I knew I had been anxious about my first group therapy session with the new doc. I just didn't realize how anxious I really was. The two nights before the session, I didn't really sleep much. I was a bit of a hot mess. I arrived early as I always do. It gives me a few minutes by myself in the room to collect my thoughts.
Then the doc and the other veterans showed up and things took a turn for the worse for me. It became very clear early on that doc was going to work out. She's competent and runs the group well. She involves everyone.and does a good job directing conversation. The new doc was never the issue.
I kept on looking up and expecting to see Doc Casagrande. I kept on looking over the where he had habitually set up shop in the corner of the room. He wasn't there and it hurt, knowing he would never be there again. It's one thing to grieve on your own timetable. This was not. I had to force myself to move on and pay attention to what was happening in group. I didn't want to yet but I wasn't given a choice. It hurt like hell and I suffered for it all last night and today.
I kept on thinking, if grieving was this hard for my doctor, what the hell was going to happen to me if something ever happened to my wife or daughter? The fear intense, palpable. I have never been so scared of losing something in my life and I didn't know how to handle it. I ended up rocking and holding my head like someone kicked me in the groin. It wasn't continuous. Every time I would catch myself after a little bit and force myself to stop. It wouldn't take long before I was rocking again, unaware that I was doing it.
When I woke up this morning, my emotions were still raw and I was anxious as hell about everything and nothing, all at the same time. I kept on taking doses of my anxiety medication until it made a difference. Then, off to work I went, hoping and praying that I could make it through the day without verbally decapitating someone.
Somehow, I have made it through and it is something I am very grateful for. My wife has been worried sick about me and was concerned that I was starting to regress back into a hole. While I haven't regressed, I had to explain to her that what I was mostly feeling was grief exacerbated by my PTSD. I was just grieving. That's all. It just goes to show that, while I have gotten closure on Doc's death, being reminded of that loss can still be profound and emotionally distressing. I haven't felt his loss as keenly at any other time. It is still difficult to explain to you the depth of the loss I feel and it has overwhelmed me for the past two days. Now I have to work out all of the jumbled mess that is my thoughts and see if there's anything else or any revelations hiding in the murk.
Well, let's just say that it's mostly impersonal, cold. You can't capture the imagination of readers online the way you can when you talk to them in person.
With this in mind, I will be focusing on "Boots on the Ground" (BOG) initiatives first to invest my local community in my message and the success of my non-profit. I will be planning a 5K in my area as a starting place. I will then use this proof of concept as a means for other communities around the country to become involved.
If you want to be some of those boots on the ground, please let me know. If you believe in my mission support its inception...and get in on the ground floor. Help me hit the ground marching.
This past Wednesday, I met with my individual therapist. She was concerned about what had happened over the course of the previous week and told me she wasn't sure what to expect when she showed up. After I left her a message in distress last week, she thought I would still be really banged up emotionally. She told me she was pleasantly surprised that I wasn't a hot mess.
She said, "Feeling less is not a sign of emotional growth: Feeling just as much but returning to emotional stability faster is." It made me feel really proud of myself. She was acknowledging that even though I had been through a gauntlet of emotional pain over the course of the past week, I was focused and calm. It was not at all what she was expecting and was happy that I was able to return to stability so quickly. I told her a large part of it was that I have had to grieve for too many people in my short life. I have grieving down. That was never the issue, in the first place. The real issue was being prevented from getting closure. That triggered me something fierce. Closure was the one thing I never got to any of the deaths I witnessed and experienced over in Iraq. This past week brought it all back.
And living to honor Doc's work and his memory has motivated me to move on and fight. So fight I will.
The conversation then moved on to how I handled the anniversary of crossing the berm into Iraq. I told her it really didn't affect me too much other than to give me pause. It took a little bit to really absorb the thought that a decade has passed since that fateful day. I decided to go out to lunch with my daughter and we had a blast all day long. It was great.
