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By Paula J. Caplan, Ph.D. Created Jul 25 2011 - 10:35pm ©2011 by Paula J. Caplan All rights reserved

Sexually assaulted servicewomen labeled mentally ill

Think you'd heard it all? Being sexually assaulted apparently is not enough. The Service Women's Action Network reports that it is receiving reports from women serving in the United States military or attending service academies who, after being sexually assaulted and reporting what happened, are diagnosed almost immediately afterward by military therapists as having personality disorders. [http://groups.yahoo.com/group/GSN/message/40367]

This is not a diagnosis that has the slightest relationship to the assault, certainly is not a label applied with the intention of describing a consequence of being raped. A personality disorder is considered to be a lifelong maladaptive organization of the entire personality, so it would have preceded the assault.

Why does this matter? Let me count the ways. First, it takes the focus off the perpetrator, because the victim who is supposedly mentally ill, and, by applying a personality disorder label, takes the focus off the assault and its consequences, placing it instead on the victim's life way before the time of the attack. Readers of my blog know I am no fan of psychiatric diagnosis in general, but if you want to diagnose an assault victim, how about choosing a label that is connected with the effects of assault, reflecting terror, despair, hypervigilance, hopelessness?

This also matters because, as if being assaulted is not enough to have to bear, now the victim has the added burden of being told she is mentally ill, with all of the shame and fearfulness associated with that, and it makes the attack itself seem so diminished in importance that she may wonder if it really happened or at least if she is over-reacting.

Furthermore, personality disorder diagnoses have been used by the military before now to try to get rid of people it no longer wants. In the same way that family members of someone who reports that a relative sexually assaulted them may try to eject the victim rather than deal with confronting and punishing the perpetrator, so some people with power in the military and in military academies want to do the same.

Finally, applying these diagnoses can be a way to ensure that victims do not receive Veterans Affairs benefits for the care they ask for in order to recover from the emotional effects of the assaults, because whatever they are feeling is alleged to be attributable to their alleged personality disorders rather than to what happened to them in the military.

This is the kind of practice of which few Americans are aware, and its existence is a manifestation of what should properly be called some form of sickness that needs eradication.

©Copyright 2011 Paula J. Caplan                      All rights reserved

Missing money and lack of social support for war veterans

If you are one of those Americans who rests easy, certain that somebody up there in government must be dealing with all those who have experienced the psychological carnage wrought by war, I hope you will read on.

It’s major and deeply troubling news that the Government Accountability Office, often called the federal government’s “watchdog,” found that the Pentagon’s Defense Centers of Excellence, set up to help vets with emotional devastation or with traumatic brain injury after the 2007 scandal about appallingly poor treatment at Walter Reed Army Hospital, is riddled with unexplained financial problems and an unclear mission. The GAO found itself unable to determine even what is happening at DCOE, and the DCOE spokespeople themselves acknowledged the problems.

A report published on Propublica.org [1] included this statement: “Because of unresolved concerns with the reliability of funding and obligations data provided by DOD (Department of Defense), we [the GAO] cannot confirm the accuracy of figures related to DCOE.” It also included the remark that the GAO report “reproduces this disclaimer no fewer than five times.”

This news comes close on the heels of the 9th Circuit Court of Appeals’ order for the VA mental health system to undergo a complete overhaul because of its “shameful” workings and “egregious” delays. [2]

As I’ve pointed out here before, my essays about veterans that appear on my Psychology Today blog receive orders of magnitude fewer hits than my essays about any of the other varied subjects about which I post there. Many Americans believe that they support veterans by putting yellow ribbons on their car bumpers or saying, “Support the troops!” but their support goes no farther. Some cannot think what else to do. Some believe mistakenly that if they are not trained therapists, there is nothing else they should or can do. Some just don’t like to think about anything as unpleasant as war experiences.

But as I discovered some years ago, and as a wealth of excellent psychological research has shown, some important steps in helping veterans begin to heal are taken by any civilian who is willing to listen to a veteran’s story without judging, interpreting, or even asking much of anything except if the vet would like to talk. [3]

Consider this: People who describe themselves as experts about war trauma — which is usually wrongly pathologized as a mental illness called Post-traumatic Stress Disorder rather than as a common, ordinary, understandable, human response to war’s horrors — often express bewilderment about why the signs of suffering often seem to appear some months or even years after the veteran returns home. During the interviews I have done with veterans from all American wars beginning with World War II, I repeatedly learned that those who have the most trouble are often those who have been the most isolated from close, loving relationships with nonjudgmental people. I am not here blaming anyone, certainly not with a broad brush the family members of veterans, who are often (though not always) doing the best they can to be caring and supportive in the face of what are often puzzling, distant, mistrustful, and sometimes violent behavior from the vet. Elsewhere [3] I describe in detail some of the reasons for these kinds of behavior. But the point at the moment is that veterans who struck me as the most isolated, judged, mocked, and rejected were the ones who seemed to have the most trouble moving even a step beyond their trauma.

