PTSD - Katrina, Combat Theater Vets, Psychologist Who Developed It Herself

Katrina

The following, Hurricane Katrina Victims' Mental Health Worsens was aired on NPR's Morning Edition on Nov 1st

A new report on the mental health of Hurricane Katrina victims shows patterns in the Gulf Coast that are contrary to post traumatic stress disorder usually seen after major disasters. The mental health of Hurricane Katrina victims is worsening with the drawn out recovery time.

You can listen to a discussion of the report at subject link above.

Now if you follow Dr Kessler's name over to Harvard Medical School you will find this Hurricane Katrina Community Advisory Group this link being the Project Overview of this Advisory Group.

At the top of the page you find a link for Dr Kessler as he testified before the US Senate Commitee on Homeland Security, Post-Catastrophe Crisis: Addressing the Dramatic Need and Scant Availability of Mental Health Care in the Gulf Coast, you'll need to slide the player bar over to the 1hr. 47min. spot into the hearing to listen to Dr Kessler and a few others.

There are a number of side links at the Project Overview page, such as 'Oral Histories', 'Publications', and others.

In the Reports link, on the left of page you find the following:

The Hurricane Katrina Community Advisory Group: Overview of Baseline Results
Katrina Baseline Report: August 25, 2006 (PDF). This is an 108 page report put together by the Advisory Group, I'm not completely sure if this is the report mentioned in the NPR report, but it is the only one published at site.

On page 5, of this PDF report you find this:

Post-traumatic stress reactions
About 15% of survey respondents were estimated to have a serious mental illness
at the time of interview and another 15% were estimated to have a less serious
current mental illness. These are about twice as high as the prevalence estimates
for this population in the years prior to the hurricane.
Despite the higher prevalence of mental illness, suicidal ideation and suicide plans
were not significantly more common in the post-Katrina survey than in surveys
carried out in similar samples in the years prior to the hurricane.
Analysis of survey results suggests that the absence of an increase in suicidality is
linked to a pervasive optimism in the sample regarding the likelihood of being
able to reconstruct their lives.

Post-traumatic personal growth
The optimism noted in the last point is part of a larger pattern of resilience found
throughout the sample. For example, 88.5% of respondents said that their
experiences with the hurricane helped them develop a deeper sense of meaning or
purpose in life; 83.8% said that the hurricane led them to realize that they had
inner strengths that they did not previously know they had; 83.4% reported that
they had a lot of faith in their own abilities to rebuild their lives.
These aspects of what has been referred to in the literature as “post-traumatic
personal growth” cut across the full range of social and demographic variables
assessed in the survey.
It is not clear, though, how stable these beliefs and feelings will be over time,
especially if personal success in rebuilding lives does not keep pace with the high
expectations of respondents. It is conceivable that the low rates of suicidal
ideation, plans, and attempts found in the sample will become much higher if
these positive beliefs and feelings erode.

On page 17 we find this:

Post-traumatic stress reactions
As one might imagine, a substantial proportion of respondents reported having
emotional problems related to their experiences in the hurricane. Our paper published the
same day as this report was posted, which appears in the Bulletin of the World Health
Organization, showed that the proportion of CAG respondents who screened positive for
a clinically significant anxiety or mood disorder at the time of the survey (5-8 months
after the hurricane) was double the number in a comparable survey carried out two years
before the hurricane in the same Census Divisions as the areas affected by the hurricane
(Kessler et al. in press).
We also asked about anxiety reactions associated with traumatic stress reactions
and found that many survey respondents reported experiencing such reactions within the
month of the interview even though the interviews were carried out between four and
seven months after the hurricane. A full one-fourth (25.3%) of survey respondents, for
example, reported having nightmares in the past month about their experiences in the
hurricane. (Table A30) Upsetting thoughts or memories about the hurricane, flood, or
aftermath were reported by 50.5% of all respondents. (Table A31) More than one-third
(37.6%) of all respondents reported being more jumpy or easily startled than usual (Table
A32), while more than half (51.8%) reported being more irritable or angry than usual
(Table A33).

