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22 August 2013, PTSD & Trauma News Roundup

August 22, 2013 / no comments

We know it’s bad… when it happens to a white woman

CNN featured the story of Michele Cross, a University of Chicago student who was diagnosed with PTSD after she returned from her studies in India. CNN and other news outlets who discussed the story never failed to mention that Cross was a “fair-skinned, red haired” woman, as opposed, one assumed, to all thosee dark-skinned, dark-haired Indian women who inhabit the continent. The story Cross originally told in a CNN iReport under the screen name of RoseChasm” rack[ed] up more than 800,000 page views” within 3 days of publication. Could it be because Cross herself emphasized her whiteness, her hair color, her blue eyes in a short piece of dramatic prose, full of florid passages like the following:

There was no way to prepare for the eyes, the eyes that every day stared with such entitlement at my body, with no change of expression whether I met their gaze or not. Walking to the fruit seller’s or the tailer’s I got stares so sharp that they sliced away bits of me piece by piece. I was prepared for my actions to be taken as sex signals; I was not prepared to understand that there were no sex signals, only women’s bodies to be taken, or hidden away.

I covered up, but I did not hide. And so I was taken, by eye after eye, picture after picture. Who knows how many photos there are of me in India, or on the internet: photos of me walking, cursing, flipping people off. Who knows how many strangers have used my image as pornography, and those of my friends. I deleted my fair share, but it was a drop in the ocean– I had no chance of taking back everything they took.

If everything Ms. Cross says is true, she endured a level of harassment that was awful. And of course no woman should have to put up with that. But I find it incredible that in all her description, she did not find it in her heart, even once, to mention what daily life must be like for Indian women, who have been in the streets protesting a campaign of murder and rape waged against them by their countrymen. A “South Asian Studies” scholar, Cross did not for a moment contextualize her own suffering — nope, this was all about her. And the public ate it up—this story of a white woman pawed by native men. Though Cross claims she is not the only UC student who experienced this harassment, at least one other woman on the trip attempted to counter the tone of Cross’s narrative. Katherine Stewart, a black UC student, confirms that there were attacks on women in the program, but takes issue with—what she tactfully does not say outright—the racism evident in Cross’s response. Stewart wrote:

RoseChasm does not address the fact that there are warm and honest men in India. When we do not make the distinction that only some men of a population commit a crime, we develop a stereotype for an entire population. And when we develop a negative stereotype for a population, what arises? Racism….

I understand RoseChasm’s pain, and I too had a hard time readjusting to life in America after my experience in India. I truly hope for her to be well again, but I will not sit back and allow the image of India’s men to be tarnished by an article that does not articulate other sides to India. I experienced love, excitement, and awe in India. And while I did experience unacceptable harassment, I know that my ability to not generalize a population will allow people to see that we must find another way to deal with this issue.

You can bet Stewart didn’t get 800,000 hits in three days.

You’re all whiners… or maybe not

Psychologist Michael J. Hurd (Ph.D., LCSW) rants on delmarvaNow!com about the lack of definition of “trauma.” This pretty much sums it up: “Our government and educated intellectuals (psychiatrists included) have frankly turned many of us into a bunch of babies.” His “argument” seems to be that if psychiatrists didn’t go around inventing ridiculous diseases, we wouldn’t have them. Just makes you want to jump up and run to his office for therapy, doesn’t it?

On the other side of the spectrum is Michael Pond, a therapist who works with First Nations patients in British Columbia. He thinks it’s a good thing that the diagnosis is now “pervasive”:

And before anyone rolls their eyes derisively, according to the updated criteria for the illness in the new DSM 5, the bible of psychiatry, it’s very likely the diagnosis is correct.

I treat a lot of First Nations people for addictions, depression, anxiety and aggression. But the more they reveal the extent of the horror they experienced in residential schools, the more obvious it is to me that my clients actually suffer from PTSD, and all the other problems are symptoms of it.

The pervasiveness of the condition, Pond argues, will help us take the victims of violence more seriously.

Making money off of war…

HeroBracelets.org (don’t let the “org” fool you — it’s a commercial endeavor) was founded by Chris Great, an advertising executive who speicalizes brand development, marketing and entrepreneurship. His company markets commemorative bracelets to soldiers and their families for prices ranging from $14 to $134.50, says it donates $2/bracelet to “military support organizations.” One of these organizations is the Intrepid Fallen Heroes Fund (where do they get these names?), to which they recently donated $150,000 in bracelet money (which means they sold at lest 75,000 bracelets, at, say, an average price of $25, which totals to something around $7.5 million earned from soldiers and veterans and families. IFHF raised money to build a treatment center for Traumatic Brain Injury (TBI) on the Navy Campus of Bethesday, as well as other centers for treatment and study of TBI. We’re talking big, big bucks here — these centers can cost upwards of $50 million, so HeroBracelets.org’s $150,000 is a drop in the bucket. But Herobracelets has certainly used this as a PR opportunity, marketing its bracelets as a way to “support our military”:

HeroBracelets.org gives them an opportunity to spread awareness by wearing their bracelet, and it allows them to make a financial contribution to a charity of their choice.” said Christopher and Loree Greta, founders of HeroBracelets.org. “$2 per bracelet may not seem like much, but it has certainly added up – and $150,000 later, it’s allowed us and our customers to make a difference for the thousands of service members and their families who rely on Intrepid Fallen Heroes Fund and the NICoE Centers for treatment of their invisible wounds.

