Veterans for Common Sense

New York Times OP-ED COLUMNIST

By NICHOLAS D. KRISTOF

IT would be so much easier, Maj. Ben Richards says, if he had just lost a leg in Iraq.

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Daniel Borris for The New York Times

Maj. Ben Richards, who suffered repeated head injuries in Iraq, sums up his future: “It comes to failure.”

On the Ground

• Room for Debate: How Can We Prevent Military Suicides?(November 20, 2011)

Enlarge This ImageCourtesy of Ben Richards

A car bomb in Iraq in May 2007 left Ben Richards, then a captain, with a severe concussion. A second concussion left him with debilitating injuries.

Instead, he finds himself losing his mind, or at least a part of it. And if you want to understand how America is failing its soldiers and veterans, honoring them with lip service and ceremonies but breaking faith with them on all that matters most, listen to the story of Major Richards.

For starters, he’s brilliant. (Or at least he was.) He speaks Chinese and taught at West Point, and his medical evaluations suggest that until his recent problems he had an I.Q. of about 148. After he graduated from West Point, in 2000, he received glowing reviews.

“Ben Richards is one of the best military officers I have worked with in 13 years of service,” noted an evaluation, one of many military and medical documents he shared with me.

Yet Richards’s intellect almost exacerbates his suffering, for it better equips him to monitor his mental deterioration — and the failings of the Army that he has revered since he was a young boy.

Military suicides are the starkest gauge of our nation’s failure to care adequately for those who served in uniform. With America’s wars winding down, the United States is now losing more soldiers to suicide than to the enemy. Include veterans, and the tragedy is even more sweeping. For every soldier killed in war this year, about 25 veterans now take their own lives.

President Obama said recently that it was an “outrage” that some service members and veterans sought help but couldn’t get it: “We’ve got to do better. This has to be all hands on deck.” Admirable words, but so far they’ve neither made much impact nor offered consolation to those who call the suicide prevention hot line and end up on hold.

The military’s problems with mental health services go far beyond suicide or the occasional murders committed by soldiers and veterans. Far more common are people like Richards, who does not contemplate violence of any kind but is still profoundly disabled.

An astonishing 45 percent of those who served in Iraq or Afghanistan are now seeking compensation for injuries, in many cases psychological ones. It’s unclear how many are exaggerated or even fraudulent, but what is clear is this: the financial cost of these disabilities will be huge, yet it is dwarfed by the human cost.

Richards’s finest hour, and in retrospect his worst, came in Iraq in 2007. He was then a captain assigned to the city of Baquba, a hotly contested area where he was welcomed on his first day by a 12-hour firefight. In Baquba, Richards pioneered an initiative tocooperate with local Sunni Muslim militias — who had previously attacked Americans — to defeat the local branch of Al Qaeda.

This was ferociously controversial at first and Richards was bitterly criticized by other officers for collaborating with the enemy. But the strategy worked and was broadly adopted by the military in Iraq. The New York Times wrote that year about Richards’s leadership; the Army promoted him, and he seemed destined for greatness.

Then one day a car bomb destroyed his Stryker vehicle, giving Richards a severe concussion that left him nauseated and dazed for a week. Three weeks later, a roadside bomb knocked him out again, and he suffered a second concussion, with similar results.

Richards, now 36, struggled for months with headaches, fatigue, insomnia and fainting spells; once he passed out in the middle of a firefight. Still, he didn’t seek medical care. He figured he wasn’t really injured, and that has been a widespread problem: the military value system is such that warriors disdain medical care as long as they are physically capable of fighting.

“Coming from an Army ethos,” he says wryly, “you’re not even entitled to complain unless you’ve lost all four limbs.”

Yet there’s growing evidence that concussions — whether in sports or in the military — are every bit as damaging as far bloodier wounds. When someone suffers blows to the head, the result can be a traumatic brain injury, or T.B.I. This, eventually, was Richards’s diagnosis.

