Some Ideas about the Fort Hood Shooter, PTSD, Vicarious Trauma & Multiple Rotations…. | Print |  E-mail
Monday, 16 November 2009
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Well, as you might imagine, since the Fort Hood shootings, the phones have been ringing off the hook and emails have been pouring in.  People want to know why the Dept. of Defense and the V.A. aren’t using portable, digitized guided imagery in a more systematic way to combat PTSD in our troops, given the research results we’ve been seeing with it.

It’s hard to know where to begin, so I’ll just start with some random thoughts. Hopefully they’ll come across as sequential.

  • First of all, it’s always good to have public discussion about posttraumatic stress and our troops, but I’m not at all sure these particular horrific murders had anything to do with PTSD.

  • I don’t have enough detail to diagnose this guy, but off the top of my head, he’s more likely to be a paranoid schizophrenic under extra pressure from an imminent deployment than somebody suffering from vicarious trauma. 

  • Vicarious trauma is the result of a caregiver’s or reporter’s or bystander’s compassion.  In fact, it’s been called “compassion fatigue”.  People loaded up on too much identification with the suffering of others are the least likely bunch to go around shooting innocents.  Mostly, they suffer and smile less.

  • People with PTS rarely shoot anyone, period, and on the rare occasion that they do, it’s most likely to be themselves.  (Secretary Shinseki has already reported that as many service people from Iraq and Afghanistan have committed suicide as have been killed thus far in these wars – and that’s now over 4,000, folks. Do the math and be horrified.)

  • Although it’s certainly possible that this was part of some radical, extremist, Islamicist, terrorist plot, it’s far more likely (again, given the limited info) that, like most paranoid schizophrenics, this guy is using the content of his religion as part of his psychotic delusional system.  It’s possible that both are true, but that would be highly unusual.

  • If we want to get rid of PTSD, the first thing we need to do is stop the cruel, multiple rotations.  We’re sending some of our service people out on their 8th rotation, people.  Do you know what kind of havoc this wreaks on anyone’s psyche, let alone what it does to their families’?
     
  • We already know from a very decent pile of accruing research that the things that work quickly and efficiently on posttraumatic stress are the image-based, body-based and energy-based interventions - guided imagery, hypnosis, healing touch, biofeedback, EMDR and the like.  This is because PTSD sits in the primitive, survival based parts of the brain, and you need techniques that go straight to those structures to get the job done.

  • The V.A. has to get over its singular love affair with Prolonged Exposure Therapy and start looking for other kinds of therapy as well - methods that don’t create as much distress, that don’t require 12 sessions with a highly trained therapist and that the troops and vets will actually use – like audio self-help, for instance – shown to be their top choice in two separate studies. 

  • The DoD has to stop throwing frantic money at unproven (for combat stress) methods and start seeing what’s actually out there and working reliably for this population of combat-stressed service people. BG Loree K. Sutton MD at the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE) is drowning in proposals for every possible ‘cure-all’ scheme – but we have solid results in multiple studies with imagery downloads from Duke/Durham V.A. Hospital; with imagery and biofeedback from Bethesda Naval Hospital in Maryland; from imagery and Healing Touch from Scripps Hospital in La Jolla.  This is where they need to look, for heavens sake.  


OK, I’ll be back, no doubt with more ranting next week.  Feel free to post your own ideas and reactions to all of this.

All best,



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Comments (21)Add Comment
...
written by Donna, November 16, 2009
Dear Belleruth,
I'm so struck by this... I am wondering if, since the V.A. does not embrace these proven methods,there is some OTHER way to get the materials to the vets and their families without going through the endless frustration of trying to convince the machismo driven sensibilities of our leaders that yes, indeed, "imagination" and "pretending" are powerful tools for healing. As an Early Childhood professional, I am saddened that these innate gifts (others call them skills I guess) are dismissed from a very early age. What a LOSS, as they are the tools MOST likely to help us out of our various crises and mental/emotional/physical/spiritual stuckness. So, it's not surprising that guided imagery is not embraced by the military talking heads...maybe it looks "too easy".... it's not painful enough. It must seem 'mamsy pamsy' to them, and an insult to their strength or power when it comes to managing deep trauma. I am not trying to insult them at all. I think it is very painful for them, and I have great compassion for people who are blocked from trying what might be their best hope. And, I am frustrated when their resistance blocks others from getting what they need.

I'm sure you have heard the expression "You are preaching to the choir"? Well, I was wondering if "the choir" (that's US... your readers) could help somehow? Could WE fund the manufacturing costs of the CDs to be distributed through the VA? It has to be less than the retail cost, and I think we could make a huge dent. It just seems like those of us whose lives have been impacted through the healing power of your work are the ones who are least likely to resist... we already know it works... so we can imagine (because we have learned to allow ourselves to IMAGINE) that there is great hope in this method for our troops. We want to give back, and sticking a yellow ribbon to our cars just won't cut it.

