So having seen what opioid abuse has done to the civilian population in the previous blog (“Opioid abuse may be fueling a heroin epidemic”), let’s take a look at what it is doing to our nation’s vets.
“More than 50 percent of all veterans enrolled and receiving care at VHA (Veterans Health Administration) are affected by chronic pain, which is a much higher rate than in the general population,” said a 2014 VA report. “Veterans who suffer from chronic pain also experience much higher rates of other co-morbidities (post-traumatic stress disorder, depression, traumatic brain injury,) and socioeconomic dynamics (disability, joblessness) that may contribute to the challenges of pain management when treated by opioids.”
However, prescription painkillers became the preferred tool for dealing with that pain.
The Center for Investigative Reporting, using data provided under the Freedom of Information Act, said prescriptions for four opioids (hydrocodone, oxycodone, methadone and morphine) surged by 270 percent between 2000 and 2012, leading to addictions and a fatal overdose rate that was twice the national average.
In 2014, the VA said it issued 1.7 million prescriptions for opioids to 443,000 vets to be taken at home.
Citing a VA Office of Inspector General’s report, the Center for Ethics and the Rule of Law (CERL) said: “Between 2010 and 2015, the number of veterans addicted to opioids rose 55 percent to a total of roughly 68,000. This figure represents about 13 percent of all veterans currently prescribed opioids.”
Alarmed, the VA began cutting back its painkiller prescriptions in 2010. The agency says it reduced the number of vets receiving painkillers by 115,575 individuals between 2012 and 2015 and that it has 100,000 fewer vets on long-term opioid therapy.
Still, it says it treated 66,000 vets for opioid addiction in fiscal 2016.
“We owe it to the nation’s veterans to help them end their dependence on opioids,” said VA Secretary Robert McDonald, “and break the downward spiral that all too often leads to homeless, prison or suicide.”
McDonald said vets are 10 times more likely than the average Americans to abuse opioids and that such abuse is a leading cause of homelessness among vets.
However, one problem is that there’s no adequate replacement for prescription painkillers. “We do not have another silver bullet that we can say, ‘Instead of opioids, try this,’” Dr. Carolyn Clancy, the VA’s deputy under-secretary for health, told FRONTLINE Enterprise Journalism Group. “It’s much more a matter of individualizing and trying different alternatives, and that can be really frustrating for patients, as well as clinicians.”
Some VA centers have started to introduce programs on managing chronic pain by use of yoga, acupuncture, qigong and tai chi, but those programs are rarities. Most therapy is still cognitive behavioral, which isn’t very effective for chronic pain.
Furthermore, the VA system is currently overloaded, and most physicians don’t have the time to experiment with alternative therapies. And doctors are often pitted against their skeptical colleagues in trying to provide pain relief in a way that’s effective, but not dangerous to the patient.
Even the regulations adopted by the federal Drug Enforcement Administration have had a backlash by forcing vets to return every month to a VA facility to renew their medications. This only increases the patient load at facilities that may have a three- to six-month wait even to get an appointment.
So what does this do to our vets? Listen to the stories that some of them have told the nation’s news media in the past few years:
Robert Deatherage, a 30-year-old Army vet, told the Wall Street Journal that he has battled addictions to pain pills and heroin after suffering severe injuries in Afghanistan. He said he hit rock bottom a year before when he took refuge in an empty church in Fayetteville, N.C., and tried to kill himself – twice.
“I was just so sick of being as sick as I was,” he told the WSJ. First, he tried to shoot himself, but the gun misfired, so he injected himself with all the drugs he had, but he didn’t overdose.
Believing he might recover after all, Deatherage walked to a nearby VA Medical Center, but it was full so they sent him back onto the street with a jacket from the lost and found and the phone number for a homeless vets coordinator. After he picked up his disability check a few days later, however, he checked into a motel that he knew was frequented by vets and addicts.
“It gets discouraging,” Deatherage told the Journal. “”It makes it easier just to say, ‘F—k it, I’ll just keep doing what I’m doing.”
The youngest son of a single mom, Deatherage adored his grandfather, a Vietnam helicopter pilot who died when he was 10. Shortly after enlisting in 2006, Deatherage was prescribed Percocet for a back injury during helicopter training and continued taking the painkillers during his deployment to Afghanistan in 2009-10.
“I got blown up seven times,” he told the WSJ. “I would go see my medic, get bandaged, get Percs and get on with it.” During that time, he suffered back, neck and facial injuries, and he suffered a traumatic brain injury when he cracked his skull during an explosion.
Later stationed on the West Coast, he was prescribed opioids for his pain and began buying additional relief from other soldiers. He lost his job, his savings and his marriage, and he received a medical discharge for substance abuse in 2014.
“They threw me out of there and said ‘Take care of yourself,’” he told the WSJ. “So I did.”
Deatherage spent the next two years either in jail or homeless, according to the Journal. At the time of publication, he remained in jail.
Craig Schroeder, a former Marine corporal, was injured by a roadside bomb in the “Triangle of Death,” a region south of Baghdad, according to the Washington Post. He suffered a traumatic brain injury and lost some hearing, memory and movement. Due to pain from a broken foot and ankle, as well as a herniated disc in his back, he has had a steady supply of prescription opioids.
But after the DEA regulations were put in place to reduce opioid prescriptions, he was unable to get an appointment to see his doctor in North Carolina for nearly five months, he told the Post.
“It was a nightmare,” he said. “I was just in unbearable, terrible pain. I couldn’t even go to the ER because those doctors won’t write those scripts.”
His wife Stephanie told the Post that getting her husband a VA appointment became her main mission in life, but she said the VA seemed to become hostile toward patients who asked for painkillers.
“Suddenly, the VA treats people on pain meds like the new lepers,” she told the Post. “It feels like they told us for years to take these drugs, didn’t offer us any other ideas, and now we’re suddenly demonized, second-class citizens.”
Jeffrey Waggoner, a former paratrooper, was sent to a VA hospital in southern Oregon for detoxification from a brutal addiction to painkillers, but instead of sobering Waggoner up, medics doped him up, the Center for Investigative Reporting reported.
CIR obtained medical records in which one doctor said, “when not stimulated, (he) lies on the gurney and rapidly falls asleep.” And a nurse reported that Waggoner’s “eyes were like slits and he appears to be overly sedated” as he was rushed to the emergency room after falling out of bed.
Waggoner told a nurse at the Roseburg, Ore., VA hospital that he had been taking painkillers since he had been injured by a rocket-propelled grenade blast in Afghanistan and that he suffered from severe flashbacks that interrupted his sleep.
