Category Archives: PTSD

October 11, 2014 · 20:23

Is it Really God or do I Make You Uncomfortable? PTSD, Mental Illness and Christians

Christians can be among the most clueless people regarding how their language and theological prejudices negatively impact others and harm their own witness regarding their professed devotion and love of Jesus the Christ. Sadly much of what they spout is neither scriptural or has any roots in reason or church tradition. Instead it is a product of their own prejudice and uncomfortableness with those who express doubt that they have learned from very popular, yet extremely ignorant and often hateful political ideologues who masquerade as preachers in mega-churches, on television, radio or the internet.

There are many Christians, particularly conservative Evangelicals and Charismatics who are fine people, men and women of integrity who I can honestly say love God and try serve God and also to care for his people. That being said many of these same people in their attempts to help others; especially those dealing with PTSD, depression, anxiety, suicidal thoughts, substance abuse and faith crisis’s do more far damage and harm than good. This is because they are unaware of their prejudices that they learn in church and how wrong their preachers are about such subjects, but still presume that what they have learned trumps other people’s experience. Yes this is a generalization, but there is much truth in it.

Those who read this site regularly and know something about me know that I am a Navy Chaplain, a Priest in an Old Catholic denomination and have been in the military over 30 years including a tour in Iraq and one at sea for Operation Enduring Freedom. You also know that I am very transparent about my struggle with PTSD as well as faith following my return from Iraq in 2008. According to many I am now a “liberal” which for some is even worse than being an “unbeliever.”

Being transparent about this difficult because it involves risk and as a person who is extremely introverted to begin with I am a very private person and eschew risk. I can understand why people who struggle with different parts of themselves that are unpopular or stigmatized by people in “normal” society feel, especially in the church. However in 2009 in consultation with my first therapist I decided to in a sense “come out of the closet” in regards to PTSD, moral injury, depression, anxiety, suicidal thoughts and mental illness in general; as well as my struggle to dealing with faith and God. All of those things are fraught with danger in a military society where the stigma regarding all of these things is all too real and all to prevalent in the military. But I digress…

Stigma is difficult and I deal with it all the time. What I represent by being so transparent, especially to Christians who have an absolute need for certitude in their lives is a topic that they don’t want to face. PTSD and other mental illness is a subject that scares many people. For some religious people, not just Christians, it forces them to retreat into the certitude of a Fundamentalist theology that blames the victim rather than to face reality of the issue, and the uncomfortable truth that it could happen to them.

Of course when your theology is that of “Job’s comforters” the only way to deal with such subjects is to retreat to that certitude. Admitting the truth would be something that would shred their faith and maybe even destroy their belief structure, thus to keep that certitude the experiences and faith of others which are different must be dismissed, confronted or shown to be wrong so the offending individual can repent and turn back to God.

Last week I had an officer come up to me after a ceremony and begin to tell me that “God sent him to our school” and he was there “not to learn what we teach” regarding what he as a relatively senior and up and coming officer is there to learn, but “to do the Father’s business.” For those that don’t understand this him that business meant that he had to tell me that God didn’t send him here to learn what he was sent to learn but to bring me back to the right way of thinking and belief.

I have no doubt of the man’s sincerity, but sometimes sincere people scare the hell out of me. I understand why Eric Hoffer wrote these words about “true believers”:

“The impression somehow prevails that the true believer, particularly the religious individual, is a humble person. The truth is the surrendering and humbling of the self breed pride and arrogance. The true believer is apt to see himself as one of the chosen, the salt of the earth, the light of the world, a prince disguised in meekness, who is destined to inherit the earth and the kingdom of heaven too. He who is not of his faith is evil; he who will not listen will perish.”

It has been my experience that such people are more inclined to want to tell you what to do rather than listening. This man began to tell me about his “testimony” that though he “didn’t have PTSD that he had a right to have it” and that “God wanted to take my “garbage” from me…but I kept taking it back.”

It took me the night to sleep on it before I realized the full implications of this man’s words.