Importantly, distress symptoms were higher in those who lived in New Orleans,
the most affected area. Nightmares were reported by 49.6% of the respondents who were
pre-hurricane residents of New Orleans City, 8.0% of them reporting that these
nightmares occurred most every night and another 7.1% two to four nights a week. A full
one out of every four respondents from New Orleans City reported having these thoughts
just about every day. More than half (52.8%) of those living in New Orleans reported
being more jumpy or easily startled than usual and 79.4% reported being more irritable or
angry than usual.
A question can be raised whether these emotional reactions are indicative of
clinically significant mental disorders or are merely normal reactions that one might
expect of anyone exposed to experiences as stressful as those associated with Hurricane
Katrina. We are still in the midst of carrying out clinical follow-up evaluations of
respondents by mental health professionals to address this question. Preliminary results
suggest that, as one would expect, a minority of the CAG members who reported these
emotional reactions are judged by our clinical interviewers to have significant mental
disorders, while the majority is judged to have normal emotional reactions. Specific
estimates of the prevalence and correlates of clinically significant post-traumatic stress
disorder, though, are not yet available.
( HEAR ORAL HISTORIES ABOUT POST-TRAUMATIC STRESS REACTIONS )

They end page 21 with the following header:

Suicidal ideation, plans, and attempts
As readers of our recent paper in the Bulletin of the World Health Organization
will know (Kessler et al. in press), our analyses of the baseline CAG data in comparison
to data from an earlier survey suggest that the post-traumatic growth documented in the
last section might be protective against suicidal ideation, suicide plans, and suicide
attempts among Katrina survivors with clinically significant anxiety and depression. It is
noteworthy that the indicators of post-traumatic growth were not strongly related to
serious mental illness (SMI) or mild-moderate mental illness (MMI), which means that a
great many Katrina survivors are, understandably, depressed by their loses and anxious
about their uncertain future.
However, the suicidality often associated with these syndromes in the general
population was much lower at the time of the baseline interview among people in the
CAG who were able to develop a sense of new purpose and meaning and inner strength
in the wake of the hurricane. The causal processes underlying this pattern presumably
involve the creation of positive future orientations that provide psychological scaffolding
protecting against the suicidality often associated with extreme distress. Although
processes of this sort have long been discussed in the psychoanalytic literature (Frankl
1959; Heisel and Flett 2004), the current study is, to our knowledge, the first to provide
quantitative evidence regarding such a pattern in an epidemiological sample of a disaster
population.
This is an extremely encouraging finding. However, an implicit caution in the
results also has to be pointed out: that the low suicidality might be temporary, if the
feelings of purpose, meaning, and inner strength reported by so many respondents are
linked to an expectation that the practical problems of living created by the hurricane will soon be solved, and if these expectations are not met as time goes on. One could easily
imagine that this type of situation could lead the positive cognitions we documented to
erode and to be replaced with a sense of hopelessness that, in the presence of the high
levels of estimated mental illness found here, could lead to a substantial increase in
suicidality. The finding of low suicidality, then, should be considered evidence of a shortterm
postponement -- a window of opportunity for the officials who are leading the
recovery efforts -- rather than as a permanent absence of suicidality in this population.

As I stated above, it's a long report of many pages, these were just snippets of the problems developing within the communities who went through Katrina, and they are being exasporated by the almost total lack of Government Policy, of aiding the citizens, in many of the area's of the Gulf Coast especially New Orleans.

Now added to the stress levels and trauma, so long after the devestating destructive hurricane reports are coming out, once again, about survivors living in FEMA trailers and suffering from formaldehyde exposure, such as this report FEMA U-TURN ON TRAILER TESTS

Combat Theater Vets, Psychologist Who Developed It Herself

Also on November 1st the following was aired on NPR's All Things Considered:

Memoir Details Psychologist's Combat Hospital Duty

Heidi Squier Kraft, author of a new memoir called Rule Number Two: Lessons I Learned in a Combat Hospital, served more than seven months as a clinical psychologist at a remote air base in western Iraq.

The book's title is based on two rules of war from the TV show M*A*S*H: (1) that young men die; and (2) that doctors can't change rule No. 1.

Kraft talks with Melissa Block.

You can listen to the interview at above link, Heidi relearned her profession in Psycology by being a War Theater Clinical Psycologist.

This is an excerpt of her book which can be found at the site link and Heidi reads at the beginning of the interview:

Excerpt: 'Rule Number Two'

by Heidi Squier Kraft

In this passage, Dr. Heidi Squier Kraft describes riding in an unarmored convoy between two air bases in western Iraq, just as U.S. Marines were laying siege to the city of Fallujah in April 2004. She recalls a patient she knew as Corporal Dunham, a badly injured Marine whom she helped resuscitate before he was airlifted from her field hospital.

