(Please welcome author Ilona Meagher who is here to discuss her book, Moving a Nation to Care: Post-Traumatic Stress Disorder and America's Returning Troops — JH)
He was known simply as "the Marlboro Man," the "Face of Fallujah. No one knew his name. Everyone was introduced to the myth. Back home he was simply known as Smokey. He was 20 years old when the photograph was taken. It was the real life version of a recruitment poster. But Marine Lance Corporal James Blake Miller, a member of Charlie Company, 1st Platoon, 8th Marines, was also a flesh and blood man underneath the bravura of the soldier everyone saw and was now worshiping, even wanting to be like. How Miller became the myth is recounted in the first pages of Ilona Meagher's amazing book Moving a Nation to Care. It's not the story George W. Bush and the Republicans pushing escalation want to tell, but it's the reality of war, especially the Iraq war as it is being fought today. The real life recruitment story as seen through the picture that became synonymous with military heroism and self sacrifice long ago crumbled in on itself. "The Marlboro Man," "the Face of Fallujah," the war hero, Smokey, now has PTSD.
Miller has now become the chronicler of another war–the war within. He now appeals to the country that declared him a hero because of a photograph, asking that they look beyond the image and see the human cost of war. "I want people to understand what PTSD is and what it can do to you–what it can to do your life."
Moving a Nation to Care, by Ilona Meagher (p.10)
"There's a strange pressure on these soldiers not to have any problems with what they are doing. It's that old idea that a real man and a true warrior will stand strong." – Psychologist and trauma specialist Michael Phillips
Moving a Nation to Care, by Ilona Meagher (p.93)
Warfare has changed. It started with WWII when nighttime battles were ushered in. During Vietnam our soldiers were introduced to guerilla combat. Today in Iraq (and beyond), our fighting men and women are now barraged with 360 degree asymmetric hell. But especially in Iraq there is never any time to recoup from battles; no moment to regroup after a skirmish. Extended deployments have only made matters worse.
"Unlike most conflicts where only front line troops face hostile fire, nearly all our service members in Iraq are being exposed to constant fear … on a 24/7 basis for periods often lasting over a year at a time. The constant fear of dying is overwhelming and it is taking its toll. They say the average infantryman in WW2 saw 44 days of action; the rest of the time was training and transportation." – Eric Massa, from Moving a Nation to Care
The other very real issue is that our soldiers are moving targets for everyone, because in the Iraq theater our soldiers don't know who is friend and who is foe. Being on guard 24/7 would deplete anyone's reserves and put your nerves on edge until you finally crack.
Now add female soldiers. As a strong proponent for women serving in combat positions, it's important to remember that women are indeed fighting and dying next to men, regardless of Mr. Bush saying they are not.
Contrary to President Bush's statement, "No women in combat," and current federal law that is meant to keep them far from conflict, women warriors are fighting and dying on today's battlefields. Indeed, the Army's 3rd Infantry Division has been collocating (i.e., placing side-by-side) women with combat support units since February 2005.
Moving a Nation to Care, by Ilona Meagher (p.95)
According to Ilona's research, women suffer from PTSD at rates "twice that of men." Women deserve the right to fight in combat, as far as I'm concerned, but we need to know the costs they're paying when they choose soldiering.
Much needs to be done to bring PTSD out into the light, but we've come a long way from Patton's day, when artilleryman Paul G. Bennett said he couldn't stand the shelling any more and got a face full of one general's rage for what he was experiencing.
"Your nerves, hell; you are just a Goddamned coward, you yellow son of a bitch. … You're going back to the frontline and you may get shot and killed, but you're going to fight. If you don't, I'll stand you up against a wall and have a firing squad kill you on purpose." – General George S. Patton
But just because we've recognized PTSD doesn't mean that our soldiers feel any less ashamed when the diagnosis comes. Denial often sets in next. The image of the ever rough and ready, give 'em hell super human American warrior will likely never die. We must understand that our soldiers need the image in order to stay alive, but we also have to help them dismantle it when the shooting stops. Our ability to recognize the human suffering underneath is the only way to make our veterans whole again.
One last thing to think about that also gets overlooked. The rapid immersion back into civilian life after battle isn't helping anyone, especially our soldiers coming back from combat zones they haven't even grappled with themselves. As Ilona states in her book, soldiers need time to decompress and get used to being off the battlefield before going home. Even something as simple as modern air travel has affected our soldiers' ability to heal by short-circuiting the time that's actually required to re-enter civilian life without getting whiplash from the stimuli.
One week before Memorial Day we should all get prepared to share, shout and hear the tributes all of our soldiers so justly deserve and have earned one hundred times over. We will watch President Bush march out and trumpet the troops. What no one will do is mention the thousands of soldiers fighting to live normal lives long after they've come home. All the soldiers serving in Iraq and Afghanistan who right now are doing so while fighting PTSD. Memorial Day is reserved for the fallen and the brave. The battle scarred and struggling soldier fighting PTSD every day to stay alive and live normally is never mentioned. The soldier fighting on the front lines with PTSD does so silently in order to try and stay alive. We don't even know the numbers of fighting soldiers struggling on the front lines with PTSD today.
We have the bravest, most unselfish, most talented and brightest group of soldiers on planet earth.
But no one should think about Memorial Day without knowing the costs these soldiers pay for their service, not only on the battle field but long after their deployments and redeployments have ceased. When you put our fighting men and women into war they're glad to serve and give their life for America. It's the pledge they take upon volunteering.
However, no soldier's oath has anything to do with fighting another country's civil war. The stress of doing so is causing our soldiers and the U.S. Armed Forces to crack. Mission creep unfolding into policing a civil war not your own would do that to anyone, even the bravest.
You can't see PTSD, but it's often right there in front of you. Just ask "the Marlboro Man." He'll be living with it the rest of his life. So will his wife and the wives and husbands, as well as children and siblings, of thousands of other soldiers. That is if these military marriages and families make it through PTSD together. The outcome is rarely certain.
He told the San Francisco Chronicle that he was grateful to those who paid for the wedding but that he had found dealing with day-to-day issues and stress from the war too much. "I love Jessica, I really do, but I can't be with her," he said.
Mrs Miller told the paper she still hoped they could be together. "I think neither one of us recognised the scope of post-traumatic stress disorder and what it does to you and what it does to people around you," she said. "Now he's got to figure out how to deal with it before he can deal with me."
The more we know about PTSD the more we can help.
- Taylor Marsh LIVE! is streamed 3-4 pm eastern – 12-1 p.m pacific, Mon.-Thurs, with podcasts available.
Related posts:
- FDL Book Salon Welcomes Dahr Jamail, The Will to Resist: Soldiers Who Refuse to Fight in Iraq and Afghanistan
- FDL Book Salon Welcomes Hillary Rettig, The Lifelong Activist: How to Change the World Without Losing Your Way
- FDL Book Salon Welcomes Jurgen Todenhofer, Why Do You Kill?: The Untold Story of the Iraqi Resistance
- FDL Book Salon Welcomes T. R. Reid, The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care
- FDL Book Salon Welcomes Rana Husseini, Murder in the Name of Honor





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zed
Hello firepups.
Welcome, Ilona. Thrilled to be hosting this amazing book salon at FDL.
Thanks so much to Jane for inviting us in. But most especially I’d like to thank Ilona for such an amazing book. I can’t recommend it strongly enough to you all.
hello ilona…welcome
Ilona and Taylor—
Welcome to firedoglake!
Thank you for writing this book. Few issues trouble me more than ignoring the needs of our troops once they return.
egregious @ 5
Seconded.
Ilona, thanks for your work and welcome to the Lake!
Taylor, welcome back!
It is mystifying that this administration didn’t plan for huge numbers of returning vets with PTSD.
Did they just cling to the original shock and awe plan, and assume no one would be injured after that? Did they hope the private sector would step up? Did they just not care? The mind reels.
There is a question that has been bugging me since the Iraq invasion first happened. The govenment has reported casualty figures, including the number of killed, but I don’t think that the number reported as killed includes anyone who was wounded on the battlefield and then later succumbed to their wounds.
What is the real U.S. military death toll in Iraq?
egregious @ 9
The more attention the Administration gives to PTSD the more people will pull away from supporting the war. It’s the hidden flag draped coffin syndrome take to greater heights.