Then my therapist asked how I felt in situations where parent stand or sit around and talk while their kids play.
I shifted uncomfortably. I told her that I tried to avoid conversation as much as possible because I don't want it to come out that I am a combat veteran with PTSD. It's not for my sake, it's for my daughter's. I don't want other parents to not allow their children to play with Caley out of misplaced fear that I'll go nuts. Caley is at a fragile age where she will think that she did something wrong. I don't want to visit that stigma upon her life. My clinician asked me if I identified myself that way when someone asked me what I do. I said that I do because my advocacy work is what defines me, not my job.
Well, she told me in no uncertain terms that I need to work on my ability to engage in safe and meaningless small talk. It's what most people do when they are standing around while their kids play. She asked me to think about how else I could answer the question: 'What do you do for a living?'
Still working that out. But, for my daughter's sake I better figure it out and fast. She starts learning day care in less than two weeks.
I hope that other veterans that are reading this ask themselves that question, too. I know that I have a tendency to be blunt. Not only that, but I also believe that a lie by omission is still a lie. So vets out there, think about it. How to we engage in small talk? Is it something we are comfortable with? Or do we just avoid those awkward situations entirely. I know I have done my best to avoid those situations. I guess now I can't. Time to step outside my very small comfort zone and re-learn something new...
It's hard to believe it's been ten years since I crossed the border into Iraq. Harder still to fathom why it is still as clear in my mind as if it happened yesterday. I was initially concerned about how this anniversary would affect me, but I was pleasantly surprised that it didn't really do much to affect my mood. Well, I guess it did. I spent the day with my daughter, Caley. We had a daddy and daughter day. We went to Applebee's and had lunch and spent the afternoon enjoying play time. I was on and off the computer checking on my fundraising campaign. The whole time, I reflected on how I have spent the past ten years - my victories and, especially, my stumbles.
Needless to say, I have a lot to be grateful for. My wife, my daughter, my family. I wouldn't be here if it wasn't for them and I know now, more than ever, that I am one of the lucky ones. Suicide rates are embarrassingly high, disability claim wait times are so long that some have been waiting for compensation longer than the length of their deployment to Iraq or Afghanistan. PTSD is still a scary four letter 'word'.
Should I continue? We all know the score. Our struggles are the legacy cost of a decade of war. A decade that saw the burden of waging war fall on the shoulders of 1% of our population. The military community has become more and more isolated from the general public in spite of the best efforts of advocates everywhere. It makes me wonder: With all of the high-profile advocacy going on out there, why aren't there more 'boots on the ground'? What I see is tons of advocacy groups spending a lot of money and time marketing themselves and their image. I don't see advocates in the crowd wearing t-shirts, bracelets. I don't see fundraising efforts on TV like they used to have for Jerry's Kids. I see the same partisan gridlock in DC fouling up everything they touch (sequestration caused suspension of tuition assistance for our active duty service members).
Most importantly, I have seen too many veterans that are tired of the frustration of the VA, politics, PTSD stigma, and unemployment just give up and let themselves fall through the cracks.
You all know what I'm talking about. It hurts my heart to see it happen, day in and day out.
It just feeds my fire. I will not submit. I will not give in. Instead, I will give back.
All I need to make my dream of helping veterans a reality is $3165. That means I need less than 3% of my followers and supporters to make that commitment.
I have asked myself a thousand times why I made it back and others didn't. We all know that surviving war is like playing Russian Roulette. What they don't tell you is the guilt you will have to live with if you survive. It took me a long time to work up the courage to do this. It was in large part because of the guilt. I felt like I would be 'taking advantage' of those in need. Stupid Survivor's Guilt. I know now that my cause is just and noble. The only way I can do more is by having the resources to make an impact. Help me start small. On this day, of all days, help arm me to fight for those that suffer in silence. Let me advocate for those too hurt to fight for themselves.
