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How to talk to a child about a Suicide Attempt in your family

By: Rocky Mountain MIRECC for Suicide Prevention



How to Talk to a Child about a
Suicide Attempt in Your Family

If there has been a recent suicide attempt in your family, this may be one of the toughest experiences you and your children may ever face. It is important to take care of yourself, so that you are better able to care for your child.

This guide is intended to provide you with some of that support, and also share other resources that may be helpful for you now and as your family recovers. The guide is not intended to replace professional mental health advice. In fact, it may be best to use this along with professional support if you or your child is struggling with how to talk about this difficult subject.

Each of the three buttons (preschoolerschool age and teenager) above will take you a page that provides information and ideas specific to the age group. Each page includes sections related to:

  • Why talking about a suicide attempt is important;
  • Ideas about when you should talk about an attempt,
  • Ideas on how much information to share;
  • Ways to support a child (preschoolerschool age and teenager); and,
  • Examples on what to say and how you might say it.

..::NEW VIDEO!::.. How to Talk to a Child about a Suicide Attempt in Your Family

Also, there are videos for each individual age group:

Order the Free Full-Color 24 Page Guide

There is a new 24 page full color booklet that can be ordered for free that combines all age groups. This booklet is currently only available in English but look for a Spanish version soon.

Download the Guide

The full guides can also be downloaded in two different versions:
full color version or a black and white version for easy printing.

There are also English and Spanish quick-versions available. Currently, the Spanish version uses a previous format. Download:

How to talk to a preschooler about a suicide attempt

Cómo hablar con un hijo de 4 a 8 años acerca de un intento de suicidio en la familia

How to talk to a school age child about a suicide attempt

Cómo hablar con un hijo de 9 a 13 años acerca de un intento de suicidio en la familia

How to talk to a teenager about a suicide attempt

Cómo hablar con un hijo de 14 a 18 años acerca de un intento de suicidio en la familia

– See more at:

New program puts military liaisons at mental health centers


CONCORD, N.H. (AP) — Each of New Hampshire’s 10 community mental health centers will have a staff member devoted to helping veterans, military service members and their families connect with other community resources under a first-of-its-kind initiative being launched by the state’s Department of Health and Human Services.

Commissioner Nick Toumpas was joined by state military officials, the directors of VA health centers in New Hampshire and Vermont, and numerous civilian sector partners on Wednesday to describe several initiatives aimed at improving health care and other services for veterans, active military and their families. He said the federal Substance Abuse and Mental Health Services Administration recently confirmed that no other state has created military liaison positions within its entire community mental health system.

“We’re improving access to care and creating new access points, and we’re doing this together with all of you,” Toumpas said. “It’s an exciting time for the state, and it’s really an opportunity for all of us.”

In addition to serving as a point person to direct patients to available resources, each liaison will also take the lead in educating others in the health centers about military culture, said Suellen Griffin, chairwoman of the New Hampshire Community Behavioral Health System.

“We don’t want this to be sort of a sleeping dog, where only one person in the agency knows about it, but rather they keep it alive and well and talk about it, and make sure our folks are confident in being able to treat our veterans that may present themselves to us,” she said.

The mental health centers also are part of a second initiative being formally launched Wednesday called “Ask the Question.” The program, being run by Easter Seals NH, is a statewide campaign to encourage health care providers, social service organizations and others to ask patients and clients if they had served in the military.

“We don’t know who we serve. We’ve never been able to get our hands on it, it’s like sand through your fingers,” Griffin said.

The state is contracting with a Portsmouth-based group called Dare Mighty Things for a third new program to will train health care providers and others in military culture to ensure that providers understand veterans and know where to refer them. Navy veteran Nick Tolentino said having health care providers who asked him about his service before a recent surgery made a big difference in helping him avoid a bad experience in the recovery room. Instead of a violent wake up like he had experienced after a military surgery, he worked with a fellow veteran and staffer atExeter Hospital to ensure a calm experience, he said.

But Tolentino said he hasn’t always disclosed his military service to health care providers for main reason: the stigma. He said he feels shame about what he has seen and done, and guilt over surviving when friends were killed.

“You’re always fighting the stigma,” he said. “You were fighting it over there. You’re fighting it when you come home.”

New Hampshire has the fifth-highest ratio of veterans in the United States, with 115,000 veterans making up nearly 11 percent of the state’s population. But the state does not have an active duty military installation where veterans can easily find support and services, and it is one of a few states without a full-service VA hospital. The VA medical center in Manchester, however, collaborates with its counterpart in White River Junction, Vermont, and the directors of both on Wednesday praised the new programs as further examples of how government, military and civilian groups have worked well together.

Marine on life after severe injury: ‘Beauty is who you are’

By:Scott Stump

Disfigured Marine corporal inspires with his story

A few years ago, Christina Geist was thumbing through a People magazine in a nail salon when she came across a story about an organization helping wounded veterans.

Moved to tears, she rushed home to tell her husband, Willie, about what she had read.

It was the TODAY anchor’s first exposure to Operation Mend at UCLA Medical Center, which provides returning military personnel with severe facial and other medical injuries access to top plastic and reconstructive surgeons. The Geists became active in their support of the organization, beginning an inspiring friendship with U.S. Marine corporal Aaron Mankin, whose life has been transformed by the program.

In 2005, Mankin’s face was badly damaged when his amphibious assault vehicle drove over an improvised explosive device in Iraq. His nose, ears and part of his mouth were badly burned in the blast, which killed four marines and wounded 11 others. In 2007, Mankin became the first patient at Operation Mend, whose surgeons have helped remarkably restore his face. Geist shared Mankin’s story on Monday as part of TODAY’s “Inspired By’’ series where the anchors reveal their own inspirations — and invite viewers to share theirs, via #InspiredBy.

U.S. Marine corporal Aaron Mankin's face has undergone a remarkable transformation thanks to more than 60 surgeries by the surgeons in Operation Mend at UCLA Medical Center. TODAY

U.S. Marine corporal Aaron Mankin’s face has undergone a remarkable transformation in the last eight years thanks to more than 60 surgeries by the surgeons in Operation Mend at UCLA Medical Center.

“A lot of what I have to tell other veterans, and that’s that there’s so much in life you can’t control,’’ Mankin told TODAY. “Life happens to you. But your power resides in the fact that you can choose how you respond to that.”

“He looks fantastic today,’’ Geist said on TODAY Monday. “If you look at the pictures from five years ago or from the very first day when he checked into this program at Operation Mend, you wouldn’t recognize him.”

Mankin has come a long way since seeing the damage to his face for the first time.

Aaron Mankin, before his accident, couldn't look in the mirror after his first surgery. TODAY

Aaron Mankin, before his accident, couldn’t look in the mirror after his first surgery.

“I woke up in the ICU, and there was a mirror in my room that I willingly ignored for weeks,’’ Mankin said. “When I finally got the courage, I cried for the longest time. It’s such a disconnect looking at yourself and you expect to see someone that resembles you, and it was a stranger staring back at me, and it was a lot to deal with.”

“The first time I ever saw Aaron Mankin was in a photograph projected up on a screen, and your heart sank and there was a feeling of horror, almost,’’ Geist said.

Mankin has undergone more than 60 surgeries in nearly nine years of recovery.

“Aaron had a lot of unique challenges because of the nature of his injuries, (and) how badly he was burned,’’ Dr. Chris Crisera, Mankin’s surgeon, told TODAY.

Geist recalled the emotional day when they first met face-to-face.

“When we saw each other, it wasn’t a handshake,’’ Geist said. “It was a hug right away. And that’s the kind of guy he is.”

Mankin is also a dedicated father who looks to impress upon his children that what you are inside is what counts the most.

“Beauty is who you are,’’ Mankin said. “It’s not the way you look. That’s important for my kids to learn. Just the way they look at me makes me feel special.

“My children don’t know me any differently,’’ Mankin told Matt Lauer. “I’ve always been this way and they see me getting better through the years. I feel like they had a misunderstanding what doctors do because every time I go see them I come back looking a lot worse than I did. Just seeing that healing process and people reaching out to me, they’re a part of that.”

Mankin has since become a compelling public speaker for Operation Mend, sharing his inspiring journey with others.

“The fact that that’s part of my life now, that I just get to be myself and people want to say thank you, and however that manifests itself, shaking my hand or hugging my neck or buying me a beer or fixing my face, they just want to serve or volunteer like I did,’’ he told Lauer. “It’s a feeling that you can’t…it’s hard to express.”

“We are so honored just to know these guys and to help in some small way because of the sacrifice they’ve given to this country,’’ Geist said. “This is literally the very least we can do, and there is more help needed.’’

Mankin regularly works to help other injured veterans.

“It’s a great responsibility,’’ he said. “I try and fill their day with some type of positive experience.”

Tetris video game may ease PTSD, study suggests

By: Patricia Kime, Staff Writer

(Photo: Mark Lennihan/AP)


A new study out of Oxford University suggests that playing Tetris — the venerable puzzle game featuring interlocking shapes — can keep bad memories or flashbacks at bay, easing their frequency and impact on those who have experienced trauma.

The research, from the same scientists who wrote in 2009 that Tetris reduced flashback frequency when played within four hours of a trauma exposure, could lead to development of drug-free treatments for preventing or easing post-traumatic stress and other combat-related mental health conditions.

The most recent research involved showing 52 subjects graphic videos of car accidents and drownings and reminding them a day later of the carnage by showing them still images of the films.

Half the group then was asked to play Tetris after a brief break while the other half simply sat quietly.

A week later, the Tetris players reported far fewer flashbacks over that previous week than their counterparts, and they scored much lower on PTSD questionnaires, according to the report, published July 1 in Psychological Science.

“We showed that intrusive memories were virtually abolished by playing the computer game Tetris following memory reactivation,” wrote the research team from the Medical Research Council Cognition and Brain Sciences Unit, Oxford and Cambridge universities, and the Karolinska Institutet.

While the results are similar to the group’s previous work, the findings are thought to be more applicable for developing PTSD therapies because they indicate that visual-spatial games like Tetris may be useful in disrupting intrusive memories long after the causative event.

The earlier research had subjects playing Tetris within four hours of a trauma — an impractical scenario for most of life’s traumatic events.

Both studies contribute to the understanding of memory imprinting and recall, with the latest research finding that a combination of memory recall and Tetris can help disrupt involuntary recall of intrusive memories.

But researchers cautioned that the combination is key to the improved scores and reduced flashbacks among the game players, adding that their research found that “playing Tetris alone … or memory reactivation alone was [in]sufficient to reduce intrusion.”

They say more work is needed to confirm the findings and develop possible PTSD preventive therapies. But they added that the study raises some interesting questions about modern living and computer engagement.

“A critical next step is to investigate whether findings extend to reducing the psychological impact of real-world emotional events and media,” they wrote. “Conversely, could computer gaming be affecting intrusions of everyday events?”

Clinician’s Corner: Military Psychological Health Experts Answer Providers’ Treatment Questions

Posted by DCoE Public Affairs

To support Mental Health Awareness Month in May, experts from Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE) invited questions from health care providers who treat members of the military. The questions and answers appear below.

  • Q: “Is there anything in the DoA/DoD regulations or elsewhere indicating that a service member must be chapter separated if the member demonstrated suicidal behavior (parasuicide) only once and was subsequently diagnosed with a personality disorder (borderline personality disorder)? A driving factor in this specific case is that the service member is a military police officer.”

    Sheila B. Albers, LCSW, CAP, ASAP Counselor

    A: There are many policies in place across the Defense Department, services, and specific military occupational communities that spell out requirements for military readiness and specifically state service members must be medically qualified. Often, these policies mention specific disorders (such as personality disorders) and risk factors (such as suicidal behaviors) that warrant special attention, require additional assessment, or compel additional considerations. For some military occupational specialties that have high risk-management requirements, such as air traffic control, nuclear reactor operation and air combat, the need for optimal medical readiness and high occupational functioning is obvious. In other cases, policies can be overly restrictive and may seem prejudicial to those who have a psychological condition or mental health treatment documented in their health records.

    Diagnosed personality disorders are not automatically disqualifying. They usually require corroborating evidence that a service member’s condition causes poor adaptation to the military, interferes with the performance of duties, or represents a continuing, unmanageable risk of harm to self or others.

    In the example you present, a comprehensive clinical evaluation and a careful assessment of current and ongoing risk, usually by a psychiatrist or clinical psychologist, would need to be performed. Based on this assessment, a recommendation for administrative separation might be made. The Army requires an additional review and endorsement by the Army Surgeon General’s office. For additional information on administrative separations for personality disorders, please see Army Regulation 635-200 for qualification/disqualification for military police, see Army Regulation 190-56.

    Navy Capt. (Dr.) Anthony Arita
    Deployment Health Clinical Center director

  • Q: “What role do you think post traumatic growth and factors of resilience can or will play in the care of veterans?”