$2/bracelet. Doesn’t seem like much to do for our veterans, does it. Especially when it’s them and their families forking over the money in the first place.

Research

It’s rare that clinical studies include PTSD with comorbid disorders, so it was nice to see this August 7 randomized clinical trial on Naltrexone and Prolonged Exposure Therapy in patients with both PTSD and alcohol dependence. It’s tough to do a double-blind study for psychological interventions, since therapists need to be trained in the methods they use. Thus, this was a single-blind study, meaning the patients did not know whether whether they were receiving the medication or a sugar pill, and did not know if they were receiving Exposure Therapy (ET) or supportive counseling (SC). As usual, symptom severity was the measure of success, along with the Alcohol Craving scale: were symptoms and drinking days reduced more by the naltroxene or the Exposure Therapy or by both in combination? The group they studied was mostly between 36-43 years old, about 66% male, and the majority of subjects were black. (An odd note here — blacks made up 70-75% of those given ET+Naltrexone and ET+Placebo, but only 50-60% of those given SC+Naltrexone and SC+Placebo.) Also unusual is the fact that combat vets made up only about 15% of the study group. The predominant traumas were sexual assault and physical assault. Like many other surveys, this one found that there was no significant difference between the effectiveness of Exposure Therapy and supportive counseling, and PTSD symptoms did not decrease significantly in any of the combinations. The study found that the patients prescribed naltrexone drank less often. The best they could say about Exposure Therapy is that it “was not associated with an exacerbation of alcohol use disorder.” That’s a good thing to know about one of the most frequently prescribed talk therapies for PTSD: at least it doesn’t make it worse.

Fund Raising

Veteran Doug Setter, and his colleagues Linh Lai and Dave Iten are doing a “four-mile open water relay swim across Bellingham Bay [WA] in honour of American and Canadian servicemen that lost their lives to Post Traumatic Stress Disorder.” Along with other military stressors, Setter blames “the public’s [negative] perception of soldiers” for some of the stress veterans feel when they return home. It’s not clear what the swim is designed to do except “honour soldiers who killed themselves because of PTSD” and “shine a light on the challenges soldiers face with their duty is done.” The swim is named after a local veteran who committed suicide after a tour in Iraq.

War on Film

Steven Grayhm of Astoria Film Co.(Los Angeles) is trying to raise $750,000 on Kickstarter to fund Thunder Road, a film based on a story told to him by Iraq war veteran Nick Carbonell, who witnessed the death of his best friend on a nighttime operation in Iraq. From the Kickstarter site:

Thunder Road is the story of returning U.S. soldier SGT. CALVIN COLE (played by Steven) whom we meet in present day Detroit as a troubled veteran who suffers from PTSD (Post Traumatic Stress Disorder) and tbi (Traumatic Brain Injury) from multiple deployments to Iraq and Afghanistan. Initially resistant to the VA system COLE must find a way to assimilate back into civilian life before he ends up dead or in prison.

Through his rekindled friendship with his estranged childhood friend PFC. DARRYL SPARKS (played by Matt) who he served on the “buddy system” with and his newly formed relationship with a doctor at the VA Medical Center, COLE finds redemption and salvation through sharing his captivating experience as a combat infantryman. The film also explores the psychological repercussions of war and seeks answers to the growing epidemic of PTSD and tbi in returning soldiers.

A pretty predictable plot trajectory, and certain one right out of the mainstream pop culture representations of PTSD: damaged warrior helped back to health by a wise VA therapist, finds redemption in sharing his story of trauma. A report on its quality will have to wait until the film is made, but I don’t hold much hope it’ll be groundbreaking. I’m sick of films that imply that the only two choices choices facing a vet with active PTSD are either winding up dead or in prison. The vast majority of people with PTSD continue on with their lives, dealing as best they can, and commit neither crimes nor suicide.

