Soldier's Home : Medical Issues

The Sex Lives of Wounded Vets

David Botti — Fri, 23 May 2008 11:46:44 GMT

Though the Iraq War has lasted more than five years now, and health issues concerning veterans are constantly in the news, there's always been one subject that seems to be overlooked -- sex. Last Wednesday in Washington, D.C. a conference was held to take a look at just how a veteran's war injuries -- both physical and psychological -- can affect his or her sex life. The Associated Press took a look at what was discussed at the conference, including an appearance by former senator Bob Dole, who was wounded in WWII.

Said Dole: "Most of us go through this transition from able-bodied to disabled, and it's tough. And I worry about these young men and women ... who are 17, 18, 19, because I don't think it's really going to hit them until they're 20, 25, 30 years of age." For the injured, questions of self-worth and a fear of rejection because of physical or other changes they've undergone can form barriers in their relationships.

Mitchel S. Tepper, assistant project director at the Center of Excellence for Sexual Health at Morehouse School of Medicine in Atlanta, which organized the conference, told the AP one of the hardest things about this issue is the lack of discussion between doctors and patients.

Tepper said badly injured patients are extremely interested in the subject, even if they're shy about asking. He said studies of the general population of people with spinal cord injuries find that some rank the desire to have sex above the ability to walk again. Healthy intimate relationships add meaning to life and can aid in recovery from other injuries, he said. And the loss of a relationship can be detrimental, even a factor in suicide.

Then there was this veteran who decided to tell his story as an example of what kinds of difficulties are involved:

Jackson, of Des Moines, Iowa, was injured in Iraq in 2003 while serving in the Iowa Army National Guard. In addition to losing his legs, he had burns, post-traumatic stress disorder, and he was heavily medicated. When his wife initially wanted to be intimate, he refused.
His wife said she felt rejected, and went to talk to his doctor with specific questions. She said the doctor just told her things would get better with time, and she wasn't sure what that meant. She said she and her husband kept talking and were able to work things out.

In a separate interview with About.com late last year, Tepper gave an in-depth look at what the sexual intimacy problems are affecting vets, and what he plans to do about them. But he was clear to make this distinction:

Is important to note that sexual health encompasses more than the absence of disease and more than reproductive function. Sexual health includes how people feel about themselves as lovable and capable partners; establishing and maintaining intimate relationships; freedom from stigma, discrimination, sexual abuse, coercion and violence; and the ability to enjoy sexual pleasure and satisfaction.

In the News: Night Patrols, Psych Units, and Military Town Money

David Botti — Tue, 13 May 2008 16:53:53 GMT

News roundup:

*Bill Ardolino of The Long War Journal takes his readers along on a night patrol with U.S. soldiers and members of a Baghdad neighborhood watch called Sons of Iraq:

Co-founded seven months ago by local leaders and members of the 82nd Airborne, the Al Sadria branch of the neighborhood watch is composed of about 250 members who are paid by and coordinate with American units. The branch is responsible for a series of predominantly Shia neighborhoods in central Baghdad that include part of the Shorja Market. Though leader Faris Abdul-Hassan refers to his group as “the first Shia Awakening” against criminals and terrorists, he refuses to hire anyone with sectarian allegiances.

According to Ardolino, with a decrease in the number of U.S. troops, the Sons of Iraq have been successful in shouldering the burden of peacekeeping in their own section of Baghdad. While the final goal is integration with the Iraqi police, many in the Sons of Iraq are weary of high infiltration rates within the police by members of the Mahdi Army. See a photo slideshow of the patrol here.

*The Marine Corps Times reports that the Navy plans to expand the number of mobile psychiatric teams embedded within Marine units. A bit of context: the Marine Corps doesn't have its own medical services, but rather relies on the Navy to provide personnel (the Marine Corps is part of the Department of the Navy). The units, known as Navy Operational Stress Control and Readiness (or OSCAR), should number at 23 within two years. The purpose is to provide initial psychiatric counseling to Marines while they are still serving out in the field:

“We want to put mental health professionals with our small-unit leaders,” Navy Surgeon General Vice Adm. Adam Robinson said. “We think if we can train them there. Tere’s a real synergy that can come. We can be there to help with treatment, training and surveillance.”

*One doesn't see much reporting out of Basra these days, but the New York Times Baghdad Bureau blog has an interesting piece today. An Iraqi member of the Times staff took a four-day reporting trip to Basra to see just what the situation is there. Some selections:

I stopped for a while and I saw many Iraqi Army cars riddled with bullets. I saw troops deployed everywhere I looked: on the roof of every high building, every road intersection, occupying government offices that before were occupied by political factions.

I was shocked when I saw traces of the fight, which was clear on the buildings close to the main streets.

As an Iraqi from the south who knows exactly what was going on, with the militias controlling everything in particular cities or ports, I did not expect that the Iraqi forces – which are majority Shia - would be able to confront the militia influence.

There was a new feeling. I had never seen before the Iraq Army, without hesitation, accusing the Mahdi Army of being involved in all the disorder there.

One of the soldiers told me: “The Mahdi Army are a group of criminals, they will destroy everything if we don’t stop them.”

In the past, I have never seen soldiers dare to say anything about them. I felt the reign of fear is broken, and that is it. Exactly the same feeling as when the Baathist regime fell.

