Suffering moral injuries

Written by Eric on January 31, 2013 in: Uncategorized |

For years, I’ve argued that PTSD is really two very different disorders, improperly lumped together as one by the American Psychiatric Association in its Diagnostic and Statistical Manual of Mental Disorders (DSM).

The first, of course, is the fear of being killed which manifests itself in hypervigilance, vivid nightmares and flashbacks. It’s about what others have tried to do to you.

But the second, which I’ve come to call the Wounded Soul Syndrome, is based in the guilt of what you have done to others. It’s about violating your own moral code, about trying to reconcile your actions to your beliefs.

I saw a classic example of the Wounded Soul Syndrome recently in a guest column published in the Washington Post. Authored by retired Marine Capt. Timothy Kudo, it said that military suicides reflect the moral conflicts of war.

“I held two seemingly contradictory beliefs: Killing is always wrong, but in war, it is necessary. How could something be both immoral and necessary? I didn’t have time to resolve this question before deploying,” wrote Kudo, who had deployed to Iraq in 2009 and to Afghanistan in 2010-11. “And in the first few months, I fell right into killing without thinking twice. We were simply too busy to worry about the morality of what we were doing. But one day on patrol in Afghanistan in 2010, my patrol got into a firefight and ended up killing two people on a motorcycle we thought were about to attack us. They ignored or didn’t understand our warnings to stop, and according to the military’s ‘escalation of force’ guidelines, we were authorized to shoot them in self-defense. Although we thought they were armed, they turned out to be civilians. One looked no older than 16.”

Kudo, who’s now a graduate student at New York University, says he thinks about killing those people on the motorcycle every day. He also remembers the first time a Marine several miles away asked him over the radio whether his unit could kill someone burying a bomb. The decision fell on him alone, and he said yes.

“Many veterans are unable to reconcile such actions in war with the biblical commandment ‘Thou shalt not kill.’ When they come home from an environment where killing is not only accepted but is a metric of success, the transition to one where killing is wrong can be incomprehensible,” Kudo wrote. “This incongruity can have devastating effects. After more than 10 years of war, the military lost more active-duty members last year to suicide than to enemy fire. More worrisome, the Department of Veterans Affairs estimates that one in five Americans who commit suicide is a veteran, despite the fact that veterans make up just 13 percent of the population.

“While I don’t know why individual veterans resort to suicide, I can say that the ethical damage of war may be worse than the physical injuries we sustain. To properly wage war, you have to recalibrate your moral compass. Once you return from the battlefield, it is difficult or impossible to repair it.”

Kudo says he didn’t return from Afghanistan as the same person – “I’m no longer the ‘good’ person I once thought I was.” He says he wrestles with justifying his actions, but that he’s beginning to believe that killing, even in war, is wrong.

I have to salute Kudo’s courage and honesty in writing this Op-Ed piece. It should make us all reconsider what we’re asking our young men and young women to do in combat.

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Hope Glimmers

Written by Eric on January 24, 2013 in: Uncategorized |

There’s a glimmer of hope now for soldiers who worry that they may be suffering long-term effects of battlefield concussions.

Previously, the only way to know if concussions were progressing into degenerative brain diseases like Alzheimer’s or Parkinson’s was to autopsy the brain of a dead soldier or athlete. So that wasn’t much good for the living victim.

But researchers at UCLA used PET (positron emission tomography) scans on five retired NFL players, all 45 years or older and suffering from mood swings, depression, or difficulty in thinking and remembering – all potentially early signs of CTE (chronic traumatic encephalopathy).

All of the players’ scans showed signs of tau protein deposits, which is consistent with the autopsied brains of other pro football players and combat vets suffering from CTE.

Tau is a protein that occurs naturally in brain cells, but it’s the bunches or tangles that are abnormal. Normally tau links together to bring nutrition to brain cells, and that long supply line also helps hold up cell walls. When tau proteins clump up, the supply of nutrition is interrupted, and the cell walls may collapse, letting in external salts and/or calcium.

So researchers may be able to use brain scans to tell living athletes and combat vets whether they are beginning to develop CTE.

There are a couple of caveats, however, which is why I said a “glimmer of hope.”

First, five players is a sample size so small that it’s easily subject to error; we need a much larger sample, and then we need to be able to replicate it. Second, we don’t know yet whether the players actually are suffering from CTE so the tangled tau proteins can’t prove anything yet. And third, if this is an early indicator of degenerative brain diseases, we still don’t know how it progressives or how we can stop that progression.