    Thad S. Rydberg, MA, LCPC

    A: Posttraumatic growth refers to the experience of positive change that occurs as a result of struggling with highly challenging life crises. These positive changes can take many forms, including increased appreciation for life, more meaningful interpersonal relationships, a greater sense of personal strength, changed priorities, and more spiritual life.

    The Defense Department definition of resilience is the ability to withstand, recover and grow in the face of stressors and changing demands. Resilience factors include viewing situations in ways that provide positive meaning and expectations, using active and problem-focused coping strategies, being able to act and respond effectively despite feeling fear, attending to one’s physical well-being, and reaching out for support from leaders, families and communities. These resilience factors can hasten the recovery process for those who have had traumatic exposures, and in fact, most people show natural resilience in their responses to trauma.

    Resilience factors and posttraumatic growth can play an important role in the care of veterans. Many of the evidence-based psychotherapy options include a focus on elements of resilience and posttraumatic growth, and it is common for providers to integrate these factors into care.

    Dr. Mark Bates
    Deployment Health Clinical Center associate director psychological health promotion

  • Q: “Are there recommended treatment modalities for use with sub-threshold PTSD symptoms in a nonmedical setting?”

    Stacie Coduto, MSW, LCSW

    A: It’s important to note that “sub-threshold PTSD symptoms” can mean several things:

    • symptoms aren’t so intense that they’re significantly disruptive or distressing
    • symptoms do not include at least one avoidance symptom
    • symptoms have not persisted the length of time required to meet the diagnostic threshold for PTSD

    Although the diagnosis and treatment of PTSD is conducted in medical settings by medical providers, there are a variety of non-medical support services that may be able to assist with specific issues related to sub-threshold post-traumatic stress (PTS) symptoms. These resources include the Military and Family Life Counselor program, chaplains, nonclinical social workers, wellness centers and self-help technology resources.

    Nonclinical providers can help address a range of potential PTS-related issues in a way that complements the natural PTS symptom recovery process. These issues include anger, grief and loss, stress management and coping challenges, sleep issues and relationship problems. Nonclinical providers can also help enhance problem-solving skills, which help people reach their goals, decrease stress and restore a sense of control. They also help people build and maintain a personal support network, including communicating effectively and identifying ways to be creative, relax and enjoy spending time with others.

    Chaplains are often the first line of defense for service members wrestling with moral and spiritual concerns. The chaplains’ pastoral approach can help people process memories, find more effective ways to understand their experiences, and increase a sense of meaning and purpose.

    Finally, Defense Department self-help technology resources like the AfterDeployment website and the PTSD Coach mobile app offer self-guided assessments and self-care strategies. The Breathe2Relax mobile app provides excellent coaching for diaphragmatic breathing, which is a powerful stress management tool often used as part of treatment for PTS symptoms.

    Dr. Mark Bates
    Deployment Health Clinical Center associate director psychological health promotion

  • Q: “I would like information on treatment for veterans with PTSD that includes a significant focus on moral injury.”

    Lia Pendergrass, LCSW

    A: As you’re likely aware, moral injury is not clinically defined and is not captured by a formal diagnosis, so clinical practice guidelines have not been developed specifically for it. However, Defense Department mental health providers often addressmoral injury when treating a mental disorder.

    A patient being treated for PTSD, depression or other mental health diagnoses may disclose information that indicates a moral injury (for example, guilt over accidentally killing a civilian during a combat operation or another dilemma). When this occurs, mental health providers often help the patient explore the event they experienced or actions they took or failed to take that conflict with their values or deeply held beliefs. There is a lot of meaning to explore, and the exploration must be done without judgment, haste or expectation of a linear path to resolution.

    To the degree that a moral injury relates to spiritual matters, a collaborative care or support approach involving a chaplain might be helpful. This process, of course, depends on the nature and extent of the patient’s symptoms, the presence of co-occurring conditions (such as alcohol or substance misuse), current life circumstance (demands and overall stressors), available support resources, and the character and value system of the individual. As a clinician, you can help the patient appreciate the impact of his struggle on his personal, occupational, and interpersonal functioning, while also helping to scope and prioritize areas of clinical attention and targets for intervention.

    Navy Capt. (Dr.) Anthony Arita
    Deployment Health Clinical Center director

A veteran suicide prevention network built by veterans



SALT LAKE CITY — Six weeks ago Special Forces veteran Johnny Primo logged on to his Instagram account and says he was horrified to see a suicide note from a veteran who lived just a few miles away.

The note read: “Very few people know the truth … I want this in everyone’s memory.” Desperate to help, Primo tracked down his address.

“I was 45 minutes too late from him taking his own life,” said Primo. “Immediately it was a gut wrenching feeling, knowing that there was a chance that if he had my phone number he wouldn’t have killed himself.”

Primo called friend and fellow veteran Casey Gray and that night they launched anInstagram suicide prevention page by posting a message pleading with veterans who are having suicidal thoughts to call them, day or night.

They call it “22 Too Many” — highlighting an estimate of the number of veterans who commit suicide every day. Veterans responded immediately.

“Within the first three hours we saved one person,” said Primo. “Within the first 24 hours we saved five people, people who were on the verge of suicide.”

Casey Gray served in Iraq, lost friends in combat and was severely injured in a helicopter crash. He says his experiences help him connect and built trust with other veterans.

A view of the “22 Too Many” Instagram page where veterans’ contact information is posted so that veterans in need can have someone to contact.

“Guys get to the point where they feel secluded and they isolate and they need to know that there’s somebody still there for them,” said Gray.

There are now about 180 veterans offering a lifeline on the “22 Too Many” Instagram page and they’ve already helped more 400 veterans who were contemplating suicide.

Casey Gray, left, Dr. Carrie Elk, middle, and Johnny Primo, right.

When professional help is needed, they contact a network of psychologists — which includes Dr. Carrie Elk.

“Veterans take care of veterans in the community and then they call me if they need mental health help,” explained Dr. Elk. “It’s a team effort and both are needed.”

Primo and Gray are currently developing a website and a smartphone app which will give vets more resources when they find themselves in a dark place. They intend on doing this for the long haul with the goal of saving lives.

Primo’s ultimate message to veterans: “You’re courageous enough to do what you did in the military, just pick up a phone and call. That’s all you have to do.”

Resources for veterans: Veterans Crisis Line | Tragedy Assistance Program for Survivors (TAPS)


Suicide rate of female military veterans is called ‘staggering’

Their suicide rate is so high that it approaches that of male veterans, a finding that surprised researchers because men generally are far more likely than women to commit suicide.

“It’s staggering,” said Dr. Matthew Miller, an epidemiologist and suicide expert at Northeastern University who was not involved in the research. “We have to come to grips with why the rates are so obscenely high.”

Though suicide has become a major issue for the military over the last decade, most research by the Pentagon and the Veterans Affairs Department has focused on men, who account for more than 90% of the nation’s 22 million former troops. Little has been known about female veteran suicide.

The rates are highest among young veterans, the VA found in new research compiling 11 years of data. For women ages 18 to 29, veterans kill themselves at nearly 12 times the rate of nonveterans.

In every other age group, including women who served as far back as the 1950s, the veteran rates are between four and eight times higher, indicating that the causes extend far beyond the psychological effects of the recent wars.

The data include all 173,969 adult suicides — men and women, veterans and nonveterans — in 23 states between 2000 and 2010.

It is not clear what is driving the rates. VA researchers and experts who reviewed the data for The Times said there were myriad possibilities, including whether the military had disproportionately drawn women at higher suicide risk and whether sexual assault and other traumatic experiences while serving played a role.

Whatever the causes, the consistency across age groups suggests a long-standing pattern.

“We’ve been missing something that now we can see,” said Michael Schoenbaum, an epidemiologist and military suicide researcher at the National Institute of Mental Health who was not part of the work.

The 2011 death of 24-year-old Katie Lynn Cesena is one of a dozen cases The Times identified in Los Angeles and San Diego counties. Cesena’s death highlights two likely factors in the rates.

First, she had reported being raped by a fellow service member. The Pentagon has estimated that 10% of women in the military have been raped while serving and another 13% subject to unwanted sexual contact, a deep-rooted problem that has gained attention in recent years as more victims come forward.

The distress forced Cesena out of the Navy, said her mother, Laurie Reaves.

She said her daughter was being treated for post-traumatic stress disorder and depression at the VA Medical Center in San Diego and lived in fear of her purported rapist — who was never prosecuted — and his friends.

Cesena had started writing a memoir and shared the beginning on Facebook. “I would like to dedicate this book to the United States Navy and all the men and women who have bravely served our country with humility and have been raped and were brave enough to tell someone, whether anything came of it or not,” she wrote.

The second factor was Cesena’s use of a gun, a method typically preferred by men.

In the general population, women attempt suicide more often than men but succeed less because women usually use pills or other methods that are less lethal than firearms. Female veterans, however, are more likely than other women to have guns, government surveys have shown.

In the new data, VA researchers found that 40% of the female veterans who committed suicide used guns, compared with 34% of other women — enough of a difference to have a small effect on the rates.

Another area of interest to researchers is the backgrounds of women who join the military.

Female service members have always been volunteers, and their elevated suicide rates across all generations may be part of a larger pattern. Male veterans 50 and older — the vast majority of whom served during the draft era, which ended in 1973 — had roughly the same suicide rates as nonveteran men their age. Only younger male veterans, who served in the all-volunteer force, had rates that exceeded those of other men.

The differences suggest that the suicide rates may have more to do with who chooses to join the military than what happens during their service, said Claire Hoffmire, the VA epidemiologist who led the research. A more definitive explanation would require information not included in the data, such as when each veteran served and for how long.

In the general population, women attempt suicide more often than men but succeed less because women usually use pills or other methods that are less lethal than firearms. Female veterans, however, are more likely than other women to have guns, government surveys have shown.

In the new data, VA researchers found that 40% of the female veterans who committed suicide used guns, compared with 34% of other women — enough of a difference to have a small effect on the rates.

Another area of interest to researchers is the backgrounds of women who join the military.

Female service members have always been volunteers, and their elevated suicide rates across all generations may be part of a larger pattern. Male veterans 50 and older — the vast majority of whom served during the draft era, which ended in 1973 — had roughly the same suicide rates as nonveteran men their age. Only younger male veterans, who served in the all-volunteer force, had rates that exceeded those of other men.

The differences suggest that the suicide rates may have more to do with who chooses to join the military than what happens during their service, said Claire Hoffmire, the VA epidemiologist who led the research. A more definitive explanation would require information not included in the data, such as when each veteran served and for how long.

The numbers were much further apart for women: 28.7 for veterans and 5.2 for everybody else.

A stratification of the data by age group — which was provided to The Times — shows that young veterans face the greatest risk.
Among men 18 to 29 years old, the annual number of suicides per 100,000 people were 83.3 for veterans and 17.6 for nonveterans.

The numbers for women in that age group: 39.6 and 3.4.

The differences between female veterans and other women are less extreme in older age groups but still considered alarmingly high by researchers.

The states in the study represent about half the nation’s veterans but did not include California.

In the local cases identified by The Times, one pattern stood out: Several women had been discharged early for psychiatric or medical problems.

A back injury forced out Sara Leatherman in 2009 and continued to cause her pain. She was also suffering from traumatic memories of maiming and death she witnessed as a medic in Iraq, said her grandmother, Virginia Umbaugh.

Leatherman was 24, attending community college in La Mesa in San Diego County and receiving treatment for PTSD when she hanged herself in her grandmother’s shower in 2010, Umbaugh said.

The war, however, was not the only factor. Leatherman had tried to kill herself with pills while stationed in Texas, before going to Iraq, said Umbaugh, who raised her. “I don’t think there’s any one answer,” she said.

In other cases, veteran status seemed almost incidental, with decades passing since military service and no clear link to the broken relationships, financial problems, mental health troubles and other disappointments that can accumulate in the course of a life.

Linda Raney was 65 years old in 2011 and dealing with problems that mounted for several years: the death of her sister in a car accident, money and health difficulties.

She was living with an aunt in Acton and was disappointed that she didn’t meet the financial requirements for the VA to help her get her own place.

“She didn’t want to be a burden on her aunt,” said her nephew, Kevin Pearcy. One afternoon, she called him to say goodbye, then committed suicide with prescription pills.

She had never talked much about her time in the Air Force.

“I don’t know her specialty,” Pearcy said. “She was very young.”

Twitter: @AlanZarembo


Hidden Wounds to participate in 2nd Annual Midlands Gives!

What is going on!?

On Tuesday, May 5, 2015, the Central Carolina Community Foundation is sponsoring the second Annual Midlands Gives Day. The goal for this day is to raise as much money for Midlands nonprofits as possible in a 24 hour period. The event will start at 12:00AM (midnight) and go through 11:59PM.

All donations must be made online using a credit card at the Midlands Gives website. When you make a donation on this day, all of the proceeds will go to the designated nonprofit. We hope you choose us!

Who is the Central Carolina Community Foundation and what is Midlands Gives?