*Military.com recently posted an article taking a look at the rise in per capita income within military communities:

The wars in Iraq and Afghanistan could be behind the jumps in income, according to experts. Combat pay and re-enlistment bonuses for professional soldiers, combined with the activation of National Guard and Reserve units, put more money in the bank accounts of personnel shipping out of Fort Bragg, said David G. Lenze of the U.S. Commerce Department's Bureau of Economic Analysis, which issued the income data.

According to the piece, in North Carolina two major military communities ranked first and second in areas of the state with the highest per capita growth. The first of these, the Fort Bragg area, saw personal income rise more than $8,900 over five years. Military towns in Georgia and Tennessee saw these numbers rise by between 35 and 37 percent.

Veterans Suing the VA, Senators Call for Resignation

David Botti — Wed, 23 Apr 2008 13:57:35 GMT

A trial in U.S. District Court is now underway as a group of veterans challenge the Department of Veterans Affairs over the lack of care afforded to returning troops. The case, Veterans for Common Sense v. Peake, is said by the plaintiffs' attorney to be the first of its kind. Yesterday a suicide expert testified on behalf of the plaintiffs that veterans are killing themselves at three to seven times the rate of the general population. The American Lawyer has a good summary of what the case is all about:

The suit claims that many disabled combat veterans are in dire need of counseling and other services they are not currently receiving from the U.S. government. Erspamer [the plaintiff's counsel] estimates that 120 veterans who served in Iraq or Afghanistan commit suicide each week. The veterans' groups are not seeking monetary damages but want reform of a health care system in which they allege a huge backlog of cases prevents veterans from receiving timely care.

The San Francisco Chronicle outlined what suicide expert Ronald Maris sees as a complete lack of readiness within the VA to deal with the great number of veterans suicides:

A majority of the VA's counselors, doctors, social workers and psychologists "don't have the tools and the information that they need to intervene effectively with suicidal vets," said Maris, a former president of the American Association of Suicidology who has been a consultant to the Army on suicide prevention.

He was particularly critical of the VA's top health care administrator, William Feeley, who said in a pretrial deposition April 9 that the agency has no systematic national plan for suicide prevention. Feeley also said he was unaware of any methods of tracking veterans at risk of suicide and that suicide rates "are not a metric we are measuring."

The impact of the trial is being felt in Washington, D.C. where two U.S. senators are now calling for the resignation of the VA's chief mental health official, Dr. Ira Katz. Senator Patty Murray (D-Wash.) is citing evidence learned in the trial showing that the VA withheld information on the rising number of veterans suicides. As her statement reads:

"Doctor Katz's irresponsible actions have been a disservice to our veterans and it is time for him to go. The number one priority of the VA should be caring for our veterans, not covering up the truth...I have spoken with Secretary Peake and I have asked him to take immediate action to restore the faith of our veterans in the mental health care provided by the VA."

The Associated Press details the contents VA emails disclosed at the trial:

An e-mail message from Katz disclosed this week as part of a lawsuit that went to trial in San Francisco starts with "Shh!" and claims 12,000 veterans a year attempt suicide while under department treatment.
"Is this something we should (carefully) address ourselves in some sort of release before someone stumbles on it?" the e-mail asks.
A VA spokesman declined to comment Tuesday.
Another e-mail said an average of 18 war veterans kill themselves each day — and five of them are under VA care when they commit suicide.

For more on why the plaintiffs brought this case against the Department of Veterans Affairs, you can visit their website here.

19 Percent of Iraq/Afghanistan Vets Suffer from Depression

David Botti — Thu, 17 Apr 2008 17:22:13 GMT

A new comprehensive report by the RAND Corporation has concluded that 300,000 veterans of Iraq and Afghanistan suffer from depression or PTSD--and only about half have sought out treatment, according to the Associated Press. The report surveyed 1,965 vets in what the AP calls the first large scale private study of its kind. The numbers show that 18.5 percent of all Iraq and Afghanistan vets suffer from these these symptoms. According to RAND, possible solutions to temper these problems may be available:

Among our recommendations is that effective treatments documented in the scientific literature — evidence-based care — are available for PTSD and major depression. Delivery of such care to all veterans with PTSD or major depression would pay for itself within two years, or even save money, by improving productivity and reducing medical and mortality costs. Such care may also be a cost-effective way to retain a ready and healthy military force for the future. However, to ensure that this care is delivered requires system-level changes across the Department of Defense, the Department of Veterans Affairs, and the U.S. health care system.

The AP offered up more conclusions drawn from the study, including why vets are not seeking care:

They gave various reasons for not getting help, including that they worried about the side effects of medication; believe family and friends could help them with the problem, or that they feared seeking care might damage their careers.

The report also noted who is most susceptible to depression and PTSD, although, in the end, it is a vet's exposure to combat trauma that is the greatest predictor:

Rates of PTSD and major depression were highest among Army soldiers and Marines, and among service members who were no longer on active duty (people in the reserves and those who had been discharged or retired from the military). Women, Hispanics and enlisted personnel all were more likely to report symptoms of PTSD and major depressions.

Last November the Pentagon opened the Defense Center of Excellence for Psychological Health and Traumatic Brain Injury in an effort to bring together education, treatment, and research. From the Department of Defense:

The center also will set standards and assess, survey and validate DoD programs, and decide, in part, how resources are directed... Center officials are reviewing hundreds of research project proposals that hope to claim a piece of the $300 million set aside by Congress last year for brain injury research. The office also will work with the military services to see which of the many programs funded with another $600 million from Congress are working and how to direct those funds to programs most beneficial to servicemembers and families.

