AN ENDURING RECOLLECTION WAS A SCENE AT THE MOST DISTANT POINT OF MARINE ADVANCE. AMONG THE NVA BODIES THERE LAY A SHORT LINE OF DEAD MARINES, LIKELY OF FOX COMPANY. ONE MARINE WAS SPRAWLED HEAD FIRST ACROSS THE FORWARD EDGE OF AN NVA GUNPIT. THE BAYONET OF HIS EMPTY RIFLE WAS BURIED IN THE GUNNER’S CHEST.

FORTY FIVE YEARS AGO THIS MORNING.

Captures the essence of what “close combat,” and the U.S. Marine Corps, is all about,

And raises the question facing every generation of Americans: “Where do we get such men?”

(As Hack would point out, not a Perfumed Prince was to be found on this killing field.)

Traumatic Brain Injury and Post Traumatic Stress Disorder are injuries that apparently only afflict second-class soldiers. These soldiers are S#!%-bags, f*&#-ups, weak, can’t hack it, malingerers. At least that ‘s how I felt by the time I was diagnosed with TBI more than three years after a literal run-in with a suicide car bomb on the Al Qaeda-controlled streets of Baqubah, Iraq. And since then, I’ve observed countless other invisibly-wounded warriors treated the same way—as no-account dirt bags.

Part of the problem is inherent in the nature of the wounds themselves: They only become visible through a sustained pattern of behavior that interferes with a soldier’s professional and personal life. If a soldier is not having a problem, goes the logic, then he or she is not invisibly wounded—even though many struggle to conceal any problems out of fear of the consequences of being found out.

I would like to share some of the reasons for this unfortunate reality that I’ve both experienced and observed.

First, invisible injuries are extraordinarily difficult to diagnose. According to the guidelines established by the Defense and Veterans Brain Injury Center, a closed-head TBI (aka a concussion) where no bullets, fragments, or objects have penetrated through the skull, is diagnosed and classified as either mild, moderate or severe entirely by the symptoms displayed in the first 24-hours after the injury. That’s the easy part. But this limited classification system has only marginal relevance to how much lasting damage the TBI did to the brain. A soldier with a severe TBI (unconscious for 30 minutes or more) may appear to recover to full function, while a soldier with a mild TBI may have sustained significant lasting damage that is permanently disabling. The problem is further complicated by the fact that behavioral symptoms of brain damage from blast-TBIs mimic the symptoms of PTSD.

Even advanced diagnostic tools like MRIs, if a soldier is lucky enough to get one, may not “see” the brain damage. Military hospitals are under-resourced with brain imaging tools, and the scans are expensive, so the military has been reluctant to use them unless there is already evidence of damage from other sources. Diagnosis of brain damage often relies on performance and behavioral problems consistent with Post-Concussive Syndrome because a negative scan does not at all preclude the possibility of brain damage. TBI diagnoses therefore often remain tentative and based on circumstantial medical evidence (something Physical Evaluation Boards and the VA Benefits administration are more than happy to exploit to the detriment of the wounded). Many doctors appear to be content to just label the problem PTSD in order to avoid the time and cost of a TBI investigation.

PTSD, though technically easier to identify, also depends on the subjective recognition or admission of a pattern of problematic behaviors over an extended period of time. In fact, when I returned to Fort Lewis from Iraq, we were told not to seek behavioral health assistance for ninety days (unless we were at risk of harming ourselves or others) because everyone was expected to experience symptoms of post-traumatic stress after returning home. Only if you continued to experience problems after this waiting period would the doctors consider evaluating PTSD and attempt to help you. However, many soldiers move on to other assignments or leave the military before they are willing to recognize that they have a problem and need help.

Consider the case of one of my friends, a West Point classmate. When we graduated he became an infantry officer, and a few days later he married a beautiful young lady. Shortly after the Hussein-regime toppled, he deployed to Iraq as a lieutenant in an infantry company.  He spent a dangerous and stressful year trying to stabilize a failing society while fighting off an emerging insurgency. Shortly after returning home to his wife and two young children, he decided to leave the Army. He resigned, went to graduate school and found employment as a promising young professional.

Except that he had returned home in one piece, but not entirely whole. He was struggling at work—and it’s likely he was struggling at home. Then he was fired from his job. With that black mark on his resume, he felt like a failure, lost all confidence and had difficulty finding suitable employment. Soon he couldn’t afford the payments on their modest suburban home. Eventually delayed diagnosis of PTSD brought him a paltry $500-a-month disability payment from the VA—small recompense for the price he and his family continue to pay every day for his service to the nation.

