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.
Rating: 4 out of 5 Stars
Author: Welby O'Brien
Part One: Reaffirm
This first section is laid out as a list of common questions you definitely hear spouses and loved ones asking on a regular basis when they are trying to educate themselves about PTSD and learning how to cope with the PTSD. It also goes into a lot of detail about how to best love a veteran with PTSD. Welby does a great job of answering these questions in a clear and caring way. She doesn't offer expert advice. She offers advice based on her experiences and those of the people she knows who are in the same situation. She uses a very conversational tone that keeps the reading from getting dry and engages the reader. This section of the book is a great tool for folks new to PTSD, vastly experienced with dealing with PTSD, and everything in between. Not all of the questions will apply to everyone. Some of the questions are directed at spouses, some at siblings and parents. Some are even directed at people considering whether they should get into a serious relationship with a veteran with PTSD. The nice thing is that the table of contents lists all of the questions and what pages they are on. It makes this section a very useful reference tool as your situation changes.
The Good: The stories and advice offered are from someone who is speaking to her peers - not as a therapist or expert to her 'pupils'. The tone of her writing engages you respectfully and doesn't assume you are stupid while still explaining the basics better than a 'For Dummies' book.
The Bad: I showed segments of this section to some of the spouses I know and a few were turned off by the way she recommended treating veterans. One even equated it to 'treating my veteran like a puppy'. Her contention is that Welby's choice of wording in some cases made it sound like loved ones should treat their veterans like they are constantly in an emotionally fragile state and in need of a constant 'pat on the head'. While some of this can be accounted for by cynicism from frustrated loved ones, there is an element of truth to what they say. If you treat someone like you expect them to be fragile, it could lead to an unhealthy level of dependency upon this affirmation from loved ones to function day-to-day.
The Unexpected: I was very surprised how much of what she talked about seemed like common sense to me but my wife and I had never actually sat down and talked about. I found myself, as a veteran with PTSD, highlighting passages that I wanted to sit down and discuss openly with my wife. It created a basis for incredibly productive and healthy discussions and cleared up some misapprehensions we both had about each other's behavior and beliefs.
Part Two: Replenish
This section of the book is aimed directly at spouses and people in serious romantic relationships with veterans with PTSD. The whole focus is to underline how important it is to take care of yourself. If you are not taking care of yourself and depleting all of your considerable energies on caring for your veteran, you are doing yourself and your veteran a disservice of epic proportions. If you are exhausted and stressed and burnt out, you can't effectively care for a veteran with PTSD. The basic format is set up as specific situations followed by checklists. The idea is for loved ones to be able to self-evaluate how well they are taking care of themselves and whether they are ignoring their own needs without realizing it or our of habit. Just like Part One, the scenarios and page numbers are listed in the table of contents.
The Good: This section highlights, what I would say, is the most common problem that couples have. Spouses run themselves into the ground taking care their veteran, feeling guilty if the veteran's problems don't come before their own. The veteran watches this behavior and can see the deterioration in well-being, making the veteran feel incredibly guilty that they are such a burden. That this section unabashedly espouses taking care of yourself first...Something that every person in a committed relationship with a veterans with PTSD should constantly be aware of and ACT on.
The Bad: The checklists contain healthy and unhealthy behaviors. If people is burnt out and confused, they may find themselves wondering, "It this a healthy behavior or not?" Granted, most of the unhealthy behaviors are pretty obvious, but it would have been helpful to identify clearly which was which on the checklist.
The Unexpected: It became very obvious from the tone of the writing that this was written to spur deeply honest and unflinching evaluation of behavior and patterns of behavior. The whole tone reminded me a lot of what we, as veterans with PTSD, are taught to do in Cognitive Processing Therapy - identify troublesome behavior and discover the underlying cause. Many of the patterns of behavior exhibited by the spouses of veterans are habitual and not a conscious response to the actual situation. This section works diligently to teach spouses how to self-evaluate their current state of mind, physical health, and the behavior they direct at their veterans.
Part Three: Reflect
This section of the book is a collection of other useful information to help loved ones keep their ultimate goal clearly in front of them: Loving their Veteran. It covers everything from stories, to personal mantras, to advice on forming and facilitating group discussions, prayer, and more. For lack of a better way of putting it - now that you have the tools to love your vet, here's how to effectively put them to use.
The Good: There were a lot of 'Keep It Simple Stupid' (KISS) examples that are easily put into practice and a lot of information that is critical to know if you want to be successful, long term.
The Bad: It seemed kind of disjointed, unorganized. I am not sure why some things were included and why some things weren't. It would make sense to include a useful list of online resources on the major subjects covered in this book, but that was mysteriously missing.