The Foundation emerged in 1984 with a vision to establish itself as the central resource for philanthropy in the Midlands. Since then, through the generosity of donors, they have given more than $90 million to organizations nationwide and have invested time and resources in identifying the critical needs within the community.

Midlands Gives is a 24-hour local online giving challenge spanning 11 counties in the Midlands region of South Carolina. Last year’s inaugural Midlands Gives event was an incredible success, generating more than $705,000 for 150 local nonprofits through a one-day-only online public fundraising campaign that went viral.


Why should I pick Hidden Wounds?

Your donation on May 5th will help us further our mission of providing vital mental health services to veterans and their families. You can help ease the pain of a soldier, the worry of a mother and the grief of a child. An underestimated 22 Veterans lose their battle to PTSD everyday. We are helping make a difference in the military community and we can’t do it without your help.

Is anyone matching gifts?

An anonymous donor who wished to be called the Cheerful Giver is going to match the first $1000 that will go towards our goal of $5,000. That means when you help us hit the $1000 mark, we will only have $3000 left to go! Of course we don’t have to hold ourselves back; we can surpass that goal but we are leaving that up to you. Another opportunity for matching gifts will take place from 5:00pm until 5:15pm. Every gift of $100 will automatically be matched by AFLAC.

We are counting on your support!

Is there anything else we should know?

Midlands Gives along with awesome partners like AFLAC are holding contests for all organizations to participate in and possibly raise more money. Check this out!

Throughout the day, AFLAC is sponsoring Power Hours. Whichever nonprofit has the most donors during that hour will receive a $1,000 bonus. You can donate during each power hour, but only one donation per donor will be counted toward the contest during that particular hour.

  • 6:00 AM to 7:00 AM
  • Noon to 1:00 PM
  • 7:00 PM to 8:00 PM



Breaking the Chain: PTSD, Substance Abuse and Domestic Violence

By Mark Wollacott,

Last week, the Military Compensation and Retirement Modernization Commission (MCRMC) outlined its plans for a 21st century military system. And so they should because we now have an eye popping 23,816,000 veterans alongside current personnel and all of their families. Few families are left untouched by our military in one way or the other.


According to the Department of Veteran Affairs, two in ten veterans have turned to substance abuse of some kind or another. One in three of these veterans suffer from PTSD and the department estimates that 31% of all veterans are suffering from Post-Traumatic Stress Disorder. This means 7-8 million veterans require treatment. According to veteran mental health specialist Monica Mathieu back in 2008, this care is not integrated properly.

Dov Zakheim, writing in Foreign Policy Magazine, outlined the bipartisan agreement on the Capitol, which given the divided state of government at the moment was quite a surprise, which covers current and former members of the military. Four decades on from the creation of the All Volunteer Force, the modern military now encompasses families as a fixed part of the landscape, but also takes into account that women make up a far larger proportion than any time in our history.

The benefits offered, including great government contributions to retired personnel, are welcome, but with such a large number of veterans with problems, something more integrated is required that goes beyond personal finances. With large numbers of veterans turning to substance abuse – 6 in 10 PTSD sufferers are smokers, many have alcohol and drug addiction problems, a total care package is required.

It is important to look at PTSD and substance abuse because people with a Substance Use Disorder (SUD) are more likely to commit domestic violence. For example, 25-50% of men who committed battery against a spouse had a substance abuse problem. It goes beyond the veterans too because it forms part of a vicious circle. Various studies seem to suggest that 31% to 84% of women who suffer domestic violence show symptoms of PTSD. Many of them then turn to substance abuse themselves.


Back in 2008, Matthieu said that “the increasing number of veterans with post traumatic stress disorder (PTSD) raises the risk of domestic violence.” In talks with Peter Hovmand, a domestic violence expert at Washington University in St. Louis, Matthieu outlined a solution: “Veterans need to have multiple providers coordinating the care that is available to them, with each provider working on one treatment goal. Coordinated community response efforts such as this bring together law enforcement, the courts, social service agencies, community activists and advocates for women to address the problem of domestic violence. These efforts increase victim safety and offender accountability by encouraging interorganizational exchanges and communication.”


Given the agreed updates to retired veterans in the modern world and the taking into account their spouses and families, it’s time to make sure there is a truly inter-organizational and integrated approach to veteran mental health to help prevent them from turning to substance abuse and domestic violence.



December 2nd is the National Day of Giving


Photo Nov 25, 17 31 19

Hidden Wounds has joined #GivingTuesday, a first  of its kind effort that will harness the collective power of a unique blend of partners—charities, families, businesses and individuals—to transform how people think about, talk about and participate in the  giving season. Coinciding with the Thanksgiving Holiday and the kickoff of the holiday shopping season,  #GivingTuesday will inspire people to take collaborative action to improve their local communities, give back in better, smarter ways to the charities and causes they support and help create a better world. . Taking place December 2, 2014 – the Tuesday after Thanksgiving – #GivingTuesday will harness the power of social media to create a national moment around the holidays dedicated to giving, similar to how Black Friday and Cyber Monday have become days that are, today, synonymous with holiday



Everyday 22 veterans die by suicide, everyday. That’s one suicide every 65 minutes. In fact, in recent years, military suicide deaths have surpassed combat deaths.

Up to 20 percent of veterans who served in Operation Iraqi Freedom or Operation Enduring Freedom have suffered from post traumatic stress. 23 percent of women in the military have reported being sexually assaulted while in the military. 55 percent of women and 38 percent of men have experienced sexual harassment while in the military.

Shocking numbers. Even more shocking is that there are so few resources for our veterans to heal. The mission of Hidden Wounds is to provide interim and emergency counseling services to ensure the psychological health and well-being of veterans and their families.

We have helped more than 3,000 veterans receive mental health treatment. More than 20,000 group and private counseling hours have been provided to veterans and their families. Everyday more help is needed.

The National Day of Giving is December 2, 2014. On Giving Tuesday, as it has come to be known, you will likely receive many requests for donations. This year we’d like to invite you to stand with the men and women who have stood for you and our country in the past and help us reach our goal of raising $10,000.

Your donation on December 2nd will help us further our mission of providing vital mental health services to veterans and their families. You can help ease the pain of a soldier, the worry of a mother and the grief of a child. Please, consider making a contribution that is significant to you to help us reach our goal on Giving Tuesday.

Please click on the link here to donate online

DoD: It takes only one person to stop a suicide

Security guards open a gate for motorist at the visitor entrance to Fort Lee, Va., on Aug. 25 after a female soldier with a gun turned the weapon on herself. (Steve Helber / AP)

Security guards open a gate for motorist at the visitor entrance to Fort Lee, Va., on Aug. 25 after a female soldier with a gun turned the weapon on herself. (Steve Helber / AP)


By Patricia Kime 

Just six days before the start of Suicide Prevention Month in September, Army Sgt. 1st Class Paula Walker, 33, barricaded herself inside an office at Fort Lee, Virginia, and, in what military leaders later described as “upset and rage,” killed herself with a personal firearm.

The Aug. 25 death stands out for several reasons. First, female troops like Walker die by suicide at rates much lower than male service members; they tend not to use firearms; and, unlike more than half the service members who commit suicide each year, Walker had deployed to a combat zone, spending 15 months in Iraq in 2007 and 2008.

Her death and others by military personnel this year show how difficult a challenge suicide is for the Defense Department, which is launching several initiatives in September as part of National Suicide Prevention Month.

“Suicide is complex and the trajectory toward death is as individual as the person,” Defense Suicide Prevention Office Director Jacqueline Garrick said in an interview Sept. 4.

Together with the Veterans Affairs Department, DoD is launching the “Power of 1” awareness campaign — a public service initiative based on the idea that it takes just one person asking a question, texting a friend in need or making a phone call to save a life.

In a DoD-wide message Sept. 2, Defense Secretary Chuck Hagel emphasized the impact of simple intervention.

“These brave individuals shouldn’t be avoided or stigmatized. They need to be embraced. Whether you’re a service member, a veteran, a DoD civilian, or a friend or family member of someone who is, you have the power to make a difference,” Hagel said.

Garrick said statements conveyed in a nonjudgmental manner, such as, “I’m worried you might hurt yourself,” “You don’t seem yourself,” or “You seem to be taking risks,” accompanied by, “Let’s figure something out,” can help.

“It’s knowing how to ask the right questions without being afraid of the answers, and part of not being afraid is knowing where the resources are,” Garrick said.

Last November, DoD expanded its Vets4Warriors program, an around-the-clock call center that offers peer counseling and support, to active-duty, National Guard and reserve members, retirees and their families.

Staffed by veterans representing all service branches as well as a handful of family members, the toll-free line (1-855-838-8255) receives an average of about 1,500 calls a month, according to the Pentagon.

Garrick said the program not only gives those under stress someone to talk to, but the staff can help callers navigate the complexities of the mental health system as well as provide case management.

“When someone is really stressed, it’s hard to navigate. Our peers are really good at problem solving,” Garrick said.

For service members in emergencies, the Military Crisis Line, 1-800-273-8255, is staffed by trained mental health specialists — many of whom also are veterans, according to VA.

The 24-hour phone service, online chat and text-messaging system, overseen by VA, has fielded more than 1.25 million calls since 2007 and is credited with nearly 40,000 lifesaving rescues, according to the department.

While DoD is ramping up its suicide prevention programs in September, officials say the department maintains a full-court press on the problem year-round with the goal of reducing a surge in suicides in the past 12 years.

In 2013, 259 active-duty personnel, 87 reservists and 133 Guard members died by suicide.

The suicide rate per 100,000 personnel in 2013 was 18.7 for the active component, 23.4 for the reserves and 28.9 for the Guard.

In comparison, the civilian rate, adjusted to similar demographics as those who serve, is 18.8 per 100,000.

“Getting help when you need it is not only a sign of strength, but it works,” Army Lt. Gen. Michael Linnington, military deputy to the undersecretary of defense for personnel and readiness, said in a news release. “Having the confidence to seek help when you need it is important.”

Concerned over the frequency of suicide among young veterans, Iraq and Afghanistan Veterans of America made the subject its top priority this year.

IAVA founder Paul Rieckhoff said the DoD figures underscore the scope of the problem and call attention to the broader issue, that troops and veterans — including those recently discharged — are dying by their own hands in significant numbers.

“We’re outraged, which is why we’ve asked the president to draft an executive order focused solely on military and veteran suicide,” Rieckhoff recently told Military Times.

A poll of IAVA members earlier this year found that 31 percent said they have thought about taking their own lives since joining the military and 40 percent have a friend who served in Iraq or Afghanistan and died by suicide.

First Sgt. Paula Walker’s brother Paul told the British paper MailOnline on Aug. 27 that his sister’s suicide “came out of nowhere.”

“I am devastated at the loss of my twin sister. This was totally unseen. … You never know what’s going on in a person’s mind,” Paul Walker said, according to the paper.

And that, precisely, is the major challenge of preventing suicide, Garrick said.

In studying military suicide in the past several years, DoD has found the majority of those who take their own lives are young, white, enlisted men who have never deployed to a combat zone. About one-third told someone of their intent and nearly half had seen a doctor in the months before they died.

But often, those who die by suicide fit none of those descriptions.

“As much as I wish I could say there is a known portion of the population that dies by suicide, there are constant exceptions to the rules,” Garrick said. “Constant vigilance is needed.”

Related Links

Hearings on the Veterans Administration Mental Health Care July 10 2014.

JULY 10, 2014

The House Veterans Affairs Committee held a hearing on improving access to mental health care services for former soldiers, and the level of care veterans receive for problems such as post-traumatic stress disorder and brain injury. The witnesses included Veterans Health Administration (VHA) officials, mental health experts, and family members of war veterans who killed themselves after returning from active duty. Jean and Howard Somers told a story about their son, Daniel, being told no beds were available when he attempted to check himself into the VHA for a mental health crisis. Daniel in response sat down on the floor and cried. A VHA staff person told him he could stay and cry as long as he needed before driving himself home. .

VA health care failed suicidal vets, families testify

Retired Army Sgt. Josh Renschler said veterans need a health care system that truly serves them, 'not one that requires the veteran to accommodate the system.' (Photos by Mike Morones/Staff)

Retired Army Sgt. Josh Renschler said veterans need a health care system that truly serves them, ‘not one that requires the veteran to accommodate the system.’ (Photos by Mike Morones/Staff)

By Patricia Kime

In March 2011, former Marine Clay Hunt faced a life full of promise. Having survived a gunshot wound and combat tours in Iraq and Afghanistan, he traveled to Haiti to do humanitarian work, had a new job and was shopping for a truck.

Hunt was considered by many a poster-boy for suicide prevention, a veterans advocate who worked with Team Rubicon and Iraq and Afghanistan Veterans of America to raise awareness of post-traumatic stress disorder and the need for expanded care for post-9/11 veterans.

But below his upbeat, gregarious manner, Hunt struggled. When he moved to Houston in early 2011, he sought care at the Veterans Affairs Department hospital to make medical appointments for his PTSD and ensure his medications arrived uninterrupted.

