Category Archives: PTSD

Articles dealing with my own struggle with PTSD and that of others

Miscellaneous Thoughts on a Friday

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Friends, I am tired. It has been a busy week and I am going to try to rest some over the weekend as well as spend some quality time with my wife Judy.

Part of the issue with my tiredness is that I haven’t been the same since my experience over the last month or so dealing with the military mental health system. I won’t bore you with details since I have already written a lot on it, including the fact that I got some resolution, but frankly I didn’t realize just how fragile that I was still was. I had no idea that trying to get help would be so emotionally punishing. Truthfully, I have not had a good night sleep since the initial conflict with the physician and the system. The nightmares, terrors and restlessness are all back. Hopefully in a few weeks or months things will settle out again.

On the positive side I was provided new hearing aids which are quite remarkable in their capabilities and are already helping me to understand speech better. For those that don’t know I hear noise just great. I have almost no loss of that ability. However, since Iraq I suffer unending tinnitus and my speech discrimination, a neurological function is in the third percentile, meaning that 97% of people understand speech better than me. So I am grateful for the hearing aids, as Judy, who was becoming ever more frustrated with me not understanding her or others. The ironic thing is that she has been severely hard of hearing her whole life and has a 77% hearing loss, but she usually understands speech better than me. a funny thing did happen yesterday. I was asked by a Charismatic Christian about praying from my hearing. While I appreciate that and I am touched by such sincere desires to help, it would be a shame if the government wasted over 5,000 on the hearing aids that are working so well.

Likewise, it looks like I have been invited to speak at the Military Officers Association of America conference in Washington DC in September on the topic of being a care giver to those suffering from PTSD while suffering from it myself. That should be interesting. In a way it is something that I hope to do on a regular basis once I retire from the military.

I have been writing a lot about Gettysburg and each thing that I write helps bring me a better understanding of the battle, but also the people, as well as the culture and philosophic ideas that had such an influence on those times. So you can expect that as I write new material and revise old material that I will share them with you here.

Finally as to current events. I am troubled by the events in Ferguson Missouri, especially many of the surprisingly racist reactions by “white America.” Since I wrote about that recently as well, I won’t go back into it.

The situation in Iraq with the rise of ISIS and its “Caliphate” has me greatly concerned. This is not a normal terrorist organization, it is Al Qaeda on steroids. The Secretary of Defense, Chuck Hegel, sounded a clear warning in the wake of the public execution of  American photo journalist James Foley and threats to bring their war to the United States and the west. I do not think that Secretary Hegel, a very circumspect man would make such an announcement if there was no real threat. The problem is that back in 2003 the Bush Administration sewed the wind in Iraq and left a very fragile and unstable state, whose leaders failed their people, and now we are reaping the whirlwind. We want peace, I know I think I speak for everyone, but the rise of ISIS with its apocalyptic vision, vast financial resources, international reach and success on the battlefields of Syria and Iraq is drawing radicalized Moslems to it’s black banner around the world. Because of this I expect that we are in for a long hard fight, and that our new opponent will cause us grave damage.

That being said, I fear for civil liberties in the wake of any attack, and I especially fear that, if something bad happens in the United States, that we will react not just against the culprits; but innocent, loyal and patriotic Americans of Moslem or Arab descent or because they look like the bad guys, or because they share the Islamic religion. Since I know a good number of such people I worry. We can be quite a xenophobic people when aroused, and our quite often “yellow journalism” and jingoistic politicians and preachers stir the cauldron of hatred to the point of paranoid insanity. Our history is colored by such xenophobia.

Finally, the news that the Russians may be attacking in the Ukraine is seriously bad news, which we all, Americans and Europeans need to wake up to.

So I close this Friday sharing my sense of foreboding even while I hope and pray for peace and justice.

Peace and have a wonderful weekend.

Padre Steve+

 

 

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Filed under faith, Loose thoughts and musings, middle east, News and current events, PTSD

A Good Day to Speak Truth to Power and to be Listened to

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I have been writing about my recent experiences in trying to get help for my own issues dealing with PTSD as well as my frustration with a military mental health system that is, at least in my view, floundering.

That effort over the past month or so has been quite painful, at times humiliating and dehumanizing, and frankly driven me into a depressed and nearly suicidal fog, from which I am slowly emerging.

Today was a good day. Not just for me but maybe for all of those seeking help at our local Naval Medical Center. Instead of being blown off and shunted aside by providers as well as mid and high level administrators I was able to have a long, nearly forty-five minute phone conversation with the Admiral who commands that facility as well as every Naval Medical facility on the East Coast and Europe, with the exception of the Bethesda-Walter Reed complex in Washington DC. Bottom line up front; it was a very good and positive experience for me that I believe will help others get better care.

I have to say up front that I was terrified about asking to talk to him. One of the people on his staff told me that “it would not be a good thing for me to talk to him.” When I heard that comment my heart sank. I didn’t know what to do, I was perplexed because most commanders of Medical facilities in the Navy that I have worked for actually did want to hear about negative experiences of the people that are their customers, most because they care, but if nothing else because they want to make sure that they pass the Joint Commission accreditation that their facilities get every few years. So I wondered if the Admiral actually knew what was going on, at least in regard to the Mental Health Department and the experiences of people like me.