Though I have heard this kind of talk for decades growing up in evangelical and charismatic Christian circles what this man said to me stunned me. I don’t expect educated professionals to make those kind of comments. However, religious fundamentalism, be it Christian, Jewish, Moslem or whatever can make educated professionals as fanatical and even as bloodthirsty as unlearned oafs. Please note that many of the top leaders of the Islamic State are educated professionals with highly technical backgrounds. Being educated does not mean that you cannot allow your religion to turn you into a sociopathic killer.

Let me just share my thoughts on his words. First there was the comment that he “was not at our Staff College to learn what we taught” but rather “to do his Father’s will.” I am sorry, I cannot accept such logic from either a Christian or a military professional perspective. First from the Christian perspective we have multiple responsibilities in our lives, faith should inform us. At the same time if a person is a Christian but also an officer, he or she is also an agent of the state who has sworn an oath to the Constitution.

The more that I thought about this man’s words, that he wasn’t at our college to learn, but to “do his Father’s will” I got more angry. He said that he wants to talk to me about my stuff next week but I think that I will have to tell him that if he is not here to learn that he should resign his commission. If he is not learning and does not care to learn then it is a waste of the taxpayer money and an abuse of his office and I am going to tell him that, and I may even inform the senior officer of his service on our faculty of his comments. Of course I cannot divulge his name or anything about him, but maybe the senior officer of that service can fire “warning shot” across the bow of all of the students from his service. But that comment angered me, it was arrogant and if I have any Christian concept of our responsibilities to God as well as our responsibilities to the citizens of our country who employ us.

The second thing that bothered me was that he insinuated that “though he did not have PTSD that he had a right to have it.” First, if he does not have it he is lucky and should be thanking God and not judging others. Second, if he does not have it he doesn’t have any right to have it. That statement is arrogant and presumptive and it totally devalues and dehumanizes the suffering of the person who would rather not be dealing with it. It would like someone telling a person with cancer that “though they don’t have cancer that they have a right to it.” I’m sorry, that would be reprehensible, just as this man’s words were to me. No one who does not have a disease or illness does not have a right to it.

But that’s the difference for the fanatic. Mental illness is not the same as physical illness. I cannot imagine this man telling me what he said if I had an illness like cancer, but I could be wrong because I have heard Christians, especially charismatics and Pentecostals say similar things to those with cancer or other terminal illnesses. The attitude is hateful, arrogant and so against what Jesus would do in a similar situation based on the words of scripture.

The last thing was that the man told me that “I kept taking my garbage back from God.” That devalued my experience, my suffering and my struggle to still believe even when I couldn’t believe. The fact is that I have heard this metaphor so many times that it is not even funny. What the illustration says in so many words is that if we suffer and God does not grant relief or healing that it is our fault, and we are guilty of keeping our garbage, even though God wants it.

Sorry that is bullshit of the worst degree. That metaphor is not even in scripture and I cannot even recall any of the Church Fathers who made such a statement. If we believe in God at all, and have faith to believe that in spite of trails, tribulations and suffering that God still loves and cares for us, that God has not abandoned us even when we feel that he has abandoned us that to say what this man said is outright blaspheme.

As you can understand from what I have said here, I am angry about this on a number of levels. I hope that this officer comes to see me this week because while I will be pastoral to him and care for him, I will not mince words. Unless he cares about his commission and duties as an officer then he better be at the Staff College to learn If he is not he should resign his commission and become a missionary. He is wasting taxpayer money and pissing on his oath of office and I am going to tell him that.

Second, I am going to tell him that if he doesn’t have PTSD that he doesn’t know what the hell he is talking about and he has no “rights to it.” I am going to tell him that if he says those words to the people who serve under him who do have it that he is misusing his office. I know far too many soldiers, sailors, marines and airmen who suffer the very real effects of PTSD, who suffer the discrimination and stigma that comes with it to have some “Christian” senior officer tell them that their suffering is “their problem” because they “took their garbage back from God.”

The whole thing was offensive, and last night I had a terrible time sleeping and this morning woke up suffering a lot of anxiety. On the way home from a visit to the local Navy Exchange I told Judy that I felt anxious and couldn’t put my finger on the reason why. Now I know, I was really bothered by what this officer said and it was much more disturbing than I had initially thought, because it is more than about me.

