Pentagon may drop mental health question

By PAULINE JELINEK and ROBERT BURNS, Associated Press

WASHINGTON – U.S. troops would no longer be asked to reveal previous mental health treatment when applying for security clearances under a proposal being considered by the Pentagon.

The idea stems from the finding that service members avoid needed counseling because they believe that getting it — and acknowledging it — could cost them their clearance as well as do other harm to their careers, The Associated Press has learned.

“This is just one of several items under review by the Department of Defense and the services in an effort to remove the stigma associated with mental health issues,” said Air Force Maj. Patrick Ryder.

The proposal is to omit a question regarding mental health treatment that appears on a form required by the Office of Personnel Management, the agency that does the majority of investigations for granting clearances to military and civilian workers in the federal government.

Currently, the questionnaire asks applicants whether they have consulted a mental health professional in the last seven years. If so, they are asked to list the names, addresses and dates they saw the doctor or therapist.

The Pentagon has been working for some time to end the stigma of counseling. Studies indicate that soldiers most in need of post-combat health care are the least likely to get it because they fear that others will have less confidence in them, that it will threaten career advancement and that it could result in loss of their security clearance and possibly removal from their unit.

Statistics indicate that the perception of stigma is “far worse than the reality” when it comes to getting security clearances, Ryder said. Last year, less than .05 percent of some 800,000 people investigated for clearances were rejected on the sole issue of their mental health profile, he said.

That’s because the clearance process is done on the “whole-person concept” — that is, it weighs a number of factors about the person’s past and present, favorable and unfavorable. People can be prevented from getting a clearance if they have been convicted and imprisoned, are addicted to any controlled substance, have been discharged dishonorably from the service or are currently mentally incompetent.

If the application for clearances is changed to omit the question on previous counseling, it would be just a small part of the effort to encourage service members to get mental health care.

An education program for personnel at all levels of the military is among main recommendations of a yearlong mental health study. The task force study, ordered by Congress, called for urgent action to improve care for members of the military, under strain from simultaneous wars in Iraq and Afghanistan, officials said earlier Friday.

A change already made is a program called Respect.mil, Maj. Gen. Gale Pollock, the acting surgeon general of the Army, said at a news conference on the task force report. Under the program, instead of requiring soldiers or their family members to go to a designated location where it’s clear they’re getting behavioral health care, they can get the care at a primary care center.

The overall conclusion of the report was that it will take more money and staff to keep up with health care needed because of the high tempo of operations in Iraq and Afghanistan. Long and repeated deployments in the wars have been blamed for some of the mental health problems.

The two “signature injuries” from the conflicts — mostly Iraq — are post-traumatic stress disorder and traumatic brain injury, the task force said, adding that the new demands “have exposed shortfalls” on a system that has not been war-focused for decades.

The military also needs to train leaders to understand that physical health and psychological health are equally important, said Vice Adm. Donald Arthur, co-chair of the task force.

“We concentrate a great deal on … how fast can you run a mile, how many sit-ups and push-ups can you do,” Arthur told reporters. “But we don’t often concentrate on the psychological health of the service member.”

“If you break your leg, it’s not your fault; if you get cancer, it’s not your fault; if you have a post-traumatic stress reaction, it’s not your fault,” he said.

Noting that the problem of stigma is pervasive not only in the military, but in American society as a whole, they said the evidence in the military is overwhelming. Fifty-nine percent of soldiers and 48 percent of Marines said thought they would be treated differently by leadership if they sought counseling, according to a survey among troops who had been deployed.

Of even greater concern, the report said, are recent findings that service members who screened positive for symptoms consistent with mental illness were twice as likely as those without symptoms to express concerns about stigma.

“Individuals exhibiting the greatest need were the most hesitant to seek care, even though empirical data from at least one military study indicates that service members do not suffer any negative career impact from seeking services related to their psychological health,” the report said.

“Post-traumatic stress, combat stress is an absolutely normal reaction to a very abnormal situation,” Arthur said, adding that care can prevent it from turning into a disorder.

“Combat is like nothing else that one can experience in peacetime. It is not like you see in the movies,” he said.

“It’s not 90 minutes of show with 30 minutes of commercials and the good guy wins in the end. You have a real chance of being seriously injured or killed in your service to your nation.”

Army plans to hire more psychiatrists

PAULINE JELINEK, Associated Press

WASHINGTON – Overwhelmed by the number of soldiers returning from war with mental problems, the Army is planning to hire at least 25 percent more psychiatrists, psychologists and social workers.

A contract finalized this week but not yet announced calls for spending $33 million to add about 200 mental health professionals to help soldiers with post-traumatic stress disorder and other mental health needs, officials told The Associated Press on Thursday.

“As the war has gone on, PTSD and other psychological effects of war have increased,” said Col. Elspeth Ritchie, psychiatry consultant to the Army surgeon general.

“The number of (mental health workers) that was adequate for a peacetime military is not adequate for a nation that’s been at war,” she said in an interview.

The new hiring, which she said could begin immediately, is part of a wider plan of action the Army has laid out to improve health care to wounded or ill veterans and their families. It also comes as the Defense Department completes a wider mental health study — the latest in a series over recent months that has found services for troops have been inadequate.

Ritchie said long and repeat deployments caused by extended wars in Iraq and Afghanistan are causing more mental strain on troops. “At the time that the war began, I don’t think anybody anticipated how long it would be going on,” she said.

Surveys of troops in Iraq have shown that 15 percent to 20 percent of Army soldiers have signs and symptoms of post-traumatic stress, which can cause flashbacks of traumatic combat experiences and other severe reactions.

About 35 percent of soldiers are seeking some kind of mental health treatment a year after returning home under a program that screens returning troops for physical and mental health.

The military has seen a number of high-profile incidents of alleged abuse in the wars in Iraq and Afghanistan, including the killings of 24 civilians by Marines, the rape and killing of a 14-year-old girl and the slaying of her family and the sexual humiliation of detainees at Abu Ghraib prison.

Officials and military analysts have blamed ethics lapses partly on the strain of combat and insufficient training troops got before being sent to the battlefront.Ritchie said the 200 new medical health workers will be added to more than 600 uniformed and civilian mental health professionals now working at three dozen Army medical centers and hospitals.

The Army also is planning a number of other improvements, such as streamlining bureaucracy that vets must go through to get care and adding more lawyers and other workers to help them and their families.

A report from a Defense Department task force released Thursday also found “current efforts fall significantly short” in providing help for troops.

“The psychological health needs of America’s military service members, their families and their survivors pose a daunting and growing challenge to the Department of Defense,” it said.The task force was required by Congress under in 2006 law.

Also on Thursday, a Senate panel voted to expand brain screenings and counseling for wounded veterans of the Iraq war and to reduce red tape for service members moving from Pentagon to Veterans Affairs care.

The bill, approved by the Senate Armed Services Committee, also would boost disability pay and provide more counseling for family members of tens of thousands of U.S. service members wounded in combat.The action, which sends the bill to the Senate floor, capped a flurry of activity in recent weeks to reach broad agreement on a single measure that would improve health care following reports of shoddy outpatient treatment at Walter Reed Army Medical Center.

Separately, the VA said that it would bolster programs to prevent suicide among veterans by hiring additional counselors at each of its 153 medical centers after an internal review found that current VA programs were inadequate.

