Here is a news flash that the clinical community just received – People who work in combat zones and other arduous environments are resilient. So, when the operator tells the doctor, family member, corporate executive, or whoever else will listen; “Hey, I am all right here”; they are more or less spot on.

For the past half a decade contractors, soldiers, career international workers and the host of other short and term overseas workers have had to run the “clinical care gauntlet” upon return to their homes after a deployment or extended work contract. The prodding is ever so soft but there nonetheless. Most react negatively. Which is probably the right reaction given two factors. The first is that resilient individuals “bounce back” from the type of challenges and experiences that would floor most people. Returnees learn this fact themselves when they tell the first “you wouldn't believe this” story around the dinner table and are surprised to see mouths agape in dead silence. What most of us encounter on a regular basis is far and away more than most can imagine. But for the resilient...all in a days work.

The second factor resides under the banner of stigma. The commentary might go something like this. “You think I'm crazy don't you?”, says the contractor to the doctor. “No, do you think you're crazy”, he responds. “No, but then again I am used to having doubts”, he offers. “But you have been in such difficult places. Shouldn't you be concerned about that?, asks the doctor who has lived in the same neighborhood for thirty five years. To which the contractor responds, “Doc, if I got a problem I can show you a lot of people I know who are worse.”

Stigma is what you get when you others try and tell you what it is like to be you.

Stigma is best examined in reverse. The issue is not strictly that you, me, or any operative overseas has the potential for some negative physical or emotional trauma...we know that. What we have a problem with is others telling us there is a problem after we have worked so hard to stay focused and competent in our work. It ignores our hard fought battle to achieve and produce at all costs.

So, let's explore the natural resiliency that produces those results. In most research resiliency is measured in seven key areas: health, emotion, finances, relationships, life choices, spirituality, and neurological (if someone previously sustained serious injury). Over the years baselines have been established for international contractors soldiers, and aid workers that take into account their natural ability to rise above challenges. A “ Resiliency Review” is a self-report that provides insight directly to the respondent on these seven key resiliency factors. Knowledge is power. Once an individual rates themselves in these seven areas, finding ways and means of protecting or enhancing his or her natural resiliency profile is a given.

The example I like to use is being resilient financially. Most of us work in combat zones because the money is good. So, if money is a prime motivator, am I meeting my own financial benchmarks while I gut it out, often alone, in far flung places worldwide? Resilient people bounce back but finances can get still cause a ton of heartache. A not uncommon issue that comes with significant wealth in contractor communities are major life decisions that can reduce that wealth dramatically. Sometimes it is a relationship decision, followed by a real estate deal, then some emotional changes, or possible a wholesale shift in how we want to live life. Are these related? Good question. Is it me making these changes or is this part of the a “resiliency surge” that is inexorably moving me along?

The key for resilient people is to have control over their own lives. That's where a self-generated and completely confidential resiliency review can be useful. It puts the contractor in the drivers seat with respect to personal hopes and goals on health, emotional health, finances, personal and professional relationships, and choices made and to make. It also can explore 'spirituality' in light of some of the banal and unflattering things witnessed overseas...providing a guide to a larger peace of mind. In a nutshell, it is a personal blueprint that helps the resilient individual march on. No one else reads it. No one else cares. But, the resilient person is able to use it as a means of structuring (controlling) the complicated factors that drive us to be who we are in the world.

The person who says life is simple ignores the complications of demanding and productive living. Simple living is by and large the path of least resistance. When was the last time you went down that path?

Resiliency is a given for those of you who work in arduous, challenging, and often dangerous environments. That you are specially able through your resilient nature to succeed is a fact. That we can all benefit from learning how to “stay ahead” of things before we have to “bounce back” from them is something we know already.

In an effort to provide a platform for resilient individuals to be able to identify and interpret their own resiliency, MCA Services will be launching “The Combat Zone Resiliency Review” for its client group. Login or send for an invitation at vettrauma.org.

Read More: www.articlesbase.com/.../bouncing-back-8-tips-for-becoming-more-resilient-1069862.html

This is not an observation of great note. Nor will it provide anyone with the wherewithal to withstand the pressures of your lives while engaged in combat, contractor, and other arduous duties worldwide. It is, though, I think humorous.

We were standing in the lobby of the Hilton Hotel in Dar E Salaam, Tanzania. I was present as the United States USAID representative for manpower. With me was the irrepressible Ken Magagula, the Kingdom of Swaziland’s Ministry of Labor chief and erstwhile party animal. We were waiting for the desk staff to put through a phone call to the Deputy Minister for Labor so that we could provide an update with regard to our mission in Tanzania and Kenya the week previous. It was a desperate call.

The week prior I was ensconced in the New Stanley Hotel in Nairobi after meeting with several highly placed Kenyan government representatives…alone. Ken had wandered off to see the sights about fifteen minutes after our arrival and about three hours after being grilled on entry to Kenya by immigration officials. Ken needed to ‘shake off the rust’ after the ordeal and I didn’t blame him one bit. It seems the Kenyan’s were perfectly happy to accept me into their country, traveling on a Kingdom of Swaziland passport, white, and on a mission for the U.S. government. What they had a problem with was Ken Magagula doing the same thing while black.

My one or two questions, one of which was whether I had had a good flight to Kenya, was followed by a flourish of hand and a entry stamp in my passport. For Ken, it started with why Swaziland was determined to suckle on the breast of South Africa economically and wouldn’t it be better if they led counter-insurgency against the apartheid state with Ken at the helm. I didn’t see that I had anything to contribute to Ken’s answers, so I retired to the baggage claim area and waited…for three hours. Evidently, Ken was not skilled in the art of political obfuscation. I noted as I darted away that he seemed determined to take on the Kenyans. I was reminded of this stubbornness as his bag circled the baggage carousel and was finally shifted into a pile ‘for the unclaimed’ next to toilet. Of course, the toilet was ‘under repair’ as was Ken.

This was why Ken needed to get out of the hotel in Kenya so quick and, I am assuming, why he failed to appear for three days. It would be better for my own reputation if I explained that I had called the police after day one and spent a fortune in taxi fares running up and down Nairobi streets. All that was out of the question in the residential sprawl where Ken was last seen ambling into. I attend all our meetings, though, and when Ken finally arrived at the hotel lobby with one shoe, a shirt not his own, and in his underwear, you might say it caused a stir. Evidently the delay was caused by forgetting the name of the hotel we had booked into ...and Campari. Enough said.