Now here is the bigger issue for me. It is a societal and policy issue. Chaplains are in the military to facilitate the free exercise of religion for all those in the military. We are not to proselytize and are to either perform or provide for the religious rights of all assigned to the units that we serve. I do that, and have done it for over 22 years as a chaplain in the Army and the Navy, honoring and caring for the religious needs of people across the spectrum.

But here’s the deal, thanks to the Christian right there are a host of fanatical Christians, mostly lay people who serve as officers and NCOs who have no concern for the rights of others, even the Chaplains who are there to make sure that they get what they need. Instead they are there not to serve the country but on their own religious mission paid for by tax payers and this is being promoted by many leaders of the American Religious Right, including James Dobson, Franklin Graham, Mike Huckabee, Pat Robertson, Phyllis Schafly, the leaders of American Family Association and Family Research Council including Jerry Boykin, Tony Perkins and Bryan Fischer, not to mention the corporate leaders of the big and politically mega-churches.

Can you imagine if Moslems in the military were to say that they in the military to serve “Allah” first what the same Christians who say that they are in the military to “do the Father’s will” would say? They would be apoplectic and protest how Moslems were trying to use the military to take over the government. But isn’t that what they are trying to do? As retired Army Lieutenant General and religious right activist Jerry Boykin said: “The military is the most respected institution in America. So if you want to change the rest of society, you have to target the military.”

As the late Dr. D. James Kennedy said before his death: “As the vice-regents of God, we are to bring His truth and His will to bear on every sphere of our world and our society. We are to exercise godly dominion and influence over our neighborhoods, our schools, our government… our entertainment media, our news media, our scientific endeavors—in short, over every aspect and institution of human society.”

Personally I cannot see how this is different from the the statements and actions of those of militant Islamic leaders of Al Qaida and the Islamic State. But then my presence and my transparency must be a threat. I’m pretty sure that this officer when he comes to share his “testimony” will further attempt to devalue my faith and experience. In fact I believe that this man is not so much driven by God but rather by his own doubts, fears and uncertainty about his own faith which is threatened by my words. Truthfully I have seen this far too often. People who must have absolute certitude in their own life who are threatened by those that express doubts. I felt that almost immediately when this man told me these things.

The stage is set, but I don’t plan on becoming a notch in his Bible and I am going to tell him straight up I believe that his theology is flawed and that I believe him telling things like this to me, or anyone else suffering PTSD is an abuse of his office. I also will ask him if he is sure that this is God, or if it is not his own fears hat he is expressing; and finally I will tell him that if his purpose at this highly selective level of military education is not to learn what we are teaching in order to serve as an officer, that he should immediately submit his resignation and retire from the military.

Why will I do this? Because simply I care about my country and my faith more than I do my career. I’ve been in the military a long time, well over half of my life, and frankly encounters like this are getting old.

Pray for me a sinner, because I will need it.

Peace

Padre Steve+

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Filed under christian life, faith, leadership, mental health, Military, PTSD

Tagged as christian right, faith, jerry boykin, Military, PTSD

October 6, 2014 · 23:29

Living with Dark Places and Pain

“There is nothing that can take the pain away. But eventually, you will find a way to live with it. There will be nightmares. And everyday when you wake up, it will be the first thing you think about. Until one day, it’s the second.” Raymond “Red Reddington (James Spader) The Blacklist

I am haunted by many things, unlike many people who have little self-awareness I might have just a bit too much. I have talked about the nightmares, night terrors and insomnia that I have many times following my return from Iraq. I used to believe, at least back in the first year or so after I returned that I thought that eventually I would get over it. I don’t believe that anymore, now I just believe that I will find a way to live with them.

I guess that is the secret to life. Instead of wishing that something would miraculously take way the pain, I guess that it is better to find a way to live with it because one day something else will replace it.

Is that an ideal way to deal with life? Probably not, but I know that I am an idealist anymore. I used to be, but that was a while back. It took time, but war and the lies of men that I voted for, men who I trusted because they professed my faith, my love of country, and some who even shared my vocation as a priest and chaplain took that from me.