Yet despite Hunt’s advanced understanding of the VA health care system, he wrestled with the massive bureaucracy. At Houston, he wouldn’t be able to see a psychiatrist for two months. His much-needed medication was unavailable at the VA pharmacy because the hospital didn’t stock brand-name drugs.

He confided to his mother that the loud, crowded, impersonal medical center was “too stressful” and he wouldn’t return.

Two weeks later, he shot himself at age 28.

‘Something went wrong’

“In that two-week window, something went wrong,” Hunt’s mother, Susan Selke, told members of the House Veterans’ Affairs Committee. “He just got a job, he bought a truck on Friday. By the next week, he was dead.”

Since news erupted in April of delays in patient appointments and scheduling that contributed to delays in care and, possibly, deaths, the VA has been under fire for covering up the scope of its problems, punishing whistleblowers who tried to alert supervisors and ignoring patients who begged for help.

On Thursday, the House Veterans’ Affairs Committee sought to put a “face” on the issue in an oversight hearing focused on continued problems with access to mental health treatment at VA.

“None of the [hearings held so far] have presented the all-too-human face of VA’s failures so much as today’s, a hearing I believe will show the horrible human cost of VA’s dysfunction and, dare I say, corruption,” said Rep. Jeff Miller, R.-Fla., chairman of the committee.

VA data show that suicide rates among veterans who use VA health care have increased by nearly 40 percent among male veterans under 30 and by more than 70 percent among male veterans ages 18 to 24.

The statistics are shocking, but families whose children have died since serving in combat say they aren’t surprising, given the system’s inability to track patients and privacy laws that prevent family members from speaking with physicians or learning anything about their loved ones’ health.

Dr. Howard and Jean Somers’ son Daniel died last year after a long battle with PTSD and guilt related to his combat service. As a National Guardsman, Somers’ status as a veteran was questioned, dragging out his efforts to get help.

When he finally was deemed eligible, he fell victim to an antiquated appointment system, missing notifications and appointments. He also was uncomfortable with the type of care he was offered.

Frustrated and feeling alone, Daniel wrote a heartbreaking suicide note before shooting himself: “Too trapped in a war to be at peace, too damaged to be at war … not only am I better off dead, but the world is better without me in it.”

Outsourcing urged

The Somerses say they want to work through VA to fix the system, envisioning an organization that is a “center of excellence” for war-related injuries.

They would like to see much of the routine care now provided by VA, including primary care appointments and treatment for illnesses and injuries not related to deployment, outsourced to private providers.

“Our son was told they had no psych beds and no ER beds. He lay down in the corner of the VA and cried. No effort was made to see if he could be admitted to another facility. He was in crisis and was told, ‘You can stay here, and when you feel better, you can drive yourself home,’ ” Jean Somers said.

Witnesses who testified at the hearing noted that the Health Insurance Portability and Accountability Act, or HIPAA, designed in part to protect patient information, serves as a major roadblock for families trying to help those with mental illness.

Frequently, mental health patients feel so stigmatized by their illnesses that they are reluctant to sign release forms allowing a loved one or family member to participate in their health care. And sometimes their mental health conditions affect their ability to make sound decisions.

While there are exceptions in HIPAA that allow providers to speak with family or caregivers if a patient is a danger to themselves or others, this exception is not widely used and also is debatable: What one doctor considers “dangerous” may differ from another‘s.

“I never knew of Brian’s PTSD, traumatic brain injury or high suicide risk,” said Peg Portwine, mother of Brian Portwine, who died by suicide in 2011 after having been redeployed to combat with a traumatic brain injury and PTSD.

“I think that life-threatening situations like his should be shared with an emergency contact person who may be able to help,” she said. “VA needs to work with the service organizations and include the families in the plan of care.”

Families seek input role

Dr. Maureen McCarthy, the Veterans Health Administration’s deputy chief patient care services officer, said VA continues to take steps to improve its mental health treatment capability. But she acknowledged “there have been veterans with complaints about access.”

More than 1.4 million veterans sought VA mental health treatment in fiscal 2013, up from 927,000 in fiscal 2006. VHA now employs 21,128 full-time mental health employees.

McCarthy said VA continues to fight to expand its mental health treatment capability. “VA is committed to providing timely, high-quality care that our veterans have earned and deserve and we continue to take every available action and create new opportunities to improve suicide prevention services,” she said.

The families who testified at the hearing said they would welcome an opportunity to contribute to the restructuring of VA mental health treatment.

The Somers family brought a 22-page report with recommendations, while retired Army Sgt. Joshua Renschler, said the system needs a substantial overhaul, suggesting a team-based approach of interdisciplinary care, with all doctors responsible for treating a veteran working as a team, providing the patient care tailored for their case.

It seems that should be standard practice, but it’s not what he experienced at VA, said Renschler, who has TBI and is volunteering with Branches of Valor, a nonprofit that helps troops and veterans with deployment-related trauma.

“We need a system that serves the veteran, not one that requires the veteran to accommodate the system,” Renschler said.


Eighteen holes to help heal soldiers’ Hidden Wounds

Pictured above left to right: Members of SVL Michael Bradbury (2015), Ryan Templeton (2014) and John Wall (2015) present a check to Hidden Wounds board members Freddie Brock, US Army (Ret.) and Steven Diaz, USMC (Ret.). Also pictured is Ashley Canara, a senior public relations student at USC and a volunteer with Hidden Wounds.

Pictured above left to right: Members of SVL Michael Bradbury (2015), Ryan Templeton (2014) and John Wall (2015) present a check to Hidden Wounds board members Freddie Brock, US Army (Ret.) and Steven Diaz, USMC (Ret.). Also pictured is Ashley Canara, a senior public relations student at USC and a volunteer with Hidden Wounds.

How can a round of golf help veterans with post-traumatic stress disorder?

Start with a group of committed law students who are driven to serve those who have served our country.

For the third straight year, two University of South Carolina School of Law student-led organizations, Service Members and Veterans in Law (SVL) and the Student Bar Association, joined forces to host a charity golf tournament with the goal of raising money and awareness for Columbia, S.C.-based non-profit, Hidden Wounds.

Hidden Wounds’ mission is to provide peace of mind and comfort for military personnel suffering combat stress injuries such as PTSD, traumatic brain injury and other psychological post-war challenges by providing interim and emergency psychological treatment for veterans, military personnel, and their families.

The tournament raised $2800, which will provide much-needed counseling services to area-veterans suffering from combat-related stress injuries.

It was just the latest event that SVL has sponsored to help South Carolina veterans. In 2013, the group brought the national initiative Project Salute to the state for the first time, and worked with local attorneys to help local veterans file or appeal their benefits claims.

Additionally, SVL members help other military-turned-law-students make the transition into law school, and work to create networking opportunities with veterans in the legal community, such as career advice and resume workshops.

Medal of Honor recipient offers advice to troops about PTSD and surviving war

Sgt. Kyle J. White will  <A title='' href='' srcset=

receive the Medal of Honor on May 13, 2014. U.S. ARMY” width=”300″ height=”211″ /> Sgt. Kyle J. White will receive the Medal of Honor on May 13, 2014.

By Jon Harper

Stars and Stripes
Published: April 23, 2014

WASHINGTON — Former Army Sgt. Kyle J. White, who will be awarded the Medal of Honor next month, said troops suffering from post-traumatic stress disorder shouldn’t suffer in silence.

“There’s no shame in going and getting help,” White, who was diagnosed with PTSD before he left the military, said at a news conference Wednesday in Charlotte, N.C.

The first thing that servicemembers with symptoms of PTSD need to do is reach out and get help, he said. “These servicemembers need to realize that they went to war and they made it back, but they might have some scars remaining. Reach out to your chain of command, and they will help you get the treatment that you need. If I can do it … then there’s no reason they can’t as well.”

He said getting troops to come forward and tell people they’re suffering is perhaps the biggest challenge to tackling the mental health issues that many combat veterans face.

The treatment and assistance programs are out there, he said. “But I think it’s just those first steps — that servicemember who needs help coming forward and actually admitting, ‘Hey, I need to go see somebody’ — that’s the issue that needs to be addressed, I believe.”

White, 27, will receive the Medal of Honor — the nation’s highest award for military valor — for his actions during a dismounted movement in mountainous terrain in Aranas, Afghanistan, on Nov. 9, 2007.

White was serving as a Platoon Radio Telephone Operator assigned to Company C, 2nd Battalion (Airborne), 503rd Infantry Regiment, 173rd Airborne Brigade, when his team of U.S. and Afghan National Army soldiers were set up and ambushed by a much larger, more heavily armed Taliban force after a meeting with Afghan villagers. During a marathon battle, he exposed himself to heavy enemy fire and risked his life numerous times to help his wounded comrades.

By the time the fight in Aranas ended, six U.S. servicemembers had been killed. White paid tribute to his fallen comrades at the news conference.

“On 9 November, 2007, America did not lose five Soldiers and one Marine, but gained six heroes,” he said. “I will forever be a voice for them. I will tell their stories and preserve their memories. … Although they are gone, they will not be forgotten. Their sacrifice and the sacrifices of so many others is what motivates me to wake up each and every day and be the best that I can be. Anything I do in my life is done to make them proud.”

White also offered some advice to younger servicemembers for improving their chances of surviving war.

“Take all of the advice you can from those who have been deployed before, those who have more experience than you, and then also your leadership,” he said. “Learn as much as you can, and then take as much advice that’s out there, because that piece of advice that that leader gives you could be the one that saves you or your buddy’s life.”

White will be awarded the Medal of Honor at a White House ceremony on May 13. He will be the seventh living recipient to receive the Medal of Honor for actions in Iraq or Afghanistan.

White, a native of Seattle, separated from the Army on July 8, 2011, and used his GI Bill to attend the University of North Carolina. He now works as an investment analyst for the Royal Bank of Canada in Charlotte. 
Twitter: @JHarperStripes

Do You Turn to Alcohol for PTS Relief? You’re Not Alone, and Help is Available

By Liz Grow, MA, LPC

It’s no secret that many adults use a drink to unwind after a long workday. For many, a glass of wine or a beer is a ritual that signals a transition out of the stress in the workplace and into to a more casual and comfortable mindset. Troops are no different, but often, their stressors are related to their physical safety and extend well beyond the 9-to-5.

A recent study conducted by the National Institute on Drug Abuse (NIDA), showed that 27% of Army soldiers screened 3 to 4 months after returning from deployment to Iraq met the criteria for alcohol abuse.

One explanation for the high percentage of alcohol abuse is that soldiers are self-medicating with alcohol because they’re suffering from readjustment issues beyond their control. Self-medicating is used to escape or alleviate distressing symptoms brought on by post-traumatic stress.  Rather than dealing head-on with post-deployment readjustment issues, many troops turn to alcohol to numb their feelings of vulnerability and anxiety, and to “feel normal” again, even if only for a brief time.

One doesn’t need a study to know that self-medicating with alcohol is a serious issue within the military community. With the recent troop withdrawals, the health community fears that the problem will only grow. Among people with diagnosed PTS, approximately 40% have also been addicted to alcohol. PTS sufferers use alcohol to quell the most common symptoms of PTS such as hypervigilance, insomnia, and anxiety.

It’s crucial that soldiers have alternate methods of stress-reduction and use them on a regular basis. Becoming dependent upon alcohol can lead to risk-taking behaviors, loss of relationships, financial distress, and even job loss. Alcohol use will only compound the problems of a soldier suffering from post-traumatic or combat operational stress, and will most certainly delay a healthy recovery.

Exercise, meditation, and taking on a hobby are all great ways to reduce levels of stress. If you feel that your readjustment issues are bigger than stress management, it’s important that you consult with your physician about other ways in which you can keep your readjustment issues in check and work toward feeling normal again.

If you think that you may be using alcohol to manage post-deployment stress and to avoid facing the readjustment issues that you’re experiencing, reach out for help. You can take a free, anonymous alcohol use assessment.You’re not alone, and trying to deal with your issues alone will only prolong the suffering. Solicit the help of your support system and reach out to one of the many communities that can help you work through your readjustment issues in a healthy way. You can find ample resources on Military Pathways, or through your local VA.

Liz Grow, MA, LPC is the Director of Counseling Partnerships for Fidelis, a technology company committed to solving the military to civilian career transition challenge. As a former psychotherapist and Army brat, Liz is committed to serving those men and women of the military who want to find as much success in the civilian workplace as they have in the military.

Suffering in Silence: Psychological Disorders and Soldiers in the American Civil War

Angelo Crapsey, 1861

Angelo Crapsey, 1861

Kutztown University of Pennsylvania

Did soldiers of the American Civil War suffer from post-traumatic stress disorder and other psychological disorders? It has only been several decades since mental illness attributed to war conditions was clinically recognized. Recent research has shown a strong positive correlation between war time events such as witnessing the death of comrades, friendly fire or IED explosions and post-traumatic stress disorder.1 With a conflict as devastating as the American Civil War, it would be logical to hypothesize that Civil War soldiers were subjected to events that put them at risk similar to today’s soldiers. There is a strong relationship between attributing events during the Civil War and psychological affects; for instance revolutionary weaponry developments, medical procedures, psychological warfare, and hand to hand combat could have invoked psychological ailments. Data compiled from diaries and letters will affirm the presence of psychological disorders in soldiers who fought in the war. From this body of evidence, it is clear that soldiers of the American Civil War did indeed suffer from post-traumatic stress disorder and other psychological disorders.