Richards’s wife, Farrah, was thrilled when he returned “safely” from Iraq in the fall of 2007, and she counted them both very, very lucky. But almost immediately, Farrah says, she noticed that the man who came home wore her husband’s skin but was different inside. “There were obvious changes in his personality,” she recalls. “He was extremely withdrawn; he would go into the bedroom for hours.”

A once boisterous dad who loved to roughhouse with his children — now there are four, ages 1 to 14 — Ben no longer seemed to know how to play with them. He often suffered incapacitating headaches, overwhelming fatigue and constant insomnia. Especially when dozing, he was on a hair trigger. If Farrah rose at night, she sometimes didn’t return to bed for fear that her husband might think she was an enemy and attack her. Instead, she’d spend the rest of the night on the couch.

For a woman who had been functioning as a single mom and was now eager to resume her former married life, all this was devastating. And it got worse. Farrah would tell her husband things, and then he would repeatedly forget — and reproach her for not telling him. He was distracted, withdrawn and unhelpful, and he repeatedly let her down.

“Our marriage was at real risk at this point,” Richards says. “We got to a point where we thought about separating.”

Yet it became increasingly apparent that the problem wasn’t that Richards was a jerk. It was that he had a war injury, an invisible one.

Read more….http://www.nytimes.com/2012/08/12/opinion/sunday/war-wounds.html?pagewanted=1&_r=2&ref=opinion

By Maria LaMagna (CNN) –

Things probably should have turned out differently for Samantha Schilling.

The stories she tells have dark beginnings and could have had, under different circumstances, dark endings — as so many stories for those in the military do.

Schilling, now 31, served in the U.S. Navy from 1999 to 2003. She was never deployed but worked as an information systems technician at Naval Station Norfolk in Virginia.

Several of her friends were killed during the 2000 al Qaedabombing of the USS Cole in Yemen, which left 17 dead and at least 37 injured. Some of the injured were transferred to her base in Norfolk.

Many of the survivors suffered from mental trauma after the bombing. One of them, a man who had been aboard the ship, attacked Schilling and attempted to rape her.

That assault drove home the impact that active duty had on her colleagues’ mental state.

“I experienced military sexual trauma, and that just inspired me,” she said. “Coming back into civilian life, you’re not the same person you were in the military. … You carry with you all these burdens, all these stressors.”

Schilling was released from service with an honorable medical discharge in 2003. Since that time, she has taken on a personal mission to help others who need counseling after military service. She’s nearly completed a masters in a joint military psychology and neuropsychology program at the Adler School of Professional Psychology in Chicago and plans to finish her doctorate degree in 2015.

Samantha Schilling, with her father, lost several friends in the USS Cole bombing.

“I’m determined to be able to be helpful to others,” she said. “Helping others helps me. … I think therapy can help people adapt to civilian life again instead of maladapt. People who have PTSD and other (issues) can maladapt and cause trouble in the civilian world.”

It’s no secret the U.S. military has struggled to adequately support its troops after they leave active duty.

A large number of service members suffer from post-traumatic stress disorder (PTSD). An estimated 11{cd9ac3671b356cd86fdb96f1eda7eb3bb1367f54cff58cc36abbd73c33c82e1d} to 20{cd9ac3671b356cd86fdb96f1eda7eb3bb1367f54cff58cc36abbd73c33c82e1d} of veterans returning from the Iraq and Afghanistan wars suffer from the condition, according to the U.S. Department of Veterans Affairs.

That’s between 220,000 and 400,000 of the 2 million troops deployed since the September 11 terrorist attacks.

A new study (PDF) shows that only about half of U.S. service members deployed to Iraq and Afghanistan diagnosed with PTSD received any treatment for it.

And statistics from the U.S. Department of Veterans Affairs show that about 18 veterans commit suicide every day.