Experts call this “moral injury.” For me it is connected with my tour in Iraq, PTSD and what I experience when I came home from colleagues, and people in my former church. Betrayal and abandonment is a terrible thing, but I am learning to live with it. It is not pretty but I am learning with every passing night and morning. Alexander Dumas wrote in The Count of Monte Cristo:

“Moral wounds have this peculiarity – they may be hidden, but they never close; always painful, always ready to bleed when touched, they remain fresh and open in the heart.”

My life is full again, there is meaning and purpose, but it is tempered by realism and the expectation that every day I will wake up and still think about those painful memories until finally something else takes their place.

I guess that the secret to living with darkness and pain is simply to live with it because the saying that “time heals all wounds” is a lie, it is the fabrication of people that don’t want to deal with the real world. God might heal, but then God may not. So I will live with it and in doing so I will continue on and in the process hopefully be there for others that also struggle with pain that does not want to go away and nightmares that never seem to end. As Henri Nouwen wrote:

“Ministry means the ongoing attempt to put one’s own search for God, with all the moments of pain and joy, despair and hope, at the disposal of those who want to join this search but do not know how.”

Peace

Padre Steve+

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Filed under christian life, faith, ministry, PTSD

Tagged as count of monte cristo, henri nouwen, insomina, james spader, moral injury, night terrors, nightmares, PTSD, raymond reddington, the blacklist, time heals all wounds

October 4, 2014 · 22:30

I Wish I Did Not Dream That Much…

“I wish I did not dream that much. They make me sometimes dread to go to sleep. Scenes from the war, are so constantly recalled, with bitter feelings I wish to never experience again. Lies, vanity, treachery, and carnage.” Major General Gouverneur Warren, hero of Gettysburg in 1867 in a letter to his wife

I have had a pretty good couple of weeks with my trip to the Oktoberfest and this past week. Apart from being tired from the travel and trying to catch up and reset myself my sleep has been good, well until last night. It was surprising because I have been happy, good things are happening in my life and I found out that I am being inducted into my high school’s Hall of Fame laster in the month. I have been catching up at work and preparing for the next iteration of the Gettysburg Staff Ride which I lead and I am working with a number of others on a new ethics class for our students. Likewise the baseball teams I want to win in the playoffs are winning, what could be wrong?

That being said since coming home I have been following the events in Iraq and Syria. Of course I have been horrified, but not surprised in the least at the latest public execution of an innocent hostage by the Islamic State. However, I have been watching the continued Islamic State advance in Al Anbar province where I served with out advisors and the Iraqi Army, Border and other security forces. Islamic State appears to be on the verge of capturing a number of important bases including Al Asad, and are advancing on Baghdad and may be in control of Abu Ghraib, nearly in artillery range of Baghdad International Airport. The fact that this is where I left so much of my heart and soul is particularly upsetting.

As the situation grows more serious and U.S. and allied involvement grows deeper I have no doubt that eventually ground troops will be fighting the Islamic State, which is perhaps exactly what they want. Last night I was surprised as I had a nightmare which went on and on. My wife Judy woke me up at one point, I was awoken again when I kicked the bookcase that serves as my nightstand. The nightmare did involve Iraq, but this time it was not set in the past, but in the future and it was frightening in its vividness and reality involving me as well as a number of people that I know from the military and other agencies including the State Department involved in a humanitarian mission.

As the politicians, pundits and preachers who lust after war and are seemingly eager to commit the sons and daughters of other people to a new ground war, without of course providing them the funding and equipment that will be needed because they would rather have tax cuts for the rich and corporations chum the waters; I am concerned. Sadly, we may have to commit ground forces, perhaps a sizable number to halt the advance of the Islamic State, and possibly even defeat them in Iraq. However, the Islamic State will not be stopped with military victories; they will regroup and morph into something else. I don’t think that the war we are in won’t end, at least in my lifetime. It will be like the Thirty Years War, but maybe longer. I would like to be wrong and I pray that I am, but the war keeps growing and nightmares keep coming.

