Relocate These Troops to Fort Gordon

Instead of complaining, we offer a solution today. With regards to this issue at Fort Benning, Georgia:

Across the street from their assigned housing, about 200 yards away, are some of the Army infantry's main firing ranges, and day and night, several days each week, barrages from rifles and machine guns echo around Strickland's building. The noise makes the wounded cringe, startle in their formations, and stay awake and on edge, according to several soldiers interviewed at the barracks last month. The gunfire recently sent one soldier to the emergency room with an anxiety attack, they said.

"You hear a lot of shots, it puts you in a defensive mode," said [Army Sgt. Jonathan]Strickland, who spent a year with an infantry platoon in Baghdad and has since received a diagnosis of [Post Traumatic Stress Disorder] PTSD from the military. He now takes medicine for anxiety and insomnia. "My heart starts racing and I get all excited and irritable," he said, adding that the adrenaline surge "puts me back in that mind frame that I am actually there."

Soldiers interviewed said complaints to medical personnel at Fort Benning's Martin Army Community Hospital and officers in their chain of command have brought no relief, prompting one soldier's father to contact The Washington Post. Fort Benning officials said that they were unaware of specific complaints but that decisions about housing and treatment for soldiers with PTSD depend on the severity of each case. They said day and night training must continue as new soldiers arrive and the Army grows.

The solution? MOVE these troops to Fort Gordon, Georgia. Spend the money to relocate them immediately. Determine, regionally, which posts offer the best environment for treating PTSD troops and put them there. Here's a hint--Fort Riley and Fort Hood probably aren't good candidates for this type of unit, either. They can be moved to facilities at Gordon, receive treatment at Eisenhower Medical Center, and there is virtually no way to "hear" the rifle ranges while on the main post at Fort Gordon--they are located miles away.

The Army is not at fault for this--Fort Benning is the home of Infantry training. This is an unfortunate co-mingling of two things. While Fort Gordon is also a TRADOC post in some respects, it is also home to several other units. As stated, the firing ranges at Gordon are NOT co-located where the troops would be housed and cared for. The Army is only at fault if it does nothing.

Contact the House Armed Services Committee and the Senate Armed Services Committee if you want to advocate on behalf of this issue.

--WS

As war rages on, Iraq's psychiatric patients are plunged into an archaic past

The Ibn Rushid psychiatric hospital in central Baghdad was once, in a time before the war, a jewel in the crown of Iraq's healthcare system. Now, after five years of war, the staff struggles to deliver services under horrific conditions where they lack medications and equipment and are forced to compromise and make do, because the alternative to that is doing nothing, and that is anathema to most helping professionals.

They struggle on, doing the best they can, even though they are feeling the strain and exhibiting signs of PTSD themselves.

Nevertheless, he does his best to help his patients. Some he treats with the limited number of psychiatric drugs at his disposal. For others, patients who are suicidal or catatonic or do not respond to drugs, he prescribes electroconvulsive therapy, administered with a 25-year-old machine that, he says, has “technical problems.”

The patients are sometimes given Valium before the treatments. But because there is no anesthesiologist on staff, the shocks are delivered without anesthesia, as they were decades ago in the United States.

Dr. Hussain is acutely aware that what he has to offer is far from ideal — that the way the hospital gives electroshock therapy is “inhuman and dangerous,” that patients do not receive the panoply of special programs and therapies routinely available in other countries.

“I feel frustrated,” Dr. Hussain said. “I feel sad. I see the correct things but I cannot do them because there are barriers and limitations. We do not have the equipment, we do not have the treatable medication.”

Despite that, he says, patients often improve.

Only four psychiatrists, from a pre-war staff of eleven, remain on staff at Ibn Rushid, most have departed for the Kurdish areas in the north where the odds of being kidnapped or murdered is far lower than it is in Baghdad. Others have fled the country and never looked back.

The facility is so understaffed that patients admitted for treatment must be accompanied by a family member who stays with them at all times to help keep them calm.

And still, in spite of seemingly insurmountable odds, patients seem to get better.

Dr. Hussain envisioned things differently when he chose to become a psychiatrist in the 1980s, fascinated by the psychiatric symptoms of soldiers returning from the distant battlefields of the Iraq-Iran war.

But now a different war has settled over his country, and his patients, though not soldiers, are all, in a way, the casualties.

He could leave Iraq, but he has no intention of doing so, he said. He loves his work.

“Nobody forced me to be a psychiatrist,” Dr. Hussain said.

"the severest case of PTSD she'd seen in her life..."

Photo: Travis and Willard Twiggs

Marine with PTSD kills brother, self:

Last month, Marine Staff Sgt. Travis N. "T-Bo" Twiggs went to the White House with a group of Iraq war veterans called the Wounded Warriors Regiment and met President George W. Bush. Twiggs had been through four tours in Iraq, one in Afghanistan and months of therapy for post-traumatic stress disorder in which he said he was on up to 12 different medications.

