18 August 2013, PTSD News Roundup

August 18, 2013 / no comments

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It wasn’t genocide! It was PTSD!

The story that wins the prize for the Most Loathsome Example of Exploiting Sympathy for PTSD to Excuse Egregious Behavior is…  “Excessive drinking, PTSD plagued Thomas Weir.”

Not all of the fatalities of the Battle of the Little Big Horn took place on the battlefield.

After the defeat of George Armstrong Custer at the Little Big Horn on June 25, 1876, Lt. Thomas Weir went into a deep depression (now defined as post-traumatic stress disorder) and died Sept. 28, three months after the battle.

I’m not sure where to file this except under “frickin’ unbelievable.” This is a sob story that’s supposed to leave us feeling deeply sympathetic towards Lt. Weir, who survived the Battle of the Little Big Horn.  Weir was an instrument in the U.S. government’s genocidal campaign against Native Americans and participated in the Washita Massacre, where Custer’s troops murdered women and children. (The article describes the event as “the Battle of Washita, or as many call it, a massacre” — “many” apparently not including the author of the article, Curtis Eriksmoen.)  Though the article lauds Weir, it’s impossible to tell his story without admitting that he was a drunk, well before the Battle of the Little Big Horn. This is the first of a two-part story, so we’re left hanging without evidence for the premise of the story, which is that poor Weir developed PTSD as the result of his failed attempt to save Custer at the Little Big Horn, which contributed to his demise.  What the authors don’t consider is that Weir’s PTSD might instead have been a result of his participation in the slaughter of innocents. A fine example of misusing PTSD in the cause of right-wing revisionism.

Veteran homelessness is a racial issue

The Augusta Chronicle gives us the story of Anthony Garrett, a homeless, unemployed 51-year-old black veteran who spends his jobless hours as a street preacher in Augusta’s Under the Bridge Ministry. For staff writer Wesley Brown, Garret illustrates the way “homelessness has become a way of life” for the estimated 300 homeless veterans in and around Augusta.  We learn little about Garret from the article, only that he was at some time married and lived in his own home (rented or bought, it’s not clear), and that he was laid off as a forklift operator, got a job digging graves at a funeral home, and was unable to continue doing hard physical labor because he received a back injury during Operation Desert Storm that left him with fused discs in his back. He currently does carpentry work for his ex-wife’s uncle, in exchange for a place to sleep, so, unlike many other vets, he’s not quite homeless, “just” destitute.  The story wanders, as if it’s not really sure of its subject, bouncing around from the claim that Augusta vets are not receiving the help for which they are eligible (statement from the Augusta Warrior Project, a non-profit dedicated to connecting veterans to the benefits for which they are eligible), to the problems of having a “documented” disability (“Once an employer learns you are a veteran with a certain illness, they will not hire you,” Garrett says, towards the end of the article.)  The third sentence from the last reveals his disability: PTSD.  It ends with Garrett’s comment that “Augusta is not a good environment for recovering veterans.”

What I find most interesting in the article is that it doesn’t mention Garrett’s race at all. (I could see from the  photo that he’s African American.) In May of this year, the National Coalition of Homeless Veterans (NCHV) published a report that documented the unequal effect of military service on African American veterans, from the Vietnam war era to the current day.  Income disparity is the most important determiner of whether a veteran will wind up homeless or not, and the NCHV report emphasizes that.  It’s worth looking at this telling statistic from 2002:  “… Blacks were 47% of the homeless population, and were over 4x as likely to be homeless as other veterans.” The percentage of the homeless population that is African American has not changed much since 2002. It’s also notable that in 2007 the VA found that 71% of the homeless women vets in their program were African American. The NHCV report notes that veteran status is only one of the risk factors for homelessness among African American vets. For example, black vets are unemployed far out of proportion to their numbers: 48% of black veterans between the ages of 18-24 are unemployed.  This was pretty easy for me to find out, with a quick google of “African American veterans homelessness,” and should have been an obvious search question for any responsible reporter.   Ignoring race, and emphasizing PTSD as an equal opportunity cause of homelessness is deeply dishonest. I can’t say I’m surprised that this is the practice in Augusta, but it shouldn’t be.