“Then, inexplicably, the VA released him for the weekend with a cocktail of 19 prescription medications, including 12 tablets of highly addictive oxycodone,” CIR reported. “Three hours later, Wagoner, 32, was dead of a drug overdose, slumped in a heap in front of his room at the Sleep Inn motel.”
“As a father, you’d want to know why this happened to your child,” his father, Greg Waggoner, told the center. “You send your child to a hospital to get well, not to die.”
The center also reported that medical records showed doctors at the southern Oregon VA hospital where Waggoner was treated prescribed eight times as many opioids as their colleagues at the VA hospital in Manhattan.
Ken Grady, a 45-year-old Air Force veteran, has been prescribed OxyContin, Percocet, Vicodin, and fentanyl patches throughout the 2000s to relieve pain from a series of surgeries for back injuries, the Wall Street Journal reported. “The VA made it so easy,” he said. “It was endless, and I abused it.”
When he couldn’t get prescriptions, he was able to buy opioids on the street, often outside the Fayetteville, N.C., VA hospital from patients who had just had their own prescriptions re-filled. While he has been struggling to stay clean, Grady told the Journal that he has spent all but 65 days of the preceding two and a half years in VA-funded treatment or in jail.
During one stay at the VA’s mental health unit, a doctor prescribed him Percocet for chronic back pain, he said, but he told the doc “Please don’t give me that.”
More recently, the WSJ reported, Grady had several teeth pulled by a VA contractor who prescribed him Vicodin for pain. He took the pills that time, relapsed, bought some more on the street and landed in jail again, where he remained at press time.
Army veteran Joshua Renschler developed liver damage after years of taking 13 drugs, including opioids, to numb his back pain following a mortar blast in Iraq, according to FRONTLINE. In testimony before Congress, he said doctors in Washington kept prescribing pills to manage the pain and the side effects of the medication, but offered few other solutions.
“When it comes to opioids, if we’re relying on the VA to provide this care, it almost mandates the need for opioid-based therapy, as sad as that is,” Renschler said, adding that he still struggles with severe pain, but now avoids medications due to his liver damage.
“I’m just about as good as I’m going to get,” he said.
FRONTLINE also interviewed Jim Reed, an Army veteran and anesthesia provider who is concerned about the Army’s reliance on prescription painkillers. Although he suffers from chronic neck pain, he refused a VA doctor’s prescription for opioids, as well as one pill to help him sleep and another pill to help him stay awake. Instead, he said he take Motrin and practices relaxation techniques.
But most vets don’t question the doctor, he added. He routinely sees vets in their 20s and 30s who are taking a “laundry list” of medications.
“We’re sentencing these young people to a life of chemical dependency,” Reed told FRONTLINE. “They’re living these lives of despair because we’re just not doing things that make sense, that are evidence based.”
Finally, the Center for Investigative Reporting told the story of Tim Fazio. Fazio started getting opioids from the VA in 2008 and has received nearly 4,000 oxycodone pills and more than a dozen bottles of Tramadol, another opioid painkiller.
But Fazio told CIR that he’s never been in serious physical pain – he uses the painkillers to blot out feelings of guilt for surviving when many of his close friends have not. On a shelf, he keeps a picture of four of his Marine Corps buddies; one killed himself, another was found dead in a Florida ditch after battling opioid addiction and PTSD, and a third was charged with murder.
“Last year, researchers at the San Francisco Medical Center published a paper in the Journal of the American Medical Association that found VA doctors prescribed significantly more opioids to patients with PTSD and depression than to other veterans – even though people suffering from those conditions are most at risk of overdose and suicide,” CIR reported.
Dr. Stephen Xenakis, a psychiatrist and retired brigadier general, told the center such prescriptions are counter-productive. “Opioids have an adverse effect for most of these patients,” said Xenakis, who was commanding general of the Army’s Southeast Regional Medical Command. “They make sleep more difficult because they disrupt your usual sleep pattern, and as your sleep gets worse, your mood and your anxiety get worse, and you find yourself not being able to think as clearly.”
Furthermore, opioids are downers, so they tend to make depressed vets even more depressed, Xenakis said.
Hospital records indicate that the VA knew Fazio was an addict in 2009 and provided him with detox. But VA doctors continued to prescribe opioids for three more years until his parents hired an attorney and threatened to sue the agency for medical malpractice, CIR reported.
“It’s so sick. It’s so wrong,” his mother, Kathy Fazio, told the center. “The kid is flagged everywhere with what he’s addicted to, and they’re still giving him Percocets. He’s better off to the Veterans Administration dead than … paying all that money to help him.”
Two new reports underscore the danger of over-reliance on prescription painkillers like OxyContin.
The first report, from Johns Hopkins University, suggests that our current heroin epidemic may have been fueled by people originally addicted to painkillers (opioids) who switched to illegal drugs after their prescriptions (or their cash) ran out. The second, from the University of Pennsylvania’s Center for Ethics and the Rule of Law (CERL), shows that our nation’s veterans are particularly at risk of becoming addicted to painkillers.
Let’s look at the civilian side first.
In the fall of 2016, Johns Hopkins Magazine reported on OxyContin, which had been introduced in 1996 by Purdue Pharma. The drug supposedly blocked pain for a full 12 hours, but its low dosage of opioids made it much safer than similar drugs and so there was much less possibility of addiction, the company told regulators and doctors.
Opioids had been primarily used to control pain in cancer and surgical patients, but primary care physicians quickly began prescribing OxyContin for less severe pain. From 1999 to 2014, prescriptions for OxyContin nearly quadrupled nationwide. According to the Los Angeles Times, sales of OxyContin topped $3 billion in 2010.
But there were problems. Many patients didn’t get a full 12 hours of pain relief, and doctors began prescribing larger and larger dosages in response. Secondly, OxyContin – which is a chemical cousin of heroin – was more addictive than doctors and their patients realized.
Then in 2007, Purdue Pharma and three of its top executives pleaded guilty to misleading regulators, doctors and patients about the hazards of OxyContin and agreed to pay more than $600 million in fines and damages.
West Virginia, Kentucky and southeastern Ohio were particularly hard hit, due to their heavy reliance on the coal industry. Coal mine injuries are frequent, and opioids like OxyContin seemed to be an attractive way of managing that pain. So the pharmaceutical companies began flooding the Tri-State area with drugs.