Yours in Health,
I went out to the cemetery today. I had learned late Thursday night that Doc does have a final resting place and it was less than a half hour from my house. Needless to say, after spending Friday getting everything sorted out with the VA (that's another post for another day), I was exhausted and couldn't make it out the to cemetery yesterday.
So I went this morning. Talk about surreal. There I was, not a soul in sight anywhere. I was standing in front of his grave marker, solemn and contemplative, head down. No cars drove by the cemetery in that moment and the snow started to come down very heavily. It felt like one of those moments you read about in books or in serious dramas. Yet this was real life. This was MY life and, for some reason, it just felt right that I should have solitude and quiet in that moment.
And then it passed and the emotional pain hit like someone ripping off a Band-Aid. Intense, searing, yet short lived. I was left with the dull throb of missing someone I would never see again, but being there - seeing Doc in his final resting place - gave me the closure I needed desperately to fully move on. I didn't realize how badly I needed it until that moment. It made me wonder why I needed that closure, that finality, so keenly.
I thought about it on my walk back to the car, on the ride home and a good portion of the early afternoon. And then, it hit me. I needed this because I never got closure for all of the death and violence I experienced over in Iraq. It made me think about all of the other veterans with PTSD that were suffering just like me and it made me realize: If there is ONE THING that can trigger us and bring it all back into our consciousness, it's having someone close to us die and not getting the closure we need to move on.
In retrospect, I recognize now that a lot of the anger I have felt for the past few days was not anger felt but, rather, anger remembered. Grief. Not felt, but remembered. Helplessness, intensely remembered. I recognize now that this event, the unfortunate circumstances surrounding Doc's passing and the way in which I was informed, has been a blessing in disguise. It may take it a while for me to fully accept that, but I know I eventually will. What I have gained from this experience is how losing someone I care about will affect me in the future. It also equips me to support my fellow veterans if they find themselves in the same position.
So take heed. If it is in your power, do everything you can to provide adequate closure for veterans with PTSD. Don't blindside them. Do what you can to be compassionate and try to leave them feeling like they are in control of the situation and how they choose to grieve.
VA Admin, ARE YOU LISTENING?
After everything that happened yesterday, I needed to find answers. I was in no condition to work but tried anyways. I made through a little over two and a half hours of my shift before I couldn't hide my grief anymore. I was emotionally drained and physically exhausted. I left work and I headed straight to the VA and asked to speak to the Patient Advocate. I was ushered into his office and he asked me how I was doing and what he could do for me.
I told him about the past month and the way that I had been treated and that I was very upset with the manner in which I had been informed of Doctor Casagrande's passing. He responded without remorse that he and upper level administration had decided the best way to handle this 'situation' was to not allow non-clinical personnel to say anything and to keep mum until the vets came in for their next scheduled appointments. At that time another doc would be waiting to (sarcasm here) 'blindside' an unsuspecting veteran with this horrible news. I was stunned. I told the advocate that I don't have scheduled sessions with Doc Casagrande and that I was only in his group CPT session. The advocate responded, "So many people come and go through the groups that we didn't bother." Again - stunned. I told the advocate it would have been easy to see, if he would have bothered to look at the rosters that I had been at EVERY session for the last six to nine months. Remorseless, he deflected my comment with something along the lines of what's done is done and 'gee, we're so sorry you found out this way.' I followed up by telling him that no one offered me grief counseling, nothing. He very quickly offered, :"would you like to talk to someone now?"
It was at this point that I realized that the administrators had no flipping clue how to handle these situations. This advocate, along with administration higher up, put hundreds of behavioral health patients at risk with their approach to dealing with the doc's passing. I wondered if the disconnect flowed into the care side, so I said I would like to talk to someone. I was introduced to a clinician (I don't remember if she was a doc or a nurse or a social worker) and talked about how messed up I was from all of this and it became very evident to me that she was distressed at how distressed I was. She told me that every veteran that she had seen in connection to Doc Casagrande's death had reacted EXACTLY the same way I have. She also mentioned (although I don't think she really meant to) that there were still veterans that didn't know because they hadn't been in for their scheduled appointments yet. She told me, "I know, after everything that's happened that you have no reason to trust us, but would you at least talk to one of the docs tomorrow who is taking over Doc Casagrande's patients?"
