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Veterans with PTSD

Jenna Babcock, Brett Bonetti, Alicia


Ellingson, Kamrie Fryer, Julia Lytton, Jaimee
Perea, & Elisa Santizo

Overview
Introduction

Background information

VA

Issues and discrepancies

Societal Stigmas
Occupational Roles
within Family
Retrieved from www.dodlive.mil

Book Introduction
PTSD
o Delmer, primary affected
o Christal, secondarily affected

Symptoms
o
o
o
o

Easily agitated by environmental triggers


Suicidal ideation
Isolation from family and community
Difficulty expressing emotions

Father/Daughter Relationship
Purpose of the book
o School writing project

Retrieved from
http://www.amazon.com/Thirty-Days-MyFather-Finding/dp/0757316468

Background Information
Diversity factors
o
o
o
o
o

88.4% of men who served in Vietnam were Caucasian


10.6% were African American
1% other races
170,000 Hispanics served; 3,070 died in Vietnam
Religions:
Protestant: 64.4%
Catholic: 28.9%
Other/none: 6.7%
(Sobering Statistics, n.d.)

Background Information
Sociocultural
o Homecoming

Roughly half of all Veterans returning from Afghanistan and Iraq with PTSD seek
treatment
Rejection of treatment for PTSD at clinics
Oppression of Veterans by U.S. citizens

o Politics:

U.S. occupation in Vietnam highly criticized

o Norms

Validation of trauma survivor vs. rejection/blame


Validation of help seeking vs. stigma/discouragement

After deployment everyone does a Post Deployment Health Assessment, which is a


bunch of Bull Shit and a waste of time and paper. Being in the medical part we had to
assess all Marines and nothing really ever got done, unless you were suicidal.
(RAND Center for Military Health Policy Research, 2008; Sobering Statistics, n.d. ; Vet 2,personal communication, February 13, 2015)

Background Information
Socioeconomic
o 76% of men sent to Vietnam were from lower middle/working class
backgrounds
o Three-fourths had family incomes above the poverty level; 50% were
from middle income backgrounds
o 79% of the men who served in Vietnam had a high school education or
better when they entered the military service
... I originally wanted to pursue firefighting due to the medical
training I received in the military. But being medically retired for
PTSD, the departments think that I am a major liability. It also seems
that people say that they are a veteran friendly employer, but I ended
up not getting hired.
(Vet 2, personal communication, February 13, 2015)

Background Information
Lifestyle choices
o Lack of healthcare resources
o Occupational balance interrupted
o View of faking illness
They arent too impressed with my PTSD. There are too many of us.
Basically the way it works is if you give us any chance to take you off the
list, were going to take you off.
(Vet 3, who received Less than Honorable discharge due to drug use to cope with PTSD).

Population - Societal Stigma


Beliefs: stoic facade, can handle on own
Values: comradery, work ethic, discipline, respect, duty, loyalty, honor,
integrity, personal courage
Roles: leader, selfless service
Customary Practices: group outings/participation, protocol
Yeah, I think theres a stigma associated with it. Even with minor
cases, everyone thinks youre going to snap at any timeNegative
connotation associated with it. Thats why I dont really tell people
Ive been diagnosed.
(Vet 1, personal communication, February 13, 2015)

Occupational Injustice
Health
o Difficult to access

Well-being
o Limited resources
o Lower QOL

Occupational Engagement
o Affected due to PTSD symptoms
(Retrieved from
http://ecps.educ.ubc.ca/files/2013/11/pt
sd-770.jpg)

VA Limitations
Vietnam:
PTSD was not a recognized diagnosis
VA ignored & covered up problems related to Agent Orange
Ron Kovic lead a 19 day hunger strike to protest poor
treatment of Veterans at VA hospitals.