A second reason is the unforeseen by-product of the Army’s “Life-Cycle Manning” system. Under this policy, soldiers are brought into a unit to serve together for a two- or three-year “life cycle” that culminates with a combat deployment in the last year. After returning home the majority of soldiers in the unit are quickly reassigned elsewhere. The policy was implemented at the beginning of the wars and was successful in fostering effective and cohesive combat units. However, leaders failed to anticipate, and may still not recognize, the negative impact this policy has on soldiers struggling to deal with invisible combat injuries.

Allow me to illustrate this point with the story of a young soldier who served in my Cavalry Troop in Iraq. In the spring of 2007 our unit was sent to Baqubah– at the time the declared capital of Al Qaeda’s ‘Islamic Caliphate’– to help hold the line there until further reinforcements could be spared from the Surge in Baghdad. We were outnumbered four to one in a provincial capital almost entirely under AQ control. For three terrible months we were fighting every day, and almost every night we were saluting fallen comrades one last time as they began their final journeys home.  Through the worst of it, I watched this young warrior repeatedly volunteer to take the place of wounded comrades and go to the places of greatest danger.

At the end of our tour, he returned home in one piece, but he too was not entirely whole and quickly entered into a close relationship with the bottle. His performance declined. Then late one night he was arrested for a DUI. A few weeks later he was arrested for a second DUI. I didn’t need the military police reports to see he was struggling.

In the hierarchy of army organizations, our positions were separated by two non-commissioned officers and one junior officer. Army manning policy had rotated out all the men who’d filled these positions during our tour and replaced them with new junior leaders who had not known this young warrior as the stud and courageous hero he’d been. They only knew him as a discipline problem, a drunkard and a poor performer. The policy had also stripped away this soldier’s support structure. Most of his unit “family”, the people who he knew, trusted and could have turned to for support and encouragement to get help, was gone. The Army does not look kindly on DUIs, and military justice—untempered by earned and appropriate clemency—brought heavy punishment. He had gone from stud to dud just like that.

Consider this hypothetical scenario. Suppose you had a medical condition that was very uncomfortable, but unlikely to become fatal. A medical treatment was available that had been effective in helping other people with your problem only about 50 percent of the time with no guarantees of a cure and not very promising existing statistics of treatment outcomes. And the treatment has some seriously bad side effects. Like possibly ruining your career, resulting in the loss of your job, even leaving you and your family destitute. Suppose that if you get the treatment, almost everyone who finds out about your condition will ostracize you; That you might even die at your own hands after taking drugs during the course of treatment that according to the side effects labels “may cause suicidal thoughts or actions;” That at the end of the treatment, there’s a good chance you’ll still have the problem and be forced into poverty and dependence on a fickle, uncaring and dysfunctional bureaucracy for your pittance of a pension and continuing so-called “help.”

What would you do?

This is the conundrum invisibly-wounded warriors face. The third reason many invisibly-wounded warriors resist seeking “help” that too often turns into a very bitter medicine. Is it any wonder that many soldiers are reluctant to recognize their problems or try to fix them through the system?

Until a few years ago, “help” meant the certain end of your career because ‘mental illness’– which PTSD is still considered– would disqualify you from the security clearance necessary for promotions and service in many military career fields. Today “help” still means there’s a good chance you’ll lose your job or ruin your career. “Help” still means possibly being labeled as weak, incompetent or as a malinger faking a condition to get out of work. “Help” still means possibly being stripped away from your unit and sent to live in limbo among callous strangers in a Warrior Transition Unit. “Help” still means being judged as “mentally ill,” just like the psychos institutionalized because they are risks to themselves or society. “Help” still means being stamped with a stigma reinforced on the nightly news by stories of violent crimes committed by former service members who are unfailingly categorized as driven by PTSD whether they are or not. “Help” still means being thrown on the fickle and not-so-tender mercy of America’s most dysfunctional bureaucracy– the Veterans Affairs Administration.

Take the example of a young, former non-commissioned officer in the Marine Corps whom I got to know while we were both getting some “help.” He’d been promoted quickly to the rank of sergeant and had led an armored vehicle section in combat. He loved the Marine Corps and had planned on being a career Marine.

He had also returned home in one piece, but again not entirely whole. Not long after returning home his marriage ended. An explosive temper led to discipline problems which cost him his sergeants’ stripes. Only afterwards was he diagnosed with PTSD and exiled to a Warrior Transition Unit where he continued to be ill-treated. He was hurting and angry, stripped of everything that mattered to him. Only after both his marriage and career were in ruins and he’d been deprived of his honor and dignity did doctors do an MRI that revealed damage to the area of the brain that controls emotional regulation—the consequence of too many IED hits in Iraq. His problem was a consequence of duty, honor and service to country, not a flawed character. Where was timely, respectful help?