I could sense her frustration with the whole situation. This was an utter mess and Doc's co-workers were just as caught in this storm as I was. I said I would meet with someone tomorrow and I scheduled my time to meet.
After I left and was on my way home, I thought about the whole situation and it made me incredibly disgusted. That patient advocate was to advocate for what was best for the patients. Either one of two things explain his decision: He was lazy and didn't want to put in the extra work and due diligence to make sure every one of the doc's patients was informed as quickly as possible OR he was put in the position to make this decision without any knowledge of what WAS best for us. The VA needs to understand how much danger they put the veterans in. If I was any less stable than I am, I would have done things I would have regretted (become a danger to others) or done something I would never be able to regret (committed suicide). Every veteran should have been afforded an equal opportunity to grieve and should have been told in enough time to attend the memorial services. The way they decided to handle this situation was reprehensible and inhumane.
So, I stand by what I said yesterday in my post. The VA needs radical change. And it needs it now. No longer can we continue to put our nation's heroes at risk due to the ineptitude or apathy of bureaucrats. I will fight from now until my last breath to make sure this change happens. Come hell or high water. I have had people tell me the system is too big to change. I respond with this. Bullshit. When the people you are designed to serve are forced to go elsewhere to ensure they receive quality care and compassion, you have failed to meet the most basic of requirements for your continued existence. I will not bear the legacy costs of a broken VA when those legacy costs are paid for with the blood of my fellow veterans who have lost hope and take their own lives. The time for change is now. Let's be heard, folks. Don't stand silent and condone this with your inaction. Fight for the change we all deserve.
I try to keep the tears from hitting the keyboard as I write this. I found out today that I lost a man who held a special significance in my life. In his honor, I want to share what I knew of the man.
Read His Obituary Here: Dr. Joseph Casagrande
I never even knew his first name. We just always called him 'doc'. I didn't even know him for very long, but Doc Casagrande had a huge impact on my life. About a year ago, when I was out on short-term disability and learning how to cope with my PTSD, I found out about his Cognitive Processing Therapy (CPT) Group and asked to join it. That's when I first met him. We met one on on and he asked me pointedly whether I was committed to learning the tools I needed to learn to better my life.
That should have been the first clue that this doc was different. I went to my first group session two weeks later...and my life was changed forever.
Over the course of the past year, I have taken control of my life. I still have horrible nightmares, I still get triggered. I still have to fight the depression, the anxiety. The difference is that I have acquired, through emotional growth and a considerable amount of emotional pain, how to better cope with these symptoms of PTSD. I learned these skills in my CPT group and at the direction of Doc Casagrande.
He was an amazing man. He never wore his heart on his sleeve but his passion for helping veterans came through in his straightforward attitude and brutal honesty. He told us what we needed to hear, no matter how difficult. This was his gift to us, he taught us to look at our behaviors and beliefs unflinchingly, to never back away from a problem. Doc always knew what we needed to hear and talk about the most and directed group discussion. He didn't drone on and monopolize group time. He asked pointed questions and, throught his direction and the support of the other veterans in the group, each of us learned more about ourselves and what we could do to make changes for the better.