The unspecified number of new counselors would join 9,000 mental health professionals already employed by the VA to help veterans.

Meanwhile, the White House has backed away from earlier threats to veto a spending bill containing $4 billion more than President Bush sought for veterans’ health care.Just last month, White House budget director Rob Portman pledged that Bush would veto bills from Congress that would break through Bush’s budget caps.

The House is slated on Friday to take up the $64.7 billion measure, which also funds military base construction. A companion Senate bill sailed through the Appropriations Committee Thursday afternoon.

From our Peace and Freedom series:
War Wounds of the Mind Part VI: Half of Soldiers, Marines Returning With PTSD — Red Alert

War Wounds of the Mind Part III: The Commanders

(Search this site using “PTSD” for more information)

A Shock Wave of Brain Injuries

By Ronald Glasser

Sunday, April 8, 2007; Page B01

“We can save you. But you might not be what you were.”

Neurosurgeon, Combat Support Hospital, Balad, Iraq

This is the new physics of war. Three 155mm shells, linked together and combined with 100 pounds of Semtex plastic explosive, covered by canisters of butane or barrels of gasoline, can upend a 70-ton tank, destroy a Humvee or blow an engine block through the hood of a truck. Those deadly ingredients form the signature weapon of the war in Iraq: improvised explosive devices, known by anybody who watches the news as IEDs.

Some of the impact of these roadside bombs is brutally clear: Troops are maimed by projectiles, poisoned by clouds of bacteria-laced debris and burned by post-blast flames. But the IEDs have added a new dimension to battlefield injuries: wounds and even deaths among troops who have no external signs of trauma but whose brains have been severely damaged. Iraq has brought back one of the worst afflictions of World War I trench warfare: shell shock. The brain of a soldier exposed to a roadside bomb is shocked, truly.

About 1,800 U.S. troops, according to the Department of Veterans Affairs, are now suffering from traumatic brain injuries (TBIs) caused by penetrating wounds. But neurologists worry that hundreds of thousands more — at least 30 percent of the troops who’ve engaged in active combat for four months or longer in Iraq and Afghanistan — are at risk of potentially disabling neurological disorders from the blast waves of IEDs and mortars, all without suffering a scratch.

For the first time, the U.S. military is treating more head injuries than chest or abdominal wounds, and it is ill-equipped to do so. According to a July 2005 estimate from Walter Reed Army Medical Center, two-thirds of all soldiers wounded in Iraq who don’t immediately return to duty have traumatic brain injuries.

Here’s why IEDS carry such hidden danger. The detonation of any powerful explosive generates a blast wave of high pressure that spreads out at 1,600 feet per second from the point of explosion and travels hundreds of yards. The lethal blast wave is a two-part assault that rattles the brain against the skull. The initial shock wave of very high pressure is followed closely by the “secondary wind”: a huge volume of displaced air flooding back into the area, again under high pressure. No helmet or armor can defend against such a massive wave front.

It is these sudden and extreme differences in pressures — routinely 1,000 times greater than atmospheric pressure — that lead to significant neurological injury. Blast waves cause severe concussions, resulting in loss of consciousness and obvious neurological deficits such as blindness, deafness and mental retardation. Blast waves causing TBIs can leave a 19-year-old private who could easily run a six-minute mile unable to stand or even to think.

Another problem is that these blast-related brain injuries differ from other severe head traumas, and the complexity of treating returning troops with “closed-head” injuries is taxing an already overburdened military health-care system. There is not a neurosurgeon who works in a trauma unit anywhere in the United States who doesn’t know what to do when an ambulance brings in a biker who has suffered a severe head injury in a highway accident. The standard care involves using calcium channel blockers to protect damaged nerve cells against further injury, intravenous diuretics to control brain swelling and, if the swelling becomes too great, removal of the top of the skull to allow the brain to swell without increasing neurological damage. This is what surgeons did in the case of ABC News anchor Bob Woodruff, who suffered severe brain injuries from an IED blast in Baghdad last year.

All this works with the common types of severe head injuries, but it does not work with brains damaged by shock waves. Despite the usual interventions and treatments, the majority of blast-injury patients who have neurological damage do not fully recover. There is a growing understanding within the neurosurgical community that blast injuries are different from those caused by penetrating or skull-fracture trauma. It is thought that shock waves damage the brain at a microscopic, sub-cellular level. That’s why surgeons who are quite capable of reconstructing the skull of a motorcycle crash victim — something for which they have been well trained — struggle to come up with treatment and rehabilitation techniques for the explosion-damaged brains of troops.

“TBIs from Iraq are different,” said P. Steven Macedo, a neurologist and former doctor at the Veterans Administration. Concussions from motorcycle accidents injure the brain by stretching or tearing it, he noted. But in Iraq, something else is going on. “When the sound wave moves through the brain, it seems to cause little gas bubbles to form,” he said. “When they pop, it leaves a cavity. So you are littering people’s brains with these little holes.”

Almost as daunting as treating TBI is the volume of such injuries coming out of Iraq. Macedo cited the estimates, gleaned at seminars with VA doctors, that as many as one-third of all combat forces are at risk of TBI. Military physicians have learned that significant neurological injuries should be suspected in any troops exposed to a blast, even if they were far from the explosion. Indeed, soldiers walking away from IED blasts have discovered that they often suffer from memory loss, short attention spans, muddled reasoning, headaches, confusion, anxiety, depression and irritability.

What’s baffling is the Pentagon’s failure to work with Congress to provide a steady stream of funding for research on TBIs. Meanwhile, the high-profile firings of top commanders at Walter Reed have shed light on the woefully inadequate treatment for troops. In these circumstances, soldiers face a struggle to get the long-term rehabilitation necessary for a TBI. At Walter Reed, Macedo said, doctors have chosen to medicate most TBI patients, even though cognitive rehabilitation, including brain teasers and memory exercises, seems to hold the most promise for dealing with the disorder.

Oddly enough, having more military patients than can be adequately treated is, in terms of warfare, a gruesome kind of success. These are the war injured who once would have been the war dead. And it is the unexpected number of casualties who in a previous medical era would have been fatalities that has sunk the outpatient clinics at Walter Reed and left those in the VA system lost and adrift.

In Iraq and Afghanistan, the ratio of wounded service members to fatalities is 16 to 1, if the definition of “wounded” is anyone evacuated from a combat zone. During the Vietnam War, according to the VA, the ratio was 2.6 to 1. U.S. troops no longer die from the kind of injuries that killed many thousands in Vietnam. The majority of combat deaths there occurred right where the soldier was hit. If you were going to die, you were dead before there was any need of a medevac chopper. If you’d had an arm or leg blown off, the chances were that you had also suffered a penetrating chest or abdominal wound and would bleed to death waiting to be taken to the nearest surgical hospital.

But if the bleeding could be staunched and you were still breathing when the medics got to you, the odds on survival were in your favor. The military medicine practiced in Vietnam wasn’t so different from what World War II medics practiced: Stop the bleeding and hope for the best until the helicopter shows up.

It wasn’t until October 1993, when a U.S. combat assault team rappelled down from a helicopter into a 72-hour gunfight in the streets of Mogadishu, Somalia, that the notion of military medicine changed from basic life support to intensive care. In that siege situation, medics had no choice but to care for a growing number of wounded on their own, because evacuation was impossible. But without clear intensive-care procedures, they ran out of medications and fluids to treat the most severely injured.

