Tag Archives: veterans administration

PTSD, Medical Records, Malfeasant Malpractice, and the Minstrel Boy: Surprises You Discover by Seeing Your Actual Medical Records

Friends of Padre Steve’s World,

I was going through some of the 1000 pages of my electronic medical records and close to 500 pages of hard medical copy records. My God, they are a treasure trove of information. I am beginning to organize them for my meetings with Disabled American Veterans and Veteran’s Administration for my military disability claim. According from one of my friends, a retired Navy Physician who now works for the VA in dealing with claims I should have an 80-100% disability rating from the VA due to all that is goofed up with me. I’d settle for 80-90%, 100% sounds too extreme. But severe chronic PTSD, Traumatic Brain Injury, chronic insomnia, night terrors, injuries sustained in physically acted out nightmares, severe Sleep Apnea, hearing loss, Tinnitus, speech comprehension at the 3rd percentile, not to mention numerous injuries to my legs, knees, hips, ankles, shoulders and wrists incurred through years of physical abuse in and out of combat environments.

These do not include many of my psychiatric and psychological records which are in a different system, nor the hard copy records from my time in the Army which I still have, but they are impressive and full of surprises.

For me this included an obviously punitive diagnosis made by a Psychiatry Resident four years ago who had only met me for 15 minutes. During that time she treated with such contempt and disrespect that I issued a formal complaint about her. My complaint actually helped get me a competent therapist, but this physician attempted to harm me by diagnosing me with a disorder than cannot be made in such a short time of clinical observation. The fact is that I was dealing with PTSD and combat trauma while she was still in high school, and that was before it happened to me. As a result I am going to seek some kind of sanctions on that doctor through the military or through her accrediting body.

If it wasn’t for the restrictions of the Feres Doctrine I would immediately sue the Navy because how badly that encounter effected me then. I do actually plan on exploring ways to punish that doctor for what she did because the diagnosis was made purely to poison the relationship that any future Navy (Military or Civilian) therapist might have with me, but I digress because I went all of this to write about a Star Trek the Next Generation episode which I just watched as part of my current binge watching of Star Trek TNG seasons. The episode was called The Wounded and dealt with PTSD, combat trauma, loss, and the unwillingness of some to let wars end. It has always been one of my favorite episodes of that franchise, long before I ever went to Iraq or came back with PTSD and TBI.

One of the quotes from the episode was uttered by Captain Jean Luc Picard, played by Sir Patrick Stewart. He made a comment about people who could not get over their anger, that is especially applicable to those who went to war or lost friends or family in war:

“I think, when one has been angry for a very long time, one gets used to it. And it becomes comfortable like…like old leather. And finally… it becomes so familiar that one can’t remember feeling any other way.

I understand that. I still have a lot of anger. Not at the Iraqis, but the men and women who sent us into Iraq. Trust me, I have no lingering sympathy for Saddam Hussein and his thuggish dictatorship, but that being said the justification to go to war was so unjust that had our leaders been in the dock at Nuremberg they would have been found guilty of at least two counts on those charges. No honest person who looks at history or international law can say otherwise, especially it because it was an American, Justice Robert Jackson who organized the trials and who noted before they began:

“If certain acts of violation of treaties are crimes, they are crimes whether the United States does them or whether Germany does them, and we are not prepared to lay down a rule of criminal conduct against others which we would not be willing to have invoked against us.”

Once again I digress, because what brought all about my post tonight was that Star Trek TNG episode that I first saw some 27 years ago. When the episode comes to it’s conclusion Chief Miles O’Brien played by Colm Meaney tells his former Captain, Benjamin Maxwell played by the noted character actor Bob Gunton that the war is over. He then reminds him of the Irish song The Minstrel Boy which they begin to sing:

The Minstrel Boy (Thomas Moore)

The minstrel boy to the war is gone, In the ranks of death ye will find him; His father’s sword he hath girded on, And his wild harp slung behind him; “Land of Song!” said the warrior bard, “Tho’ all the world betray thee, One sword, at least, thy rights shall guard,One faithful harp shall praise thee!”

