Wednesday, January 17, 2007

Viewing Combat Stress Injuries as Opportunities
for Preventing PTSD:
Invitation to the
on February 16, 2007
Charles R. Figley, Ph.D

This is a call to arms! That was our attitude last year when we held the first National Symposium on Combat Stress Injuries. We organizers sensed that there was insufficient attention to those who “bore the battle.”[1] In particular most of the attention was on combat-related PTSD and what to do about it once these men and women returned from war. Far more needed to be done when they were IN the war. This article is part of a special publication of that will focus on the upcoming Symposium I will co-chair on February 16, 2007. I talk more about the Symposium later.

Combat Stress Injuries

I have been investigating the immediate and long-term psychosocial consequences of combat for the combatants since 1971. As one of the Symposium organizers I want to emphasize the distinction between the stress of combat, something every combatant experiences if they are alive, and combat stress injuries that most often lead to Post-traumatic Stress Disorder (PTSD).

No matter what you think of today’s wars being fought by the US military, these warfighters represent less that 1% of the US population.[2] They deserve our respect and our help. One way of helping is for the other 99% of the US to be more aware of what these men and women are going through and how best to help them during and following deployment. The 2nd National Symposium will increase awareness.

The concept of combat stress injuries[3] is an important distinction. Mental health diagnostic labels can harm both warfighters and the military units they serve within. Navy Captain Bill Nash, MD who is co-chair of the Symposium and co-editor of Combat Stress Injuries, makes the point in Chapter 3; that there are major problems associated with medicalizing and pathologizing operational stress problems. Stress injuries have been kept separate from the physical injuries or wounds. He points out that if given any label at all, they have been classified as having something benign like “battle fatigue,” “exhaustion,” or “combat stress reaction.” The avoidance of labeling and a focus on normalization have also long been central to civilian crisis management efforts. The Israeli Defense Force has always used Combat Stress Reaction (CSR), for example, which is discussed by Zahava Solomon in her new book by the same name.[4] But there are limitations for normalizing what might be acute dysfunction with long-term negative consequences unless the right action is taken, rather than simply returning the injured warfighters to battle or discharging them to fend for themselves as a civilian.

As with any injury, complications may set in. In the case of combat stress injuries, the complications may be a stress disorder, depression, substance abuse, family violence, homicide, and suicide. Further, Dr. Nash suggests that combat stress injuries can be divided into three categories depending upon the source of the stress: (1) stress fatigue, caused by the wear-and-tear of accumulated stress; (2) grief stress, caused by the loss of someone or something that is highly valued, and; (3) traumatic stress, caused by the impact of terror, horror, or helplessness. Each requires acute care as soon as possible. Navy Captain Nash will discuss the implications of these injuries at the upcoming National Symposium.

It may be surprising to some but the actual rate of combat stress injuries have actually declined over the years. Unpublished stress casualty rates for United States troops deployed to Iraq vary but have never exceeded 2% of all war theater soldiers and Marines deployed to Iraq and Afghanistan. However, this makes the assumption that there were no false negatives. In other words: Our current ability to accurately tell who is and who is not injured is very poor. These current wars, some would argue, are far more stressful than previous wars because of the sectarian violence, the complicated political context, numerous individual explosive devices; multiple tours with insufficient between deployment down time, and; the high percentage of troops from the National Guard and reserve forces.

Fortunately, most authorities agree that the Military is getting better at being able to anticipate and prevent combat stress injuries. This is due to better training, great reliance on chaplaincy and mental health services. They in turn are better trained thanks to the cumulative knowledge about the causes of such injuries and how best to respond to minimize damage.

Normal Stress versus Stress Injury

At the same time, because stress reactions are viewed by some as a “normal reaction” to being down range (the combat environment), differentiating what is normal and what is not, is a major challenge. Everyone experiences combat stress. Deciding who experiences a stress injury is tricky. But even if we are able to determine which is or is not a stress injury, there is considerable resistance to admitting injury among warfighters – physical or mental. A buddy or small unit leader may be the only ones who have witnessed the indicators of a combat injury and are in the best position to get help. Many are not trained to administer the appropriate interventions and those to whom they are referred have minimal training and resources.