In the civilian world, trauma medicine had progressed throughout the 1970s and ’80s, well past the simple expedients of tourniquet, plasma and keeping an airway open. Mogadishu forced the military to abandon the last of its medical practices from Vietnam. It was time to teach the medics a new trade.

Pentagon officials increased the training period for a 91W, or combat medic, from 10 to 16 weeks. Medics now trained on patient simulators that would “bleed to death” if blood loss was not stopped or “suffocate” if chest tubes weren’t correctly placed or a tracheotomy wasn’t performed within three minutes. Medics learned the new intensive-care theory of “hypotensive resuscitation,” in which intravenous fluids are given only in minimal amounts solely to keep the heart pumping, as opposed to the old Vietnam method of keeping blood pressure elevated, which only added to blood loss. Medics today use better-designed tourniquets and hemostatic bandages — dressings that act to stop bleeding for better hemorrhage control. They administer the latest non-opiate painkillers, which, unlike morphine and Demerol, do not slow breathing. This is the first war in which troops are very unlikely to die if they’re still alive when a medic arrives.

Another large part of the 16-to-1 wounded-to-fatality ratio has to do with advances in body armor. Today’s body armor is dramatically effective in preventing fatal wounds of the chest and upper abdomen. There is not an orthopedic or general surgeon in Iraq or Afghanistan who hasn’t been astonished the first time a trooper with two missing limbs and a traumatic brain injury is carried off in a chopper and the surgeon removing the armor cannot find a scratch from the chin to the groin.

But the unseen damage can be long-lasting. Most of the families of our wounded that I have interviewed months, if not years, after the injury say the same thing: “Someone should have told us that with these closed-head injuries, things would not really get all that much better.”

Now in its fifth year, the Iraq conflict is not a war of death for U.S. troops nearly so much as it is a war of disabilities. The symbol of this battle is not the cemetery but the orthopedic ward and the neurosurgical unit. The men and women inside those units have come home alive but missing arms and legs, many unable to see or hear or remember who they were before being hit by a roadside bomb. Survival clearly represents as much of a revolution in military medicine as does the dominance of the suicide bomber and the roadside bomb in the age of “shock and awe.” But now both the medical profession and the country are left to play a terrible game of catch-up.r

Ronald Glasser is a pediatric nephrologist and the author of ” Wounded: Vietnam to Iraq,” published last year. From 1968 to 1970, he was deployed at the U.S. Army Hospital at Camp Zama, Japan, treating U.S. soldiers wounded in Vietnam.

Related:
http://johnib.wordpress.com/2007/02/28/war-changing-lives-in-an-instant-bob-woodruff-and-mike-who-has-ptsd/

Search PTSD on this site to see our multi-chapter story.

Senators question Walter Reed conditions

By Anne Flaherty
Associated Press

WASHINGTON – Senators vowed Tuesday to consider all options to fix a broken system of caring for wounded troops as President Bush said former Sen. Bob Dole and former HHS Secretary Donna Shalala will lead the administration’s investigation into problems at Walter Reed Army Medical Center.

“The war in Iraq has divided our nation but the cause of supporting our troops unites us,” said Sen. Carl Levin, D-Mich., who chairs the Armed Services Committee. “We will do everything we can possibly do — not as Democrats or Republicans — but as grateful Americans — to care for those who have served our nation with such honor and distinction.”

As his panel questioned top defense officials, Levin also used the revelations of bad conditions and outpatient care at Walter Reed to take a swipe at President Bush’s war polices.

“Today’s hearing is about another example of the lack of planning for a war that was premised on the assumption that combat operations would be swift, casualties would be minimal, and that we would be welcomed as liberators, instead of being attacked by the people we liberated,” he said.

Levin’s panel convened the second congressional hearing in two days regarding the poor conditions at Walter Reed. Reports of wounded troops battling excessive red tape and dilapidated living conditions have enraged Republicans and Democrats, who say they are worried that problems at Walter Reed point to a broader problem of neglect across the nation at military hospitals.

Meanwhile, Bush told an American Legion audience that had chosen bipartisan leaders — Dole and Shalala — to head the White House probe. “We have a moral obligation to provide the best possible care and treatment to the men and women who served our country,” Bush said in a speech to the American Legion. “They deserve it and they’re going to get it.”

Dole was a longtime Republican senator from Kansas and one-time GOP presidential candidate and Shalala headed the Department of Health and Human Services during the Clinton administration.

At Tuesday’s Senate hearing, David Chu, the personnel chief at the Pentagon, also promised action.

“I’m deeply chagrined by the events that bring us to this hearing this morning,” Chu said.

Sen. John McCain, R-Ariz., said Congress in coming weeks will consider whether legislation or additional resources are needed.

“I am dismayed this ever occurred,” said McCain, top Republican on the Senate Armed Services Committee, who was captured and wounded during the Vietnam War. “It was a failure in the most basic tenets of command responsibility to take care of our troops.”

During a hearing Monday, two soldiers wounded in combat and a spouse of a wounded soldier recounted nightmarish stories of frustration as they tried to get medical attention and disability compensation.

“I’m afraid this is just the tip of the iceberg, that, when we (get) out into the field, we may find more of this,” said Rep. Tom Davis, R-Va., a member of the House Oversight and Government Reform subcommittee that held the Monday session.

Army officials said they accept responsibility but denied knowing about most of the problems.

“As we’ve seen, in the last couple of weeks, we have failed to meet our own standards at Walter Reed. For that, I’m both personally and professionally sorry,” said Lt. Gen. Kevin C. Kiley, who was in charge of Walter Reed from 2000 until 2004, when he became Army surgeon general.

Kiley has said he had been aware of some issues, including an October service assessment citing problems with Walter Reed staffing, medical evaluations and patient handling. But Kiley told the Senate panel he was not aware of specific problems, including a backlog of maintenance orders and a lack of staff to conduct room inspections.

Sen. Joseph Lieberman, I-Conn., said Congress might need to revisit an earlier decision to close Walter Reed in light of the increasing number of wounded troops from Iraq. Sen. John Warner, R-Va., said lawmakers should examine its own oversight process, which failed to unearth problems.

Democrats have vowed to add money to the Bush administration’s request for war spending to take care of wounded active-duty troops and improve health care for retired veterans.

Commander, Walter Reed Army Medical Center Fired: Problem Not Medical Care but Neglect

By John E. Carey 

Yesterday the United States Army relieved of command Major General George W. Weightman, commanding officer of Walter Reed Army Medical Center.  The action comes as a result of a series of articles in the Washington Post that exposed irregularities and neglect not in medical services but in the care and lodging of the post inpatient  patient care.

The Secretary of Defense, Robert Gates said, “The care and welfare of our wounded men and women in uniform demand the highest standard of excellence and commitment that we can muster as a government. ” This says it all.

