Bob Reiter, Director of Veterans Services for Rensselaer County, was a helicopter door gunner during two tours in Vietnam, and served on active duty in the Marine Corps and the Armed Forces Police from 1960 to 1968. He had never talked about his military service, not even with his wife and children. But last September Reiter traveled from his office in Troy to Wheaton, Illinois, to address a gathering of veterans who had served in wars past and present. The gathering was a three-day Soldier’s Heart Healing Workshop for combat veterans suffering from post-traumatic stress disorder (PTSD). Filling out this 65-member gathering were mental health care providers, social workers, nurses, and vets’ family members.
Reiter knows what PTSD looks like and he knows that there is no statute of limitations on the number of years a vet’s pain can be buried deep before it unexpectedly erupts. This was the case when he shared his story in a segment of the workshop where other vets did likewise. Surrounded by so many others who carried similar burdens, Reiter found his nearly 40 years of bottled-up terror and grief suddenly beginning to flow. Through tears, he described the fear that engulfed him when his helicopter was shot down by enemy fire. “We were in firefights every day. We got shot at every single day,” said Reiter, as if in disbelief. Two other Vietnam vets in the group embraced Reiter while he sobbed.
The workshop’s leader was Dr. Ed Tick, a clinical psychotherapist with extensive experience treating veterans. Tick describes PTSD as “frozen war consciousness,” a psychological reaction to warfare that causes survivors to repeatedly replay the trauma, sometimes months and even years later. In 1980 the American Psychiatric Association (APA) added PTSD to its manual of diagnosis, in response to the flood of Vietnam vets seeking treatment for a host of physical and psychological symptoms.
While the APA categorizes PTSD as an “anxiety disorder,” those who work closely with vets know that the symptoms are much broader, encompassing physical, emotional, psychological, spiritual, and social dimensions. Hypervigilance, depression, anxiety, spousal abuse, sleeplessness, drug and alcohol addictions, and suicide attempts are familiar symptoms of PTSD sufferers. In his highly acclaimed book War and the Soul, Tick describes PTSD, first and foremost, as a spiritual disorder, a “soul wound.”
Tick began his psychotherapy practice in the 1970s, when, many of his first patients were combat veterans who had served in Vietnam. Now Tick encourages vets to tell their stories “in a safe and sacred space,” as he calls it, like that created during the experiential workshop that Reiter attended. There, vets’ family members, chaplains, social workers, and mental health care providers literally formed a circle around the veterans. “As witnesses, they share in carrying the burden of the warrior,” Tick explains. In another segment of the workshop, Reiter was among a roster of speakers—all veterans—who spoke to the numerous implications of PTSD and its prevalence among combat veterans.
Barriers to care
The Veterans Administration’s National Center for PTSD estimates that 30 percent of people who spend time in a war zone will develop PTSD. Many of them don’t get help for it. A 2004 study of Army and Marine troops returning from Iraq and Afghanistan, published in the New England Journal of Medicine, found that only 23 to 40 percent of those with PTSD sought treatment.
Reiter understands, first hand, that many factors contribute to these disturbing and, in his opinion, grossly underreported statistics. He names stigma within the military, fear of job loss, and a severe shortage of VA services as barriers to care. He believes that a frighteningly large proportion of servicemen and women returning from Iraq and Afghanistan who exhibit symptoms of PTSD will never be diagnosed, let alone provided with the necessary treatment. What’s more, in Reiter’s experience, it can take up to 120 days to get treatment for PTSD through the VA once a diagnosis has been made. “If you’re suicidal, this isn’t going to help you much,” he says.
Troy is headquarters for New York’s 42nd Infantry “Rainbow” Division of the Army National Guard, and for Reiter this place reflects the reality of cities and rural towns across the country. “The biggest problem in getting treatment for PTSD is getting the vet to admit they have a problem,” he says. Yet another disturbing aspect of the problem, according to Reiter, is a new VA rule stating that National Guard and Reserve service members must serve two years active duty before they are eligible for VA health care coverage over the two years following their service. “It’s criminal,” he says. “There should be no cap on this. Lots of times, PTSD doesn’t show up or isn’t reported until after that point.”
Back in his office following the workshop, Reiter says, “This has been a rough week. We had three deaths from motor vehicle accidents. Spousal abuse, DWI—this is typical of what turns up, especially with soldiers who have been back from Iraq and Afghanistan for two years or so.” Reiter expressed both grief and frustration over a suicide in the same week: a young soldier who sought treatment from a VA psychiatrist, only to be sent home. He shot himself a few days later.
Reiter has been advising veterans for the past 10 years. Among thousands of requests for assistance he handles each year (1,890 last year alone), Reiter recognizes some as harbingers of catastrophic scenarios. Though his tasks are frequently simple and straightforward, such as arranging transportation to VA health care facilities and providing the proper application forms for various benefits, he increasingly receives desperate calls from spouses, siblings, and parents of despondent, violent, and sometimes suicidal vets. Reiter estimates he now makes one to three interventions each month, urgently meeting with vets in living rooms and coffee shops.