Then the Charleston (WV) Gazette and other newspapers began writing about the abnormally large number of opioid prescriptions in their area. And the West Virginia Attorney General’s office began suing individual pharmacies. In one suit, the AG’s office said a rural pharmacy in Raleigh County had dispensed 2.3 million hydrocodone pills and another 2.3 oxycodone pills in the preceding seven years in a town with 2,700 residents.
The lawsuit said the pharmacy “made substantial profits from providing opioids to the citizens of West Virginia.” It also said sales of the combined prescriptions dropped from 905,000 in 2010 to 267,000 in 2016 as the danger became more widely recognized.
Johns Hopkins reported that opioids killed more than 28,000 people in 2014, more than any year since the Centers for Disease Control began keeping track. It also quoted the CDC as estimating that 2.6 million Americans are addicted to prescription painkillers.
But when the supply of opioid prescriptions began drying up, many of those addicts began switching to heroin, which is similar in structure to opioids but much cheaper on the black market. Between 2002 and 2013, the CDC said, the number of women using heroin doubled, while the number of men using heroin increased by 50 percent.
According to a study published in “JAMA Psychiatry,” 75 percent of the new heroin users seeking treatment said they had first become addicted to prescription painkillers.
According to the CDC, West Virginia has the highest rate of drug overdose deaths in the nation. In 2014, there were 627 deaths in the state, which works out to about 36 per 100,000 population. In 2015, drug-related deaths rose to 725, or 42 for every 100,000 people.
The CDC estimates that Huntington, W.V., a small city of 49,000 which sits on the Ohio River bordering Kentucky, has a rate of drug-overdose deaths about 10 times the national average. According to the Pew Charitable Trusts, about 8,000 residents (16 percent of its population) are addicted to drugs, primarily to opioids and heroin.
Last year, the city made national news when it recorded 26 drug overdose calls within a single day, a situation which prosecutors say was caused by a drug dealer selling heroin laced with another drug used to tranquilize elephants.
The CERL report said that between 1.9 million and 2.1 million Americans are addicted to opioids and that nearly 19,000 deaths a year result from opioid addiction. An estimated 34.5 percent of civilian males and 26.9 percent of civilian females who suffer from post-traumatic stress injury (PTSI) also abuse drugs or are dependent on them, according to the center.
“Individuals who abuse opioids are 19 times more likely than the general population to end up abusing heroin as well,” said the CERL report.
In 2016, the CDC concluded that there has never been any significant evidence that opioids are safe and effective for alleviating pain, and it reduced new guidelines for the prescription of opioid painkillers that recommended significant reductions in the quantity and duration of opioid use.
So having seen what opioids has done to the civilian population, let’s take a look at what it is doing to our nation’s vets.
Writing is a critical part of therapy, so you might consider Julie Davey to be a therapist for the U.S. Marines at Camp Pendleton, Calif.
But her real job description is as a volunteer writing coach, teaching young Marines how first to identify their deepest feelings and then write them down – a way of coming to terms with the experiences that have been seared into their brains.
It’s a therapy she knows all too well first-hand.
A former investigative newspaper reporter in Texas and Mexico, Davey later spent nearly two decades in southern California, teaching journalism at Fullerton College, a community college which is a little east of Los Angeles.
In 1984, she had her first brush with breast cancer; it returned in 1996, but the City of Hope Cancer Center was able to treat it successfully.
Then on 9-11, two hours after terrorists commandeered planes to bring down the World Trade Center Towers, Davey was again teaching a journalism class at Fullerton College as she and her students sought to understand a drastically changed world.
“With tears in my own eyes, I stared at their tear-stained faces,” she writes. “I was barely able to speak. ‘We all have skills,’ I told them. ‘Use yours; help somebody. Make a difference.’”
A couple of weeks later, she took her own advice and volunteered to teach her fellow cancer patients at City of Hope Cancer Center in Duarte, Calif., how to write about their own experiences. That has made a big difference to her new students — and also to their teacher.
“What I have learned is simple: Words can help us heal,” Davey writes. “”A doctor can help heal your body, and a psychiatrist or a good friend with a soft shoulder can help heal your spirit. But focused and directed writing about what you are going through in the depths of your soul provides a unique and sometimes immediate sense of relief. That experience can also be the beginning of a special kind of healing.”
In 2007, she compiled what she had learned as a writing coach into a book: Writing for Wellness: a prescription for healing. Learn more about the book and her class at this website: http://writingforwellness.com/
It’s based on the tell-one, show-one, do-one method of teaching. First Davey writes of her own experiences. Then she provides examples of other students writing about their own experiences. Finally, in a section called “It’s Your Turn,” the book helps readers begin writing about their own lives.
To make it easier, Davey provides “prompts.” That means students may plug their own words into a pre-written formula, such as the following:
“When I think about the best times in my life, I always remember ….”
Or, “A day I would like to relive and change the outcome of was when ….”
Or “… made the biggest difference in my life because ….”
Then out of the blue one day, Dr. James Johnson, who is a Navy commander of Camp Pendleton and also its head chaplain, called to tell her he had read her book and wanted to know whether she’d join him in co-teaching a writing class on base to help his Marines. The only real difference was that they’d make it more relevant to Marines by changing the program’s name to “Writing for Strength.”
The class was voluntary, but many Marines were hesitant. Free pizza and home-made cookies kept the classroom full – the home-made cookies, in particular, were an almost irresistible magnet for many of the young men.
No one was required to read his or her writings aloud, but there were invitations to do so. And often the responses were gut-wrenching. “We get a lot of writing like, “I wish I hadn’t seen my buddy die,” or “I wish I hadn’t seen all the dead people in the street,” Davey told me.
Sometimes, the results can be totally unexpected.
Chaplain Johnson read an article aloud to the Marines. It had some excellent advice on how not to “become engulfed” by negative experiences and losses in our lives. The Marines were clearly moved by the information in the article which said none of us ever really forgets life’s traumas, but we can put them into perspective and “carry on,” searching out positive experiences and remembering our losses without having them take over our present-day lives.
Then, Davey suggested the group write their reactions to the article, giving them assurance that what they wrote would not have to be read aloud.
Davey remembers one such incident: “Well one Marine did not wait. He just jumped to his feet and said, ‘I’ll read MINE!’ It was kind of shocking. I had no idea what he’d say. In a strong and determined voice, he read word-for-word what was on his paper, but he also gestured as he read.
“He said, ‘Do them justice
Perhaps I am odd
I don’t waste time on tears
I simply pick up their pack
And carry on.’
“With that, he reached down, making a gesture as if he were picking up the pack of a fallen Marine. The chaplain and I were spellbound.
“He spoke, ‘You have to accept the horrible things in life. Ignore them or they will consume you.’