2000s:
Individuals who served but are not considered Veterans
do not receive coverage
Pregnant women are not allowed to receive OB services at VA
PTSD continues to be questioned as a diagnosis

(Retrieved from
www.flordiamemory.
com)

(Ron Kovic Biography, 2015; Howell, 2010; Karr, 2013; La Curan, 2014;
Pearson, 2014; Rouner, 2015; Sisk, 2015 )

Difficulty Accessing Care


Long delays to access care
o Several perish due to delayed treatment
o Falsified records
o Reports of understaffing
o Long wait time
o Problems maintaining regular
appointments

Retrieved from http://www.nameplatesdiv.com/blog/Historyof-Dog-Tags.html

(Zoroya, 2014)

Veteran Opinions
55% of veterans report difficulty accessing care
No veterans reported regional difficulties indicating system-wide flaws
60% of veterans report they do not have confidence in the system
When asked if Vet 2 utilizes the VA he replied,
Thats a big negative to be honest.
The VA Medicine is a death trap especially
if you have PTSD. All they do is pump you
full of pills.
Retrieved from http://www.wallpapervortex.com/ipad-wallpaper20888_flags_eagle_flag.html#.VN-KMPnF-So

(Jones, 2014; Vet 2, personal communication, February 13, 2015)

Attitudes toward Vets


VA Employee Attitudes
o Suspicion of motives
Reinforcement that it pays to be sick
Disability is incentive not to work
Over-reporting symptoms for greater compensation
PTSD is easy to fake
Patients make more money than staff
V-A-cations
o Lack of mental health awareness
Retrieved from
http://ptsdasoldiersperspective.blogspot.com/p/familyand-friends-resources.html
Greater emphasis on illness and injury
(Hanafin, 2010; Sisk, 2015)

Results of Ineffective Care

Since the start of the Afghan and Iraqi conflicts, an estimated 181,000 to 270,000
soldiers are likely to have experienced PTSD.

2012, more active duty U.S. soldiers have committed suicide than were killed in combat

Eddie Ray Routh, shooter of the American Sniper was not admitted despite evident
symptoms and family pleas

I have had 3 friends commit suicide since thanksgiving


...One big secret out there that a lot of people dont know, that of 22 veterans a
day committing suicide, 90% of those veterans are committing suicide because of
the trauma before the trauma.
(RAND Center for Military Health Policy Research, 2008; Baker, 2015; Burns, 2013; Vet 2, personal communication,
February 13, 2015; Vet 3, personal communication, February 24, 2015)

Affected Occupations
DSM V Diagnostic Criteria

Stressor
Intrusion Symptoms
Avoidance
Negative Alterations in Cognition
and Mood (2 requirements)
Alterations in Arousal and
Reactivity (2 requirements)
Duration
Functional Significance
Symptoms not caused by
medication

Functional Significance
Significant symptoms related to
distress or functional impairment
(e.g. social, occupational).

Retrieved from: www.sogoodwill.org

(PTSD, n.d.)

Affected Occupations
Areas of Occupation
Rest and Sleep
Work
o Employment
o Performance
o Participation
Social participation
o Community
o Family
o Friends/Peers

...the suffering associated with combatrelated PTSD extends beyond the signs
and symptoms of the disorder to multiple
domains of functional impairment. The
impairments in physical health and
functioning, role functioning, social
functioning, and emotional well-being
not only reflect diminished quality of life
for individual veterans, but also have
marked and measurable costs to society
through more days spent off work,
unemployment, and interpersonal
violence,
(Zatzick et al, 1997)

The Impact on Family


According to the National
Center for PTSD; Vietnam
Veterans have:
o
o
o
o

Increased Marital
problems
Elevated levels of
violence within the home
& their families
Spouse or partner has
distress
Children have more
behavioral, academic, &
interpersonal problems

Statistics:

It was estimated in 1988 that 900,000 vietnam


veterans spouses & over a million children were
affected by secondary traumatization of their fathers
PTSD

