Tuesday, April 13, 2010

PTSD on foot

Post-traumatic stress disorder or PTSD is on the rise in our population, and according to the Chicago Tribune, the costs for treatment are escalating. It is a syndrome we believe we are familiar with.

Most narrowly and properly defined, however, it is not applied to flashbacks or stress or mental trouble related to a single incident. It is most properly defined as a disease coming from the stress of war, or a long-lived history of child sexual abuse.  It applies to duration as well as severity of trauma. Many of us say we have it, a little. I've said it myself. It does not compare.

I copied a lot of welcome packets.
I worked for awhile as a volunteer in the Veteran's Hospital, in one town I've lived in. I worked in the mental ward as a clerk-ette and pinch-hitting art therapist. I am not trained to be an art therapist, but they didn't have one, and I do know about art. Furthermore, I am not afraid of crazy people. It was actually fun and/or meaningful to interact with the patients on the ward.

They did not give a damn about me. I understood that. Perfectly. I got yelled at a lot for no reason other than unbounded frustration, unless it was time to go down and buy the snacks. At that point, I was not superfluous. I was the trustee of their desires and their allowances. It was the moment of maximum friendliness and minimum honesty in our relationships. I do not mean the money of course, which I counted back carefully to each and every one.

 There were some vets from World War II and some from Korea. They had a chip on their shoulder, or else an out-sized belief in their ancestry and prosperity. Very poor men would tell me their grandparents used to own the land the VA was standing on, or some such tale, all similar, and all involving riches and past success not quite their own. One ordered me to call his limo, since he was going home. That was my first day. I knew better, but I had to ask anyway. No limo, no discharge, no concierge service on the ward.

The ones I met from Vietnam have settled into homelessness. They come to the VA when the nightmares and the craziness and the bugs in their clothes get to be too much for them. They are not freeloading on the VA system--they are in distress every day. They appear when they know they cannot control themselves or their environment well enough. They are taking themselves off the street for the good of the public.

The public wants them to 'get a job'. Their job is to keep sane, keep that bundle of rags they call a bed, find a way to self-medicate the crap away for just another few hours. The VA gets them off the shit and onto legal drugs, gets them stabilized, and then out they go again.

We have done little or nothing for them. What they have chosen to try doesn't work either, but this is what they have now: a house with no walls or roof, varying degrees of salesmanship or guile, and a limited set of enjoyments, all of which are annoying to the rest of us.

And then there are the convicts and the trouble-seekers. Those come too, to a short-handed ward. They served too.

I will say we had some bright people working the ward. We had a head nurse that was tough as nails with flashes of sweetness. She was a black, stern, sometimes humorous older woman who insisted on decorating for every holiday in the calendar. We also had a low-key guy who had his head on straight and his heart in the right place. He was the go-to guy: he knew how to do the meds, how to play games, how to stay calm and not get lost in the drama. It was easy to see that the job was going to kill him eventually--too many fatty dinners at the VA commissary, too much heartbreak. We also had a stern Amazon in dreads and plastic gloves, washing, washing, washing, the lice out of the clothes. Full of good sense. She and the head nurse could have gone to Iraq and kicked serious ass just on backbone alone. Where they kicked ass was in the VA system. It took a lot of kicking. They never had a full staff in mental health. Ever.

So, the art gig. 
I went down to the V.A. art supply room. The ward is a little like prison, you have to turn in your toothbrush, no vienna sausage cans with razor-sharp lids. No plastic forks: you dump the sausages into a styrofoam bowl and they are eaten as finger food. Down in the V.A. supply room they have craft kits. My personal favorite was the log basket kit. It had one hundred to five hundred short dowel pieces to glue and nail together. Just looking at the kit you knew a. it would not work and b. if you weren't crazy when you started it, you would be by the end. It was one hundred to five hundred weapons, no good on the ward. The other favorite was the moccasin kit. you could make shoes, which might be good for a homeless man. Only it had needles. Can't have that either.

There were spirit catchers with wire (garrote) and there were plaques to make with little bonnet girls and 'have a nice day!' (glue). It was quite discouraging, because it was evident the purchasers and vendors didn't give a shit about the clientele. So I spent my own money. I got magic marker sets, pastels, grown-up art paper to stretch out the VA's faded construction paper, writing paper, envelopes, stamps,  and a couple of card games. Turns out they had cards, and even checkers, but no chess. Limited chess and limited cigarette breaks turned out to be the big down side of leaving the street to come onto the ward. These are both very important items to a full life on the street.

The World War veterans wrote letters to people in orange or purple markers. They were pleased with this project, up to and including asking for the envelope. Getting the envelope was always a sad moment--they rarely had an address to send the letter to. It still counted, because they could talk about their family and reflect on other days. I gave each of them steady encouragement for an hour or two, but it didn't change the isolation, the disconnect, the reality of no address.

The Vietnam vets played checkers, and they were damned good at it too. Their shells were tougher. They laughed. They wouldn't write a letter, but they always wanted an envelope. A few of them drew. Mostly not.

The origami was a bust, almost as bad as the log basket would have been. But everyone loved Miles Davis. 'Kind of Blue' was even worth turning off the television set.

Jazz wasn't everything.
The Iraq vet I remember best sat there, looking at the paper.
At last he asked me, what should I draw?

"Well, you can draw whatever you like." I ran through a few suggestions, "A favorite animal, or whatever you think you can draw to start. Maybe a memory," I told him. "Or even shapes. What do you want to draw?"

He drew a car with flames pouring out of the windows. He was called to talk to a therapist in the middle.