My last Command Master Chief, who read some of my very angry posts on a social media site suggested that I call my former Commanding Officer, a man who helped me a lot, cared about me and who is soon to become an admiral. I finally worked up the courage to call him, not out of fear, but because I felt like I might be bothering him, and would not be worth his time. I left his command a year ago and frankly I thought why should someone moving up in an organization be bothered by the problems of a former subordinate.

However, he was both concerned and helpful. He did not just listen but he took action by contacting the Admiral here. He told him that he knew me and that he knew that it was my desire to make sure that people get the help and care that they need, that I wasn’t just complaining or seeking special treatment.

Yesterday the admiral called me, of course my phone went directly to voice mail so I missed the call, but his message, and the tone of his voice conveyed a sense of care and concern. I called back and got his voice mail. So this morning I called again and was able to share my heart, in a very respectful way with him. He listened and seemed to be attempting to formulate some kind of positive response that would actually help people. He wants to get answers and he told me that he wanted those that come to that facility to be treated as he would want his grandparents treated.

As I said we talked for forty-five minutes and he listened. I have no doubt, within the very real fiscal constraints faced with current budget cuts and the still looming threat of sequester that he will do his best to improve and change the system that is within his control. He also did something that I have never experienced before from a superior officer, he called me “sir” a number of times. I am not used to that and I don’t think that I have ever in all of my reading of military history recall an Admiral or General calling a subordinate “sir.” I was blown away.

That system appears to be undermanned, under-budgeted and overwhelmed. It is struggling and as it struggles, as it reacts to criticism from the media, politicians and advocacy groups, it resorts to protecting itself as any bureaucracy does in such a situation. The Admiral realized this and he encouraged me to call him again on his office number if I see things that he can help. That was very encouraging. I don’t think that I will have to ask him to intervene on my part, but I have an open door to use this relationship to help others.

All that being said, most people do not have the connections that I have in the system, nor are they willing to take the risks to rock the boat. The stigma is great and personal risk can be or at least seem too great to make the effort, so most people just give up. After all the bureaucracy can be unbending and even vindictive in the way that it rebuffs those that try to raise issues. They resist change and try to keep bad news from enquiring superiors. Bureaucracies and those who faithfully serve them do just that. It is part of who and what they are; be they military, other government, business or ecclesiastical organizations. Admiral Alfred Thayer Mahan wrote:

“It [the bureaucracy] tends to overvalue the orderly routine and observance of the system by which it receives information, transmits orders, checks expenditures, files returns, keeps the Service the touch of paper; in short, the organization has been created for facilitating its own labors.”

However, when I first collapsed after Iraq, I decided that I could not be silent and have “sky-lined” myself which probably will not help me get promoted, not that care anymore. I am sure that being so public about my struggles with PTSD, Moral Injury and even my crisis of faith, which left me an agnostic for a couple of years, while serving as a Chaplain in adult and pediatric Intensive Care Units has marginalized me in the Chaplain Corps. I don’t know that for a fact and would hope that it is not the case, but it is the feeling that I get when I deal with most Chaplains.

All of that said, the past few weeks have been some of the most difficult since my return from Iraq. I personally find no pleasure in being anxious, depressed or feeling suicidal and getting even less sleep than my chronic insomnia normally allows.

At least I was listened to, and I really did get the sense that the Admiral that I was able to have such an honest conversation with today, does really care and wants to help improve the system and change the culture.

But that is the thing. This is a systemic and cultural problem, not just in the military or the Veterans Administration, but in society as a whole. In our desire for efficiency, supposed effectiveness  measured by profits and the bottom line; we have forgotten to care about people. Sadly that is statistically verified in poll after poll by people from all parts of the political spectrum. People don’t trust the government, they don’t trust big business, they don’t trust health care systems, they don’t trust the police, they don’t trust the banking and insurance industries and they certainly don’t trust the church or religion in general. Can I get an amen?

Thank you…

But our culture has to change, we have become so materialistic and embrace the most crass forms of predatory Capitalism and Social Darwinism, even in church, that people don’t matter, especially the poor and those with no voice or power, especially those who volunteer to serve the nation and come back broken in body, mind and spirit.

Joshua Chamberlain the hero of Little Round Top at Gettysburg spoke years after the Civil War something that should be a warning to us about how we treat people. Of course Chamberlain was talking about the horror of war, but it can apply to anyone, anywhere:

“But we had with us, to keep and care for, more than five hundred bruised bodies of men–men made in the image of God, marred by the hand of man, and must we say in the name of God? And where is the reckoning for such things? And who is answerable? One might almost shrink from the sound of his own voice, which had launched into the palpitating air words of order–do we call it?–fraught with such ruin. Was it God’s command that we heard, or His forgiveness that we must forever implore?”

His question is as operable today as it was then. There has to be a reckoning somewhere for destroying peoples lives, and further traumatizing them when they seek help, otherwise there is no justice nor anything that resembles a loving God.

We have to start valuing people, regardless of their social status, their race, religion, sexual preference, disability or even their alma mater. If we don’t start caring for people as human beings, then why bother with anything else? It is either about humanity or its not. Those who are comfortable cannot turn a  blind eye thinking that these issues don’t affect them, because they will.

So in spite of being unpopular in some circles I take the personal risk to speak the truth the best and most honest way I can to anyone that will listen. I have to do it, for those that feel that they have no voice, as well as those who I have known who have lost their lives after giving up on the system. I owe it to them. It is now my mission in life and I do that I can both inside the system and outside of it to speak out for those who need it.  I guess I have become something of a liberal social activist, not that there is anything wrong with that.