Four weeks ago, Doc wasn't at group. Neither was anyone else. When I asked where everyone was, I was told that Doc was out sick. Concerned, I let it ride. Two Wednesdays ago, someone else was leading the group, a clinical social worker (for more about this group session, click here.) By this time, Doc Casagrande had already passed away. No one said anything. When I asked about Doc, the social worker evaded the questions with 'I don't knows'. Growing more and more concerned, I went to group today and noticed that the room was empty again. I didn't wait around. I left and drove around for a little, thinking. In the end, I came back just after the group was ending and I ran into another doc that I have worked with and asked him for a no-bull explanation as to what was going on. The doc stared at me, stunned. The look in his eyes told me everything I needed to know but the doc said. He passed away. I found out that Doc Casagrande had passed before the last group session that I had been to and I felt the lights grow dim. My world took on a much more threatening glow.
As I said in my previous post, 'The VA Screwed Up, Big Time.' I was angry and very distraught. My grief was eating me alive. As I have had many times in the past when I have worked with Doc Casagrande, I felt a moment of clarity. The grief is still there and still profound. The fact that I never got the chance to say goodbye, to have closure, will haunt me for quite some time. What that moment of clarity gave me was resolve - to continue to do the work he would have wanted me to in order to make the most of my live. And to make a difference for others. That moment of clarity showed me that, while I was robbed of my right to honor the man after he died, I could live my life - the live he had made possible - in his honor. To live my life as he lived his: with compassion, honesty, integrity, and unflinching resolve to do the right thing.
It is with this in mind that I share with you my vision. I want to take what he has taught me and make a difference for veterans with PTSD. As I move forward with creating my non-profit, I will be needing a physical location. In his honor: It will be named the 'Joseph Casagrande Center'
I ask for your support in making this a reality. Please help me and others that knew him honor his memory and his mission.
So I go to the VA for my CPT Group therapy and I see doc's not in there again. Feeling angry, I track down another doc I know and ask him what the hell is going on. I demanded to know what was going on with Doc Casagrande.
The doc I confronted looked at me, stunned. He had that 'oh, God, you don't know' look on his face. He told me that doc had passed away over two weeks ago. Yep, that's right over two weeks ago. The social worker in the room two weeks ago KNEW and didn't say anything, didn't address the subject or the grief we would feel. To the deepest core of my psyche, I felt violated - emotionally raped.
***UPDATE: They got the date of his passing wrong...It was AFTER my last group session. They never contacted me and no grief counseling was offered when I did find out.
I stood there stunned as I felt the floor fall out from under me. I asked about memorial services - already been held. Could I visit his grave? - Cremated. I asked about a few more things at the desk and then stumbled out to my car.
That's when the anger hit. The most furious and hell-bent anger I have ever felt. I was shaking. I thought, "THEY ROBBED ME OF MY RIGHT TO SAY GOODBYE, TO FIND CLOSURE". I got in the car and started driving home. All the while I was thinking:
Our veterans deserve top quality care. The dangerous actions (or, in my case, inaction) of the VA endanger the veterans they so strongly profess to care about. The VA proved to me today that radical change is needed. They need to be replaced with a system that is patient first, bureaucracy second. Enough is ENOUGH. This is to all of the politicians who want to sit around and squabble like spoiled brats. ENOUGH! You claim to have your constituencies' best interests at heart. Put your money where your mouth is. Your petty partisan politics have continually put funding for the VA programs at risk, making it impossible for them to make long-term plans for improvement. This, Congressmen and Senators, is YOUR dishonor. Prove to me that you are worth even a fraction of the sweat and love that Doc Casagrande gave to the veterans he served. Let his legacy be the standard to which we, as veterans, hold you accountable.
I arrived home and opened the door to get out of my car. As I closed the door to my car, I felt the anger blow away in the crisp spring wind. As quickly as the anger was there, it was gone. Blown away by my resolve to honor the man who had made such a huge impact in my life. Stay tuned for the memorial piece, being written now.
This past week has been a whirlwind as I worked to get everything ready for the fundraising campaign to go live. It has been an amazing experience and I have found myself looking at the world from a different perspective. I never realized how fulfilled I would feel as I pushed the envelope to advocate for veterans. I have felt energized and happy, better able to attend to my family, better able to attend to my own needs. I have felt so good this past week that I started to think something must be wrong. Being this happy was alien to me.