So, why the lobby of the Hilton in Dar E Salaam awaiting the phone connect to the Deputy Minister? One word…topishauppa. We were in a country were banks were also ‘under repair’, credit cards were not accepted, and cash was king. Now I digress to tell you that upon entrance to Tanzania we were compelled to convert one hundred U.S. dollars into local Tanzanian shillings, which is physically impossible to carry. Bricks of shilling notes bound by wire filled three large paper bags. During the conversion ordeal I was admonished no less than eleven time to never break the wire. And so we arrived in Kenya where cash – big sums of currency – are king. And we starved.

Apparently, Ken had spent the bulk of cask on tourist activities in Kenya.

And yes, it was good to give the Deputy Minister and update on our progress. At issue for Ken, ever the proud Kangwane warrior, was that this escapade was taking place in a public setting. Admittedly, he was clothed but we were at that moment financially naked. But Ken was prepared for this challenge and executed his plan to perfection. “Your call, Sire, to the Minister, is connected,” announced the desk clerk with a flourish to all and sundry in attendance. Ken, with what can only be described as a regal air, reached for the phone and began to speak in loud siSwati. Greetings, praise names, appropriate homage, invocation of ancestors, and the appropriately phrased compliment to the minister were provided in a ringing and indecipherable dialect. He proceeded to frame our accomplishments in glowing terms adding:

“Na Baghitsi (dear friend), Namenje l’imlungu wami nga’lapha (my white man here) s’wafa l’imali yetfu (has killed our money). Inalo, siyafuna kuhamba laKangwane (we now wish to go home). And then, as if a matter of national importance were next, paused and looked about the room as if highlight his next statement.

Every eye in the lobby was now focused on Ken Magagula. Every ear awaiting some clue as to what would follow next. And he proceeded; Nkosi (Lord), ngiyafuna ku’ (I am requested that you) …topisha’uppa.”

Then the penny dropped. Almost on cue the lobby erupted into laughter as they recognized the international clarion call for more money. To top up, send cash, bail me out, please help now…whatever the language. It all meant that Ken (and his white guy) needed money. “Hey, Mr. Minister, top me up please!” doesn’t have the same royal ring to it but by God, it’s a common thing.

We made it home without the minister’s money. We hid out on the fringe of the Julius Nyrere International Airport, Tanzania and awaited the arrival of the Swazi national airline, the “Lijubanzazele”. Our entire plan was to walk slowly to the fuselage, catch the eye of the pilot whom was know to us, and ask if we could accompany them back sitting in the navigation seats. And it worked.

The moral of the story? Don’t ask a minister for money. Or, when traveling as a team, make sure everyone keeps both their shoes on.

On the African veld where I spent most of my adult life, there are flocks of birds that flit and dive to and fro. Most are innocuous types, unless of course a circle of vultures make more than the casual sweep of your personal space. But one in particular, the “inyoni angiphumuli”, will drive you nuts. Early in the morning, with rooster-like endurance, they call out Eeee-ahhhh, ca ca ca, Eeee-ah ! Then bolt to a different location and call out again. Their name is literally translated “the bird that never rests”. Which reminds me that we live in a world that requires this bird-like kind of productivity out of all of us. Ever notice that we are so accustomed to measuring our performance that we now refer to everything in percentages. “Hey, I’m giving it 100%,” says one guy. Another chimes in; “on this job you have to give it 110%.” Now that’s a figure that drives the math purists crazy. But think about it, where have all these never ending percentages come from? We’ve got non-alcoholic bar graphs, spreadsheets that don’t fly and pie charts that taste like...well, paper! And every guy in America says at least once an argument the phrase; “ninety nine times out of hundred.” Who puts the stats together that make it always 9 out of 10, or 999 out of 1000? The exacting argumentarian (read “management”) will even throw in a decimal point; i.e. 99.999, a figure that leaves little room for any opposing view just because he passed algebra. I am coming around to the opinion that people only view themselves as valuable when they can prove their usefulness. Listen around in the work-a-day world and you’ll hear folks metricalizing on their overall good for the organization. Ever here this one - “Ninety-nine guys out of a hundred would have quit this dump where 20% of the workers do 80% of the work. Sure we got a 3% increase in pay, but my bills are 12% higher since last year. I’m giving 110%, but 50% of that is spent doing useless stuff. ”  Now there’s a guy with an ax to grind and the facts to back it up. The problem is, who is measuring what?  And why are we measuring in the first place? (Forgive me Robbie !) It might be that someone got the dosage all wrong. When we’re born, some fella who works for the government slips into maternity hatchery and injects the little wee lads and lasses with “the work ethic serum.”  The Freedom of Information Act has revealed that the dosage amount was screwed up by computer error as a result of underfunding during the Cold War, but its too late to change. We may not be Stepford worker bees, but we certainly are not members of the Banana Republic siesta team. We work, prove our worth on the basis of sweat and cold hard success, then try to scrounge up enough energy in the waning years of life to steer those big motor homes (with the portable spare vehicle in tow) down the interstate. Work hard, push the envelope from the inside, get a regular rectal check up and - for God’s sake - don’t forget to vote, play with the kids, write a letter home, take a vacation, digest your lunch, workout, beat traffic, correct your slice, drive four hours to fish for one, buy as big a house as you can and then keep it clean, fertilize your lawn then cut it like hell, and always wear your seat belt - even while parked!  My father-in-law always tells me to stop and smell the roses. A point not lost of weary travelers who are in the grip of the barrenness of a busy life. The problem with roses is that 8 out of 10 don’t really smell nice and the one that does has got bee in it. My God, I’ve become that stinking bird -  Eeee-ah, ca ca ca! 

Think of all the plane flights you’ve been on. The noise, frustration, pushing and shoving, line standing, heat, cold, insensitivity and the like can be overwhelming. Many of us huff and puff, a natural reaction where we breath deep to release tension. Or the open-ended bad relationship that causes stress and strain, life circumstances, rising anger and frustration, anxiety…you get the picture.

Mindfulness is, according to this study, a way to gain some control over the circumstances that surround us that we cannot – for whatever reason – change or exclude ourselves from. The study states that we can “practice” how to beef up our brain (brain cortex, actually) in order to become more adept (and younger!) at handling pressure(s). Kabat-Zinn’s 1994 book; “Wherever You Go, There You Are” is a great primer on this topic. His 1990 book; “Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, pain, and Illness” is good as well.

I know…exercise, weight management, relaxation, good eating habits, and regular medical check-ups are my regular mantra. But, what if I couldn’t do a damn thing about all the other stuff and it was clogging my brain? Well, that might be something I ought to be mindful of…even if I didn’t think I had the room for it in a busy life.

Dr. Mike!