Today I heard from Dr. Thomas Dikel about some careful research he conducted about war trauma. [4] He and his colleagues found that after the war trauma itself, the next most important predictor — and a strong one — of the continuation of emotional suffering was the absence of deeply caring interpersonal support. Sadly, this important finding, despite fitting well with the ample research showing the importance of social support — or what VA Vet Center (Salem,OR) head Dr. David Collier, a Viet Nam veteran himself and a psychologist, calls the importance of love — is too often ignored.

I hope that everyone who reads this essay will make a commitment to listening to the story of at least one veteran…to listen without judging so that a healing connection has a chance to begin.

[1] http://www.propublica.org/article/gao-raps-pentagon-centers-for-post-traumatic-stress-brain-injuries

[2] http://articles.latimes.com/2011/may/11/local/la-me-0511-veterans-ptsd-20110511

[3] Paula J. Caplan. (2011). When Johnny and Jane Come Marching Home: How All of Us Can Help Veterans. Cambridge, MA: MIT Press (see especially Chapter 6 for simple guidelines about listening to a vet’s story, and see also whenjohnnyandjanecomemarching.weebly.com)

[4] T.N. Dikel, B. Engdahl, & R.Eberly. PTSD in former prisoners of war: Prewar, wartime, and postwar factors.  Journal of Traumatic Stress, Vol, 18, No, /, February 2005, pp, 69-77.

Just published in Atlanta Journal Constitution at http://www.ajc.com/opinion/this-july-fourth-listen-995546.html
By Paula J. Caplan

8:37 p.m. Friday, July 1, 2011

Veterans Administration officials cite rising rates of suicide, incarceration, homelessness and unemployment. Small wonder a U.S. appellate court recently ordered complete overhaul of VA mental health treatment.

For July 4th, every American can immediately ease veterans’ emotional burdens, reducing the terrible isolation of those returning from war with devastating internal conflicts.

The good news: action is simple but remarkably effective. Every civilian can listen to a veteran’s story. Many veterans I’ve interviewed have said, “The night I told my story was my first good night’s sleep since the war.”

Americans are woefully unschooled about war’s lingering effects. Fewer than 1 percent served in the military. Veterans talk little to non-soldiers about war, and few civilians volunteer to listen. Consequently, few of us really understand war’s enduring impact.

The appeals court decision found the VA mental health system “incompetent and plagued by egregious delays.” While veterans await a transformation, the need is urgent to educate ourselves about slow-healing emotional wounds. Suicide rates for service members and veterans continue to spike despite new VA programs. More than 100,000 veterans are homeless on any given night. The most common reason for hospitalization of military personnel remains serious emotional suffering.

The cost of a nationwide “Listen to a Vet” program: practically nothing. Listening also works better and carries fewer risks than psychiatric diagnosis followed by drugging veterans.

It is hard to learn war’s realities when veterans do not want to talk. Many fear if they describe their torment, listeners will “think I’m crazy.” Indeed, clinicians and lay people often conclude that those wrestling with war’s anguish are mentally ill. What is a healthy response to the carnage of war?

Many fear being judged for their actions in war, for failing — as they see it — to show sufficient valor or both. Others fear upsetting relatives by recounting stories of horror, grief, shame, moral conflict and utter despair. Many sense danger in breaking a cultural taboo against speaking of death by reporting wartime encounters.

Why do few civilians ask veterans about their ordeals? Many fear that we cannot handle what they will tell us. We may think they should “move on” with their lives, which we translate into urging them not speak of war. Far too many non-therapists commit two regrettable errors: They believe that professionally trained clinicians can repair war’s emotional carnage (though some can help, there are too many sufferers and too few compassionate listeners), and they believe lay people lack the skills to help. But data show that, even were all the recently hired VA therapists helpful, an order of magnitude more help is needed.

Abundant research shows that social support — not high-powered clinical approaches, but ordinary, compassionate connecting — has enormous healing power. In other cultures, but less so in our own, communities help the traumatized heal by reconnecting them with friends and others.

It’s time to challenge cultural biases against showing heartfelt empathy. Across America, citizens either know or sense that veterans are suffering, often alone and in silence.

Let each civilian talk to a service member or veteran. Tell them that as Americans whose country prosecuted a war they were sent to fight, we take responsibility for hearing what they have gone through and how it affects them, that we wish to understand but not judge. Everyone can seek opportunities to tell them we witness their suffering, we would no doubt have responded the same, and above all, we do not believe they are mentally ill because of the trauma of war.

It is remarkable how this can be done by anyone who cares, whether or not they and the speaker share the same views about politics or war. Listening to veterans helps break down the isolation that is one of the most damaging perils of returning home.

Committing to “waging” peace of mind for those who have served at least as much national energy as goes into war, we bring new meaning on the Fourth of July to what it means to be an American.

Paula J. Caplan, author of “When Johnny and Jane Come Marching Home: How All of Us Can Help Veterans,” is a clinical psychologist, fellow at Harvard’s Kennedy School, and advisor to The Welcome Johnny and Jane Home Fund.