The Unexpected: The Tsunami analogy was apt. It is amazing, once triggered, how quickly our emotions and behavior can overwhelm our loved ones. This segment gives an actionable plan to recognize the pending tsunami and learn to ride the waves, rather than get crushed by them.
All in all, this has been the best and most readable resource for helping loved ones and veterans better understand each other and themselves. Welby O'Brien has done an excellent job ensuring that her advice is clear, concise, actionable, and inclusive. Many other books and online resources that I have seen and read have a tendency to exclude certain parties, whether it be parents, siblings, or unwed partners. There is one overtone that becomes very clear in the course of reading this book: Welby sees having a relationship with God as necessary. While this will be welcomed by the vast majority, this could be a potential turn-off to some readers. The wonderful thing about the way Welby writes is that she fully accepts that not everyone shares her views and invites the reader to take only what they need from her book. The critical thinker will notice that she doesn't specify God as being Christian, Muslim, Jewish, Hindu. Don't be dissuaded by this overtone and lose out on an exceptional resource that will help you have a more fulfilling relationship with your veteran.
Yesterday, I posted my latest blog entry (you can see it here). I had been having a rough few days and I talked about it extensively. I talked about how the Phillip Phillips song, 'Gone, Gone, Gone' is what had gotten me through the moment and allowed me to find peace. As is the usual when I reference someone in my blog entry, I add them to my tweet in the hopes that they see it. Honestly, I didn't think, with how crazy P2's twitter feed is that anyone would even notice my post.
And then it happened. I started getting a lot of traffic from Twitter. People started retweeting my post, favoriting it and reaching out to me to comment on my blog. It was an amazing and overwhelming response. I never thought that so many would connect with my writing. It was an amazing feeling to know that I was able to reach so many and illustrate the human side of what it means to have combat PTSD.
With this in mind, I wanted to thank the fans or 'Philatics' who have demonstrated an amazing capacity for compassion for a stranger. Your passionate comments and support are a testament to the type of music that Phillip Phillips makes - it only draws to highest quality of individual.
Again, thank you all so much for your amazing display of support. I promise, no matter how bad it gets that 'like a drum, my heart won't stop beating'.
Yours in Health and Happiness,
WARNING: The following blog post is very graphic and will disturb some readers. If you have PTSD, this account could trigger you. Despite this, I had to get it out of my head and try to think through what happened.
The silence was deafening, but we all knew what was coming. I don't know if I held my breath for seconds or minutes. Time has ceased to have meaning when they fired on their own troops.
I startled awake and felt the familiar pain of bile burning the back of my throat. As was becoming the norm, I had woken up from the nightmare choking on my own vomit. I scrambled out of bed and ran to the bathroom. I vomited repeatedly into the sink. I dry-heaved for an hour, unable to clear the bile from the back of my throat. When the gag reflex receded, I continued to salivate and spit for another hour. I finally dared to look up and didn't recognize the person staring back at me. My face had a gaunt, almost skeletal quality to it that I hadn't seen before. My eyes were swollen and red, the blood vessels in my eyes inflamed.
"I thought things were getting better"
That's a common thought that runs through my mind every time I start to physically recover from my nightmares. It finally sank in yesterday that the nightmares seemed to be their worst after the deepest and darkest moments of my latest episode have receded far enough for me to see and recognize the insanity that others call 'hope'.
I was too exhausted to sleep after that moment. I somehow didn't let on at work that I had this horrible experience Friday night into Saturday. I was afraid to go to sleep last night and slept fitfully until something woke me up. I had only been in bed for an hour or so, but my heart was racing and I didn't know why. Determined to fight this feeling of complete helplessness, I ran for my iPad, plugged in my earbuds and turned on the Phillip Phillips. Something in one of his songs vibrated through me and I finally felt at peace.
"Gone, Gone, Gone"
I'd listened to this song many times before, but the lyrics never really registered until last night and I knew I had found an anthem that would put my mind at ease and always remind me that I wasn't going through this alone. I had the love of my wife, friend, family, and even strangers to keep my head above water - even when I didn't have the strength to keep myself afloat. So this one's for all of you - You Know Who You Are.
So, it appears that my therapist's advice really sank in. I woke up yesterday with a clear sense of purpose and a vision of where I wanted my life to go. I decided to conserve my energy at work (yeah, still a work in progress) and devote that conserved energy to my advocacy and my family. I started moving things forward and saw results. Here's what's happening right now:
As I said yesterday, it was an eventful day. I look forward to sharing all of this journey with you! Let's make a difference for each other and for the vets we still n
This past Monday, I met with my individual therapist and we talked about how I feel trapped by my current situation: I am not able to make a job change easily because my family depends on my income and health insurance. I can't get to the gym consistently because my work schedule is erratic and I come home from work emotionally spent. I don't have the time I would like to pursue my advocacy endeavors because of my work schedule making it nearly impossible to meet with my colleagues. It has made me feel more and more depressed and more and more demotivated.