When Reiter is able to get these vets the help they need, he attributes this success to a vast network of service providers with whom he collaborates. Equally significant, Reiter feels, is his ability to establish a bond of trust, based upon the shared experience of war.
The national picture: a grassroots approach
Nationwide, mental health care services through the VA, like those that Reiter painstakingly beggars for vets and family members, are in short supply. Instead, local grassroots organizations are often the lone voice in the wilderness. These, however, are primarily dependent upon volunteer efforts and are perennially underfunded. Working in Philadelphia, Jeff Russell has joined the ranks of a nationwide movement determined to overcome the government’s failings in healing our wounded warriors. Retired after 15 years in the Army, Russell is now a chaplain for the Philadelphia Prison System. Though Russell has never served abroad, his military experience includes assignments at several US bases—key combat training grounds for soldiers being deployed during the Gulf War—where he served in active duty, reserve, and National Guard units. Russell’s motivations for both leaving the military and becoming a veterans’ advocate are similar to those fueling Reiter’s impassioned mission.
While Russell is remarkably proud of following in the footsteps of a military family, he carries the scars of friends and family members who fought in Vietnam and, more recently, in the Persian Gulf. He is particularly outraged by the parallels he sees between the VA’s response to veterans’ claims of exposure to Agent Orange in the post Vietnam era, and the military’s response to US troops’ chemical exposure leading to Gulf War Syndrome. “The military left them to rot,” says Russell of both generations of service members. “They were sick: physically, psychologically, and spiritually.”
He sees the current situation with PTSD among returning troops, however, as “far worse,” and feels that National Guard and Reserve members are those most vulnerable to slipping through the cracks. Many express a sense of isolation from the military family. “Reservists are called for two and three tours. Their lives are disrupted. And then they come back to their jobs and their families with no safety net in place to help them gain access to mental health care services.”
Russell is looking for ways to reach out to National Guard and Reservists, such as by bringing to Philadelphia an initiative called Beyond the Yellow Ribbon. Pioneered by the Minnesota National Guard, this program provides counseling for veteran reintegration, health care, and for legal, educational, and employment issues. Russell’s working knowledge of military culture lends “an inherent trust factor,” he explains, and he believes the simplest solution to the PTSD epidemic is to mobilize former veterans into collaborative healing networks.
Holistic help for PTSD
Experts like Tick feel that to exclude any component of care—whether social, psychological, or spiritual—is to doom treatment outcomes from the outset. In his opinion, antidepressants or other drug therapies do little to reach into the boundless abyss of pain that those with PTSD endure. Tick advocates for a holistic approach with a spiritual component, as modeled at the Wheaton workshop and now being replicated throughout the United States.
But, says Russell, civilian clergy and spiritual leaders may be reluctant to address combat-related PTSD. “Many have been afraid to reach out because they don’t know how to relate to someone who has been through such horror. It takes a very unique person, one imbued with credibility and spiritual authority, to help veterans get the answers they’re looking for.”
Recently the Army made an unusual move by hosting a unique military-civilian collaboration: a two-part Spirituality and Traumatic Stress Symposium at Walter Reed Army Medical Center. Speakers included Dr. Jonathan Shay, clinical psychiatrist at a Boston VA outpatient clinic and winner of the 2007 MacArthur “genius” award, and Tick, among others. Awash in a sea of camouflage, audience members included some of the military’s best and brightest chaplains, social workers, and mental health care providers.
The common denominator for participants at the Walter Reed symposium, and Tick’s healing workshop, is the understanding that PTSD has an inherently spiritual dimension; further, that men and women who go to war frequently undergo what they describe as a profound moral and spiritual crisis. “When you are at war, you set aside all of the mores of civil society,” says Russell. “These 18- and 19-year-old kids have seen horrors. They are using a judgment system they’ve been trained to use. But then they have to reconcile that war experience with what’s right and what’s wrong when they come home. They’ve been on the precipice of what it means to lose touch with what is human. Their souls have been destroyed. They are hurting for answers and they are hurting to be embraced.”
Healing the Wounded Soul
Larry Winters, a licensed mental health counselor, and author of The Making and Un-making of a Marine (Millrock Writers Collective, 2007), knows both personally and professionally the deep and searing pain of a traumatic “soul wound.” A Vietnam veteran, it has taken him 35 years to heal; finally, though, reading Tick’s book and completing his own brought Winters a life-changing catharsis.
Like Tick, with whom he now frequently collaborates, Winters believes treatments for PTSD must be holistic and provided over time, in order to build a strong patient-therapist rapport. Winters has developed a treatment approach in over more than 20 years of working with vets at Four Winds Hospital in Katonah that he calls Directive Group Therapy (DGT).