Soldiers facing death, 1861
Photo: Library of Congress
The most common disorder that results from exposure to combat is called post-traumatic stress disorder or more commonly known as PTSD. According to the Diagnostic and Statistical Manual of Mental Disorders, there are several categories of symptoms for PTSD. The symptoms include the experience of actual harm or threats to be harmed physically and or emotionally, intrusive symptoms that include flashbacks, disturbing dreams or memories, negative changes in cognition, the avoidance of stimuli associated with the event and changes in arousal levels. In order for there to be a diagnosis, symptoms must be present for over a month and the level of stress has to be significant enough where everyday activities are negatively affected.2

Another common and relatively novel disorder is Traumatic Brain Injury (TBI). This is a neurological disorder that inhibits cognitive functioning as a result of an injury to the head. Symptoms include moderate to severe amnesia, headaches, changes in personality and accumulating more sleep than normal.3 This disorder is becoming widely recognized and diagnosed more frequently in veterans today. Over 30 percent of all casualties in Operation Iraqi Freedom (OIF) and Enduring Freedom (EF) were associated with the head or neck area.4 As many as ten to twenty percent of OIF/EF veterans have been diagnosed with TBI.5 It is plausible to assume that Civil War soldiers, who were not provided helmets, would have suffered from TBI if they experienced in injury to the head or neck region. General Anxiety Disorder and Depression are both common psychological disorders that plague many veterans today. Soldiers who experience traumatic events, such as the death of a comrade or innocent civilians, may experience depression as a result. It is logical that countless men of the Civil War era may have suffered from depression or general anxiety disorder.

The first mentions of symptoms correlated with PTSD dates back three thousand years ago; four thousand years before it would be clinically recognized. Ancient Egyptian Hieroglyphics depicted the emotions and fears soldiers felt while in combat. The Greek historian Herodotus wrote, in 480 B.C, of a Spartan soldier who was taken off the front lines due to his trembling and later took his own life in shame.6 In the seventeenth century any disorder associated with depression or changes in personality was termed melancholy or nostalgia. Symptoms similar to PTSD were called Soldier’s Heart and Da Costa Syndrome during the mid and late nineteenth century.7 The catalyst for the recognition of PTSD was the outbreak of World War One. The Great War had some of the worst casualties in human history as a result of revolutionary weaponry that redefined warfare. The psychological effects of this war were often seen in the returning veterans as many experienced involuntary ticks and shook unaccountably.8 This later would be termed Shell Shock.

While not to the extent of the First World War, The Civil War had revolutionary weapon and technological developments that negatively affected soldiers physically and mentally. This included the Minie Ball, a cylinder shape bullet that was more aerodynamic, making it more precise and effective. Instead of a round bullet that would break the bone, the Minie Ball would completely shatter it.9 Another technological development that changed the world as well as warfare was the railroad. For the first time in human history, mankind would not have to rely on horses or their own two feet to transport them. This drastically changed warfare by allowing supplies and troops to move into the most remote areas at record speeds. This meant that more soldiers were exposed to significantly more carnage than past wars. A soldier was no longer confined to a specific geographical location allowing them to fight in more battles. Witnessing this novel amount of gore would have been a severe trauma that could have produced anxiety and other psychological symptoms associated with PTSD.

Wounded soldiers in a Union hospital
Photo of Library of Congress
The Civil War is unique in that it took place during a time of great weaponry and technological developments but it was only decades shy of medical advancements that could have saved countless lives. Disease rather than bullets proved to be a significant factor in the death toll of the Civil War. For every one death in combat, there were two deaths caused by disease. The lifesaving technique of sterilization was a foreign concept to Civil War physicians and as a result thousands of soldiers succumbed to infections.10 The omnipresence of decay and death of thousands of sick men only added to the carnage witnessed not only by soldiers but nurses and doctors. On a daily basis, medical teams witnessed horrific wounds, ghastly amputations and men succumbing to their injuries and illnesses. Procedures and surgeries performed by army surgeons and physicians also left Civil War veterans literally scarred for life. The survival rate for a man going into surgery was roughly eighty percent depending on the location of the wound. The fatality rate was directly related to the proximity of the injury to the core of the body.11 Anesthetics, like ether and chloroform, were used for many surgeries which made the procedures much more humane.Though the fear of having to endure surgery invoked great anxiety, the fear of life after surgery was an even greater anxiety to face.

In a society that relied on physical labor for maintaining a livelihood, living without a limb meant a lifetime of unemployment. Farmers, mill workers, railroad workers or dock workers were all required to be physically able to complete the tasks required of them. An amputee could not continue working in the physical labor market. To make matters worse, majority of the men who fought in the Civil War were from lower economic classes. The socioeconomic status of an amputee would have been lowest amongst the ranks partly because there would be very few jobs that could accommodate their special needs. The anticipation of failure to provide for themselves and their families conjured major stress and anxiety.

The biological needs of humans are crucial for both physical and mental health. If humans are bereaved of biological necessities then they are at greater risk of psychological ailments. In war, especially the American Civil War, even the most basic of human essentials, such as food, water and shelter, are unavailable to soldiers putting them at an elevated risk of psychological danger.

Food supplies were frequently limited and insufficient for the amount of calories a soldier would expel. The water was often contaminated with germs making soldiers sick. Septic water is especially dangerous because it carries many diseases like cholera and dysentery. A diary entry by Union soldier Henry Tisdale implies that he got sick from drinking the water at his camp “Unwell today for diarrhea, causing me to feel weak. Think it caused by drinking too much of the aqueduct water we have here.”12 Not only were the soldiers on alert for enemy attacks but also had to worry if their next drink or meal was going to make them ill. Due to the insufficient and inadequate food and water, many soldiers did not have the caloric intake needed to support straining activities. Union soldier Cornelius Platter wrote “3 mile to our right and went into camp 8 mile South East of Jonesboro at 8 oclock — This has been the hardest days march we have had. Distance marched 22 mile.”13 A malnourished soldier would have had difficulties executing long endurance orders like this and would have been pushed to the brink of exhaustion. On top of malnutrition, each soldier was subjected to the weather and its unforgiving nature. Evolutionary instinct would be to seek shelter from the elements, but this cannot be done in war. Joseph Waddell from the Indiana Volunteer Division wrote “Off early and marched to Black River a hard rain late in the evening two men killed on the road with lightning.”14 Soldiers had very little protection, which would have affected their sense of safety. With unavailable resources and basic needs going unmet, these men were at an elevated risk of developing psychological disorders.

Arguably one of the most intense contributing factors to psychological effects and disorders were the prisoner of war (P.O.W) camps. Some of the most detestable incidences in the war occurred inside these camps. Psychologically, people are put in situations with numerous traumas, such as ubiquitous death, fighting and abuse, making P.O.W camps a minefield for psychological disorders. Camps like Salisbury, Libby, Douglas and the most notorious Andersonville were overpopulated and did not have proper supplies for the number of prisoners it contained. At one point, Andersonville detained thirty-two thousand men but the original capacity was for only ten thousand men. When Sherman’s soldiers liberated Andersonville, they found some prisoners completely emaciated. At the end of the war when supplies were scarce, rations were withheld. “No rations issued yesterday to any of the prisoners and a third of all here are on the very point of starvation…” Prisoners would fight, even kill, other prisoners for whatever they might have in their possession that could aid in their survival. “Have just seen a big fight among the prisoners; just like so many snarly dogs, cross and peevish.” The fight to survive in hellish places like Andersonville, Libby, Salisbury and Douglas was exceedingly stressful. Witnessing the intense trauma of death on a daily basis was more than enough to produce PTSD.

A unique factor of the Civil War was that units were very often created by geographical location. A town’s entire male population, brothers, friends and neighbors, would fight together. A Union soldier from Michigan found the body of his best friend who was shot and killed. During the chaos of battle, the soldier kneeled down to clear the blood off his friend’s face, while bullets and shells exploded around him. He had lost his sense of urgency and experienced heightened arousal level, which put him in physical danger. This is an example of a soldier’s psychological state putting them at physical risk. This psychological state would be even more compromised when a soldier fought their own kin. The famous motto of the Civil War was Brothers Fighting Brothers. Families were torn apart by this war as brothers would often fight on opposing sides. James and Alex Campbell were two brothers who fought on opposing side. When war broke out, James went to the Confederate Army with the Union Light Infantry also called the 42nd Highlanders and Alex went to the Union 79th Highlander Regiment. At the Battle of Secessionville in eighteen sixty-two, the two brothers were fighting against each other. Not only would losing the support system of a family member be stressful but the thought of intentionally killing a relative would be a severe psychological trauma that could generate PTSD.

Psychological warfare has been a vital part of combat for thousands of years. Biblical writings of Gideon portrayed of soldiers blowing horns, let out a fierce cry and breaking objects as a result the Mindianite soldiers were so beside themselves with fear that they committed suicide. (Judges 7:1-22) The Civil War was no stranger to these psychological tactics. The phrase “Rebel Yell” originates from the Civil War and was a weapon used to instill fear in the Union soldiers. Similar to the battle cries of the Native Americans, Confederate soldiers would yell, shout or chant certain phrases or noises to invoke fear in their enemies and many times it did its job. The sounds were described anywhere from Indian wooping noises to the shrieks of a wild animal and these yells implored great fear into the Federal soldiers. “….the Union troops were startled by the most hideous of modern war cries, known as the ‘rebel yell’…This was the first time the Vermont boys had heard that fiendish sound, and it is not too much to say that they were appalled by it for a moment, and thought their time had come to be ‘wiped out.” Fear is a great weapon in combat; unfortunately this great weapon is lethal to a soldier’s psyche.

Witnessing an event is just as catastrophic to the psyche as being a victim of a trauma. Many soldiers did not have to experience combat to receive the full effect of war. Thomas Smiley, a confederate soldier, described the horrifying event that he witnessed at the Battle of Chancellorsville to his aunt. “The large brick house at Chancellorsville took fire and burnt up with about two hundred wounded Yankees who were so badly hurt that they could not move and their own soldiers did not help them any. Later in the day the woods took fire and a great many more helpless men perished.”15 At the battle of Seven Pines, a Confederate soldier was horrified not by fighting but from what he heard on that day. The soldier, lying wounded on the ground, described the cries and screams for help from the Union soldiers as they lay in the ditches too wounded to move. A heavy rain came and the water had accumulated in the ditches and the wounded men were slowly starting to drown.16 Stories like this would find their way back to the small towns and cities, terrifying the men who were eligible for enlistment or conscription. Joseph Waddell wrote of a young man who was sobbing because he was called up by the draft. “I heard a sound of lamentation…. A negro woman informed me that it was a soldier crying because he had to go to the war!… Several men and women stood in the street, some laughing and others denouncing the recruit”.17 Severe anxiety plagued the prospective soldiers as the news of the bloodshed and atrocious fighting trickled from the battlefield to home.

The amount of hand to hand combat in the Civil War left soldiers particularly vulnerable to PTSD, depression or any battery of psychological illnesses. This is the last major American war and one of the last major wars in the world to significantly utilize hand to hand combat. After the twentieth century, the technologies gained in World War One, such as planes, bombs and machine guns, did most of the heavy labor. While linear warfare was the fighting style of choice in the Civil War, almost every battle had some form of hand to hand combat . Union Naval Officer William Ferguson testified to Major-General Hurlbut as to what he witnessed when he arrived at Fort Pillow after the massacre “[There were] Bodies with gaping wounds, some bayoneted through the eyes, some with skulls beaten through, others with hideous wounds as if their bowels had been ripped open with bowie-knives…”18 This archaic style of fighting is tremendously personal and has exceedingly negative effects on a person’s psyche. To defeat the enemy, one must look into their eyes and take their life. Hand to hand combat is arguably one of the leading causes in the development of PTSD.

The evidence of psychological effects and disorders as a result of combat is clearly illustrated in the suicides of the soldiers. Numerous soldiers took their own lives rather than live to see another fight. Many men wrote home telling their loved ones about the unfortunate souls that would rather die by their own hand then fight for a chance of survival. Jacob Stouffer wrote about his friend Absolam Shetter saying, “he had been in trouble and at times in a State of despondency-this with the troubles and Excitements around us-deranged his mind and on yesterday morning ended his existence by hanging.” Newell Gleason, a lieutenant colonel, was described as a fearless leader but had experienced nervousness and anxiety after the Atlanta Campaign. Gleason had difficulty sleeping and battled with depression. In eighteen eighty-six, Gleason committed suicide as a result of his time spent in the Union Army. A majority of the suicide victims were Confederate veterans. Besides the fact that they lost the war, the South lost twenty percent of its population. Families were torn apart by this war. Fathers and mothers lost sons, brothers lost brothers and wives lost husbands. The men that were lucky enough returned from war found their homes and lands destroyed. They lost everything. The war and its surrounding events could have thrown the soldiers into a depressive state leading to psychological ailments.