We sped into the night. An ebony sky extended in every direction, and with each passing mile, new stars appeared. Starlight alone illuminated the road. Shuddering in the cold, I pulled my fleece face cover over my mouth and nose. I briefly considered gloves but decided against them when I imagined how slippery the wool would feel next to my pistol. Slippery was not good.

After the first half hour, I allowed myself to lean my head back, focusing on the muscles in my shoulders, which felt like rubber bands under tension. Had it only been twelve hours since that mass casualty? I scrunched my eyes shut, willing the tears to stay inside. Distracted by my trepidation about this convoy, I had not allowed myself time to think about Corporal Dunham. Or about that young lance corporal I had met early in the day as he recovered from surgery on our ward. I remembered the tattoos on his arms. One said USMC. And one, he told me, used to say SEMPER FI. After that day's car bomb had taken out most of his forearm, only the S and the E remained.

I remembered his tears and the way he swiped mercilessly at them. He felt fear. He felt shame that far outweighed the fear. He went on to explain that he had been in Iraq almost two months. This injury would earn him his third Purple Heart. He told me he was afraid his luck was about to run out.

He was ashamed to feel afraid.

I remembered struggling to form the words that would normalize this nineteen-year-old man's experience. And, using a therapeutic technique I made up as I went along, I consciously decided to take another path instead. I told him there was nothing normal about three Purple Hearts in two months. I told him there were no feelings that were usual for people in that situation. I told him he was going home. He laid his head on his pillow and sobbed without making a sound. I sat with him a long time. I thought of my Brian, only seventeen months old. I pictured myself lying in bed when the phone rang in the darkness. I physically experienced that sick, sinking sensation that must invade every mother's heart the moment she hears a shrill ring fracture the night. I thought of that lance corporal's mother. I thought of Corporal Dunham's mother. I bit my lip hard and tasted blood.

The roar of the Humvee's engine changed pitch, whining with the decrease in speed. My eyes flew open and I peered outside. Through tall, leaning shadows I discerned storefront buildings lining the road. Decrepit and broken, they reminded me of a movie set for an old Western. I remembered our Marines calling the Al Anbar province of Iraq "the Wild, Wild West."

Now I knew why.

My driver called back over his shoulder. "We're in Hit," he yelled, easing on the brake. A quiver shot through my chest. The street curved to the right in a half circle around a patch of dirt and a dead tree. The vehicles of our convoy sped up as they rounded the half circle and slowed as they left it. My pulse pounded in my fingertips pressed against the handle of my pistol. And then, maintaining that perfect interval between vehicles, our convoy stopped — in the middle of the highway. Our driver dismounted, telling us in a low voice to stay where we were. I remembered his instructions and turned my chest square to the fabric hatch, ensuring that my body armor faced outward. I rested the barrel of my pistol along the edge of the hole in my door.

I watched the lance corporal. He held his rifle at shoulder level, pointing it at the night, moving it slowly back and forth as he gazed through his goggles. I was glad the blackness in front of my eyes was not in front of his. Our vehicle had stopped beside a small dirt hill, overgrown with desert brush and weeds. Skinny trees peppered the landscape. I squinted past the mound, making out the shadow of a house in the lot behind it, four hundred feet off the road. All the lights were off. A dog barked in the distance. My driver froze, his rifle aimed just left of the hill. Moving only my eyes, I focused on his face, waiting for a move from him. The dog barked again. I heard the distinct crack of a twig under a boot and sucked in my breath. The barrel of my driver's rifle and of the rifles of the other men who stood on the road beside him moved in unison toward the sound.

Oh God, I thought. I cannot believe this is about to happen. I braced myself for an assault of gunfire. Four or five minutes passed in total silence. My lungs burned with every breath. Each swallow fought with my pounding heart for space to move down my throat. My eyes watered in the cold, dry air.

Suddenly the desert night was shattered by a tremendous boom. I ducked, lowering my helmet below the level of my window. In that same moment, I realized the source of the sound. They were Cobras, the Marine Corps' awesome attack helicopters. Their big, beautiful rotor blades chopped the air, flooding the night with thunder as they roared overhead. They flew tight circles over our convoy. Limp with relief, I crumpled at the waist, lowered my weapon to my lap, and rested my helmet on the door.