This notion that sharing a trauma is an end in itself is very popular, despite the fact that thousands of such stories have been shared by traumatized soldiers, and that there’s no evidence that simply sharing these stories actually contributes to improved reintegration or happiness. Trauma survivors who make a practice of telling and retelling their stories, particularly for public consumption, over many years, rarely seem to move beyond the trauma of war. It cheers the public up to see stories in which an earnest vet, traumatized in war, regains his ability to connect with his emotions and with his significant others, and it’s even better if he then shoulders the burden of dealing with other vets like himself. But that’s a rarity — the vast majority of vets who are treated for PTSD by the VA are still under treatment four years later. If there is “healing,” it’s a slow process and conclusion is far from assured. And one reason that it’s such a slow path to recovery might be that the public taste for trauma narratives does not seem connected to the public’s interest in ending the circumstances that cause trauma.

And the inevitable PTSD Diagnosis by Media section…

The L.A. Times says that journalist Michael Hastings “may have suffered PTSD from work as a war journalist.” Hastings died in a single-car accident, and in such cases there’s often speculation that the crash was a form of suicide. Despite the claim of journalists Richard Winton and Andrew Blankenstein, the coroner’s report seems to contain no evidence at all that PTSD had anything to do with Hasting’s death. Hastings may well have had PTSD, given his experiences in the war, and he may have said that he used medical marijuana to treat PTSD, but that’s a far cry from PTSD causing a suicide. Perhaps the L.A. Times journalists confused the coroner’s comment that Hastings had died of “traumatic injuries,” with “post-traumatic stress disorder,” contemporary journalistic standards being what they are.

20 August 2013, PTSD & Traumatic Stress News Roundup

August 20, 2013 / no comments

A couple of folks complained that all I seemed to cover was combat-related PTSD. That’s because almost all the PTSD-related news stories that Google serves up are about that population. So, to try and catch any other stories, I broadened my search terms to include “traumatic stress”. One thing this exercise shows me is how under-reported and discussed other populations of survivors are, especially since soldiers make up the minority of those with PTSD. So let’s see what Google offered us yesterday and today:

The Trauma Diet

Dr. Kathleen Kendall-Tackett is giving webinars in “How Trauma Makes You Fat.” She makes the same links between obesity and trauma that have lately been described in the research, but makes a claim that is, so far as I can find, unsupported in the literature, at least in human studies: “The good news is that when traumatic stress is addressed, inflammation and insulin resistance can be reversed.” She’s hyping a book that she will self-publish later this year. The info is taken verbatim from this press release (there is very little real science journalism any more). While I easily found more than one 2013 study that suggests that weight loss has a beneficial effect on PTSD symptoms (as it does on depression, and also for reasons that are as yet unclear), I found no studies that suggested the opposite: that PTSD treatments resulted in weight loss for obese patients. I’ll be curious to see her references when the book comes out, but my guess is at this point they’re confined to conclusions drawn from animal studies.

Fund Raising Efforts

The Republican American featured a story on a motorcycle ride to raise money for PTSD, organized by Arthur Melcher of American Legion Post 43 in Minnesota. They raised about $3000, which will will go into the Post’s “Post-Traumatic Stress Disorder account.” The ride was in memory of Matthew Marc Melanson, who committed suicide after returning from military service in Afghanistan.

Also in the fund-raising department, The Northwestern.com has published a story about Tom Voss and Anthony Anderson, the Iraq war vets from Wisconsin who plan a 2700 mile journey to raise money for Dryhootch. They’ve so far raised about $15,000 of the $100,000 that they’re looking for. The bulk of that comes from a $10,000 donation by the U.S. Concealed Carry Association, a commercial organization that carrying concealed weapons is a “social obligation,” and that strongly promotes gun ownership in houses where there are children.

Send ’em back into the field!

The military’s failure to either “prevent” or to “cure” PTSD has spawned a new philosophy: Redeploy soldiers with PTSD, again and again.

But a diagnosis of post-traumatic stress disorder is not a barrier to being redeployed. Not when the Army needs its most experienced soldiers to wrap up the war. Instead, the Army is trying to answer a new question: Who is resilient enough to return to Afghanistan, in spite of the demons they are still fighting?

As the Army has knowingly redeployed soldiers with symptoms of PTSD – and learned of the remarkable coping skills of some – it is now regularly embedding psychologists with units in the field. They are treating men and women recovering from 12 years of relentless combat, even as the soldiers continue to fight.

It seems the military has discovered that some soldiers with PTSD can continue functioning in a wartime environment, and it’s willing to redeploy them until they crack for good. Although many studies suggest that each successive retraumatization does more damage to the individual psyche, the military is apparently unconcerned with a soldier’s capacity to function in the civilian world, post-combat. The argument that some people seemed to survive years in a concentration camp, and to come out intact, would never be used to justify concentration camps since we know that many of those who were high-functioning in the world of the camps, and who survived many years there, failed to adjust to normal life after they were released, had breakdowns, or committed suicide. There’s no reason to think war is any different: some soldiers with PTSD will continue to be high-functioning combat soldiers, but we have no idea how the 7-tour combat veterans that the article describes will adjust to civilian life postwar. The role of the therapist, in such a combat mill, becomes deeply troubling.