"He said, `Sir, I've served over there many times, and I would serve for you any time,' and he grabbed the president and gave him a big hug," said Kellee Twiggs, his widow. About two weeks later, Travis Twiggs went absent without leave from his job in Quantico, Virginia. He and his brother drove to the Grand Canyon, where their car was found hanging in a tree in what appeared to be a failed attempt to drive into the chasm. The brothers carjacked a vehicle at the park Monday.

Two days later they were at a southwestern Arizona border checkpoint, and took off when they were asked to pull into a secondary inspection area, Border Patrol spokesman Michael Bernacke said. Eighty miles (130 kilometers) later, the car was on the Tohono O'odham reservation, its tires wrecked by spike strips.

As tribal police and Border Patrol agents closed in, Twiggs, 36, apparently fatally shot his 38-year-old brother, Willard J. "Will" Twiggs, then killed himself. Pinal County Sheriff's spokesman Mike Minter said no motive has been established. But Kellee Twiggs said the decorated Marine would still be alive if the military had given him enough help.

[SNIP]

Travis Twiggs, who enlisted in the Marine Corps in 1993 and held the combat action ribbon, wrote about his efforts to deal with post-traumatic stress disorder in the January issue of the Marine Corps Gazette.

The symptoms would disappear when he began each tour, he said, but came back stronger than ever when he came home.

He wrote that his life began to "spiral downward" after the tour in which two Marines from his platoon died.

"I cannot describe what a leader feels when he does not bring everyone home," he wrote. "To make matters even worse, I arrived at the welcome home site only to find that those two Marines' families were waiting to greet me as well. I remember thinking, 'Why are they here?"'

Weeks later, Twiggs "saw a physician's assistant who said that was the severest case of PTSD she'd seen in her life," his widow said.

He began receiving treatment, but the Marine wrote that he mixed his medications with alcohol and that his symptoms did not go away until he started his final tour in Iraq.

When he came home, "All of my symptoms were back, and now I was in the process of destroying my family," he wrote. "My only regrets are how I let my command down after they had put so much trust in me and how I let my family down by pushing them away."

Kellee Twiggs said her husband was "very, very different, angry, agitated, isolated and so forth," upon his return. "He was just doing crazy things."

She said her husband was treated in the psychiatric ward of Bethesda Naval Medical Center and then sent to a Veterans Administration facility for four months.

Most recently, Travis Twiggs was assigned to the Marine Corps Warfighting Laboratory at Quantico, a job he said helped him "get my life back on track."

"Every day is a better day now," he wrote in the Marine Corps Gazette. "... Looking back, I don't believe anyone is to blame for my craziness, but I do think we can do better."

Twiggs urged others suffering from similar problems to seek help. "PTSD is not a weakness. It is a normal reaction to a very violent situation," he wrote.

Kellee Twiggs said she cannot understand why her husband was not sent to a specialized PTSD clinic in New Jersey.

"They let him out. He was OK for a while and then it all started over again," she said.

We Need Action to Go With That Outrage

This is a continuing series of posts that follow up the lawsuit against the Veterans Administration and highlights what happened yesterday before a Congressional Committee.

That's all well and good--now follow it up with something that forces these people to act and that holds them accountable for their massive fuck-up:

...Committee Chairman Bob Filner lashed out at the man in charge, Secretary James Peake, accusing the V.A. of "criminal negligence," reports CBS News chief investigative correspondent Armen Keteyian.
"What we see is a pattern -- deny, deny, cover up, cover up," Filner said.

Filner's colleagues quickly followed, piling anger on top of disbelief.

With his embattled Director of Mental Health Dr. Ira Katz at his side, Secretary Peake presented a detailed series of charts and graphs generally backing CBS News suicide data.

"I've never had a concern with their overall numbers," Katz told the committee.

"We're as far from hiding information from the public as anyone I know," Peake said.

But several lawmakers weren't buying it, citing a Feb. 13 e-mail titled "Not for CBS News" where Katz appears to be trying to keep attempted suicide numbers quiet.

These bastards have to go. Replace them with people who care and who will work hard to fix this problem.

Of necessity, the Pentagon strikes "Question 21" from the Security Clearance questionaire

As the war in Afghanistan grinds on toward the seven-year mark, and the war in Iraq is almost two months into the sixth year, the effects on our military forces have been overwhelming. Last month the RAND corporation released a study that pulled the curtain back on the horrors of what our Soldiers, Sailors, Airmen and Marines are being forced to deal with and should have served as a wake-up call for the homefront - and the Pentagon. It also compliments and confirms an Army study on mental health that was released by the Joint Chiefs earlier this month that pegged the number of soldiers suffering from PTSD after one deployment at 12%, after two deployments at 18.5% and after three deployments at 28%.

Many units have deployed multiple times, and as the studies showed, the members of those units are suffering horribly. The more times they deploy, the worse they suffer.

Until yesterday, many of those who are suffering the effects of repeated combat rotations suffered in silence...because of "Question 21."

Anyone wo has ever gone through the process of getting a security clearance knows what it is..."Have you consulted a mental health professional in the past seven years for issues other than martial problems or grief?" A "yes" required excruciating details of the reason treatment was sought, and the treatment method(s) employed. This usually raised other questions and led to closer scrutiny.