For me, I have my own chapter in this story. After awhile, I began to see myself as a S#!%-bag, a f*&#-up, weak, dishonored and a failure in every aspect of my life. It is not a far journey from there to thinking your loved ones would be better off without the burden their relationship with you places upon them. From there it is not much further to the 349.

This column is dedicated to the 349 active-duty soldiers, sailors, airmen and marines who committed suicide in 2012. And the 22 Veterans who commit suicide every day.

Maj. Ben Richards

Found below is a rather lengthy interview (26 minutes) by Josh Zepps of Huffington Post with four panelists, including SFTT’s Medical Advisor, Dr. Yuval Nuria, discussing how people react to traumatic situations. Dr. Nuria is Professor of Clinical Psychology at Columbia University. Dr. Nuria begins speaking at minute 3 in the video:

This tragic terrorist event brings home the incomprehensible grief and trauma faced daily by our brave young men and women in uniform who serve in harm’s way. SFTT is indeed fortunate to have someone as experienced as Dr. Nuria to help develop effective treatment programs that address the needs of our brave warriors who suffer from PTS.

SFTT is thrilled to count on the assistance of Yuval Neria (see below) is a Special Advisor to SFTT’s Medical Task Force.    We welcome his active collaboration.

Yuval Neria

Medical Center (CUMC Director of Trauma and PTSD Program, and a Research Scientist at the New York State Psychiatric Institute (NYSPI) …

While SFTT often focuses on the men and women suffering from PTS, it is clear that their spouses, children and immediate families are not immune to the terrible side-effects.

Study: PTSD affects veterans’ spouses, too – ksl.com

PTSD affects veterans’ spouses, tooksl.comResearchers have know for some time that PTSD places relationships at risk, but this new research raises red flags for health risks for a spouse or partner. “It’s having an effect beyond the vet …

Military May Be Turning to Meditation for PTSD – PsychCentral.com

Military May Be Turning to Meditation for PTSD.  Military May Be Turning to Meditation for PTSD With its emphasis on developing tranquility, meditation may seem an odd fit for the military. But recent studies have shown that mindfulness …

Two and a half million Americans have served in Iraq and Afghanistan; many of them, more than once. The VA tells us about 20 percent come home with post-traumatic stress disorder, known as PTSD. So, that comes to about 500,000. For some, returning is harder than they imagined. The suicide rate for the Army is up 15 percent over last year. For the Marines its up 28 percent. A few of our troops return to become something they never thought they could be: criminals, for the first time in their lives.

Around Houston, in Harris County, Texas, 400 veterans are locked up every month. We met a judge there who saw them coming before the bench, fresh out of the warzone and he thought a lot of them were worth saving. Judge for yourself once you meet some of our troops, coming home.

A byproduct of the 1995 Crime Bill, the Veterans Treatment Court (Vets Court for short) is a way for Veterans facing jail time to avoid incarceration. If they accept, they are assigned to a mentoring Veteran and must remain drug-free for two years, obtain a high school diploma and have a steady job at the end of the probation period. This may seem like a good deal, but the path to recover their lives is difficult and fraught with temptation, particularly for those Veterans with PTSD.

SFTT applauds those in law enforcement and the judicial system and supporting Veterans organization for developing such an effective and common sense approach to help Veterans reintegrate into society. 60 Minutes paints a very sympathetic picture of the Veterans Administration in this rehabilitation process, but Vets that we have talked to who have participated in Vet Court programs paint a somewhat different picture.

It is evident that there is a high incidence of dependency on drugs, potent painkillers, antidepressants and alcohol among those with PTSD. One graduate of the Veterans Court Program who now is a substance abuse counselor told me that close to 90% of Vets with PTSD have substance abuse issues.

Now, the VA has very strict rules on issuing prescription medication to Veterans with documented substance abuse problems. In other words, it may be difficult for Veterans to receive proper treatment for PTSD if substance abuse and PTSD are treated as mutually exclusive problems. This clearly introduces a level of difficulty for the VA in providing the type of comprehensive rehabilitation treatment these Vets deserve. Some may call it Catch 22, but I am sure our Vets find it no laughing matter.

In any event, SFTT applauds the Veteran Treatment Courts and is committed to help them expand across the United States.

