Tag Archives: military mental health care

It’s Not You It’s Me: Firing Your Military Therapist

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Friends of Padre Steve’s World

Another week, another therapist… At least that is what it seems like to me. Those who have been following my writings for any length of time know of my struggles with PTSD and its associated maladies, as well as my struggles dealing with the military mental health system. This week is no different.

Last week I got a new “bungee-therapist” who I would have had less than three months before his rotation at the clinic is done. He is a nice young man, only 32 years old, I have been in the military longer than he he has been alive. He still in his residency; well trained, but not very experienced and it shows. Truthfully, though I don’t have as much specific education in psychology as the provider, I do have more clinical experience working with trauma and PTSD than the young man.

So on the second appointment I fired him. I think the biggest issue was what I saw as a lack of continuity in care and the mismatch in age and experience.

I was really anxious about the visit. This was based on an experience with another young provider last year. That experience caused me to crash and have some troubling thoughts about offing myself. Since I love life and am not a fan of taking the eternal celestial dirt nap; which some readers assure me will have me taking the eternal vacation on the Lake of Fire, but I digress….

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Like I said I was anxious due to the previous experience. But, the two of us handled it very well and it was an amicable parting, a clean breakup if you will. I even used the George Costanza tested “it’s not you it’s me” breakup line. But hey, Ces’t l’apres-guerre… (such is life after war)

My plan now is to get with a senior shrink that I know and have worked with to help get me someone more compatible for what I need at this point in life. I just hope that by “breaking-up” with my therapist that I won’t get shafted by the institution.

But I have learned to live with this; I realize that the military mental health system is not in the business of trying to get you better, it is in the business of trying to return young men and women to be able to go back to war. If you actually get better in the process that is kind of a twofer. Honestly I could have gone back to war with  a year of coming home. Going to war is easy, coming home intact is not.

Do not get me wrong, it is not that there are not providers willing to help; there are plenty of them. But the system , crowded with people who need more help than it can provide and without with ever shrinking budgets; almost makes it impossible to get help. If you can be patched up and sent back out, they have done their job, if you crash after you leave the service not their problem. Sadly, I have lost too many friends, some to suicide after they left the military, including men whose credentials as real American heroes were unmatched. This is not a new issue, ask any vet who has dealt with getting post-service care at the VA or anywhere.

Likewise, if you remain in service and have a chronic-long-term condition, of any kind, physical or mental the attitude seems to be “fuck you.” If you get the label as a “broke” Marine, Sailor, Soldier, or Airman your career is pretty much over, unless you are one of the lucky few like me who had some superiors who looked beyond that and protected you. I know that because it is not just my experience but the experience of hundreds of combat vets that I have dealt with.

I can live with this as long as I am on my meds, and have friends and beer, but then I am an old guy looking at retirement at the end of this tour. If I were a young guy, with my whole career ahead of me I would be fucked. So when I retire I will be a pain in the ass to the system to ensure that the young guys who will be fighting our wars in the future as well as those who are out of the military gets the care that they need.

But as far as my condition goes, I am oddly comforted by the words of Raymond “Red Reddington (James Spader) in The Blacklist:

“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.”

Many things haunt me; but 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.

Some 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. I have learned to be okay with that. I know that there are some Christians who might disagree and even say that I do not have enough “faith,” whatever that means, but I can live with this.

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 the late 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.” Not exactly perfection, but it will work.

This now is my goal and my prayer: God grant me the courage to change the things I cannot accept; Serenity to accept the things I have changed; And the wisdom to know I’m different. Amen.

Peace

Padre Steve+

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Filed under faith, healthcare, mental health, PTSD

There Will be Nightmares: PTSD & Memories of War

Friends of Padre Steve’s World

I’m really very tired today so another short post. I haven’t slept well in several weeks, part of this of course was the worry I had regarding my wife Judy and her cancer diagnosis, surgery and recovery. As she has gotten better I have been dealing with stuff from my own closet of anxieties. Those who have been reading my articles here know that I deal with PTSD, Traumatic Brain Injury and moral injury from my time in Iraq, and my return home.