John E. Fortunato, chief of Fort Bliss' Restoration and Resilience Center, which treats soldiers returning from combat with post-traumatic stress disorder, called Thursday's announcement an important first step.

Fortunato, who has treated 37 soldiers since his center opened nearly a year ago, said commanders have taunted troops and told them to "soldier on" when they complained of combat stress.

Soldiers have "paid such a high price for PTSD," Fortunato said.

The cost of treating a soldier is far less than pushing him or her out of the Army, Fortunato added. He estimated it costs his center roughly $20,000 to treat someone with post-traumatic stress disorder, compared to the hundreds of thousands of dollars the military would have to spend to replace the discharged soldier.

"The measure (of mental health treatment) success is retention," he said.

During his visit, Gates said the military must lift the stigma on mental health care and encourage troops to see it as equal to physical care.

"The most important thing for us now is to get the word out as far as we can to every man and woman in uniform to let them know about this change, to let them know the efforts that are under way to remove the stigma and to encourage them to seek help when they are in the theater or when they return from the theater," Gates told reporters here as he announced the change.

"The department considers it a mark of strength and maturity to seek appropriate health care, whenever required," James Clapper, the undersecretary of Defense for Intelligence, and David Chu, the undersecretary of Defense for Personnel and Readiness, wrote in a letter announcing the change.

It is a welcome change that is long overdue, but truly - it's better late than never.

PALE RIDER ADDS...

It's a welcome step--but will they really strike the question and not hold that against someone when they are adjudicating a clearance renewal? Because that's what this essentially affects. A soldier who reclasses into an MOS or job specialty that requires a clearance after an initial tour shouldn't be penalized, and those who already had clearances shouldn't be penalized for getting PTSD counseling. So you need to strike that question for the FIRST application for a clearance and then for the 5 year periodic updates.

MORE IMPORTANTLY--they strike Question 21, but did you know--Questions 27, 28, and 29 are about ANY kind of "illegal drug use" and the number one item detailed is marijuana? Did you know that Question 30 asks about alcohol and whether or not use of alcohol led to any kind of counseling?

Seems to me, they can strike Question 21, confident they will catch anyone who has PTSD who "self-medicates" with marijuana or alcohol, and as we know from the data, sufferers of PTSD have to self-medicate with whatever they can find while they await treatment in a very slow system and while they go through a phase of getting their various life issues under some kind of control.

The medications that go with that treatment have always been of interest on the clearance paperwork as well--meaning, if you were prescribed valium or some other form of legitimate drug for treatment, you had to disclose that in detail as well. So I hope they end the scrutiny of counseling AND they end the scrutiny of asking what medications were used to treat the PTSD.

As it sits right now, forget about medical marijuana for an active duty soldier. If an active duty soldier legitimately needs it to calm down, the tests hot on a urinalysis, their career is essentially over if they've been in longer than 36 months. This reform is welcome, but the treatment of PTSD often conflicts with what they allow, culturally, in the military, and that's a nearly zero level of tolerance for anything relating to marijuana. If a person who has separated from service needs it, that is less complicated. And if someone is a reservist or guardsman, their testing regime might be less often than for the active duty, but they're in jeopardy of testing positive and facing UCMJ.

A mature and considered debate awaits--do we treat these men and women with medical marijuana or not? And if we do, then THAT should not endanger their clearances nor should it end their careers. So, it's all well and good to strike Question 21 if they then know they can turn around at get someone on the other questions, which ask about use at any time since the age of 16, use while holding a clearance, manufacturing and distribution, and whether use of alcohol led to ANY kind of counseling or treatment. Those questions would surely catch quite a few people who might have answered in the affirmative on Question 21.

Blue Girl adds -

Pale Rider raises a damned good issue. Medical marijuana would, in my (medical) opinion, be preferable to long-term use of any of the anti-anxiety drugs in the benzodiazapine family. They are highly addictive, and highly intoxicating. They also have a long half-life, which means that the drug builds up in the system, and tolerance from intoxication takes a long, long time to kick in. Frequently, by the time it does, an addiction has set in, and abuse soon follows. Benzos should only be used for short periods of time for this reason. But PTSD is not a short-term disorder. It takes a long time to treat.

Marijuana, too, has a long half life, but it stores in the fat cells and doesn't have an amplified intoxication effect.

And by the way, it's bullshit to say it can't be regulated and dosed, because it sure as hell can. By one of the oldest and most effective methods of extracting active ingredients from medicinal herbs...tincturing. Tinctures can be tested for efficacy by batch via chemical assay, and graded by a system something akin to proofing of alcohol. We don't have to distribute two-finger bags and rolling papers at sick call.

And we might need to have a serious discussion about what is best for those in need and forget what gets the authoritarians, hippie-haters and conservatards in a lather. Stop even paying attention to those whack-jobs. They have been wrong about everything and that is never going to change, it's a hallmark of the species. The sooner we get past trying to placate those implacable mouth-breathers and marginalize them to the degree they so richly deserve, the better off we'll be as a society.