I guess I am asking you to set up a program here so that we, the choir, could donate funds for this? You may have already done this, and if so I missed it and would appreciate being pointed to that spot. If not, I think you would get a response that would help a LOT of people... a lot more than if we wait for this to become "standard issue" in the armed forces. Maybe you could run a quick survey to get an idea of how many would be interested in helping in this way? My guess is if it is offered to schools as a community service fundraiser you might even find more helping hands... not to mention scouting, religious, and community organizations. Oh... and how many of us that have blog sites or other sorts of sites would be more than happy to link our readers to a project like this? It just seems like if we want something done we just have to do it and not wait for the resistant ones to soften... that will come in time but the troops and their families need help now. Just a thought or two.

Thank you for your wonderful work. It has (you have) changed my life. Sometimes I wonder what it must be like for you to know that you have changed, for the better, hundreds of thousands of lives... and to know that people all over the place are falling asleep to the sound of your voice?

Best wishes to you,
Donna
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written by Cynthia S., November 17, 2009
Belleruth,

Thank you for being a true advocate for our nation's troops and for real peace. I encourage you to submit your comments to the New York Times as a letter to the editor. No matter where folks stand re: the wars in Afghanistan and Iraq, they need to understand the real effects on our troops and the economy. The suicide statistics are heartbreaking and that is the real "story" that needs to be on the front page of the New York Times. I hope you will use the Fort Hood tragedy to get this message out.

With all good wishes,

Cynthia S.
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written by Maarten, November 17, 2009
"I don’t have enough detail to diagnose this guy, but off the top of my head..."
I must say that have difficulties with such declarations from somebody whose voice is trusted. It's great that you acknowledge not having sufficient info, but then: why pronounce yourself in this way?

"... he’s more likely to be a paranoid schizophrenic under extra pressure from an imminent deployment than somebody suffering from vicarious trauma."
As a psychiatrist he has treated numbers of retruning vets with PTSD, so why exclude vicarious trauma - exacerbated by an imminent employment (that for years he dreaded, for very inderstandable reasons)?

"People with PTS rarely shoot anyone, period"
elsewhere I found: "at least 122 Iraq Veterans have been charged or convicted of murders since coming home."
Most of us know that people with PTS are vulnerable to substance-abuse. And we all know the violence that this can lead to...
And how to differentiate between a flash-back and an acute psychotic episode? The boundaries are thin, I'd say...

I understand that you want to counteract the idea that people with PTSD are "latent murderers", but can't this be done otherwise?

Having said this, i tremendously appreciate what you're doing; I think that's why I take the trouble to write you, here...

Sincerely,
Maarten



at least 122 Iraq Veterans have been charged or convicted of murders since coming home.
...
written by belleruth, November 17, 2009
Maarten,
Thanks for your comments.

An educated guess should be stated as such, and that's all I've got. But it's the result of 35 years of clinical practice and it's pretty educated, so to my mind, worth stating. But a healthy dose of respect for limited info from the files is a good thing.

As for vicarious trauma, this psychiatrist barely worked. His last few years were in a research job. When he did see patients before that, he averaged something like one a week, because he scrupulously avoided work and colleagues were profoundly uncomfortable referring to him anyway and didn't. He was what we used to call "dead wood". No vicarious trauma there.

I don't know what the general murder rate is among young adult males (average age around 22), but it may come very close to or be greater than the percentage of murders committed by the 1.8 million troops who have come home from the Afghanistan and Iraq theaters. (In fact, Maarten, that number of 122 has to be wrong - it's way too low.)

All best,
BR


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written by Maarten, November 17, 2009
Hi Belleruth, thank your the additional info about this man, that I wasn't aware of.

As a strategy, I wonder if it wouldn't work better if your work is presented as complementary to work actually done, rather than as an alternative? After all, there is so much war already going on, also in the psych. field...

Best to you and all,
Maarten
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written by Elisabeth Pozzi-Thanner, November 17, 2009
Thank you so much, Belleruth, for your clear words. I hope that many people in healing professions - in the military as well as in the outside world - will read this and pass on the wisdom of your text.
I certainly will.
Thank you, Belleruth,
Elisabeth
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written by Tom, November 17, 2009
Fromwhat Iread I got the impression that theFt. Hood shooting was more aroung being aradical islamic so more of a terroist than anything else

So not sure in this case a treat able situtation exist

I practice and deeply beleive in use of meditation-visulaization and all forms of energy work

But would doubt any of this would aply to the Major
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written by Anna , November 17, 2009
Dear Belleruth,

I am adding to Donna's enthusiastic, creative and practical suggestions about actively sharing your tried and tested CD with the veteran population, especially from Fort Hood.