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Last year I went through a very difficult time dealing with the military mental health system that I never want to repeat again. I hope I don’t have to, but I may. My therapist who I have had since last summer took a new job thousands of miles away and now I am going to have to find another therapist. I am hoping the man I see for my medication management can get me referred to someone good, because I do not want to be thrust back into the system and take the luck of the draw. That scares me to death, and since I found out my therapist was leaving and that I will not see her again I have been trying to keep my anxiety under control and not to panic. Awake I do pretty well with this, but when I try to sleep, all my Iraq stuff, plus all the very real and bad experiences that I had with the military mental health system last year flood my psyche. The night terrors are back, the terrible dreams and fears. It is not fun waking up in the middle of the night in a state of terror. Last year, after dealing with a number of providers and administrators I was nearly suicidal. It took the intervention of a former commanding officer who had been recently selected for promotion to Admiral in the Medical Corps to get me listened to and to get me the help that I sought.

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But I know that I am not alone, I will get the professional help that I still need and I do have some friends I can talk to about these issues. Likewise I know many combat who veterans deal with similar issues related to their service, as well what happened to them when they returned home from Iraq or Afghanistan. The return from war is often worse than actually being over there, few people really understand, unless they too have been there.

Guy Sajer wrote in his book The Forgotten Soldier, “Only happy people have nightmares, from overeating. For those who live a nightmare reality, sleep is a black hole, lost in time, like death.” General Gouverneur Warren, a hero of many Civil War battles including Gettysburg wrote to his wife after the war “I wish I did not dream so much. They make me sometimes to dread to go to sleep. Scenes from the war, are so constantly recalled, with bitter feelings I wish never to experience again. Lies, vanity, treachery, and carnage.”

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I am a realist about this. I know that there is no magic wand which will make it all go away and I don’t expect any therapist, or even God to cure me. I can understand why Alexander Dumas in the Count of Monte Cristo wrote, “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.”

That is true and I know to some people that may sound like I have given up, especially because it runs counter to the snake oil salesmen who write self-help books which promise to heal you in whatever number of steps or exercises; especially the ones written by preachers. But that is not the case, despite everything I still have a love of life and lust for learning. Except that now I just have moved to a new level of understanding concerning my own dark places, and that pain that manifests at night as I try to sleep. Since nothing will take it away I need to live with it and realize that it won’t always be the first thing that I think about when I wake up in the morning. That my friends is the essence of hope. 

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One of my favorite actors, James Spader, plays a character named Raymond Reddington on the television show The Blacklist. During one episode he told another character something quite profound, something that if we actually embrace it can be somewhat comforting. “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 every day when you wake up, it will be the first thing you think about. Until one day, it’s the second.”

I think that is why I can continue and at the same time seek to be available to those who suffer similar afflictions, and thankfully, I do still have those opportunities and as the late 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.”

Anyway, have a nice night.

Peace

Padre Steve+

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The Opportunity to Act Upon a Dream

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“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

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

No Shutting Up Until it is Fixed: Veteran and Military Mental Health Care

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“If a policy is wrongheaded feckless and corrupt I take it personally and consider it a moral obligation to sound off and not shut up until it’s fixed.” Col David Hackworth

Over the past couple of weeks I discovered just how mentally and emotionally fragile I still am. As those that follow my writings here know I wrote a couple of articles recently about the treatment that I was receiving at the local Naval Medical Center, and my perceptions of that command. Those, as well as the e-mails to my provider, which were then shared by the person in charge of fixing the problem with the Medical Center Executive Officer without my permission, (I think there is another violation of my HIPPA rights there as well)  were very difficult to write.

They were extremely painful because of the emotions that were unleashed, especially because I thought of doing something that scared me to death. I considered, very briefly in my pain, anger and my sense that the system had betrayed me and for that matter all of us seeking help; the possibility of committing suicide, in a very public and dramatic way. It scared the hell out of me that I developed a perfectly executable plan to do it, a plan that for a moment would have drawn attention to the issue, but at the same time would have traumatized many others.

Of course I do not think I would ever do it. The death of Robin Williams by suicide yesterday shattered me, and no matter how bad things are I wouldn’t want my death to cause distress to anyone. Frankly, I love life too much, and God knows that one more dead body won’t change how the military or the Veteran Administration medical systems treat people in crisis.

However a living person, especially a pain in the ass like me, that won’t stop speaking out just might make a difference. That might take a while to do, but I will do it until war, and the indifference of soulless bureaucracies are  no more. That may be unreasonable, unrealistic and unattainable but it is a windmill worth tilting at.