Therapy Dogs

I’ve been avoiding this issue, but stories about vets and their dogs are in the news pretty much every day, so I guess I have to face it. So I’ll start with the wynt.com article about Jeremy Walton, a Rensselaer County veteran who was happy to receive his PTSD therapy dog, Alanna, a brown labrador retriever.  “‘I haven’t smiled like this in years… Another one of the best days of my life,” said Walton.  I like dogs, and I think they’re good for a lot of people, and especially for people who don’t get as much human companionship and love as they need. I’ve always had dogs myself, and I think my life is better for it.  But the scientific evidence that psychiatric service dogs can alleviate PTSD symptoms is sparse to non-existent.  PubMed lists only a dozen studies of psychiatric service dogs, and I found only four results that linked service dogs to treating PTSD. Of those, only two were actual studies. A 2008 study in Issues Ment Health Nurs is of a single case in “a patient who received animal-assisted therapy as a psychiatric rehabilitation tool to ameliorate his atypical depression following an assault and subsequent head injury.” This study claims only that service dogs have “therapeutic potential.” And one study, from U.S. Army Med Dept J (2012) claims only that there is “anecdotal evidence that training service dogs reduces the PTSD symptoms of Warrior-trainers and that the presence of the dogs enhances the sense of wellness in the NICoE staff and the families of our Wounded Warriors.” A more general search on “pets mental health” brought further results, and the most recent studies made claims like this:

Although scientific evidence on the effects is far from being consistent, companion animals are used with a large number of human subjects, ranging from children to elderly people, who benefit most from emotional support. Based on a comprehensive review of the literature, this paper examines the potential for domesticated animals, such as dogs, for providing emotional and physical opportunities to enrich the lives of many frail subjects. In particular, we focus on innovative interventions, including the potential use of dogs to improve the life of emotionally-impaired children, such as those affected by autism spectrum disorders. Overall an ever increasing research effort is needed to search for the mechanism that lie behind the human-animal bond as well as to provide standardized methodologies for a cautious and effective use of animal-assisted interventions.

If you’re used to reading scientific papers, you can boil this down to the following:  There are a lot of untested programs that provide service animals to people with various illnesses. But we don’t know if they work.  We should probably figure out if they work, and then why they work before we go around handing over animals to people they may or may not benefit, under circumstances that may or may not be good for the animal or the veteran. If a vet wants a dog, and has the means to care for the animal properly, he or she should have the same right to have one as any other person.  But I’m opposed to programs that spend money on providing unvalidated treatments for PTSD, the effects of which (on veteran or dog) we do not know in the medium- or long-term.  Well-controlled research studies are necessary.  If you give a vet a dog with the expectation that she or he will form a deep emotional bond with the animal, and you’re pretty sure the vet will outlive the dog, can you say for certain that the ultimate effect that living with the dog will have on a vet is undoubtedly positive? Folks without PTSD are devastated with their dogs die.  How are folks with PTSD going to handle that devastation?

Today’s news also gives us a glimpse of that pain. Devastated by the loss of her service dog, veteran Karen Sagahon “says life has been incredibly difficult without her service dog and friend.”  Sagahon, whose dog disappeared at a local mall explained, “”It’s another day of putting one step in front of another until we can find him and bring him home. I won’t quit until I can bring him home and make our family whole again.” Better to have loved and lost, than never to have loved at all? The truth is, we don’t know. It’s possible that vets with service dogs will have a higher rate of suicide after the death of the dog.  We probably ought to find out before we start singing the praises of these programs, but it’s so easy to play this as a “feel good” story that news media never take a critical view.