The Center for Disease  Control and Prevention reports that there were approximately 38,000 suicides in 2010 and of those, roughly half were by firearm.   Which brings us to a very alarming statistic:  A military veteran commits suicide every 80 minutes or 22 a day!  In other words, nearly 8,000 veterans commit suicide each year.  Astonishingly, 1 in 5 suicides in the US is a military veteran  and it rarely raises a ripple among that smug crowd within the DC Beltway who appear to use gun control legislation to press some self-serving political agenda.  Some writers suggest that military suicides (includes Vets) could be closer to 1 in 4! (see below).   Shouldn’t the focus of the discussion be on those most at risk from death by firearm rather than the weapon of choice?

It would be reassuring to think that our government leaders would spend as much energy focused on helping our brave warriors reclaim their lives rather than dissipate their energies on political rhetoric which dramatizes gun violence without providing a responsible solution.   Sadly, our political leadership don’t seem up to the task of focusing on the BIG PICTURE.

As much as the Sandy Hook tragedy stirred our nation into looking for answers to deter gun violence, our Vets and their loved ones experience their own Newtown massacre each day  when on average 22 Vets commit suicide.    Isn’t it time we as a Nation wake up to the BIG PICTURE and mobilize the necessary resources to deal with this unending tragedy?   This is a time for REAL LEADERSHIP!

Gun Control and Suicide – NYTimes.com

Modest regulations are more likely to deter suicide than prevent murder, and should be judged accordingly.

What Researchers Learned About Gun Violence Before Congress …

We’re not just looking at mass shootings, but also looking at the bulk of the homicides that occur every year and the suicides, which account for a majority of all gun deaths. Then the last question is how do you do it? Once you …

Record Numbers of US Military and Veteran Suicides | Global …

Headlines like this should shock: Suicides Outpace War Deaths. Surge in Military Suicides. Nearly Two Dozen Veterans Commit Suicide Daily. These reports and similar ones reveal imperialism’s dark side. War takes its toll.

REAL Number of Veteran Suicides in the U.S. Too High To Be …

I’d thought that everyone in U.S. was aware of the mass number of veterans that we lose to suicide each day, but a recent message I received from a supportive Facebook group administrator who helps me by sharing my …

Report: Veterans suicides may be underestimated – Marine Corps …

Veterans make up 22.2 percent of all suicides in the U.S., and that startling figure might actually be an underestimate because of difficulty in determining veterans’ status, according to a new report.

VA studies suggest (see below) that there is no “silver bullet” and as SFTT’s Medical Advisory Board has recommended, one needs to experiment with a number of treatment modalities to determine which one(s) are best suited for a Vet’s particular situation.   Certainly, it is more than medication and may involve extended job retraining and the acquisition of other practical life-skills to help returning vets on the path to a richer life.  Just because there is no easy solution, doesn’t mean that we need to turn our backs on these brave heroes.

Public Insight Network | Beyond PTSD to “moral injury”

“I really don’t like the term ‘PTSD,’” Department of Veterans Affairs psychiatrist Dr. Jonathan Shay told PBS’ “Religion & Ethics Newsweekly” in 2010. “He says the diagnostic definition of “post-traumatic stress disorder” is a fine …

PTSD: The Futile Search for the “Quick Fix” | Guest Blog, Scientific …

Short-term TFTs are regularly prescribed by the VA, and yet, VA studies indicate that the majority of veterans treated for PTSD are still in treatment four years later (see Fig. 2). The military and VA want a quick fix, but that’s not …

The Truth About PTSD and America’s Military Veterans | Video …

There are few people who inspire more respect and admiration than our brave servicemen and women — those willing to selflessly serve their country and at times, even face death for the sake of others. While it is always a …

Families: Vets’ PTSD ‘like living in hell’ – NavyTimes.com

Families: Vets’ PTSD ‘like living in hell’NavyTimes.comUntil the day she wrestled a gun from the mouth of her drunken husband, the 37-year-old wife of a Tennessee Army National Guard sergeant thought she was holding it together. But then the flashbac …

If you want to help, please consider becoming a Member of SFTT and add your voice to a growing chorus of concerned citizens.  Our brave warriors need more than lip service.

Earlier, SFTT reported that OxyContin or “Hillbilly Heroin” was regularly prescribed to Veterans by the VA. The side effects were devastating and some independent researchers have suggested that the prescription of OxyContin actually led to more self-destructive behavior in Vets rather than provide any real cure.

SFTT Medical Advisory Board is examining all recommended PTSD treatment options. Your generous contribution help insure that our brave warriors get proper information on treatment modalities and where possible discover treatment options that may be better suited to their particular circumstances.