First Iraq Vet Selected for Beijing Paralympics

David Botti — Mon, 07 Apr 2008 17:13:35 GMT

A young woman who lost her left leg to a roadside bomb attack in Baghdad recently became the first Iraq war veteran selected to compete in the Beijing Paralympics. Former Army 1st Lt. Melissa Stockwell was one of 18 women selected for the U.S. Paralympic Swim Team. As the Associated Press reports:

As a first lieutenant in the Army, she was traveling through Baghdad on April 13, 2004, when a bomb ripped through her Humvee and took part of her left leg with it.
Infection and surgery claimed another significant portion of her leg, leaving her with just a few inches of stump below her hip.

Doctors fitted Stockwell with a titanium prosthesis so she can walk around, but the leg comes off before she takes the starter's blocks and gets ready to swim.

"I definitely made a decision early on that I was going to put it behind me and move on and try to do something positive," Stockwell said. "I wouldn't have it any other way. I lost my leg. Of course I would like to have my leg, but I have no regrets. It's opened so many doors for me."

A Wounded Warriors Project profile of Stockwell notes that she received 15 surgeries as a result of the bomb blast. At the time of the profile's publication in 2006, Stockwell was earning a second bachelors degree -- this time in prosthetics.

[Stockwell] felt absolute joy when she made a prosthetic leg for a ten-year-old girl, watched the child put the leg on, then get up and jump around. In the future, she is hoping to help wounded soldiers coming back from Iraq and Afghanistan get their lives back through prosthetic care.

According to a Washington Post profile of Stockwell, between four and 10 disabled veterans will eventually qualify for this year's U.S. Paralympic Team. And, by the 2012 summer games in London, 10 to 15 percent of the U.S. team may be comprised of veterans.

As part of her Paralympics trials earlier this month, Stockwell set a new American record for the women's 400-meter freestyle.

Below is a video profile of Stockwell produced by the Wounded Warriors Project.

Video: How to Loose Your Hearing

David Botti — Thu, 13 Mar 2008 15:05:16 GMT

ThisDudesArmy gave a personal response to a recent VA report saying that hearing loss (the "silent epidemic"), is the number one disability in the War on Terror. The report said at least 70,000 vets are on disability for having tinnitus--the "ringing in the ears" sort of hearing loss commonly associated with rockers such as Pete Townshend. Here's what ThisDudesArmy had to say:

Perhaps very recently they've started to evaluate hearing more closely, but when I returned from Iraq six months ago, we sat down for a simple hearing test like the one we did before we deployed. My roommate already was legally deaf in one ear and wasn't supposed to deploy, but he did anyway. He was on a patrol when an IED targeting dismounts went off right next to him, sending him sprawling to the ground with a concussion. He sat out for a few weeks to recover.

Back in the states, hearing in his bad ear was even worse than when he left. The only compensation, he was told, was free hearing aids for life.

The rest of us weren't lucky enough to receive that kind of slap in the face. Tests that showed degenerated hearing were looked at with suspicion and doubt, as if we had overstated our problems.

He then posts a video to illustrate the kind of noise troops are dealing with. The guns firing along with him are two M16's and a SAW (Squad Automatic Weapon).

More from the blogger:

I had a trick where I covered my ear with my right index finger when my rifle was resting on the ledge. This did little but was far better than the cumbersome foam earplugs we were given. It's too little, too late for those of us who were already given our hearing to the wars. I'm now in a customer service job where I answer the phone constantly, and I can't use my left ear with the receiver.

Treating (or Not Treating) Mental Health Issues at NY Base

David Botti — Wed, 13 Feb 2008 17:53:02 GMT

The Army's 10th Mountain Division located in Fort Drum, NY, has been the most deployed unit since the 9/11 attacks. A new report highlights an inadequate system in place at the Army base for treating soldiers with mental health issues. The report, published by the advocacy group Veterans for America, said soldiers can wait more than a month before seeing a proper health care worker.

Fort Drum is located near the Canadian border. Its remoteness and harsh winter weather doesn't exactly provide the most uplifting setting for soldiers recently back from combat tours in Iraq. Veterans for America notes this as the report begins, offering a glimpse into the setting where PTSD can begin to surface among veterans:

Generally speaking, winter conditions at Fort Drum are dreary, with snow piled high and spring still months away. More than a dozen Soldiers reported low morale, frequent DUI arrests, and rising AWOL, spousal abuse, and rates of attempted suicide. Soldiers also reported that given the financial realities of the Army, some of their fellow Soldiers had to resort to taking second jobs such as delivering pizzas to supplement their family income.

The report illustrates an atmosphere where lack of trained mental health professionals, combined with a military culture of keeping things to one's self, can leave many veterans going untreated. As the systems stands now, soldiers can easily provide false information on questionnaires designed to seek out those who need counseling. The most common way a soldier can received treatment is through self-referral. Furthermore:

In meeting with Fort Drum Soldiers, VFA found a number of disconcerting examples of inadequate mental health care at Fort Drum. Some Soldiers reported that the leader of the mental health treatment clinic at Fort Drum asked Soldiers not to discuss their mental health problems with people outside the base. Attempts to keep matters “in house” foster an atmosphere of secrecy and shame that is not conducive to proper treatment for combat-related mental health injuries.

The New York Times profiled Eli Wright, 26, an Army medic based at Fort Drum. He described common episodes of flashbacks and shot nerves as routine occurrences.

Mr. Wright said he waited weeks at Fort Drum to see a mental health professional, who diagnosed post-traumatic stress disorder. He was prescribed medication and pointed toward group therapy, where, he said, “half the time the group is staring at the floor.” At times, he was taking two pills at once. “I couldn’t stay awake,” he said.

