Friday, March 23, 2007

Beyond Walter Reed: The Full Tragedy of Lessons Unlearned From Vietnam to Iraq
Dr. Raymond Scurfield
Associate Professor and Director of the Katrina Research Center at The University of Southern Mississippi

Dr. Raymond Scurfield, recognized internationally for his expertise in war-related trauma, has written a trilogy of books about war’s impact. The most recent is War Trauma. Lessons Unlearned From Vietnam to Iraq. He also has several writings about the impact of Hurricane Katrina. He is an associate professor and director of the Katrina Research Center at The University of Southern Mississippi Gulf Coast and can be contacted at &

GULFPORT, Miss. -- Does the widespread reaction to the recent expose at Walter Reed and the neglect of some of our nation’s physically wounded Iraq veterans indicate that our nation has had a wake-up call to what the full impact of war entails—and what is required to address it? As a Vietnam veteran with a 25-year leadership career with the VA, please forgive my skepticism. The underlying institutional problems go far beyond any benefits from sacking high-ranking officials; cosmetic cover-up and pest control treatment at one military facility; and renewed time-limited Congressional oversight that eventually dissipates.

Walter Reed characterizes one of over 30 lessons unlearned about our nation’s treatment of war casualties over many decades: Our country sends us to war. Our military uses us in war. And our country forgets us after war. This unlearned lesson is compounded by a second--When our nation sends us off to war, a sacred covenant is made--in return for going into harm’s way and putting our lives and our comrades-in-arms’ lives and health at risk, the nation promises to honor our sacrifices and provide humane and timely war-related financial benefits, health and medical/mental health services. When this sacred covenant is broken, despair, isolation, rage, and alienation cascade in turbulent waves over our war-wounded and their families.

The wounded languishing at Walter Reed reflect the plight of many veterans who have been, are, or will return to find themselves warehoused too often in sub-par facilities and inattention in the limbo of “medical hold” status at numerous military installations. Just check out medical holds at Ft. Benning, Ft. Dix, Ft. McClellan—or elsewhere. As one mother of a severely wounded Iraq veteran said, “When he was no longer of use to the military, they forgot about him.”

These physically wounded are a fraction of a much greater number of casualties even more forgotten --- those suffering posttraumatic stress and other serious mental health problems. Various studies indicate mental health problem prevalence rates of up to 30 percent or as many as over 400,000 uniformed Americans who have been deployed to Iraq and Afghanistan to date! And this number will grow exponentially, because the acute psychiatric casualty rates of war always are much less than the longer-term casualty rates.

And then, the Department of Veterans Affairs, the object of several recent investigations, epitomizes more unlearned lessons. The head of the VA is a political appointee; thus, VA officials typically echo what the White House stance is and not necessarily act as vigorous advocates for veterans’ interests (Max Cleland was a notable exception)…another unlearned lesson. When a “new” war is being conducted, veterans of prior wars, their families and programs are pushed to the bottom of the priority list. In the midst of the emotionally charged climate to support our forces in harm’s way, perhaps this is somewhat understandable---understandable, but absolutely not acceptable.

A related unlearned lesson: pro-military political forces are not necessarily pro-veteran; too often they consider funding for veterans’ programs to be detrimental to funding the enormous costs to sustain the DOD in (or out of) war. And veterans’ programs suffer. It was the case before and during my leadership of several VA national and regional PTSD programs, and it is the case today.

One recent example: a McClatchy Newspaper study revealed that some 100 local VA clinics provided essentially no mental health care in 2005! And this is to a veteran population that includes still as much as well over a half million veterans from the Vietnam War alone with war-related mental health problems---the unseen or hidden casualties of war. And both physical and mental health casualties and their families are left, by and large, alone during the ensuing decades to fight the unglamorous, unbelievably courageous daily battles with lifelong, unremitting severe chronic pain, disabilities, disfigurement, impairment and/or anguish from seemingly indelible horrific war trauma memories. Research reveals that those wounded are among the highest at risk to develop PTSD---a double whammy.

Another lesson unlearned is the collusion to not tell us all that studies since WW II consistently demonstrate a very strong linear relationship between exposure to combat and the development of mental health problems, e.g., those who encounter the heaviest combat, have extended or multiple deployments are at higher risk to develop war-related problems. This is exactly what is happening today. The costs and implications for war policies and taking care of our own now and later are enormous—and lest we forget or not care, for tens if not hundreds of millions of Iraqis.

Furthermore, in Iraq, the increasing nastiness of and prolonged exposure to horrific combat conditions are combined with the increasing polarization and divisiveness about the war in Iraq and the growing specter of no honorable way out. These factors fuel a perfect storm of anguish and malaise that may well engulf untold legions of yet another era of wounded warriors and families.