PTSD Feature Articles

The Napa Valley Register profiled Juan Mora, a Calistoga High School footballer who served in the Marines and the Navy. The high school sports star (“starting center of a Wildcats team that reached the summit of the CIF North Coast Section Class B playoffs, capped by a 22-18 come-from-behind win over St. Bernard [Eureka] in 1999”) was a natural leader.  After high school he joined the Marines and then the Navy, served two tours in Iraq, is married, with two children, and has a BA in criminal justice. He worked as a corrections officer in Arizona, and is now in school again, getting an Associate of Arts in sports sciences. The article reads like an average Sunday section “local hero makes good” piece, and Mora sounds like a perfectly nice, normal guy who has gained some wisdom along the way:

I don’t take things for granted like I used to when I was younger,” Mora said. “I’ve been in a Third World country. I’ve seen that a bathroom is a privilege. Over here in the United States, you can pull over to a gas station wherever you want. Also, I learned that not everyone in Iraq is a mean person. They live and try to survive just like we do over here in the United States.

But then the article changes gears:

With exposure to most any combat situation comes the greater risk of being afflicted by PTSD (Post Traumatic Stress Disorder). Though seeing numerous forms of “Support the Troops” communications from civilians have an uplifting tone, Mora, by his own admission, still experiences PTSD.

I’m not even going to tackle the incoherence of the paragraph. I’m just going to use it as a marker of the beginning of the “wounded vet” part of the feature, where it move from “local hero makes good” into revelations of Mora’s problems with alcohol, the failure of stoicism (macho) in his efforts to cope with PTSD, his need and gratefulness for professional help, the obligatory mention of “nightmares, cold sweats, and flashbacks,” and his reintegration into a stable family life in which “his wife, mother and children” are “his security blanket.”

This may indeed be Mora’s story, and it could be that he, not the reporter or editor, chose its trajectory.  But I’ve read a thousand of these features, and they are starting, more and more, to sound like morality plays to me.  Here’s the trope:  1) Normal guy goes off to war; 2) Unspeakable things happen offscreen; 3) Vet comes home to the civilian world where can’t readjust; 4) Vet develops serious problems with alcohol/violence/relationships/other placeholder, and hits bottom; 5) Vet admits he needs help and brings his problems to a therapist or program; 6) Vet is healed with help from the therapist/program/wife/other placeholder; 7) Vet is reintegrated into “normal” life, signified by family bonds, and can serve as an “example” to other vets.  This is a pretty safe story for a Sunday paper, and I can see why they might look for subjects who seem to fit the bill.  There’s nothing threatening in this story at all; it has a happy ending and it reassures the reader that veteran stories, generally, can have happy endings if only vet is willing to go “find help.”  What’s not part of the story is that help is pretty hard to find for a lot of vets, and that PTSD treatments don’t work for the majority of them, even when they are available, and that most vets with PTSD have other hard-to-treat problems (substance abuse, depression, etc), and that PTSD isn’t the worst problem for many vets, particularly vets of color who face terrible unemployment problems… well… we don’t really want to talk about that in a feel-good Sunday feature article.

Indigenous veterans in Australia

And speaking about racial discrimination and its effect on veterans, there’s an excellent (and rare) article on Australia’s indigenous Vietnam War veterans in The Age today. It’s clumsily titled, “War does not discriminate,” but the point of the article is actually that discrimination plays a strong role in war and its aftermath.  An excerpt:

Though there are many points where the indigenous and non-indigenous Vietnam experiences were similar, there are also significant points of difference. Before signing up for the armed forces, Aboriginal and Torres Strait Islander Vietnam veterans grew up in an Australia under assimilation policies. This meant restrictive legislation in every state and territory that regulated indigenous people’s movements, marriages, education and job prospects, and, as indicated already, they also faced the threat of child removal.

Like Dave Cook, many Aboriginal soldiers were members of the stolen generations. Even those Aboriginal veterans who were not separated from their families have memories of hiding from welfare as children. They remember confronting prejudice in their everyday pre-service lives, whether in the form of taunts, job discrimination or police harassment.

Unfortunately for Aboriginal veterans, the return to civilian society after Vietnam also often entailed a return to racial discrimination. Many RSLs denied entry to Aboriginal and Torres Strait Islander veterans because of their race. In some states, publicans would not even serve alcohol to them. In some instances, racial discrimination merely compounded the problems of PTSD, leading to downward spirals in their personal lives.