Now I fully realize some would call me naive and perhaps simple minded. But it sems to me that if we bring our soldiers home from Iraq, then… no more Iraq War related PTSD. And there are some other pluses to ending our, what amounts to criminal activites, in Iraq.
Hi Ilona,
You mentioned on your website today that one of the things we need to keep in mind is that communities are important in healing PTSD. What is it that you think communities aren’t doing that they could be doing?
Thank you so much for the warm welcome, Taylor, and echoing your thanks to Jane and the whole FDL community.
Right out of the gate, I’d like to drop a link to an excerpt from Moving a Nation to Care, Chapter 6: The Rumsfeld Revolution in Military Affairs. The book was meant to hit stores on May 1, but through a series of minor shipping date snafus, books arrived late from distributor to stores and Amazon.com.
Apologies to anyone who’s pre-ordered and has been waiting as long as you have. Books are on their way as we speak…yeah!
Ilona, welcome to the Lake.
Taylor, always a pleasure to have you join us.
For all commenters, please stay on topic during Book Salon. If you want to make OT comments, feel free to do so in the previous thread.
Thanks.
Here is a link to Aaron Barlow’s admittedly biased review of Ilona’s book: In the Aftermath: A Review of Moving a Nation to Care: Post-Traumatic Stress Disorder and America’s Returning Troops
Aaron says:
In the two years that I have known Ilona, it is clear that she has indeed helped to move our nation to care.
Oklahoma kiddo @ 12
Until the next time. I think as the survival rates improve in our wars we’re likely to see more the next time we have one. Speaking purely as someone who gets to see these folks in his own work, I’d say that there ought to be more attention paid to making sure there are treatment facilities available.
Thanks so much for being here today, Ilona. And thanks for bringing attention this matter, it shines a very important light on yet another group of George Bush’s victims.
Most of the world is suffering PTSD as a result of the various Bush administration enterprises.
Welcome, Ilona. This is so important: thanks so much for your work on this and for joining us to talk about your book today.
Taylor Marsh @ 11
Taylor, that’s why I find some small hope that things are gradually changing toward seeing the reality of the returning troops.
There was a front page above the fold article in the Washington Post today about the huge number of fresh graves at Arlington Cemetery and the people who come to mourn them.
Ilona and Taylor—
Thank you for this Book Salon; this is a subject that this generation will be dealing with for a long time.
RBG @ 15
Always a pleasure, RBG.
Hello Ilona :)
My husband was a Viet Nam vet and a POW, who was tortured by the North Vietnamese. He lived with his injuries for over thirty years until his fatal heart attack 23 months ago. His missions were covert, so he never got treatment for, what I now believe to be PTSD.
My question is: How do we make sure that covert military members get the treatment they need and deserve?
With gratitude,
For Dan,
Heather
Welcome, Ilona. Do you have any thoughts or interactions to share regarding he military’s use of Regulation 635-200, Chapter 5-13: “Separation Because of Personality Disorder” as a way to deny acknowledging soldiers’ suffering from PTSD and as a mechanism to short them on long term treatment and benefits?
When this salon was announced the other week, FDL reader kirk murphy linked to this article that appeared in the Nation dealing with this matter: “How Specialist Town Lost His Benefits” http://www.thenation.com/doc/20070409/kors
.
Ilona, I started to type out a question about whether the DOD offers ameliorative medications to reduce the duration and/or severity of PTSD in soldiers with new-onset symptoms.
Then I realized the question is predicated upon the DOD actually having the capacity to diagnose new onset PTSD in active duty troops.
From what I am told by colleagues in the VA, they perceive that in the DOD active duty personnel in combat theatres receive no real diagnostic evals, much less treatment.
From what you have learned, does it seem that active duty troops receive any real diagnostic screenings for PTSD during their combat tours?
Ilona, thank you for your caring spirit. I was moved by your earliest diaries at dKos and am looking forward to reading your book.
Cujo359 @ 17
That’s very true. But the impression is treatment for war related issues is symptomatic. I’d like to see a bit more emphasis placed on the preventative aspect. And I can only wonder how the families and friends of the victims of the Bush war are coping with their own PTSD. We all do what we can. ;0)
Sangemon @ 10
This is the $500,000 question, isn’t it?
Believe me, no one really knows what the figures are — and I would suggest that ignorance reaches all the way up to the very top rungs of government/military/research institutions. I have had Walter Reed Army Medical Center researchers and VA officials and others of the same capacity ask me — which is really stunning, if you think about the fact that I’m a citizen journalist who only took this issue up two years ago — what’s going on with the figures.
The DoD has so muddied up the WIA count to render it basically useless. Think: How is that the official count is around 25,000, yet the VA has already handed out over 100,000 disability claims to OEF/OIF troops?
I believe that’s why the PTSD Timeline hosted and fact-checked by my colleagues at ePluribus Media has been so well-received by Senator Kerry’s office (who has accessed the data to suplement their own research), media outlets like USA Today and others, as well as universities, etc. There just isn’t anyone seriously compiling this kind of stateside incident data — post-deployment incidents such as police standoffs or suicide that aren’t being included in the official KIA count.
Hi Taylor…. I hate to comment and run by my DFA fund raiser is this afternoon but I wanted to post my experience with PTSD. [anyone want to donate go to
Reply
Chacounne @ 24
I watched people come home from Vietnam shell shocked and dazed. Few from the Vietnam era got treatment for PTSD.
Hi Ilona, Taylor, JANE! and pups.
Ilona, just today I was listening to the Wednesday hearing/meeting on PTSD on CSPAN and was taken aback by Dr. Sally Satel of the American Enterprise Institute.
I didn’t disagree with all that she said, but her attitude seemed to me to be that PTSD was easily treatable with a job and if the soldiers would just buck up, they could move on with their lives.
How widespread is this view of the illness in the medical community?
Hello, Taylor, Jane and Ilona.
Yesterday I had a diary up at Big Orange prior to your Greenwich Village appearance. When I stated that the tour is just beginning and that other cities would be possible, Crashing Vortex said that he wanted you in New Orleans.
Seems like you will be getting around more than you thought. Where else would you like to appear – and who would be your targeted audience?
What do we tell a service person returning from Iraq with PTSD? I have family members, some of whom are on their second and third tour in Iraq.
Taylor Marsh @ 30
Thirty years later he was still screaming in his sleep and also in his sleep, desparately trying to convince people he was talking to in Vietnamese not to do something.
Sadly,
Heather
Elliott @ 32
Always take note of the source and who pays the doctor. In Satel’s case it’s the AEI. That tells you a lot right there, imho. Again, masking the problem with platitudes, because if they didn’t no one would support the war anymore.
Elliott @ 31
My fellowship (subspecialty) training in psychiatry was in PTSD (and severe medical illness).
Dr. Satel’s paycheck comes from AEI rather than from a medical school for a very good reason – her stated opinions are not supported by the scientific literature on PTSD.
Dr. Satel’s jihad against PTSD from her perch at the AEI dovetails nicely with the VA Secretary’s campaign to “talk away” the magnitude of PTSD for the VA system.
Dr. Satel is to PTSD what the physiology PhD. Laura Schesslinger is to psychotherapy – ignorant, and therefore dangerous.
kirk murphy @ 37
I thought you had some expertise in this area, Kirk. Thanks for your insights, very interesting.
We will be seeing the emotional and physical destruction of untreated mentally ill vets for decades.
FOR SHAME. We sent them into battle, we owe them adequate treatment. Hell, we owe them superior treatment. And what are they getting? The run around.
katymine @ 30
We have a bunch of terrific physicians here at FDL, starting with Kirk, which always makes me loathe to criticize their peers. Unfortunately, based on my perceptions, the American Psychological Association, won’t do anything until the psychiatrists weigh in. I hope your book causes them to step up as a group.
And it looks as though we are going to be in Iraq for a very long, long time. Therapeutic treatment, physical and emotional. A growth industry.
Here’s the solution. Give our returnees all the treatment they may need for the rest of their lives. And stop the war. Now.
Jane, thanks for your kind reply and your tolerance of my credential waving.
“Colleagues” who sell their titles and professonal souls to help deny care to the suffering make we want to spit.
I’d love to see Satel forced to defend her AEI propaganda in a debate with real PTSD clinicians.
She’d finally learn the meaning of “intrusive traumatic memory”.
Thanks, Ilona, for bringing the subject out into the light. I’ll put it in my Amazon cart (via FDL, bien sur) for next time.