The articles below illustrate the ongoing debate about various drug treatment modalities and their repercussions. Please note that the articles below describe the complexity of dealing with PTSD and neither SFTT nor or Medical Advisory Board necessarily recommends any of treatment modalities discussed below:

PSTD vets given drugs against guidelines – Big News Network.com

PSTD vets given drugs against guidelines.  The study, published in Psychiatric Services, found in 2009, among all veterans with PTSD who had continuous VA medication use, 65.7 percent were prescribed elective serotonin-norepinephrine …

The Deadly Rise of Prescription Drug Abuse in the Military – MyABC50.com

The Deadly Rise of Prescription Drug Abuse in the Military.  Over the past decade, the military has spent $1.6 billion on painkillers (opioids) such as Oxycontin and Hydrocodone. $2.7 billion has been spent on anti-depressants and …

Military turns to meditation for PTSD – Fort Wayne Journal Gazette

Military turns to meditation for PTSD. PTSD is usually treated with drugs, behavioral therapy and other approaches. But for many, these methods don’t work. Now, researchers are looking at a new method that might limit future c …

A Potential Therapy for PTSD? – TIME

Potential Therapy for PTSD? My research focuses on the harmful effects of a class of drugs called quinolines, most notably the antimalarial drug mefloquine (or Lariam), which has been widely prescribed to deployed troops in Somalia, Iraq, an …

Drug Free PTSD Treatment & Cure for Soldiers & Military

The website is patriot outreach.org, I have nothing to do with this organization other than I know it has changed lives. It’s very simple and powerful.

Clearly, the symptoms of PTSD can be traumatic for the veteran and loved ones.  Many organizations promise support, but very few deliver a replicable and comprehensive treatment program that allows veterans a better than average chance of reclaiming their lives.  Claims of successe in dealing with this terrible affliction need to be carefully evaluated.

SFTT will continue to provide a synopsis of the latest news developments on PTS.  Some of these stories are heart-wrenching, but we do need to get these stories out in the open to raise the level of public awareness of this terrible social cancer.  This is not a military problem or the VA’s problem – PTS is our problem and we have an  obligation to help provide our Vets with a glimmer of hope that they can reclaim their lives.  Add your voice to others  at SFTT to bring about the change we need to help deal with PTS as adults.   Donations are accepted to help SFTT’s medical advisory board investigate new treatment methodologies.

PTSD and Suicide

This past weekend I lost a friend to suicide. She was a combat medic with the Army. She was “treated” by the Army for PTSD. Their treatment consisted of restricting her to base, having her check in daily with her supervisor, and meds. Then as …

Charts: Suicide, PTSD and the Psychological Toll on America’s Vets …

Charts: Suicide, PTSD and the Psychological Toll on America’s Vets … Don’t miss Mac McClelland’s feature on the PTSD epidemic among returning vets, and how it’s spreading to their families. Additional reporting by Mac …

PTSD Survivor: Suicide…

It’s been a while…. It’s also been very rough. My son refusing to speak to me has me in a deep depression. He’s 600 miles away. A week ago, I was up by myself online and happened to look over and see my …

Suicidal ideation

Ideation is a medical term for thoughts about or an unusual preoccupation with suicide . … Post-traumatic stress disorder (PTSD) …

Let’s mobilize our resources to help these brave young men and women reclaim their lives.  You can help.

Pre-War Vulnerabilities Impact Veterans’ PTSD | Psych Central News

Researchers are learning that pre-war psychological characteristics are as important as the actual combat-related trauma for predicting the course of.

Gene Linked to PTSD Risk in Soldiers | Psych Central News

A particular gene variation may play an important role in determining whether or not a soldier develops post-traumatic stress disorder (PTSD), according to new.

The Truth About PTSD and America’s Military Veterans | Video …

There are few people who inspire more respect and admiration than our brave servicemen and women — those willing to selflessly serve their country and at times, even face death for the sake of others. While it is always a …

Mindfulness and meditation training could ease PTSD symptoms, researchers say – Washington Post

Mindfulness and meditation training could ease PTSD symptoms, researchers say.  PTSD is usually treated with drugs, behavioral therapy and other approaches. But for many, these methods don’t work. Now, researchers are looking at a new met …

War zone killing leaves troops with ‘moral injury,’ may rival PTSD cases – Newser

War zone killing leaves troops with ‘moral injury,’ may rival PTSD cases.  Though there may be some overlap in symptoms, moral injuries aren’t what most people think of as PTSD, the nightmares and flashbacks of terrifying, life-threatening combat …

SFTT’s medical advisory board continues to track promising PTSD treatments to help our brave warriors reclaim their lives.