A Dark Week For the Department of Veterans Affairs

We expect resignations this week. Lots of them. Barring that, hopefully, these officials will have the decency to at least start owning up to their colossal lies and outrageous mistakes.

A top-ranking official at the Department of Veterans Affairs defends the agency's treatment of disabled veterans and denies the agency has tried to cover up the number of veterans committing suicide. Dr. Michael Kussman, a department undersecretary for health, testified during a trial in San Francisco federal court that will determine whether the VA is shirking its duty to provide adequate mental health care and other medical services to millions of veterans.

The two veterans groups suing the VA want U.S. District Court Judge Samuel Conti to order the agency to dramatically improve how fast it processes applications and how it delivers mental health care, especially when it comes to preventing suicides and treating post-traumatic stress disorder.

This trial actually features some lawyers who are willing to put the VA under some scrutiny and challenge their methods. For other agencies and for other issues like public safety, public health and public housing, hopefully this trial will serve as the framework for beginning the process of unravelling the incompetence and the outrageous behavior of the Bush Administration:

The groups contend that veteran suicides are rising at alarming rates in large part because of VA failures. In court, plaintiffs' lawyer Arturo Gonzalez clashed Thursday with Kussman over how to compile and report the suicide rates.

For instance, VA Secretary James Peake told Congress in a Feb. 5 letter that 144 combat veterans of Iraq and Afghanistan committed suicide between October 2001 and December 2005.

But Gonzalez produced internal VA e-mails that contended that 18 veterans a day were committing suicide. Kussman countered that the figure, provided by the Centers for Disease Control and Prevention, included all 26 million veterans in the country, including aging Vietnam veterans who are reporting an increased number of health problems.

You know, lying is a good way to get your ass in a sling, especially if you're in a position of public trust:

Gonzalez also asked Kussman to explain several e-mail chains among agency officials that discussed an unwillingness to share suicide statistics with CBS News, which was preparing a story on the subject.

"I don't want to give CBS any more numbers on veterans suicides or attempts than they already have - it will only lead to more questions," wrote Everett A. Chasen, chief communications officer in a March 10 e-mail to several VA officials.

On Monday, the first day of trial, an e-mail message written in December by Dr. Ira Katz, the agency's mental health director, was given as evidence. It alerted Kussman and others that 12,000 veterans under VA care were attempting suicide a year.

"Is this something we should (carefully) address ourselves in some sort of release before someone stumbles on it?" the e-mail asks.

Katz also reported that of the average of 18 military veterans who kill themselves each day, four to five of them are under VA care when it happens.

Three Democratic senators, including Sen. Daniel Akaka of Hawaii, chairman of the Veterans Affairs Committee, called for Katz's dismissal this week.

"I disagree with the premise that there was some effort to cover something up," Kussman testified Thursday. "We don't obfuscate."

Well, the E-mail chain says otherwise. Hopefully, these men will do the right thing and leave public life. This wasn't their thing, apparently, and they've done a great disservice to Veterans. Now that Doug Feith is out of work, maybe they can all get together and start a company that gives people bad advice and then covers it up--that might get some play. My advice is, give that service to retiring Republican Congressmen who face indictment or disgrace and quit playing with the lives of people who have actually served this country.

A Travesty in the Making

Well, this can't be good:

TIJUANA, Mexico - Massive, running gunbattles broke out between suspected drug traffickers on the streets of this violent border city Saturday, killing 13 people and wounding nine, law enforcement officials said.

Dead bodies scattered along the road marked one of the deadliest shootouts in Mexico's three-year-old drug warfare.

All of the dead were believed to be drug traffickers, possibly rival members of the same cartel who were trying to settle scores, said Rommel Moreno, the attorney general of Baja California state, where Tijuana is located.

Two of the dead were believed to be senior hit men for the Arellano Felix cartel and were identified by the large gold rings on their fingers. The rings carried the icon of Saint Death, a ghoulish figure that gangsters believe protects them, police said.

"Today shows we are facing a terrible war never seen before on the (U.S.-Mexico) border," Moreno said during a news conference.

We can't have this on our southern borders. The people who live there shouldn't have to put up with the corruption in the Mexican government, nor should they have to live under the yoke of our policies in the so-called "war on Drugs" that is really nothing more than a campaign slogan from a bygone era.

This administration doesn't say anything at all about these kinds of issues, preferring to pander to wingnuts and yank funding on shitty ideas. The next President should seek to legalize small amounts of marijuana and the American people should seek to grow the fuck up if that happens. As in, just grow the fuck up and accept the fact that you can't float to heaven on a cloud of blue smoke, dumbass.

And then we've got to figure out a way to cut demand for harder drugs in this country, by offering people treatment instead of prison for non-violent offenders. If we can make progress in these areas, some normalcy can return to the border area. Well, about as much normalcy as can be expected, perhaps.

UPDATE I - PALE RIDER 10:30PM

This is the other part of the post that I meant to put up--sorry, just been busy.