I wonder if this would be a good project for Dem clubs all across the country – educating their communities about ways to reintegrate their vets, how to help without patronizing, talking about PTSD out loud so it’s not such a stigma.
Thanks Kirk and Taylor. I knew the AEI was a red flag, and I wondered if she actually had any patients.
I feel a little better knowing that she’s at least somewhat marginalized — except that she had forum at this hearng/meeting.
I’m surprised she didn’t suggest that the soldiers could make a little extra money if they sold one of their kidneys.
John Casper @ 41
I read this book in galley form. It is excellent. I think that this book will only come into its’ own when both psychiatrists and the families of those with combat PTSD step up, yell loud, and are heard above the Bush noise machine.
kirk murphy @ 44
I would love to help take this spokesperson for “No problem here” down. Future fdl post?
Let’s at minimum make it impossible for her to go on the talk shows and say that everything is fine.
Maybe if our soldiers were fetuses the Republicans would care what happens to them after they survive a war.
Ilona,
Thanks so much for taking this topic on as a grail. I just spoke with another vet over the weekend who suffers from the syndrome.
Amazing to me. The right wing types who supposedly “support the troops” sweep this and many other vet related issues under the carpet.
TRex @ 49
You’re so bad, TRex. (But in a very good way.) Unfortunately, there’s a lot of truth to it.
Taylor Mash … chick or dude?
Elliott @ 32
If I could fault one person for disinformation or a shrugging off of this problem it would be Dr. Satel (in addition to the current Pentagon leadership).
Ilona’s work as been yeoman effort built brick by brick, tear upon tear. I did a bit of work on the research for the PTSD timelines on ePluribusMedia.org and I have to tell you that it is the most depressing work to confront the inefficiencies of our current PTSD screening efforts.
Ilona – I am so proud to know you.
Jane Hamsher @ 18
Can’t say enough about the fine Girl Power Day you lovely ladies put together today with Laura Flanders to boot! Honored.
You know what’s interesting, Jane?
I started collecting this data, these heartbreaking incidents back in the summer of 2005.
I was moved by an August 2005 piece by Rick Anderson in Seattle Weekly, called Home Front Casualties. It was the first such article I’d seen (although after my research I did see that others were doing some incredible reporting on this issue — people like Mark Benjamin of Salon and Chris Adams of Knight-Ridder) and it really shook me up.
It listed some 7 violent incidents (murder/suicides) that had occurred to troops who’d recently returned from Iraq to Fort Lewis, Wash., and I began wondering if there were more familes that were being destroyed in this way after having celebrated the safe return of their loved one.
From the Seattle Weekly piece:
I know part of my agenda was to find out if these incidents were common, but that quest was fueled, of course, by amazement and anger over the fact that our troops and military families were being asked to pay a steep price while the rest of us were literally asked, even conditioned not to care or pay attention by the media and the adminstration.
But, once I drilled down further and got to know about the situation, I was suprised to find I became much less radicalized than I would have originally expected. Healing the individual is key for me — even if they’re Republicans. But I’m so glad others are using their time to do what they feel they need to do to push for resolution to this mess.
We need all hands on deck, that’s a given.
kirk murphy @ 44
Oh, I get it.
Jeff Huber @ 50
This administration and the wingers support the troops, right up to the very moment they enlist. After that, not so much…body armor, unsafe vehicles, lack of support when they get home.
It reminds me of the winger position on life: they support life, until the moment of birth. After that YOYO you’re on your own.
I almost done with Ilona’s book, Moving a Nation to Care, and frankly, it is indeed moving along a number of dimensions. As a psychologist and stress researcher, I didn’t expect many surprises from the book, and in many ways, there weren’t many. In fact, nothing of substance in the book appears to be factually questionable or at odds with what is known and largely accepted by stress physiologists. Probably the main dispute among stress physiologists and psychologists would be over whether PTSD is a “disorder” at all, or rather the “normal” functional adaptation of the brain to extreme and/or chronic traumatic experience. I fall into the latter camp. In other words, it seems quite expected that extreme, chronic traumatic experience can irreversibly alter the physical neuronal and therefore mental landscape of the traumatized, in such a way that normal functioning in non-traumatic environments is permanently affected. A good deal of evidence backs this up. However, in a sense, that is merely saying that we now have mountains of physiological evidence supporting the claim that when you smash your thumb with a hammer it hurts, which is somehow pedantically orthogonal to Ilona’s rather masterful exposition of psychological trauma which caused me to well with emotion. Ilona keeps her own sentiments at an appropriate distance from the soldiers’ tales, in much the way Robert Frost might report a poem about a child losing a limb to the snarl and rattle of a table saw, before bleeding to death in front of the family. I am deeply impressed with this book. To me it reflects a Katrina-like moment–a quiet Katrina–another test of our national character. I truly hope this book makes the NYT bestseller list.
tomsch @ 52
Chick, babe.
What advice would you give someone,a lay person with little experience,about dealing with a friend,neighbor or family member with PTSD who may be ashamed to admit there is a problem or to find help?
Ilona;
What additional impact do you believe it will have on troops suffering from PTSD when they come home and, as they become better informed on the origin and conduct of the Iraq war itself, begin to have horrible feelings about how they were used by the Bush administration for an agenda having nothing whatsoever to do with national security and defense?
Do you feel that will add to what they are already experiencing from emotional wounds suffered there?
From a Vet, thanks for being here and for the book.
Bob
Just found this article that points to a recognition by the military for a need to take action to better diagnose PTSD and assess how to best allocate assistance for those affected serving in the military: Better testing, aid urged for vets with PTSD
It’s a bit disconcerting to realize how behind the curve we are in coping with this very complex problem in the context of what is amounting to a ‘mass casualty’ event in its own right for Iraq and Afghanistan.
Dr. Robert Ursano is referenced in the article linked above. He is chairman of the department of psychiatry at the Uniformed Services University of the Health Sciences in Bethesda, Maryland. He is the father of a woman I trained with in psychiatry at UNC Hospitals in the late 90’s and someone I’ve met. I’d be interested knowing more about his thoughts on the last 4 years.
John Casper, thanks for your very kind comment.
(Sadly, Satel is a medical doctor – an MD. I don’t know if she’s an APA member – if so, I hope the APA expels her.)
Lots of psychologists play central roles in PTSD research – Edna Foa, PhD chaired the DM-IV PTSD task force.
My sense as a clinician is that both psychiatrists and psychologists motivated to treat PTSD have identified effective treatments for many patients.
anangryoldbroad @ 59
Start with the concept that they are probably feeling overwhelmed and humiliated. They need help but don’t feel they deserve it and are ashamed to seek it. They when they do, they will probably be kicked in the teeth.
These vets need friends and supporters who will work with them lovingly keeping in mind their sense of being vulnerable and ashamed.
Be a friend to a vet in your community. Pretty soon there will be wounded vets in ALL our communities.
Oh, and that doesn’t even count when they realize the war was based on LIES and was for nothing. Then we are gonna see some real rage. And spouse and child abuse. And suicides. And more.
A large percentage of the troops in Iraq and Afghanistan still believe they are fighting the people who attacked us on 9/11. Wait until they find out that isn’t true.
Elliott @ 32
Veterans call her Silly Satel.
I don’t disagree with every point she makes, either, but your impressions of her are dead on. A choice quote of hers in Mark Boal’s recent Playboy piece, The Real Cost of War:
Asking for more money to treat soldiers returning from Iraq with physical and emotional difficulties, is not good PR. Same with attending the funerals of those KIA. Bad form.
Much as I agree with the basic sentiments here I take issue with the unsupported claim : “We have the bravest, most unselfish, most talented and brightest group of soldiers on planet earth.”
This is the jingoism I think we need to avoid.
We have many brave, unselfish, talented, and bright young men and women serving as volunteers–so do the suicide bombers who oppose us.
Your rhetoric does not honor the former by underestimating the latter.
Ilona, I’m not sure if you’re familiar with the HUNT REPORT
I hope you’re publishers’ marketing plan includes the military. Marshall and Hunt both understood long before WWII that “occupations” required units who had not been “blooded” by the identical people they were occupying. Referencing the Hunt Report, which is still taught at West Point, might help spur some sales via the Pentagon. Clearly they forgot to inform Bush and DeadEye about the Hunt Report.