Davey continued to describe the scene. “Well, I could hardly speak. It was stunning. I was quiet for about a minute, as was everyone else in the room, and then I asked him to read it one more time. He did, and the message again was powerful. Hearing his words and seeing his actions became a life lesson for all of us. I realized that my own pack has my brother, my mother, my father and lots of friends in it. The precision of the Marine’s words brought vivid images. I saw a person picking up fallen tears and placing them in the pack he carried.
“After class, I asked him if he had anything else to say about what he wrote and he said, ‘After the chaplain read the article, we were asked to write about something sad so I wrote about losing Marines. Every Marine carries a pack on his or her back. There’s a lot of gear in these packs and things that weigh more than the gear itself. The way I see things, you respect the dead by carrying the weight they once carried.’”
That poem, “Do Them Justice,” was written and delivered orally in class by Sgt. Brendan S. Bigney. It’s part of a new book of poetry that he’s preparing to have published.
Another Marine, who asked not to be identified due to an ongoing active-duty status, wrote in response to the prompt about what he or she missed the most: “I miss myself. I miss my innocence. I miss my faith in my government.”
Such compelling honesty is precisely why writing is therapy.
New research findings indicate that some post-traumatic stress disorder cases may actually be the result of traumatic brain injury.
“We talk about PTSD being a psychiatric problem – how people respond to the horrors of war,” Dr. Daniel Perl told the New York Times. “But at least in some cases, no – their brain has been damaged.”
If these findings hold up – and they come from a very small study – it would indicate three similar but distinct forms of PTSD.
The first, of course, is the traditional PTSD, a form of persistent hyperarousal which begins when a soldier struggles to survive as others are trying to kill him, but which fails to lessen after he returns home amidst relative safety.
The second is what I call the wounded soul syndrome. It’s not about the fear of what others are trying to do to you, but the opposite: a sense of guilt over what you have done to your enemies (or failed to do for your friends).
Now Perl, a neuropathologist, has examined the brains of eight former soldiers who experienced concussive TBI and discovered that all had a distinct pattern of astrogial scarring which he believes could account for their neurological and psychiatric symptoms.
The implications are large because it suggests that some forms of PTSD may actually be the results of physical injury.
Perl and his colleagues at the Uniformed Services University of the Health Sciences in Bethesda, Md., examined the brains post-mortem of three military personnel exposed to acute blasts who died days or months after their injuries and five others with chronic blast exposure who died several months to years later.
All had a unique pattern of damage to the brain involving scarring in parts of the brain crucial for emotional and cognitive function, memory, sleep. That scarring was found in the subpial gilal plate, penetrating cortical blood vessels, grey-white matter junctions and structures lining the ventricals.
Perl compared their brains with 13 others – men with impact TBI such as found in athletes, opiate use or healthy controls – and found no indication of scarring.
“We believe this is the brain attempting to repair the damage produced during the exposure to the blast,” Perl told MedPage Today. “This pattern of scarring is exactly what biophysicists who study the effects of a blast wave on a biological structure would have predicted for the brain.”
And this scarring differs from brain injuries caused by impact TBI, the kind of injury seen among football players and boxers. Blast TBI occurs when an explosion creates a wave of compressed air, traveling faster than the speed of sound, that inflicts intense pressure on the body, including the brain.
“It interacts with whatever it happens upon, including the service members who are standing in the range of the explosion,” Perl was quoted as saying. “”Others have shown that a blast wave can penetrate the skull and can be measured inside an intact skull. So it makes sense that it may damage the brain.”
Soldiers suffering from blast TBI often develop persistent neurological and psychiatric symptoms, including PTSD, headaches, sleep disturbance, and memory problems.
Perl’s study raises the possibility that better head protection for active-duty soldiers could deflect away some of the blast wave’s most damaging aspects. Dr. Ralph DePalma, a special operations officer in the office of research and development at the VA, told the New York Times that the prospect of better protection could be “the most important aspect of this paper.”
He added that soldiers should not assume they will automatically be damaged by blast waves. Genetics are believed to protect some combat soldiers against PTSD, so damage varies from individual to individual.
In the future, researchers will continue to study how the magnitude of a blast leads to scarring, how clinical damage might correlate to various behavioral and neurologic areas, and whether there is a way to determine these kinds of damages in living service members.
“Our study makes an important contribution in terms of understanding the nature of what a blast does to the brain,” Perl told MedPage Today. “But we need a great deal more work to better understand it.”
The New York Times Magazine summed it up best: “If Perl’s discovery is confirmed by other scientists – and if one of blast’s short-term signatures is indeed a pattern of scarring in the brain – then the implications for the military and for society at large could be vast. Much of what has passed for emotional trauma may be reinterpreted and many veterans may step forward to demand recognition of an injury that cannot be definitively diagnosed until after death. There will be calls for more research, for drug trials, for better helmets and for expanded vet care. But these palliatives are unlikely to erase the crude message that lurks, unavoidable, behind Perl’s discovery: Modern warfare destroys your brain.”
Scientists in San Diego, Calif., think they have at least one of the answers to a question that has puzzled psychologists for years: why some soldiers are more resilient to combat stress than others.
They believe the answer is in their genes.
After studying the DNA of 13,000 American soldiers, researchers have found two genetic variants that they believe may explain why some combat vets are afflicted with PTSD, but others are not.
“The first, in samples from African-American soldiers with PTSD, was in a gene (ANKRD55) on chromosome 5,” said Dr. Murray Stein, Distinguished Professor of Psychiatry at the University of California-San Diego. “In prior research, this gene has been found to be associated with various autoimmune and inflammatory diseases, including multiple sclerosis, type II diabetes, celiac disease, and rheumatoid arthritis. The other variant was found on chromosome 19 in European-American samples.”
A team from the UC-San Diego School of Medicine, the VA San Diego Healthcare System, and the Uniformed Services University compared the genomes of 3,167 combat vets diagnosed with PTSD and another 4,607 combat vets who had not been diagnosed with PTSD. A second study involved 947 diagnosed vets compared with 4,969 combat vets without PTSD.
“We compared the two groups in all markers for all genes and found differences that were distinctly different between the two groups,” Dr. Stein told me. “But it wasn’t a 100 percent difference. The group with the variant was about 60 percent more likely to develop PTSD.” Their hope is that one day in the future a DNA test during basic training will tell commanders which soldier will be more able to withstand combat stress and which might be better suited for an administrative role.