A few weeks ago NPR broadcast a lengthy report in which it detailed a number of the same issues outlined in today's report. One soldier said he felt like he'd been tossed aside like a pair of worn-out boots. Last week Army Surgeon General Eric Schoomaker was interviewed by NPR about what was detailed in its initial story:

NPR: What do you say to these people who've had less help with their paperwork because of what you've described as a misunderstanding?
SCHOOMAKER: So far — you're giving me new information, I wasn't aware that anyone has not gotten the best advice. If anyone out there feels that they didn't get the best advice, they need to come forward and let us know about that.

Meanwhile, last Friday 19-year-old Pfc. Jack Sweet, a Fort Drum soldier, was killed by a roadside bomb in Iraq.

Vets and Defense Spending Through Proposed Budget

David Botti — Tue, 05 Feb 2008 16:57:55 GMT

President Bush's release of his $3 trillion budget yesterday included a number of veterans' and military-related provisions. Here's a few of particular interest:

Pay Increase:
For 2009 the new budget seeks a 3.4 percent pay raise for current active duty service members. As the Military Times reports this is the minimum raise allowed under federal law--and some advocates are displeased with the projected numbers. Here's the paper's rundown of sample salaries for the troops in 2009:

An E-4 with more than three years of service now earns $1,949.10 per month; that would rise to $2,015.40 per month on Jan. 1 under the Pentagon plan.
An E-7 with more than 10 years of service now earns $3,263.10 per month; a 3.4 percent raise would turn that into $3,374.10 per month.
An O-3 with more than six years of service now earns $4,763.10 per month; that officer would earn $4,925.10 per month with a 3.4 percent pay increase.

A Hospital
Veterans in the Orlando, FL area are speaking out against what they perceive as the proposed budget's lack of funds for a local VA hospital. As the Orlando Sentinel reports:

President Bush put $120 million in his proposed budget Monday for the long-awaited Orlando VA hospital, but area veterans said they were disappointed that more of the nearly $600 million needed will not come right away. Michael Kussman, undersecretary of health at the Department of Veterans Affairs, said $120 million is all the agency needs this year to begin work on the facility...But area veterans are not so trusting after waiting years for a hospital. Orlando is the largest metropolitan area in the country without a VA hospital, forcing veterans to drive to Tampa or Gainesville for care.

"What a disappointment," said retired Air Force Col. Joseph Kittinger, a decorated veteran. "All of the politicians give lip service to the veterans, but that is all it is, lip service." He added, though, that the $120 million "is a start and better than nothing."

Long-term
The Iraq and Afghanistan Veterans of America took a long-term look at where it sees facets of the budget allocated for veterans ultimately ending up.

For veterans, the 2009 budget provides $47 billion in funding for veterans’ health care, benefits, and other services. This reflects a modest increase over 2008 levels. However, starting in 2010, the budget predicts sudden (and unrealistic) drops in costs for veterans’ care. The administration’s argument is that the deaths of earlier generations of veterans will reduce expenses, but this line of reasoning fails to account for the dramatic increase in the cost of caring for Iraq and Afghanistan veterans. This will push future budget expenditures up, not down. Like the budget as a whole, the long-term accounting in the VA budget is improbable.

Defense Budget
For the defense budget itself, USA Today provides a good summary of highlights covering where the money is intended to go:

•Increasing the size of the Army and Marine Corps: $20.5 billion, an increase of $8.7 billion or 73%, compared with 2008. This year, the Army would grow to 532,000 soldiers, and the Marine Corps would increase its ranks to 194,000. By 2012, the plan would be complete, with the Army topping out at 547,000 soldiers, while there would be 202,000 members of the Marine Corps.

•Aircraft and weapons: $45.6 billion, a $4.9 billion increase, that would include purchases of fighter planes such as the F-22A Raptor and F/A-18 Hornet and unmanned aircraft like the Predator and Reaper.

•Cyberspace security: The budget shows at least $65 million for research and development projects tied to computer security. Some elements of the effort are secret, and funding levels are not disclosed.

•Pay and health care: $149 billion to increase salaries and fund health care. Military salaries would increase by 3.4%.

For an overall political view of how things are shaking out, the Associated Press provides this quick piece on reactions to the budget.

The Image of a Veteran

David Botti — Fri, 01 Feb 2008 21:18:35 GMT

The current series in the New York Times on veterans who've committed murder has spurred tremendous debate over the way vets are portrayed by the media. To understand origins of the prevailing portrayals of our current veterans, it's a good idea to take a step back and view the issue in a historical perspective.

Jerry Lembcke is a Vietnam veteran and professor of sociology at Holly Cross college in Worcester, Massachusetts. Lembcke's book "The Spitting Image: Myth, Memory, and the Legacy of Vietnam," looked in part at how the news media and pop-culture cultivated narrow portrayals of Vietnam vets. He has also written op-eds for the Boston Globe, Newsday, and the San Francisco Chronicle among others. In 1968 Lembcke was drafted into the Army, serving as chaplain's assistant before returning home and joining the anti-war movement.

I talked to Lembcke about how the Vietnam-era vets experience impacts that of those men and women coming home from war today -- and how he thinks the media is handling its coverage of veterans and issues associated with them.

SOLDIER'S HOME: You've written that a veteran's behavior can be influenced more from how past vets were portrayed in pop-culture, as opposed to personal experiences he/she might have had. How specifically does this happen?