(text and link is from the terrific poster, Sara, over at tnh.)
Ilona – I’m so proud to know you.
I’ve said that so many times I can’t count. That seems to be the consenious of opinion about Ilona. The most remarkable thing about her involvement with combat PTSD, is that to succeed, she had to earn the trust of veterans and active duty personnel first.
She does that every day.
I am a veteran. I was in a meeting with Ilona, 2 top sargeants, and 1 retired top enlisted man. Also, in the meeting were 3 other non-veterans.
Ilona was able to get these veterans to open up, say what was on their minds, and enlighten the non-veterans. All the veterans attending that meeting agree: she gets it. She is to be trusted. That is a very rare thing, indeed.
Ilona Meagher @ 64
That Playboy article is worth a read. That quote from Satel is simply mind boggling.
Has the Administration ever admitted what almost everone else knows? That there is a civil war in Iraq.
anangryoldbroad @ 58
AOB, one concept that may help is “normalization” – sharing with the suffering person how frequent their experience is.
Here current research (or my knowledge thereof) fails. For Iraq vets with multiple tours, is there data about PTSD incidence as a function of increased duration of Iraq service?
Re: Dr. Sally Satel, a psychiatrist and adviser to President Bush on mental health issues views PTSD this way: “I’m not saying PTSD doesn’t exist, but it’s gotten out of hand. I mean, if you see a lot of action and then you come home you have a hard time walking your dog by the bushes at night, maybe you just avoid the bushes.“
One way to think about PTSD is that it’s a disorder related to forgetting. The problem is not remembering, but rather the inability to forget. Avoidance of things that intensely trigger traumatic memory can be a result of PTSD. But avoidance isn’t palliative, it’s part of the problem that causes suffering.
Ilona, thank you for your tireless work on this vital issue. As I have mentioned to you before, my Marine nephew has PTSD from his three tours in Iraq. I am going to send him a copy of your book, after I get it signed by you when you are in the area.
Ilona,
We have so many problems and scandals currently competing for the attention of the media, Congress and the public. Do you have any suggestions as to how we can help keep some of the spotlight on PTSD so it does not fall thru the cracks?
Muzzy @ 73
Do you mean that it’s because the sufferer is changing his life to avoid suffering, or just because the problem’s still there?
I have to run.
But a word of warning. Do NOT order or buy just one book. You’ll regret it. Order at least two – one for you and one to loan. More bad news: the loaner ain’t coming back.
Earlier I spoke about some veterans in a meeting. Well, I snatched one galley copy from someone, and my copy. I gave it to the top sargeants. They have read it.
Now, they are sharing the galley copies with members of their units. That’s how good this book is.
Thanks Kirk and egregious for your replies.
Taking the other route in my questions,what should one NOT do when relating to someone with PTSD? The last thing I’d ever want to do is make someone’s suffering worse from my own ignorance.
standingup @ 74
Arranging to get Ilona’s book reviewed in the mainstream press (anyone know someone at NYRB?) would be a huge help.
egregious @ 21
Taylor Marsh @ 11
You’re not alone. I think many of us are being a bit more optimistic after the WRAMC WaPo investigation put an end to the idea that things are working in the DoD and VA outpatient experience. Veterans for America’s Steve Robinson (a Gulf War vet who is a tireless advocate for the troops returning home today) just said recently:
If Steve is cautiously optimistic, then I trust that.
I’ve heard the same reports from a scattering of employees at the VA. But, as Robinson points out, what this means is that we need to pay attention now more than ever, to make sure we get some necessary changes in place before the window of opportunity closes.
Moving a Nation to Care has a 20-page resources section to help citizens get active politically as well as individually in their own space and community. Included are three pages of DoD/VA improvements we could do some hard lobbying for.
Bob Geiger asks:
Ilona alludes to the related concepts of control, uncertainty, and group cohesion as important factors in the development of PTSD, or the recruitment of the chronic stress response network more generally. Briefly, there is an inverse relationship between between control and stress–the greater the control, the less stress. High unit cohesion for soldiers helps immunize from stress because it leads to a greater sense of control over an unpredictable environment. A high sense of purpose or mission can also function that way. Of course, betrayal of that mission (being lied to) is quite unlikely to be prophylactic to, and if anything would exacerbate any sense of uncertainty or loss of control. This is why ordinary Americans need to show cohesion with the troops, to get their backs, as the administration simply refuses to do so.
I thought one of the “extra” things included in the Supplemental funding bills was PTSD treatment — is it still there, and is it properly focused?
Has Sally Satel, M.D. ever seen any “action?” I just think a few weeks on patrol in Baghdad, in close proximity to a few exploding “IED’s,” might really “help” Sally’s research. Come on Sally, roll up your sleeves. I think “camoflage” is a great color for you.
John Casper @ 82
Just avoid the bushes.
Dr. Satel’s comments strike me as not merely vacuous, but the height of professional irresponsibility. Rule 1: Do no harm.
Is it even possible to have soldiers, fighting for any length of time in a situation like we have in Iraq, with a healthy mental attitude?
Could, should every single soldier go through PTSD therapy before during and after deployment?
Ilona, I just jumped on, sounds like an important conversation. Besides being aware of what American soldiers have gone through in this unnecesary war. How do we move the American people to become concerned about the tragedy that we have created for the Iraqi people by our illegal invasion of their country?
4 million refugees, 650,ooo dead (the Lancet from months ago) who knows how many have been injured. It really appears the majority of Americans could care less about the Iraqi people. We sure are not seeing any pictures of Iraqi dead on our T.V. Screens.
anangryoldbroad – one resource for information and access related to help for friends and family of sufferers of a variety of mental health problems is NAMI (National Alliance on Mental Illness): http://www.nami.org/
I think just acknowledging that someone is suffering, without labeling it or needing to know details, goes a long way towards helping someone feel supported and can provide a sense of relief.
There was hopeful discussion in the Wed hearing/meeting about integrating care. First working on making the transfer from military coverage to the VA seamless, but also figuring out a way to have these soldiers treated in their own location using non VA doctors, if there isn’t a VA facilty near them. That would be a huge help for all those vets who do need medical care but live in rural areas.
of course, it’s only talk so far.
David Robinson great suggestion. Every soldier!
Cujo359 @ 75
Cujo – PTSD is classified as an anxiety disorder (as opposed to mood disorder or a psychotic disorder, for instance). Some kinds of anxiety disorders are always present but become acutely symptomatic under specific circumstances that trigger a form of anxiety attack. People get conditioned to withdraw and avoid such triggers as a basic means to cope. Often with severe PTSD, basic human relations are challenged as a result of affective (emotional) instability. People can become shut-ins, unable to pursue work or enjoy functional relationships as a result of generalized avoidance. The more severe the PTSD, the less anxiety is tied to a specific trigger that might result in a flashback or other symptoms of the condition. PTSD is a very heterogenous and complex condition that is often comorbid with other conditions such as major depression and chemical dependency.
Taylor marsh writes:
When I was in college in the early ’70s, I had a friend who was a marine vet of ‘Nam. The first time I eve saw this man was at a bar and he was an absolute WILD man, just totally nutzo. We had classes together starting the next year and after a couple of years I asked him if he remembered that day. He did and told me that the day in question, he had been back in the States for less than a month. He basically left ‘Nam, flew to the left coast and was discharged to home. No support no nothing, just left to face the world and muddle through. By the time we became friends, he had made some level of peace with himself but I KNOW he was not alone.
Cujo359 >
I think we can all agree this would have been a good idea but now, *sigh*, we are stuck with them & all their delusional friends and associates
Thanks, to all, for the effort put into this issue. I had a long discussion w/some vet friends yesterday. It wasn`t about PSTD but that certainly was in the background.
“We the people…” have a very long road to travel with these people.
“If you`re not nervous, you don`t understand what`s happening.” – John Young
Chacounne @ 24
My condolences, Heather, over Dan’s loss.
Moving a Nation to Care includes the suicide of just such a seventeen-year Army Special Forces Green Beret soldier based out of Fort Carson. He had returned home in 2004, filled out the usual post-deployment health assessment form saying that he was fine, and then dug himself in deeper by dulling his pain through alcohol. One day he snapped and nearly killed his wife in a blind rage; instead he ended his life by lifting the gun to his head in his yard as police officers and his wife stood by and watched helplessly.