Slideshow: Military.com Veterans Day Tribute to All Veterans

We join the rest of the nation on Veterans Day in remembering the sacrifices of America's 25 million veterans and expressing our appreciation for your service. Please watch this tribute to those who served past and present.

http://www.military.com/veterans-day/veterans-day-slideshow.html?ESRC=marine-a.nl

Note: It is my belief that all of you who take it on the chin and work in arduous environments for what everyone hopes is the greater good...are veterans. Thereby deserving our various countries admiration.

Dr. Mike!

Private First Class Mark Siegel set out on his first patrol in Iraq with a bad feeling in the air. The Army road on which he and fellow soldiers in the Fort Lewis–based 4th Stryker Brigade were traveling had two known hot spots for Improvised Explosive Devices. Others on the team had patrolled the road many times before without incident, but they couldn't help worrying that their luck was running out.

Their convoy of four eight-wheel-drive combat vehicles, called strykers, drove through the forestlands of the north, a topography different from the desert that covers much of Iraq. With Siegel riding in the rear of the lead stryker, making sure nobody approached from behind, they warily passed the first IED hot spot. Nothing. As they approached the second, they paused. "We moved forward about an inch and boom," Siegel recalls. As the IED hit, he closed his eyes. "When I opened them, it was all smoky. I looked around and saw fire. I remember hearing someone scream, 'Climb out through the air guard hatch.'" That's the opening at the top of the stryker.

He did and took a breath, reassuring himself that he was alive. The team leader was not so lucky. Siegel had caught a glimpse of him engulfed by flames in the stryker, "burning like a candle." Siegel says he himself suffered a concussion, smoke-inhalation burns, and other injuries. He was eventually diagnosed with post-traumatic stress disorder (PTSD) as well, he says.

Shortly after the incident, the Army transported him back to Fort Lewis, where on May 28 he became one of approximately 20,000 Iraq War veterans so far to receive a Purple Heart.

Less than a month later, Siegel was escorted off the same Army base and instructed to sign a document stipulating that he could not return. He had been kicked out—or in military parlance, "administratively separated"—due to a urinalysis that revealed the presence of cocaine. As a result, he lost a host of benefits he might have otherwise received, including military-provided health care, disability pay, and eligibility for the GI Bill.

Siegel is one of numerous combat veterans being penalized after turning to drugs and alcohol or acting out in other ways. The Army and Navy discharged 3,300 people for drug use alone in the 2007 fiscal year (which ended September 2007) . (The two military branches did not supply figures for how many of those people had served in Iraq or Afghanistan.) Fort Lewis released nearly 200 soldiers for drug use in the first 10 months of the 2008 fiscal year—almost twice the number that it did in 2003, the year the Iraq War began.

The military's approach troubles many people inside and outside the Armed Forces. They maintain that soldiers who are having trouble coping with their wartime experiences—often because of medical conditions like PTSD and traumatic brain injury—are being disciplined rather than helped.

"Nobody's saying [substance-abusing soldiers] should stay in," says Bart Stichman, co-director of the Washington, D.C.–based National Veterans Legal Services Program, which recently started an initiative to aid combat veterans facing misconduct discharges. "The question is: What kind of benefits should they have?" Stichman and others assert that the military should ensure that physically and mentally damaged soldiers are set up with medical care and other assistance.

"If you've honorably served in the war, then we owe you the assistance you need when you come home," adds Steve Robinson, a longtime veterans' activist who currently works for a Colorado-based organization called ONE Freedom that provides training on post-deployment adjustment.

Colby Vokey, a retired lieutenant colonel who until recently supervised the Marine Corps' defense attorneys (kind of like public defenders in the civilian world) along the West Coast, puts it this way: "We send the soldier to Iraq. We break him. We have an obligation, at least, to fix him."

Siegel grew up in New York City. He wrote short stories and poetry and learned to play the flute, saxophone, trumpet, and guitar, among other instruments. After high school, he got a degree in computer networking and security from a vocational school. He then bounced around various tech-support jobs and had a falling-out with his parents. "I wasn't doing anything with my life," he says.

So at 22 he joined the Army. "It felt like I was getting my life back on track," he says.

He made a good impression upon arriving in Iraq in October 2007. "When Mark first got there, he was a good soldier," recalls Shenandoah Reynolds, a 30-year-old sergeant in the 4th Brigade who served alongside Siegel both in Iraq and at Fort Lewis. "He was gung-ho. He did everything right. He showed the proper respect and acted accordingly."

A month later came the stryker explosion. Siegel says he struggled over the next couple of months as he continued his Iraq deployment. "Because I had banged up my knee, it was hard for me to keep up with my duties," he recalls. Plus he was obsessed with the notion that he was going to die. In January the Army transported him for medical care to Landstuhl, Germany, where he was judged sick enough to send home. Back at Fort Lewis, he says he received a diagnosis of TBI and PTSD. (Fort Lewis spokesperson Joseph Piek says he cannot discuss Siegel's medical information for privacy reasons. He did confirm the stryker incident, Siegel's Purple Heart, and details of his military service in Iraq, which Piek described as "honorable.")

Siegel saw a therapist on base once a week, but was still deeply troubled. "My entire body was convulsing and shaking almost daily," he says. And he says he couldn't sleep. Not at all.

By the time he went home to New York on a two-week leave in March, he was exhausted. Finally he fell asleep. "But every time I closed my eyes, the blast kept replaying in my head," he says. He had visions of the enflamed stryker and the team leader he watched burn.

"I'd fall asleep and five minutes later I'd wake up. So I started drinking to see if I could black out without having any dreams. It didn't work out that well. I wasn't able to get drunk. So I figured, hey, if I'm not sleeping, I might as well stay awake." That was another way of avoiding the dreams, he figured.

He turned to an old bad habit: cocaine. He says he had used the drug before joining the Army, but had been clean for a year and a half. The day he got back to Fort Lewis he had a urinalysis, which came up positive.

"I understand that I fucked up," he said a month later by phone. "I got an Article 15 for it, that I have no problem with." An Article 15 refers to an Army regulation that allows commanders to discipline soldiers without a court-martial. Siegel was booted down from a private first class to a private. He lost a month's pay, and for a time his movements were restricted to his barracks and a few other places on base.

Siegel was more upset by the news that he was going to be discharged and by the constant hassling he says he was getting from his superiors. He maintains that they were trying to push him until he snapped in order to build as strong a case as possible for a discharge, a decision that rested with the brigade commander. He claims they reprimanded him for little things, like an athlete's-foot problem he had, and required him to do onerous tasks, such as mow the lawn with a push mower. They also leaned on him, he says, when he hesitated to do things that were hard for him because of his injured knee, like moving furniture. By his own account, he was in return "abrasive and confrontational," and quite possibly wasn't pulling his weight.