Do you see why we need far more attention to this critical issue? We can’t help if we don’t know who needs it. All of the experts on combat stress and recovery agree that the earlier the detection and intervention the better. Why? Because low rates of combat stress injuries do not necessarily predict low rates of eventually diagnosed combat-related stress problems. The mental health problems experienced by Vietnam veterans after their war ended attest to the gap between identified battlefield stress casualties and the true extent of combat stress reactions actually generated in that conflict. A Walter Reed Army Hospital research team has found that 17% of heavily engaged Army and Marine “trigger pullers” admitted significant stress symptoms 3 to 6 months after returning from Afghanistan or Iraq. The team also reported, unfortunately, these those most affected were least likely to seek help. Why? They saw that the costs were too high. They were concerned about stigma and treatment effectiveness. Numerous government and journal reports confirm that there is a looming public health problem among these brave 1% who volunteered to serve in the military who “bore the battle.”

Personal Invitation to the 2nd National Symposium

This is where the National Symposium on Combat Stress Injuries comes in. The co-organizers have created a Symposium which offers serious and significant resources for understanding and helping combat veterans without a hint of politics or partisan rah-rah. The organizers are not pro-war but pro-warrior. We hope that the Symposium will be seen as one of the most inclusive and interdisciplinary gatherings of its kind. Innovation and thoughtful debates are welcome as we maintain a central focus on the welfare of the
warrior and warrior families.

Finally, I would like to personally invite everyone who reads this article to join us at the 2nd National Symposium, February 16th at Florida State University in Tallahassee, Florida. The purpose of the symposia series is to note and discuss new and important knowledge about how to understand, measure, prevent, and management combat stress injuries in order to avoid the long-lasting, negative consequences for the warfighters and their families. One major development since the first Symposium (held at the same venue, February 10, 2006) is the publication of the Combat Stress Injuries book. Through a special arrangement with the publisher (Routledge), the first 100 registrants for the Symposium will receive a copy of the book as part of their registration materials.

One of the co-sponsors of the Symposium is the Vietnam Veterans of North Florida, Inc. The VVNF is incorporated in the State of Florida and is a federally incorporated veteran’s non-profit organization (a 501.c19). The VVNF Color Guard raised the first flag over the Vietnam Veterans Memorial in Tallahassee, after touring with it all over the northern half of Florida to every county seat to display that first Flag prior to it being dedicated with the Monument. That operation was known as the Great Vietnam Veterans of Florida, State Coalition, Flag Drag. Other co-sponsors include the Collegiate Veterans Association and the National Veterans Foundation. We welcome co-sponsorships as a way of emphasizing importance of both the history of veterans’ causes and the importance of inclusiveness in unity of cause. If you are either unable to attend or to co-sponsor the Symposium, feel free to join the join the Combat Stress Forum to collaborate on research.

[1] `` let us strive on to finish the work we are in, to bind up the Nation's wounds, to care for him who shall have borne the battle and for his widow and his orphan ,'' Abraham Lincoln, Second Inaugural Address
[2] As of January 2005, there are some 250,000 military service personnel out of nearly 300,000,000 estimated population of the US.
[3] There is increasing reason to believe that overwhelming stress of combat can inflict literal, physical injuries to the neurobiology of warfighters and civilians. The term “injury” has significant advantages when communicating with warfighters about the nature of their reactions to severe stress and how best to care for them. Warriors understand that stress injuries, like sports injuries, may be unavoidable, at times—they are just part of the cost of doing what they do. And like sports injuries, most stress injuries heal up quickly, even without professional attention. But also like sports injuries, stress injuries are most likely to heal quickly and completely if warfighters monitor themselves for symptoms of injury, and take proper care of those injuries that are sustained.
[4] Dr. Solomon is a keynote speaker at the National Symposium.