When I explained all of this to my therapist, she understood how this could adversely affect me but brought up one point that stuck with me and made me think: It is your choice, whether you realize it or not, to stay in that job. It is also your choice to put all of your emotional energy into your work even though you don't get paid to be emotionally invested in it. She asked me, "What do you think would happen if you chose to save that emotional energy for the other things in your life?"
Why is it the simple things that always seem to be the hardest to change? Being emotionally invested in my work has been ingrained in my since childhood. I told my therapist that and she came back with, "No, that's your job. Advocacy is your work. Put your emotional energy into that and I bet you will feel better and have more energy to find a way to get to the gym and to be there for your family".
It's a foreign idea, but makes a weird kind of sense to me. She followed this up by explaining to me that I have the ability to choose what I devote my energy to. I can't control the fact that I am currently unable to change jobs because of my financial responsibilities. What I CAN control is who benefits from my energies the most - my job or my advocacy for veterans. I have felt trapped because couldn't see any way to take control of the situation and it was causing me to become extremely depressed and unable to see any positive outcomes.
So now comes the hard part. I have to change my behavior - a behavior that has been an integral part of my professional identity since I first started working. I have to learn how to redefine what my work is so that I can devote my emotional energy to my advocacy, my health, and my family. It is definitely not going to be easy but it will be worth the effort.
I was asked to address this issue by folks on the Facebook Page. It is a delicate subject and I wanted to take the time to really think about how I feel about the whole situation, so it took me a few days to write all of this down.
Over the past few years, there has been a very strong push to create an adjunct court system for veterans called the Veterans' Court. Supporters of the concept argue that veterans are not treated equitably by the court system and that the punishments/sentences meted out are much more severe than, in many cases, the crime dictates. They also argue that there are often mitigating circumstances that cause many of these veterans to break the law, PTSD being one of those circumstances. While I agree that veterans aren't currently being treated equitably by the court system, I think that the concept of a separate court system for veterans sets a dangerous and irresponsible precedent. Before punching your computer in anger, let me explain.
Being Singled Out for Stigmatization:
As anyone in the veteran community knows already, veterans with PTSD (and veterans in general) are often stigmatized by the public. It's called the 'Rambo Effect'. The ignorant believe that you and I, as law abiding citizens, are exponentially more likely to go crazy, cause mayhem, and commit mass murder. When you spell it out like that it sounds pretty stupid. If we created a separate court system to address veterans crimes, do you see this stereotype improving or getting worse? How does anyone think that being singled out as different and warranting special treatment helps? For generations, minorities have been getting the short end of the stick in the court system. Do you see any initiatives to create 'Black Court' or 'Latino Court' or 'Gay Court'? All of these minority groups (in this day and age, veterans are an extreme minority) accept, understand and value the court system we have and strive to affect long-term change by changing the system that already exists.
A Crime Is A Crime Is A Crime:
If a veteran with PTSD turns to illicit drugs to numb himself or gets in a heated argument with someone and commits assault and battery, how is this different from anyone else with PTSD doing the same thing? While I understand that, as veterans with PTSD, what we experienced is truly horrible, a bad decision is a bad decision. Don't get me wrong, I am not condemning their actions. I understand how easy it can be to head down that road. The first time I was on prescription pain meds after the PTSD, I almost got hooked. If I would have gone down that road and gotten in trouble for abusing prescription medication or worse, who do I have to blame for that? Me. No one else. Just me. I don't think it's a good idea to create a system that would unintentionally encourage a lack of accountability. I have heard veterans say, "It wasn't me, it's the PTSD", completely deflecting blame for undesirable behavior off on their disorder. Creating this system would encourage this.
So, If Not Veterans' Courts, Then WHAT?
From my experience with vets who have gone through the court system, it seems that veterans get held to a higher standard of conduct than the average citizen. It the curse of honor and duty. Do we not hold ourselves to a higher standard than civilians? If a civilian and a veteran pulled a punk move and hit their respective wives, which one would you be angrier with? Which one would YOU hold to a higher standard? I know I would hold the veteran to a higher standard, fair or not. So, what is the solution?