The Minstrel fell! But the foeman’s chain Could not bring his proud soul under; The harp he lov’d ne’er spoke again, For he tore its chords asunder; And said “No chains shall sully thee, Thou soul of love and bravery! Thy songs were made for the pure and free They shall never sound in slavery!”

The Minstrel Boy will return we pray When we hear the news we all will cheer it, The minstrel boy will return one day, Torn perhaps in body, not in spirit. Then may he play on his harp in peace, In a world such as heaven intended, For all the bitterness of man must cease, And ev’ry battle must be ended.

It is a breakthrough, a new war is averted, a former enemy warned of that future activities would be watched, and the possibility of peace and understanding between old enemies. Honestly, that is what I want to see in life. I have written about that many times.

I have meandered too much tonight, so I wish you a good night and a happy Labor Day Weekend.

Peace

Padre Steve+

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Filed under ethics, iraq, mental health, Military, PTSD

Admiral Ronny Jackson: As Qualified to Head the V.A. as Tom Cruise is to Command the Top Gun School

Dr. Ronny Jackson Briefing

Note: this Post was written before Admiral Jackson withdrew his name from nomination.

Friends of Padre Steve’s World,

President Trump foolishly nominated the White House Physician, Rear Admiral (Lower Half) Ronny Jackson to head the Veterans Administration. That nomination is in the process of coming apart as allegations by over 20 current and former military personnel which detail of Admiral Jackson’s abusive leadership, drunken rampages, and careless dispensing of controlled substances including opioids has come to light. If any of those allegations are true he should not only be removed from consideration for the Veterans Administration position but he should be forced out of the service.

But even if none of those allegations are true Admiral Jackson in completely unqualified to be the Secretary of Veterans Affairs.

From a career standpoint Admiral Jackson is an oddity in military medicine. Most officers who rise to the rank of General or Admiral in the Medical Corps, Medical Service Corps, or Nurse Corps earn their rank in a variety of demanding assignments of increasing responsibility after they are promoted to the grade of Major or Lieutenant Commander in their respective services. Most combine clinical, administrative, and command assignments, serve on combat deployments, and spend extra time to do advanced fellowships in their medical field, or obtain degrees in Medical Administration, Business, or subjects like Ethics. Quite a few take the time to earn higher military education at schools like the Naval War College, Army Command and Staff and War College, the Air War College, or Marine command and Staff College.

Their assignments usually encompass commands of clinics, field hospitals, hospitals, major medical centers, and medical regions which cover half of the United States. The men and women who go through this process have to understand the extremely complicated world of the military and civilian medical systems, insurance programs, veterans medical benefits, and Medicare. These are men and women who are exceptional, honed in combat and erudite enough to understand the complexities of the Veterans Administration. Having served two full tours in Naval Medicine as a Chaplain I know a lot of them and could name five Flag Officers from the Medical Corps and the Medical Service Corps, active duty and retired off the top of my head who would be excellent candidates for the position, as well as a number of exceptional Navy Captains. All of them are far more qualified than Admiral Jackson.

Admiral Jackson has never been in charge of anything more than a medical clinic, the White House is his second clinic assignment despite its rather high profile patient base. From all accounts he is an excellent Emergency Medicine physician, he is a qualified Navy Diver, and he has served in a combat setting caring for the wounded during some of the bloodiest times in Iraq’s Al Anbar Province. That being said he has served in the insular and politicized world of the White House for 12 years, during which time he was promoted to Captain and later Rear Admiral. The White House clinic is the largest that he has ever commanded, a mere 70 people. When I was a 25 year old Army Medical Service Corps First Lieutenant I commanded a Medical Company overseas of 110 soldiers, most of them medics.  When I was a 27 year old Captain I served as a personnel officer for the largest Medical training organization in the U.S. Military. Neither qualify me to command a hospital or oversee an agency as vast as the V.A.

I’m sorry, but by any means that is not a career path that should lead to an appointment that would oversee the largest medical system in the nation.