If we ever want to treat the hundreds of thousands of Veterans, from all eras, who have signs of Post Traumatic Stress Disorder, then we have to accept the fact that marijuana is an effective means of helping them cope. I am not going to get off on this whole hemp/legalization thing--that's not the point. A good number of people are wrapped up in something personal with this, and I ain't going there. We're not hippies, we're realists. I am not advocating handing out bags on the street. I am saying that a program of counseling, tracking, helping and medicating these people would alleviate a lot of other issues, like spousal abuse, alcoholism, hard drug use, and suicide. Keep it out of the hands of kids, keep it out of the hands of people who can't use it responsibly, and free up the cops by decriminalizing personal use.

Decriminalize it, use it for medicinal purposes, and, again, we as a nation have to grow the fuck up and start looking NOW at ways to deal with a tsunami of Veterans who are going to need anything and everything to help them with PTSD.

UPDATE II - PALE RIDER 12:00AM

And just so no one thinks this isn't an issue, it is. What you see in this story is directly related to the comments on this thread, the Mexican drug lords running roughshod over the people, the corruption on both sides of the border. All of it ties together. And it's fucking nuts...it really is:

(AP) Timothy Garon's face and arms are hauntingly skeletal, but the fluid building up in his abdomen makes the 56-year-old musician look eight months pregnant.

His liver, ravaged by hepatitis C, is failing. Without a new one, his doctors tell him, he will be dead in days.

But Garon's been refused a spot on the transplant list, largely because he has used marijuana, even though it was legally approved for medical reasons.

"I'm not angry, I'm not mad, I'm just confused," said Garon, lying in his hospital bed a few minutes after a doctor told him the hospital transplant committee's decision Thursday.

With the scarcity of donated organs, transplant committees like the one at the University of Washington Medical Center use tough standards, including whether the candidate has other serious health problems or is likely to drink or do drugs.

And with cases like Garon's, they also have to consider _ as a dozen states now have medical marijuana laws _ if using dope with a doctor's blessing should be held against a dying patient in need of a transplant.

Human beings have limits

And those boundaries have been breached where about 20% of our defensive forces are concerned. A new study by the RAND Corporation, released just today, pegs the number of veterans suffering from PTSD and depression at about 300,000 and the number of veterans who sustained brain injuries at about 320,000. With only one direction for those numbers to go, we are facing an immediate future where we have somewhere in the neighborhood of a million veterans of the wars in Iraq and Afghanistan needing care that the VA is ill-equipped to handle - they are overstretched now, and only half of the soldiers struggling with depression, PTSD and TBI have sought treatment.

The new study gives us a glimpse at a cringe-worthy future if we don't get our collective act together and deal with the issues facing these good men and women who stepped up and served. It also compliments and confirms an Army study on mental health that was released by the Joint Chiefs earlier this month that pegged the number of soldiers suffering from PTSD after one deployment at 12%, after two deployments at 18.5% and after three deployments at 28%.

Here is the cold hard truth that these studies tell - if the US Army was a distance runner, it would be hitting the wall about now, unable to go on one more step.

The Rand study, completed in January, put the percentage of PTSD and depression at 18.5 percent, calculating that approximately 300,000 current and former service members were suffering from those problems at the time of its survey, which was completed in January.

The figure is based on Pentagon data showing over 1.6 million military personnel have deployed to the conflicts since the war in Afghanistan began in late 2001.

RAND researchers also found:

_About 19 percent — or some 320,000 services members — reported that they experienced a possible traumatic brain injury while deployed. In wars where blasts from roadside bombs are prevalent, the injuries can range from mild concussions to severe head wounds.

_About 7 percent reported both a probable brain injury and current PTSD or major depression.

_Only 43 percent reported ever being evaluated by a physician for their head injuries.

_Only 53 percent of service members with PTSD or depression sought help over the past year.

_They gave various reasons for not getting help, including that they worried about the side effects of medication; believe family and friends could help them with the problem, or that they feared seeking care might damage their careers.

_Rates of PTSD and major depression were highest among women and reservists.

The report is titled "Invisible Wounds of War: Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery." It was sponsored by a grant from the California Community Foundation and done by 25 researchers from RAND Health and the RAND National Security Research Division, which also has done does work under contracts with the Pentagon and other defense agencies as well as allied foreign governments and foundations.

This war is going to end. It has to. We can't keep fighting it, no matter what the keyboard kommandos fighting the War of the Words™ in their jammies think (I'm using 'think' loosely here).

They aren't doing the hard work of service, and have no idea what it entails. But those soldiers they simultaneously lionize and abuse are human beings. They are sons, daughters, husbands, wives, fathers, mothers, brothers, sisters, friends, neighbors...human beings.

And they deserve to be treated as such. And that is going to require that society start stepping up now - because 'late' is at least a little bit better than 'never.'

From the L.A. Times:

Thousands more mental health professionals -- both in government hospitals and the civilian healthcare systems -- are needed to meet the need of troops and veterans, and new training is needed for current medical professionals, according to the report.

"Since the dramatic increase in the need for services exists now, the required expansion in trained providers is already several years overdue," the report said.

The study recommends finding ways to help Iraq and Afghanistan veterans get access to the civilian mental health providers.