38% of Vietnam veteran marriages failed within six


months of the veteran's return from Southeast Asia

60% of Vietnam Veterans reported marital,


parental, & family adjustment problems

More than of male Vietnam veterans with PTSD


have a child with health problems in the clinically
significant range
(Jordan, Marmar et al. 1992; Cosgrove, Brady, & Peck, 1995)

The Impact on Family


PTSD Effects on Family
& Relationships:
Sympathy
Negative feelings
Anger & guilt/shame
Depression
Avoidance
Health problems
Sleep problems
Drug & alcohol abuse
Interpersonal violence
Caregiver burden

Children:
Fear & worry
Decreased emotional
connection
Unwanted/Unloved
Retrieved from:
publicaffairs.cua.edu

Problems experienced:
Social & behavioral problems
Emotional problems
Secondary Traumatization
Problems continue into adolescence
(National Center for PTSD, 2014)

The Impact on Family


Project Sanctuary: Where Military Families
Reconnect
o Colorado-based non-profit organization
o Addresses the family as a whole
o 6 day therapeutic retreats for military families
(Retrieved from
http://sierraclub.typepad.com

(Project Sanctuary, 2014)

Coping Through Participation


...[Lack of comradery] was the hardest part of leaving the Marine Corps, that was the hardest part
about rejoining society. And that is what Ive had to do to heal myself.
After the weekend and hunting is all over. You see guys have one of the best weekends theyve had
in a long time. Not only did we teach them the art of duck hunting, but there was a lot of peer to
peer counseling going on and guys didnt even know it.
I like to work out a lot and that really helps me reduce my stress. And I like to play guitar, its
another way that helps. I dont know, just relaxing at home is just another way of de-stressing.

Qualitative study with 67 participants in therapeutic fly-fishing program in Utah, themes emerged from
participants journals:

The necessity of camaraderie while undergoing treatment

The benefits from outdoor recreational activity participation

(Vet 3, personal communication, February 24, 2015; Vet 2, personal communication, February 11, 2015; Vet 1, personal
communication, February 13, 2015; Mowatt & Bennett, 2011)

Interview Questions
1) What military branch were you apart of? Which conflict were you apart of?
2) Would you be comfortable sharing what type of PTSD symptoms you deal with most?
3) Are you currently employed? If not, do you feel being a veteran with PTSD has hindered you from
finding a job?
4) Do you have difficulty doing some of the things you used to enjoy doing, prior to your
deployment? How do you interact with your environment currently? Do you avoid certain
places/things?
5) Did your relationship with your family change when you came home from your deployment? In
what ways?
6) Do you feel youve been marginalized/oppressed, or looked at differently, as a veteran with
PTSD?
7) Is the military doing all it should for our soldiers returning from Iraq, Afghanistan and other
areas of heavy fighting? (Treatments etc)
8) Do you utilize support from Veterans Affairs? Do you use other resources for treatment for fear
of the military finding out?
9) How do you reduce stress and does exercise, reduce stress?
10) What alternate therapies could you recommend to use for reducing stress?
11) Has your experience with PTSD motivated you to reach out and help others with this diagnosis?
12) Would you want to return to the country in which you were deployed?

Video Clip
https://www.youtube.com/watch?v=L83DVg6A65w

In-Class Exercise

(Retrieved from www.cmhc.utexas.edu)