The article describes embedded mental health professionals who travel with the troops, and who are charged with keeping them going between combat engagements. Capt. Stacey Krause is “one of dozens of behavioral health experts deployed across Afghanistan.” She doubles as marriage counselor and financial advisor, and is “often the only person on Arian who knows how the soldiers of 10th Mountain are holding up.” She says, that soldiers “can meet the criteria for PTSD but still be able and willing to serve this kind of mission… After multiple deployments, soldiers are able to build robust coping mechanisms.” As any properly trained psychotherapist will tell you, “coping mechanisms” are not the same thing as “mental health”. The former might allow you to endure the combat environment, but it’s the latter that allows you to reintegrate into civilian society. But given the increasing number of combat tours that veterans are accruing, perhaps the army wants troops that can find a “safe harbor” only under combat conditions, who can “cope” only by redeploying over and over again. Says one of the soldiers quoted in the article, “It just seems inevitable that we’ll be sent somewhere again… That’s the one thing we’ve learned from experience.”

This attitude is summed up beautifully by U.S. Army Brig. Gen. Walter E. Piatt, who wants to turn meditation and mindfulness into tools of war. (The irony just never stops, does it?):

“We fight now in a cognitive struggle with an enemy that can’t be defeated through technology. They’ve taken our strengths, big weapons and technology, and changed the game,” Piatt says. “They attack on their terms. They don’t care about civilian casualties. Our best weapons in that fight is the soldiers’ minds.

“You’re not letting your mind wander, you’re focusing straight on. This is what her technique teaches you to do, focus on the task.’’

The rhetoric of “hearts and minds” that was once cynically applied to applied to winning over the Vietnamese people to the American cause has now shifted into a battle for the hearts and minds of our own soldiers. Piatt doesn’t just admit that U.S. soldiers suffer from PTSD, he positively revels in it. The answer? Crazy shit, like the Mind Fitness Training Institute founded by Georgetown University professor Elizabeth Stanley, Ph.D. MMFT® allegedly “blends mindfulness skills training, stress resilience skills training, and concrete applications for the operational setting.” This as-yet-unproven “stress innoculation training”, administered under a registered trademark, has already reaped the benefits of military largess towards those who promise to keep their troops in the field longer. I’m pretty sure meditation and mindfulness have positive effects, but it’s exceedingly doubtful that those modest good effects will overcome neurological stress reactions in the long term. What’s most interesting is the way that meditation techniques have been hijacked from cultures from which they emerged. Meditation and mindfulness are traditionally activities engaged in by those who seek peace, not those who prepare men and women for war. And it’s about as true to the tradition as claiming that the central tenet of Buddhism is “every man for himself.” This kind of training resonates more with magical thinking movements like The Secret (no I won’t link to that garbage), and “failure to meditate properly” will doubtless be listed as the reason that troops are succumbing to PTSD in the field….

Social Media

The Facebook page Military with PTSD was apparently shut down for 12 hours by FB admins, over a post (which I can’t find anywhere) “about God and religion.” The page has 22,000 “fans”, and was started by Shawn Gourley, the wife of a military vet who suffers from PTSD. FB is notorious for banning and unbanning sites at will, so it’s disturbing to read Gourley’s comments: “On our page, I am a certified suicide gatekeeper… And we do have suicidal vets on the page that come to us for help. We cannot contact them or message them… Someone posted on my personal page that they felt like the walls were closing in on them and they don’t know how much longer they can hang on and I can’t respond to her.” It’s even more disturbing to read the words of another page administrator, veteran Marcus Spaulding, who claims, “Facebook put a lot of lives in danger… We have many veterans who come to that page to talk to counselors, to talk to Shawn, to talk to me… They don’t know where else to turn to… We could be burying another vet.” These statements are in direct contradiction to the description of the Facebook page:

We are not doctors or in any sort of health care field. We are just veterans and spouses coming together for support. We are not responsible for suicidal/homicidal content or actions. If you are in crisis, please call 911, go to your nearest Emergency Room, or call 1-800-273-TALK (1-800-273-8255)(Spanish/Español 1-888-628-9454). Veterans, press “1” after you call — or go to Veterans Suicide Prevention Hotline to chat live with a crisis counselor at any time of day or night.

No veteran should be dependent on a Facebook page as a lifeline, and if the site administrators see themselves as providing such a service, then they’re acting in a deeply irresponsible fashion. While online communities and fora can be very helpful for people with medical and psychological conditions, they are no substitute for local support networks, qualified therapists, and treatment centers. Online communities attract all kinds of people, and there is no way to certify who is who: real vets mix with fakes, and qualified therapists mix with well-meaning amateurs who are simply not equipped to deal with the problems they are attempted to help solve, and with quacks who “prescribe” fake cures. A responsible administrator would nip in the bud any relationship with a veteran who seems to be growing dependent upon the page, and suggest they redirect their focus to a local source of help. Instead, the two administrators who were quoted above seem to revel in the alleged dependence of the vets with whom they interact.