One of his Special Forces friends said at the time that soldiers at his level especially are stigmatized from reaching out for help. They have a great fear that if they come forward and tell the truth about their nightmares or reliance on drugs or alcohol to mask the pain, that they won’t be able to get their promotion or be assigned to the next great mission, or they worry that they’ll let down their team if they show any ‘weakness’.
We need to turn things on their head a bit.
Currently, troops suffering the most have to find a way to work past the very real stigma and fear and retribution of coming forward that exists today. Families who’ve been dealing with the fallout of war say, “Wouldn’t it be better if *everyone* returning automatically had to do some form of ‘bootcamp in reverse’ or some type of holistic reintegration session 2, 3, 4 months after their return from combat?”
It should be mandatory, it should include reaching out to family members and including them in the process, and it should be supported and demanded by society of our military.
We can move the military culture in the right direction if we want to do it. Fortunately, there really is no better window of opportunity than right now to our doing just that.
Oklahoma kiddo @ 70
Critical to be concerned about the PTSD that our soldiers have, are and will continue to be effected by.
Our nation would really be waking up if we demonstrated concern for the Iraqi people that are and will suffer from far more PTSD than we can imagine. The Iraqi people and children have been hammered by our nation since early 90, the sanctions and now the destruction of their country as a direct result of the invasion.
How do we move our nation to take responsibility for what we have done there and to demostrate real concern? Or do we just need to accept that most Americans could give a flying —- about the Iraqi people
Muzzy @ 87
Excellent resource, Muzzy!
More here and here, as well as in the final chapter of Moving. I tried to focus on complimentary resources that are springing up in commmunities all across the country.
Please email me and let me know if you know of any that I haven’t listed, and I’ll be happy to add them to the others, too. TY
Sounds like Dr. Satel should put on her uniform and put her own ass on the line, instead of collecting checks from the American Enterprise Institute, and telling people to get over it.
Ilona Meagher @ 93
((((((((((((Fort Carson Green Beret vet))))))))
Tragic :( My thoughts are with him and his family.
I agree with you about the integrated return.
Dan wasn’t even allowed to say he had even been out of the US, never mind in a hole in the ground covered by a grate. I worry about ALL of the soldiers, sailors, airmen and marines, but especially those “who were never there.”
Hugs,
Heather
Not having served themselves, it makes perfect sense.
Kathleen >
I happen to think the majority of the American pople really, really do care but are locked up as to how to follow through on that caring. The continued insanity at the upper levels of our society (not just the government) just does not allow much of a coherent method that most people can trust to actually do something that will accomplish the necessary goals.
Sad to say but very true I think
“Small men follow the letter of the law, great men seek justice” – Buck Rodgers
dakine01 @ 91
When I was in college in the early ’70s, I had a friend who was a marine vet of ‘Nam. The first time I eve saw this man was at a bar and he was an absolute WILD man, just totally nutzo. We had classes together starting the next year and after a couple of years I asked him if he remembered that day. He did and told me that the day in question, he had been back in the States for less than a month. He basically left ‘Nam, flew to the left coast and was discharged to home. No support no nothing, just left to face the world and muddle through. By the time we became friends, he had made some level of peace with himself but I KNOW he was not alone.
It’s an aspect few people consider. I knew people back from Vietnam that experienced much the same thing, dakine01. Ilona brings the issue up front in a very powerful way. It’s hard for many to believe that getting back to family fast, straight from a war zone, could have a negative impact on the soldier. Most people think the exact opposite is true.
Unsure whether to share what I know, but a little bit of info from a slightly different perspective is always O.K.
I suffered (sometimes still suffer from) PTSD. however I am not military. It arose from an incredibly volitile time in my life, combined with a lifelong problem with depression. Together the two formed an inability to see beyond what is currently happening, and to actively re-experience the old situations.
this has cropped up now and again since the original occurrence. but now I know what it is and have developed effective ways of dealing with myself. At times I can visually ’see’ the situation back 30 years ago, and NOT see what is happening right this moment.
It is amazing how the brain can recall, without voluntary thought, an old picture, an old voice, old memories, and make them alive in your mind. It is terrifying.
Thank you for writing this book. I will buy it and read it. I so worry about those military people returning — knowing what many of them are facing. To my layperson’s mind, it is the deadly combination of extended stess on certain personalities that make the deadly PTSD.
Ilona I have quite a few Vietnam Vet friends, most are in their late 50’s and early 60’s and quite a few of them have just started talking about what REALLY went on.
I have also had long conversations with numerous young soldiers returning from Iraq. Many seem deeply troubled by some of the things that they claim that they were required to do. What is the best approach to encourage someone to seek help for what may be PTSD?
I liked David Robinson’s suggestion, that every soldier returning be evaluated. I know that would be an expensive initial cost, but could save lives, mental problems and money being spent in the future.
Oklahoma kiddo @ 42
if Shrub only smoked weed, but, nooooooooooo….legalize it. Psychotherapy plus cannabis for treatment of PTSD…Mikuriya, Tod dig it,
many vets try alcohol to mask symptoms…only exacerbates the nightmares…thanks for nothing Commander Codpiece
Ilona Meagher @ 95
Just a word of warning about NAMI, a lot of the local chapters and national leadership have been completely taken over by unscrupulous psychiatrists and Big Pharma. NAMI is for the most part a non-profit in name only that fronts for their narrow financial interests.
An informal reference to relative rates of PTSD in past conflicts as discussed on a 1/14/04 pbs newshour by Dr. Robert Ursano:
“From World War II, POWs — prisoners of war — have been shown to have as high as 50 percent of them having PTSD that might persist for decades and decades. After the Vietnam era, perhaps 35, 38 percent of individuals experienced PTSD, of those who experienced combat exposure.
There have been no large-scale studies of the first Gulf War, but based on the studies that have been done, the rates of PTSD were somewhere between perhaps 7 and 12 percent.”
From the above statement, it’s difficult to ascribe a causal relationship between developing PTSD and duration of exposure to a traumatic stressor, but being a POW tops that stated list. I have little doubt that the toll from the long wars in Iraq and Afghanistan will be greatly increased by relentlessly extended tours and decreased down time.
Elliott @ 87
Elliott, did you happen to note if the hearing discussed telepsychiatry?
This may seem like a small thing – but in VA psych care, it’s huge.
US psychiatrists are overwhelmingly located in (wealthier) urban/ suburban areas.
Enlisted personnel and the majority of US shrinks don’t live near each other.
(And the majority of US shrinks lack thorough training in diagnosis/treatment of PTSD.)
The minority of shrinks and psychologists with PTSD training tends to live in urban areas large enough to support medical/psychological research.
Most of rural America doesn’t live near a med school (or a major VA PTSD facility).
The effective PTSD treatments don’t happen in a single visit.
Hence effective PTSD treatment is not currently accessable to most rural Americans.
Telepsychiatry (video/audio) works – that’s why Medicare authorizes payment. Telepsychiatry is also a very efficient way for skilled/expert clinicians to provide diagnostic evals for distant patients (and patients housebound from severe behavioral symptoms).
Barring a cultural revolution in academic medicine/psychology, I don’t see the trained cadre of PTSD clinicians moving out to Green Acres anytime soon.
So I guess that’s why this seemingly arcane question of technology may help meet the tremendous need for effective PTSD assessment and treatment among Iraq war veterans.
And help out a whole lot of vets’ families, as well.
Treating every soldier would, if nothing else, take the stigma out of it. In a sense, PTSD is a sign of a healthy mind.
I look at a (very small) blog that attracts ex-military. Two things they always say about PTSD:
1. The Democrats use the issue of PTSD for political gain.
2. They accuse soldiers who complain of “milking” the system.
I know my father suffered from PTSD and I can see how it has affected me and my relationships.
I’m not saying that NAMI is everywhere and always evil. What I can say is that in WI that they are horrendous enablers. Abandoning our Mentally Ill is a Pulitzer nominated series. There’s no housing for the mentally ill, because the local government simply stopped applying for the HUD funds to build it. There are other reasons, but that’s the main one. NAMI WI has never come out and even criticized the local officials who simply ignored the proceeds of Wisconsin tax payer’s Federal taxes, that were supposed to be redistributed in WI. HUD gave that money to other communities that applied to it. It looks to me as though psychiatrists and Big Pharma want to concentrate as much government spending for the mentally ill on psychiatrists and pharmaceuticals. Incidentals such as food and shelter would appear to come later wrt their priorities.
de Cascadian…Nine Try it is great that you believe that “most Americans care”. But I just think this is what folks say to make themselves feel better or have hope.