References
Baker, P. (2015). Obama signs suicide prevention for veterans act into law. Retrieved from
http://www.nytimes.com/2015/02/13/us/politics/obama-signs-suicide-prevention-for-veterans-act-into-law.html?_r=1
Burns, R. (2013). 2012 military suicides hit a record high of 349. AP:The big story. Retrieved from http://bigstory.ap.org/article/2012-military-suicides-hitrecord-high-349
Cosgrove, L., Brady, M. E., & Peck, P. (1995). PTSD and the family: Secondary traumatization. In D. K. Rhoades, M. R.
Leaveck, & J. C. Hudson (Eds.), The legacy of Vietnam veterans and their families: Survivors of war: catalysts
for change (pp. 38-49). Washington: Agent Orange Class Assistance Program
Department of Veterans Affairs. (2012). Analysis of VA health care utilization among operation
enduring freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND) veterans.
Hanafin, B. (2010). Hostile attitude toward Americas Veterans using the VA is nothing new.
Retrieved from http://www.veteranstoday.com/2010/05/14/hostile-attitude-toward-america%E2%80%99s-veterans-using-the-va-is-nothing-new/
Howell, T. (2010). VA starts paying new agent orange claims. Retrieved from http://militaryadvantage.military.com/2010/11/va-paying-on-new-agent-orangeclaims/
Jordan, B. K., Marmar, C. B., Fairbank, J. A., Schlenger, W. E., Kulka, R. A., Hough, R. L., et al. (1992). Problems in
families of male Vietnam veterans with posttraumatic stress disorder. Journal of Consulting and Clinical
Psychology, 60, 916-926.

References Cont.
Jones, J. (2014). Majority of U.S. veterans say access to VA care difficult. Retrieved from
http://www.gallup.com/poll/172055/majority-veterans-say-access-care-difficult.aspx
Karr, D. (2013). Navy Veterans' organizations suing VA over agent orange exposure during Vietnam War. Retrieved from
http://www.mesothelioma.com/blog/authors/doug/navy-veterans-organizations-suing-va-over-agent-orange-exposure-during-vietnamwar.htm#ixzz3Sasobc00
La Curan, D. (2014). House of lies: Agent orange and the governments policy of cover-up. Retrieved from
http://www.veteransresources.org/2014/05/house-lies-agent-orange-governments-policy-cover/#.VOZGCPnF-So
Project Santuary. (2014). Project sanctuary. Retrieved from http://projectsanctuary.us/
PTSD (n.d.). PTSD: National center for PTSD. Retrieved from http://www.ptsd.va.gov/professional/PTSD-overview/dsm5_criteria_ptsd.as
Mowatt, R.A., Bennett, J. (2011). War narratives: Veteran stores, PTSD effects, and therapeutic fly-fishing. Therapeutic Recreation Journal, 45(4), 286-308
RAND Center for Military Health Policy Research. (2008). Invisible wounds: Mental health and cognitive care needs of Americas
returning
veterans. Retrieved from http://www.rand.org/pubs/monographs/MG720
Ron Kovic Biography. (2015). In Bio. Retrieved from http://www.biography.com/people/ron-kovic-21058843

References Cont.
Rouner, J. (2015). Female service members can go to war but cant give birth in a VA hospital. Retrieved from
http://blogs.houstonpress.com/news/2015/02/female_service_members_cant_give_birth_in_a_va_hospital.php?page=2
Sisk, R. (2015). Wounded warriors treated as slackers at Hood, Bliss, and Brooke. Retrieved from
http://www.military.com/daily-news/2015/02/04/wounded-warriors-treated-as-slackers-at-hood-bliss-and-brooke.html?ESRC=dod.nl
Where Military Families Reconnect. (2014). Project Sanctuary attains BBB accredited charity status. Retrieved from
http://projectsanctuary.us/?pressreleases=project-sanctuary-attains-bbb-accredited-charity-status
Zatzick, D. F., Marmar, C. R., Weiss, D. S., Browner, W. S., Metzler, T. J., Golding, J. M., . . . Wells, K. B. (1997).
Posttraumatic Stress Disorder and functioning and quality of life outcomes in a nationally representative sample of male Vietnam veterans.
American Journal of Psychiatry, 154(12), 1690-1695. doi: 10.1176/ajp.154.12.1690
Zoroya, G. (2014). VA treatment records falsified, probe finds. Retrieved from
http://www.usatoday.com/story/news/nation/2014/05/04/va-healthcare-delays-treatment-phoenix-cheyenne-deaths/8602117/