More media “diagnoses” of PTSD

Fox News is reporting that actress Amanda Bynes, who has been hsopitalized for schizophrenia, has PTSD, and that story is being echoedfox around the web. The PTSD “diagnosis” apparently comes from “a source close to” Bynes. The anonymous source claims, ““There are no drug problems involved, it’s all mental. She has deep anger and PTSD, which tripped a psychotic episode… She is very ill, but manageable. Amanda genuinely wants to get better and has wanted to get better for some time.” The source also claimed her PTSD “stems in part from the pressures of her Hollywood career, in which she shot to Nickelodeon stardom as a child…” and from “very deep-seated conflict issues with her parents.” It’s news to me that child stardom and the pressures of Hollywood are causes of PTSD, and “deep-seated conflict” is a far cry from traumatic abuse. I don’t know Byne’s specific history, but the point is that neither does Fox, which is lobbing out a faux diagnosis based on alleged symptoms.

And now from Big Pharma…

Tonix Pharmaceuticals is promoting cyclobenzaprine, the active component of TNX-102, a new sublingual tablet, at the International Pain Society’s 9th World Congress on Myofascial Pain. In December of 2012 Tonix raised $2.3 million to further develop TNX-102 (CNS Drug News, 6 December), which is a proprietary formulation of cyclobenzaprine (CBP). Tonix pitches the drug as a treatment both for fibromyalgia and PTSD since both seem related to poor sleep. Tonix claims that “the unique qualities of TNX-102 SL provide for rapid absorption into the bloodstream and rapid excretion from the system. This is ideal for a bedtime medicine to reduce next day somnolence. In addition, since TNX-102 SL avoids first-pass metabolism by the liver, a psychoactive metabolite of cyclobenzaprine, norcyclobenzaprine, is not generated. TONIX believes that this metabolite contributes to reduced long term efficacy with the off-label chronic use of generic cyclobenzaprine.” Since the military is cutting down on the number of benzodiazepines it prescribes, this would leave the billion-dollar military pharmaceutical market wide open for Tonix. The results they’re reporting are from non-clinical studies; clinical studies won’t start until later this year. I’ll follow this drug as it moves through testing and towards the market.

18 August 2013, PTSD News Roundup

August 18, 2013 / no comments

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.

17 August 2013, PTSD News Roundup

August 17, 2013 / no comments

Bad Science Department

Sometimes the names of the trauma-focused therapies that folks come up with make me shudder all by themselves, they’re so weirdly Orwellian. That’s the case for “reprogramming therapy,” of which Accelerated Resolution Therapy (ART) is being hyped as the latest and greatest “cure.” Here’s the headline: “Scottish nurses are to be trained in a treatment for post-traumatic stress disorder that works by reprogramming the brains of combat veterans.” Though it sounds like a kind of Orwellian brainwashing, it’s yet another version of Francine Shapiro’s endlessly “promising” (no-longer-so-)new therapy, Eye Movement Desensitization and Reprocessing (EMDR). EMDR and its variants have proved no more effective than any other trauma-focused therapy, which means they’re moderately effective at relieving clinical symptoms in the short-term, for a very small segment of the population that suffers from PTSD (the 20% of women, and about 12% of men with no co-morbid psychological disorders). The description of how ART works is pretty weak: “The patient is asked to move their eyes back and forth while recalling traumatic events, a process which is thought to “unlock” the memory and enable the therapist to start a discussion aimed at detaching the associated negative emotions.”

Since even variations on EMDR that don’t use eye movements all seem to work about the same, it’s pretty hard to argue convincingly that eye movements are the key to “unlocking” the memory. The idea of “unlocking” is purely metaphorical anyway, since there’s no proof that the memory mechanism (whatever it is) “locks” or “unlocks” at all. Since we don’t (even the neuroscientists) have good models for the mechanisms by which we remember, forget, revise or associate, “explanations” like the above are no better than “just so” stories, and often worse than no explanations at all. Sterling University of the UK is teaming up with University of South Florida (USF) to implement ART, which was developed at USF. The rationale is a an allegedly successful study “carried out among 80 war veterans in the US found that the proportion showing signs of PTSD fell from 90 per cent to 17 per cent after four sessions or fewer. (When I found the study, it did not seem to include any war veterans. See next paragraph.) Incidences of depression in the same group dropped from 80 per cent to 28 per cent.” The people who report on science these days are so dim that they don’t understand that stats like this are like giving half a baseball score. A drop from 90% to 17% sounds pretty stunning, but it sure would be nice to know the response rate in the control group (if there was a control group), if they accounted for the placebo effect, and if there was a follow-up study to find out if the treatment had lasting effect. So I poked around and looked for the study (not referenced in the article).