#1/ Is there a someone, or a petition campaign (see http://www.care2.com/causes/ )- website where we can initiate an effective petition signature campaign? See seedsforpeace.org for other possibilities, as well as globalmojo for supporting specific causes with each search click of the computer with funds.

#2/ Civilian therapists are serving on armed forces bases, because the amount of vets who need trauma counseling exceeds the amount of army counselors in service. Is there a list?

#3/ The civilian therapists may be a good direct resource for sharing info about the effectiveness of audio-CD's, specifically the ones that are tried and tested by Belleruth with the veteran population.

#4/ Is there a therapist organization or venue that could support the audio therapeutic option AAMFT, AHHA, NIH/NAACAM, Bravewell (I apologize for all the lack of links, but I am afraid if I move from this page I'll lose it).

#5/ Letters to the editor is great idea: "Tricycle' recently had an article on the first Buddhist army chaplain, the "Networker's" letters and clinician notes are two options as well. I am guessing that the armed forces has a large population from many diverse groups--maybe specifically focusing on these groups would be very welcome in their specific magazines, websites, etc.

I don't doubt that this specific trauma effects others that were civilians on base, families and the general population that serves in the armed forces. For example two populations that I identify closely with are pro-choice and the Jewish community. Both of these communities have been attacked and individuals murdered at home, work, community centers, the Holocaust museum, and houses of worship. Would I want a job as a front desk receptionist at Planned Parenthood or the Jewish Federation in Seattle where a shootings and murder occurred? I would have to think carefully about the perceived and actual risk involved in working on-site for any of the targeted organizations I align with. No doubt the civilian workers there need/deserve healing help as well. Communities feel the shock. For example, after the shooting and murder in Seattle, our synagogue (and other synagogues across the country) discussed and hired security guards.

#6 I have a friend who works as a therapist for the vets, traveling to a variety of army bases. I would like to send her a CD or download (which may be more practical) that she can share with the vets she sees and other civilian therapists on base and off that work with this group, She may be aware who is working with vets on and off the bases.

Thanks too for the clarifying info you shared with Maarteen I didn't know those details

Peace, Anna
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written by Jane Twitmyer, November 17, 2009
Keep it up! Eventually someone with the power to make change will hear!

As a Penn grad ... where the inventor and perpetrator of 'Double Exposure' resides ... I see that the protocol claims to be "evidence based", and I would love to be able to question "as compared to what"?

AND I also see that Rachel Yehuda, the cortisol researcher in New York is working with the Penn group. Rachel verified the LOW, not high, levels of cortisol in long term PTSD patients; what the yogi's used to call "adrenal exhaustion". Since the low levels do not show up for 3 months ... here's a thought ... what if the Double Exposure actually increases the percentage of those exposed to traumatic events who go on to develop long term PTSD? Reliving the worst 4 times a week in full body activation might actually exhaust the adrenals beyond the point of repair!!! YIKES! Just a thought!
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written by Stephanie, November 17, 2009
My mom is involved with an organization that sends care packages to troops. I was wondering if your PTSD CDs would be good to send to those who are currently involved in conflict....or if those are better for when they return. What would be best to send to those who are in Iraq or Afghanistan right now?
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written by CJ, November 17, 2009
Thank you for saying what many of us would like to express but have not found the words or forum to do so!
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written by Belleruth, November 17, 2009
Stephanie,
I'd recommend the Stress Hardiness, Healthful Sleep, Relaxation & Wellness or Relieve Stress over the PTSD imagery for active military. Once home, the PTSD, Grief, Anger & Forgiveness, and others make more sense.
Say, if your mom's organization is interested, we could donate some CDs, and we could also look into setting up a donation option for site visitors to contribute CDs to the troops via her organization. If you want to discuss this further, please email This e-mail address is being protected from spam bots, you need JavaScript enabled to view it and we'll get serious!
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written by Matt Erb, November 17, 2009
Thanks, as always, Belleruth for you comments, experience and expertise. I found this very informative as well as agree with the parts of it that I have experience with.

I am sure you are aware, but some readers may not, that the VA is currently involved in a reasonably well funded study on Dr. Jim Gordon's (Center for Mind-Body Medicine in D.C.) model of mind-body medicine - group skills training groups that openly supports/integrates imagery as one of the included skills. It is centered out of the New Orleans VA. I see this as progress that they are at least open to exploring the model of treatment that you and I both know from experience is what is badly needed to get the root/core/origin of trauma physiology... experiential, sensory based processing that gets a person back into the bodily experience of the present moment and out of the 'mind'.