I have come to just the opposite conclusion. Look at the reality, Americans in their cars, pedals to the metal going to malls, school, work. Most are not asking or concerned about how many Iraqi people have died, are injured, are refugees. The MSM is happy to comply and keep Americans in the bubble.
Our invasion created an enviroment for a genocide to take place in Iraq, millions of refugees and hundreds of thousands injured.
Sorry but I do believe most Americans could give a flying —-. The whole world knows this and this is why they fear us!
Just walk out your door, look at the news, look at the mad car race…the evidence is clear.
Taylor, before I forget, I wanted to say thank you, too, for sharing your uncle’s story.
As of 2004, the National Center for PTSD reported that there were still 24,000 WWII-era soldiers drawing PTSD disability benefits. As you point out, they had PTSD just as sure as some troops do today. I believe symptoms were masked by a number of factors in place back then:
- A booming economy, so you really had to work hard to not find a job back then (unlike today’s vets who are facing double the unemployment rate vs. the general public, @ 15% and are at risk of having their lives at risk for something called ‘pancaking’ — i.e., where one problem leads to another deeper problem compounded on top.
Example of pancaking:
Let’s say you’re unemployed after you separate from service or you lose your business because you’re a National Guard soldier who originally signed up for one weekend a month duty community service. This is going to stress you out further and may lead to fighting with the wife or husband; maybe getting divorced. This may then lead to problems with the law, further debt and perhaps even homelessness).
- Drinking was much more socially acceptable back then, so masking post-war pain at the American Legion or VFA clubhouse with a drink in the hand was considered a positive way of dealing with war stress.
- Most (not all) believed that the war was ‘necessary’ and that the sacrifices worthy; since the whole society sacrificed together, there was also a much stronger bond between those serving on the frontlines and those serving on the homefront.
There are more factors, these are just a few off the top of my head. Every war may be different, but no war is ‘clean’ — and all warriors are susceptible to war trauma.
I hope this isn’t too off-topic. I live at Ft. Knox, and I wanted to share an editorial that appeared in this week’s post newspaper concerning the extension of deployments to 15 months:
http://www.thenewsenterprise.c…..edit02.txt
This is a column that tends to run more toward the feel-good, “military-spouse-toughest-job-in-the-military” kind of things. In light of that, I found the conclusion all the more powerful:
tbsa @ 98
Oh, boy. You said it there, tbsa.
I don’t know very much about the treatment of Iraq war related PTSD. But does accountability, that is, evidence of holding those responsible for the misery help?
Ilona Meagher @ 110
Terrific comment. This is wholistic and very welcome.
I would also add that Iraq is not a war, it is an “occupation.” Soldiers are trained to destroy targets. We’ve got a Posse Comiatatus law that prevents them from acting as a police force in the US. There’s no reason we should expect them to do it in a foreign country.
Pet Wrecker @ 103
Seems to me that this was Mr. Bush’s drug of choice.
http://www.youtube.com/watch?v=mJqgxjUy7lc
Howdy, Ilona, and thanks, Taylor; wish I could have dropped in or stay for long as this is a topic that has affected my own family. Ilona’s book is in my reading queue, couldn’t get to it before this salon, unfortunately.
My stepson served in Iraq during 2003-2004; I was afraid to leave the house that year for fear we would miss one of his few phone calls. We’ve never been able to talk much about what happened while he was there; we can sense what happened like black holes around which we can talk more freely. There’s nothing quite like being told that your fridge really doesn’t smell like something died in it after all to fill the blanks for the family…
He came back with PTSD, on scrips for Wellbutrin and Xanax and a few other pharmaceuticals; we could tell when some drugs weren’t working by the amount of talking he would do at any given time, or the amount of smoking or pacing he would do. Although driven to go back to school, it took him awhile longer than expected to settle into a pattern where he could return to both work and studies.
But then the frustrations with the VA hit, in sync with changes in his scrips and he was calling every day, having to be talked down. We’d thought he was doing fine, getting better…but what seemed like a fairly simple bit of beaucratic bullsh*t that would merely aggravate the rest of us set him in a tailspin. It took nearly 9 months to straighten out the mess at the VA, as well as eight grand out of pocket for tuition while the VA got its sh*t together. (The schools involved were no better, in spite of having VA representatives on staff; they actually made the bureaucracy much worse.) As the 9 months passed, we had to teach/re-teach simple coping mechanisms that even grade school kids have already mastered. He complained of other aggravations, like not being able to handle crowds, suggesting there were times when he was just squeaking by and we couldn’t help.
And meds? tweaked, re-tweaked, adjusted for school, adjusted for work, adjusted for winter’s lack of sun, adjusted for dealing with the government.
This was a happy-go-lucky, even-keel kid in 1999 when he went into the service, now an adult who is up and down like a yo-yo, not knowing when the next thing will bring him down and push him into a panic.
He’s one of the very lucky ones, too. We thank our stars that he is not married, has no children so that we are all of us not having to help an entire family but only one young adult. We are fortunate to have the resources and smarts to be able to help him; we know our story is nowhere near the challenge the “Marlboro Man” faces.
But how sad is it that he cannot yet have the family he might want or that we would ordinarily welcome at this point in his life; this wasn’t part of the bargain, you know? At this point I can only hope and pray he will not end up like my uncle, a Vietnam vet, 40 years after still suffering from the affects of his service, his family scarred by the ongoing damage of his experience. And yeah, my uncle was one of the lucky ones, too.
John Casper @ 104 – Although I don’t have a personal account of that pitfall, I think it’s a fair warning that applies to many things. I reference them mainly as an available source of infomation and supportive contacts for people who have zilch.
As a matter of my own practice, I don’t meet with drug reps and I don’t attend their free dinner giveaways. When I was a resident in training, I took a vocal lead in making our clinic offices off limits to reps who loved to stop by for face time. After years of it being the norm, that practice came to an end. Nothing against them personally, but obviously it’s in the patient’s best interest to have treatment decisions determined by accurate unbiased evidence, not the principle of reciprocity.
fwiw, I always listen first and listen some more, and try to minimize the prescription of medication while avoiding it if at all possible. That said, medications used properly for the right conditions work and save lives.
Wo John Casper, I would have to take issue with your characterization of NAMI.
They are doing the work of the angels in fighting for people who are mentally ill. It is totally an uphill struggle.
Don’t think they are doing enough? Join and help us change things. There is no other such organization. If you crush this one, there is nothing left.
John Casper @ 67
This is a great suggestion, John, thank you.
You’re so right that there are a lot of friendly people in the DoD and VA who want to help to push things towards improvement. The same can be said of the mainstream media, too. Some good people on the inside trying their best to find ways to work with citizen journalists such as myself and so many others of you out there doing what I’m doing but in your own niche.
I have a very impressive bunch subscribed to my blog who visit my site regularly. My work, for some reason, doesn’t lead to energetic discussion and debate online at my site via comments (so this is a real treat, ty everyone), but my audience is quite supportive on the back end via email.
The activists working on this issue are so embracing of anyone willing to come in and begin working alongside them. Very humbling experience.
Ilona Meagher @ 110
I will never forget him, Ilona, or the sight of him in that hospital.
It’s interesting that you mention drinking, he became an alcoholic as well.
Oklahoma kiddo @ 113
That seems critical! I am so tired of hearing on T.V. and the news how wonderful it is/was for soldiers to be serving our nation and how they are fighting in Iraq for our “freedom”. Hogwash!
Ifsoldiers were able to discuss the truth, that they were lied to about why they were sent to Iraq.
That they were manipulated and that the Bush administration and Israel wanted control of the access to oil and regime change in the region, and that their lives were put on the line to implement this agenda.
It would really seem that holding those responsible for the lies and for sending mostly young men to Iraq for an unnecesary war would be so healthy.
Like holding the rapist accountable, or Nazi war criminals. Justice and
accountability
for the crimes committed by lying our nation into war.
Yes Ok Kid.
For folks on the Lake seeking more information about anxiety disorders (including PTSD) the Anxiety Disorders Association of America has a really useful site.
Self-screening tools for PTSD, great selections of literature for the public and for professionals, good descriptions of anxiety disorder diagnosis and treatment.
