PTSD/Substance Abuse Committee Update January/February 2019

Thomas C. Hall, Ph. D., PTSD/Substance Abuse Committee Chair


On a recent beautiful Midwest afternoon, I attended my PTSD support group at our local VA outpatient facility.

Approximately seventy people attended. The gathering started in the usual way, with people saying hi, finding a seat, awaiting the group leader. As we waited, some of us began talking. As our discussion veered to suicide and suicide prevention, it became clear that part of our motivation was how to make it through the holidays. This was spurred by concerns over a member of the group who died by his own hand just a couple of weeks earlier.

One member of the group was invited to lead the discussion. This happened because there were no VA clinical staffers in the room, just a nurse observer. Where were the VA clinicians? Where was the suicide prevention coordinator?

The 2007 Joshua Omvig Veterans Suicide Prevention Act was supposed to ensure the presence of a suicide prevention coordinator in every VA medical center. Most recently, the VA’s FY2018 budget contained $6.7 million for outreach on suicide prevention.

Yet my support group experience harkens back to the time of rap groups. They were popular among vets when most counselors, therapists, psychiatrists, and psychologists—along with much of the country—were wary of the powder-key Vietnam veteran.

Rap groups may have been around from the first time troops went off to war. Our discovery of this way of processing our experiences happened in the late ’60s and ’70s. This was before PTSD was recognized and included in the Diagnostic and Statistical Manuel used by psychologists and psychiatrists to diagnose veterans afflicted by what was then called “Post-Vietnam Syndrome.”

It seemed that the experiences of returning troops from earlier wars were forgotten. Shell shock? Combat fatigue? Soldier’s heart? The impact of war on the warrior can be traced back to hieroglyphics written on tablets in Egypt around 1900 BCE and to the ancient Greek warriors. The rap groups were what we had, and through them we learned that we were not unique. We were reassured we were not alone. By today’s standards, these groups might seem like something out of the Wild West. The point here is that we were struggling to come home, yet there was nowhere we felt welcome.

A gathering of some seventy veterans is not a therapy group in any sense of the term. At a gathering of this size, where veterans are trying to process concerns about the looming “happy holiday,” a celebration that is known to trigger suicidal ideation—and successful attempts to take one’s life—the presence of a clinician well-versed in the myriad aspects of depression and anxiety, suicide and suicide prevention is a necessity—especially when a brother-in-arms died by his own hand only weeks before.

Where were the VA clinicians?

Leadership at this VA medical center was remiss. They missed the opportunity to assuage the concerns of a vulnerable community at a particularly intense time of year. This group was encouraged to meet at a local VFW, coffee house, or restaurant. But this misses the point.

Veterans want to be—need to be—in a setting with other veterans, with a professional group leader who is part of their health support system. Coping with the mental and emotional tensions of the season, and discussing issues surrounding suicide, are not subjects for quiet conversation in a diner. Leadership at this VA did not have a Plan B if the standard treatments from currently recognized effective treatments such as Eye Movement Desensitization and Reprocessing, Prolonged Exposure Therapy, and Cognitive Processing Therapy did not cover all bases.

So, we are back to the future. That fine Midwest afternoon brought back memories of our experience when we were weary troops just home from the war. We were a group of unruly Vietnam veterans needing help to cope, but that required the presence of an experienced clinician.

But again: Where was that clinician?

If the experience at this local VA is our canary in the coal mine, then we—and the VA—have a bigger issue to confront. Without any assurances to the contrary, more than a few veterans are beginning to ask if the policy directives coming from the VA in Washington, D.C., are intended to move Vietnam veterans out to make room for freshly minted veterans or only allow veterans access to manualized treatments without continuing care to maintain any gains.

More than a few Vietnam vets wonder about the attitude at the highest levels of the VA, some of whom suspect that we older guys come only for the travel money, or because we just don’t want to change. All of this leads to the perception that the VA has returned to letting troubled veterans find their own way through the maze of memory. Do policy makers believe that what helps people get better does not jibe with what is needed by some veterans to manage living with PTSD?

VVA’s PTSD/SA Committee is very concerned when we learn of incidents like this. I ask anyone reading this column to contact us and tell us about your experiences, good or bad, at your local VA medical center. To be clear, the committee is an ardent supporter of the VA and the great good they do for veterans of all ages and eras.

Let us always remember that the VA is as good as it is, in part, because veterans voice their concerns when they are not getting what they need.

Which is exactly what we’re doing now.

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