“In theory, that is how this could be used, but we’re nowhere near there yet,” Dr. Stein said. “We have a lot of work yet to do to be sure of these findings. But we may be able in the future to analyze this data and say someone would be very good at combat, while someone else might be better as a supply sergeant – or may need additional training to boost his resilience.”
In addition, further testing is needed to determine whether other racial groups – Asian Americans or American Indians, for example – express the same difference with different genes.
Jennifer Sluga, six-year veteran of the Wisconsin National Guard, originally participated in the VA’s new oral history program to help her caregivers understand her military sexual trauma, but her ordeal made her a strong advocate for others who had been assaulted.
“In the beginning, telling about my story helped me heal,” she told me recently. “But now I want everyone else who has ever experienced sexual trauma to know that they are not alone. By talking about it, we can get back the power that was taken from us.”
Now a psychotherapist at the Vet Center in Madison, Sluga estimates that 90 percent of her patient caseload also suffers from MST.
Sluga spent 17 months with the National Guard in Kosovo, but she told Thor Ringler, the “poet-in-residence” who runs the VA’s pilot “My Life, My Story” program in Madison, that her PTSD probably started well before her deployment from her military sexual trauma during her military training. (For more about the oral history program, see my previous blog, “An Oral History Program to Tell Veterans’ Stories.”)
“When he started that program, I told him it was the most amazing program ever,” she said. “Talking this trauma out of my system and using it to help others is just an amazing and powerful experience. It’s important for medical personnel to know that when I’m in those situations, I’m gonna be a little uptight, that I wonder whether I can trust that person, and that I’d prefer work with female doctor.”
Her ordeal started in boot camp when she and her “battle buddy” both reported to sick call. Her buddy was sent to the hospital, and that left her alone with the doctor.
“He had lot of rank on his chest and expected me do anything he said,” Sluga said. “He wanted me get undressed, then he began touching me and it became pretty obvious that this was nothing in the realm of anything medical.”
Sluga finally managed to push him away and ran to her barracks, only partially dressed.
“I ran to our barracks because I wanted to shower and cry, but another woman saw the marks on my body, asked about them, and then called the drill sergeant,” she said. “He ran over to sick call, and I thought he was going to kill the medic. It was really cool to be validated like that.”
But it didn’t stop there.
Several members of Sluga’s unit reported also sexual abuse during their deployment, and she began advocating for them.
Finally, the medic was charged with sexually assaulting his patients, and Sluga, her battle buddy and her drill sergeant were all required to testify at his court martial. “He finally admitted to sexually assaulting more than 70 soldiers and excused it by saying he had been raped as a child,” she said.
No wonder Sluga was severely traumatized. But she didn’t realize it until after she had left the National Guard and returned to college.
“I didn’t recognize that I wasn’t doing well until I went from an A student and I was failing all my classes, not attending classes, sleeping 20 hours a day,” she said. “I just wanted to go hide.”
Her breaking point came after she and her classmates got an exam back, and one of the girls was complaining about a bad grade.
“She said, ‘It really raped me,’” Sluga remembered. “And I just wanted to jump over the chairs and scream at her: ‘Did it really rape you? Did it make you feel completely out of control? Did it actually hurt you?’”
That led to counseling and therapy. It led to Ringler and the “My Life, My Story” program, which has now spread to six other VA facilities across the country. And it led Sluga to a career helping others as a psychotherapist.
More men than women are sexually assaulted in the military, she said.
“One of four women reports she has been sexually assaulted,” said Sluga. “The rate for men is one in ten, but since there are so many more men than women, the number of male victims is greater. Females are assaulted by men and other females, and males are assaulted by males and females as well.”
Rape and sexual assault are not about sexual gratification, she added. It’s all about power and control.
“In the military, you have no control over much of anything, so if you can find an area you can control, you take it,” Sluga explained. “A lot of people bully up and take advantage of other people — it’s almost like a sport.”
Now look at Sluga’s ordeal in light of our previous discussions on moral injury. She was betrayed by virtually everyone in her chain of command: the medical officer who sexually assaulted her, the officers who let such conduct go unchecked. Those fellow soldiers who are supposed to save your life if necessary and have your back should be the last individuals anyone should need to protect themselves against.
VA psychologist Jonathan Shay argues that moral injury is present when there has been a betrayal of what is right by a person in a position of legitimate authority in a high-stakes situation. “Moral injury impairs the capacity for trust and elevates despair, suicidality and interpersonal violence,” he wrote in an article, “Moral Injury,” published last year in the journal of Psychoanalytic Psychology.
Sluga would agree that military sexual trauma can lead to PTSD.
When you lose your sense of self, especially from someone who’s supposed to be helping you, and they take your power and use it against you, to me that’s combat,” she said. And we all know that combat trauma leads to PTSD.
Ed Tick, founder of Soldier’s Heart, argues (persuasively, in my opinion) that America has failed its veterans. Not just the government – all of us.
Soldiers should only be asked to fight in just wars to protect our country, he says. And since they are being asked to kill, there should be social rituals to protect them emotionally before they do. And when they return home, there should be purification ceremonies.
“Countless Americans who served in our politically and economically motivated wars feel broken because they betrayed the warrior’s purpose and code, because the war was not unquestionably and purely defensive, because society and the government refused their tending tasks and judged and blamed veterans for their psychological problems afterward, and because both government and citizenry refuted collective responsibility,” Tick wrote in his newest book, Warrior’s Return: Restoring the soul after war.
After the war, vets feel isolated. They don’t talk about what they did (or didn’t do) because they feel they’ve violated our moral code. And we don’t ask them what they did (or didn’t do) because we’re afraid of what we might learn.
In other cultures, though, warriors are celebrated for what they have been through, which makes it easier for them to feel accepted back into society.
That’s particularly true among the Native Americans of the Great Plains, who were often at war with their neighbors and later with federal troops. The entire tribe felt a collective responsibility to reach out to their warriors, Frank Fools Crow, ceremonial chief of the Lakota Sioux, told author Thomas Mails in the mid-1970s.
“So many who went war came home wounded and crippled,” he said. “Others were physically well, yet never mentally the same again. A person cannot return easily to normal life once he has been in that kind of a war.
“The elderly people of those days understood this,” Fools Crow added. “They knew very well what it was like to return home after fighting other Indian tribes and whites. So as the veterans returned back to Pine Ridge (S.D.), the elders and other religious leaders did what they could to restore and renew them. They gave the veterans sweatbaths, which cleansed and purified their bodies and souls; the best food available; and they talked with them for days on end.”
To some extent, that’s what the VA is doing through a fascinating pilot program spearheaded in Madison, Wis., by a poet and counselor, Thor Ringler.