I can be as persistent and irritating as Mustard Gas; I am doggedly determined to speak out for those that do not feel that they matter or have a voice; and I will stay in the fight until I can’t fight anymore. As Paul Tillich said “It is my mission to comfort the afflicted and to afflict the comfortable.”

I admit that sometimes it is like tilting at windmills, but this week, two men who have the position to influence the system took the time to listen and just maybe at least at some level things will begin to change. I am grateful tonight, maybe I will sleep well…

Peace

Padre Steve+

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Filed under faith, healthcare, mental health, Military, PTSD, suicide, US Navy

Moral Injury: Betrayal, Isolation, Suicidality, & Meaninglessness; the War after the War

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“Great Odysseus woke from sleep on native ground at last- he’d been away for years- but failed to know the land.” Homer, The Odyssey 

War changes the men and women that fight them. This is a truth that dates to antiquity. It does not matter the age or era, where the war was fought or what weapons were used, the pathology is similar, the scars of war, physical, The trauma of war, as Jonathan Shay notes in his book Odysseus in America, “shows ugly deformities of character that trauma can cause, but these deformities are fully human such as might happen to ourselves….” The fact is that the does happen is normal, but how we deal with it is not.

One of the most difficult things that many returning combat veterans face is being re traumatized upon returning home. As the Odyssey shows, for many returning combat veterans it is as if they are returning to an alien planet, which looks familiar, but feels like an alternate universe. It looks the same, but it is profoundly different. Erich Maria Remarque in his classic All Quite on the Western Front wrote:

“I imagined leave would be different from this. Indeed, it was different a year ago. It is I of course that have changed in the interval. There lies a gulf between that time and today. At that time I still knew nothing about the war, we had been only in quiet sectors. But now I see that I have been crushed without knowing it. I find I do not belong here any more, it is a foreign world.”

Shortly before his death in a motorcycle crash T.E. Lawrence, the great Lawrence of Arabia wrote a friend. Lawrence certainly suffered from PTSD and other afflictions that lingered long after the war. The words are haunting and they so describe how many veterans feel, even long after they left the combat zone. For Lawrence and so many others the war after the war never ended. Lawrence wrote:

“You wonder what I am doing? Well, so do I, in truth. Days seem to dawn, suns to shine, evenings to follow, and then I sleep. What I have done, what I am doing, what I am going to do, puzzle and bewilder me. Have you ever been a leaf and fallen from your tree in autumn and been really puzzled about it? That’s the feeling.”

This has been a facet of life for American military personnel ever since the Vietnam War. Much of the trauma comes from the unnatural and ahistorical manner of how we send men and women to war and bring them home. Now generally we prepare people for war fairly well. However, we send many to war as individual augments, away from their units and people they know, place them in units or organizations where they are relatively isolated and sometimes face great danger, then we bring them back alone, with barely any time to decompress, tell their story and face the consequences of war with those that they know.

Guy Sager, writer of the classic The Forgotten Soldier wrote of his return from war:

“In the train, rolling through the sunny French countryside, my head knocked against the wooden back of the seat. Other people, who seemed to belong to a different world, were laughing. I couldn’t laugh and couldn’t forget.”

The result is that most don’t get the help that they need to make the adjustment. The fact is that the best help is usually found among our comrades who have shared our experience. Before trans-ocean air travel, soldiers came home on troopships, with those that they served and the voyage home lasted anywhere from two weeks to a month. That gave these soldiers the opportunity to process what they had been through, and while they might not have had much in the way of “professional” mental health care, they did have each other. Likewise, they returned to a country where many if not most of the citizenry had shared at least some of the sacrifice of war, and many of whom had family members who had served at war, or who had lost people they knew.

A survivor of World War I’s “Lost Battalion” wrote after the war:

“We just do not have the control we should have. I went through without a visible wound, but have spent many months in hospitals and dollars for medical treatment as a result of those terrible experiences.”

Today soldiers are sent from the United States or United States military bases in Europe or Asia into harms way, and when their tour of duty is done, are sent home in a process that seldom takes more than a week, usually less. Apart from a few airport greeters and their family, if they have a family, their return goes almost unnoticed. They return to a world where there has been no shared experience and people go about their business untouched by war. The return is often overwhelming, and many times disorienting and frightening to the combat veteran who no longer feels connected to the country or people that sent him or her to war. The normal issues faced by redeploying soldiers, especially with their families are often even more pronounced, they and their families struggle.

The general feeling of social isolation is often made worse when they return to their home bases, stations or units and discover that instead of being welcomed home, that they are treated as if they made the life of those who did not deploy harder. “Welcome back, now you can get back to real work, now you can be back on the duty roster.” Within weeks they are submerged in routine, often mind numbing tasks among people who have not shared their experience. Alone they try to cope, quite often not very successfully. For those suffering from combat trauma, especially the unseen injuries of PTSD and Traumatic Brain Injury the experience is magnified. There is a sense of isolation and meaninglessness as they attempt to put their lives back together. For those that seek help, on the active duty side of the house there is a stigma to getting mental health care, which is so pronounced that many either avoid treatment or stop shortly after starting, instead self-medicating with alcohol or drugs. The same is often true for those who seek help in the Veterans Administration system, except they, having finished their active service do not have to endure the shame of being called or considered “broken” by their superiors or their peers. For those that have not served, to be labeled as “broken” is one of the worst things that can happen to you in the military, it is to say that you have no intrinsic value, no matter what you have accomplished to that point or what you have suffered in the line of duty.