The VA has stepped up efforts to expand care and recently announced plans to hire 1,600 more mental health professionals and 300 support staff members to help meet the increasing demand for services.

But some former active-duty service members aren’t waiting for help to arrive.

Veterans have turned to psychology to become mental health professionals, and they’re filling in gaps in veteran care that government and civilian efforts have left open. And while they are still rare, programs to train them are slowly emerging at universities and nonprofit organizations around the United States.

“It’s just going to increase and increase”

Born a year ago with funding from the Department of Veteran Services in Massachusetts, a program through the Massachusetts School of Professional Psychology called Train Vets to Treat Vetshas recently picked up steam. It has several goals: mentoring new veterans, providing services to at-risk and homeless veterans, and educating the public about ways they can help.

“As the stigma (of seeking professional mental health treatment) breaks down more and more, and more veterans are willing to come into treatment, (the need) is just going to increase and increase,” said Robert Chester, 25, who served in the National Guard for six years and became a student at the Massachusetts School of Professional Psychology.

“That’s why we want to get more veterans into mental health, both to break down the stigma and get more clinicians out there.”

It was clear that folks … want to talk about emotional issues with somebody that understands their culture. Nick Covino

Chester is now an admissions assistant at Train Vets to Treat Vets.

Starting the program was a joint effort between the Massachusetts Department of Veterans’ Services and veterans (Chester and colleagues Greg Matos and Norman Tippens) who are also students at at the school.

“We, as the veteran students, wanted to see that we could create more of a military cohort at our school,” Chester said. “We really wanted to put something together where we can help our fellow veterans by providing mental health services in that specific way.”

Since the program’s start, Chester has fielded e-mails every day from veterans who want to get involved. Six will enroll in the school’s fall class.

Massachusetts School of Professional Psychology President Nick Covino says the idea for the program came from a Latino mental health program the school began about eight years ago.

“It was clear that folks who wanted to talk about emotional issues … want to talk about emotional issues with somebody that understands their culture and probably want to do it with somebody that’s from their culture,” Covino said. “It was a natural extension to think about returning veterans.”

Having student veterans in the program has been beneficial not only to the veterans it has helped but to non-veteran graduate students who want to specialize in veteran care.

From casual conversations to exchanging papers and working on doctoral projects together, a collaboration between veteran and non-veteran students is “radically changing the academic culture of our learning community,” Covino said.

Laptop battlefield

Leaning over an occasionally beeping laptop in a downtown Chicago office building, Robert Kyle rolls up the sleeves of a blue button-down shirt to reveal heavily tattooed forearms.

On one, a drawing that looks like the Grim Reaper. On the other, columns of initials. There are so many, his arm is more ink than skin.

He explains that they’re the initials of friends who died alongside him while deployed in Afghanistan and Iraq. There are 53, he says. But there are more to add he hasn’t gotten around to yet.

Kyle, who goes by his first and middle name online for security reasons, has his own set of challenges. At 26, he has survived three deployments and sustained a traumatic brain injury. He enlisted in the Army when he was 17 and served from 2003 to 2009.

Although he still carries burdens from his deployment, since his return, he hasn’t forgotten about his military family. Some, he knows personally; others, he’s only met through that beeping laptop. He has dedicated his life to helping veterans connect to one another and improve their mental health.

Kyle works as a peer coach at Vets Prevail, a free online forum and multistep mental health program. It was founded in 2009 by a small group of professionals, almost all of them veterans.

While working as a peer coach, Kyle is pursuing a graduate degree in psychology from DePaul University.

Six salaried professionals work at Vets Prevail, as well as three peer coaches who directly interact with veterans online. Although the peer coaches are not doctors, they complete a training process, and most important, Kyle says, they have all served on active duty.

“When they hear that you have done what they’ve done, (veterans) tend to open up more than someone that has never been in a combat zone. That opens a little more trust,” Kyle says. “Veterans are doing this for veterans.”