Mental healthcare also needs to be standardized and improved, and only a little more than half of the service members being treated for stress disorders and depressions received adequate care, according to the survey.

"The prevalence of PTSD and major depression will likely remain high unless greater efforts are made to enhance systems of care for these individuals," the report said.

Stress disorders and other combat-related mental ailments can lead to suicide, homelessness and physical health problems. But more mundane problems caused by stress disorders and depression can have long-term social consequences.

"These conditions can impair relationships, disrupt marriages, aggravate the difficulties of parenting, and cause problems in children that may extend the consequences of combat trauma across generations," the study says.

The failure to adequately treat depression and stress disorders can cost the United States up to $6.2 billion, said Lisa H. Jaycox, another of the study's authors.

"While the existing therapies do not guarantee recovery in 100% of people," Jaycox said, "we make the case that investing in treatment early would prevent some of the negative consequences from unfolding and save money."

We are blessed as a nation to have a core of good, decent men and women who are willing to serve and sacrifice for this country. When we abuse them and violate the pact that America makes with her Soldiers, Sailors, Airmen and Marines we abdicate our honor as a nation. And I, for one, refuse to be a party to treason - which, as far as I am concerned, is what it boils down to when we shit on those who serve.

Traumatic Brain Injuries or PTSD?

[image: an upgraded Personal Armor System for Ground Troops helmet with Operation Helmet-supplied kit--cost is $87 for old models, $56 for newer ones.]
I think Blue Girl might have more to say about this, but here's what we know so far:

A new military study published Wednesday in the New England Journal of Medicine says soldiers who suffered concussions in Iraq were not only at higher risk of developing post-traumatic stress disorder and depression, but also that the depression and PTSD, not the head injuries, may be the cause of ongoing physical symptoms.

Five percent of the 2,500 soldiers surveyed by Walter Reed Army Institute of Research said they had concussions in which they lost consciousness during combat. Forty-four percent of these soldiers ended up with PTSD.

Researchers were surprised to find symptoms normally associated with concussions -- headaches, dizziness, irritability and memory problems -- were actually related to PTSD or depression.

"It isn't the combat exposure or physical injury, it's the PTSD that seems to drive these symptoms. That's a surprise," said Joseph A. Boscarino, Ph.D., who studies PTSD at the Geisinger Center for Health Research in Danville, Pennsylvania. "You would expect they would have these other symptoms related to traumatic brain injury, that maybe they have a permanent injury, but it's explained by whether they have PTSD or depression."

About 8 million American adults have PTSD. A 2003 New England Journal of Medicine Study found that 15 percent to 17 percent of Iraq and Afghanistan veterans were suffering from PTSD, and more than 60 percent of those showing symptoms were unlikely to seek help because of fears of stigmatization or loss of career advancement opportunities.

As of June 30, 2007, the Department of Defense reported 3,294 soldiers in Iraq and Afghanistan suffering from traumatic brain injuries, or TBIs. Bomb blasts caused nearly 70 percent of those TBI cases.

Dr. James Kelly, a neurology professor at the University of Colorado and a co-author of guidelines the military uses to identify traumatic brain injury, expressed concerns that doctors will attribute lingering health problems to psychological issues.

"I think if people misunderstand or overextend beyond what this survey shows, they could dismiss true brain injury features as psychological only," Kelly said. "It would be a terrible disservice to our military for that to happen."

Kahlor is worried this study will make it harder for soldiers to get appropriate medical care.

"The military doesn't want to diagnose people with brain injury," he said. "So what they'll do is play it off as PTSD as the sole injury for everyone, because PTSD and traumatic brain injury have very similar symptoms," he said. "The disability [compensation] is a lot higher for traumatic brain injury. What the military is saying is, you can't be diagnosed from a brain injury unless you get better from PTSD. It's kind of like a paradox."

First of all, citing a study from 2003 is WAY out of date. The larger IEDs used against our troops are causing a more severe type of brain injury, obviously. The different vehicles being used, such as the MRV and the Stryker, are helping, but is it enough. And then there was the campaign called Operation Helmet. Here's something from their site, which you could visit and support if you choose to:

Jan 21, 2008: Received a request from a Marine Reserve unit (155 Marines) headed back into combat...and unable to use the 'GI' pads at all, so have reverted to the un-protected form of combat helmet. We MUST NOT let this happen. While we're pressuring Congress and the military to do what's right, we need an urgent fund-raising campaign to outfit these troops before they reach their combat assignment. PLEASE HELP WITH YOUR DONATIONS IF YOU CAN.

Which outrage do you want--that a Marine reserve unit is going into Iraq in 2008--nearly five years since the start of the goddamned war--WITHOUT adequate headgear? Our military health care system finding a way to get rid of people and not pay benefits??? Now, why would the military do something like that?

Remember when the military started going after people who had "personality disorders" that were really manifestations of PTSD? How could you blame them? It was a fantastic way of getting rid of people and cutting costs!