Congratulations to the Washington Post, especially reporters  Dana Priest and Anne Hull  for exposing the abuses and neglect at Walter Reed! Well done! And thanks! Every American owes you. Another point has to be made here.  Our soldiers and even others like ABC journalist Bob Woodruff, get the finest medical care on earth.  We’ve seen it with our own eyes….
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Tribute to Our Medical Men on The Front Lines of WarBy John E. Carey

Every single Soldier, Sailor, Airman and Marine, every man and woman who serves this great nation, deserves our eternal thanks, admiration and respect. The difference between our current engagements in Iraq and Afghanistan and the war in Vietnam is this: we, as a nation, have matured enough to recognize that we need to support our men and women in service: no matter our political position on the conflict.

While no segment of our military population deserves more or less credit and thanks than any other, we might take a moment to recognize the valor, selfless giving and dedication exhibited by the corpsmen, also known as “medics” or “docs,” who serve in the front lines of conflict.

Through our nation’s history, medical professionals have saved lives, assisted the wounded, performed countless amputations, and risked their own lives to save others. Many non-professionals also assisted by providing battlefield care, assisting with surgery, even saying prayers and giving comfort. The contributions of all these men of mercy are remarkable. Medics exemplify selflessness. Many carry no firearms – burdened by life-saving equipment. They are technically not in the fight and considered “non-combatants” – they are there to respond to the needs of the maimed and wounded.

Perhaps the most trying conditions experienced by wartime “docs” occurred during the Civil War.

Confederate surgeon William Henry Taylor wrote, “The bullets whizzing past me were for awhile rather dismaying, but, finding that I still lived, I heartened up gradually, and the longer I lived the greater the assurance I felt that I was not to die, till presently I stood the fire with an equanimity that astonished me.”

Like other surgeons of the war years, especially Confederates, Dr. Taylor applied his skills despite many shortages and needs. “Normally, we were scant of medicines, and, generally, they were of the commoner kinds,” wrote Dr. Taylor.

Progress was made in medical technique and care throughout America’s wars, and though casualties were severe in World War I and II, the number of men saved grew as a direct result of the prompt, professional action of so many medics at the front: and a vast number of doctors and other medical professionals stretched from the war zone back to the home towns and V.A. hospitals in America.

But even as we improve upon the lifesaving technologies and techniques of the medics, weapons designed to tear flesh apart are “improved.” Human destruction advances even with the life saving sciences.

I interviewed a Korean War U.S. Army medic who wanted to relay just two thoughts. Upon arrival in the Asian war theater aboard a troop ship, he recalled feeling the rush of adrenalin that comes when men are about to engage in a great mission. “But as we disembarked from the ship, I was horrified to face the reality of war. Stacked on the pier were coffins containing our war dead – awaiting their last sea journey home aboard that same ship that delivered me into combat.”

That same corpsman told me, “War is no place for any shirker. But a medic feels he has to be as close to the action as possible: because that is where he is needed most. Being just a few dozen meters back from the action meant I might not get to the wounded in time.”

In Iraq, the long tradition of working literally “under fire” described during the Civil War by Doctor Taylor continues to this day. “The Marines know that if they are wounded, a corpsman will ignore the firefight and just patch them up,” said Capt. D.A. Zembiec, a company commander. His Marines fought near Fallujah in Iraq.

In San Diego, at the Marine Corp Recruit Depot, a building bears the name of corpsman Michael Vann Johnson Jr., a 25-year-old Navy corpsman, killed by an enemy grenade March 25, 2003 in Iraq. Yes, corpsmen do contribute the ultimate sacrifice.

The scene at a military hospital processing wounded from the front lines can be horrific. “It’s life and death, every day,” said Lt. Col. Bob Mazur, a doctor at the 10th Combat Support Hospital in Iraq.

“If you look at the overall death rate … the case fatality rate is cut in half from Vietnam to now. And again I think that’s due to better training, tactical combat casualty training,” said Col. John Holcomb, the senior surgeon at the hospital.

The thing about war is that so many die. The thing about medics is that so many can be saved.

In Iraq and Afghanistan today, even as most American work, sleep and lead their ordinary lives, corpsmen are closing wounds, staunching the flow of blood and saving lives. They are facing high powered rifles, automatic weapons and one of the crueler demons of recent wars: the so called “Improvised Explosive Devices” or IEDs. Dozens of the medics I met deserve to have their names and stories clearly honored in this newspaper and others; but they would not hear of it.

“It’s my job, sir. I do it for that: and because these other guys need me. Besides, a lot of guys do more than me.”

That quote exemplifies the selflessness of our medics and others in the medical community, saving lives in war.

Mr. Carey is the former president of International Defense Consultants, Inc. He was recently in Iraq.  As a postscript to this we invite people to listen to the interview of Bob Woodruff and his lovely bride from National Public Radio.

.http://johnib.wordpress.com/2007/02/28/war-changing-lives-in-an-instant-bob-woodruff-and-mike-who-has-ptsd/

http://www.npr.org/templates/story/story.php?storyId=7618702

War: Changing Lives in an Instant: Bob Woodruff and Mike Who Has PTSD

Journalist Bob Woodruff had reached the top of his profession when his life changed in an instant.Several weeks after he was named as co-anchor of ABC’s World News Tonight, Woodruff and his cameraman were gravely injured by a roadside bomb while reporting in Iraq.

Thirteen months after the attack, he and his wife, Lee Woodruff, have written In an Instant, a book about his experiences in Iraq and how the couple recovered together.

The narration switches between Woodruff and his wife, who flew to Germany after his injury. Woodruff spent 35 days in a coma.

“It was like being on the other side of the moon, to see my husband’s face,” says Lee Woodruff.

Despite the crushing injury and months of uncertainty and physical therapy, Woodruff’s outlook remains positive.

“He is basically a happy person,” Lee Woodruff says of her husband. “I’ve never heard a moment of bitterness come out of his mouth.”

The Woodruffs spoke with Renee Montaigne about what life is like after the injury, shifting their priorities and how the experience has changed them.

To hear the interview with the Woodruffs, link to National Public Radio:
http://www.npr.org/templates/story/story.php?storyId=7618702

My friend Mike has been diagnosed with severe PTSD as a result of his service in the war on terror.  We will report on whatever Mike wants to discuss in a day or two but I’ll just give my own impressions.  Mike loves his country.  He volunteered to join the Army and he volunteered to serve in the war.  He had no idea what he would suffer through in combat.

 Our stories on PTSD are all here on this site.  Word search PTSD.

–John E. Carey

War Wounds of The Mind Part IV: A Warning About Troops Returning from Iraq and Afghanistan

By John E. Carey
Peace and Freedom
February 21, 2007

We are not qualified to fully assess or predict the Post Traumatic Stress Disorder (PTSD) situation of the American troops returning from Iraq and Afghanistan. And we certainly pray that each man and woman returns to the safety and security of their families without any side effects of war.

But we know now from experience that that is highly unlikely.

We would also like to hope and trust that the Veterans Administration is fully ready for the onslaught of returning PTSD impacted veterans. But reports in the media would indicated otherwise.

The VA vastly underestimated the number of PTSD cases it expected to see in 2006, predicting it would see 2,900 cases. As of June 2006, the VA had seen more than 34,000 Iraq and Afghanistan veterans for PTSD.

A top Walter Reed Army Medical Center official told Congress in September 2006 that 41 percent of National Guard and Army Reservists reported mental health concerns up to six months after deployment, compared with 32 percent of the active-duty force.“Stressors may be more intense for those in the National Guard and Army)Reserves, with many leaving families and jobs. Military pay doesn’t equate to civilian pay. When we look at the intensity of experiences, for many, this [combat duty] is a day-to-day kind of thing … out patrolling the streets every day, looking for [improvised explosive devices].”