LEMBCKE: The post-Vietnam popular culture representations of veterans was so powerful and so long lasting, and it so overwhelmed the war itself in popular culture, that as people began to come home during the Gulf War in the 1990’s, and present these same symptoms as Vietnam veterans coming back, I thought there’s a connection here. I think I used the phrase “learned experience,” and it occurred to me that this was a generation of veterans who’d grown up immersed in this popular culture of what it looks like to be a war veteran coming home.

This was very different than the culture Vietnam vets grew up in. Looking at representations of WWII veterans for example, which was not nearly as powerful in film for example. We got more war films about WWII, but not so many films about veterans coming home.

What is being portrayed in these kinds of movies that can influence veterans?

In the Vietnam war movies it was the dysfunctional, deranged, and even dangerous vet. I looked at about 100 films that portrayed Vietnam vets in them, and there wasn’t a single film that portrayed a healthy, functional veteran. So, what we see among other things is a lot of violence, the war brought home in a psychological sense, and even sometimes Hollywood portrayed guys coming home with their hand grenades and weapons and used those on the street.

Now we’re seeing one of the main representations of Iraq war veterans coming home is in the press with the violent crimes they’re committing. A lot of stories read to me like a lot of press reports and fictional representations of Vietnam vets that guys can’t leave the war behind them. They come home and they act out these war scenarios on the streets.

Is there a way the press can report on crimes committed by returning veterans without having such representations be the result?

Look at the current series the New York Times is running. The first in the series reported that one third of the violence is against spouses, girlfriends, and children. What this shows is a problem of masculinity and sense of worth as a man that perhaps the war has affected. These kinds of acts of violence against women and children are ways of acting out on that. Those are the kinds of stories that should be reported rather than this kind of pedestrian-type story of people coming home scared, and they’ve been trained up to act on their fears militarily

So it’s an issue of the press making the issue too black and white, and not attending to the gray areas?

The press is asking the wrong questions. They’re asking what is it about the military experience that causes these guys to act out like this, rather than asking what it is about the military culture (and even the culture of America) that requires men’s self esteem to somehow be related to their war experience.

You’ve said that it’s possible the behavior of Iraq veterans is influenced by past portrayals of Vietnam veterans. Is it possible reporters are also influenced by these pop culture images of Vietnam vets?

That exactly right. What we need to ask is, why did this story sound true to the reporter? What is the reporter herself bringing into this situation of reporting that leads her to think that this story is true when she hears it. These people live in the same culture you and I live in. They go to the same movies, they read the same books, they hear the same kinds of stories. Their sense of what is right is based on the same cultural references as the rest of us.

You’ve done some research on the origin of the term “PTSD.” There are some who say that the term is overused in talking about Iraq veterans. How was it used when it first came out?

I went back and looked at how PTSD came into being in the first place as a diagnostic category. I think it was attractive to the press at the time because it served a cultural and political function. It was inviting because it displaced from public view the fact that a lot of people were returning from Vietnam opposed to the war. The attractiveness of PTSD was that it re-spun the coming home story. It might have been attractive to journalists for reasons of basic liberal humanitarianism or even guilt that they didn’t go to the war. They were finding some way to speak sympathetically to the experience of people coming home from war. That may be what’s happening again. These stories [in the today’s press] are written very good heartedly. They’re not attempts to slander Iraq war veterans, as some critics seem to suggest they do. But, going back to Vietnam vets there was a stigma surrounding them. That’s the hidden danger that if indeed journalists are writing these stories because they are sympathetic, and they want to do something good for Iraq war veterans, in the long run they might be doing some damage.

What about how we use the term “PTSD” today?

PTSD had prominence in the press so quickly because that’s where the Vietnam-era story leaves off. That was sort of the easy tag line for them. Lots and lots of analogies. These stories are written with phrases such as: “it’s like with Vietnam-era veterans.” These stories are full of those kinds of tag lines. And they’re apparently written like that as a way of engaging the reader at the level that the writer assumes the reader is at. They assume correctly that the readers are coming out of a historical period in which they’ve been immersed in these images of PTSD and war veterans.

The American public remembers what happened to Vietnam vets when they came home much more then they remember the war itself. The war in Vietnam has really faded in American memory, but people have these very sharp images of the spitting incidents and PTSD. Because those are the images that have hung on in popular culture, and I think it’s almost certain that will happen with the war in Iraq--that the coming home narrative is going to displace the history of the war itself. And that could happen quite quickly.

The Latest Reports on Army Suicides

David Botti — Thu, 31 Jan 2008 17:18:40 GMT

Yesterday we learned from the Washington Post of the record-breaking number of Army suicides during 2007. This is the latest edition of veteran suicide news that's made national headlines--further evidence that this is one aspect of the homecoming experience that isn't getting any better despite all the attention.The latest figures as reported by the Post:

In 2007, suicides among active-duty soldiers reached their highest point since the Army began keeping records in 1980.
121 soldiers committed suicide in 2007, a 20 percent increase over 2006.
Attempted suicides or self-inflicted injuries rose sixfold since the Iraq war began: there were 350 cases in 2002 compared to 2,100 in 2007.
Historically, suicide rates within the military decreases during wartime; the current trend is the opposite of that.
In 2001 the suicide rate was 9.8 per 100,000 active-duty soldiers--in 2006 the rate jumped to 17.5 per 100,000.
In 2007 twice as many soldiers committed suicide in the U.S. as they did in Iraq or Afghanistan.