But instead of sending Town to a medical board and discharging him because of his injuries, doctors at Fort Carson, Colorado, did something strange: They claimed Town's wounds were actually caused by a "personality disorder." Town was then booted from the Army and told that under a personality disorder discharge, he would never receive disability or medical benefits.

Town is not alone. A six-month investigation has uncovered multiple cases in which soldiers wounded in Iraq are suspiciously diagnosed as having a personality disorder, then prevented from collecting benefits. The conditions of their discharge have infuriated many in the military community, including the injured soldiers and their families, veterans' rights groups, even military officials required to process these dismissals.

They say the military is purposely misdiagnosing soldiers like Town and that it's doing so for one reason: to cheat them out of a lifetime of disability and medical benefits, thereby saving billions in expenses

Here's the original link to WWTC [where Blue Girl spends some of her valuable time] Your government. Acting like a craven HMO. You gotta love it when they pull this kind of thing. All that stands between them and their goals is exposing their attempts at shortchanging Veterans.

VA Inconsistent in Delivery of Mental Health Services

Two internal annual VA reports that have been obtained by McClatchy Newspapers reveal that in some parts of the country mental health services are not getting the resources they need, and in several areas, they are failing to meet the VA's own goals. The reports used to be readily available to the public, but in the last year, the VA has removed them from its Web site. McClatchy obtained the reports for FY 2006 via a Freedom of Information Act request.

In fiscal year 2006, the reports show, some of the VA's specialized PTSD units spent a fraction of what the average unit did. Five medical centers — in California, Iowa, Louisiana, Tennessee and Wisconsin — spent about $100,000 on their PTSD clinical teams, less than one-fifth the national average.

The documents also show that while the VA's treatment for PTSD is generally effective, nearly a third of the agency's inpatient and other intensive PTSD units failed to meet at least one of the quality goals monitored by a VA health-research organization. The VA medical center in Lexington, Ky., failed to meet four of six quality goals, according to the internal reports.

An official at the VA dismissed the findings and played down the significance, insisting that Veterans are receiving adequate care. He insisted that the spending disparity is not as extreme as the numbers make it sound, and besides that, they are working to improve resource allocation for mental health services anyway. Spending varies widely among the units, however, from more than $2,000 per treated veteran in centers in The Bronx, N.Y., and Boise, Idaho, to about $300 per treated veteran in Augusta, Ga., and about $200 in Palo Alto, Calif., one of the reports says.

The VA is bracing for an onslaught of veterans returning from Iraq and Afghanistan experiencing PTSD, and at a time when the department is under scrutiny for shortfalls in staffing and funding for mental health units. The VA insists that they deliver high-quality care and that when comparisons are made across facilities in the system, the results are uniformly positive.

The data shows that the number of veterans who utilize the VA's specialized outpatient PTSD services is growing much faster than the number of appointments the VA is providing. The reports reveal that the number of veterans treated grew by more than 4% from 2005 to 2006, while the number of appointments scheduled grew by only 1%. This translates to veterans receiving fewer visits.

"It is the task of thoughtful planning, performance assessment and clinical care to assure that, as VA passes through a period of major change during the years to come, the treatment provided to veterans with PTSD is equitably distributed, accessible, effective and efficient," the report concludes.

Paul Sullivan, a former VA official who works for the advocacy group Veterans for Common Sense, said the numbers indicated that the VA wasn't prepared to treat the number of soldiers who were coming home with PTSD.

"If the ominous trend continues or if all our Iraq soldiers return home quickly, VA's crisis may deteriorate into a full-blown catastrophe," he said.

The influx of veterans returning from Iraq and Afghanistan needing services is already taking its toll as the agency struggles to meet demands for care. Depending on the severity of symptoms, the services provided by the VA range from inpatient intensive therapy to outpatient group therapy. Services available are split between general mental health services and individual counseling to specialized, largely group therapy programs, that deal with specific focused issues and symptoms (i.e. PTSD.) "The availability of specialized PTSD programs is an important indicator of the quality of health care provided by VA," it says.

The VA health system consists of 153 medical centers, 103 of which have special PTSD clinical units, but only 40 have specialized inpatient units for the treatment of PTSD.

Assessing the efficacy of PTSD treatment is subjective rather than objective, but by and large, programs can be evaluated for effectiveness by tracking the symptoms of veterans receiving the services. Are they abusing drugs or alcohol ('self medicating')? Are they able to hold a job? What are their work habits? Is the veteran coming into contact with law enforcement as a result of their behaviors? Are there instances of domestic violence? Other episodes of violence?

Overall, the results show, the VA offers effective treatment for PTSD, with most beneficiaries of treatment reporting that they experience a decrease of symptoms.

The VA is managing to keep it together for now, but there is only so much belt tightening and streamlining that can be done. There are only so many hours in the day and a finite number of appointments can be made. The time is long since past to fully fund the VA, and provide the care to our returning Soldiers, Sailors, Airmen and Marines that is part of the bargain when they agree to serve. They have lived up to their end of the bargain. It is time for American society to reciprocate.