Some, Wilson said, tire of questions on their war experiences from well-meaning co-workers, friends or family. “They may shut down further [when questioned].

“This is not based on statistics, but I’d say it is very likely that we’re going to see those returning from Iraq having greater symptoms and a wider range due to the nature of the combat and where (they) are stationed,” Wilson said.

 Some of his patients who served in Iraq have told him they feel alienated after going back to their jobs. “They sense that no one is really going to understand because they weren’t there.”

Good News: Exposure Therapy

There is also some good news.

Traumatized US soldiers are being treated for post-war psychological disorders by going out on patrol in a computer-generated “virtual Iraq.” Skip Rizzo, a psychologist at the University of Southern California, helped create the program that simulates life in the war zone for Iraq veterans suffering from conditions such as post-traumatic stress disorder (PTSD).The system uses a long-established therapeutic technique known as “exposure therapy.”

One of the many veterans who have written to us on this subject is Ken Larson.  We’d like to close this section of discussion by quoting him directly:

“I am currently a resident in a Minnesota Veteran’s Home after having undergone treatment through the VA for PTSD and Depression which was long overdue some 40 years after the Tet Offensive which cap stoned my military career in Vietnam with a lifetime of illness.

My blog has attracted the stories of many veterans’ such as myself and other sufferers from PTSD who were victimized by elements of society other than the VA system of medical and mental treatment. I, for one, became trapped in the Military Industrial Complex for 36 years working on weapons systems that are saving lives today but with such high security clearances that I dared not get treated for fear of losing my career. See:

http://rosecoveredglasses.blogspot.com/2006/11/odyssey-of-armaments.html

When my disorders became life threatening, the Commission of Veteran’s Affairs for the State of Minnesota, Clark Dyrud, stepped in and saw to it that I was entered into the VA System for treatment in Minneapolis. It saved my life and I am now in complete recovery and functioning as a volunteer for SCORE, as well as authoring books and blogging the world.

When I was in the VA system I was amazed at how well it functioned and how state of the art it is for its massive mission. Below is a feature article form Time Magazine which does a good job of explaining why it is a class act:

http://www.time.com/time/magazine/article/0,9171,1376238,00.html

I had state of the art medical and mental care, met some of the most dedicated professionals I have ever seen and was cared for by a handful of very special nurses among the 84,000 nursing population that make up that mammoth system. I do not say the VA system is perfect. It is certainly being run better on a $39B budget than the Pentagon is running on a $494B budget.”

Concern Rising: McClatchy Newspapers Issue an Alert

(Reprinted from an article by Chris Adams, McClatchy Newspapers, First Published February 11, 2007)

An investigation by McClatchy Newspapers has found that even by its own measures, the VA isn’t prepared to give returning veterans the care that could best help them overcome destructive, and sometimes fatal, mental health ailments.

McClatchy relied on the VA’s own reports, as well as an analysis of VA data released under the federal Freedom of Information Act. McClatchy analyzed 200 million records, including every medical appointment in the system in 2005, accessed VA documents and spoke with mental health experts, veterans and their families from around the country.

Among the findings:

• Despite a decade-long effort to treat veterans at all VA locations, nearly 100 local VA clinics provided virtually no mental health care in 2005. Beyond that, the intensity of treatment has worsened. Today, the average veteran with psychiatric troubles gets about one-third fewer visits with specialists than he would have received a decade ago.

• Mental health care is wildly inconsistent from state to state. In some places, veterans get individual psychotherapy sessions. In others, they meet mostly for group therapy. Some veterans are cared for by psychiatrists; others see social workers.

And in some of its medical centers, the VA spends as much as $2,000 for outpatient psychiatric treatment for each veteran; in others, the outlay is only $500.

• The lack of adequate psychiatric care strikes hard in the western and rural states that have supplied a disproportionate share of the soldiers in the wars in Iraq and Afghanistan – often because of their large contingents of National Guard and Army Reserves. More often than not, mental health services in those states rank near the bottom in a key VA measure of access. Montana, for example, ranks fourth in sending troops to war, but last in the percentage of VA visits provided in 2005 for mental health care.

Moreover, the return of so many veterans from Iraq and Afghanistan is squeezing the VA’s ability to treat soldiers from Vietnam, Korea and World War II. And the competition for attention has intensified as the vivid sights of urban warfare in Iraq trigger new PTSD symptoms in older veterans.

“We can’t do both jobs at once within current resources,” a committee of VA experts wrote in a 2006 report, saying it was concerned about the absence of specialized PTSD care in many areas and the decline in the number of PTSD visits veterans receive.

“There are VA facilities that were fine in peacetime but are now finding themselves overwhelmed,” said Steve Robinson, government relations director of the Washington, D.C.-based advocacy group Veterans for America. “So they’re pitting the needs of the veterans of previous wars against the needs of Iraq veterans.”

While the debate in the VA about the level of its psychiatric care is often frank, the public assurances of top officials are oddly optimistic. “Mental health is a very high priority of ours,” VA Secretary Nicholson said last March. “The VA possesses – this will sound boastful, but … as we used to say back home, it ain’t bragging if it’s true – but we have the best expertise in post-traumatic stress disorder in the world. … So we are ramped upward, and we have a terrific cadre of experts in that area, and we are adequately funded to deal with it.”

“We feel very well poised to meet the needs,” said Antonette Zeiss, a VA health official who’s helping to oversee the mental health system, in a November interview with McClatchy Newspapers.

Soldiers coming home today walk into a VA health system that’s nothing like it was when veterans returned from World War II, Korea, Vietnam or even the first Gulf War.

The change began more than a decade ago, when the agency decided to move away from focusing on high-cost inpatient hospital care and toward outpatient clinics that could tend to veterans’ primary care needs. In addition, the VA scrapped its organizational structure and created about 20 networks, more than 150 hospitals and – as of today – more than 800 outpatient clinics. The new system would provide “easier access to care and greater consistency in the quality of care,” the VA said in a March 1995 report.

Its committee of experts, however, said that specialized mental health services were declining and that the VA’s use of unadjusted dollars in an era of high inflation in medical costs rendered its annual reports “meaningless.”

At the same time, the VA began treating many more people for mental health ailments, so the amount spent has plummeted from $3,560 per veteran in 1995 to $2,581 per veteran in 2004 – even before correcting for inflation.

In the past two years, the VA has committed more money to mental health care and brought services to previously underserved areas. But it’s also changed its accounting system, so it’s difficult to compare spending after 2005 with that of prior years. What does this all mean for veterans?

It means that veterans receive fewer visits to mental health professionals, on average, than they did before. Between 1995 and the first half of fiscal 2006, for example, general psychiatry visits for those in the mental health system dropped from an average of 11.7 a year to 8.1 a year per veteran, according to VA data.

VA experts said the system already was straining to provide veterans with what they needed before the United States attacked Afghanistan in October 2001. “Even before the war in Afghanistan,” Matthew Friedman, a top VA mental health official, told Congress in 2004, “VA PTSD treatment capacity had been overtaxed.”