Those that do decide to take the risk in going to get mental health care are often then traumatized by the very system that supposedly is there to help them. While there are many gifted, caring and skillful psychiatrists, psychologists and therapists working for the military and the VA, the process of getting care can be brutal and dehumanizing. The intake process is often impersonal and quite often the ordeal dissolutions those going through it. As a personal note, when I transferred back to the area that I previously had been treated it was like I had never been in the system. It was starting from scratch, and while I had gone back to the system seeking basic follow up care, the process broke me and made me worse. Due to the intervention of so very caring people including a former commanding officer who is being promoted to Admiral, I am getting some help and may even be able to contribute to a solution. But it should not be so hard, the system in overwhelmed, undermanned, underfunded and broken, despite the best efforts of some in leadership. The result is that combat veterans are further traumatized and marginalized.

The combination of new trauma, that of no longer feeling a part of society, that of being disconnected from friends and family; that of being isolated at work and treated as a number by those in the medical and mental health system. All of those things add further injury and contributes to the sense of betrayal, the sense of betrayal that goes to the heart of Moral Injury.

Moral Injury involves the breaking of trust, confidence and core beliefs. That can encompass everything from what a person believes about God, the idealism about one’s country, the military that one serves and even the society and family. Moral Injury is an abiding sense of loss of faith and confidence in the things, the beliefs and ideals that one held dear. It is a layer of trauma that adds to what one has experienced in combat, it is another layer of trauma on top of PTSD, TBI and other Combat Stress related issues. It increases the severity of other psychological conditions including depression, anxiety and the risk of suicidal, or other risk taking behaviors.

But it doesn’t seem to me that anyone gets this, and those that do are not in a position to influence policy. Neither are they in a position to ensure that mental health providers are trained to recognize, care for and not increase the chance of further traumatizing those in their care. Instead those coming home from war seem to be condemned to a sort of hell where they do not feel they matter, are treated as numbers or even worse, feel that they no longer can contribute, because they are “broken.”

My experience is that it takes far too much effort to get the basic care that one requires, and most people after being beaten down simply give up. A person should not be reduced to tears and seriously consider suicide to get attention. A person should not have to know a doctor who is going to be an Admiral to get someone to listen to them. Honestly most people will neither endure the ignominy or pain of seeking help in such an environment, much less skyline themselves but writing and speaking about I like I do. For most any of that is far too dangerous or risky.

Some, including people that I know and love and respect have lost their families, careers and lives simply because they did not want to have the stigma of being considered “broken” or deal with the impersonal and machine like bureaucracy that is our mental health system. The sad thing is that this encompasses not only the military and VA systems, but the civilian system as well. I have known far too many people who have ended their lives after being further traumatized by the system. These people include senior officers and even chaplains, most who risked their lives in combat multiple times only to return home broken. I know too many of them, men who were real heroes, who died at their own hand, or others who lost their families and careers.

I know PTSD, I live with that reality daily, the depression, anxiety, hyper vigilance, paranoia, nightmares, night terrors, insomnia and fear of of crowds, traffic, and normal relationships. That is life and I do my best to deal with it, sometimes more successfully than others. My marriage has suffered because of my madness, and I have experienced the rejection of many of my peers in the Chaplain Corps. Likewise my former church and bishop, after two knowing that for two years I was for all practical purposes an agnostic and knowing my life was a wreck, kicked me out when my faith, though very fragile and mixed with doubt, returned. I asked hard questions, and when I asked them publicly I was tossed for being “too liberal.” That rejection, the rejection of a faith community also contributes to Moral Injury. Sadly I know too many others who have returned from war to be rejected by faith communities that advertise how the “love, pray for and support the troops.”

In spite of that I continued to seek help, and at Camp LeJeune my commanders and others ensured that I got what I needed. It helped and when I returned to Hampton Roads a year ago I really thought that I was doing better. That changed last month. I went back, seeking follow-up care, which I assumed was just to download my issues with once in a while and manage my medication. Instead that attempt to re-enter the military mental health care system did me considerable harm, hell I considered suicide just last week after this. I no longer think that what I need is simple occasional follow up care, instead my experience shattered me. I had no idea just how fragile that I was, it was as if the floor had been kicked out from under me.

That my friends is what Moral Injury does to someone. Those are the kind of experiences that break a person’s faith and trust in the things, ideals, institutions and people that they grew up trusting and believing in. That loss of faith and trust, combined with the other layers of Combat Stress Injury can be devastating, and it doesn’t seem to matter because most people are neither aware, nor do they care. Not because they are bad people, but because there is such a gulf between the military and society at large that such issues are distant and incomprehensible to most people not in the military.

Yes, my trust in the system and my country is broken and I don’t know if I will ever regain the faith that I have lost. I honestly want to, I want to believe. God I want to believe. Now it does look like I will be getting help, and maybe even a chance to help being a part of the solution, and that will be a good thing.  Today I got a call from the Admiral at the Medical Center, unfortunately it went directly to voice mail, but he did sound like he cared and wanted to listen. For that I am grateful.

Pray for me as I get a chance to speak with leaders who have some influence to make things better, not just for me, but for all of us.