That my friends is reality even if there were no allegations of abusive conduct or careless distribution of controlled medications; allegations detailed by the Inspector General in 2012 which resulted in a recommendation for his relief and reassignment which did not happen. However, Admiral Jackson is white, male, and Hollywood good looking, and exactly the kind of man that the President hyperventilates about, especially when they engage in hyperbole and lies to describe his physical condition. Admiral Jackson is as qualified to head the Veteran’s Administration as Tom Cruise is to Command the Top Gun School.

Admiral Jackson is not qualified for the head of the Veterans Administration or any higher post in Navy Medicine. His nomination should be immediately withdrawn instead of being allowed to become yet another disgusting political spectacle designed to polarize the nation.

If the GOP Congress had any balls, which they don’t but can be purchased at the National’s Shop, they would tell the President right now to drop this nomination like his trousers at a Playboy Club party.

The President set himself and Admiral Jackson up for this and if he has any sense of honor he would end it now and go back to the drawing board to pick a truly qualified person. Like I said I can name five off the top of my head, he can ask me for recommendations if he wants, and if he picked any of them they would make him and the nation proud.

This isn’t about politics. It is about qualifications and character. Admiral Jackson certainly lacks the qualifications, and very likely the character needed to serve in such a responsible position involving the care of millions of veterans. I’m a combat veteran, and all veterans deserve better.

Peace

Padre Steve+

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Filed under ethics, Military, News and current events, Political Commentary, US Navy

The Continuing Racket of the War Profiteers

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

With all the domestic political news and the apocalyptic talk and actions surrounding John Roberts the Supreme Court and Obamacare it is hard to believe that we are at war for over 10 years and are at war or now preparing for war all over the Middle East. Iraq, Iran, Syria, Afghanistan, Yemen, Somalia, the Persian Gulf, Libya, Egypt, Pakistan, you name the place there is a real a present danger of US forces becoming involved in even more war. The Trinity of Evil, those Politicians, Pundits and Preachers and over 60% of Americans now are in favor of sending in ground troops to fight the Islamic State.

There are no statesmen left in Washington DC only shills of the Right and Left and their masters from Wall Street to K Street. The only people profiting from this are the war profiteers who even if the budget gets cut and they fail to deliver usable weapon systems on time or in budget will still get paid. The losers will be the military personnel who must fight the wars who will get tossed onto the street by those that claim that personnel costs are the problem. Of course those that make this point are almost always the same lobbyists that shill for the defense industries and the banks. But enough about them.

Right now tens of thousands of American military personnel and other Department of Defense, Federal law enforcement, intelligence, diplomatic, humanitarian workers as well as contractors in Afghanistan. Tens of thousands more (mostly contractors)  are helping to shore up the Iraqi government against the Islamic State or are fighting wars by other names in Pakistan, Yemen, the Horn of Africa.  Others are deployed to counter Iran or standing by to assist other allies should the conflict in Iraq and Syria spill over the boarders. Of course this does not take into account the instability in Egypt, Libya, Eastern and Central Africa that threatens even more war or the potential of turmoil in Europe, especially the Ukraine. Likewise a crisis with the Euro Crisis could bring about more financial disasters or even revolutions in countries that are our allies. By the way let’s not forget about the nutcase leaders of North Korea who could provoke war on that side of the world in a heartbeat.

But never mind this, let’s fight each other instead threaten insurrection when we don’t get our way. But wait, I digress…

Did you know that while Americans stand in harms way almost every real or potential enemy has been armed, subsidized or assisted by American corporations and paid for by American tax dollars.  We have armed much of the world with weapons that have already in Iraq and Afghanistan killed thousands of American military personnel. But those were small time weapons compared to what we have provided to Egypt, Pakistan, Saudi Arabia and yes even Israel. F-15, F-16 and F-18 fighter planes, Tomahawk cruise missiles and Harpoon Anti-Ship Missiles, M-1 Tanks, M113 Fighting vehicles, Patriot Air Defense systems, you name the weapons system the war profiteers will sell it and US taxpayers will pay for it. These are weapons that very easily could be used with great effect to attack American interests should leaders in any of those countries decide to use them against us. I only include Israel because in 1967 its forces viciously attacked the USS Liberty which was operating in the Eastern Mediterranean Sea as Israel launched its pre-emptive war against Egypt. Although all of these countries are “allies” we must remember that alliances are only as good as the interests and values that unite nations.