The VA’s mental health experts started pushing for specialized PTSD programs in all medical centers in the 1980s. Top VA officials agreed “in concept” that it would be a good idea. But in 2005 and 2006, despite telling Congress that it was setting aside an additional $300 million for expanding mental health services, such as PTSD programs, the VA didn’t get around to spending $54 million of that, according to the Government Accountability Office.

McClatchy reviewed two dozen mental health measures, based in part on an analysis of every inpatient and outpatient visit in the VA health system. Among the findings:

• Some veterans get in for visits far more than others. The average number of visits per veteran with PTSD ranged from 22 in the Hudson Valley, N.Y., medical center and clinics to a low of 3.1 in Fargo, N.D. The national average was 8.1.

• Some VA medical centers spend far more on mental health care than others. In Connecticut, it was an average of $2,317 for each veteran’s outpatient psychiatric care. In Saginaw, Mich., it was $468.

• Some veterans get in quickly. Others wait. At the Loma Linda, Calif., VA network, only 39 percent of new mental health patients were able to get appointments within 30 days, the VA’s standard. In other networks, 90 percent or more did.

• Once they’re in the door, so me veterans get visits of 75 to 80 minutes, while others get 20- to 30-minute appointments, the shortest psychotherapy appointments listed in the system. Asked about the disparities, the VA’s Zeiss said: “It’s true there are disparities. … Disparity is a part of health care. … I can tell you that the data you’re looking at we’re looking at too, and we’re using it to make decisions about how to close the gap and ensure a standard of care nationally.”

The VA’s top mental health services official, Dr. Ira Katz, added that variation in mental health measures wasn’t necessarily good or bad. It could reflect different strategies being tried in different states. As for the wide variation in spending per veteran on mental health care, Katz said it could be explained by the presence of special programs in various medical centers. There’s a national PTSD research center at the Connecticut VA, for example, that inflates spending figures there.

The VA has begun to pump more money into local clinics to ensure that they begin to provide mental health treatment.

More on PTSD

Post-traumatic stress disorder is an anxiety disorder that can occur after a person lives through a traumatic event, such as military combat.

Not every combat veteran will get PTSD. But those who do can become easily startled and irritable, and they often feel that they are on guard. They might constantly relive a life-threatening event through flashbacks or nightmares, which often trigger intense feelings of fear, helplessness and horror. Others may isolate themselves or try to numb their memories with drugs or alcohol.

People with PTSD suffer more unemployment, divorce or separation and spousal abuse than people without PTSD.

Source: Department of Veterans Affairs National Center for PTSD

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http://peace-and-freedom.blogspot.com/

Read Parts I, II and III:
http://www.nowpublic.com/war_wounds_of_the_mind_part_iii_the_commanders

War Wounds of the Mind Part III: The Commanders

By John E. Carey
Peace and Freedom
February 16, 2007

This is Part III; links to Parts I and II are at the bottom of this essay.

Very little is written about the impact of Post Traumatic Stress Disorder (PTSD) on the “Commander, “ meaning Field Grade Officers and above.

Company Grade Officers, Captains and below, are generally believed to be impacted by PTSD about the same way as their combat GI’s. But the officers in the rank of Major and above experience war from a different vantage point: they send men into destruction, make the plans that lead to horrific death, and bring together the fighting forces that create the nightmares and the ghosts the poet in Part II refers to.

The Commanders leave the battlefield and return to a very different life from that encountered by the junior enlisted men. The Commanders are unlikely to be eating in soup kitchens, seeking treatment from the VA, or ending up in shelters.

The Commanders are almost always highly educated with families and money to fall back on. Therefore, after the Commander leave the battlefield, they bypass the normal PTSD “tracking system” of VA statistical analyses.

So how do we know about The Commanders and their PTSD experience?

Well, what we know is mostly anecdotal.

Peace and Freedom sought out the Commanders through research in the Northern Virginia community of Vietnam war veterans. The officers interviewed, all now retired, were brigade and battalion commanders, pilots and air wing commanders, ship Commanding Officers and the like. One was a Navy SEAL, two were green Berets, one a Marine Colonel.

The Commanders told us that they, like the front line combat soldiers, felt PTSD very deeply but that their place in the community generally shielded their lives from any public scrutiny. Many told us they suffered from alcoholism or alcohol abuse and one even told us he was addicted to drugs.

The Commanders generally lived their lives in a very structured, orderly environment. Therefore, more so than with the frontline combat veterans, these veterans have a low incidence of DUI, public drunkenness and other aberrant behaviors that might involve the police.

One Vietnam Veteran Commander, Mike, said to us, “The Commanders, as you call us, are just as sick, just as disassociated, just as traumatized by war as the guy who led a platoon, maybe more so. I figure I sent about 800 men to their deaths and that doesn’t sit well with me. Moreover, I came home to an America I couldn’t understand. I guess when you think about it, I left the United States for Korea and the Army in the early 1950s. When I got back to Virginia in the early 1980s and looked around — I was in a foreign country. Nobody much understood me. Nobody much had any use for me. And I couldn’t relate to many people or many things in my environment.”

What did you do? I asked him.

“Well, I drank for a few years because I could and then I decided God still had some things for me to do. I joined the church, got involved in a lot of activities, and so it goes.”

What activities?

“I am the President of the Church Council, I drive for Meals of Wheels, I dance one night a week, I teach college one night a week, I take my dog to the hospital to amuse patients on Wednesdays, that sort of thing. It keeps the mind active and helps the community a little I guess.”

Mike is now 77 years young and still going strong.

Sam graduated from the U.S. Military Academy at West Point in 1965. As a young Lieutenant he led a platoon in Vietnam, then a Company, and then, as a Major he served in a staff.

“I guess I am more like a GI than most of the guys you refer to as ‘commanders,’” Sam told us.

“But I did witness the anguish up close of a General Officer who had to put these wonderful young men into combat. All pay-grades suffer PTSD. It is just that senior officers don’t readily admit to it. It tears them up inside and often tears their lives up, tears up their families. Often senior officers who have returned from combat have trouble relating to people, even their own wives and children. They suffer and relive the war and the battles alone. Mentally, what I’ve seen, there seems to be a higher incidence of Alzheimer’s Disease and that sort of thing as they age. I know there are no statistics on this but I feel I am right. I know it is true.”

George told us, “I was the guy who shook the hand of the soldier, the young sergeant and their captain. Then I had the unfortunate duty to send them to their ends. Then I had to tell their families what I had done. War hurts every participant. Sometimes I think it is the lucky one who died.”

Read Part I at:
http://johnib.wordpress.com/2007/02/15/war-wounds-of-the-mind-part-i-historical-perspective-on-ptsd/

Read Part II at:
http://johnib.wordpress.com/2007/02/16/war-wounds-of-the-mind-part-ii-discussions-with-ptsd-sufferers/

War Wounds Of The Mind Part II: Discussions With PTSD Sufferers

By John E. Carey
With Thanks to all those who shared their stories.
They know who they are.

This is Part II. Part I is at:
http://johnib.wordpress.com/2007/02/15/war-wounds-of-the-mind-part-i-historical-perspective-on-ptsd/

World War II combat veterans pretty much to a man told me there was no such thing as PTSD when they came home from war in 1945. Most of them said things like, “To go for medical care, you had to have a hole in you!”