Peace

Padre Steve+

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Filed under mental health, PTSD, suicide

“You Broke it, You Bought It” The Responsibility of a Nation at War

The past couple of days have been very trying as I have been dealing with trying to get simple basic follow up care for the PTSD that I have been dealing with since 2008. Over the past couple of days I have experienced the push back of a system that is attempting to save money at the expense of patients, and inexperienced treatment by mental health providers who are insolent, disrespectful and disdainful of the professional colleagues that they are treating.

Since I dealt with this at length last night I am not going to bore you with those details.  Today was actually worse than yesterday as the provider made the situation worse. In fact the HIPPA violations and disrespectful treatment that would get a lawsuit in the civilian world, but active duty military can’t do that because of the Feres Doctrine.   There are a couple of people seeing what they can do to get me help, and I am glad. However, if they are unsuccessful this will go to the highest ranks of the Navy Medicine system, to Congress and the media.

As I noted last night, our former Secretary of State and retired Chairman of the Joint Chiefs of Staff, Colin Powell said, referring to the country of Iraq: “You break it, you buy it.” this is certainly something that that certainly should apply to those who have served their country in combat and come back broken, just as much as it does to the nations that we occupy and destroy during war.

Last night I wrote and published the article about the terrible treatment I have received since trying to get back into therapy for my PTSD issues. This morning I received an e-mail from my mental health provider that displayed a tremendous, almost stupefying disregard of my experience, as well as the facts that are recorded in my medical records. That e-mail has settled the issue and hardened my resolve to see this through.

My provider basically told me that the choice was not mine to make. She offered me options that neither work for me as a patient, nor were clinically indicated based on my medical record. The sad thing is that as a professional I have probably have more clinical experience and training dealing with PTSD than most providers including her. The fact that she didn’t even graduate from medical school until the war in Iraq was almost over, and has not deployed herself and then treated me with such disregard and disdain.

As I said yesterday this is bullshit. First from the perspective of a senior officer I can totally understand why senior officers and enlisted personnel avoid the military mental health system. First there is the stigma, which whether we like it or not is still very real. I decided to ignore the stigma in order to get help. However, the stigma  keeps many senior leaders from getting help as does the way they are treated when they do try to get help. The system  refuses to deal with people as individuals and instead treat all patients regardless of their rank or experience as if they were 19 year-old recruits with no maturity or understanding.

As I mentioned last night I fear for senior leaders that do not get help because they are afraid of the stigma and the treatment by providers that treat them with disrespect; as well as the junior enlisted personnel that whether they seek treatment on their own, or are told to go by their command enter into a system that on the whole treats them with disrespect as if they were cattle.

The fact is that no matter if they are old veterans, or young men and women, they deserve better. Especially those suffering from PTSD, TBI or other combat stress injuries. They deserve the best the nation can offer, not sloppy seconds. As an old salt that I will fight for all of them, while I am in the military and after I retire.

Have a nice nice night,

Peace

Padre Steve+

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Broken and Unlikely to Get Better: Military Mental Health Care

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Well, my friends it’s time for me to get on the PTSD soapbox and go “Smedley” on the military mental health system. The fact is the system is broken, maybe not as bad as the VA, but broken nonetheless. The biggest part of the problem is not that there are not enough providers, there are not even though many more have been hired. The biggest part of the problem is that the system has lost any humanity that it once had, all in the name of efficiency and the budgetary bottom line. The fact is that the bottom line actually matters more than people and bean counters, not providers have the final say.

Marine Corps Major General, and two time Medal of Honor winner, Smedley Butler wrote after he retired in his classic book War is a Racket:

“I have visited eighteen government hospitals for veterans. In them are about 50,000 destroyed men- men who were the pick of the nation eighteen years ago. The very able chief surgeon at the government hospital in Milwaukee, where there are 3,800 of the living dead, told me that mortality among veterans is three times as great as among those who stayed home.” 

Two years ago, the Navy seeing a increase in healthcare costs decided to bring as many people back into the Navy Medicine system as possible and cut back on referrals for active duty personnel. I understand that, money is short and Lord knows we need to save it wherever we can in order to buy aircraft like those in the grossly over-budget, behind schedule and substandard F-35 Lightening stealth fighter plane program, or ships like the Littoral Combat Ship which are over budget, under armed and not designed to survive the slightest combat. Mind you, none of the F-35s are in service, despite a decade of tests and production delays, costing hundreds of billions of dollars. But I digress…after all, war is a racket.

Now let me be honest and as fair as possible. There are many great mental health providers in the military and the Navy Medicine system; active duty, reserve, civilian and contractors. These people actually do care, but often they don’t get to make decisions that they think are right for their patients. At the same time there are others working in the system that are just in it for job security or the money. However, all of them are at the mercy of commanding officers that decide how they want to spend their budget, and dictate to their providers, sometimes at the threat of their job, contract renewal, a positive fitness report or promotion recommendation what they will approve, or more likely, deny. Thus in some cases commanders will support their providers doing whatever possible to get patients help, while others look at the bottom line. I have had both experiences.

I have been getting mental health treatment for PTSD since July 2008 when my life fell apart after Iraq. I have had mental health providers in the Navy Medical system. I also had a civilian psychiatrist who I was allowed to see when I was at Camp LeJeune, even after Navy Medicine decided to bring people back into the Navy Medicine system.

You see at Camp LeJeune, the old hospital commander, who I worked for, and the Director of Mental Health who I worked with realized that as a Chaplain that my personal and professional privacy, and my need for continuity of care was important. They realized that I needed to feel safe. There I was treated with professional courtesy, with humanity and I felt like people actually cared about me. That was was something that I needed then, and still need now. Unfortunately that is not happening now.