Understanding events and conditions that contribute to PTSD and psychological disorders help to create a mental picture of the soldier’s experiences. These events are correlated to psychological disorders but neither confirm or deny a conclusion. Examining individual soldiers provides insight into the effects of the war. It also makes the connection personal and the event feel real instead of words on a paper. The next three case studies are the smoking gun evidence that there were indeed psychological disorders as a result of the Civil War. More importantly, they were all real people who were once very much alive and they were all victims of something far greater than themselves.

Albert Frank was a soldier in the Union Army. At the Battle of Bermuda Hundred near Richmond, Frank was off the front line and sitting on top of a trench. He offered a drink from his canteen to a fellow soldier sitting next to him. While the soldier was taking his drink, a shell exploded and decapitated the man, covering Frank with blood and pieces of brain. Frank experienced a complete loss of cognitive functioning being unable to speak, communicate or understand his fellow soldiers. He was later found on the floor shaking and making bomb noises. The only thing he would say was “Frank is killed.”19 He was taken to the Government Hospital for the Insane in Washington D.C and declared mentally insane. Witnessing such an intense trauma had affected Frank greatly. He was re-experiencing and reenacting the event and he associated himself to the trauma in a negative way saying he was the one killed. These are indicators of post-traumatic stress disorder.

Angelo Crapsey from Potter County, Pennsylvania eagerly enlisted in the Union army in 1861. Early in his military career, a sergeant in his unit committed suicide by placing his rifle between his knees and putting the muzzle in his mouth. This event would have a profound impact on Crapsey. As Crapsey started to engage in combat, his glorified perception of war began to fade away. “Rebels charged on us & we had to run, run for [our] lives…through an open field & we had showers of bullets sent after us.”

Crapsey became more withdrawn and the radiant spirit he possessed prior to the war disappeared. At the Battle of Fredericksburg Crapsey was taken prisoner and he spent time in at Libby Prison. While contained, Crapsey developed a case of lice infestation and frequently tried to rid himself of the pest even after they had subsided. After his release he fought at the bloodiest battle of the Civil War, Gettysburg. Upon his discharged, he returned back home to Pennsylvania were he experienced illusions, involuntary ticks and violent fits. On August 4, 1864, Crapsey said he was going out to hunt but instead stuck a gun in his mouth and shot himself; the same way the sergeant had done three years prior. Major General Thomas Kane said that he “loved no one of his men more than Angelo. He came up to his ideal of the youthful patriot, a heroic American soldier.” Crapsey embodied the image of the ideal soldier and possessed a luminous spirit that was contagious. Unfortunately, he lost himself in the tremendous force that was the Civil War.

Just like the soldiers in the Great War, Angelo had experienced involuntary ticks and violent fits. World War One soldier’s ticks and fit were attributed to constant bombardment at battles like Verdun and Somme. Angelo fought at Gettysburg, the sight of the largest artillery bombardment in North American History. While the bombs never physically harmed him, they drove him to insanity. Angelo experienced a change in personality, diminished personal relationships, a loss of previous interest, flashbacks, disturbing memories, negative emotions and he associated the negative trauma to himself which created a sense of self hatred. It got to the point where Angelo could not find a way out of his own prison and the only solution was death. Angelo displayed numerous symptoms of post-traumatic stress disorder.
Did soldiers in the American Civil War suffer from psychological effects and disorders? Through revolutionary weaponry developments, horrific medical procedures, psychological warfare, and the great deal of ferocious hand to hand combat, there appears to be a great deal of evidence for psychological effects in civil war soldiers. The Crapsey, Minor and Frank case studies provide significant evidence of psychological disorders as a result of Civil War combat. With this body of evidence the question can be definitively answered; psychological disorders are present in soldiers of the Civil War as a result of combat and or its attributing factors. Without a shadow of a doubt the Civil War psychologically scarred and damaged its soldiers. Those brave men put their “sacrifices upon the altar of freedom” and endured a fate worse than death by living their lives in silent suffering. The presence of psychological effects and disorders are evident in the soldiers of the American Civil War.


Attorney, family wish troubled veteran had received help sooner

By Henry A. Barrios / The Californian Tim Birdsong, pictured, who himself struggled with PTSD after serving in the Vietnam War, is convinced his son-in-law, Steven Cordova, needed similar treatment to overcome the problems he faced upon his return home from Kuwait.

By Henry A. Barrios / The Californian
Tim Birdsong, pictured, who himself struggled with PTSD after serving in the Vietnam War, is convinced his son-in-law, Steven Cordova, needed similar treatment to overcome the problems he faced upon his return home from Kuwait.

BY JASON KOTOWSKI Californian staff writer

Steven Cordova rose to the rank of lieutenant in the California Department of Corrections and Rehabilitation, and served in the U.S. Navy and later with the U.S. Army Reserve in Kuwait. He never had trouble with law enforcement until the day last November he told his family to leave the house and held a gun to his head.

A standoff with Kern County sheriff’s deputies ensued. Both Cordova and deputies fired shots.

Cordova, 40, was eventually taken into custody and charged with four felonies, including assault with a gun on a peace officer. Bail was set at $185,000.

He was released from Lerdo Jail after about three months. He received counseling and attended court hearings.

His attorney filed a request for Cordova to be admitted to the National Center for PTSD in Palo Alto. Cordova never made it.

He killed himself March 7.

Cordova became a statistic, one of the 22 veterans committing suicide across the country each day, according to U.S. Department of Veterans Affairs figures. Now, his family and attorney are hoping others who return from war and are suffering can get help before they lose hope.

A 2008 study done by the RAND Corp. found that 18.5 percent of U.S. service members who returned from Afghanistan and Iraq have post-traumatic stress disorder or depression. About half who need treatment seek it, but only slightly more than half of those who received treatment got minimally adequate care, according to the study.

California Penal Code 1170.9 allows the court to provide treatment instead of incarceration for veterans who suffer from PTSD, substance abuse, mental health problems and other issues as a result of serving in the U.S. military. It encourages treatment as early as possible.

Randall Dickow, administrator of Kern County’s Indigent Defense Program and an Air Force veteran, helped start a local veterans justice program about two years ago, and he said to date at least 100 people have gone through it. The program’s mission is to divert PTSD-suffering vets from the criminal justice system to a treatment program.

If a defendant is found eligible for the program, his attorney can submit a report to the court that outlines the available services he might obtain. The attorney can then argue for sentence mitigation, probation or diversion, whichever best fits each particular case.

Dickow said at least two other veterans have killed themselves in Kern County in the past 18 months after being charged with crimes. He said he could not name the men because of confidentiality issues.

Troubled by the war

Tim Birdsong will never know if the program would have been a good fit for his son-in-law, or if it would have spared him a felony conviction. He wishes Cordova hadn’t given up.

The man Birdsong knew for 18 years was a caring husband and father who often took the kids to the park to play games. Cordova and his children swam together, and he was involved with their school sports.

Evelyn Sprouse, Cordova’s grandmother, said he was “very good” with animals and especially had a soft spot for dogs. He was a talented photographer who snapped numerous photos of his wife and daughters.

“He took a picture of his youngest girl, all black and white except a bright red rose she held by her chest,” Sprouse said.

Cordova enlisted in the U.S. Navy following graduation from Taft Union High School. And, years later, he enlisted in the U.S. Army Reserve after 9/11.

“I guess he felt a duty to his country,” Birdsong said.

Cordova’s reserve unit was eventually activated, and he spent a year in Kuwait. The man who returned was not the same man Birdsong knew.

Formerly outgoing, Cordova was now aloof. He didn’t talk to anyone unless they spoke to him first. He’d come home from work and just sit in the corner, watching TV.

Cordova drank heavily the day of Nov. 10. Then he began calling his daughters, and his comments caused them so much concern they went home to him.

He pulled out a gun and told his family to leave. He planned on killing himself, he said. One of the daughters called 911, and deputies soon arrived. What happened next is under dispute.

Birdsong said Cordova fired his gun only at the interior walls of the house during the standoff, never aiming or intending to shoot at deputies. But deputies said in a news release that Cordova opened the front door and fired several shots at them. SWAT responded, and deputies said Cordova continued firing at them from inside his home.

Nearby residences were evacuated and traffic on Highway 33 between Cloud and Derby avenues was diverted.

More than 21/2 hours after the incident began, Cordova left the house armed with an assault rifle and handgun, deputies said. Deputies opened fire and hit him in the hand. Cordova was treated at a hospital and then taken to jail.

Prosecutors charged him with recklessly discharging a gun, assault with a gun on a peace officer, threatening with the intent to terrorize and exhibiting a gun to resist arrest. Cordova spent the next three months incarcerated, crying much of the time.

David A. Torres, Cordova’s attorney, said Cordova “cried profusely” at least three or four times when he visited him. Torres said Cordova was remorseful for what happened, for what he’d put his wife and children through.

It became the family’s mission to get Cordova out of jail so he could be evaluated for PTSD and receive treatment. Torres, a veteran himself, lobbied for Cordova’s release so he could be examined.

They were successful. Cordova was taken to the Bakersfield VA Clinic. He filled out paperwork and was examined by doctors. A psychiatrist diagnosed him as suffering from PTSD.

Prosecutors offered him a six-year sentence if he pleaded no contest to assault with a gun on a peace officer. Or, he could get out in four years and eight months but would have two strikes on his record if he pleaded no contest to that charge and recklessly discharging a gun.

Cordova faced as much as 20 years and four months in prison if convicted of all charges.

Chief Deputy District Attorney Mark Pafford said the DA’s office generally doesn’t consider a defendant’s status as a veteran at the time they file charges. Judges, however, can consider a veteran’s PTSD diagnosis and determine whether they’d be a good fit for a program instead of jail, or maybe a program following some time in custody.

In some cases, Torres said, prosecutors may consider a veteran violent and a threat to society because of the type of offenses they’ve allegedly committed.

Veterans who are charged with a crime are “not all … given consideration for the veterans justice program,” he said.

Birdsong said Cordova, a correctional officer who knew in detail what an inmate’s life is like, couldn’t fathom spending years behind bars. Instead, he overdosed on prescription medication he’d been given to address his PTSD issues.

If anyone could understand what Cordova was going through, it was Birdsong. He wishes Cordova had revealed what pressures or demons were gnawing at him before choosing the overdose as his escape.

Birdsong knows those demons well; Cordova’s path was one he himself could have followed after returning home from Vietnam.


Birdsong remembers when his sleep first became troubled. He was 21 years old and reliving the horrors of his combat experience in Vietnam in 1967.

He was first haunted remembering when his company was loaded into helicopters for an assault on North Vietnamese Army forces. His company was flown to one side of a river, while another company landed on the opposite side.

The NVA soldiers were trapped on the riverbank between the two sides. Huey gunships kept the NVA contained while the American soldiers swept the riverbank, ultimately killing more than a hundred enemy soldiers.

“As we swept (through) we just kept killing the NVA, and there was just a lot of bodies,” Birdsong said.

The nightmares began soon after.

Upon his discharge, Birdsong returned home to Taft. He got a job at a bank, and was transferred to Porterville, Barstow and San Diego in different capacities with the company.

Something was always off. The pressures of the job easily got to him, and his home life — he’d since married — wasn’t good. He quit the bank.

“I had no idea what I was going through,” Birdsong said.

He didn’t start to get to the root of the problem until 1994, when he met a veterans’ advocate in Bakersfield who persuaded him to see a psychologist. Birdsong was diagnosed with PTSD and began attending a weekly support group.

“I can deal with this a lot better now,” he said.

Birdsong is convinced his son-in-law needed similar treatment to overcome the problems he faced upon his return home from Kuwait. He said Cordova wasn’t a bad person, just a troubled one.

“He often looked at me and said, ‘I’m not a criminal,'” Birdsong said.

Ending it all by their own hand: Corps probes Marine suicides

Sgt. Martin Scahill and his wife Genevieve Scahill are pictured in this family photograph. (Courtesy of Genevieve Scahill)

Sgt. Martin Scahill and his wife Genevieve Scahill are pictured in this family photograph. (Courtesy of Genevieve Scahill)

By: Brett Kelman and Drew Schmenner
The (Palm Springs, Calif.) Desert Sun

As the sun rose over the sleepy desert town of Yucca Valley, Sgt. Martin Francis Scahill stood in his backyard, a black 12-gauge shotgun pressed against his chin, a single shell in the chamber.

After contemplating suicide for months, Scahill pulled the trigger. His body fell backwards onto the ground, the shotgun landing between his legs.

It was 6:30 a.m., April 5, 2010, the day after Easter Sunday. Blood seeped into the sand.