On Thursday I was sitting in the waiting room of the doctor who prescribes my psych meds I caught the first part of an interview by Fox News with former President Bush. When I heard the questions and his answers I was livid, because it was Bush and his chicken-hawk advisers who in their ill-conceived and criminal invasion of Iraq helped birth the Islamic State, and now they were claiming that they predicted this. If these people were held to the same standard that we held the major war criminals of the Nazi regime at Nuremberg, they would all gone to the gallows. These people and their propaganda machine at Fox News keep trying to blame everyone, especially President Obama for their criminal negligence.

To me that it is infuriating. I know too many people whose lives have been devastated by their policies and decisions. I was so angry when I heard Bush say that “he understood the enemy” that had to tell the receptionist that I would be outside. The man has no clue about the enemy, he helped create them and will not take any responsibility for his decisions and the actions of his administration. Those decisions and actions were the seeds of a strategic defeat in terms of geo-politics and economics for us in the Middle East, a defeat from which we may never fully recover. As the former President spoke I wanted to rise up like the First Officer of Soviet Alpha Submarine Konovalov in The Hunt For Red October and say “You arrogant ass. You’ve killed us!”

Jesus says we are not to hate others, however I wrestle with this. When I experience the dreams and feelings that I have over the past couple of days I think I have to admit that I hate George W. Bush almost as much as I hate war and the Islamic State. Frankly

Maybe that is why I cannot sleep and why that nightmare was so terrifying and would not end. I can fully understand what Gouverneur Warren felt after the Civil War, because I feel the same way. “bitter feelings I wish to never experience again. Lies, vanity, treachery, and carnage.”

I pray for sleep tonight and I pray that I am wrong about this war, but I know that I am right.

Peace

Padre Steve+

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Filed under civil war, Foreign Policy, History, iraq,afghanistan, Military, Political Commentary, PTSD, Tour in Iraq

Tagged as abu ghraib, al asad, baghdad international airport, battle of gettysburg, dreams, fox news, george w bush, gouverneur warren, iraq, iraq war, isil, islamic state of iraq and the levant, nightmares, thirty years war

September 23, 2014 · 19:13

Oktoberfest Pilgrimage Live Blog: A Visit to Beer Land

“Beer is proof that God loves us and wants us to be happy.” Benjamin Franklin

One of my favorite comic strips is Stephan Pastis’ Pearls Before Swine. A few months ago one of the main characters appropriately named Rat, since he is a rat, decides to open his own amusement park called Beer Land. The series of strips is amazingly brilliant, especially to true beer drinkers. I think the strip from that series that I most enjoyed was this one, because of the way Pastis linked a ride at the strip to the syrupy Disney ride It’s a Small World.

Today we did a bit of a road trip and took the U-Bahn from Munich to a small town on the outskirts of the city called Erding, for a visit and tour of the Erdinger Weisbier brewery, the largest brewer of wheat beers in the world. Before heading to Erding we had taken a short visit to the historic Marianplatz where we were able to see the famous Glockenspiel at the old city hall, or Rathaus.

Now Judy has incurred a couple of injuries to her knee, ankle, and a couple of years ago had to her Achilles’ tendon repaired. As such sometimes a lot of walking causes her a lot, I mean a lot of pain. We tried to go out some yesterday but after a few minutes at Marianplatz but she was in such pain so we went back to our hotel until later in the evening when we went to dinner with our friends.

This morning she was in less pain but she knew if she didn’t get some European style crutches that she would not do well and possible be confined to the hotel for must of our remaining time here. For those that don’t know, European or as they are referred to in the United States Canadian crutches are far superior to the type most of us know and loath so much. They provide the user much more mobility and less pain to the armpits and shoulders because you do not swing from them.