The Post provides this sober passage about a young Army reservist currently hospitalized after her suicide attempt:

On Monday night, as President Bush delivered his State of the Union address and asked Congress to "improve the system of care for our wounded warriors and help them build lives of hope and promise and dignity," Whiteside was dozing off from the effects of her drug overdose.

Taking a look at the issue of veterans suicides it's somewhat alarming to read this USA Today article from 2003. The language, the sense of urgency, the utter surprise in statistical findings can make one wonder if five years from now we'll still be reading the same type of articles--waiting for things to get better. The lead paragraph from the article could easily be substituted for a story about the current findings:

Alarmed by the number of suicides among soldiers in Iraq, the Army has asked a team of doctors to determine whether the stress of combat and long deployments is contributing to the deaths.

Everyone knows it's an issue. But, what can actually be done? Jon Soltz of VoteVets.org has this to say via the Huffington Post:

One very simple idea that would have helped relieve the mental burden of our troops (short of finding a way out of Iraq), and help them get the care that they need, is to give them substantial time off between deployments. Spend two years in Iraq, spend two years at home. And, on the homefront, aggressively test, treat, and monitor troops for mental injuries...

...Even without dwell time, and a much deserved rest for our forces, we have got to be more diligent about mandatory and exhaustive screening of returning troops, and providing adequate care and monitoring.

The Washington Post itself provides a summary of online reader comments for the article, and highlights particular entries. Here's an excerpt:

Our Readers Who Comment for the most part commend The Post and reporter Dana Priest for continuing to report on what happens to mentally and physically wounded soldiers returning from Iraq. They express sympathy for the individual around whom this story is built, call for a change in political leadership, improved patient car...Some contend that such reporting aids the enemy and question the patriotism of the journalist and her news organization. And, as sometimes happens, commenters take the opportunity to issue boilerplate condemnations of the Iraq War, some of which are anti-Semitic.

With almost regular headline-making reports of the suicide issues it can sometimes get confusing where things stand. Here are some key stories to revisit from 2007:

OCTOBER 30 -- A study by the American Journal of Public Health reports findings that younger veterans are more prone to suicide. This is the opposite of suicide trends among the general public.

NOVEMBER 13 -- CBS News concludes a five-month investigation into the "hidden epidemic" of military suicides.

DECEMBER 12 -- The House Veterans Affairs Committee holds a hearing on how to stop veterans suicides.

UK Ad Aims to Galvanize PTSD Awareness

David Botti — Fri, 25 Jan 2008 16:01:44 GMT

When movie-goers in the United Kingdom sit down to watch the Iraq war movie "In the Valley of Elah," they'll first be greeted by a new advertisement by the organization Combat Stress: Ex-Services Mental Welfare Society. As the Guardian reports, Combat Stress was founded in 1919 to help WWI veterans recover mentally from shell-shock. Today, after growing concern over the lack of treatment available to today's veterans, Combat Stress is ramping up a public relations campaign to highlight the issue:

Combat Stress is alarmed at the huge increase in veterans from the Falklands, Sierra Leone, Northern Ireland, Iraq and Afghanistan, who come knocking on their door for help. A few are still turning up suffering long-term effects from the second world war and Korea. The oldest applicant for help recently was aged 100.

What's their reasoning for this alarm? Eight years ago 300 veterans sought help from Combat Stress; during the last fiscal year the number jumped to 1,000. The number of Falklands War vets who've committed suicide has risen to 300—more than the 256 British soldiers who were killed in the war itself. Of particular note is how many view the Iraq war's unpopularity in the UK as exacerbating vets' mental health issues. From the Guardian:

The problems of veterans today are compounded by the widespread recognition through much of the army that the Iraq campaign is unpopular, nasty, unpredictable and brutal—and, in the views of a significant minority of soldiers and officers in private conversation, a pretty unnecessary conflict at that. In the first and second world wars, the plight of service personnel was shared by almost everyone in the land. More than 1 million soldiers served in Northern Ireland over 30 or so years, so that became part of the national experience.

But combat in Iraq and Afghanistan is not a national experience, and the services are worried that they appear in the minds of many now to be detached from most of British national life. Though more American soldiers have been involved—more than 3,000 killed and nearly 50,000 injured, physically or mentally—Iraq is not a shared experience nationally for Americans in the way that Vietnam was.

Combat Stress' advertisement doesn't hold back any punches, as it tries to impart what's going on behind the closed doors of veterans' homes:

A well-trained fighting machine reduced to nothing more than an empty shell. Combat stress is their calvary, the infantry to fight off their demons. They were protecting you, now they need your help.

You can view the advertisement here:

In the News: Female Soldiers, a British Study, and a Young Private

David Botti — Tue, 08 Jan 2008 17:08:04 GMT

A number of stories out there worth a look:

Here's a comprehensive USA Today article on the mental health needs of women veterans:

Master Sgt. Cindy Rathbun knew something was wrong three weeks after she arrived in Iraq in September 2006. Her blond hair began "coming out in clumps," she says.

The overarching theme of the piece shows an increasing awareness of gender-specific issues women face both in the combat zone and on the home front. A look at the numbers presented:

--More than 182,000 women have been deployed to Iraq, Afghanistan, or surrounding regions--about 11 percent of U.S. troops who have served there.

--7,500 women (mostly nurses) served in Vietnam; 41,000 women deployed during the Gulf War.

--More than 100 female servicemembers have died, and nearly 570 were wounded in Iraq and Afghanistan.

--According to USA Today, "In 2006, nearly 3,800 women diagnosed with PTSD were treated by the VA. They accounted for 14 percent of a total 27,000 recent veterans treated for PTSD last year."