Do not let Walter Reed be only a wake-up call; insist that our nation rallies to support the full range and duration of physical, psychological and social casualties of war and fully honors that sacred covenant that has been forged in blood and sacrifice. And yet . . . the experiences of innumerable Vietnam and (still counting) Iraq and Afghanistan veterans and their families keep intruding and pulling at my heart, whispering loudly to me, “You know that this, too, shall pass and if history tells us anything, it is that, once again, selective amnesia will eventually envelop yet another era of veterans and their families.

Dr. Raymond Scurfield, March 2007

(This article reprinted from THE UNIVERSITY OF SOUTHERN MISSISSIPPI Marketing and Public Relations OPINION COLUMN; Media Release 3 March 2007)

Tuesday, March 06, 2007

PTSD/PVS, Combat Stress Injury
& Walter Reed
by Willie Hager (aka Wilder)
When a beginning is born of an ending, and there’s no breathing space
in between; it’s kinda like a circle that always in motion,
it can’t really be touched or seen." From the song Movin‘ On In Circles

This posting was intended to be my report and review of the 2nd National Combat Stress Trauma Symposium at FL State University held on Feb. 16 in Tallahassee, FL. However, the ugly reality of our government's "first class care" of its returning warriors must first be addressed. It is imperative that recent events at Walter Reed be placed in empirical, historical perspective before (once again) political spinmiesters and spoon-fed media distort reality, whitewash real conclusions and solutions and fix the blame on the Veterans themselves.

Cracker Swamp, FL - Callous, uncaring, and often disgraceful care of America’s Veterans are definitely not new issues. They have been directly visited, reviewed and addressed starting as far back as 1973. Not only by myself, but by many, many others as well. This stressor identification and research was begun by the returning Vietnam Veterans themselves, initially in conjunction with Robert Jay Lifton. See War of Words- Time 1973, Rob't Jay Lifton-Wikipedia, Still At War-Willie Hager 1976. But it was consistently ignored by the powers-that-be, with both capital costs and political costs being used as the primary criteria for veterans' care. This model stands in complete opposition to what is best for the Veteran, the Veterans’ families, and ultimately the entire country as the primary criteria for their evaluations. Sadly, considering recent developments; it looks like it’s still that way today.
Case in point: Vietnam Veterans are still, after thirty years, locked in struggle with a V.A. more mindful of the political agenda of sitting presidents, political pandering by congress, and budget turf battle considerations implemented by the V.A. bean counters, than with true Veteran advocacy and support. Many Vietnam Veterans are only just now asking for assistance, after struggling unsuccesively with the symptomology of what is currently known as PTSD. As a result of their asking for "help", and in order to obtain services and benefits, they are put through a mentally gruelling exercise of “proving” their cases to the V.A. and the Dept of Defense against an ever-changing medical paradigm. Any resistance, challenge or questioning of the program results in a Kafkaesque nightmare of compromising hoops that a Veteran must jump through in order to receive consideration for care or earned benefits for their Honorable service to their country.
These hoops, I believe, are actually insidiously and cynically designed to discourage Veterans from filing initial claims or to discourage them from continuing with any appeals that they might have in mind if they are not satisfied with their initial award. Many receive ridiculously low ratings on their claims, ratings based on the V.A. budget and the prevailing political winds, and whims of the powers-that-be. If this is still happening with Vietnam Veterans thirty years later, imagine the flood of misery our current burgeoning population of combat Veterans and their families face if we don’t get it right this time!

Speaking directly to recent events at Walter Reed and elsewhere: The most common expressions from the media and public appear to be ones of shock. Excuse me?! These revelations are only shocking because the government wants them to appear shocking -- as if they just found out about these problems. They say; "By God! Heads will roll when we get to the bottom of all of this...". But they will never get to the bottom of it all on their own, because that would be political suicide. To admit that they had it wrong for all these years would legitimatize the very Truth that they have been denying for over thirty years. And this admission would culminate, once again, into yet another ballooning national tragedy.
Anatomy of a Ballooning National Tragedy

In the thirty days since I returned from the FL State Symposium, there have been many new developments, including:

1) Virtual Reality Treatment for PTSD: The Florida Times-Union newspaper recently depicted a Navy medic in a Navy hospital near Balboa Park in San Diego with some kind of futuristic head gear strapped to his head. This medic was "trying out the program" as part of a virtual reality approach to behavior modification at the hospital. LtCdr Robert McClay, Navy psychiatrist and research leader on virtual reality treatment of PTSD in San Diego, stated in the article:
...some PTSD sufferers are unable, or unwilling (emphasis mine) to recall things in counseling sessions without stimuli, such as the digital images of a combat hospital, a recorded Islamic prayer melody or the smell of cordite explosives misted into a psychologists office.

The article also stated:

Sufferers might have anxiety, nightmares, flashbacks, emotional numbness, extreme jumpiness and physical pain...With a therapist’s supervision, the virtual Iraqs are designed to vividly, yet safely (for who?) enable those veterans to confront war experiences in ways that go beyond traditional counseling and drug therapy. The computer programs, even with the somewhat cartoonish digital depictions of combat, seek to relieve trauma by repeatedly revisiting its origins and not letting fear fester.