After one scrap with a sergeant who yelled at him for disappearing to make phone calls, he says he was ordered to check in at a central desk every hour. That day in May, Siegel, who often seemed morose during several months of conversations, sounded particularly despondent. "It's just getting really difficult," he said.

"Mark was treated like a complete piece of crap," affirms Reynolds. The problem, he says, is that "a lot of people thought Mark was just faking it."

Reynolds knows firsthand how war-time trauma can cripple a man. After two tours in Iraq, a number of near-death experiences (such as stepping on a land mine that broke instead of blowing up), and the loss of many friends—including an entire squad of 14 people whom he had trained with—he finally lost it in a hotel room in Connecticut. He had gone there to visit his wife, which did not go well. He downed 28 Percocets and a quarter-bottle of rum, and got into a fight with the police who came to save him after being alerted by someone Reynolds had called to say goodbye to. He eventually was hospitalized and returned to Fort Lewis, where he also has had a hard time coping. At one time he was so spooked by the noise and the crowds on base, so convinced that somebody was out there waiting to get him, that he says he needed a few drinks in him just to walk around.

Reynolds saw the way Siegel went from being a good soldier in Iraq to one barely functioning. After the stryker explosion, Reynolds bunked next to Siegel. "He was only sleeping one or two hours a day," Reynolds says. "He would just sit there and stare at the ceiling."

Piek, the Fort Lewis spokesperson, won't comment on Siegel's discipline in detail, except to point to an Army policy that mandates the initiation of a "separation" proceeding whenever drug use is discovered. While soldiers can also be kicked out for alcohol abuse and the resulting behavior, the military takes a harsher stance on drugs, citing their illegality.

As Piek notes in a written statement, however, the start of such a procedure "does not automatically equate with actual separation." Commanders are given leeway to decide whether or not to go through with the discharge. He declines to comment on why Siegel's commander decided that a discharge was the right course in this case.

Army policy also requires that soldiers who test positive for drugs be referred to substance-abuse programs on the base. "Every effort is made to help a soldier rehabilitate," says Lt. Col. George Wright, an Army spokesperson based at the Pentagon.

Yet Siegel says he was never referred to the substance-abuse program at Fort Lewis.

"It may not always happen," admits Col. Elspeth Cameron Ritchie, a top psychiatrist for the Army's Medical Department in Falls Church, Virginia. "One of the problems is that we don't have enough drug and alcohol counselors. We're trying to hire more." The Army Substance Abuse Program at Fort Lewis, operating out of the Madigan Army Medical Center on base, employs 17 counselors, according to Madigan spokesperson Sharon Ayala. She says that number is "sufficient," but allows that plans are in the works to hire four more.

Siegel says he didn't particularly want counseling, since he saw his drug use as a momentary relapse. And these programs are "a double-edged sword" for soldiers anyway, notes former Marine defense attorney Vokey. Everything a soldier says about his drug and alcohol habits can be used against him in separation proceedings.

In any case, Siegel got something of a break in the end. There are three types of administrative discharges: honorable, "general under honorable conditions," and "other than honorable." A soldier facing a drug charge can receive the worst of the three, which may result in their being stripped of access to health care from the federal Department of Veterans Affairs (or VA). Siegel received the second type.

But while he retains VA coverage, he lost out on the possibility of military-provided health insurance, which would have allowed him to see ordinary civilian doctors, and which covers not only a soldier (for life), but also his wife and kids. This insurance is generally provided to military personnel who "medically retire." PTSD is grounds for such a retirement. Before the drug charge, Siegel had initiated the evaluation process that determines whether a soldier's condition warrants a medical retirement. When his urinalysis came up positive, however, that process came to a halt and his discharge proceedings began.

Siegel's discharge also means the loss of education benefits under the GI Bill and no possibility of monthly disability payments from the military. That's apart from losing normal retirement benefits, including a pension, that soldiers otherwise receive if they serve 20 years. Mike Colson, a retired Navy commander who coordinates outreach to War-on-Terrorism veterans for the Seattle Vet Center, says he's seen "people 16, 18 years in [the military] losing their benefits" by getting discharged for errant behavior after coming back from Iraq or Afghanistan.

While he sympathizes with their plight, he also understands the military's position, he says. "There are standards of behavior," he says, "and those standards need to be enforced."

Extensive scientific literature, dating back years, points to the relationship between PTSD, substance abuse, and other behavioral problems. Dr. Andrew Saxon, director of the addiction program at VA Puget Sound, points to one 1987 study in The New England Journal of Medicine which found that men with PTSD, including Vietnam veterans, were five times as likely to abuse drugs as others, and nearly twice as likely to be alcoholics. Describing the classic PTSD symptoms, he says those afflicted might have "unpleasant, unbidden memories, they might have nightmares, their heart might start to race, or they might react physiologically and physically to something in the environment like loud noises. You can imagine if you have those symptoms, it's easy to reach for alcohol or obtain other drugs that temporarily help you cope."

Captain Robert Koffman, acting director of psychological health for Navy Medicine, affirms that PTSD often brings with it other medical disorders like substance abuse. "Self-medication is typically what we see," he says.

But the military has not fully figured out what to do with that knowledge. "It is a subject of very active debate," says retired Captain William Nash, a psychiatrist now working as a consultant to the Marine Corps' Defense Centers of Excellence for Psychological Health in Rosslyn, Va. "I think the issues are: Where does one draw the line in terms of responsibility and culpability? To what extent should a history of exposure to combat stress, or a diagnosis of PTSD, be considered mitigation?" Nash notes that "legally, as long as someone is not insane," they're considered responsible for their misdeeds. And, he says, if all combat veterans who misbehave were excused from punishment because of the trauma they've experienced, "it would really take away from all the other soldiers and Marines who went through those stressors and for whatever reason did not get in trouble."

Still, Nash says, "Justice requires that whoever it is making the decision really honestly takes into account all the factors involved." At a minimum, he says, any uncharacteristic behavior should be treated as a red flag that mental-health issues might be involved. He thus successfully urged the Marines to begin screening such individuals for PTSD and other disorders before going through with discharge proceedings. As of May, the Army has adopted a similar policy.

But the Army and Marines left unresolved the critical question of what to do after such a screening. "Whenever you have a medical diagnosis and a disciplinary action, there needs to be a decision made about which way to go forward," says Ritchie, the Army psychiatrist. "The commander makes that final decision. In my opinion, if [the medical diagnosis] is something severe, the case should go to a medical board." That's the process of evaluating soldiers to see if they qualify for a medical retirement.