When I returned to the Hampton Roads area I knew that I still needed mental health care. I finally got my first visit and intake evaluation in June. My first appointment with a psychiatrist came on July 7th. The psychiatrist herself was not the issue. You see I used to work at the Naval Medical Center for two years and continued to work at the Naval Hospital Camp LeJeune for another three. I am fairly well known in the Navy Medical Region East.

I suffer a tremendous amount of anxiety. I admit it, I am still bat-shit crazy. I have the PTSD “Mad Cow.” The night before my first appointment I could not sleep, most likely because of being anxious about going to the Naval Medical Center outpatient mental health clinic. The fact is, it is really big and impersonal, and frankly that scares the hell out of me. I can’t go to big churches for the same reason. I feel terribly unsafe in them.

My worst fears were borne out. The waiting room was crowded, and after waiting I had my name and rank called out for everyone to hear, so much for the expectation of privacy, in fact I think that was a HIPPA violation. In the intake room I was met by three very junior hospital corpsmen. I didn’t even get a “hello, how are you doing sir?” from them. Instead one told me to take off my shirt, one told me to step on a scale and after that I was told to sit down, and got my blood pressure taken. My blood pressure was twenty points, actually almost 30 points higher than normal, even after I have just had a bunch of caffeine, which I did not on July 7th. I have to attribute the rise in blood pressure to the anxiety of just going in to the clinic, there is no other reason. After I had my vitals checked, I was asked a series of rapid fire questions that were very personal in nature and that I would prefer a doctor or nurse ask. I was then told to go back and wait.

The whole process was impersonal, embarrassing and dehumanizing. But it was very efficient, and the bean counters should be happy. That being said it was the absolute worst experience I have had with military medicine, and that includes having a thumb stuck up my ass and having to duck walk at the Military Entrance Processing Station. That was a rite of passage, but this scared the absolute hell out of me, I did not feel like I mattered as a person to anyone in the clinic.

When I saw the doctor she was pleasant. I told her of my experience and requested that I be referred to a provider in town as I had at Camp LeJeune. I was told that she would submit the request to her division officer who is a doctor that I know, and get back to me in a day or two. I didn’t hear from her. I waited two and a half weeks, and finally decided to e-mail the doctor on July 24th asking what was going on. Today I got an e-mail telling me that “my case could not be sent to the civilian network.” No reason was provided. The time between that appointment and the denial of my request was almost four weeks, totally unacceptable by any standard of care, military, civilian or even Klingon.

I was given the option of seeing a provider at an outlying clinic however the one close to where I work would be similar to the main hospital, crowded and impersonal. The other option was using a resource called “Military One Source” where I could get up to 10 or 12 appointments with a civilian provider in town with no guarantee that I would be able to see them after those visits were up without approval from the same people who just told me that I couldn’t be seen in town. If I do that my medication would then be managed by my PCM instead of a shrink. At this point I no longer have any trust in the military mental health system, at least for me, and the Military One Source providers are not really there to deal with long term chronic conditions.

I knew that I was being blown off. In military speak it is the old adage that “a mission passed is a mission completed.” The fact is that I do not matter to these providers. Unlike the people at Camp LeJeune, they have no personal investment in me as a patient or as a professional colleague, so why should it matter to them? I don’t write their evaluations, the bean counting admiral does so, why would an old and broken chaplain who doesn’t work with them matter?

Likewise I am being treated like a child in regard to medication. I have no history of drug abuse, prescription or otherwise. Unlike LeJeune where my doctor put refills on my as needed PRN anxiety medicine, I now have to subject myself to the industrial “production line” inhumanity of that clinic, just to get a refill each month.  Even if I didn’t want therapy I would have to endure the ignominy of the inhuman treatment at the clinic 12 times a year just to get a pittance of very low dose anti-anxeity medication. I don’t need that kind of abuse, and that it exactly what it is no matter what the bean counting admiral calls it.

But here’s the deal. I am a senior officer. No wonder so many senior officers decline treatment, attempt to hide their symptoms and self-medicate. The treatment in the system is demeaning and the stigma is there. I have known of a good number of senior officers, Marines, Navy and Army who have ended up losing their careers or lives over untreated PTSD. Right now I am debating even if I should go back to therapy. I know I need it, but if it is a choice of the abuse I am going through at the mental health clinic or maintaining a semblance of human dignity, a good craft beer tastes far better than Xanax.

Not only that, but an even far more important reason than me and my needs, that of the junior enlisted personnel who seek help or are directed by their commands to get help from mental health. Now I cannot imagine what it would be to be a powerless junior enlisted soldier, sailor, Marine or airman. But wait I can, I enlisted in the National Guard back in 1981. However, back then I wasn’t broken, and I cannot now imagine what is is for young, powerless enlisted personnel have to go through what I am going through when getting mental health treatment. That is the bigger issue.

Is it any wonder that the military suicide rates are still high and that this year the Navy is up from the same time as last year? According to statistics released last week, there have been 36 Navy suicides this year, last year at this time there were just 24 with 43 for the entire year. I wonder if that has something to do with pushing people into an often uncaring bureaucratic system that is more concerned with saving money than meeting the needs of patients.