PTSD Features in Web Series

Atlantic City is premiering at 8:00pm tonight at atlanticcitychronicles.com:

The series follows Frank Porter (played by Richard John Patrick), who returns home to Atlantic City after a tour in Afghanistan. In addition to his war-related trauma, Frank also faces terminal illness within his family, his girlfriend’s marriage to another man, joblessness and the temptation of street life. His experience with PTSD will rear its head and lead him into crime.

Dave Polgar, 29, a resident of Ambler, plays Julian Foster, a Marine assigned the task of tracking Frank down. While the cast and crew are keeping details about the series secret, Polgar admits that Frank’s PTSD leads him to do “some very, very bad things.” Although Frank is the lead character, he isn’t the only one embracing the bad.

Sigh.  Yes, of course.  In pop culture, PTSD makes people do very, very bad things.  I thought we’d gotten over the crazy vet bullshit, but here it comes again, full force.  I’ll watch and let you know whether it’s going to be as awful as it sounds.

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16 August 2013 PTSD News Roundup

August 16, 2013 / no comments

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Yesterday I talked about the military funding yoga as a PTSD “treatment”.  Today, it’s military funding for studies on transcendental meditation. I don’t have anything against yoga or TM; in fact, I practice TM because it makes me feel more relaxed, and yoga is great for stretching.  But that doesn’t mean it’s a “treatment” for people with posttraumatic stress.   According to Iraq war veteran David George, “Veterans spend a few hours learning how to meditate with certified TM instructors and can work on the skill independently after that. Veterans never have to take a pill or go through Veterans Affairs for health care.”  I guess not having to go through the VA and endure its notably lousy treatment of soldiers and vets with PTSD is a plus, whether TM works or not, but  reporter Megan Cloherty of WTOP is not real strong on the science.  The treatment is being pushed by Sarina Grosswald of the David Lynch Foundation. The Lynch Foundation runs Operation Warrior Wellness, and claims on their website that “More than 340 peer-reviewed studies, including research funded by $26 million in grants from the National Institutes of Health, document the effectiveness of the TM technique for relieving stress and stress-related disorders.”  340 peer-reviewed studies?  Really?  A pubmed search gives me only 44 studies that include the very broad keywords of “meditation + post + traumatic” in any field.  I’m not sure where the other 296 studies are hiding, and the site doesn’t say. My guess is that they don’t exist. The only study on TM and PTS that was actually listed in the promo material for the Operation Warrior Wellness program includes Ms. Grosswald as an author, was uncontrolled (meaning that it was impossible to measure the effects of TM against a group of people who did not engage in the practice) and included only five veterans. (The authors claimed that the vets showed “significant improvement”, but I’m not sure how they measured that, since significance testing on a group of 5, with no control, is pretty much impossible. That this passed peer review in Military Medicine simply underlines the journal’s low standards, and you don’t get much lower than an impact factor of 1).  But, hey, that was enough for the DOD to dump $2.4 million dollars into studying TM among vets at the San Diego VA Hospital.  Maybe it’s the inanity of the reporter, but I’m not impressed by Greenwald’s assurance that TM works because “in brain scans taken during TM, the prefrontal cortex of patients’ brains lit up.”  Sheesh.

And though the DOD and the VA can throw hundreds of millions at “foundations” that push pseudoscience, and pharmaceutical companies that push expensive drugs, they can’t seem to do much for guys like Howard Berry, whose son, Josh, committed suicide after battling PTSD for years. Josh had been wounded eight years before by Nadal Hassan, the Fort Hood shooter. Berry believes that soldiers with PTSD “need more” than the government is giving them.  He’s right, of course.  Unless militaries admit that the psychological cost of war and violence are ongoing, and last lifetimes after combat has ended, they will never provide adequate services to soldiers and veterans. Iraq war veteran Sgt. Mike Bergman might agree.  A Colorado 9 news article says of Berman: “Looking back, he knows he changed forever when he saw the faces of the first three people he killed. His message to the politicians and military leaders: thousands more like me are coming home.” The article also mentions Curtis Bean, “a sniper, who also attributes his PTSD to his decisions to kill.”  It’s clear enough to the soldiers that killing people is bad for you, even if extenuating circumstances (like a declared war) make it necessary.  But the military is so invested in the notion that “war makes men” that they’ll never admit that war breaks men, and especially not that it breaks strong, normal men who were perfectly healthy and psychologically well-adjusted before they got into the military.