Our defense industries with the support of the government sell advanced weapons to nations that often are less than trustworthy allies, allies of convenience that have little love for the United States but welcome the weapons and training that we provide.  They often use them to suppress the aspirations of their own people and plant the cultivate the seeds of radicalism and revolution.  It is hard not to cringe when pro-democracy protestors are killed by totalitarian regimes whose police and military are armed to the teeth with American made weapons. When those totalitarian regimes fall as did that of the Shah of Iran in 1979 those weapons fall into the hands of people radicalized against us by our support of their former oppressors.

Certainly nobody seriously believes that the angry masses in the countries that we have armed to the teeth with the latest in American weaponry would not use that weaponry against us should they desire.  But wait…. our politicians, arms dealers, bankers and their political, religious and financial backers certainly wouldn’t put Americans in harms way? Perish the thought, but not so quickly. They have done so before and will do it again.

Smedley Butler is one of under two dozen American military personnel to win the Congressional Medal of Honor twice. He saw the dangers of Fascism as well as the danger of unlimited corporate and business power to profit by war. Butler was not only a  valiant Marine he was also a commander that in war and peace cared about those who served. He saw how American finance and banking interests helped drag us into the Fist World War, the promises broken by the government and the lives destroyed by war.

In his book War is a Racket Butler wrote eloquently about how the heads of corporations and their political supporters in both parties were the only benefactors of war. He wrote of the plight of the soldiers that served and returned wounded and often changed by war and he did not mince words in what he saw. He became an anti-war activist. He was a supporter of the Bonus Army, the veterans that “occupied” Washington DC during the last year of the Hoover Administration to get the bonuses promised for their service and were violently evicted by troops under the command of General Douglas MacArthur. If he was alive today I have no doubt that he would be an active supporter of the current “Occupy” movement and opponent of politicians, political activists, lobbyists and even preachers that advocate even more war.

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Butler’s War is a Racket as well as other published works are a worthwhile read and should make the most rabid fan of war think twice. Butler’s patriotism and devotion to the United States and the Constitution is unquestioned. His warnings are strong, he was a prophet in regard to the dangers of the Military-Industrial Complex well before President Eisenhower coined the term as he left office. He detailed how corporations made obscene profits often by selling the US Military vast amounts of materials that it could not possibly use and which taxpayers bought while business leaders and bankers made their fortunes that they never had realized when the nation was at peace. He reminds us of the dangers that our founders recognized about entwining ourselves in other people’s wars. While his answers on how to end war are now utopian dreams because of advances in technology and the wars which now rage without end in sight they are nonetheless not a bad place to start a debate.

Butler writes movingly about the price paid by veterans years after the war, men broken in body, mind and spirit from their war service.

“But the soldier pays the biggest part of this bill.

If you don’t believe this, visit the American cemeteries on the battlefields abroad. Or visit  any of the veterans’ hospitals in the United States….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.” 

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One would think that things would be better now but our veterans’ health care system is a train wreck and there is an epidemic of suicide among active duty troops and veterans. In 2005 after years of hand wringing the Bush administration grudgingly increased the number of Soldiers and Marines even while cutting Navy personnel and ships to the  minimum that they could despite ever increasing operational tempos. The Navy was reduced by over 50,000 sailors during the Bush years and now when the Navy is needed more it has been reduced to the point that 8-10 month deployments with short turn arounds will be normal.

Now the Obama administration is cutting back partly due to the withdraw from Iraq but mostly because of the economic crisis. However the bulk of these cuts are falling on the military personnel and not the war profiteers. The Army will be cut by nearly 80,000 in the coming years the Marines by 20,000 and that may increase if the budget takes the sequestration hit without any reduction in operational tempo. These Soldiers and Marines will enter a bleak job market where many employers give little value to military experience or training, which has resulted in a vastly higher unemployment rate for Iraq and Afghanistan veterans than the general population.