--Also according to USA Today, "The Defense Department's 2-year-old Sexual Assault Prevention and Response Office says there were 201 sexual assaults in 2006 within the U.S. Central Command, which includes Iraq and Afghanistan. That's up from 167 in 2005, when the Pentagon began a policy that allows victims to get medical help without launching a criminal investigation."

For a better understanding at issues related to Military Sexual Trauma, take a look at this interview Soldier's Home did with an author who's extensively studied the subject.

Over in the U.K. the largest medical investigation of its Armed Forces is about to get underway, according to The Times. Researchers will look at how public opposition to the war in Iraq and Afghanistan affects soldiers' mental health. In particular they'll be focusing on British reservists who, unlike their active duty counterparts, are faced with assimilating back into civilian society almost immediately following combat deployments. The leader of the study told the paper:

“We will look at negative perceptions of the war and how that impacts on service personnel. If this has had an effect, it is a good question whether this affects reservists even more than regulars, as they have more interactions with civilians.”

[Other research has found] that as many as 6 per cent, or about 700, of the 12,000 reservists who have served in Iraq may be suffering from PTSD and that rates of depression were higher than among regular soldiers. At least two Territorial Army Iraq veterans, Private Dave Forshaw and Private Peter Mahoney, have committed suicide since returning to civilian life.

The Saginaw News provides a brief profile on a Michigan National Guard unit shipping out to Iraq. It's the kind of article that's been written hundreds of times by local papers to the point where it's easy to gloss over them. While most of us Americans are now used to having a country at war, the words of this 18-year-old soldier are a reminder of the individuals who are still facing war for the first time:

Pvt. Jim M. Wilk is imagining a year in Iraq, and he's a little anxious. "I'm not really sure what to expect," the 18-year-old Au Gres native said. "It's going to be an experience."

The unit contains veterans of a 2005 deployment to Iraq; seven members were killed in the 16 months the unit was in the country.

A 2007 Timeline of Veterans News

David Botti — Fri, 28 Dec 2007 15:42:48 GMT

As the last days of 2007 come upon us, I've compiled a timeline of veterans news throughout the year. What struck me is the vast number of veterans stories pouring out from all media outlets. Will this continue to be the case in 2008? Most likely it will be for the simple fact that the number of Iraq/Afghanistan vets is getting bigger.

Here are selected stories from throughout 2007:

FEBRUARY 18 -- The Washington Post exposes decrepit living conditions for wounded soldiers recovering in Building 18 at the Walter Reed Army Medical Center:

Behind the door of Army Spec. Jeremy Duncan's room, part of the wall is torn and hangs in the air, weighted down with black mold. When the wounded combat engineer stands in his shower and looks up, he can see the bathtub on the floor above through a rotted hole. The entire building, constructed between the world wars, often smells like greasy carry-out. Signs of neglect are everywhere: mouse droppings, belly-up cockroaches, stained carpets, cheap mattresses.

MARCH 8 -- A New York Times study finds vast inequities in how veterans receive disability checks based on location and type of service.

MARCH 9 -- President Bush forms the Dole-Shalala commission with a mandate to review the military health care system. The group, formed in response to the Walter Reed scandal, includes veterans, advocates, and health administrators.

MAY 22 -- The Associated Press reports a federal court that hears veterans' disability appeals has the highest ever caseload. This is due to the number of disability rejections handed out to vets by the government.

JULY 18 -- VA Secretary Jim Nicholson announces his resignation effective October 1. Nicholson's tenure was plagued by the theft of VA computers and a billion-dollar budget shortfall.

JULY 25 -- The Dole-Shalala commission issues its final report, saying the VA system is insufficient to deal with vets from Afghanistan and Iraq.

SEPTEMBER 19 -- Outgoing VA Secretary Jim Nicholson reports his department is struggling to process disability claims, saying payments can take up to 177 days to make. His hope was for the VA to reduce this time to 145-150 days.

OCTOBER 16 -- Sen. Bob Dole and Donna Shalala write an editorial in the Washington Post outlining their commission's findings:

According to research our commission conducted among wounded and evacuated service members from the current conflicts, the disability rating system at both Defense and Veterans Affairs is poorly understood and is a source of major dissatisfaction. Almost 60 percent of the service members had difficulty understanding the disability evaluation process. Our recommendations would update and simplify the disability determination and compensation system; eliminate parallel activities between the two departments; reduce inequities; and provide injured veterans with the tools to return to productive life.

OCTOBER 18 -- A report by the National Academies says many common PTSD treatments lack scientific evidence that they are effective at treating the problem.

OCTOBER 30 -- A new study by the American Journal of Public Health reports 1.8 million U.S. veterans are uninsured. The number increased by 290,000 from 2000 to 2004.

OCTOBER 30 -- Another study by the American Journal of Public Health reports findings that say younger veterans are more prone to suicide. This is the opposite of suicide trends among the general public.

OCTOBER 30 -- Retired Army Lt. Gen. James Peake is nominated by President Bush for the position of VA Secretary. Peake is a former Army doctor and Vietnam War veteran.

NOVEMBER 8 -- The National Alliance to End Homelessness issues a study finding that one in four veterans are homeless in the United States. Included in this number are 1,500 veterans from the wars in Iraq and Afghanistan.