Winters’s approach falls within the rubric of psychodrama, a method of supervised reenactment that aims to provide the protagonist with the opportunity to repeat and work through painful events, with the goal of experiencing catharsis and then resolution. In Winters’s words, “DGT is based on skills developed by the therapist that involve intervention, reframing, and a series of techniques to help the patient focus quickly. In the DGT method, the therapist works one-on-one in a group using his or her awareness that the issues and
stories are aff ecting others.”
Winters notes that the DGT process is “much slower, much longer, much deeper,” than the recently touted approach of Eye Movement Desensitization and Reprocessing (EMDR). During EMDR the client focuses on a therapist-directed, external stimulus such as movements the client watches, hand-tapping, or auditory tones, while briefl y attending to emotionally disturbing material. Developed by psychotherapist Francine Shapiro in 1989, EMDR is now the most researched treatment for PTSD. In a chapter of Charles Figley’s Brief Treatments
for the Traumatized, Louise Maxfi eld suggests that “EMDR works by linking elements of traumatic memories with adaptive information contained in other memory networks, leading to a cognitive shift.” A recent meta-analysis of 12 outcomes studies shows a decrease in PTSD diagnosis in 70 to 90 percent of
civilians after three to four sessions, and in 78 percent of combat veterans after 12 sessions. The Department of Defense and the Department of Veterans Aff airs recommend EMDR for all trauma populations at all times.
Winters, however, worries that EMDR doesn’t address the underlying moral and spiritual dimensions of PTSD. “Using EMDR alone—not in conjunction with other therapies—is like putting a Band-Aid on the problem; deep healing does not take place. These are moral dilemmas that vets are suff ering with.”
Winters has worked with many vets, and, like Reiter, fi nds that veterans of Afghanistan and Iraq tend to avoid seeking treatment for PTSD until a crisis occurs. “When these young vets come home,” says Winters, “they want to get back to normalcy. They don’t want to go to a VA facility for help.” Sadly, by the time they seek help, after years of struggling, they often are suicidal. “They come when domestic violence or substance abuse becomes an issue and they come at the insistence of a spouse or family member.”
For now, Winters, Tick, Reiter, and Russell, along with a band of determined veterans, will continue to reach out to our nation’s newest veterans, to divine the wounded souls that call out to them in the darkness. With the US now in its sixth year of war, it is imperative that we, as individuals and as communities, follow suit.
Resources
Robert M. Reiter, Director
Unified Family Services
Veterans Service Agency
1600 7th Avenue
Troy, NY 12180
Phone: (518) 270-2760
bReiter@rensco.com
Chaplain Jeffrey Russell, Facility Chaplain
Philadelphia Prison System
8201 State Road
Philadelphia, PA 19136
Phone: (215) 685-8353
Pager: (877) 416-0696
Lawrence Winters
Four Winds Hospital
800 Cross River Road
Katonah, NY 10536
Phone: (914) 763-8151
Toll Free: 800-528-6624
winters.lawrence@gmail.com
http://www.makingandunmaking.com/
Edward Tick, Ph. D., Co-Director
Kate Dahlstedt, Co-Director
Soldier’s Heart/Sanctuary
500 Federal Street, Suite 303
Troy, NY 12108
Phone: (518) 274-0501
Phone: (518) 463-0588
ed@mentorthesoul.com
info@soldiersheart.net
http://www.soldiersheart.net
Nancy McGrory, Co-Director
Martin Richardson, Co-Director
Return to Honor Program (Freedoms Foundation)
1601 Valley Forge Road
Valley Forge, PA 19842
Phone: (610) 933-8825
nmcgrory@ffvf.org
mrichardson@ffvf.org
John Melia, Executive Director
Wounded Warrior Project
7020 AC Skinner Parkway
Suite 100
Jacksonville, FL 32256
Phone: 904-29-7350
Fax: 904-296-7347
Al Giordano, Deputy Executive Director
New York Office
Phone: 212-629-8861
Fax: 212-629-8885
Victoria Bruner, RN, LCSW, BCETS
Walter Reed Army Medical Center
Deployment Health Clinical Center
Bldg. 2, 3rd Floor, Room 3G04
6900 Georgia Ave., NW
Washington, DC 20307-5001
Phone: (202) 782-6563
DSN: 662-6563
Fax: (202) 782-3539
www.PDHealth.mil
The Iraq War Clinician Guide, 2nd Edition
http://www.ncptsd.va.gov/war/guide/index.html
The PILOTS Database
An Electronic Index to the Traumatic Stress Literature
http://www.ncptsd.va.gov/publications/pilots/
US Army Wounded Warriors Program
1-800-237-133
aw2@conus.army.mil
This article appears in March 2008.