Essentially, counselors at the William S. Middleton Memorial Veterans Hospital in Madison realized that they really didn’t have the time to get to know their patients, so Ringler began interviewing vets who were willing to participate and producing oral histories to be included as part of their medical records.
“I first started realizing how important stories are to vets when I was an intern at the Vet Center,” Ringler told me. “They do a pretty thorough military history, and I came to realize that those stories were really important for me to be able to learn about the vet experience. I learned so much from those little histories.
“Then when the grant became available (from the VHA Office of Patient-Centered Care and Cultural Transformation), I realized it would be a tremendous opportunity to tell those stories in an honest way,” he added.
The program, called “My Life, My Story, began in 2013. Since then, Ringler and a group of 20 or so volunteers have interviewed nearly 1,000 vets about their military experiences. They write up the interviews, which generally take about an hour, and then read them back to the vets to make sure they are an accurate and honest reflection.
“It’s a moving experience for a lot of vets to hear their own stories read back to them, but it’s also a humbling experience for me,” said Ringler.
One guiding principle is that interviewers don’t probe issues that vets are unwilling to discuss, but Ringler doubts that a lot is held back.
“There’s more honesty than I would have ever guessed,” he said. “People talk about their relationship things, and they admit to being part of their own problems and accepting their sadness about the things that happened. I don’t think people tell me everything, but they tell me as much as they trust my willingness to be a non-judgmental force.”
In addition to being a part of the medical record, copies are made for the vets’ families and friends. And some oral histories are also posted on the hospital’s Facebook page:
Recently, the “My Life, My Story” program has expanded to six other sites across the VA: Ashville, N.C.; Bronx, N.Y.; Iowa City, Iowa; Reno, Nev.; Topeka, Kan.; and White River Junction , Vt.
“Veteran stories, when skillfully elicited and carefully crafted, give providers an opportunity to know their patients better, without impinging on their time,” Ringler and four co-authors wrote last year in the “Federal Practitioner.” “For veterans, the experience of being interviewed and the knowledge that their story will be shared with providers is an important recognition that they matter and have a voice in their health care.”
Coming up in our next blog will be the painful story that one vet shared with the VA and how it felt to make a painful experience public.
Lt. Col. Bill Edmonds was shattered four years ago when he made a personal moral inventory and came to the realization that he had done too little to prevent Iraqi interrogators from abusing or torturing jailed suspects, some of whom may have been innocent.
It only deepened his devastation that he had recommended an investigation into the torture of suspected Iraqi insurgents, apparently with American troops being complicit, but the investigation by our military officials cleared all the interrogators.
“I came to the brink of insanity and quite literally lost my mind,” Edmonds writes in his book, god is not here. “Desperate and within an inch of losing my life, I reached out for help, to both mental-health professionals and my military superiors – and they rolled their eyes.”
Talk about a triple whammy! Just about all the elements for moral injury are present here.
Edmonds’ journey into hell started in 2005 when, as a major and a U.S. Army Special Forces officer, he was assigned to be an adviser to an Iraqi intelligence office who conducted interrogations in the basement of a palace in Mosul that Saddam Hussein used to call the Guest House.
But it wasn’t just questioning. Interrogators regularly lied to the insurgents, telling them that their wives, brothers or children had been killed and that unless they confessed, they’d be stuck in prison during the funerals.
Edmonds had forbidden extreme interrogation techniques in the wake of the recent scandals at Abu Ghraib, but the Iraqi interrogators constantly argued for more extreme measures, arguing that without using force to get confessions, these killers would be back on the streets within days to ramp up lawlessness and violence against American soldiers.
It got harder to resist, until Edmonds reached a breaking point.
“I feel a fracture slide down the center of my chest,” he wrote. “Tonight, for the first time in my life, I passionately, fervently want to kill another human being. I want to reach across this small prison cell and let my shadow fly.”
Edmonds was able to walk away without losing it, although he wrote: “I became a man I no longer recognize. I’ve lost myself.”
Then came a new challenge: one of the Iraqi interrogators slapped a suspect in front of Edmonds. “Regardless of my excuses to ignore what I know is right, I am overwhelmed by the atrocity and the inhumanity of these killers and here, in these cells, I have the power to stop them,” he writes. “And I’m morally wrong when I do, and when I don’t.”
His response was to quit going to the prison, but that only increased his sense of guilt as he thought about what was probably happening to the suspects being held there.
Then Edmonds discovered that eight Iraqi prisoners were missing from another of the Iraqi prisons where other American advisers worked. When he finally tracked them down in another part of Iraq, the abuse was apparent.
“Those eight prisoners … were horribly tortured: burns, knife wounds, broken bones, electrical burns and welts from slashing cables,” he wrote.
He suspected the Iraqis tortured these prisoners at another prison overseen by Americans and sent them to a different location where they couldn’t be found. His conflict over what was right vs. what might save lives paralyzed him for a long time, but he finally forced himself to report his findings to the military authorities.
A full-scale investigation was ordered, and everyone was exonerated, he said.
“God help me,” he wrote. “Because I still so desperately want to torture, to kill, these evil people: I can already feel purgatory stalking me. But I have never done what I uncovered and then covered it up by vanishing them! And then this? I finally sensed a light in the distance and then I find out that no one gives a shit?”
So here you have a terribly conflicted man trying to force himself to do what he knows to be morally right, but being betrayed by his superior officers.
Dr. Jonathan Shay, the psychologist credited with coining the phrase moral injury, defines a situation like that as betrayal of trust. And he says that a betrayal of what is right by a person in legitimate authority can impair the capacity to trust and elevate despair, suicidality and interpersonal violence.
Five years later, Edmonds began a month-long meltdown. He tried desperately to fix his problem himself because he didn’t want to jeopardize his top-secret security clearance, but he couldn’t function.
When he sought help at a base mental health clinic, a psychologist listened to as much of the story as he was able to tell, then told him there was nothing wrong with him and sent him home. That’s likely because his symptoms were those of someone suffering from a moral injury, and the medical definition of PTSD doesn’t include moral injuries. The traditional diagnosis of PTSD is only about what others are trying to do to you – moral injury is about what you have done to others, or failed to do for others. PTSD should encompass both aspects, but it currently doesn’t.
So Edmonds said the docs told him he didn’t have a problem, just go home and get a grip. And that, of course, was another betrayal.
When he reported for work, Edmonds told his bosses what he figured they’d find out anyway, that he had gone to a mental health clinic seeking help for PTSD. With that, he said, they concluded he was a security risk and made his life an even greater hell for a month until they told him that if he would transfer out of the unit voluntarily, the episode wouldn’t be reflected in his personnel file.