Sunday, January 14, 2007

The Mission Evolves:
Swift Boat Vets to PTSD...
Willie Hager
(Sometimes AKA Wilder)

Vetspeak has been in a state of evolution, from day one. Originally conceived, it was to be a one-stop on-line writers group and a forum for veterans with an aspiration for writing. It quickly evolved into an on-line magazine, but time and money ultimately became too big of a hurdle in providing an attractive, timely, and informational site for the veteran perspective. The current format as a blog-site seems to be, for now, a workable forum for topics that directly affect veterans and their quality of life, as well as the circumstances that they find themselves in sometimes, as a direct result of their unselfish service to their country.

Given the present day situation with the war in Iraq and in Afghanistan, and now in combat operations in Somalia, again; it seems that topically the debate follows the mood of the rest of the country, and polemics always bubble to the top. Everyone demands that everyone else adapt whatever opinion they might have about the war on terror, regardless of facts; whether they are for it, or against it. Sadly, often times these opinions are bereft of the facts (often by design). Folks who hold dogmatic opinions ears and minds are for the most part closed to input of any other, often more factually informed sources, with differing perspectives.

This is also true when it comes to electoral politics due to the mis- and dis-information campaigns mounted by both the Left and the Right through the mechanics of the two major political parties, who, up until this election haven’t listened to the Peoples voice in a very long time, and have spent most of their time and resources in publicly name-calling and personally trashing anyone who disagrees with them. Political Correctness from the Left would be a prime example of this, as would the act of “Swift-Boating”, from the right. Would that these were the only two examples of my point! But, they are not. There are far too many to go into here. The problem with all of this is that Objective Truth always suffers and uncivil debate always ensues, thereby often successfully smoke-screening the True trail to a solution.

It is with this in mind that as the debate roars on over what to do in Iraq, and in the War on Terror everywhere else on the globe; will be shifting its focus to a problem that is growing at an alarming rate. One which results from direct active participation in all of the above mentioned arenas; and that is the inability to reconcile one’s experience as a warrior in these conflicts with a normal, productive, American Dream kind of life.

This was a problem which was first brought to America’s attention back in the 1970s by the veterans returning from Vietnam, themselves. They called it Post Vietnam Syndrome. After years of debate and politics, it was finally accepted in the early 1980s by the V.A. and the Mental Health Community at large, recognized on the pages of the DSM, their diagnostic Bible, as Post Traumatic Stress Disorder; a now “legitimate” diagnosis described as an anxiety disorder resulting from psychological and social trauma. A problem that ultimately affects, at some point, each and everyone of ours’ dealings with our returning service personnel as they wander unprepared into the mine field of readjustment, encountering the unexpected changes at every level in the social order of things, as they remember it being on the home-front. They only remember the home-front that they originally left to defend, even with their very lives if necessary. It is seldom that the home-front of their hopes and dreams is the one that they return to. It is often very traumatically different.

In the ‘70s, research demonstrated that 15% of returning vets were experiencing problems to some degree. Today, that figure is a reported 30% of returning Iraq and Afghanistan vets. That’s double the number of those experiencing problems from Vietnam, from a much smaller population of candidates and a much shorter time span of stressor opportunity, than in the Vietnam era research populations. Houston; we have a problem…! Dare we hem and haw about who is right and who was wrong? Or, shall we put aside our pro-war, anti-war, and party politics, and on these pages and elsewhere combine our resources to get it right this time. Can we work together to give this problem the time, attention, and possible available remedies that have, to date, been overlooked; and that it and our returning troops deserve?

I don’t know the answer to that, but is gonna try. We hope that regardless of political affiliation or philosophy, those who read these words will join us. I assure you that there will be plenty of opportunities to participate as we move forward on this mission. A mission begun by Diane Ford Wood, co-founder of VetSpeak, with a proposal at a National Vietnam Veterans Against The War Annual meeting, just over a year ago, in Chicago. That proposal; to pull together a national PTSD Symposium too draw attention to this obviously unsolved problem from as far back as Vietnam, and now again a rapidly growing problem for a new generation of troops.