We spoke to several WWII veterans that were referred to treatment years after the war. Many had entered programs to treat their PTSD because of demonstrated abnormal behavior or alcohol abuse or alcoholism. Some had been brought to treatment by wives and other loved ones. Many told me that they thought they were OK but they just had some trouble fitting in and they need the camaraderie of their friends (other veterans). This often meant long period of time at the Veterans of Foreign Wars (VFW) or other club-like environment that included a bar.Many of the WWII veterans who were subsequently treated for PTSD spent two decades or more searching for what was the solution to their nightmares and trouble: their ghosts as the poet below calls them.

Vietnam War combat veterans are vastly different from their WWII brothers. They all told me their problems naturally started in the field, but many said they first started to feel alone when they came home. They came home alone: not with a unit. The U.S. Army has now corrected this – one of the many lessons learned that are applied to today’s returning troops over those that came home from Vietnam.

I thought Vietnam War veterans would talk more about not having a parade. But that was not the problem. The problem was not so much indifference, according to these men. The problem was the distain of their fellow citizens.

“When I would tell people I was in Vietnam, people would right away ask: ‘Did you kill anyone?’ I don’t know how to answer that. I still don’t. It was a war.”

He said he felt hostility from his fellow citizens for his service.

He told me he ultimately left the United States to live in South America. “There,” he said, “I was at least an ordinary guy. Sometimes I was admired. In the U.S. I had no chance.”

Because the United States was so terribly divided, nearly every one of the Vietnam combat veterans treated for PTSD told me they felt a terrific sense of dislocation once they returned to normal society. Many had trouble finding jobs. When asked what kind of work he was good at a job center, one veteran told me he thought, “Well, if you had a 155 here I could drop a round on your desk from a long way away….”

Another told me he was offered a lob as a floor sweeper in a factory. He thought he had real skills but he didn’t know how they applied to “normal” society.” He said he had been an aircraft forward air controller. There was no established system to find these veterans appropriate jobs, as far as they could recall. They also said that PTSD was not much understood – and that to go to the VA you better have a visible wound.

More than one Vietnam Veteran told me they thought the VA had the fine PTSD effort it has today because the misconduct of suffering Vietnam veterans became an embarrassment to the government and the VA. Then action was taken.

Several veterans wanted me to know they “took it.” A typical line went like this. “The men you see here are all in the mental ward for check ups. All suffer from PTSD. They are not here because they ran away or cracked up. They are here today because they could take it. And they did take it.”

This line of thinking was repeated over and over and I was reminded of the movie “Twelve O’ Clock High,” about the 8th Air Force bombers in WWII.

In this movie, Major General Ben Prichard relieves an air group commander for being too soft on his men.

Then he lays out the dilemma to the man he wants to take the job. “There is only one hope of shortening this war. Daylight Precision Bombing. 50,000 airplanes. That’s what they say they are making. I wish I had 500….I gotta ask you to take nice kids and fly them until they can’t take any more. And then put them back in and fly them some more…We’ve got to find out what a maximum effort is….how much a man can take and get it all. I don’t even know if any man can do it.”

Many of the Vietnam Veterans could empathize with this film and this theme. But as Army Veterans they still thought the Army Air Corp men of WWII “could at least come home every night to a meal, the club, and a bed.”

One veteran talked very eloquently, as if it was just yesterday, that he would spend weeks in the field, eating rations, no able to bathe, and then return to real sheets, real beef and lots of running water. He said his brain was “always seeking the real reality.”

One Vietnam veteran told me he was on Hamburger Hill. He was among the relief troops that fought their way into Plei Ku. He fought at An Kie near the DMZ. He was in Vietnam for Tet 1968 but he had arrived in 1965. He was with the 1st Air Cav.

“Why were you in Vietnam so long?” I asked. He said he was the oldest brother. Another brother was near him during the first part of his tour (199th Light Infantry from Fort Hood) and he extended in country to be with brother number three (1st Marine Division) when he arrived. Good reasons.

Many of these veterans admitted that the war may have brought out or aggravated pre-existing conditions. Some talked of alcoholic or abusive fathers and other situations often associated with trouble later in life.

One Vietnam veteran had obviously given a lot of thought to his condition and the condition of his fellows. He told me, “When you are young, you think you can do anything and handle anything. So you come home from war and you cope. You know things aren’t right but you keep moving. Maybe you drink or do drugs. The problem is: as you age, the disease doesn’t get any weaker and maybe it gets stronger. But YOU get weaker with age. Like a shed with a tin roof that gets snowed on every winter; it is good for a long time. Then one winter it rusts through and everyone is amazed.”

Another said, “We were wolves. We trained as wolves. We became wolves. And after a long plane flight home we were expected to be perfect lambs. It didn’t work for me.”

Looking at these aging veterans, it was difficult to see the wolves. And one of them must have seen that in my eyes. He said, very softly, “John, we were all young and beautiful once. We were SEALs, Marines, Airborne. We were the young, the proud the tough. It is only when you become old that you become philosophical.”

Young wolves aren’t philosophical, I know from my own experience.

Finally, without too much introduction I would like to share the poem below with you pretty much the way it was shared with me. He introduced himself, told me his story briefly, and said, “This popped out of me during treatment and I have carried it ever since.”

I sat down, read it twice with a tear in my eye, and then said a short prayer, asking God to protect warriors everywhere and always. And I thanked Him for bringing these men to me or I to them.

+++++++++++++++++++++++++
Poem From A Vietnam PTSD Patient
During Inpatient Care
Year Approximately 1985
Anonymous
(More Appropriately, Name Withheld at His Request)

The ward is so cold this evening,
And I am so very alone
Except for the ghosts to keep company,
and the sins I’ll never atone.

I am sorrow, I am pain. I am
tears that won’t go away
I am the shiver of the first chilly night
When autumn has come to stay.

My brothers are tucked here with me,
Sharp objects are all locked away
But there is no protection from inside
Of hearts whose lives have gone astray.

And yet these hearts keep beating
Inside bodies long ago dead
Not from bullets or bombs or wars other harms
But the ghosts that live inside our heads.

Yes, they speak to us often,
yes dailywe are never allowed to forget
And the names on the wall do not cover all
Alone, we are living regret.

Like a flower is snipped from a rose bud
Our youth was cut off long ago
Those who cared for us then do not want us again
we bring trouble like winter brings snow.

So Just sweep us away in the closet
Call the closet Ward Seven “E”
Let us scream in the night in unconscious fright
Just my brothers, my ghosts, and me.

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http://peace-and-freedom.blogspot.com/2006_10_27_peace-and-freedom_archive.html

War Wounds of The Mind Part I: Historical Perspective on PTSD

By John E. Carey
February 15, 2006

Always a student of the human mind and the complexities of the “space frontier between our ears,” we are taking the risky step of discussing Post Traumatic Stress Disorder (PTSD) in a series of articles over the next week or more.

Our teachers are psychiatrists, other medial professionals, historical documents, the available academic literature but most compelling of all: the sufferers with whom we have met.

We start our story with a view from the 1860s. We’ll also include some personal observations from hours of discussions with war participants, from World War II to the present.  And hopefully, we’ll all end this journey with a more sensitive and thorough understanding of PTSD.