However, several studies at Boston University and the Boston VA Heathcare System have demonstrated that brain injuries, and particularly repeated brain injuries, can progress into CTE. So all we can do is watch – and hope – as researchers attempt to understand how a brain injury progresses into the massive death of brain cells.

As I said, it’s a glimmer of hope. But it’s still more than we had before.

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Skyrocketing Military Suicides II

Written by Eric on January 17, 2013 in: Uncategorized |

The skyrocketing number of military suicides is perplexing. Why did more American soldiers take their own lives last year (349) than were killed in combat (310)?

The first conclusion is that the suicides don’t appear to be related to combat stress. Most of the suicide victims had never been deployed. Only about 47 percent had served in Iraq/Afghanistan, 15 percent had direct combat experience, and only 8 percent had a history of multiple deployments.

It’s true that just the possibility of being deployed overseas adds additional stress, but that should be less of a problem last year with the prospects of massive deployments apparently behind us.

Instead, it appears that personal issues were a greater problem.

The 2011 DoD Suicide Event Report found that death rates for divorced service members were 55 percent higher than for married service members. It said that 47 percent of the decedents had a history of a failed marriage or intimate relationship, with more than half of them experiencing breakups within a month before their deaths.

Legal problems were also common. More than 18 percent were facing Article 15 judicial proceedings, and another 13 percent faced civil legal problems. More than 21 percent had lost their jobs or been demoted.

A couple of years ago, Gen. Peter Chiarelli, the Army’s vice of staff at the time, blamed the mounting suicides on loosened retention standards that had allowed 47,000 personnel to remain in the Army despite histories of substance abuse, misdemeanor crimes, or misconduct.   He noted that loosened recruitment standards also were allowing people “coming in the Army to start all over again, and we see this high rate of suicide.”

Since 2009, the Pentagon has been pursuing an anti-suicide initiative that stresses the importance of counseling and attempts to reduce the stigma of a soldier reaching out for help. Among other things, it has increased behavioral health care providers by 35 percent over past three years, increased the number in a primary care setting, and embedded more counselors in front-line units. But clearly, that’s not enough.

One new tool is contained in the National Defense Authorization Act of 2013, which President Obama recently signed. It authorizes military commanders to ask at-risk soldiers about the firearms that they privately own and to recommend that they get those weapons out of the house until their mood stabilizes.

The act also requires the Secretary of Defense to develop a comprehensive suicide prevention program for the entire military rather than a hodgepodge of individual service programs.

Those are undoubtedly valuable initiatives, but I think back to the recommendations that came out of the Montana National Guard following the suicide of one of its members six years ago, and I think some of them could be adopted nationally. They certainly served Montana well.

One of the key steps taken there was setting up a crisis response team – typically a senior commissioned office, a senior NCO, a personnel officer and a chaplain – which was poised to check out any concerns about an individual’s mental or emotional health. If needed, the team could immediately refer a troubled soldier to counseling.

A second key step was creating a system of embedded counselors, who were present during the weekend drills. Soldiers could make appointments to see them, but the counselors also mingled with the soldiers, observing those who appeared to be struggling and talking with troops about how fellow soldiers were faring.

Both were highly effective. For those who want more information, I wrote about “the Montana model” in my book, “Faces of Combat: PTSD & TBI.” Check out:

Many also worry that soldiers aren’t getting the help that they need because they’re afraid they’ll be flagged for visiting military counselors. Despite the official policy, there remains a stigma among soldiers who believe their mission is to provide help, not seek it. Some suggest the Pentagon ought to reimburse soldiers for seeing private, civilian counselors. Certainly, it’s worth a try.

Finally, there’s a special Military Crisis number: 1-800-273-8255. Please pass it along to anyone you think might need it.




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Skyrocketing military suicides

Written by Eric on January 9, 2013 in: Uncategorized |

More American soldiers took their own lives in 2012 than were killed in combat, according to new statistics just released by the Department of Defense.

It said that 482 service members killed themselves last year. By comparison, there were only 310 combat-related deaths, which is 64 percent of the suicide rate.

Again by comparison, there were 301 active-duty suicides in 2011, 205 in 2010, and 309 in 2009 – the year the DoD launched its anti-suicide initiative – and 268 in 2008.

The numbers are shocking … but also deeply puzzling. They suggest that personal factors are more important than combat-related deployments; that the vast majority of suicides occur at home, not on a battlefield; and that the majority of deaths are among Army and Marine Corps personnel, not among the National or the Reservists.

The 2012 DoD Suicide Event Report isn’t available yet, but the 2011 report gives these statistics:

A whopping 89 percent of the deaths were regular service members. Only 7 percent were National Guard personnel and 4 percent were Reservists.