I was talking to a friend, an officer at the Medical Center today while at a different clinic where I am treated with great compassion, care and dignity, a clinic that is not afraid to get me the medical help that I need, even though it is expensive. This officer and I served at Portsmouth together back in 2008-2010 and that officer told me today that the place has changed. He said it was all about business, impersonal and machine like, devoted to the bottom line, with lip service being given to actual patient needs by those in senior leadership.

Thank God I won’t have to stay in the military medical system the rest of my life. The good news is that when I retire I get to go to the amazingly proficient VA system for that care. Won’t that be grand?

No it won’t. Not for me or any of the tens of thousands, maybe hundreds of thousands of military personnel with PTSD, TBI or Moral Injury. We’ve all read about the problems in the VA, they are persistent, endemic and won’t change anytime in the near future. That is shameful.

General and former Secretary of State Colin Powell famously said “you broke it, you buy it.” Of course he was talking about Iraq, but the same principle should apply to those who have put their lives on the line during the last 13 years of war and come back broken. It is a moral obligation, it is something that we as a nation promised. The country pledged to care for those who served, and the fact that it is barely a half percent of the population who have served in war for the last 13 years, men and women who now have to fight for the basic care that a civilized, and as the Religious Right likes to call a “Christian nation” should provide as a matter of basic human decency. It is not special treatment that broken veterans deserve, it is simple decency and honoring a commitment that we made as a nation.

Yes I am going “Smedley” here, because war is a racket, and it is a racket that those inside the military, the government and the private sector promote.

I’m sure that I will get some blowback from this from some in the system, but I don’t care. The system is broken and until we as a nation stop bullshitting and admit there is a problem and elect to do something about it won’t get better. The bean counters, war profiteers and bureaucrats need to be held accountable by our elected representatives.

I am going to be contacting the Admiral that commands the medical center as well as my Congressman, and probably the chairmen of both the House and Senate Defense committees because I suspect from what I hear from soldiers, sailors, Marines and airmen around the country that this is not an isolated instance. So, if someone like me, a senior officer still in the system doesn’t do this who will?

I hope that this post will become viral so that our sailors, Marines, soldiers and airmen get the quality care, delivered with compassion and humanity that they deserve. For some it will be a matter of life and death.

Pray for me a sinner.

Peace,

Padre Steve+

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Filed under healthcare, Military, PTSD, US Navy

Faith and Doubt on a Sunday Afternoon

shakethefinger

 

“Most priests, if they have any sense or any imagination, wonder if they truly believe all the things they preach. Like Jean-Claude they both believe and not believe at the same time.” Andrew Greeley “The Bishop and the Beggar Girl of St Germain”

Many off my readers as well as people I deal with on a regular basis struggle with faith and doubt. Today I was reading a column in the New York Times that brought up a very interesting article called Where Reason Ends and Faith Begins  by T.M. Luhrmann, http://www.nytimes.com/2014/07/27/opinion/sunday/t-m-luhrmann-where-reason-ends-and-faith-begins.html?hp&action=click&pgtype=Homepage&module=c-column-top-span-region&region=c-column-top-span-region&WT.nav=c-column-top-span-region a professor at Stanford. It talked about the point in different where individuals make a decision of what they chose to believe because it is reasonable and what they chose to believe by faith. I also read an article by Bishop Gene Robinson called Hope When the World’s Gone off the Rails  http://www.thedailybeast.com/articles/2014/07/27/hope-when-the-world-s-gone-off-the-rails.html Both were excellent articles because they deal with a reality that many religious people don’t want to deal with. Something that I have struggled with most of my life, but especially after I returned from Iraq in 2008.

When I returned from Iraq in 2008 I was a mess. I had gone to Iraq thinking that I had the answers to about anything and that I was invincible. I felt that with years of experience in the military and in trauma departments of major trauma centers that I was immune to the effects of war and trauma. Likewise I had spent years studying theology, pastoral care and ethics as well as military history, theory and practice. I had studied PTSD and Combat Stress and had worked with Marines that were dealing with it. If there was anyone who could go to Iraq and come back “normal” it had to be me.

Of course as anyone who knows me or reads this website regularly knows I came back from Iraq different. I collapsed in the midst of PTSD induced depression, anxiety and a loss of faith. For nearly two years I was a practical agnostic.
During those dark days, particularly the times where I was working in the ICU and Pediatric ICU at Naval Medical Center Portsmouth attempting to have enough faith to help others in crisis, be they patients at the brink of death or families walking through that dark valley even though I did not have any faith to even believe that God existed.

It was during those dark days that the writings of Father Andrew Greeley, mainly his Bishop Blackie Ryan mysteries that provided me with one of the few places of spiritual solace and hope that I found. Baseball happened to be the other.
During those dark times when prayer seemed futile and the scriptures seemed dry and dead I found some measure of life and hope in the remarkable lives of the people that inhabited the pages of the Bishop Blackie Ryan novels. Through them I learned that doubt and faith could co-exist and that there was a mystery to faith in Jesus that defied doctrinal suppositions as well as cultural, political and sociological prejudices.

I did learn something else, something that makes many people uncomfortable and that took me a long time to accept. That was that doubt and faith could co-exist and as I read Greeley’s stories I began to see scripture in a new light, especially the stories of men and women that we venerate for their faith who doubted and even when they believed often disputed God. The Old Testament is full of their stories and there are even some in the New Testament. Greeley wrote that is was possible for a priest to lose their faith “no more often than a couple of times a day.”

Thus I find it hard to deal with preachers and others who are so full of certitude that they are full of shit, no matter what their faith tradition. God is too big for that.