Forty-five minutes later, two deputies from the San Bernardino County Sheriff’s Department rang the doorbell at the Scahill home, waking his wife, who was asleep on the couch. Together, they found the body in the backyard. Scahill’s belongings were scattered around his bedroom.

A laptop was left open, lingering on an image of his infant daughter, Emma. A gun box was open with a revolver inside, unloaded. A box of shotgun shells sat on a nightstand, one shell missing. A notepad rested on the bed, covered with messages his wife scribbled during an argument the night before.

“I loved you.”

“I want to separate.”

Scahill, 25, was a man desperate for help he could not find. Alcohol abuse had strained his marriage and threatened his job, but he continued to drink, bragging about downing 18 beers or a half-gallon of whiskey every night. Scahill’s family had a history of suicide, but when he threatened to take his own life he was never taken seriously.

Five weeks after Scahill shot himself, a military investigation of his suicide would contradict itself, reporting that the Marine’s death was both unsurprising and yet impossible to foresee.

The investigation report, which was partially redacted by the military, said Scahill did not demonstrate any suicidal warning signs before his death, and that any indications of his intentions were either “too subtle” or “masked by his morose sense of humor.”

However, the same report said that Scahill’s suicide did not come as a shock to his immediate family. To them, suicide was “not a matter of if, but when,” the report said.

Scahill is one of at least 16 service members — 15 Marines, and one sailor — who committed suicide from 2007 to 2012 while at the Marine Corps Air Ground Combat Center in Twentynine Palms. That tally does not include one Marine from the Combat Center who killed himself while deployed to Iraq in 2008.

The military has not yet released base-specific suicide data from 2013. A Combat Center spokesman said he could not confirm how many Marines had killed themselves at the base last year because he could not speak for the multiple battalions that operate at the base.

Even with incomplete statistics, suicide is the second leading cause of death for Marines in this desert, with a death toll surpassed only by vehicle deaths, according to a yearlong investigation by The Desert Sun. The dual crises of crashes and suicide are compounded by alcohol abuse, and together, speed, depression and booze make the peaceful deserts of Southern California as dangerous as a war zone.

Since 2007, there have been 60 combat deaths of Twentynine Palms service members. During the same time period, at least 64 Marines and sailors have died non-hostile deaths while either stationed or training at the Twentynine Palms base.

The Desert Sun investigation found that, although Marines at Twentynine Palms are no more likely to take their own lives than Marines at other bases, they are twice as likely to be under the influence of alcohol at the time of their suicide. About half of the Marines who killed themselves while at the Twentynine Palms Combat Center had used alcohol, according to a review of reports from police, coroners and the military. Throughout the entire Marine Corps, only about one-quarter of suicides are confirmed to be alcohol-related.

From 2007 to 2012, both the Twentynine Palms Combat Center and the Marine Corps as a whole averaged an annual suicide rate of 19 deaths per 100,000 troops. According to the American Association of Suicidology, the overall U.S. suicide rate is about 12 deaths per 100,000 people. This rate doesn’t statistically compare to the Marine Corps because 95 percent of Marines are men, who are four times more likely to commit suicide than women. The Marine Corps argues that if the civilian suicide rate is adjusted for Marine demographics, it would equal 22 deaths per 100,000.

Pvt. Kythe Yund is pictured with his wife, Stephanie, in this family photo. (Courtesy of Karin Varner)

Pvt. Kythe Yund is pictured with his wife, Stephanie, in this family photo. (Courtesy of Karin Varner)

A growing crisis

The military first recognized its suicide crisis in the mid- to late 1990s, when each military branch launched its own prevention programs. In 1999, the U.S. Department of Defense created the Suicide Prevention and Risk Reduction Committee, which formalized how suicides and suicide attempts were reported.

Despite the creation of prevention programs, the rate of military suicide rose over the next decade, climbing from 10.3 suicides per 100,000 military members in 2001 to 18.03 suicides per 100,000 military members in 2011.

In 2010, suicide supplanted transportation accidents as the leading cause of non-combat death in the military, according to a 2012 Armed Forces Health Surveillance Center report.

In 2012, military suicides reached a record 351, surpassing the number of troops who died in Afghanistan that year. Forty-eight of those deaths were Marines.

Another 45 Marines killed themselves in 2013.

Both former Secretary of Defense Leon Panetta and current Secretary of Defense Chuck Hagel have said that military suicides are among the most frustrating problems they’ve encountered. Panetta said in 2012 that military suicides were on the rise “despite increased efforts and attention” from both the defense department and the Department of Veterans Affairs. Last year, Hagel stressed that suicide prevention programs are so critical that they should be immune to wide-sweeping military budget cuts.

The Marine Corps operates a host of initiatives as part of its suicide prevention program, and base services include counselors, medical personnel and a 24-hour suicide helpline. In 2009, the Marines started annual suicide prevention training for non-commissioned officers, called “Never Leave a Marine Behind.” In 2011, the training expanded to include all Marines. In 2012, a new order required every battalion and squadron to appoint a suicide prevention officer.

But the existing efforts aren’t enough, according to the Department of Defense Suicide Prevention Task Force, a group of experts that spent two years studying suicide in the military. In 2010, a task force report found suicide prevention efforts were hampered by a troubling lack of communication on military bases. Commanders, clinicians and counselors weren’t talking about Marines who were at risk of suicide, and when they did talk, their conversations were stymied by medical privacy laws, which were often “misunderstood and over-interpreted,” the report said.

A year after the task force report was released, the Marine Corps launched its Force Preservation Council program on every base, encouraging battalion leaders and social support officials to share information about Marines who may be suicidal. In Twentynine Palms, the councils meet monthly.

“If there are Marines who are facing challenges in their lives, there are people that may have pockets of information,” said Lt. Col. Michael A. Bowers, commanding officer of the base’s headquarters battalion. “We want to make sure that everyone does have that information … and there are no gaps in what we know.”

One year after the council formed, the Marine Corps expanded its reach, launching a mandatory mentoring program at all bases, including in Twentynine Palms. Under this program, each Marine is required to meet monthly with a mentor — like a platoon commander or sergeant — to discuss life in the Marine Corps. Mentors use these meetings to look for six signs of trouble: disciplinary problems, relationship turmoil, substance abuse, money problems, mental health and social withdrawal.

If a mentor decides that one of his Marines is struggling, he can send the case up the chain of command, where battalion commanders use the council to connect with support services. Bowers believes the program is effective if Marines know the aim of the council and mentors is preventive, not punitive.

“They know they’re not going to the principal’s office to get scolded,” he said. “They actually know there are a lot of professional people caring about them and trying to get them back on track.”

The Marine Corps launched an in-depth study of suicide victims after the task force in 2010 said the military makes an admirable effort to record deaths, but not enough to understand suicide. Currently, suicide data is compiled into the Department of Defense Suicide Event Report (DoDSER), but the report offers only a superficial understanding of the suicide crisis.

“It’s inadequate on a whole bunch of levels,” said Dr. Alan Berman, a member of the suicide prevention task force. “Most profoundly, methodologically, (the DoDSER) relies on a single interview, oftentimes with somebody who didn’t observe the decedent in the days prior to death.”

Berman is executive director of the American Association of Suicidology, the organization hired to examine how Marines who committed suicide acted during their final days and weeks. They hope to discover a common “trajectory toward death” and early warning signs that could save others, Berman said.

The organization has begun psychological autopsies of Marines who died of suicide from 2010 to 2012. The results of the study should be out in May or June, Berman said.

Tragic end to the spiral

One of the Marines in the study is Pvt. Kythe K. Yund, a Twentynine Palms Marine who shot himself in Joshua Tree on June 17, 2011, the day before his 22nd birthday. Researchers from the American Association of Suicidology interviewed Yund’s mother, Karin Varner, for 90 minutes, starting the examination with Yund’s childhood.

“If it helps save another parent from losing their child,” Varner said, “I will do whatever it takes to even just help one family not have to go through it.”

Yund was a quiet child whose parents divorced when he was 3. There was a history of suicide on his father’s side of the family, and when Yund was in high school, he attempted to kill himself by overdosing on painkillers at his father’s home in Washington, his mother said.

This suicide attempt should have disqualified Yund from military enlistment, so it is unclear how he managed to join the Marines. A recent Harvard University study suggests that recruitment screening is far from perfect. About half of Army soldiers who attempt suicide while in the service admit to prior attempts before they enlisted, the study said.

Yund enlisted in the Marines Corps in November 2007, then was assigned to the 1st Battalion, 7th Marine Regiment in Twentynine Palms as a rifleman. While deployed to Iraq in 2009, Yund witnessed one of his friends die from a gunshot to the head. He returned home early from Iraq because his wife, Stephanie, almost died after giving birth to their daughter, Kyndel.

Stephanie lapsed into a coma and suffered short-term memory loss after gaining consciousness.

Back home, Yund drank heavily and abused drugs. He was punished for using cocaine, demoted from lance corporal to private. Unnerved by Yund’s behavior, his wife returned to her home in Illinois with Kyndel. The couple eventually started divorce proceedings.

On the day Yund killed himself, he was scheduled to meet with his superiors about another disciplinary matter, which could have led to another demotion. Varner believes the shame of another punishment, and the embarrassment it may have caused his wife and daughter, triggered her son’s suicide.

On a Friday about 5:42 a.m., Yund shot himself with a 12-gauge shotgun in his bedroom.

His roommates told police that Yund had spent the night before at home, drinking a little, but did not seem upset. At the time of his death, Yund’s blood-alcohol content was .03.

Varner spoke to her son for the last time five days beforehand. He called her on the phone, sounding more relaxed and hopeful. He was leaving the Marine Corps in about a month, and was anxious to move to Illinois to try to reconcile with his wife.

Yund also asked his mother to research counseling options in Illinois. He wanted help, but had avoided counseling in the Marine Corps after his fellow Marines mocked him.

“Some of the other mothers I’ve talked to have gone through the same thing with their child,” Varner said. “They would go ask for help through the Army, Marine Corps, whatever, and their child would be ostracized later because of it, so that’s why a lot of them didn’t go seek help.”

This refrain is common for family members of suicide victims, said Kim Ruocco, manager of suicide outreach for the Tragedy Assistance Program For Survivors (TAPS), a Virginia group that helps the family members of deceased military members.

If the military truly wants to combat suicide within its ranks, it must destigmatize counseling and prioritize the importance of mental health, Ruocco said.

“If you were sprayed by poisonous gas, you wouldn’t expect to just suck it up,” Ruocco said. “If you broke your leg … you wouldn’t expect to just keep going until it was infected. You’d get immediate, comprehensive care and get back on the battlefield. That’s the way we’ve got to start thinking about behavioral health.”

Ruocco said it is especially hard to reach out to Marines, a proud group tied close to the rough and tough identity of the Marine Corps. She speaks from experience — her husband, Maj. John Ruocco, an accomplished Marine helicopter pilot, killed himself in 2005.

John Ruocco had battled depression since the mid-1990s, when two helicopters collided during a training exercise, killing several of his friends. A memorial service was held for the fallen men, but within Ruocco’s squadron, discussion of the crash was taboo. He suffered in silence for a decade, eventually hanging himself in a hotel room near Camp Pendleton, a Marine base in San Diego County.

“When it happened to me, when my husband died by suicide, I remember saying: ‘I didn’t even see it coming,’ ” Ruocco said. “But then as I got over the shock and the grief, and I looked back, I thought ‘Wow there were many times within his life span and his career where he had trauma or loss. … We should have gotten help way back when. I think pretty much every survivor I’ve talked to says that.”

A rattled mind

After five months together, Cpl. Richard McShan and his girlfriend were struggling with trust. It was the evening of March 29, 2009, and they had each had a few drinks at a bowling alley in Twentynine Palms. Sometime after midnight, when they returned to her apartment on Bagley Street, she caught him snooping through her text messages.

McShan apologized, but she demanded he leave. The Marine went outside to load his clothes into his car, prepared to leave, at least for the night.

“You can’t forgive me, can you?” McShan asked.

“Not right now,” his girlfriend said.

Furious, she stormed back inside, leaving the Marine alone in the driveway, standing between their cars.

Seconds later, she heard the gunshots.

McShan had pressed a 40-caliber handgun against the right-rear of his skull, squeezing the trigger twice. He fell backwards, somehow still alive, the gun clattering onto the ground near his feet.

An ambulance rushed McShan to the Hi-Desert Medical Center in Joshua Tree, where he was hooked to a ventilator. Two hours later, as the sun rose, a helicopter flew the comatose Marine to Desert Regional Medical Center in Palm Springs. Doctors there said McShan had no hope of recovery.

Two days later, at the request of his family, medical staff turned off McShan’s ventilator, letting him slip away. He was pronounced dead at 2 a.m. on April 1, 2009.

McShan, 23, the son of a 20-year Army veteran, was born in Germany but grew up in Colorado Springs, playing trumpet and football at his high school. He joined the Marine Corps shortly after graduation, Sept. 11, 2005. He was stationed in Twentynine Palms with the 2nd Battalion, 7th Marine Regiment, deploying once each to Iraq and Afghanistan.