Vindication for a long-running hissy-fit

I have a long history of writing about mental health issues and repatriated soldiers. (More here, here, and here)

Sometimes it has felt like I was shouting down the well. Thank goodness these issues are finally getting some traction. Yesterday I got one more bit of vindication when the Institute of Medicine, which advises the federal government on issues of medical science, released their long awaited report on the treatment returning soldiers are not getting.

The report suggested changes to VA policies, but the panel could not say whether those changes would result in more or fewer PTSD diagnoses, or in greater or lesser expense for taxpayers. "PTSD has become a very serious public health problem for the veterans of current conflicts and past conflicts," said psychiatrist Nancy Andreasen of the University of Iowa, who chaired the panel. Noting the shortcomings of the VA system, Andreasen added that "a comprehensive revision of the disability determination criteria are needed."

She said the current VA system, in which PTSD compensation is limited to those who are unable to hold a job, places many veterans in a Catch-22.

"You can't get a disability payment if you get a job -- that's not a logical way to proceed in terms of providing an incentive to become healthier and a more productive member of society," she said.

The practice is especially wrong, she added, because it is at odds with VA policies for other kinds of injuries. To determine the compensation a wounded veteran should get, the government assigns one a disability score. Veterans who are quadriplegic, for example, can be assigned a disability level of 100 percent even if they hold a job, whereas veterans with PTSD must show they are unable to work to get compensation.

Andreasen said the policies are "problematic, in the sense that they require the person given compensation to be unemployed. This is a disincentive for full or even partial recovery."

I personally favor adopting the suggestions offered by Linda Bilmes of Harvard. She has offered the most troop-centric approach to offering services to those who need and deserve those services. Her notion is so simple it hurts: Give the troops who apply for benefits the benefit of the doubt!

The Institute of Medicine panel said the scale used to evaluate veterans is outdated and largely designed for people who suffer from other mental disorders. Andreasen and other members also said they had heard from veterans who had received wildly different kinds of evaluations -- some lasting 20 minutes while others took hours. The scientists said VA should standardize the evaluations using state-of-the-art diagnostic techniques.

While VA requires its experts to determine what proportion of a veteran's disabilities were caused by particular traumatic experiences, and to what extent overlapping symptoms are related to particular disorders, the IOM said there is no scientific way to classify symptoms in this manner.

Frankly, if you aren’t mad as hell about the way our troops are being treated – if you aren’t pissed off about the fact the VA is still not fully funded – don’t be mouthing platitudes about supporting the troops around me.

Gut-Check Time

Do you support the troops? I mean, do you really support the troops? Or is that just some words you say when the subject comes up? If you really do support the troops, you need to take stock of reality.

Our military is seriously compromised. These kids – and most of them are kids – are in the middle of an urban guerrilla war in an Arab country. Four years on, it has taken it’s toll, and the situation is unsustainable.

Here is reality – we are apace to create a couple of million people who have been repeatedly exposed to percussive trauma. It has an effect on the person after the frontal lobes bounce off the inside of the skull a few times. Couple the physical compromise with the constant anxiety. Now tell those same soldiers that they just had their out-date yanked and they have another three freakin’ months in this hellhole, and you have a recipe for atrocity. Especially when you are rotating people back in with inadequate dwell time, and things like War Ethics aren’t being taught.

Human beings can only take so much, god-damnit. What the fuck do you people want? How much more do you expect your Army to give? You have to knock this shit off and face the fact that you have asked too much. Not only has too much been asked, it was all predicated on lies. In a just world, the architects of the war would be charged with one count of murder for every “comma” out of Iraq.

Bullshit slogans like “Defeat is not an option” are a fucking insult. You got that? If defeat is not an option – don’t get in the pissing match in the first place, because you know what? Both sides always believe that, and one side always has to accept that they were wrong.

Reality trumps rhetoric every god-damned time. And the assholes who work at the think tanks need to get a new name for their various ventures if they can’t accept that.

A study released last week revealed some disturbing trends in the psyches of soldiers.

More than one-third of U.S. soldiers in Iraq surveyed by the Army said they believe torture should be allowed if it helps gather important information about insurgents, the Pentagon disclosed yesterday. Four in 10 said they approve of such illegal abuse if it would save the life of a fellow soldier.

In addition, about two-thirds of Marines and half the Army troops surveyed said they would not report a team member for mistreating a civilian or for destroying civilian property unnecessarily. "Less than half of Soldiers and Marines believed that non-combatants should be treated with dignity and respect," the Army report stated.

About 10 percent of the 1,767 troops in the official survey -- conducted in Iraq last fall -- reported that they had mistreated civilians in Iraq, such as kicking them or needlessly damaging their possessions.

Now think about this: These guys are going to come home and reintegrate into society. We are already failing returnees with TBI and PTSD on the mental health front. Society –it has the potential to get really ugly. We have vets becoming homeless waiting for benefits. First they get blown up, then they get blown off. What a fuckin’ deal.

If you really support the troops, if you realize they are beings with lives, loves, hopes, dreams and futures that are being denied them at your behest, and you have half assed it from the get-go, you need to suck it up, admit the error of your ways, apologize, and bring the troops home now.