“Brief Treatment of Symptoms of Post-Traumatic Stress Disorder (PTSD) by Use of Accelerated Resolution Therapy (ART®)” wasn’t hard to find. It was published in June of this year in a relatively new open-access journal called Behavioral Sciences. It’s so new that it’s published a total of 45 articles and I can’t find any record of its impact factor. This doesn’t make it a bad journal, and it’s from a reputable publisher, but a more robust study would have found a more prominent home. So let’s see what the study says… 1) Those selected for the study suffered from PTSD, but veteran status was not a criteria for inclusion; 2) 77% of the subjects were women, and 29% were Hispanic: those numbers are not representative of the population of British veterans (none of the subjects appeared to be vets); 3) 17.5% of the subjects dropped out before the end of the study, and 18.2% of the remaining subjects dropped out before the 2-month followup, which means that they collected full data on less than 70% of the full group of participants (54 people); 4) they excluded substance abusers (which would exclude 64%-84% of veterans with PTSD); 5) there was no control group, and all therapists were trained in and administered only ART therapy, which means that the effect of researcher allegiance on the patient was unaccounted for; 6) all data was self-reported. So there is no way to know if the amazingly large effect they reported was due to ART or simply a product of entering any kind of very short-term trauma-focused treatment. Section 4.2, “Possible Therapeutic Mechanisms,” is pretty funny. I’ve rarely seen a longer list of “may be.. postulate… may help… may occur… may simultaneously…” and so on. The chain of conjecture continues for miles. Some of it is just plain pseudoscientific gobbledygook: “… ART involves an additional therapeutic element known as the ‘Director’ intervention that directs the patient to establish a new narrative to address ‘unfinished business’ in much the way that Gestalt techniques are used experientially to achieve positive results. Success of the intervention is determined by the therapist asking the participant to pull up the original distressful [sic] images, and reporting being unable to do so.” In light of the fact that the study did not include combat veterans, the final line of the paper is telling: “Future controlled studies with ART are warranted, particularly given its short treatment duration, and in light of current heightened emphasis on health care cost constraints, as well as the very large clinical burden of treatment of PTSD being experienced from the lengthy wars in Iraq and Afghanistan.” To me, this just screams: “We’re gonna sell this to the military!” And, of course, the military bought it: the DOD paid for the initial research, and now ART® (don’t forget that trademark!) is a product now offered to British war veterans.

PTSD Made Them Do It!

In Denver, a military veteran named Daniel Abeyta was arrested for allegedly shooting two women and blowing up a propane tank. The CBS Denver headline was “Neighbors say shooting suspect is vet with PTSD,” but that’s not mentioned in the article until the final paragraph: “Neighbors said Abeyta… suffers from post-traumatic stress disorder and is involved in a difficult marriage.” It’s always fun when your neighbors diagnose you for the news media and then the news affiliate headlines the hearsay. In other news, 43-year-old Dinalynn Inez Andrews Potter, a retired Navy vet, allegedly jumped on stage and clobbered elderly soul singer, Lester Chambers when he sang a song dedicated to murdered teenager Trayvon Martin. Apparently Potter’s claim she has PTSD makes this “not a racial attack” in the eyes of the arresting officer, even though Potter yelled, “It’s all your fault, you caused this shit,” before she knocked the frail singer on his ass. This “It’s not racism, it’s PTSD” stuff is just silly. It’s not like the two are mutually exclusive. PTSD doesn’t change your political beliefs or give you prejudices you didn’t have in the first place, even though it might remove your inhibitions to acting on them.

16 August 2013 PTSD News Roundup

August 16, 2013 / no comments

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.

15 August 2013 PTSD News Roundup

August 15, 2013 / no comments

Second day in a row… I feel a streak building. Though I think that if I take too much of this material in, my head will eventually explode.

A post on the U.S. Air Force website waxes enthusiastic about a “feelings free, scientific analysis” of the body’s reaction to stress that emphasizes “biological processes.” Tania Glenn (a psychology Ph.D. and clinical social worker) emphasized the importance of cortisol, calling it “the key factor of PTSD.” Anybody who keeps up with the literature knows that the role of cortisol in traumatic stress reactions is poorly understood, and that results of studies have been mixed. A 2012 meta-analysis found that cortisol levels were not significantly different between trauma exposed people with PTSD, trauma exposed people without PTSD, and and healthy people who suffered no trauma. I can’t speak to the accuracy with which Senior Airman Whitney Tucker recorded Dr. Glenn’s words, but if the quotes are correct, she’s pushing a dangerous line. In her universe, “well-trained” soldiers “fight” while “flight” is a product of “the untrained brain and the passive personality.” Glenn apparently tours the country, and is paid by the military to push this nonsense down the throats of military personnel, while emphatically denying the necessity of talking about feelings (which she coyly refers to as the “F-word”). Your tax dollars at work here, buying snake oil once again….