I trust the ADAA’s clinical info.
(Like virtually all clinical organizations, they do, however, take Big Health donations.)
Kathleen >
You are free to believe as you wish of course but I would suggest the behaviors you have noted as showing that most Americans do not care shows exactly the opposite. The behaviors you mention are all methods to hide from those inner voices of awareness that nag at us as we consider our situations
I do agree with you that “the evidence is clear”, just not what it is clear about
“You don’t prevent anything by war except peace.” – Harry S. Truman
John Casper @ 114
I’m not positive but I believe as part of the Patriot Act, the Posse comitatus act has been at least weakened if not partially repealed, which is just another of the reasons we need changes in DC.
kirk murphy @ 106
I didn’t hear them talking about that specifically, but I didn’t see the complete whole thing
They did seem to be open to thoughts from outside the box, tho.
One good thing that was brought up was the absurdity of separating substance abuse from the PTSD itself, as in not treating someone with PTSD until s/he went through rehab, which is ludicrous.
egregious @ 118
egregious, you can take issue with it all you want. Please read the link, “Abandoning Our Mentally Ill. Please look at the articles which extend for over a year. You’ll find one quote from NAMI, early. They blamed it on the caseworkers. The “it” gets a lot worse than what I went into.
NAMI has never even criticized local and state government, much less asking for resignations.
Bob Wrenn is on the Board of Directors of NAMI WI and he runs one of the biggest Medicaid billing mills in Milwaukee. He employs shrinks who “skim” patients out of the system, who really aren’t that sick. Then Bob and his shrinks bill WI Medicaid’s brains out. We’re talking an average of $18,000 per year just for caseworkers and psychiatric sessions. That doesn’t include medications. That’s another $6,000 annually for medications that cycle through Bob’s pharmacy. This is just white collar stealing from the tax payers.
If you know someone at NAMI, please by all means ask them to read the articles. I’m certainly hopeful that NAMI national will eventually step in.
Also, don’t forget to check out Ilona’s blog. She’ll keep you posted on what’s going on and how to help.
Muzzy @ 117
Muzzy, I apologize. I have great respect for a lot of the great psychiatrists who are out there. Unfortunately, I know of some really unscrupulous ones out there who put lining their 401(k) way, way ahead of their patients. When it’s called for aggressive medication is really required. I have no problem with that. It sounds like you’re a big believer in “symptom education.” When possible that’s the way to go. When it’s all said and done, however, you have to medicate according to the symptoms.
Appreciate you hosting this Taylor.
I’m the first one to say that I’m still on this journey of discovery myself, so I’m very appreciative of this kind of information and boots-on-the-ground report.
John Casper @ 129
It’s been such a pleasure. Ilona’s book is so important. I hope you all spread out and share this FDL book salon in the comments of other blogs far and wide.
Thanks, John.
Very late, but just in case Ilona checks back in:
As you may recall, I’ve posted about PTSD and linked to your website several times. I’ve also been writing about the military healthcare systems failures with some analysis and alternatives. Since then, I have a steady military readership coming from the Pentagon and the healthcare commands of the Army and the Navy. During this past week, I’m getting steadily increasing numbers of searches for military nurses and PTSD. I do know that nurses are leaving the Army twice as fast as any other type of officer, according to the acting Army SG Pollock. Ilona, have you done any work specifically around PTSD experienced by physicians and nurses? They may have different coping needs because of being confronted with the dead and dying in such overwhelming numbers and without the ability to take any “time out” to do any crisis intervention of their own.
Links and resources, if there are any, would be appreciated, and I’ll get them up on my blog.
Thanks for all you are doing. You are doing powerful and critical work.
kirk murphy >
I think this is an excellent insight (of course I`m a big fan of tele-technology) & one that might be boot strapable by concerned individuals since the basic tools are available.
Do you have any specific links to more information & maybe some suggestions how a group of interested parties might start to move on this without “official” authorization etc ?
I think this is right up there with idea of post experience reentry “boot camp” etc as beiing very important for actual success
“Whenever two people meet, there are really six people present. There is each man as he sees himself, each man as the other person sees him, and each man as he really is.” – William James
Muzzy, other thing that is clear in the articles I referenced above is the willingness of unscrupulous psychiatrists to blame everyone else when something goes wrong. One very successful patient was having very understandable complications with Clonapine. Instead of getting him to safety in a ward, the shrink tried to change medications on the fly, Clonapine and Charlie Murray. When Charlie went out his third story window, the NAMI belonging shrink, who defended Charlie’s shrink, suddenly said it was “everybody’s responsibility” landlord included. Bullsh*t. The shrink wasn’t sharing his Medicaid billings with the landlord. He can’t blame him when the guy goes out his window.
Comments like the shrink made in the paper only make landlords even less likely to rent to the mentally ill.
The shrink who had been prescribing the medication had been in Madison just a few months before arguing that the old formulation should be retained. AFAIK, WI is ok on this. The shrink can prescribe the older formulation. S/he just has to fill out a form and Medicaid will reimburse. My guess is that this shrink was taking payments from the manufacturer.
Thank you Ilona and Taylor — and Dr. Kirk, too.
I learned a lot today
Elliott @ 124
Here in SF a just-minted psychiatrist (SF psych residency) says she and her colleagues were trained in substance abuse treatment at the local VA…
where – she says – the vets had to get off substances to receive significant psych eval/tx for other Axis I disorders.
As you point out, ludicrous.
Demonstrating lethal ignorance of the concept of dual diagnosis.
And lethally flawed treatment plans.
I am so hoping my very junior colleague is simply misinformed.
If she is correct, I hope that since her training the VA has adopted non-lethal policies for treatment of psychiatric disorders in patients with dual diagnoses.
Taylor Marsh @ 127
Thanks, again, Taylor, and everyone.
What a great turnout. I’ll be dipping back in throughout the evening to answer a few more questions.
^5 to everyone for a great beginning…
And speaking of PTSD some of us who are on the edge are pushed far deeper into mental illness by the egregious acts of this administration, killing hundreds of thousands of people in our name and destroying our Constitutional liberties.
God help us.
A choice: ignore all this and focus on recovery, or engage. A daily decision.
John Casper @ 129
Yes, Taylor, thanks so much for hosting this very important discussion at the Lake.
Ilona, thank you so much for your writing and your advocacy.
Taylor
chick, thanks for your gracious hosting today!I came way late to this discussion, but it looks like it’s quite something. Thanks, Iloha and everyone else — I’ll be thinking about this one for quite some time.
Don’t feel you have to leave here if you want to keep chatting about this, but there’s another thread up: It’s Commencement Season!
egregious, I apologize. My 4:21 was unnecessarily direct. I don’t want to dilute the content of what I said, but I am sorry that I was not more diplomatic. I am especially sorry that I was not more diplomatic to a long time FDLer.
Re John Casper @ 127: “When it’s all said and done, however, you have to medicate according to the symptoms.”
To comment, I medicate according to the diagnosis. Symptoms overlap considerably between various diagnoses.
There are shared symptoms that get better through non-pharmaceutical interventions when they originate from a particular diagnosis, whereas they might be more responsive to medications if originating from a different diagnosis. And of course, more than one diagnosis can be present at any given time.
John Casper @ 142
John, much appreciated. My only concern was that people not be turned away from one of the few resources out there. NAMI might have problems in the state you speak of, but in a lot of places they are alone, the -only- thing standing between people and the cliff. We need all such possible resources, speaking from experience. I may sound perfectly normal here at fdl except for the meltdowns a few people have witnessed. I try to keep those offblog as much as possible. It is very painful to think that this administration is creating MORE situations where people feel desperate. FOR SHAME.
Ilona Meagher @ 130
I would definitely invite you to consider contacting Meg Kissinger at the Journal Sentinel. She’s an excellent journalist. She also might be helpful with your publisher in determining if it would be profitable to schedule a book tour in Chicago or Milwaukee?
Thanks Muzzy. IMO the unscrupulous psychiatrists of whom I speak, see “non-pharmaceutical interventions” as a threat to their income and simply try to starve them out of the revenue loop.
FWIW, I am not a provider of any kind.
kirk murphy @ 136
Here’s a link for the hearing
cspan hearing on PTSD
Thanks Taylor and Ilona!