Huge betrayal and a gaping moral injury.
“I don’t know how to put Iraq in words,” Edmonds wrote. “I don’t have the words to describe that inner fight, how my many selves struggled to navigate a year-long moral battlefield. How every day I was forced to make a choice – do I torture another human being or not – and how every day, over and over again, no matter the decision, I made a soul-crushing wrong choice, and how the other stresses of war, the daily expectation of death, the failing war strategy, the isolation, the austere environment, and the girlfriend back home, how these other things only compromised my mental immunity, lowered my resistance. Over time, my mind slowed, and then I just … turned off. I shut down.”
Did you notice that phrase, “I don’t have the words”?
That’s exactly what Bessel van der Kolk was talking about a couple of months ago in Philadelphia. When a brain is traumatized, the prefrontal cortex – the center of rational, ethical decision-making – shuts down. In particular, the brain’s language center – the Broca’s area – shuts down. “Without a functioning Broca’s area, you cannot put your thoughts and feelings into words,” van der Kolk said.
If Edmonds couldn’t talk about it, he could at least try to write about it. And writing became his therapy.
Getting up well before dawn, he thought about each of the moral quandaries he had found himself in. Slowly, he analyzed each of the actions he had taken … or failed to take. And when he felt his analysis was honest and accurate, he wrote it down on a pad over the kitchen table while his wife and children slept.
“The main lesson I took away from my moral examination is that it’s not the person that’s bad – it’s the situation,” Edmonds told me over dinner one night recently in Washington, D.C.
His book ends with one challenging statement: “The never-ending search for redemption is how I survive my purgatory.” I asked if that meant he was seeking to make atonement for what he had done, or failed to do, and Edmonds said that was right.
“My decision to write was my therapy, just for me,” he said. “But my decision to publish that writing was my way of seeking redemption.”
After battling a Missoula veteran’s disability rating for a traumatic brain injury for more than three years, the VA has finally blinked.
“The VA’s Appeals Management Center conducted a records review inclusive of my prior neuropsychological test results conducted by the Department of Defense (Army) and determined those original test results were sufficient to overturn the VA’s initial rating decision,” Charles Gatlin said last week.
Meanwhile, a second mental health advisory council to Montana’s governor accused the VA of providing substandard care to vets suffering from TBI.
Gatlin, a former infantry captain, suffered head injuries when a vehicle bomb exploded near him in Iraq in 2006. His wife, Ariana Del Negro, said his concussion was caused by the blast, by the engine block hitting his head, and by hitting his head again when he fell.
After undergoing extensive neurological testing for two days each in 2006, 2007 and 2009, the Army concluded that his injuries were permanent and discharged him with a 70 percent disability rating.
When Gatlin moved to Missoula to attend graduate school at the University of Montana, he went to Fort Harrison for his VA disability rating. His Army medical records were received by the VA in January 2012, but apparently ignored. Instead, Gatlin was given a brief screening assessment called RBANS (Repeatable Battery for the Assessment of Neuropsychological Status).
Then the VA dropped Gatlin’s TBI rating from 70 percent to 10 percent, although it attributed some of his difficulties to PTSD and added a 30 percent disability rating for that.
Gatlin challenged that rating and testified before the VA Board of Appeals in Washington D.C. in October 2013.
Gatlin and Del Negro also took their case before the Montana Board of Psychologists in Helena, arguing that the RBANS test was inadequate to measure mental deficits, that the psychologist who administered the test misinterpreted the results, and that the psychologist, Robert Bateen, wasn’t qualified to interpret the results.
The VA objected strongly, but the state licensing board agreed a year later. It concluded that Bateen was not qualified to provide a neuropsychological assessment of Gatlin, that he had failed to provide an adequate standard of care, and that he could not argue he was merely following VA policy.
“Licensee has an independent professional obligation to ensure his work as a psychologist complies with the statutes and rules governing his license,” concluded the Montana Board of Psychologists, and it barred him from evaluating vets for traumatic brain injuries at Fort Harrison.
In response to a query from Sen. Jon Tester that fall, the VA said it fully supported the test and the psychologist. It also said it had no intention of re-evaluating other vets who had been evaluated by Bateen.
“The stipulation Dr. Bateen signed with the Montana Board has not impacted our ability to conduct residual TBI C&P (compensation and pension) examinations in the state of Montana,” wrote Dr. Carolyn M. Clancy, interim under secretary of health for the VA in Washington, D.C. “The VA Montana Health Care System has three additional licensed psychologists who perform TBI C&P examinations, so there will be no impact on the completion of these examinations.
“These psychologists are not licensed in the state of Montana and need not be because this is a federal jurisdiction,” she added.
Then in May of 2015, after mulling the case for a year and a half, the VA Board of Appeals directed that all of Gatlin’s medical records be added to the case, that he be re-evaluated by “an appropriate medical specialists,” and that the claim be re-adjudicated. If the decision was adverse to the veteran, the appeals board said it wanted to see the case again.
But nothing happened until the Appeals Management Center, the VA’s top medical board actually read the record and reached its decision last summer without new testing.
Then two weeks ago, the Governor’s Traumatic Brain Injury Advisory Council decided to endorse the standards of the Montana Board of Psychologists, specifically citing the letters from Clancy.
“The letters …state the intention to not use methods of evaluation which apply to the condition or injury causing the disability and to not observe the standards of care outlined by the Montana Board of Psychologists,” council Chair Angela Wathan wrote in a letter to PHHS Director Richard Opper.
“It appears to the council that the VA is deliberately adopting a lower standard of care for veterans than that which is accepted for civilians,” she added. “This accepted standard of care is not always achieved in civilian care either, but it is remarkable to see it explicitly rejected by the VA.”
Wathan noted that vets who live more than 40 miles from a VA facility can choose to receive care from civilian providers, adding that she hopes they aren’t forced to abide by “the inadequate standard of care adopted by the VA.”
“Thus, veterans might still be denied access to appropriate specialists, evaluations and interventions,”Wathan wrote. “This would tend to oppose the efforts of the council to improve access and standards of care for all Montanans.”
However, Special Assistant Attorney General Tyler Moss of the state Department of Labor and Industry said Thursday that all psychologists licensed by the state are required to abide by state standards.