McShan came back from those deployments haunted by nightmares, his girlfriend told authorities. She also said that McShan had told her he had attempted to shoot himself once before, but was saved when the gun misfired.

But to Paul McShan, the father of yet another dead Marine, this suicide didn’t compute. His son Ricky had been a happy young man, brimming with competitive spirit, who loved being a Marine.

There had to be more to this story, the grieving father thought.

“I started digging and digging and digging, trying to find out why,” Paul McShan said. “We discovered that he had at least four concussions and one where he was blown out the top of a Humvee. His shoulder was dislocated and he was knocked out for three or four minutes. So my conclusion after all that digging was that his brain short-circuited.”

This theory is backed up by a growing body of evidence. In recent years, scientists have discovered a strong link between concussions and suicide, a possible explanation for the disconcertingly high suicide rate in the military.

In 2013, a study released by the National Center for Veterans Studies at the University of Utah said that military personnel were significantly more likely to report suicidal thoughts if they had suffered at least one traumatic brain injury. The study surveyed 161 service members, many of whom had been injured in Iraq.

Of the service members who had not suffered brain injuries, zero percent reported suicidal thoughts, the study said. Of those who suffered one, 7 percent reported suicidal thoughts. Of those who suffered more than one brain injury, 22 percent reported suicidal thoughts.

“Up to now, no one has been able to say if multiple (traumatic brain injuries), which are common among combat veterans, are associated with higher suicide risk or not,” said Craig J. Bryan, assistant professor of psychology at the University of Utah, who led the study. “This study suggests they are …”

Researchers believe that concussions and brain injury increase the likelihood of suicide through a neurodegenerative disease called chronic traumatic encephalopathy, or “CTE.” Symptoms of CTE include irritability, memory loss, dementia and suicidal tendencies.

In 2012, a study from the Boston University found evidence of CTE in the brains of four military veterans, each with a history of traumatic brain disorder. Three of the veterans had been exposed to explosions during deployment. The fourth, a 28-year-old with post traumatic stress disorder, had suffered four concussions caused by a bicycle accident, a football collision, a military incident and a vehicle accident. Two years after his last concussion, the veteran committed suicide by shooting himself.

According to the study, the veterans’ brains were indistinguishable from those of many professional football players, a group that has been studied more extensively, showing a strong link between head injuries, CTE and suicide. The Boston researchers have found CTE in the brains of dozens of football players, both at the college and professional levels, including some that have killed themselves.

Brain injuries also double the odds that military service members will develop post traumatic stress disorder, which further increases the risk of suicide. A new study, published in December, examined 1,648 Marines and sailors that had recently returned from deployment. About half of them were stationed in Twentynine Palms, said Dr. Dewleen Baker, a psychiatrist at a Veterans Affairs center in San Diego who co-authored the study.

Baker said the study has established a strong link between brain injuries and PTSD, but researchers still don’t understand how one causes the other. It is possible that both brain injuries and PTSD spring from similar traumatic events, like bomb blasts, but also possible that concussive injuries make it more difficult for the brain to recover from emotional hardship, Baker said.

Either way, links to PTSD and CTE have uncovered the true long-term danger of brain injuries, a field of study that was once ignored. High-tech imaging can be used to visualize brain injuries better than ever before, and with the right tools, researchers can even “see” PTSD, a once-hidden condition now revealed as over-activity of the amygdala, a portion of the brain that deals with excitement and fear.

Today, brain injuries stand on a precipice where other conditions have stood before, ready and waiting to be better understood, Baker said.

“My analogy is that in the ’40s and ’50s, we didn’t really understand heart attacks,” Baker said. “Nobody understood the details, and so there was a lot of treatment that didn’t happen when someone had a heart attack. They would put people in a room and have them rest and hope they got better. But when we began to research and image the heart, and find ways to test the heart, we found many ways to fix and prevent the damage. And now we are in the early stage of this kind of understanding in regard to head injuries.”

Alcohol abuse in the ranks

Of the 15 Marines who killed themselves while at Twentynine Palms from 2007 to 2012, seven, or 46 percent, had alcohol in their system. That’s nearly double the percentage reported throughout the Marine Corps, according to a four-year average compiled from DoDSER statistics.

As suicide rates have climbed in the military, so has drinking. From 1998 to 2008, the share of service members who were binge drinkers increased from 35 to 47 percent, and the number of heavy drinkers rose from 15 to 20 percent, according to a 2012 report from the Institute of Medicine, a nongovernmental agency under the National Academy of Sciences. Binge drinking and heavy drinking were more prevalent in the Marine Corps than other military branches.

In December 2012, the Marine Corps launched a random alcohol screening program, becoming the first military branch to do so. The rules were also the strictest: Twice a year, Marines must be given Breathalyzer tests while on duty, and they can be referred to substance abuse counseling at even the slightest hint of alcohol. Commanders can send a Marine to counseling if they have a blood-alcohol content of .01 — which could be triggered by a single beer. If the Marine has a blood alcohol content of .04, their fitness for duty can be challenged.

Since October, more than 1,000 Marines from the Twentynine Palms Combat Center’s headquarters battalion have been screened for alcohol while on duty. Only one was sent to substance abuse counseling after testing positive, said Capt. Justin Smith, a base spokesman. Smith said he could not release results for the other battalions at the base.

If an alcohol screening program like this had existed just two years earlier, it might have saved Sgt. Scahill, the Marine who shot himself in his backyard in Yucca Valley.

At the time of his death, Scahill had a blood alcohol content of .08. It is unclear if he drank that morning or was still drunk from the night before, but neither would have been out of character for Scahill, whose long battle with alcohol predated his job and his marriage.

Back in 2007, after returning from his second deployment to Iraq, Scahill confessed to drinking 18 beers a night during a post-deployment health assessment. Scahill repeated this admission to medical personnel at least four more times over the next year, according to a military investigation.

Although Scahill had reported “excessive drinking,” he was never required to go to substance abuse counseling. Because he had not been involved in an “alcohol-related incident” during his service, he was never obligated to get help for his problem, according to the investigation.

Scahill’s drinking continued after he married his wife in November 2008, immediately after returning from his third deployment to Iraq. In 2009, Scahill joined the tank battalion at Twentynine Palms, where his alcohol abuse was no secret. According to interviews with fellow Marines, included in the military investigation, Scahill would drink excessively during his off-duty hours, drinking exclusively for the purpose of getting blackout drunk. He frequently came to work hung over or smelling of alcohol, and showed up for work drunk at least twice, according to the report. His fellow Marines hid his abuse from his superiors, trying to protect his career while ultimately enabling his addiction.

Scahill’s drinking was a problem at home, too. On the day before his suicide, Scahill got in a drunken argument with his wife, Genevieve, who accused him of texting an ex-girlfriend. By the evening, Scahill was so drunk that his wife refused to allow him to hold their 11-month old daughter. Furious, Genevieve slept on the couch.

Early the following morning, she woke up her husband, sending him to physical training at the Marine base. Before he left, she told him she was tired of his drinking and wanted to go to her mother’s house in Los Angeles. It was an empty threat.

Scahill left for training but returned soon after, insisting that physical training had been canceled. As he walked into their daughter’s room, Genevieve fell back asleep.

The gunshot didn’t wake her.

“I still blame myself a little bit. I wish I had seen the signs,” Genevieve said during an interview with The Desert Sun. “I wish I would have gotten off of that couch and followed him.”

Although Scahill didn’t leave a suicide note, he did send a text message to some of his fellow Marines, perhaps a final cry for help.

“Hey man, I’m not coming to work today,” the text said, according to a military investigation report. “I’m going to blow my f—ing brains out.”

Another Marine, who assumed Scahill was joking, wrote back: “GTG,” military slang for “good to go.”

The message prompted a commanding officer to call police, sending the deputies to Scahill’s door.

Genevieve said her husband’s suicide first came as a shock, but in hindsight, the clues of his looming death were everywhere.

Both Scahill’s father and grandmother had killed themselves. Scahill had once told his wife that his father told him the only good way to commit suicide was to shoot yourself in the head.

One night, when Genevieve was pregnant, a drunken Scahill said he sometimes heard a voice that told him he was no good and that people would be better off without him. He denied it the following morning.

Later, only a few weeks before he died, Scahill showed off two guns to some of his friends. Upset at their rowdy behavior, Genevieve confronted them, telling her husband to put the guns away. He responded by pulling the trigger on an unloaded shotgun, saying, “You don’t care what I do?”

Scahill bought that shotgun — which he would later use to kill himself — about two months before his death. According to the military investigation report, Scahill would joke to his fellow Marines that he might accidentally shoot himself while cleaning the gun.

In January 2010, while attending a suicide prevention course at the Marine base, Scahill protested, insisting that “if someone is going to do it, they’re going to do it.”

Scahill had the numbers “5150” tattooed on his right forearm — a reference to the section of California law that deals with people with mental health issues who are a threat to themselves or others. Scahill had confirmed the meaning of the tattoo during chats with other Marines.

Finally, the most terrifying clue was also the most cryptic. After Scahill was gone, his wife found one of his books, arrows drawn in the corners of the pages. At first, the scribbling seemed undecipherable. However, when she flipped through the pages with her thumb, she discovered the drawings were a flip book, a rudimentary cartoon where stick figures played out a gruesome suicide scene.

Genevieve had seen this before. It was the same scene she and deputies had found in the backyard.

“The stick figure man was him waving goodbye to everybody. He took a gun, he put it under his chin,” Genevieve said. “The cartoon was everything exactly what I saw. He followed the cartoon.”

How to know the signs of TBI


WIESBADEN, Germany — Blurry vision, dizziness, mood swings, sleep problems and memory problems: these are all symptoms of traumatic brain injuries, or TBIs, and can last from a few days to a lifetime, depending on the treatment and severity.

March is Brain Injury Awareness Month. A brain injury can happen anytime, anywhere, to anyone. Brain injuries do not discriminate. Approximately 2.4 million people sustain brain injuries in the United States each year. An injury that happens in an instant can bring a lifetime of physical, cognitive, and behavioral challenges.

“It’s a multi-system dysfunction that also affects the family,” said Col. Debra McNamara, optometrist and TBI specialist at the Wiesbaden Army Health Clinic. “The quicker you get treatment, the quicker Soldiers and their families rehabilitate.”

A brain injury can affect a person physically and psychologically, and sometimes the symptoms-like memory problems or emotional and behavioral changes – don’t appear immediately. Everyone in the family is affected by TBI and changes in relationships, behavior, finances and social life can add stress to family life.

For example, if a child isn’t sleeping well, he or she will be sleepy in school and grades might slip, causing stress for the child and his or her parents. Early and adequate access to care will greatly increase overall quality of life for the patient as well as the family members, who play an important role in the care and rehabilitation of individuals with TBIs.

Vision therapy is an integral part of treatment for post trauma vision syndrome, a problem of up to 75 percent of people with a TBI experience. Brain swelling can disrupt ocular motor nerves in the brain, preventing eyes from moving in the same direction at the same time.

When this happens, patients will often tilt their head to avoid seeing double, sending poor information to the vestibular system. The result is poor balance, dizziness and headaches.

Post trauma vision syndrome is often overlooked. Until the vision problems are treated, patients may find reading, computer work, driving and shooting difficult. They might see perfectly with one eye, but not so well with both.

“People will tell me, ‘I thought I was crazy — I didn’t know how to explain something was wrong with my vision,'” recounted McNamara.

Most of the time, the problem can be fixed with a pair of glasses, prism and/or vision training. Some of the near-focusing problems resolve after systemic medications are discontinued. Headaches also will disappear.

“Alleviating vision problems significantly improves quality of life, so optometry is a rewarding role to play in TBI rehabilitation,” she said.

Other common problems associated with mild TBI include changes in sleep, mood, energy, behavioral and cognitive patterns.

During the height of combat, the numbers of service members who experienced a TBI increased by approximately 10,000 per quarter and the majority of these (80 to 85 percent) have been classified as mild TBI, or mTBI. Although most patients with mTBI recover completely within three months of injury, some patients experience persistent symptoms and have trouble rehabilitating, particularly when they have co-occurring conditions, like Post-Traumatic Stress Disorder — or suffer another TBI soon after.

As the war winds down, most new TBIs result from fights and ski, bicycle, and other sports accidents.

“If you take a fall and hit your head while snowboarding and end up with a headache, the worst thing you can do is get back on the board and risk taking another fall on the slopes,” said McNamara.

Brains need darkness and rest. In Afghanistan, she said, TBI patients would rest in “TBI tents” for up to 72 hours to let their brains heal.

The Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury Information & Referral hotline (1-800-273-8255) is staffed 24 hours/day, every day of the year, as is the Crisis Intervention line (1-866-966-1020). Visit the Defense and Veterans Brain Injury Center (DVBIC) online at or for more information.

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