National PTSD Awareness Day & Moral Injury – Make the Connection

Wednesday, June 27th was officially recognized as the >3rd annual National PTSD Awareness Day.  PTSD Awareness Day was first established by Congress in 2010 after Sen. Kent Conrad of North Dakota proposed honoring North Dakota Army National Guard Staff Sgt. Joe Biel, who was a suicide casualty following two tours in Iraq. Biel’s birthday was June 27. Tragically and stunningly, in the first 155 days in calendar year 2012, the active duty armed forces endured 154 suicide casualties – as sure a cry for help as there is.

It took a decade of war in Iraq and Afghanistan, and millions of words, and thousands of shattered lives, for our nation to finally recognize the legitimate and true nature of post-traumatic stress and the effect it has on survivors of trauma. Trauma comes in many many shapes and sizes – I call them species of trauma. Combat, certainly. Accidents, whether vehicular or otherwise. Domestic abuse. Sexual abuse. Bullying. Racism. Crime victimization.

The link above includes 12 ways to increase awareness of PTSD in the community. PTSD does not affect just returning veterans. It affects every community, and all ages. It is, in effect, a 12-Step program for community members to learn about living with trauma.

But soldiers and veterans experience something else – a different species of trauma. Because they are volunteers. Every single one of us volunteered to don the uniform, to strap on the boots, and to take up arms to support and defend the Constitution of the United States against all enemies foreign and domestic. That is a good thing. Its a morally right and defensible action. Love of country is part of the natural order. So what happens?

My friend Nan Levinson of Tufts University is a writer and PTSD researcher. She has written an incredibly insightful essay about “moral injury” crossed posted at Tom Dispatch and the Huffington Post. Entitled Mad, Bad, Sad: What’s Really Happened to America’s Soldiers, she calls these moral injuries “sacred wounds.” Here she tells the story of a soldier:

“Andy had assumed that his role would be to protect his country when it was threatened. Instead, he now considers  himself part of “something evil.” So at a point when his therapy stalled and his therapist suggested that his spiritual pain was exacerbating his psychological pain, it suddenly clicked. The spiritual part he now calls his sacred wound. Others call it “moral injury.”

Nan goes on to explain:

“While the symptoms and causes may overlap with PTSD, moral injury arises from what you did or failed to do, rather than from what was done to you.  It’s a sickness of the heart more than the head. Or, possibly, moral injury is what comes first and, if left unattended, can congeal into PTSD.”

She gives credit for the term “moral injury” to Dr Jonathan Shays, the MacArthur Genius Grant recipient and Boston VA Psychiatrist who wrote Achilles in Viet Nam: Combat Trauma and the Undoing of Moral Character and Odysseus in America: Combat Trauma and the Trials of Coming Home There is an important academic paper on the phenomenon of moral injury entitled Moral Injury and Moral Repair in War Veterans published by in 2009.

It is no accident that the first National PTSD Awareness Day happened in 2010.

Awareness is not enough. Reaching out. As in combat, creating bonds under extreme conditions of stress and trauma. The VA has a new campaign called Make the Connection. Veterans share a common bond of duty, honor, and service. Some military Veterans served in combat overseas. We experienced things – life – that most people can’t fathom. We know. We get it. That’s why we have to reach out.



Wanted: A Good Job and Some Understanding? I’m not so sure…

Four articles caught my attention this past few days. The first was titled Army Sgt Born in CT killed in Afghanistan. Sgt Edward J. Frank, 26, of Hartford CT made the final measure of devotion this past weekend when he was killed by an IED. Sgt Frank was on his third combat tour, two in Iraq, and this third in Afghanistan. He leaves behind a wife and three young children.  May he Rest in Peace, and his family’s grief be assuaged. Unfortunately, he is not the only son of Connecticut to die in Afghanistan this month, as Chief Petty Officer Brian Bill, 31 and a Navy SEAL, of Stamford CT, was also killed in Afghanistan.

The second was an editorial in the NY Times by Jonathan Raab of Iraq and Afghanistan Veterans of America. The editorial, Wanted: a Good Job and Some Understanding ends with a plaintive “Everybody wants to support the troops until they have to  share in the hardship and sacrifice,” I said. “Then all of a sudden that bumper sticker or that flag pin doesn’t mean anything anymore.”  I agree with the sentiment in general, but I have more to say. Look at the current politics – there is almost no talk about the wars, or about the effects they are having on the people fighting them, or their families, or society at large. Veteran unemployment in general is 5% higher than the civilian population; for disabled veterans it is twice, and in some states, three times as high as the general civilian population. In economic times like these – its every man for himself. People are worried about putting food on their own table, and about paying their own rent or mortgage. Unless they’re veterans or related to veterans – they’ve got other things to worry about. I submit we should not be looking for understanding from civilians – we should be looking to understand civilians, in the same way we tried to understand Iraqis or Afghans when we were deployed. In other words – civilians aren’t going to change. We’re not going to change them. We can win them over, we can overcome their fear and prejudices, just as we did with the civilian populations in Iraq and Afghanistan. And we have an advantage – no one is killing them or their families on a daily basis.

The third article was in the Connecticut Post and was entitled Returning Veterans Face Struggles Returning to the Home Front. The article talks about veterans experiences in CT returning to a civilian environment, and the trials and tribulations thereof. The theme emerges, as quoted by Joy Kiss, founder of the homeless veteran shelter Homes for the Brave in Bridgeport CT – “The returning Iraqi and Afghanistan veterans are becoming homeless quicker than the Vietnam era veterans. They’re coming back to jobs they had, but they’re coming back different so they lose those jobs. And then, as a result of the loss of the job, they lose their homes. And then on top of the stress of combat, they may lose their marriages, they may turn to alcohol or drugs to cope with whatever demons they’re living with. You just get layer after layer after layer.”

And last, this article More Homeless Female Veterans in NC, SC posted in the CT Post.The article quotes a female veteran who says she thought her work experience in the military would help her land a job “but instead potential employers seemed to dismiss her as a serious candidate.”

The message I take away is “We’re different.” And these articles, attempting to chronicle what its like to be a returning vet, actually entrenches that. And we are different. In fact, we’re special. We’re doers. We’re people who make things happen. Who accomplish missions under the most dire and difficult of circumstances. We’re people who negotiated with sheikhs and village elders and ran towns and districts and built bridges and energy grids. We’re not people who complained about not being understood or about being given a job. We went out and did what we did. That’s what we do. We don’t need civilians to understand us – we need to understand them!  Developing working relationships, doing economic development projects, accomplishing missions – these are all things we can do – whether its in Iraq, Afghanistan, or Connecticut.

With all due respect to the various authors of the articles, We don’t need civilians to understand us or give us a job.