Kyle retired from service in 2009 after his injury and went back to school, earning a degree in psychology from Lees-McRae College in North Carolina.

Seeking help from a non-veteran is like going to a marriage counselor that has never been married. Jon Neely

Since that time, he has worked to develop Vets Prevail. Now, more than 8,000 veterans from about 5,000 ZIP codes turn to the site to chat and learn coping mechanisms, and membership is rapidly increasing.

Justin Savage, a 32-year-old Army veteran who works as the head of program development for Vets Prevail, says a large part of that success is the users’ assurance that the experts on the other side of the computer screen are speaking their language.

“We live and breathe accountability,” said Savage, who returned from Iraq in 2005. “Having vets do it really brings a new level.”

“A really good fit”

It makes sense that veterans would want to become mental health professionals, psychologist Joe Troiani says. In a military culture built on camaraderie, the desire to help a fellow veteran is natural and powerful.

Troiani, an associate professor at the Adler School of Professional Psychology, where Schilling is a student, is also a retired Navy commander and is determined to ensure that veterans get the help they need.

“If I was in trouble, I could pick up the phone and call some of my veteran friends,” Troiani said. “You and I could have served together, and I have your back, you have my back. If something happens to you, I’m going to make sure that your family is taken care of.”

The Adler School offers training for a new post-doctorate specialty called “military clinical psychology” and since the program’s start two years ago has trained about 20 students per class. The need is greater, but 20 is the cutoff to ensure the best training, Troiani says.

Entering the mental health field can be “a really good fit personality-wise” for veterans, says Bret Moore, a former active-duty Army psychologist who completed two tours in Iraq.

“(Service members) want to protect and help people get through difficult times,” Moore said. “That’s really what a psychologist does: helps people who are more vulnerable, or not as strong in a certain sense, get through difficult times.”

Taking responsibility for another human life is a familiar duty for veterans, Covino says.

“To have been in situations where they’ve needed to rely on judgment and develop a capacity for reflection, an ability to act autonomously and courageously. … Those are qualities of character you can’t teach,” Covino said.

“They haven’t experienced it”

Jon Neely, a 45-year-old living in Springfield, Illinois, has been using Vets Prevail for several months and says he logs on for about an hour every week, though when he first began using it, he logged on every day. Neely served in Kosovo from 1999 to 2000 and retired from the military in 2005.

“All too often, you go seek help from somebody that is book-learned, but they don’t understand,” he said. “They don’t know. To me, getting help or seeking help from a non-veteran is like going to a marriage counselor that has never been married. They know all the book knowledge, but they haven’t experienced it.”

Sarah Bonner, 31, an Air Force veteran who was medically discharged from Ramstein Air Base in Germany in 2006, is an active user of Vets Prevail. She says that talking to a “like-minded” person is what has kept her coming back to the site.

She has bonded with the peer coaches, to whom she refers by their first names like friends, in a way she did not expect.

“There were a couple times recently, I was at a really low point,” she said. “I was angry, and I wasn’t holding back with what I said. They don’t care. If I want to cuss out and threaten to punch something, they might say, ‘Let’s think of softer things than the wall to punch.’ … They let you talk about the stuff that’s ugly.”

“Why did all of us serve?”

Training veterans to treat other veterans does involve some risk, Chester says. If veterans are not stable themselves, they should not treat others as mental health professionals. For that reason, it can be a good idea for them to work with a psychologist even while they administer care to others.

There is so much training and hands-on experience involved in a post-doctorate program that it is highly unlikely a veteran who is still feeling unstable would make it all the way through, Troiani says. Rarely, but occasionally, a veteran will say, “This program is not a good fit for me,” he says.

But if it is a good fit, the results can be rewarding.

“Why did all of us serve if not for each other?” Kyle asked. “Just because we’re not in the military any more, it doesn’t mean we are no longer brother and sister. It’s a bond we’ll have for the rest of our lives.”