It wasn’t much different in Butler’s day. He writes:

“Boys with a normal viewpoint were taken out of the fields and offices and factories and classrooms and put into the ranks. They were remolded; they were made over; they were made to “about face”; to regard murder as the order of the day. They were put shoulder to shoulder and through mass psychology, they were entirely changed. We used them for a couple of years and trained them to think of nothing but killing and being killed.

The suddenly, we discharged them and told them to make another “about face”! This time they had to do their own readjusting, sans mass psychology, sans officers’ aid and advice, sans nation-wide propaganda. We didn’t need them anymore. So we scattered them about without any “three minute” or “Liberty Loan” speeches or parades.”

Butler recounted another visit to a different veterans’ hospital:

“In the government hospital at Marion, Indiana 1,800 of these boys are in pens! Five hundred of them in a barracks with steel bars and wires all around the outside of the buildings and on the porches. These have already been mentally destroyed. These boys don’t even look like human beings. Oh, the looks on their faces! Physically they are in good shape but mentally they are gone.” 

There are thousands and thousands of these cases and more and more are coming in all the time…

That’s a part of the bill. So much for the dead-they have paid their part of the war profits. So much for the mentally and physically wounded- they are paying now with thier share of the war profits. But others paid with the heartbreaks when they tore themselves away for their firesides and their families to don the uniform of Uncle Sam- on which a profit had been made….”

I could go on but I think that Butler says it quite well and with the passion of a Marine who was wounded on more than one occasion and won the Medal of Honor twice.

The only people that want war are those that profit from it and don’t have to pay the price paid by those that have to fight them and pay for them. When I see pictures of Mitt Romney protesting in support of the Vietnam war while getting deferment after deferment to avoid service it makes my head spin. My head spins even more when I hear him talking brazenly about committing US troops to even more war. For me the pictures of Romney’s pro-war protests as a college student avoiding war on educational and religious service deferments as millions of other Americans went to war are up there with the pictures of “Hanoi” Jane Fonda giving aid and comfort to those that were killing our troops.

Butler’s detractors and they are legion on the political right attempt to paint him as an isolationist or appeaser of Hitler. However they misunderstand him and his work. They don’t understand as Butler understood that there would not have been a Nazi Germany without Versailles and that was not possible without the American intervention on the side of Britain and France in 1917. That involvement was driven by the bankers and industrialists who had supplied raw materials, weapons and technical patents to the British and French, and had done so before with the Germans who believed that they would lose their investments if the Germans won the war. That would have happened in late 1917 or early 1918 had not the Americans declared war and entered the war on the side of the British and French.

Most of Butler’s current critics have never served a day in uniform much less a day in a combat zone. They make their livings and profits by the sacrifice of others and other than a few of his quotes have never read anything about him.

If you sense indignation in my voice it is real. I have lived the nightmare of PTSD for over 7 years. I see and work with the young men and women that have bravely endured the hardship of combat deployments and come home physically, mentally and spiritually wounded. To our credit we are trying to do better, but that doesn’t always happen. But for the war profiteers even that will be too much. If military spending is cut you can bet that they will not take the hit that military personnel, their families and our veterans will take. They and their political benefactors will not allow it.

I am a military man through and through. I have spent nearly my whole life associated with the military as a dependent of a Navy Chief who served in Vietnam and a career of over 30 years divided between the Army and Navy. Some of my friends dads did not return from Vietnam, other friends and those who I have served with have paid with their lives in Iraq or Afghanistan while others suffer the continuing wounds of war.

This is personal for me and it is also motivated by my faith as a Christian. Today when I see prominent and politically influential right wing Evangelical Christian leaders and pastors beat the drums of war I am reminded of how Butler chided the pro-war clergy propagandists of the Great War. He wrote: “So vicious was this war propaganda that even God was brought into it. With few exceptions our clergymen joined in the clamor to kill, kill, kill. To kill Germans. God is on our side…it is his will that the Germans be killed.” Only today, it is not a blood lust for German blood, it is a blood lust for Moslem blood and it gets louder ever day.