But I fully understand that people in a moment of madness and despair, would make the choice to end their life, and see as it as a perfectly logical and rational act. I have known senior chaplain colleagues and former commanders who have chosen suicide, and I am sure that none of them thought that they would ever make that choice, until they actually did it. Please don’t worry about me. I am not going to kill myself, the thought scares me too much. Honestly I would rather live to a ripe old age and be a thorn in the side of the system to get veterans the care that they deserve, and the care that this country owes them than to be yet another statistic whose death is swept under the rug as quickly as the system can do it. Unfortunately, that is the reality; any bureaucratic system, military, government or the private sector will go on with as little inconvenience and reflection as is required once the body is disposed of properly.

Just a few months ago I was talking about simple teaching history, religion and ethics at local junior colleges and for profit universities “for the beer money” as I joked with friends. I told people that my desire when I retire was to be like LT Weinberg in the classic movie A Few Good Men and “have absolutely no responsibility here.” The fact is that I am tired and I don’t want to be in charge of anything when I retire, either in the military, civilian or church world. What T.E. Lawrence wrote to a friend shortly before his death in 1935 resonates with me:

“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.”

That being said, I want whatever amount of time left on this earth, and hopefully it is a very, very long time, is to make a difference in the lives of the men and women who have served in the military and who come home broken, in mind, body and spirit. I can think of no other option or higher calling at this point. To that end I have been referred to a therapist in the system, but not at the Naval Medical Center. The therapist was highly recommended by a chaplain friend who has also went through some very difficult times, even in trying to get help for himself. Thankfully, the person who I talked to a week ago agreed to the referral. So I will get help for me, something that I need and go into with a positive attitude based on my friend’s recommendation.

Now those who have never walked the dark path of long lasting, abiding clinical depression or other mental illness may not understand what I am talking about, but those that have walked this terrible path know it all too well. The feeling that no one cares and that you are alone is a major factor in the despair that overwhelms people, and acts as a trigger to suicide.  Unfortunately far too many military personnel and veterans reach that point. The numbers are staggering. No wonder that Major General Smedley Butler wrote about the cost of war, or the “bill” as he calls it: “This bill renders a horrible accounting. Newly placed gravestones. Mangled bodies. Shattered minds. Broken hearts and homes. Economic instability. Depression and all its attendant miseries. Back-breaking taxation for generations and generations…”

There are a number of ways that I could do this. I could go to work for the VA as a Chaplain, or I could go get a degree in counseling and do therapy or any number of other venues. But I think I would be limited by having to serve in ossified bureaucracies if I was to do any of those things.

Thus I am probably going to venture into the world of social activism, working with veterans organizations, political leaders and the media to draw attention to what is happening to veterans that seek care. Veterans like me who perceive that the system doesn’t really care about them, many individual providers may care deeply and deliver wonderful care, but the system itself is soulless and seems often to be clueless. Likewise I will work to expose the war profiteers who seek to cut back medical and mental health care for veterans even more and actively lobby the military, and Congress to enact those cuts. Personally I feel that is immoral and unjust and that it needs to be confronted and exposed.

I wish I could say that things were any better in the civilian mental health system, but they are not. My wife has battled and suffered from severe depression almost all of her life, and over the past 20 years what is paid for by insurance companies for people in crisis has shrunk to a pathetic “system” whereby a person that is hospitalized remains in hospital 2-5 days until they assure they providers that they will not kill themselves. There is no continuity of care, there is little or no therapy or medication management, it is simply warehousing. I’d like to take that on too, but I have to start somewhere, so I’ll start with where I am.

quioxte

I am a dreamer, and I don’t mind tilting at windmills. Lawrence wrote: “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.”

I am a dangerous dreamer because as Lawrence noted I will act on my dreams with open eyes. I may not be able to do a lot while I am still on active duty, but when I retire I will be very dangerous because I know far too much and I won’t be afraid to speak out. My heroes include men like Major General Smedley Butler and Colonel David Hackworth and I have no inhibitions at following in their footsteps. I am very determined, persistent and I can be a total ass. When I determine to do something I don’t quit.

As Colonel Hackworth, who I had the honor of corresponding with in the years before he died said: “If a policy is wrongheaded feckless and corrupt I take it personally and consider it a moral obligation to sound off and not shut up until it’s fixed.” The way we are treating our veterans is just that and I won’t shut my mouth until the day that I die, which Lord willing won’t be anytime soon.

Pray for me, I do need it.

Peace

Padre Steve+

 

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Filed under healthcare, leadership, mental health, Military

Broken and Unlikely to Get Better: Military Mental Health Care

soap-box

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