Newsflash, folks; it ain’t about fear! When I read this article, I immediately flashed back to A Clockwork Orange-Stanley Kubrick and the scene where Malcolm McDowell is shown undergoing similar “treatment,” designed to modify his Droogish behavior. It wasn’t pretty then and it ain’t pretty, now. (Original article on this topic posted on Feb 9th, Virtual war, real healing-L.A. Times. )
Does it ever stop? Programs like the one in San Diego, once again, insult America’s combat Veterans. Back in The Day (pre DSM III PTSD 1970s), the V.A. employed behavior modification "therapy" consisting of:
  • Locked wards
  • Token rewards (Dr. Skinner’s operant conditioning model) for desired behavior response
  • Crippling psychotropic drug therapy usually involving massive doses of the debilitating drug, Thorazine
  • Electro-shock therapy
Fortunately, some of these programs were documented with live on-ward interviews that I and others managed to tape and smuggle out of the locked-down psych wards of the V.A. in Los Angeles. The footage is included in the VVAW/UCLA Film Collective documentary, Still at War, which was released circa 1976. (See clip from film.) Once you’ve seen this film, the “new” McClay's therapy looks like the same ol’ behavior modification s*** from back in The Day, except that they are utilizing virtual reality as a “therapy” model and treatment plan for behavior modification, instead of Thorazine, electric shock therapy, or frontal lobotomys.

2) The Walter Reed Bldg. 18 scandal bursts onto the media scene (see Walter Reed-Washington Post.)! The first stories I heard were TV reports about rodents, peeling paint and mold; stories apparently broken by Ann Hull and Dana Priest of the Washington Post. The duo apparently managed to get onto the wards and document their findings through photos and taped interviews with patients. Deja vu! That’s exactly what we did in the early '70s at the Los Angeles V.A. psychologically challenged locked wards and the Long Beach V.A. paraplegic ward while making Still at War. In fact, approximately six years earlier, Life magazine had also done an expose’, as well. This one on the Bronx V.A. paraplegic ward. (See Life Magazine/Bronx V.A., circa 1970.) Nothing new going on at Walter Reed; it’s just the same ol’ s***, warmed over!

My friends, there is plenty of documented history to prove unequivocally that our government, at all levels, has a policy of lying about their knowledge of mistreatment of Veterans, including:
  • Unworkable programs
  • Administrative mismanagement of claims
  • Poor funding priorities
  • Unacceptable living conditions at the facilities
  • Adversity rather than advocacy toward the Veteran in the disability/benefits claims process
Government's response when the grassroots strike back? Discredit the dissidents, fire a couple of generals (Golden Parachute retirement), silence the enlisted ranks;…and deny, deny, deny! And once again, just as they did in the Vietnam Era, they will attempt to re-frame the solution in some way so as to place some sort of “blame” on the Veterans themselves. Just as they did, and are still doing, with Vietnam Veterans; they will lock arms, lock step, circle the wagons, and hire the Swift Boat Vets, or whatever that un-illustrious group is calling themselves these days, to attack Veterans who speak out against failed policies that have allowed these despicable conditions to fester.

The Washington Post report on Walter Reed demonstrates that the government obviously hasn’t changed much of anything since Still at War and Life magazine’s original forays into the heart of the beast at the V.A. In spite of the best efforts of Veterans to stand up for themselves, the powers-that-be continue to throw money, the FBI, and/or Swift Boat types into the fray in order to thwart this seemingly unending siege war for dignity and respect, along with the care and consideration that we earned through our Honorable service under arms for America. If you don't believe me, just watch the ugliness gear up to full swing as those of us who have lived these Truths bring our personal history and experience to bear on these issues.

But once again, how can they demand our silence?

We must help our returning troops from having to be Movin’ On in Circles all their lives -- and this time we must get it right. 'Cause, believe me; it affects each and every American when our own government is allowed to bleed the life, hope, and dreams out of those who have served unquestioningly and unflinchingly in combat in our name. And who are now, as a result of that Honorable service Still At War, right here on the home front. Changes can happen if we all take responsibility and pitch in. Pass the evidence of this national shame along to all of our lists, blogs, friends and families. This is the stuff grassroots democracy is made of; to legitimately and legally retrieve power from those who would want it for their own purposes, and put it to use for the greater good...that being in this instance deserved quality care for our returning combat Veterans, and a better quality of life for all of America's citizens.

If we all stand together as American voters, speak in one voice that is devoid of partisan politics and pro-war or anti-war rhetoric, and continue to Speak Truth to Power on this heartbreaking topic; change will happen.

Our returning warriors deserve no less from us.

Willie Hager, March 2007