In our preparatory research for our proposal, we found that there was already such a National Symposium that had recently had their inaugural gathering at Florida State University, under the direction of Dr. Charles Figley, PHD, and were in preparation for the 2nd National Symposium at Florida State University . After meeting with Dr. Figley, and reviewing the results and conclusions from the First Annual Symposium, National Symposium on Combat Stress Injuries, we felt that rather than duplicate already existing efforts; we would offer whatever support that we might have access to, in order to bring about the most important purpose of our original proposal; to create a forum of renown such as a National PTSD Symposium for the purpose of examining not only “accepted”, or Politically Correct thinking on the topic, but to re-examine what has been done or has not been done by the Pentagon and by the V.A. and is so obviously not working.

Another purpose would be to also incorporate alternative thought, research, and functionally successful community level projects and groups. This secondary purpose would be to gather and archive as many research papers from un-official sources, and to data base the successes and the failures of alternative grass-roots “treatment” projects, as well as “institutionalized” programs such as the Vet Centers and the V.A. This centralization in clearing house fashion, and continued support for successive Symposiums at FSU could provide the beginnings for really getting it right, for all of the right reasons, this time.

We hope that you will join us. If so, you can begin by checking out the Symposium on-line and possibly registering to attend, or by donating either in kind resources, lot’s of E-mail Attaboys, or just good ol’ American Tender to help off-set the cost of even having a Symposium by visiting 2nd National Symposium at Florida State University.

Semper Fi!

Thursday, January 04, 2007

Poetic Justice…

This in from Xonk: FEC FINES SWIFT BOAT VETS 300K

Thanks, Bro…Keep up the fire! Here’s my take on this one:

I don’t want to be an old I told you so…but…:-)! Pardon me, if I gloat a little…no, make that a lot! But, it has been quite a journey (and a rewarding one
as well, it seems…) from the 3rd Triennial Vietnam Symposium at Texas Tech University, held in Lubbock, Texas, in March of 2005, to reading about this major victory for the forces of Truth. The journey started when a group of Old School VVAW types under the leadership of Ms Nancy Miller Saunders, serving as panel moderator, confronted these liars on Saturday, March 19th , the last day of the Symposium. I was honored to both be member of Nancy’s panel as well as to be in the company of the likes of Terry Dubose, Alex Primm, and Gerald Nicosia as fellow panelists.

As a panel, we enjoyed the in person back to back support of CathyK, SgtWayne, Calixto, Scott, BettyH, LucyD, and CathyP. Old School VVAW, one and all. And as such; primary targets in the anti-Kerry hate campaign mounted by the Swift Boat Vets leading up to and during the last presidential election campaigns. All were there to personally confront the Nixon left-overs with the Truth regarding Kerry and the VVAW. The first ones up to that point to do so; including Kerry himself, I might add. The Swifties presented at 0845, and we were on at 1030 hours. Unedited live video of panel presentations and panelists’ presentation papers are available at
TTU Symposium '05.

Those who were there should definitely feel a tremendous sense of validation of personal and political principle, and most assuredly deserve acknowledgement for having been members of the crew that fired the first shots over the bow of the Swift Boat Vets in what has now become a major victory for the American electorate.

The idea of was born from that gathering. It was founded on the premise that Truth ain’t always pretty, but; it is always powerful. On my families coat of arms is inscribed on a banner the premise, in Latin; “Persistence brings down even the strongest walls…” This decision by the FEC is powerful reinforcement for both of these premises. It is an especially validating experience to have been in the fight, along with countless others joined together on the side of right, and to have prevailed.

We owe ourselves an “Attaboy!” on this one, for sure. However; we will need to remain vigilant. These guys haven’t surrendered. They’ve simply retired from the field; they are just re-grouping and will now be super busy, looking for loop-holes in these recent restrictions,, in readiness for the run-up to the 2008 elections.

I know that all hands that were at TTU will continue to provide political light, in any way that they can, to the lies of those who now must swarm like flies to sugar to any perceived loopholes in the new restrictions. will remain in the fight. We hope that all of those who brought about this social and political shift in our society, the American voter, will, too. It is to them that we truly owe this victory, and it is their hearts and minds that we will need in order to prevail in the many battles to come.

Semper Fi!