NOVEMBER 11 -- The Associated Press reports the deaths of six U.S. troops in Afghanistan making 2007 the deadliest year for Americans serving in that country since 2001. The deaths brought the number of killed to 101:

...insurgent attacks, advanced ambushes, and suicide and roadside bombs have risen sharply the last two years, and analysts say the counterinsurgency battle U.S. and NATO forces now face will take a decade or more to win.

NOVEMBER 11 -- Veterans Day is marked by a number of protests by vets around the country.

NOVEMBER 14 -- The Journal of the American Medical Association finds veterans are more likely to develop mental health problems three to six months after returning from war, rather than in the months immediately following their return.

NOVEMBER 15 -- The Supreme Court of Canada refuses to hear the cases of U.S. military deserters seeking refuge in the country. The Army desertion rate has risen 80 percent since the Iraq War began in 2003.

DECEMBER 14 -- The Senate confirms retired Lt. Gen. James Peake as the next VA Secretary.

DECEMBER 20 -- J. Russell Coffey, one of only three known living WWI vets in the U.S., dies at the age of 109.

Face Transplants for Injured Veterans?

David Botti — Thu, 20 Dec 2007 17:17:25 GMT

Every now and then I think it's wise to look at how other allied countries fighting in Iraq and Afghanistan approach veterans' issues. Last month we took a look at controversies over troop health care in the United Kingdom, similar to those we've had here in the United States. Today's look at foreign veterans isn't quite so similar to anything going on here in the U.S. According to the U.K.'s Sunday Times, the doctor tasked with conducting the world's first full face transplants is offering the surgery to disfigured Iraq/Afghanistan veterans.

Last year Dr. Peter Butler was granted ethical permission to conduct full-face transplants, and he's been looking to perform a series of these operations at 30-day intervals. In 2005, Isabelle Dinoire was the first woman to get a partial transplant.

Dr. Butler has also said American military officials have visited him to discuss nine U.S. troops who may benefit from the operation. As an older veteran severely disfigured in the Falklands War, who's come to grips with his own appearance, told the paper:

"There may be soldiers who have been disfigured for the past four years who may feel that they are so unhappy with their appearance they may wish to look at different alternatives. Face transplant is the only option for full reconstruction."

Here's a BBC graphic on the operation.

A Stateside Army Medic on Treating Fellow Soldiers

David Botti — Tue, 18 Dec 2007 16:59:50 GMT

I recently spoke by phone with a military friend who's currently a nursing student at the Walter Reed Army Medical Center. He talked about how being with the war's wounded every day affects him, both on a human level and as someone who may be deployed to Iraq in the future. Of the scandal which broke last February at the hospital, he assumes the media blew it out of proportion and hasn't seen any negative conditions at the facility.

What's interesting about his words is how in some cases they could be applied to any civilian hospital worker in the country, and in others we see how his position as a soldier informs his experiences. As he is still on active duty in the Army, he's asked for anonymity. Excerpts:

On working as a stateside medic and nursing student:

Personally I’d say that you get to see another side of the war from being on the health care side. [The wounded soldiers] are treated with a lot of respect. They’re really cared for. On an emotional level sometimes the reality of it catches you. You try to be professional, but you’re still human. And sometimes it dawns on you the situation that person’s in is a very harsh one…There are situations that I’m very happy these people are alive and everything else, but sometimes you wonder if there are fates worse than death.

On his thoughts during off-duty time:

I think off-duty I think about it more. I think about the possibility–you know, I wear the same uniform as they do. These guys are younger than us. They’re kids. It scares me because I know that I’m still gonna be in the Army until 2010, and I’m pretty sure I’m going back over [to Iraq]. And to be faced with that reality every day looking at the people you’re looking at, and knowing that this is a very indiscriminate war; knowing that you can be walking to the bathroom and just get hit by something in any kind of zone. It's guerrilla warfare. It’s ugly. Your chances are very good that you can be that guy. There’s a lot more people injured than are coming up dead.

On conversations with patients:

They’re pretty honest about what happened, or what they remember–which they usually don’t. They’re usually like, “yeah, I was driving or doing this and then I woke up and I was in Germany.” They like to talk it out. They love to try to relate to you [as an Army soldier].

On how he comforts a patient's fears:

I think it’d be safe to say it’s kind of like, you know how us infantryman have that black humor. I think humor is one of the things I use.

On controlling his own fears:

I think the biggest thing that affects me is my fears. I mean, honestly, I get nightmares and stuff. But I think that’s more my anxiety of what my future holds. Sometimes you just need to indulge in the work and do whatever it is to help that person. Sometimes you focus on that person, and that’s how you get by.

On the worst he’s seen in a stateside military hospital:

The burn ward–it was just gruesome, you know. Everything was rearranged and changed. They have pictures [of the soldiers beforehand]–you know, a family puts up pictures. It’s a common practice. You look at someone who’s burnt severely and it’s hard to ever imagine they’re a human. And then right next to that patient–that slab of meat, rearranged face, it’s almost monstrous–right next to that, only to make it more melancholy, is the picture of the young kid with his future ahead of him. Not to sound so cliché. But, you know that person has the future ahead of him. That look that says, ‘look at me I just joined the Army, I’ve got my new uniform, a young girlfriend.’ And they’re not kind of robbed, they’re a hundred percent robbed of that. I think that’s a dark reality right there.

On the best he’s seen:

The best moment I’ve had was one of my first patients I had. I actually watched him for three weeks. I took care of him. He was one of my harder cases, and I purposely took him for academic reasons. And I watched him go from being very immobile and sick–just looking like hell to now he’s talking. That was powerful. You actually watch your accomplishment by giving care, you actually nourish something back to life.