So while she hung out with our friends I googled where to find the crutches in Munich. The word for crutches is krucken and they are sold at stores that specialize in equipment for those recovering from injuries as well as those with various physical disabilities called a Saniatshaus. The closest of these was about two miles away, so with google maps to guide me I set off. I walk pretty fast so it didn’t take that long to get there and when I did after the normal greetings with the lady at the counter I asked for a pair of crutches, which she showed me and allowed me to even pick the color. They cost about 34 Euros, which isn’t too bad, and for that quality I would have payed more in the U.S, had I gotten them at home. I made my way back by hailing a taxi to save time. Had a nice conversation about Munich, beer and the Oktoberfest with the driver and he delivered me back just city meters from where Judy and some of our friends had gathered. Since we were waiting on some of the rest of our group we had a beer at an outdoor cafe across from the Rathause where we saw the Glockenspiel do its thing when the clock stuck eleven.

Once all of us were gathered we boarded the U-Bahn to Erding a trip of about 45 minutes. Once in Erding we caught a city bus to the Erdinger brewery. We got our tickets for the tours and bought a couple of items in the gift shop and then went on the tour. The tour took about an hour and a half and was amazing.

I was impressed with how well a large brewery can make great beer using only the natural ingredients of hops, barley or wheat malt and water. There are no added sugars, food colorings known to be carcinogenic, Bisphenal A (BPA); cheap filler grains such as rice and corn as well as high fructose corn syrup, dextrose, and mono sodium glutamate, and even propylene glycol (a component of anti-freeze) are found in many mass produced American beers. This is because of the observance of the strict Bavarian or German beer purity law the Reinheitsgebot which stipulates what are acceptable ingredients in beer. Frankly the difference in taste is amazing as well as the effects, especially the morning after. But I digress….

As I mentioned the tour was informative and enjoyable. At the end of the tour, which cost 12 Euros per person we were provided freshly baked Bavarian pretzels, two large Bavarian Weiswurst, which are a mildly spiced and finely textured pork sausage and three half liter glasses of whichever of the eight styles of Weisbier that Erdinger brews.

It truly was a visit to Beer Land and I am sorry to say that at each stage of the tour I kept thinking about that comic, but no, I didn’t see the German kid beat up the French kid for his Hefeweizen.

So Since this a religious pilgrimage, I will close with a quote from one of my favorite rebellious theologians, the eminent Doctor Martin Luther:

“Whoever drinks beer, he is quick to sleep; whoever sleeps long does not sin; whoever does not sin enters heaven! Thus let us drink beer!”

Have a great day.

Peace

Padre Steve+

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Filed under beer, civil rights, faith, History, nazi germany, Religion, travel

Tagged as adolf hitler, beer hall putsch, beer halle putsch, benjamin franklin, canadian crutches, erding germany, erdinger weissbier, european crutches, glockenspiel, hefeweizen, marianplatz, Martin Luther, Munich, munich alt Rathaus, odeonplatz, pearls before swine, rat, stepahn pastis, U-Bahn, weisswurst, wheat beer, whitebeer

September 8, 2014 · 18:09

The Opportunity to Act Upon a Dream

“All men dream: but not equally. Those who dream by night in the dusty recesses of their minds wake up in the day to find it was vanity, but the dreamers of the day are dangerous men, for they may act their dreams with open eyes, to make it possible.” T E Lawrence

This week I will be part of a panel discussion entitled “Paths for Achieving Readiness Tomorrow” at the Military Officer’s Association of America “Warrior Family Symposium” in Washington DC. The opportunity came about through the Department of Defense’s Real Warriors campaign which I have been working with since 2011 when they did a video feature on my struggle with PTSD. The panel will be moderated by WUSA Channel 9’s news anchor Derek McGinty and will include a number of mental health care providers or program directors; I will be the only chaplain speaking at the symposium. The panel will discuss available and developing programs designed to provide insight, skills and assistance for veterans, service members, their children and families – to aid them through handling reintegration, combat/operational stress, and mental health concerns; and provide them and the community, the understanding of the art of being present.

I am a bit nervous about presenting despite having been very open and transparent about my struggles with PTSD since beginning this website back in 2009. That is not so much because I don’t know my material, or what to say, but rather because I am an introvert and find writing to be less stressful than talking about my experiences in front of a big group of people. Part of this is also related by my need for safety as I am often very anxious in big groups of people that I don’t know, and because I have so much emotional investment in the subject of getting those who deal with the trauma of war and their families the help that they need.