But Nash points out that a discharge offers one thing to commanders that the medical-retirement process does not: a "way faster" means of getting rid of a troublesome soldier. "Somebody can be out on the street in a week instead of nine months," he says. And as Siegel's experience shows, soldiers are continuing to be discharged even with diagnoses of PTSD in hand.

"I know there's been a lot of progress [in recognizing that combat veterans need help]," says Reynolds, the Fort Lewis sergeant. "But down at the unit level, where the soldiers are," it's as though these troubled soldiers "are being swept under the rug."

The new mental-health screening "doesn't necessarily mean anything," says Vokey. "It doesn't mean the discharge proceeding stops, or they treat you any differently." Adding to his skepticism is his past experience. Marines would come into his office with "these horrific stories," he says. One had a best friend killed before his eyes, another's hand couldn't stop shaking as he talked to attorneys. About a third to a half of the Marines facing discharges had PTSD or some other mental disorder, he estimates.

Those diagnoses and experiences were "pretty much ignored," Vokey says. He would hear arguments from commanders such as "I know PTSD is a problem, but this guy did something wrong." And those were the leaders who believed in PTSD. "Many people, including senior leaders, did not," Vokey says.

Petty Officer Jermie Arnold says he ran up against the nonbelieving kind. As in the Siegel case, Arnold—an Oregon native, 10-year veteran of the Navy, and recipient of a Navy/Marine Corps Achievement Medal—is currently facing a discharge from the military on a drug charge. He's now at the Naval Station San Diego awaiting a hearing.

In early 2003, Arnold and fellow sailors were at Camp Patriot in Kuwait, where, he says, Saddam Hussein would aim missiles. At that time, nobody knew if Iraq had chemical weapons or not. And so sirens would go off warning troops to don their protective masks and suits. At 12:07 one morning, the alarm went off, and Arnold couldn't find his mask. "I'm running everywhere looking for it," he recalls. "Somebody had grabbed mine." And then Arnold could see the sky light up right above him.

Still without his mask, he remembers thinking "I don't know what I'm going to do. I'm going to sit here and die."

He didn't. As he leaned backwards onto somebody else's cot and prepared for the worst, he bumped into a mask, perhaps belonging to the person who took his. He grabbed it and ran to a bunker, where he says he spent the next six hours sweating in 120-degree heat, locked in a suit that made it feel even hotter.

He was safe. But he says that since then, flashbacks of frantically looking for his mask have caused him to wake up in a cold sweat.

Upon his return in the spring of 2003, he started drinking. Each day, he says, "basically I was drinking an entire bottle of Black Velvet. It made the day go better."

One night, after being transferred to the Naval Air Station in Kingsville, Texas, he went to a college party off base and encountered a guy shooting a cap gun. "I was freaking out," he recalls. He left the party and went to a nearby grocery, where he grabbed some shelves leaning against a wall, intending to use them on the guy with the cap gun.

When a police officer on patrol spotted him, Arnold dropped the shelves and started running, according to both his account and Kingsville police records. The reporting officer filed charges of burglary (for stealing the shelves) and evading arrest. (They were eventually dropped for lack of evidence.)

Because of the incident, Arnold says he was called before a disciplinary review board. Arnold says he told the boardmembers that he suspected he had PTSD. It didn't go well, he claims. "They were laughing and joking, telling me I didn't have PTSD, saying I was just trying to get off the charges."

The regional Navy office that covers Kingsville said they could not disclose information about Arnold's disciplinary proceedings for privacy reasons.

His father, Tom Arnold, a former Border Patrol mechanic who lives in the Portland suburbs, wrote every member of Congress he thought could help. One, Oregon Senator Ron Wyden, launched an inquiry with the Navy, according to Tom Towslee, a spokesperson for the Senator. Towslee says the Navy reported back that Arnold had gotten medical treatment.

Not so, according to Arnold. But the Navy did transfer him for a time to a laid-back job at the Escondido Ranch, used by the Navy for bombing practice as well as for recreation for its sailors.

Still, Arnold continued to have problems as he was deployed twice more. Shortly before his third tour, he says he walked into his chief's office and broke down crying. The chief sent him to a Navy counseling center, where he was diagnosed with PTSD, according to Arnold. But soon he was deployed again on the USS Pearl Harbor. After an R&R stop in Thailand, he tested positive for cocaine.

"I think I'll lose all my benefits," he now worries as he awaits his discharge hearing.

The military "should have something to help him," bemoans his father. "They created this problem, then they just want to kick him out."

nshapiro@seattleweekly.com

My eldest sister Donita was always playing mother to her imagined brood of six brothers. Her favorite trick when the parents were gone was hiding vitamin pills inside hotdogs. I am sure she always hoped we’d never notice and thereby achieve what might best be described as stealth health. Which got me to thinking about my sister’s methods for so many of us who work hard, live large, and are important to so many.

Stealth is the action of doing something slowly, quietly, and covertly, in order to avoid detection. Stealth health is slow, quiet, and private actions taken to insure optimum well being. These are actions that help us fine tune not our passion for living as much as the rhythm it beats to. Here are a few stealth actions I have found useful.

Do something big every day. This may seem too large a task but in fact it is probably the easiest for most of us. Big is often synonymous with important or meaningful and for most of us that is what we do for work. Working ten hours a day is big. So is staying at a task in spite of challenges. I have always liked to name, just for myself, what that big accomplishment was at the end of each day. Naming the action I labored to complete gave it an identity that enhanced its value. Knowing I had accomplished made me feel valuable.

Do something small. These are the water cooler moments that provide the spice and ultimately the flavor during busy days. Helping out another. Taking time to talk when you’d prefer to be working or alone. Handling a task that, though small in the grand scheme, is irritating nonetheless and is better put to rest. Writing a letter, a get-well card, or a friendly note or email. Bringing someone a small gift like a snack or cup of coffee for no reason at all. The value of these actions will be known if not greatly appreciated. There are those who might say regarding the doing of something small that “no good deed goes unpunished”. My experience tells me though that these nay sayers are more than likely just cheap with their time, talents, and money.

And finally, do something for you. When I was in graduate school it was thirty minutes with “Perry Mason” on television while eating a hastily prepared lunch. Later it was a quiet coffee, a fifteen minute nap, or a bike or motorcycle ride after work. I once pulled over at a scenic site while racing from one appointment to another and found the most perfect secluded beach. In Afghanistan, I walked a mile to get a latte’ and found a new vitality in what were long and hard commitments. There is “joy in the doing” when we take the time to pay ourselves in small installments. In the act we remind ourselves that we are important…to others and to ourselves.

The only prescription necessary for the above is to remember that if we are important to others, then taking care for ourselves has even greater value.