Best wishes and prayers to all for the healing of stress and trauma in all forms, and...

keep up the great work!

Matt
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written by Sherry DeRosa, November 17, 2009
Belleruth, et al,
I am a long time devoted fan of your work. I agree heartily that getting something going so that those of us who know the value of your CD's can get involved in getting many of them (your recommended list noted in a previous post)to both the currently serving soldiers, vets and the families of all of them. I may have a way to support that as a few years ago, my husband got involved with the Unmet Needs Program through the VFW. We raise money in the month of November at our Burger King restaurants and have expanded our local movement now into BK restaurants in 21 other states. Grants are awarded to meet the needs of the families of our soldiers. 100% of the money raised goes directly to needs such as rent, food, clothing, tires, medical care, etc. The awards are made locally which is part of the beauty of the program as needs are almost immediately met. Distribution of various CD's to the families who are struggling as their loved one serves our country could be an option as There is more than one person at risk when a person is deployed in Iraq or Afghanistan. That family member would also be a direct distributor of the specific tapes for the returning vet. Finding one more way to help so many would be wonderful.
If it sounds possible, we can discuss further, directly with the Executive Director of the VFW Foundation. Contact me if that is something you'd like to explore. This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
Finally, as so many have eloquently stated, thank you for addressing the Ft Hood incident and helping those of us reading the piece strive harder to make a difference for our soldiers.
Blessngs to all,
SD
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written by Stephanie, November 18, 2009
Thanks, Belleruth! I'm passing this info along to my mom. I think your CDs would be very helpful for troops, and I'd love to help get the CDs to those that need them.
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written by Sara, November 18, 2009
Bellatruth, your view on PTSD is really helpful to me as a practitioner using Energy Psychology techniques. With regard to the Fort Hood Shooter I agree with Tom: the most obvious stressors according to the reports is that the perpetrator was drawn in to radical Islam ideology. It is believable that he was fighting an internal battle ---struggling with concepts of morality namely, that of being on the side of serving with the 'enemy' against his Muslim breathern in Afghanistan. The question is, what is there to 'fix' here?
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written by Belleruth, November 18, 2009
Matt,
The V.A. is such a varied and fragmented institution - you'll find the best and the worst care there! It hosts Jim's wonderful work in LA (Jim Gordon took his visionary, multifaceted work with integrative cancer care and transformed it for PTS and it's superb); back in the 90's, the Brecksville V.A. in Ohio launched cutting edge work with imagery rehearsal therapy, sand tray work, guided imagery and journaling (and more) thru Edgardo Padin's and Beverly Donovan's brilliant Transcend Vietnam program, still going on today; Dana Epstein is testing our imagery for sleep disturbance with wounded TBI warriors at the Phoenix V.A... and of course there's all the work that Jennifer Strauss is doing at the Durham V.A... and that's just the tip of the iceberg.

On the other hand, as amazing as these individual efforts are - and what I mentioned is just the tip of the iceberg - as an institution as a whole, it's unwieldy and change-averse. The prolonged exposure advocates have a well-meaning but nay-saying foothold there, excluding even EMDR as an officially sanctioned method. Go figure.

Some time, you might want to read The Best Care Anywhere: Why V.A. Healthcare is Better than Yours by Philip Longman and Timothy Noah - it's a fascinating history of how the V.A. transformed itself within a few years from one of the worst to one of the best healthcare systems.

OK, I'm talking too much. Get carried away on these topics. Thanks for your comment.
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written by Belleruth, November 18, 2009
Looking into Donna's and Anna's suggestions - I'll be back re this. Thanks for sending them.
BR
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written by Kate, November 18, 2009
In response to Anna's question #2, there is an organization www.giveanhour.org that connects therapists, who would like to donate their time, to the troops and their families. They have a great resources page. As far as I could tell Belleruth's guided imagery CD's are not listed. I am not sure how you would get them on the resource list for both the practitioner's and visitors, but it would certainly be a great way to get the word out.
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written by Aimee, November 18, 2009
As a Veteran with PTSD, I was introduced to Belleruth's guided imagery for PTSD, Combating Depression, and Anger & Forgiveness by a chaplain at the Oklahoma City V.A. Hospital, during an in-patient stay. If the chaplain hadn't asked my psychologist if she could introduce imagery to me, I'd have never known the awesome healing it provides. I believe that if more V.A. chaplains embraced guided imagery and lobbied for it's use, more Veterans would benefit.

Thank you very much, Belleruth, for all that you do with imagery.
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written by Matt Erb, November 21, 2009
Thanks for the reading suggestion, I will give it a look, it sounds very interesting.
Matt

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