Such preaching is not much different from the right wing pro-war preachers who advocate killing Moslems simply because they are Moslems and that go out of their way to preach the value of “pre-emptive war” despite such wars being against the Christian understanding of the  “Just War” or international law against such war that we as Americans helped develop after World War Two at Nuremberg and to which we hold the leaders of what we call “rogue nations.”

I only wish that our leaders; political leaders of both parties, religious leaders, and even business leaders would see the folly of this course and their responsibility for the results.

Someone has to say it.

Peace

Padre Steve+

Note: All quotations from “War is a Racket” by Smedley Butler copyright 1935 and 2003 by the Butler family. Amazon Kindle edition. 

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Filed under ethics, History, middle east, Military, News and current events, Political Commentary

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Thank you…

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

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

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

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

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

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

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

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

Peace

Padre Steve+

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

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

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

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

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

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

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

Lawrence wrote:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Peace

Padre Steve+

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Filed under mental health, PTSD, suicide

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.

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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

The Enduring Crisis: Suicides in Veterans Spiking

126642_600The Veterans Administration released a disturbing report that male veterans under 30 years old saw a 44% increase in the rate of suicide. The rate for women veterans increased by 11%. About 22 veterans a day committed suicide in 2013. That did not count those still on active duty numbers which are still high but have dropped somewhat since 2012 and previous years.

The VA National Mental Health Director for Suicide Prevention, Jan Kemp said “Their rates are astronomically high and climbing…” Kemp postulated that reasons for the spike might include “the pressures of leaving military careers, readjusting to civilian life and combat injuries like post-traumatic stress disorder…”

I believe that the stigma that many felt about getting psychological help while they were in the military continues on when they enter civilian life. Unlike the military where there is still some sense of camaraderie and a chance that the chain of command might force a service member to get help, no corresponding structure or community exists in the civilian world. Young veterans are often isolated and face new stresses while they are already on edge. Many find that the military occupation specialities that they trained for have no direct civilian counterpart, leaving them struggling in the civilian job market. Combat injuries as well as injuries sustained in training often continue on, limiting what they can do and the unseen injuries of PTSD, Traumatic Brain Injury and Moral Injury, often undiagnosed and untreated lurk in the background.

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This is a national tragedy and crisis. Many of these young men and women are among the best and brightest. They volunteered to serve in time of war and now as the military, especially the Army and Marine Corps begin to shed large numbers of troops, many more will be thrust into a world that they may be ill equipped to survive.

They will attempt to go to work or attend school, quite often alone. There they will be surrounded by people who have no idea of the issues that they face or understanding of the military world that they left, or the places that they served. I think this social isolation will be a killer for many.

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My recommendation is that people who work or go to school with these young veterans, or for that matter any veteran get to know them. Help them adjust to the world and keep an eye on them. Ask them how they are doing and just show that you care. You do not have to be a veteran to do that. Likewise get to know about the resources that are available for veterans and help direct them to them. Have the courage to care.

Resources include the Veterans Crisis Hotline which is staffed 24 hours a day, 7 days a week. They can be reached at (800)-273-8255, press 1, or here to chat online. They also allow veterans to send a text message to 838255 to receive confidential support 24 hours a day.

Another resource is the Real Warriors Live Chat. The a trained health resource consultant is ready to talk, listen and provide guidance and resources. They can be reached by calling 866-966-1020 or going to their live chat service here http://www.realwarriors.net/livechat.

Afterdeployment.org http://afterdeployment.t2.health.mil offers wellness resources for the Military Community. Service members in transition to civilian life can contact inTransition by calling 800-424-7877 or at their website http://www.health.mil/InTransition/default.aspx

To me this is personal. I still suffer from the effects of PTSD and I have known far too many veterans who have taken their own lives, or struggle with mental health issues, physical injuries and illness, or social isolation. This week a brilliant and heroic senior officer I knew, who helped me when I was collapsing due to the effects of PTSD took his own life. This is something that all of us have a stake in. Please help look out for our veterans.

Peace

Padre Steve+

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Filed under healthcare, Military, News and current events, PTSD