An Honest Work

A recent trip to Denmark taught me something important about contractors residing and working in combat theaters of operation. You live honest lives. The message came conversely as I watched one person after another in several small Danish coastal villages glide from one day into the next. There are many words used to describe your days, but glide probably is not one of them. And that is where the rubber meets the road in this observation. To engage willingly in a task that by its very nature is both predictable – i.e. DFAC food – and utilitarian demands from contractors a level of honesty almost unheard of anywhere else.

There is not a whole lot of gray in the stark reality of your working life. For example, an honest view of contractor work is there are hardships, which you acknowledge and accept. Relationships are mostly task focused based on an honest appreciation of skill sets, individual capabilities, and trust. Work schedules are fixed and wherein they aren’t sufficient, an honest assessment gets the midnight oil lamp lit and extra hours added into the mix. Acceptance of risks allows for the winnowing out of extraneous non-essential factors, whether they are mission related, personal, or other. Regardless of the relationship with neighboring military personnel, your mindset often replicates the black and white nature of theirs. Again, not so much because you want to but because your honest assessment says it is necessary.

Some of this harsh honesty is an expected part of you work, especially given various remuneration packages. And work for profit is a powerful motivator. That too is an aspect of being honest. Quid pro quo is not a crime. Rather, it is the bedrock of upright and faithful dealing. Honest is as honest does.

I would be remiss (and dishonest) with regard to my own mission if I did not suggest that one additional honest assessment requires our attention…at least from time to time. That being asking the question: Am I different now than when I began?

Why this assessment? Most all of us have a version of the “Danish coastal village” that we hope to return to one day. Using honesty as the best policy, it makes sense to accept one other aspect of combat zones work - the inevitability that it will all wind down one day. And there we’ll be…the most honest person in the room.

Every guy knows one thing for sure. When your loved one starts crying…you lose. Whatever chance you had of making your viewpoint known, or escaping from yet another butt-head move or ill-advised statement that ended when the tears started.

Crying is a mug’s game.

Sure, soft guy in loafers will act like a dime store romance character and weep a bit at the theater when Hollywood pushes the sap button. Kids cry and whine when they fall down. Girls cry all the time for what reason I am not so sure. I swear blind that my baby sister used to practice the act to get her way, but that could just be latent bitterness on my part. My mom, bless her soul, cried when I left for the war zone…every time. And, I have even known some older war veterans who in their last days have succumbed to the temptations to open the spigots over long forgotten memories, dead comrades in arms, and maybe a hint of regret. Like I said…a mug’s game.

The problem is that sometimes we have to play.

It normally starts with a tingle in the upper chest, a catch of breath, and a warm feeling behind the eyeballs. What follows is just plain embarrassing. Crying is very complicated if it befalls you when in the company of others. What I mean by that is that it is pretty bad if you cry in front of your spouse or children. But it is absolutely awful when you play the fool around your mates. Crap! I am pretty sure you cannot ever recover. Trying to pretend there is something in your eye is a weak argument when your chest is heaving and gasping for air. Like I said…horrible.

I cried all by myself the other day. It came on suddenly. This time it was Tom Hank’s fault – the opening scene of “Saving Private Ryan” when he kneels at the graveside of Captain John Miller . There have been others times.

It is funny though, when I am all composed and only slightly self-conscious, I feel more alive. The guys who didn’t come home, the wink-wink-nod-nod at death and suffering, the pessimism, stoic demeanor, and the cold that envelops my emotions takes a brief by noticeable hiatus. I feel better.

Maybe the mug was me and my crying is just another opportunity for me to process through all the complications in my head. I hope so…I don’t mind looking like an ass as long as I am not one.

Turkish Delight is a holiday treat made from starch and sugar, flavored with rosewater and lemon, and an absolute terror on tummy lines. It is also pleasing to the eye, delightfully delicious, and ever so conspiratorially addictive. I think of this treat when remembering the DFAC’s (chow halls) in Iraq and Afghanistan. Bright lights, welcoming windows displaying all sorts of food items, deserts, ice cream, main meals, sandwich lines, special steak and lobster events, salad bars with olives as big as jawbreakers, all the drinks and snacks you can carry. The place resembles a real life cornucopia that I am sure is designed to help relieve us from the pressures of arduous work.

It was always a real joy to enter – with weapon! – the DFAC and get stuck into some eating. Of course, too much “delight” has a cost. Especially if there are stressors in our lives that have the potential to unbalance the delicate system by which we live healthy lives.

Food is a great source of relief besides all the positive social rewards we gain from the activity. In both British and American 21st Century living, eating out is popular as well as convenient and standard for most of us. Even “British tea” had found its niche as a civilized way to share sustenance and conversation. When we are stressed, uncomfortable, working too hard, sick, conflicted on any level, or a combination of all of these the food emporium is a welcome respite.

At issue with the DFAC and all its goodness is that we can – if slightly out of kilter as mentioned above – be over-stimulated by the bright lights and food options. And this over-stimulation can impact how we decide (control) both quantity and type of food we indulge in. As an example, take caloric intake. A nibble here, a dollop there, and a stout main course at one meal, according to recent research, can add up to the total required caloric intake (1350 calories) for the whole day. If we eat two or three more times the math is horrifying. That’s because a single tablespoon of mayonnaise has 100, one hamburger 440, and a small vanilla frosty 155 calories respectively and I haven’t yet started counting the fries.

The second issue is how comfort foods sooth us. And they really work in that capacity. At issue is what has been described as “cortisol toxicity”, when the body for whatever reason begins storing fats and other food attributes under stress as a form of “future defense.” It is preparing for some level of survival – and - might even be assisting us in how we select what foods we eat. It is not uncommon for eating habits to change. Have yours?

One way to find balance (i.e. “rage against the cornucopia?”) is to take back control. Set caloric intake goals. And if necessary, work with a medical nutrition specialist to assist in meeting intake and overall weight and health objectives. When I returned from Iraq I personally lost 26 pounds (12 kilos) by only eating lower calorie foods across the food groups. Never dieted. Never felt hungry. And though I play soccer twice weekly, never hit the gym. What we can learn is how to control the natural urges we get from complicated and often arduous work schedules.

There are virtual medical weight management information that MCA Services would be happy to provide. Remember – MCA Services is a resource for you and your family and supported by donations.

Before you do, consider that there is much at stake. This stuff can prevent hardship that hits DoD Contractors hard…where we live and work. This bulletin seeks to examine WHO you are, WHERE you are and WHAT you are…based on sound research information.