I had met the therapist a few times and thought he was the worst choice imaginable for people wrestling with war and sadness. This therapist would wave a flag over anything and would listen to nothing.  It wasn't even that he was a good American. He was a self-absorbed shit with an agenda. A cloak fits anyone--coated with stars and stripes, it might fool personnel, but never a crazy man. The only thing he had going for him was combat experience--he said--but he remains my personal embodiment of REMF.

That vet left the drawing on the table. He never came back. I still have it.

Maybe he was transferred someplace more helpful for him. Maybe he gave up and booked the hell out of Dodge. He was not tough enough for the street, though. Not any longer. But you do what you must. And that's how I'll finish.

If you are a soldier with PTSD, or depression, you should go to the VA. They can do good things for you. But if you are not satisfied, if you are not getting well, you should go further, journey harder, even into the expensive treatment.  Not getting well is one hundred times more expensive.

If you are a wife, parent, sibling of a man with PTSD, do your damndest to make the best treatment happen. The VA is prepaid, but that doesn't mean it is the answer for everyone, or a full answer for anyone. Your husband, son, brother needs you, and they might need you to pay therapy bills. Do it if you can.

When I am an old lady, using my walker to get down the sidewalk,  if I see an Iraq vet with a stolen grocery cart full of crap, I will remember. I will remember that he needed help and was given a flag, unlimited TV, an envelope he couldn't address, sardines on a styrofoam plate. That the most thought-out procedures were how to get meds and Fritos efficiently delivered. I will remember that between 1965 and 2010 they added better drugs and more subtle jingoism to the repertoire, and that wasn't enough.

Do something now to get yourself back. Ask those who--yes, don't understand it, but are in your life--to help you. Maybe it seems like panhandling, asking for assistance from people who should not be strangers. They will never understand everything, you cannot explain everything, but they can still help you. You can still save yourself.


Slamdunk said...

Thanks for sharing your experiences Ann T. Unfortunately, this problem is something that will not be going away any time soon.

Unknown said...

Its an abomination that the men and now women who sign up to protect and know full well they might be giving the ultimate sacrifice for our Country get nothing less than the BEST, no the ULTIMATE care possible for any ailment post service.

Makes me sick.

Bob G. said...


Sad to see how easily good, decent people who took time to defend our country and it's beliefs can be so readily "disposable".

If we have truly lived, then we all have seen "stuff" over the course OF our lives.
Some good...some bad, and a lot of "in between" along the way.

I believe that PTSD has managed to invade our civilian populace as well, but few (if any) professionsals are forthcoming to admit it, let alone suggest treatment for it.

That would explain much in our society, when it comes to abuse, violence, noise, along with other traumas that follow so many people around like a love-starved puppy.

Acknowledging it's existence in one's life is the first step.
Getting others to believe it not only exists, but is on the rise in America is the challenge.

Damn good post, Ann.

The Bug said...

Made me cry.

Ann T. said...

Dear Slamdunk,
I don't think it is going away either. I don't know much about war, although I have tried--study of first person accounts and photos, art, strategy--and used my imagination and things I know from other places. But it seems to me that war is now conducted within civilian populaces, and this ramps up the stress significantly.

If the military doesn't put some thinkers behind this--I think they should consider psychological attack one of the weapons of the enemy, and thereby create a defense or redress just as they would for a better missile system.

Thanks for writing in,
Ann T.

Ann T. said...

You are right. It is an abomination.

Mostly they need staff, staff, staff, and volunteers, all over the hospitals. They have a million volunteer programs. Some were easier than what I picked. Some were not a good match for me because I do not have the right kind of compassion for that.

We ask a lot of the VA staff. Of course they have civil service 'coasters' too, but the gems were real. But as long as staff is low, you can only cover the basics. Mental health is about time and talking, and there's no good "metric" for that.

It's an effing shame.
Ann T.

Ann T.

Ann T. said...

Dear Bob G.
You raise an interesting point. How many kinds of constant duress are there? What about first responders at home, or victims of crime or even accidents?

It may be that PTSD covers more than the narrow definition, and calling it by some other name is just wrong, when the treatments are the same.

I do know when I got yelled at, "No, i'm not all right! I can't stop thinking about X--" and they'd name a place, but not what they did or felt they had to do, not what they saw or were made to feel.

That may apply to many situations, but for that man yelling at me, it applied to war or perhaps an atrocity.

But we have atrocities in many places, and so your observation is very just. Like you, I don't think mental health is adequately considered in the civilian world, either.

As always,
Ann T.

Ann T. said...

Dear The Bug,
I cried too.
I am going back someday, I am not done with the VA.
Ann T.

The Observer said...

Ann T:
Oh, the VA...
How I loved working there--the fascinating vets, the dedicated staff, the challenges of all kinds medical, surgical and psychiatric...
How I hated working there--the staff politics, the malingering and drug seeking types(thus avoiding the work of really getting help and getting better), the lack of foresight in supplies--almost all hygiene supplies were donated by staff...
I agree 100% about your notes on PTSD. The toughest thing is to ask for help, and keep in pursuit until the goal of being able to function is achieved.
Thanks for the post. It made me simile, and think of my work at "Camp VA".
The Observer

The Observer said...

Smile, fer cryin' out loud, not simile...sheesh, the weather gets nice and all the proof readers take off.

The Observer

Ann T. said...

Dear The Observer,
It is an amazing place. I sometimes wanted to scream w/ frustration and grab people by the hair. Then I wanted to stick around and give others of them every good thing they deserved.

As to similes, I think that was a metaphor, to call it Camp VA, tisk, tisk, tisk.
Not to worry, dear Observer,

Ann T.

meleah rebeccah said...

Oh Ann. Thank you for sharing this story with me. It brought tears to my eyes.

Ann T. said...

Dear Meleah,
The more of us that know what is at stake for our vets, the better for our vets.

I am grateful for your reply,
Ann T.