After some of my experiences in attempting to get help myself in the military mental health care system, some of which have been more damaging than helpful, especially recently I know how scary attempting to get help can be. Likewise, I fully understand the profound stigma that many military members, especially those of more senior ranks who have invested their lives in military service, feel when they admit to dealing with these issues.

While the military has attempted to get rid of the stigma of seeking mental health treatment, even for PTSD the fact of the matter is that the stigma still exists. A very senior enlisted leader in an elite community told me following the suicide of a true naval hero who suffered from untreated PTSD and probably TBI as well who we both served with: “it’s hard when they say if you have issues and they are known that you can still have a successful career, but you will never be promoted or selected to a critical position, again.” The ironic thing was that the leader that committed suicide asked me when he took command of the unit I was in “where does a chaplain go to get help?” He obviously knew the reality of the stigma, even for chaplains. Sadly, I have to confess that as a Chaplain, Priest and clergyman there is a huge stigma to being a broken or flawed clergyperson, especially in the institutions of the church and chaplaincy. We clergy tend to take better care of our other parishioners than we do of each other and most clergy, be they in parish work, denominational structures or institutional ministry report a sense of isolation and lack of care from men and women who should be their colleagues.

I did not expect this invitation and I do hope and pray that what I say will be of help to the attendees and to those that struggle with PTSD, TBI, Moral Injury and other combat trauma or stress related issues. I dream that when I retire from the Navy, whenever that happens to be that I will be able to be an advocate and spokesman for those who suffer from these injuries. Maybe this opportunity will provide me a network of sorts to prepare for that dream.

As T.E. Lawrence said that dreamers that dream with their eyes open are dangerous, because they may act with open eyes to make those dreams possible, and I am one who does that. I have ideas and experiences that I think can be of help to others walking this path and their families. Likewise, I have a passion for trying to get people the help they need and even more importantly provide a safe place where they know that they can be honest. Admiral James Stavridis said: “overall, I think that’s an obligation to share your ideas.”

My experience is a bit more diverse than your average clergyman, mental health provider or military member. I combine my theological, philosophical, ethical and pastoral care insights, with being a caregiver to those that suffer, while struggling with the effects of PTSD, sometimes more effectively than other times. All of this is tempered by the realism that comes from 33 year military career and my academic training as a historian; both of which enable me to place these things in a broader context.

So anyway I will follow up with something tomorrow night and hopefully report out on my experience at the symposium on Thursday, as I expect to be on the road late Wednesday night returning from D.C.

I do appreciate your thoughts and prayers.

Peace

Padre Steve+

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Filed under mental health, Military, PTSD

Tagged as combat stress injury, Derek McGinty, military mental health care, military officer's association of america, military suicides, moaa, MOAA warrior family symposium, moral injury, PTSD, PTSD and family, ptsd stigma, t e lawrence, tbi

August 22, 2014 · 15:13

Miscellaneous Thoughts on a Friday

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

Tagged as crisis in ukraine, hearing aids, insomnia, iraq, isis, ISIS caliphate, middle east, PTSD, russia, russian invasion of ukraine, speech understanding, syria civil war

August 14, 2014 · 17:36

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

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

Tagged as alfred thayer mahan, bureaucracy, joshua chamberlain, mental health care, military medicine, navy medicine, Paul Tillich, PTSD, veterans, veterans administration

August 13, 2014 · 23:18

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

“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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Tagged as combat stress injury, deployments and separations, guy sager, jonathan shay, military mental health care, moral injury, odysseus in america, PTSD, tbi, the lost battalion, veterans administration

July 31, 2014 · 23:44

“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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Tagged as PTSD, robert e lee, tbi

July 30, 2014 · 21:18

Broken and Unlikely to Get Better: Military Mental Health Care

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+

2 Comments

Filed under healthcare, Military, PTSD, US Navy

Tagged as cuts in military health care, F-35C Lightning II, littoral combat ships, military mental health care, military one source, naval hospital camp lejuene, portsmouth naval medical center, PTSD, smedley butler, war is a racket

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