WHO YOU ARE: Individuals who attempt to remain private in spite of living cheek to jowl in close proximity in combat zones worldwide. You are amenable to taking on the challenge of this type of employment. You are focused on that work. You continue in it for good (and often personal) reasons. You recognize that you are part of something greater than yourself. You are fulfilled by freedom and personal autonomy and the opportunity to excel.

WHERE ARE YOU: Admit it, this type of work is not for the faint of heart. Not everyone feels comfortable in a combat zone. Where you are is right in the middle of an industrial society that by its very nature seeks to imprint each member with certain characteristics. In a combat theater of operations, this imprint can have both positive and negative impacts. The good bits tend to nurture personal productivity and performance. The negative impacts tend to retard self-care and may slowly alter the way the brain takes in and reacts to outside stimulation. Note that changes are expected because of where you are. And, that some freedoms and the loss of some autonomy is a fact in any industrial organization.

WHAT YOU ARE: Many combat zone personnel can come off the rails right about here. We all evaluate ourselves, and we are often our own worst secret critics. When the complex arrangements required for success in a combat zone are "sidetracked" – a common event given the fluctuating circumstances –we react. Then, we adjust. And finally, what we become is different over time. When things do NOT go as we planned, or we think we are "swinging in the wind" with respect to our goals and objectives... we take that seriously. Some people panic at this point while others get real quiet. Note: What we are is more often than not determined by what others say we are. A life skill that is vital for good health, welfare and morale is for you to take charge of that process and work hard at accomplishing what is best for you, your success, and your future. Sound obvious? Several recent research articles on our class of contractor rate our potential for traumatic change the highest of all career fields – and – our ability to practice self-care the lowest. What we are might be in danger of change!

PERATO’S 80/20 PRINCIPLE & LIFE THREATENING ACTIONS: 80% of the time things are A-OK. But 20% of the time the crap can hit the fan. In the 20% zone, brain changes noted above can erode a person’s ability to self-protect. We all need to prepare for that 20%! And, be on guard for changes in others. Why? Because the statistics are very clear. People in dynamic circumstances – both before and after - are at risk with respect to suicide. Because of brain changes suicide can become a reasonable option for some. Abnormal? Yes! But if my brain is functioning abnormally, and I encounter difficulty, then life-threatening acts can materialize.

YOU... NOW: You have a reputation for getting things done. Privacy concerns, productivity mandates, focus on results all make “self” and “other” care hard to manage. When there has been a death – or – something like suicide happens in a community, we have learned that the best course of action is to stand down. During this time, reflect on the reality of WHO, WHERE, and WHAT we are. Examine our pressure points. Affirm our commitment to one another. Grive and heal. And frame once again what is vital to us as individuals.

YOU…SUGGESTIONS: (1) Live large when things are going well! (2) Be prepared for the 20% of time when things get tough. (3) Know your confidential resources – vettrauma.org or lifelines.com (4) Invest yourself in your community. (5) Engage your faith traditions if you have them.(6) Learn how to live well.

“Experience is nothing more than the engine that drives adaptation, so it is always important to ask: Adaptation to what? You need to know if your particular experiences has produced the sort of adaptation that will contribute to survival in the particular environment you choose. And when the environment changes, you have to be aware that your own experiences might be inappropriate.” Lawrence Gonzales – “Deep Survival”

Point: Spirituality is one area that is influenced by myriad experiences. Many combat veterans adopt the “no good God” concept, which might even be considered a natural reaction to the horrors of war. Some seeking to survive these trauma(s) – or even be spared the banality of living a joyless and unhappy life – look to spirituality. Gonzales (above) believes that past experience retards our ability to see new perspectives. The changing environment we find ourselves in – aloneness, dissatisfaction with life, need to connect to others – might actually drive us further from spiritual awakening.

Solution: Leave the past behind. Leave old adaptive methods and seek to “survive” by seeing spirituality through a new (transformational) lens.

Suggested Ideas:

€ Look forward not back.
€ Find new ways (lenses) to understand spiritual principles
€ Live spirituality in a new ways

Method: In seeking a new grasp of a meaningful spirituality that will enlighten us, we should consider living – not in the fairways of our lives – but rather on the boundaries. In “Chaos”, James Gleick states that “strange things happen near the boundaries.” In spirituality, strange is a good thing.

Further Discussion Topics:

€ Chaos theory (“Butterfly Effect”)
€ Disorder as a means to spirituality
€ Feelings vs. beliefs
€ Predictable vs. Inexplicable

I went to war as an older person. How old? Old enough to know the difference between real love and lust, searing hate masking jealousy, and petty anger that supplants frustrations and missed opportunities. Oh, and twice as old as everyone else cramming into military transports, sleeping on the cement at BIAP, or trying to hitch a ride on temperamental blackhawks. In a word: ancient!

Ancient people – a.k.a. the experienced and combat zone hardened expert – get to the point when we believe that our age and maturity acts as a buffer to the common reactions and traumas faced by younger people. The “old guys rule” motto is found on T-shirts and hats and in our heads.

In exploring what older people experience when engaged in arduous duty, whether as a military person or a contractor, I found some valuable information about sand piles. A Danish physicist (Per Bak) set up an experiment in the 1980’s that graphically demonstrates, using sand piles, how accidents are part of the maturing process. Bak developed a computer model that replicates sand being added to a pile, much like an hourglass. As the pile grew, it reached a certain height and then began to collapse. The pile didn’t get any shorter, but it didn’t get any higher, either. It was a simple discovery and it tells us much about what we can expect when the sand keeps falling on our heads in placed like Iraq.

What does the sand pile teach us about us? That collapses are an expected part of work and life. As the body of work expands we develop a wider foundation. As we continue to work little collapses (accidents) become the norm. The longer we work, the more accidents we encounter. The more accidents we encounter the more we learn how to survive. And survival means compensation.

Old guys have a gift. We can stand extremes. To handle the demands of arduous living and working, we get very good at rolling with the punches. The problem with this natural reaction to accidents is tolerance. In time, we come not to expect them, believing we have risen above collapses. And that can be our undoing.

Accidents happen…all the time. They are not random, personal, or even arbitrary. Expecting them, knowing that arduous work increases how they impact how we think, work, live and regularly attending to them is the key to longevity. Sand piles in the sand box - how fitting!

**For further reading on this topic, read “Deep Survival” by Lawrence Gonzales and “Complexity” by M. Mitchell Waltrop.

This Veteran’s Day season I had the privilege to be part of five different public observances. I was a speaker at two large universities and two colleges, and sat as a spectator with my two sons at an elementary school in Washington State. Each event made an attempt to represent veterans. Some even succeeded in doing so without waving their proverbial political “Maggie’s drawers”. One speaker started by explaining the difference between Veteran’s Day and Memorial Day, making the point that all of us who survive combat know instinctively: Memorial Day is for heroes. We all know that “heroes” are those who did not return. They are not people who do a job, do something for personal gain, or even complete a difficult task. How can I as a returned veteran compare my experience to the nearly 4000 who have made a supreme sacrifice in Iraq and Afghanistan?