I rediscovered faith and life as I anointed that man in our emergency room in December 2009. To my surprise faith returned. I believe again but I also doubt, at least a couple of times a day, it keeps me humble. And for that I’m grateful.

Peace and have a wonderful rest of your weekend,

Padre Steve+

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Filed under christian life, faith, Pastoral Care, PTSD

Sacrifice, a Broken Heart and No Closure: Thoughts of an Iraq Veteran

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Call em up
Dust em off
Let em shine
The ones who hold onto the ones, they had to leave behind
Those that flew, those that fell,
The ones that had to stay,
Beneath a little wooden cross
Oceans away

Elton John “Oceans Away”

For me and from what I am hearing many veterans like me, the last week has been terribly haunting and filled with anxiety regarding the situation in Iraq. I can when needed detach myself from my emotions and compartmentalize them to attempt to provide good analysis of the situation and place it in its historical, diplomatic, military, cultural and religious context. However, the emotions that I feel for Iraq and what is happening there are strong and I will own my sense of grief, loss and brokenness that I feel right now as the ISIL/ISIS fighters drive through Iraq conquering city after city as the Iraqi Army abandons the field. I wish I could say that things will turn around, but I don’t know if that is possible now. That fact troubles me because I love the Iraqis and left part of me in that country. As I have written before, I left my heart in Al Anbar.

During my tour in Iraq I got to see a part of the country and meet people that the average American never met. I got to know Iraqis because I served with our advisors in country, and I got to know some on detained ships in the Arabian Gulf back in 2002. Most are good people, who have hopes and dreams much like any of us. The vast majority are not extremists and relatively secular, regardless of their religious affiliation in comparison to others in the Middle East. They hope for better for their families, their future and in simple for a normal life after over 30 years in various states of war, with us, the Iranians and with themselves. I worry for them, and pray that by some miracle that they are able to get their families out of the country to safety or be able to get to an area of the country where their safety is assured. For some that may be that may be more possible than others. I worry for them because of the reports of how the ISIL/ISIS forces are wantonly executing officers, soldiers and police officials that they capture alongside the road.

I won’t be doing any real analysis today because this essay is more about my feelings about the situation, and I really don’t want to be mixing those with some kind of analysis. What I can say is that I am grieving for all who have been affected by this cruel war, Iraqis and Americans alike. Far too many people died during and after the ill-advised and most likely illegal invasion of that country by the Bush administration in 2003.

I am the kind of person who wanted to believe the best about the reasons the Bush administration took us to war, but as each of those reasons was proved untrue based on the evidence on the ground it was disappointing. However, I volunteered to serve in Iraq in 2006 and finally went in 2007, with a goal of helping in the effort to restore and reunited the country, something that despite everything I believed was a worthwhile goal. It became apparent while I was over there that for many, especially those managing the massive support contracts to U.S. bases were not there for any noble purpose but for their profits. I saw how KBR/Halliburton subsidiaries engaged in what was for all intents and purposes human trafficking as they exploited third country nationals who did the menial work that supported U.S. and coalition forces. I saw the massive destruction in the country, some caused by the U.S. invasion, and some attributable to the civil war that followed.

I felt betrayed by my leadership and I have a fair amount of anger about this, anger toward the Bush administration, the Congress that shirked its duties and allowed this as well as the war profiteers. But I am also angry at the power mongering Iraqi Prime Minister Nouri Al Maliki, whose actions to disenfranchise the Sunnis and others have brought about the current situation, without his idiotic power mania those Sunnis would be fighting against ISIL/ISIS, just as they did against AQI.

Because of this, especially the actions of the war profiteers, I have to agree with Major General Smedley Butler who wrote the classic book War is a Racket and that it is the soldiers that fight the wars and the innocent civilians whose lands, homes and families suffer as a result of it. Butler wrote:

“What is the cost of war? what is the bill? This bill renders a horrible accounting. Newly placed gravestones. Mangled bodies. Shattered minds. Broken hearts and homes. Economic instability. Depression and all of its attendant miseries. Back -breaking taxation for generations and generations. For a great many years as a soldier I had a suspicion that war was a racket; not only until I retired to civilian life did I fully realize it….”

My world has changed. I am not the same person I was that I was when I deployed to Iraq. PTSD, nightmares and terrors and anxiety are still a regular part of my life, as is a certain distance from parts of my life that once were important. When we went to war I didn’t believe that it would end this way. Like Erich Maria Remarque wrote in his classic All Quiet on the Western Front:

“I imagined leave would be different from this. Indeed, it was different a year ago. It is I of course that have changed in the interval. There lies a gulf between that time and today. At that time I still knew nothing about the war, we had been only in quiet sectors. But now I see that I have been crushed without knowing it. I find I do not belong here any more, it is a foreign world.”

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Last night I attended the Elton John concert in Virginia Beach. He shared a song that he and Bernie Taupin wrote in honor of the members of the Greatest Generation on the 70th anniversary of the D-Day landings. The song, Oceans Away is about their sacrifice, and Sir Elton also paid tribute to those who fought and died in World War One as well as those that serve today. When I listened to the song I wondered if people like me will ever be able to go back to the battlefields that we served on.

Anyway, that is all for today. I have a number of writing projects in the works. The link to the song is here: http://www.youtube.com/watch?v=Izma0gpiLBQ

Peace

Padre Steve+

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Filed under iraq,afghanistan, middle east, News and current events, PTSD