteran with PTSD, and would he possibly help them?  The manager asked what specifically disturbed him?  She replied:  the crowd, needing a seat near the exit, some sounds, and the hope of not disturbing others.  His face cleared, and he said:  “Oh, like Captain America!”  (Captain America was the star character of a World War II movie of a veteran who was frozen in time, but when he “came back” years later, he had these same PTSD reactions and went on to become a super-hero.) 
The manager immediately asked a few smart questions, then guided them to the smallest of the many theatres, found them seats apart from others yet with clear access to the exit, and also said that if they needed to leave, he would comp their tickets.  He even went on to say that if there were a group of vets in the area who wanted to view the movie together that they would be glad to arrange it at a quieter time!

The loved the movie.  They were grateful to the manager.  And, mostly, they loved the outlook that (unlike the recent media sensationalism of PTSD), this veteran was compared to Captain America – a character that had been changed by his military service – but who was regarded as a Hero.  

Bottom line:  with calm planning, informing others of their needs, and a blessing in the form of a wonderful theatre manager, a wonderful movie night was enjoyed by all!

May you all enjoy a Captain America experience very soon,

Linda 

Thursday, April 19, 2012

Final Honors, the Flag, and Courage!

Greetings,  we have such a good story to tell you! 

There once was a very brave soldier who suffered extensively from debilitating PTSD and an extended, rugged journey to recovery.  Very recently, through an usual and very effective team effort, an alternative, comprehensive PTSD program significantly changed her perspective, her health, and indeed her life.  Throughout the long PTSD journey, however, nothing had ever gotten in the way of honoring her fellow battle buddies.  She volunteered her time as a bugler for Military Funeral Honors Corps, met with families, reached out to veterans at public events, and each time overrode her own severe discomfort with being among crowds.  Even with occasional setbacks, she always persevered and stretched to do the right thing.

Yesterday was one of those days.  In her home state of Missouri, a soldier had died in Afghanistan and Governor Nixon had ordered that all flags were to be at half-mast to honor him on the day of his funeral.  This was a law enacted in January 2011, and was to include all flags on all properties to include federal properties. 

The funeral of the fallen soldier was held yesterday 1300 hours at Jefferson Barracks National Cemetery, and though other flags were at half-mast throughout the state, the one at the VA post where the funeral took place was not.  This appalled her.  So, she went into the VA building and asked who was in charge of the flag?  A man answered that he was.  She asked why the flag wasn’t at half-mast?  He answered that it was federal property and “go tell someone else your problem”.  She left the building, went out to the flag pole marking the Path of Honor (where several veterans were sitting) and personally lowered the flag to half-mast.  She did this as a gesture of respect, honor, and in keeping with protocol.  The veterans present applauded her efforts.

However, the VA police were called and they said they would have to arrest her.  She asked, what law did she break?  She was told again that the VA was federal property and didn’t need to comply with the Governor’s request, though this is untrue.  The police repeated that she would be arrested – in fact, five  policemen surrounded her.  Remember, she suffers from severe PTSD.  She held her ground, deeply upset. Words were exchanged, but one of the policemen said he was also a veteran, and told her he understood honors and respect for a fallen comrade.  She agreed to leave and was not arrested.  Moments later, the flag was again raised to the top.  Her mission was accomplished - Corporal White was honored through the actions of this faithful soldier.

In our opinion, this veteran, a former Volunteer of the Year by the city Police Department, one of four buglers in the state of Missouri to assist at military funerals, and a solid battle buddy to the core deserves a commendation for this patriotic action.  She has been deeply effected by her service to this country, but she put herself at considerable health risk to provide honor and dignity to one who had paid the ultimate price. 

This blog posting is dedicated to Bonnie Casler, MSG, USA (Ret). 

Very respectfully,

Linda