Robert Hart of the Oregon Health and Science University in Portland found that patients who have PTSD symptoms after elective lumbar fusion surgery benefit less from the operation. The study, which included 73 patients who were psychological evaluated before and after surgery, was published in Spine 38:17 (August 2013). 22% of the cohort had PTSD symptoms. No surprise that traumatic stress inhibits healing. In line with this, a recent twin study published in the Journal of the American of Cardiology shows that twins with PTSD are twice as likely to suffer from coronary heart disease than twins without PTSD. The nice thing about this study is that it controlled for other factors and it didn’t just rely on self-reporting. Psychological well-being affects physical well-being… who knew?

And in yet another @recycle of “promising new treatments” that are really old therapies that didn’t pan out, the military is dumping our tax dollars into Hyperbaric Oxygen Therapy. Quotes like this make me want to smack my forehead: ““When you are just breathing air you’re breathing about 21 percent oxygen, by breathing 100 percent oxygen and adding the pressure it may change how the body heals the mind.” The last was courtesy of Lt. Cmdr. Daniel Lesley, staff neurologist for the Camp Lejeune Naval Hospital. But don’t worry, Lesley assures us, “Whether the therapy is proven to help PTSD and TBIs or disproven, the results will help service members…. There are service members who pay out of pocket for this treatment out in town. If we can prove it works, then we can provide the treatment; if it doesn’t work, then we can save service members their money.” Riiiight, we can prevent our soldiers from losing money on quack therapies by subjecting them to quack therapies. Hyperbaric Oxygen therapy. which does work for some conditions (decompression sickness, smoke inhalation, gas gangrene) has been pushed as a quack cure for cancer, AIDS, autism, and Lyme disease. Here’s a nice article debunking the use of Hyperbaric Oxygen for neurological conditions. And here’s a site that hypes this crap.

And hopping on the woo train, Mixed Martial Arts and yoga are both being hyped as “non-traditional” PTSD treatments by Bret Moore, a clinical psychologist and two tour Iraq veteran writing for the Marine Corps Times. The article is titled “Kevlar for the Mind,” a metaphor that implies that both activities have a protective effect. So, hey, Marines, get out there and wrestle, and do your stretching and meditating, and you’ll be protected from traumatic stress. Not. Thank goodness that this column is “for informational purposes only and is not intended to convey specific psychological or medical guidance.“

14 August 2013, PTSD News Roundup

August 13, 2013 / no comments

I’ve been meaning for some time to do a regular round-up of articles on PTSD that show up in Google News. Ive been put off by the combination of annoyance and depression they usually evoke, but I’m shaking that off today, and getting to work. So here we go….

Shoosmiths’s Access Legal (a site that advertises legal services to soldiers, so I’m not sure how it’s Google “news”) features a piece on the Bundeswehr’s decision to give psychological tests to recruits, in an attempt to “prevent” PTSD. Working backwards from a study that showed that most soldiers who suffer from PTSD after combat also survived traumatic experiences before combat, the German Defense Ministry has adopted the suggestion of Prof. Dr. Hans-Ulrich Wittchen, a professor of clinical psychology at Dresden Technical University. The theory seems to be that if they send fewer traumatized soldiers into battle, then they’ll get fewer traumatized soldiers after battle. Good luck with that, I say. The study referenced in the article is probably this one, published in September 2012. A study of inpatients in a German Army hospital, it found that in about 40% of patients, there was evidence that psychological trauma pre-existed military service. Not very surprising, really, since the same study admits that in the U.S. general population, some 61% of adults had been exposed to traumatic events, and a German study showed that 26% of men had been exposed to trauma, so that means the estimate of 40% of Bundeswahr vets with pre-military service trauma is not nearly as far off the average as the news report would have it seem. The study is worth reading, though the sample was small and skewed heavily towards inpatients. As for the Bundeswahr’s decsion, it could have some interesting results. Since we know that compounded trauma results in more cases of PTSD severe enough to impair function, it could be that screening out “pre-traumatized” soldiers will reduce the severity of PTSD, if not its incidence. This could be practical in Germany, where there’s a universal draft and the number of soldiers sent into combat is very small in comparison to the number of soldiers who serve. A screening program like this would never work in the U.S., though, since the population most likely to enlist is most likely to be pre-traumatized by the various oppressions endemic in U.S. culture/society. Pre-screening U.S. army recruits might mean rejecting over 60% of applicants on those grounds alone. At any rate, pre-screening may not be very effective for troops repeatedly exposed to combat, or exposed to moderate threat to life over long periods of time, since that trauma also compounds.