And then it hit me. And it hit me HARD. When I was telling my parents about my venture, they were 100% supportive but my mother asked me a very pointed question: "Max, you are overweight. If you are going to be the public face of this organization, you need to look the part." Something so simple. She thought I was going to get upset or feel hurt by her comments.
Nope. Not at all. As a matter of fact, she really made me think. If I am going to fight the stereotype and stigma associated with PTSD, I can't look like a 'sorry-ass dough-boy'. When I sat down and thought about it, I made another realization and it wasn't one I liked. I still hated the guy in the mirror. Despite all of the good I wanted to do, I was still striving to live vicariously through the successes of others.
For the first time, that realization didn't paralyze me. It didn't make me feel less than. It made me disgusted with myself - determined to DO something about it. It was time to Walk the Walk. I have been talking the talk for two years, shying away from holding myself accountable for my inability to take care of myself. I found it was easy to ignore my own deficiencies if I helped other veterans and their loved ones learn to live with PTSD. I can't delude myself anymore. If I am going to be taken seriously, I need to take care of myself and not look like a sloppy 'mess'.
So here's the skinny (pardon the term): I weigh 278.1 pounds. My 'fighting weight' in the army was 234. Today I started living by example. While I have done much to learn to cope with my PTSD, I wasn't able to overcome the feelings of inadequacy to take better care of myself. So no big promises. No grandiose plans. I am going to get in the best shape of my life and I'm going to show you all what grit and determination can do for a veteran with PTSD. Here's how I look now:
Yeah. Doesn't exactly scream "Support My Cause!"
This is the only promise I will make: I will do everything I can to look the part and earn the self-respect I so dearly desire. I WILL WALK THE WALK>>>No update pictures, no stories, no excuses. Just action. I will show you all what I am capable of and take a picture again on April 10th (A few days before the end of my fundraising campaign). All I ask is that you ask yourself. Do I just 'like' comments and say I support a cause or am I willing to walk the walk? Are you willing to spread the word? Are you willing to speak out against the stigmatization our combat veterans with PTSD face? Do you have the ability to donate to worthy causes but don't? What will you do to walk with me?
Due to the doc being sick in the middle of February, I didn't get to attend group CPT for over a month. I was really looking forward to talking about all the good and bad that has happened over that time with the doc and the guys in group. To my complete dismay, some other doc walked into our group and announced that he was covering the group while our regular doc was away.
He didn't even know that our group was a CPT group. He didn't know that our group was current conflict only and had invited a veteran from a different generation to the group. The regulars from my group were absent.
The meeting was a total disaster. The doc wanted to talk to us about all the the techniques he used and promoted them heavily. He pushed Emotional Freedom Technique (from everything I've read about that and 'tapping' makes me want to wonder if he got his license out of a cracker jack box) and some sort of thought interruption therapy. When you are having an intrusive recollection, you verbally shout "STOP!". It's supposed to interrupt the recollections. Then you have the freedom to 'replace' the recollection with a positive memory.
It took every ounce of effort I had not to laugh in his face. Anyone who has had an intrusive recollection knows that they call it 'intrusive' for a reason. It overrides all other cognitive processes. I could see how his therapy could work with obsessive thoughts, but that's not what an intrusive recollection is. He just didn't get us at all and I wanted to scream.
All I know is that they better not plan on fucking up our group by putting this wackadoo, therapist in charge of the group. He didn't even attempt to stay to the treatment type that the group was there to learn. If this is the result of the hiring mandate put out by the VA administration, I think we'd be better off without. It astounds and appalls me that they are allowing pseudoscience into the VA. It's dangerous and has not met even the most basic burden of proof.
For more information, Visit This Website.
As I continue my life with PTSD, I will share my challenges and discoveries on this blog.