There was a time when I discounted PTSD. This belief came from many contacts in the Vietnamese American community who deal with medical situations differently from native born Americans. In other words, over time I came to believe that people from all cultures encountered PTSD. I think that many Asian people just deal with the illness in a more stoic and quiet manner than the American Veteran soldiers that I have encountered care of the Veterans Administration. This doesn’t mean the Vietnamese Americans have a better plan for dealing with PTSD: just that many seem to deal with it in other ways.

Now, we are attempting to present this topic in a thoughtful, caring and gracious way: but we are terribly flawed and often cause offense without thinking or trying. So, read carefully and provide feedback in whatever way you feel comfortable with, including through my home email at:
jecarey2603@cox.net

Just today, a veteran of the Korean War said to me: “What is PTSD?”

One definition (and there are many others) is this: PTSD is a debilitating condition that often follows a terrifying physical or emotional event causing the person who survived the event to have persistent, frightening thoughts and memories, or flashbacks, of the ordeal. Persons with PTSD often feel chronically, emotionally numb.   Many Old Soldiers suffering from PTSD argue around the clock about that term “emotionally numb.” Many feel or felt anger or hatred, disassociation or isolation and any number of other dysfunctional feelings.

The University of Michigan uses this definition which we found useful: PTSD is a medical condition occurring after experiencing a highly stressing event (such as combat, violence or a natural disaster) beyond the usual human experience. It is usually characterized by anxiety, flashbacks, hypervigilance, recurrent nightmares and avoidance of reminders of the event.

Hypervigilance? An Old Soldier told me he used to hit the deck as if under attack whenever a firecracker went off.

Beyond the usual human experience? Well, war is not usual. Let us just say the Doctor in the story below experienced events not in the usual experience for his time: except that many hundreds of thousands during the war had the same or similar experiences.

Flashbacks? “I still remember Jimmie blowing up. And that was 1944.”

For those wanting to “Read Ahead” we recommend the U.S. Department of Veterans Affairs web site (National Center for PTSD (NCPTSD)) for starters:
http://www.ncptsd.va.gov/ncmain/index.jsp

Part one of our discussion is below. It is a story from the American Civil War (1861-1864). And yes it is a true story (we just recently heard from a living relative of Doctor Minor and many of his past relatives are buried a few miles from my home). The story was originally published in The Washington Times in 1999 by editors Woody West and Greg Pierce; two gentlemen to whom I owe a great debt of thanks.

The Doctor: A Civil War Casualty
By John E. Carey

During the Civil War the concept of “post traumatic stress disorder” did not exist. Physicians and family members close to disabled veterans certainly knew and understood the mental toll the carnage of battle inflicted on mind and body. Dr. William Chester Minor, himself a trained physician, suffered paranoia, uncontrolled fits of rage and severe headaches and nightmares after the Civil War. Ultimately his illness resulted in irrational behavior culminating in the murder of a complete stranger. Admitted to an asylum in 1872, he died in 1920 after making a major contribution to one of the most important books in the English language.

William Chester Minor, son of Eastman Strong Minor, had all the benefits of privilege. He enjoyed the advantages of a fine family name, wealth and education. His father, a true aristocrat, headed the seventh generation of Minors in the United States. Most of the Minors had established themselves as key members of the community dating back to Pilgrim times. Indeed, the property for Oakwood cemetery and an early Methodist Church expansion in Falls Church, Virginia, was donated to the church by a descendant of George Minor (T. Harrison) in 1818 (ironically, Union troops destroyed the church in 1861).

Eastman Minor closed his New England printing business, and with his wife Lucy, traveled to Ceylon (now Sri Lanka) in 1834 to spread the gospel of Christianity among the “brown peoples” from India through Singapore and up to Bangkok. William was born seven months after their arrival. Orphaned at the age of three, he saw his father re-married to another widowed missionary by the age of five.

William Minor’s father and other clergymen preached about the evils of sex and the damning temptations of the flesh. Yet young William witnessed first hand the local tropical girls bathing shamelessly naked (and apparently without fear of guilt or sin) in the surf – a vision and a dichotomy that would haunt him into adulthood.

A gentle soul, William took to water colors and other artistic pursuits. But his first love was a life-long admiration for great written works.

By the age of twelve, William Minor knew several languages and could ably navigate the back streets of Rangoon, Singapore, and Bangkok.

Sent back to the United States, William Minor completed a classical education and graduated from the difficult School of Medicine at Yale. He spent nine years in medical apprenticeship before he volunteered for service in the Union Army just four days before the Battle of Gettysburg.

After months of service far from the front, Dr. Minor was plunged into the horror of war. He was with the Army at the battle of the Wilderness, and heard wounded soldiers of both Armies crying out in pain as fire swept through the dry kindling of the battle ground. He amputated limbs and witnessed the terrible wounds inflicted by the large caliber lead rounds and cannon shot of the day. He saw gangrene, filth and infection frequently.

After the Wilderness, Dr. Minor was pressed into service by a court martial for a most unusual and difficult assignment. A Union Army deserter, an Irishman by birth, had been caught. This deserter was to face judgement in the field. Found guilty of a hanging offense by a hastily arranged court martial, the “merciful” court ordered the deserter branded on the face with a D, marking him forever after as an army deserter.

This fairly common punishment permanently marked former soldiers for shame. For an Irishman, this was a particularly heinous sentence, for it barred a man from returning to participate in the covert war against the English monarchy. The face scarred with the D alerted law officers who would watch or apprehend the wearer.

Dr. Minor was ordered to mete out the punishment of the court martial. Using a red-hot branding iron, the hesitant doctor carried out his assignment. But the sight and sound of searing flesh and the conflict with the physician’s Hippocratic oath haunted Minor for the rest of his life.

At war’s end, Dr. Minor was performing autopsies at the military hospital in Alexandria, Virginia. As he moved from posting to posting after the war, he began to exhibit unusual behavior. Irishmen, he believed, entered his quarters to molest him while he slept. He began to frequent the most unseemly establishments in the slums of New York. He complained of headaches.

Minor spent time in the government insane asylum that we now know as Saint Elizabeth’s in Washington, D. C. But doctors were unable to conclusively diagnose his illness. Then, at the urging of his family, Dr. Minor went to Europe, where, it was hoped, he could rid his mind of torment. Dr. Minor expected to read, read and paint.

But there was no escaping these post-war demons. Waking in the dark of night while living in London, Dr. Minor went into the street and shot to death a man on his way to work at the local brewery. Dr. Minor believed he had chased one of his Irish tormentors out of his apartment, but at his trial, the landlady proved that no one could have entered his locked chambers.

Convicted of murder and found to be insane, Dr. Minor was sent away to the Broadmoor insane asylum in England in 1872. While Grant became President of the United States and Chamberlain became Governor of Maine, William Chester Minor faced incarceration for the rest of his life.

But the story doesn’t end here. Dr. Minor, an educated man who became a physician because of his dogged determination and dedication to good study habits, used his Army pension to start his own library. He collected the best titles and authors of the English language. Ultimately he contributed twenty years of nearly continuous study effort to the editors of the Oxford English Dictionary.

William Chester Minor: student, physician, artist, Civil War veteran, murderer and lexicographer. Dr. Minor’s story has recently been illuminated by Simon Winchester in his book The Professor and the Madman, which sheds light upon the Civil War, the nature of man, and the roots of the English language.