A greater concern is apparently that vets who receive blast injuries generally are treated for their physical injuries and possibly for concurrent PTSD, but seldom for neurological damage. The scientific literature shows that repetitive brain injuries can change the metabolic and immune systems. For example, the metabolism of oxygen diminishes in an injured brain, causing a lack of energy, cell damage, inflammation, and potential cell death.
Vets need greater access to neurologists than they’re currently getting, some mental health experts argue.
A spokeswoman for the VA’s, public information office in Washington, D.C., said Friday that she was not aware of any restrictions of private-care service imposed by the VA and that the number of neurologists employed by the VA has increased by about 13 percent in the past five years, from 619 in fiscal 2011 to 700 at the end of 2015.
Let me share with you a heart-breaking letter from a PTSD mom in New Jersey named Sharon Eiflander. It perfectly illustrates a discussion we had several weeks ago in Philadelphia about the need to calculate the costs of going to war beforehand. As Sharon’s letter sadly demonstrates, this is something our government did not do. Here’s her story:
My son, Mark Joseph Eiflander is a Corporal in the USMC. He did his time, and has been home for the past 6 years. He is a Combat Vet, did 2 tours in Iraq and 1 tour in Afghanistan, he was a machine gunner.
Having Mark in harm’s way at that time, felt like living a nightmare. However, he did come home “bodily” safe, but the son that left, was not the son that returned.
A year after his return, he went to a VA hospital for pain in his back and legs. He was given, practically, a lifetime supply of codeine, Percocet and they were actually mailing them to our home. PTSD was not discussed. Mark would wake up screaming in the middle of the night, not willing to explain what he was dreaming about.
Over time, Mark became heavily addicted to pain medication, which led to other addictions. He was living on our couch at the time. Unable to hold a job, keep a relationship, live a normal existence. Last year, he jumped out of a moving vehicle on the NJ Parkway with no shoes. We found him, and could not get him into a VA Hospital. We took him to Red Bank where they admitted him in the psychiatric ward. They discharged him a week later.
My husband took him to the VA in East Orange on an emergency basis. They did admit him into the psychiatric ward for a week then to Building 4 (addictions) after that. The facility is horrendous. After a week, everyone on that unit developed foot fungus. This was caused because of the fact when they showered, they were standing in backed up water. The facility was covered with black mold. They were put on medication. His feet are still scarred.
Mark was told when he left East Orange that he would then have to go to Lyons. He had heard some horror stories about there, he did not want to go. He wanted to go to a VA in Virginia. He was told, there was no room, he would have to be discharged, come home and wait for his turn. They could not keep him in East Orange, there was no room.
He, reluctantly, went to Lyons, afraid of what might happen if he came home. In the 4 days he was there, there were 3 overdoses in his unit, drugs coming in from people who had outside connections. Someone stole everything out of his room. He walked out. We found out a week later he was gone.
His problems continued to escalate. He came back home. Tried AA, NA. Nothing worked. He got to the point, he was unrecognizable. He never slept, never ate. We begged him to call East Orange again. He did, but was told there was a 4-month wait. He begged and said he would not make it that long. He called them every day. Finally, about 5 months ago, they had an opening.
Mind you during all of this time, he was arrested numerous times for drug related chargers, and at one point, on the parkway, begged the police officer to shoot him! He even tried to go for the officer’s gun, in hopes he would get shot.
So, here we were, back in East Orange. Nothing had changed. Except the fact that we knew we were losing our son. While there, he was trying to make arrangements to go to the VA in Hawaii, looking for a geographical change. They said they couldn’t help him get in there. Somehow, he developed a contact in Hawaii. While in East Orange, he developed a severe tooth ache. Was told that the “in house” dentist was booked for weeks. The pain was so unbearable, Mark pulled the tooth out himself! A few days later, he knew it was infected. They took him to the ER on premises. Dr. examined him and said yes there was an infection. Would prescribe antibiotics. While the Dr. entered Mark’s information into the computer, he realized Mark was from Building 4. He yelled to the nurse “This one is from Building 4” I cannot give him a RX. The nurse yelled back “I am tired of those addicts coming up here pretending they are sick just to get drugs” Mark was mortified. Then there was a security guard right there who said “Hey, you can write me a few scripts while you are at it”
Disgraceful. Mark went back into his shell. Feeling like everything was his fault, wanting to die. And, at times, we thought he was going to.
He somehow made arrangements when his 29 days was up in East Orange, to go to the facility in Hawaii. We thought it was a bit drastic, but we were desperate. When he got to the facility, I believe his name was not on the list. Now he is in Hawaii, with nowhere to go. He lost his wallet, had no ID.
He said he made some friends, is happy, not using. We have to believe him.
Absurd is not even close to describing this. How can we send 20-year-old boys over there, have them come home, and treat them like it was all for nothing? Turn them into drug addicts so they don’t have to deal with them, and making them feel like nothing.
I could stand in the middle of the street and scream if I thought just one single person would listen. I would sit on the steps of the White House, if I thought someone would listen.
Look at the number of our men and women who do not survive. Sure, physically, they survived their tour, but then die at their own hands. I don’t know if Mark will ever be the same. Why can’t our vets get the same benefits our Congressmen and Senators get????? Lifetime benefits. Why can’t a Vet walk into a pharmacy, and not have to pay a single penny?? Why does it cost a vet, out of pocket, $6000 a week to get help at a private facility??
Right now, and I am afraid forever, is a day to day struggle for Mark, and all of our vets. Isn’t there something, and I mean something drastic that can be done??? Don’t they deserve that? Sure a “thank you” on the street is nice. But there needs to be something or someone who will fight for them, the same way they fought for us!!!
Reading Sharon’s letter makes realize how we have failed her son, as well as the 2.6 million young men and women our government has sent to fight in Iraq and Afghanistan – and then conveniently forgotten after they have returned home.
And it brings home a discussion that we had at the Center for Ethics and the Rule of Law at the University of Pennsylvania. About 30 of us (military commanders, mental health professionals, legal scholars and a couple of journalists) were invited to consider what should be the legitimate costs of going to war.
There seemed to be widespread agreement that mental health treatment should be planned for before going to war, but calculating those costs can be difficult. Vets have higher rates of alcoholism, drug addiction, joblessness, homelessness, incarceration and suicide than the general population. But how can you calculate those costs to our society.
Even worse, as a couple of philosophers pointed out, how can you calculate the human toll? How can you begin to calculate the cost to the Eiflander family – or to the families of the millions of vets?
I have no answers. And it’s obvious that our government has none. But we all should.
Finally, the Eiflander family is desperate for help. Anyone with suggestions can reach Sharon Eiflander at this email address: “Sharon Eiflander” <email@example.com>