Simply put…we cannot. But we still have a day.

I was surprised to learn that many Vietnam veterans – men and women that we as new combat veterans owe a tremendous debt of gratitude – will go to great lengths to stay away from these observances. In probing this action I further learned that they just do not feel welcome. No doubt, this is the experiential and chemical response ingrained in them as they returned home to an American population divided on the war and her warriors. I sense we, Global War on Terror warriors, are much more fortunate. People care. Organizations reach out. We can get care if we seek it. Vietnam veteran’s fought twice. Once in the jungles of Southeast Asia and again, at home fighting for care and legislation and support favorable to veterans. Their work saved at least one life…mine.

But I digress. Let me get back at the various Veterans’ Day observances and the one that moved me to tears. Sitting through the usual speeches and patriotic songs, the students at Sunnyside Elementary School in Marysville, Washington paused for a moment of silence. I perfunctorily bowed my head. And then the children – some 700 of them – began to sing to the veterans present. Not the shuffling, lumbering, forced singing often heard at school recitals, but loud, emotive, and clear words of praise for all veterans. I was shocked into crying and am sure I embarrassed myself. But it should be noted that these K-5th grade students gave to veterans their all. No holds barred. No discrimination with regard to our type of service, branch, gender, or motivation. Just a resonant multi-voice thank you directed at those who THEY KNOW rate being appreciated.

We might not be heroes. We are, though, veterans. And, we have a day for a lifetime.

I can LIVE with that.

by Joseph Shapiro, NPR

June 27, 2007
Iraq Vet Seeks Out the War's Hidden Wounded

All Things Considered, June 28, 2007 · The first Vet Centers were started almost 30 years ago by Vietnam veterans. The idea was that a veteran with a mental health problem will respond best to another veteran. Today, these storefront mental health clinics are trying to keep up with a new generation of soldiers returning from war.

The Vet Center in Seattle was one of the first to open, in 1979. It runs a therapy session every Tuesday called the Spirituality Group. Men sit in a circle with a Vet Center counselor and talk about how war hardened them and how they struggle now to find the good and joyous things in life.

Lynn Morlan was a 21-year-old Marine lieutenant, leading a platoon during the Tet Offensive in 1968.

"I was in country two days, and my platoon got hit in an ambush. I lost some men and some men wounded," Morlan tells the group. "I knew that day that I was not coming back from Vietnam alive. So I carried that through Vietnam and all of a sudden, miracles of miracles, I came back. I didn't get killed. And then I just continued to live my life that way… I know that death is just right around the corner, just ready to tap me right on the shoulder. So why plan? Why worry about a damn retirement?"

One young veteran in the group, Rob Densmore, sits at the edge of the circle. He flew jets in Afghanistan — the Navy's Prowler, a radar-jamming electronics warplane — but came home in 2004, when he developed life-stopping depression and PTSD.

"I was just unable to make even simple decisions, like if I was hungry or not, " Densmore says.

He's doing better today with help, including group sessions like this one. He prefers coming to the Vet Center because it's a small office suite, with only a half dozen staffers. At Seattle's Veterans Affairs hospital, he feels overwhelmed; it's so big and sprawling that the receptionist at the front desk gives visitors a map and marks their route. And it's hard for Densmore to see so many troubled older veterans, in the lobby and the halls, like ghosts of the future he fears most for himself.

"Just last week, I was at the VA and passed a guy walking down the hall who was a homeless amputee who lives, you know, on the streets below my apartment," Densmore says. "It's a very quick equation to this is who I am, this is my state, this is my lot, and it's not always a good picture that you see on the other side. I get good care at the VA. But you have to be tough sometimes to walk in there and see that."

Welcome Home

It's different at the informal Vet Centers. The first thing you see is a sign above the front door in bold letters that says, "Welcome Home." These signs are a tradition, started because the Vietnam veterans didn't feel welcomed back when they returned from war.

Most Vet Center clients are still Vietnam veterans. Only 17 percent are vets who have returned from Afghanistan and Iraq, but that number is growing. Ron Boxmeyer runs the Seattle Vet Center and says most of the mental health problems are the same — whether the war was Vietnam or Iraq. But there are differences.

"What is really bad about this war is that people are going back three and four times; we had one person who went back five times," Boxmeyer says. "At least in Vietnam, I knew after 12 months I could get the heck out of the Army and I'd never have to go back again. But these people they come home, they go back to work, and re-establish their families and then, bang, they're back again."

There are other differences with the new veterans. There are more women. And more veterans with traumatic brain injuries. These injuries often haven't been diagnosed, but are causing confusion and depression.

Getting Help

Mike Colson is a readjustment counselor at the Vet Center. He was a Navy chaplain in Iraq and Afghanistan, before coming home with his own PTSD. Now he tirelessly counsels troubled veterans and their families. A few Vietnam veterans have brought their sons, recently back from Iraq, into the Vet Center. But Colson also meets clients outside of the center. He regularly catches up with Ole Lindbo at a neighborhood cafe.

Lindbo served at the end of the Vietnam War. The back of his leather jacket reads, "U.S. Army Veteran," and he wears a camouflage skullcap over his long, gray braid. Over coffee, he tells Colson about what he calls "the incident." Several weeks ago, in the family garage, his son Eli, a soldier back from Iraq, started hallucinating that he was under attack.

"He kept saying, 'There's Iraqis around us, they're gonna shoot us. They're gonna shoot us,'" Lindbo says. "For all I know, I could have been an Iraqi to him, and that's why I didn't want to let go of him." Lindbo held onto his son as tightly as he could, as Eli flailed about, lost in a violent flashback.

Therapists at the VA hospital can counsel a veteran. Vet Center therapists can treat their family, too.

Colson helped Eli get immediate treatment at the VA hospital. Since then, Colson and Lindbo meet regularly over coffee.

Last year, a congressional report — and a report from the VA — showed some Vet Centers were struggling to help all the veterans home from Afghanistan and Iraq. Earlier this year, Congress gave funding to open 23 new Vet Centers and hire more staff at the existing 209 centers. But the need keeps growing. More than 1.5 million troops have served in Afghanistan and Iraq, and at least one out of six come home with a potentially serious mental health condition. So far, 51,000 have gone for counseling at a Vet Center.