Veteran Curtis Bean, mentioned above, turned to art as a method for handling his pain.  He founded an organization called the Art of War Project, which held a show in May of this year.  I dropped by his website to see his paintings and was impressed by his work: he paints with bright, bold colors, and captures monstrous and beautiful images with a combination of comic art and graffiti on canvas and wood. Photojournalist Ashley Gilbertson also practices a kind of art therapy.  In the process of working through his own PTSD and guilt over the death of a soldier in Iraq who preceded him into danger and paid the cost, he began photographing the rooms of the young American soldiers who had been killed in the war.  The series, “Bedrooms of the Fallen,” is powerful because it evokes the memory of fallen soldiers as they were when they lived in the civilian world. The rooms are untouched, and they evoke a loneliness that’s without solace. On the one hand, each room looks as if its owner has stepped out for a moment, and on the other hand there’s a sense of frozen stillness—one can almost see the dust settling deeper by the day.

And to sum it up today, we can consider the inhumanity and downright creepiness of Thomas Donnelly’s war-loving editorial in that bastion of ethical rectitude, The Wall Street Journal. Donnelly waxes nostalgic; he wants to bring back the days when soldiers were seen as “models of self-control, courage and patriotism.” He also makes absurd claims: “It is possible to identify those who are most prone to stress problems, and that has more to do with nonmilitary issues—again, substance abuse, money and family problems are the culprits—than with the experience of combat or deployment to a war zone.” His lip curl when he states firmly that military commanders have “long known” this, is almost visible.  We just have to keep out those pesky undesirables, and war will turn back into a manly game for manly men.  After all, as humans, we have an “underlying, primal instinct for violence.”  As if all this dick waving wasn’t enough, he then insinuates that the claims of rampant sexual harassment and abuse put forward by military women are baseless since (he quotes a woman here), “there is no evidence that the military has a higher rate of sexual assault than, say, colleges and universities).  Finally, he invokes the myth of the “civilian weakling” who prevents the manly soldier from doing his job:   “By regarding soldiers… as victims and patients, we are in danger of foisting our very own, very civilian and very modern, therapeutic pathologies on people who don’t need them and whose ability to do their jobs—that is, keep us safe—is likely to be diminished.”

If you haven’t already puked on your shoes from the above Rambo redux, you may wonder where he draws his evidence for the claim that we’re creating “epidemics that aren’t.”  On August 7, JAMA published a longitudinal study called “Risk Factors Associated with Suicide in Current and Former U.S. Military Personnel,” by LeardMann, Powell, et al. The study, which took place over almost 8 years, found that “suicide risk was independently associated with male sex and mental disorders but not with military-specific variables.”  So this is a suicide study, although Donnelly uses it as if it debunks any link between PTSD and military service.  I’ll talk about the study later, and what it really does or doesn’t show, in a separate essay, but I wanted to point out this pretty sneaky dodge on Donnelly’s part.  His other piece of “evidence” that real manly man soldiers are being maligned by women who serve in the military comes from Gail Heriot, who claimed in an article for the Weekly Standard (July 8, 2013) that “there is no sexual assault crisis” in the military, and that it is the military itself that is being “harassed.” Heriot’s conjecture that sexual assault is simply over-reported is taken by Donnelly as a fact.  Others have critiqued Heriot, including attorney Roger Canaff. Given that Heriot has crusaded against anti-harassment courses, calling them “propaganda,” and a “rather blatant form of racial and sexual harassment,”  and that she sees anti-discrimination laws as a form of harassment against employers, I think her agenda is pretty clear.  Of course, agendas don’t matter if you have the facts to support your arguments, but Heriot doesn’t.

 

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