Only 10 percent of the suicides occurred during deployment. The DoD report said that 45 percent of the decedents lived in homes or apartments near their bases, while 26 percent lived on base.

Most of the suicide victims had never been deployed. Only about 47 percent had served in Iraq/Afghanistan, 15 percent had direct combat experience, and only 8 percent had a history of multiple deployments.

That’s a shock because most people link combat and suicide. “That is the storyline that we have created in our society because it’s a simple storyline and it intuitively makes sense,” Craig Bryan, associate director of the National Center of Veterans’ Studies at the University of Utah, told PRI’s The World. “The problem is that the data doesn’t support the notion that it is as simple as combat leads directly to suicide risk.”

Instead, Bryan believes the culprit is increased stress. “Life in the military these days is stressful, whether you’re in a combat zone or not,” says Bryan, who has nearly completed a three-year study of military suicide. “We’re increasingly asking our military personnel to do more with less.… And even when you’re here in the United States, even if you’re not in a combat zone, things aren’t necessarily easy.”

Even more stressful would be a pending deployment.

Some have raised questions about the prevalence of pharmaceuticals among our troops, but most of the service members who took their own lives (55 percent) had no history of a behavioral health disorder. Nearly 20 percent had mood disorders, primarily major depression. Another 16 percent had anxiety disorders, primarily post-traumatic stress disorder.

Instead, the 2011 DoD Suicide Event Report found that death rates for divorced service members were 55 percent higher than for married service members. It said that 47 percent of the decedents had a history of a failed marriage or intimate relationship, with more than half of them experiencing breakups within a month before their deaths.

Legal problems were also common. More than 18 percent were facing Article 15 judicial proceedings, and another 13 percent faced civil legal problems. More than 21 percent had lost their jobs or been demoted.

Firearms were the most frequent weapon of choice (60 percent), and nearly half killed themselves with their own weapons. Another 20 percent died of hanging.

Finally, only 13 percent had a prior history of self-injurious behavior, and nearly 74 percent of the service members did not communicate their intentions to others. If they did, it was most often to family members.

So how do we keep these guys and gals (only 5 percent of the suicide victims were female) from taking their own lives? That’ll be the subject of my next column.








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Out of the swamp

Written by Eric on January 4, 2013 in: Uncategorized |

Our government asks that our soldiers give up an arm or a leg or their life,” says “Crazy Eddie” Colosimo, “but then when they get out, it says, ‘Thanks. Now go away and don’t bother us anymore.’ That makes me so mad!”

Colosimo’s revulsion at the way America’s vets are treated underscores a poignant Christmas tale that I watched play out in Florida a couple of weeks ago.

Colosimo is president and chief executive officer for Bikers/Americans For First Amendment Rights (BFFAR), which for the second year joined up with American Legion Post 361 to offer homeless vets in the Daytona Beach area a safe and warm Christmas.

About 25 vets and a few spouses showed up on Dec. 24.

“One vet had been living in a storage unit and a couple had been living in their cars,” Colosimo told me, “but most of them came out of the woods.”

The volunteers checked the vets into a motel where they could get cleaned up, then took them to the BFFAR post in Holly Hill for haircuts and shaves. Then on Christmas eve, they got a big dinner: hams, turkeys and all the side dishes.

Christmas day was spent at the post, hanging out and playing pool and talking. Alcohol was off limits. The homeless vets were given military backpacks filled with sleeping bags and survival gear, as well as about $100 in cash and gift cards. Then on Christmas night, members of the two groups joined the homeless vets for another banquet before sending them back to their motel for a second night.

“It was a very emotional couple of days,” says Colosimo, himself a vet and the father of a military family. “On the third day, we gave them breakfast, and then they went back out into the woods or wherever they had been staying.”

Most homeless vets camp out in the woods, moving from place to place to hide from the police who are always looking to kick them out of their camps, according to Dennis St. Lawrence, chaplain for the American Legion Post.

It seems heartbreaking to send our vets back out into the swamp, but Colosimo saw the upside. Twenty homeless vets came in to the Christmas celebration a year ago, and seven of them have since found jobs and housing.

“We’re trying to end homelessness one vet at a time,” Don LePore, veteran affairs chairman for the American Legion Post, told the Daytona Beach News-Journal.

This year’s vets now know there are people they can trust and look to for help. And they’ve been given cell phones so the volunteers can keep in touch with them. Finally, the two groups are working to find free housing for vets who are willing to accept it.

“These vets don’t need a handout,” Colosimo says. “They need a hand up.”

Anyone interested in contributing to this cause can call “Crazy Eddie” Colosimo at 386/316-7441 or email him at




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