Australia has a new $2.5 million MRI facility that will be used to scan the brains of Australian and American soldiers in an attempt to “follow how the brain is healing and recovering.” This looks like ABC News pulled it directly from an institutional press release. Yay, more pictures of the brain! I guess I should be happy at this “cutting edge research,” except that we already have a whole helluva lot of pictures of the brain that haven’t told us much about what’s going on inside people’s heads. If you read the story, the main point of all this scanning is to generate interest in scanning so that more people will want to be scanned.

And as if I weren’t already disappointed enough in President Obama, like his predecessors he’s emphasizing as-yet-nonexistent cures over real preventive measures. Though the fact sheet of the “National Research action Plan for Improving Access to Mental Health Services for Veterans, Service Members, and Military Families,” is going to throw (away) $107 million on creepy projects like discovering and developing “biomarkers” to prevent, detect and treat PTSD, and a nifty new classification system for traumatic brain injury (TBI), I see a whole lot of nothing aimed at violence prevention. On the other hand, Obama never misses an opportunity to collect data, so of course there are ear-markers for data-sharing across agencies, service branches and scientists. Our soldiers can look forward to more decades of playing guinea pig for big pharma and the military, after they’ve been ground through the combat mill. Shared information would include the Pentagon’s giant blood serum bank, dating back 28 years, and containing samples kept in perpetuity. The military has banked 55.5 million samples from 10 million individuals, including millions of samples from the family members of soldiers and from civilians who applied for but did not enter the military.

Laurie Halse Anderson has written a new book about second generation trauma of war and having a vet with PTSD in the family. It’s called The Impossible Knife of Memory. Fifteen years ago Anderson also wrote Speak, about a rape victim. There’s an interview with the author in USA Today. I haven’t read any of these books, but now they’re on my list. I’ll post reviews when I’m done.

Following in the footsteps of many activists, including other veterans, who have walked outrageous distances to try and raise public awareness about their plight, Iraq war vets Anthony Andersonn and Tom Voss are going to trek from Milwaukee to L.A. Their goal is to raise money for Dryhootch, an organization that provides support for vets. Both Andersonn and Voss say they suffer from PTSD after serving in Iraq for five years. Dryhootch was founded by Robert Curry, a veteran of the Vietnam war (and Laos, he says) whom Obama honored as a “Champion of Change.” Andersonn and Voss crowdfunded their walk, and Dryhootch is operating with a “grassroots” online model designed with expansion in mind. In fact, Curry was given a Social Innovator award. But unlike the grassroots organizations of Vietnam Vets Against the War in the late 1960s and 1970s, though, it’s hard to find a shred of politics in any of their material. It’s as if the production of “wounded warriors” has nothing to do with the war itself. You’d think they just grew on trees or something. Another vet, Cpt. Medric Cousineau of the Canadian Armed Froces, is also walking. He wants to raise money to pay for PTSD service dogs. Cpt. Cousineau’s route heads through Nova Scotia, New Brunswick, Quebec and Ontario and he’ll be on the road for a month-and-a-half.

But don’t despair, because in Michigan, those with PTSD may soon qualify for medical marijuana prescriptions. If you can’t prevent the violence and unbearable conditions that create PTSD, at least you can let people get stoned afterwards. And though there’s no proof that marijuana actually helps people with PTSD, it’s certainly better for you than the raft of psychopharmaceuticals for which the medical establishment is so ready write scrips.

In the Everyday Surrealism Department, we feature Ryan Culberson wigging out on the season 8 finale of Real Housewives of Orange County. Given the unreality of anything passing for “reality TV,” it’s always tough to say what’s staged and what’s not. There’s no point even uttering the word “ethics” and the phrase “reality TV” in the same sentence, so let’s set aside the fact that Culberson is, even as I type, in Afghanistan again after serving there in 2005, 2008, and 2011, and that he took a break from combat deployments in order to humiliate himself in front of a national audience for money. I don’t want to talk about Culberson. I want to mention Dr. Mark Lerner, of The Institute for Traumatic Stress, Inc, who is apparently happy to give interviews about the “reality” of Culberson’s “traumatic stress reaction.” Although Lerner emphasizes that one can’t make diagnosis over the boob tube, what he is saying (if he’s quoted correctly, which is a big “if”) is that abusive behavior like Culberson demonstrated (whether authentic or acted) is “a normal reaction to the abnormal events that he’s experienced.” “Normalizing” abuse is hardly at the top of my To-Do list. Lerner, however, makes a living on it, as you can see at his Institute, a certification mill for crisis management that draws on “the same principles being utilized by the U.S. Department of Homeland Security.” His claim is that his training program can “prevent acute stress reactions from becoming chronic and debilitating stress disorders.” Since there’s no clear evidence that any sort of training can prevent PTSD, I’m more than a little dubious.