Ok Kid. I thought your suggestion for accountability was on target. By providing recourse for those lives who have been manipulated (American soldiers) and for those who have suffered so much (the Iraqi people), real and measurable healing can take place when justice is served.
I am reading a book about Simon Wiesenthal, he was simply amazing. Mr. Wisenthal was so determined to hold Nazi war criminals accountable for their horrendous and inhumane acts.
If only we can take his example and apply those standards of accountability to those who lied our nation into the war in Iraq that has caused so much death, destruction and ethnic cleansing.
The zealots that lied our nation into an unnecesary war have not turned on gas or pulled any triggers. But they have clearly created an enviroment for crimes against humanity to take place. I for one believe they knew exactly what they were doing by creating a quagmire in Iraq.
If we apply Mr. Wiesenthals example to Iraq many people in the Bush administration would be tried for war crimes! I hope there is an Iraqi Simon Wiesenthal out there in the world!
Haralambos @ 66
I’m glad I’m not the only person jarred by the “we have the best….” statement in the midst of an otherwise wonderful and very moving post. I don’t think our soldiers would be any less deserving of honor, thanks, and the best medical treatment available if they were not the best, brightest, etc. etc. in the world, which seems a somewhat dubious claim in any event. Whoever they are and whatever their individual characters, they chose to serve and deserve so much more than they are getting from us.
Thanks egregious. I think it’s important that people hear both sides. I certainly hope NAMI in other states is better.
Here in WI, the State put NAMI (a for profit arm of NAMI) on it’s payroll. That’s one of the reasons NAMI won’t criticize them, they don’t want to lose the revenue. It’s these people in the state who get paid to make sure the tax payers and the mentally ill receive something back of value for their tax dollars that are supposed to support the mentally ill.
One of the things that Kissinger’s series highlighted was that the caseworkers and psychiatrists were billing Medicaid’s brains out for patients who were being taken care of by unlicensed “landladies” who were paying the rent to slum landlords. I think a lot of the good psychiatrists figured that they didn’t have any leverage and that complaining might make the situation worse. Unfortunately, that was where NAMI could have given them some cover, but it didn’t. It blamed the caseworkers. I agree the caseworkers have some responsibility, but they aren’t the decision makers. Milwaukee County told them that these houses had been approved for housing the mentally ill. Surprise, the State had no record of it. First the State started to prosecute some of the landlords and then they stopped. They realized they had no place to put them.
WI has laws about the licensing that is required to take care of people with serious mental illness. The state didn’t want to enforce the laws. It was a form of union busting. Milwaukee County could pay less to these landladies. One of the problems, however, was the rats that these disasters attracted, because there was crap all over the place. That drives down property values, which again hurts the tax base. Milwaukee also has a shortage of housing for the working poor. These landlords like that Federal check that comes in every month like clockwork from Social Security for the mentally ill. It’s a lot more dependable than the other paychecks that they get. They want to take care of the mentally ill, as long as they can pay some unskilled landlady to do it as minimum wage. Now you’ve got a shortage of low-income housing in addition to completely substandard housing for the mentally ill.
daCascadian @ 132
Thanks, daCascadian – but no credit due *here. All the heavy lifting was done years ago by the APA.
This idea has been around for years, with questions about when it would fly.
I hope it will now.
(*though when my analyst moved to Portland, we kept working for a few years via old-style videophones. Worked well enough for our established relationship, butwe both agreed the tiny screen wouldn’t really do for new patients. Fortunately, two iMacs can do it now….)
____________
Elliott, thanks for the link and your kind comment!
Muzzy, the other thing is the Liaison Committee on Medical Education. As you know, that’s the arm of the AMA that artificially restricts the number of US Medical students that graduate every year. The laws of supply and demand are good enough for lawyers, and accountants, it’s good enough for physicians. I understand that getting an adequate supply of physicians into the marketplace will decrease some incomes, but imvho the shortage of physicians is one thing that drives the errors that lead to so many malpractice suits.
Well I just finished reading the post an all the comments and I have to say this was very enlightening. Thank you Ilona, Taylor and all the members of the FDL commentariat. I’m definitely going to read and recommend Ilona’s book.
John Casper @ 151
John Casper, as a med student I served on the board of the Association of American Medical Colleges (AAMC) Office of Student Representatives.
For three years, I attended the AAMC’s annual meetings and their quarterly DC meetings.
The LCME has two parents: the AMA and the AAMC.
(When the LCME goes out to do inspections, the “inspectors” are from academic medicine.)
Every year the AAMC dreamt of expanding medical education – and every year they fought just to keep the Medicare “pass-through” funds for the existing level of med schools/ residency training.
Since Reagan, US medical education budgets have declined. Opening new medical schools requires increasing budgets.
The description you provide is wholly inconsistent with the reality I observed over those three years.
(However, I certainly do believe that within specific lucrative specialties, some practicing specialists oppose extending the practioner pool because of anti-competitive desires.)
Kirk, I’m grateful for the response.
Law schools are not dependent on lawyers to open up law schools. The same is true for accountants, engineers, chemists, biologists, nurses, computer science, ….. There are not the gross shortages in any of those fields that exist in Medicine.
If you say the bottleneck is not the LCME, I’m certainly eager to learn more about that. My guess is that because of the shortage of physicians, that drives up the cost of the teaching faculty. If Medical schools cannot turn a profit on each student they graduate, that’s a very serious business problem. I don’t think Medicare is going to solve it.
In WI, we just had the Aurora medical group and all its physicians tell Medicaid to “get lost.” The shortage of physicians is so acute, they don’t need Medicaid patients to meet their income goals, so they just won’t accept them as patients. There are too many patients chasing too few physicians.
I was impressed by your reference to video conferencing above for treatment. My guess is that Medical schools could save a ton of money if they invested in that technology. It doesn’t eliminate the need for Med students to see a high volume of symptoms (patients), but it might reduce the per capita cost of educating Med students if it were used in the earlier stages.
Yes, I’ve heard this. I think the key is increasing the number of seats at Med schools that currently exist.
kirk murphy @ 106
When I first explored PTSD and went looking for effective “cures” – I wanted to hear from Veterans and Active Duty people about helped. Nothing turned up here. In Canada I found someone who provided tele-consulting to Canadian Veterans. He referred me to what was then, in his opinion, the state of the art. http://www.acpmh.unimelb.edu.au/
Then I found Davo http://www.davep.info/index.html
The family wreckage link at Davo should be very helpful and encouraging for those caught up in PTSD.
Ilona Meagher @ 93
I think the concept of a reverse bootcamp is brilliant – i for one will keep this thought going.
egregious @ 9
Like so much else, I believe they just did not concern themselves with the boring details on the consequences should things not go as they deemed it to go.
Maybe they thought it was going to be a piece of cake, like the first Gulf War. But even the first Gulf War costs us nearly $2 billion every year in bills to take care of its vets. The current annual figure for taking care of our OEF/OIF wounded is now up to $2.3 billion. Every year. So, your question leads us to an important point:
We need to update the way wars are planned and and budgeted for.
We should demand these costs be factored into any war plan budget before we even go to war. But Defense Secretaries are just not going to do it on their own because it might turn out that the costs are deemed too high by society, and perhaps they won’t want to wage war.
Author Penny Coleman (Flashback: Posttraumatic Stress Disorder, Suicide, and the Lessons of War) wrote generous foreword to Moving a Nation to Care. In her book she profers that perhaps war would then be too costly in our eyes.
While they have been less than honest about the funding of the war from the outset (remember Wolfowitz and others in the administration saying it would cost us practically nothing, that Iraq’s oil revenues would pay for everything?), the DoD is still playing games with us and with the troops in their care.
The DoD today is still not screening across-the-board for PTSD, or even TBI, traumatic brain injury. Why not? We’ve known since 2004 that these issues were going to take center stage; indeed, TBI is called the “signature wound” of the Iraq War — and yet, the DoD is still not screening everyone involved in an IED blast for it. Why?
And what about all of the troops who have been booted out of the military with a less-than-honorable discharge for self-medicating? Or the 22,000 turned out with Personality Disorder (some perhaps coping with PTSD)? What about them?
How do we go back into their lives today and help them recover, when they don’t even have any VA benefits to fall back on? We’re eventually going to have to pick up the tab — either coming or going. Wouldn’t it be better to do it at the outset, rather than wait until entire families and lives are shattered?
The way the system works today, the answer is clearly ‘no’.