EDUCATION. Plain and simple. All of these lawyers espousing the creation of the veterans' court could be spending all of that time and effort educating other lawyers (especially public defenders about the issues facing veterans - especially PTSD). If the argument is made that a veteran has a service connected diagnosis of PTSD or related behavioral disorder is not fit to stand trial but should be sentenced to court mandated medical treatment, how many veterans' lives would be irrevocably changed for the better? Veterans are notoriously bad about not keeping to their treatment regimens. I should know.
What I am saying is that veterans with behavioral disorders should be afforded the opportunity to get treatment first, before they are thrown in jail. Jail is a really bad place for someone with untreated combat PTSD, for obvious reasons. That being said, if a veteran IS afforded the opportunity to get medical treatment, is deemed fit and released from care, any further violations of the law should be treated like anyone else.
Now we just need subject matter experts to stand up and educate. We need those same experts to testify at trials. The argument shouldn't be about the severity of the punishment meted out, it should be about whether these veterans are competent to stand trial in the first place. God knows, before I started getting treatment for my PTSD, I sure as hell wasn't.
As I do my best to avoid landmines on this subject, I need to put this disclaimer out there first and foremost:
I am not a doctor. I can only share my experiences with medication for PTSD, dos and do nots. Never stop taking your meds without informing your doctor of that decision first. If you are concerned about what the medications could do to you physiologically, express those concerns with your doc and see what you can do together to mitigate those effects.
OK, now that we have that out of the way, let me take you on a little trip back to 2004 when I first got home. As soon as I got into the VA system, I was put on meds. I was put on trazodone for sleep (the nightmares were nightly for months after I initially got home), Citalopram HBr for mood, and Gabapentin for jitters. I took them religiously for two years. I honestly think that the compassion of my teachers and staying on my cocktail were the only reasons I made it through college.
In March 2006, I met my wife, I made the classic mistake that all properly medicated people make at some point in their treatment. I felt so good, I went off my meds. I stayed off them until December 2007, I think. There may have been little spurts where I took them, but it wasn't consistent. I had graduated from college in May 2007 and the stress of having to find a good paying job was killing me. I found a job at a local bank and without my meds, I went belly up and out the door in six months. I went back to the VA and they put me on my meds again in December 2007. In May 2008, my wife graduated from Massage Therapy school. Somewhere along the way I had stopped taking my meds again. Part of the problem is that my PTSD was really out of control and I was having issues with loss of my sense of the passing of time. My wife would ask if I had taken my pills and I would tell her I had because I really thought I had. My head was a mess.
In June 2008, we moved down to Georgia and things got really bad really fast. I had not access to a VA hospital that I trusted and, therefore, had no meds. We had moved down because there were supposedly a lot of jobs to be had down there. Unfortunately the economy was in full recession mode and there were no jobs to be found. I worked temp work here and there but my wife couldn't practice massage therapy because the state of Georgia never, in six months we were there, sent her a licence. Our finances were at a straining point, my PTSD in full episode (all I did was play Call of Duty 4, 12-16 hours per day). In December 2008, I took a contracting job in the Middle East out of pure desperation. We moved my wife back home to be near family and I went over to Qatar. I lasted about a month without my wife before I had to bring her over. The separation was too much. Keep in mind, I am still off my meds. Shortly after my wife got over there, we moved to Manama, Bahrain. And that's where my PTSD got dangerously bad. Without going into details, I was the worst I had ever been. I was drowning. Out of desperation, my wife put her foot down and we went home in September 2009.
I knew I was screwing everything up and I was determined to get myself straight. I went back to the VA and got put on meds. I started attending group sessions. I got a job at a local grocery store and still work there. I haven't gone off my meds since. It's the only period since I have been home that I have enjoyed a true sense of stability. Over time, the docs augmented my cocktail with Lorazepam (for anxiety), and Wellbutrin (additional mood med). The reason the changes were made was because I was noticing changes in my behavior that I didn't like. The previous meds didn't seem to be working the same as they had been. So the doc evaluated me and changed it up. Brain chemistry changes over time, so there will the potential need to 'tweak' the cocktail.
So what are the lessons to take away from my mistakes?
Now, I can say that meds are not for everyone. Some people will do better with natural alternatives. Some won't benefit from either. No two veterans are alike in their emotional needs. Regardless of what decision you decide to make, I ask that you consider how your potential change in emotional stability and change in demeanor could adversely affect the ones you love. It's not fair to put our loved ones through the emotional meat grinder because we are too proud to admit we actually need our meds/natural alternatives to stay stable.
So, there you have it. That's my lowdown on PTSD and Medication. I encourage you to educate your loved ones on the meds you are taking, including side effects. Having extra eyes looking for disturbing changes in emotional and physical health will help you stay healthier too.
As I continue my life with PTSD, I will share my challenges and discoveries on this blog.