Our driver got back in the vehicle. The truck in front of us pulled away, and he followed. He yelled back at us, "Well, whoever that was out there, they're gone now." He grinned broadly as he looked upward out the windshield at the Cobras.

The muscles along my neck burned as if they'd been seared by an actual flame. I leaned my head so I could see the stars out the window, feeling the wind blast my face. This time I did not reach for my face warmer. My eyes began to water again, streaking my cheeks with cold tears — one after another, in that perfect interval.

Near the end of the interview Heidi explains her own developing trauma's from her experiances and the help she sought, part of which was in writing the book.

Rule Number Two: Lessons I Learned in a Combat Hospital

She also has a site up for her book, called Rule Number Two that you might want to visit.

There has Finally been a number of reports, and studies, along with many books, such as Ilona Meaghers extremely well researched referance book Moving a Nation to Care: Post-Traumatic Stress Disorder and America's Returning Troops, on Combat PTSD.

Will this Country, as well as the Planet, finally come to terms with not only what happens to many in Theaters of Man Made Wars but also effects, and changes lives, of many who experiance a whole host of devestating traumatic experiances, and how it effects not only them but the societies they live in and in many cases the rest of us!

Combat Theater Veterans - PTSD and Traumatic Brain Injuries

Here are just a few of the recent reports, articles, and studies on PTSD as well as Traumatic Brain Injuries:

Veterans For America Releases Major Report: Trends In Treatment Of America’s Wounded Warriors.

by jamesboyce on Nov 7, 2007

Today, we are proud to release a ground-breaking report on the challenges facing our wounded warriors who are suffering from the “signature wounds” of the wars in Iraq and Afghanistan, traumatic brain injury (TBI) and psychological trauma.

Having visited every single demobilization site in the United States and overseas, Veterans For America investigators found that care for these injuries is significantly lacking and that the decisions made by the military will negatively impact our veterans for the rest of their lives.

DNC: Bush Talks About Veterans Funding in Texas While Threatening to Veto it in DC

War Veterans Receive Poor Treatment for Combat-Induced Mental Illness, Says VFA Study

Tom Harkin: Rising Number Of Homeless Veterans A Disgrace To Our Nation

Stars and Stripes - PTSD and TBI awareness programs launched

Mental health services for returning vets in short supply

Help for soldiers outside Ft. Carson, with Video

One US soldier's father calls it the silent injury. Now Britain's forces centre is braced for an influx of cases

Outpatients move into new digs at Landstuhl

Demand Action For Our Veterans

There are many many more of these trickling out. But who is really paying attention to them, in a Society that seems to be, once again, Apathedic about a Combat Theater, two actually, that sent our Military in to destroy and be destroyed.

This Society gives more credance to it's stars and starlets than it does to those who serve in it's Military, which makes up an extremely small percentage of the whole!

As this Veteran say "Happy Veterans Day, NOT!".

Comments

What I Want To Hear......

Is what should have been heard leading up to the '04 elections, by Everyone running against those who place an (R) after their names, especially those who were already in Congress, "Where was the oversite, investigations, and funding for these new returning Combat Veterans, from Two Theaters of Operations, while your political party held total control over the federal government at a time you were not even asking questions about the Wars you helped Create, Fund, and Rubber Stamped everything the Administration wanted?"!!!!!

If they were sent to fight, they are too few. If they were sent to die, they are too many!

I Also...

Want to Hear and See, from the present Congress as well as those running with a(D)and an (I) after their names, what they are going to give as to Strong Legislation for our Returning Veterans, and All Veterans, Care!

Especially those who voiced None, or Extremely little Support, back in '04, for Senator Kerry and the Attacks by the 'Swifties'!

Being an In-Country 'Nam Navy Vet, though not riding the rivers, I can say Kerry should not have had to fight these turncoats himself. While in any Combat Theaters all jobs are and can be extremely dangerous, riding the rivers on 'Swifts', PBR's, Stabs, Zippos.......... was one of the most dangerous. Sitting ducks with jungle on both sides, that which we didn't use 'Defoliants' to destroy and contaminate!

If they were sent to fight, they are too few. If they were sent to die, they are too many!