Thursday, November 13, 2008

PTSD & the Criminal Justice System

There are a growing number of Veterans with PTSD (Post Traumatic Stress Disorder) that are entering the criminal justice system. Some say PTSD is merely being used as an "excuse" for people who make bad choices and don't want to be punished. Others recognize PTSD as a real, medical issue which, without proper treatment, can spiral out of control. I fall into that last category... and my position has been strengthened this week with knowledge of a sad situation now faced by one of our OIF Veterans and his family.

Because this case is currently being prepared for trial, I am changing the Veterans name and some of the details. For the purposes of this story, we'll call the Veteran "Hero Doe".

Hero Doe has a long, well-documented history of struggles with PTSD. Despite this disease, however, he is well-loved and respected by his family and friends. He has also been a "squeaky clean" citizen and had absolutely no criminal record... at least not until one hot summer morning. On that morning, he "broke" and long story short ended up in a gun battle with local law enforcement agents in which one officer and Hero himself were wounded.

Shortly before the incident, Hero had gone to see his mental health physician at the local VAMC (VA Medical Center) with numerous red flags that truly should have caused him to be kept for inpatient treatment. His complaints and pleas for help went unanswered. Instead, his prescription for Lorazepam (Ativan) was increased and he was sent home to "relax."

The day prior to the incident, Hero Doe exhibited signs of growing paranoia, including a flurry of almost nonsensical conversations. He was truly convinced that many in his household and surrounding community were "out to get him." He was more than out of sorts... he was desperately afraid of the storm building within his mind. He spent the day fearful, anxious, and headed toward a break down. His wife worried, as most would, but argued with herself... especially since his "qualified health professional" had said that all Hero needed was more drugs and less stress.

The next day, not long after being sent home from his VAMC, Hero woke and proceeded to initiate an unfounded argument with his wife. As the argument proceeded, he grabbed a loaded weapon and started shooting inside their home. His wife quickly fled outside and soon Hero followed. He continued shooting while dodging in and out of wooded areas and other places of "cover". He ducked and dodged... fully immersed in a fury of combat which resided only in his own mind. When the police arrived the battle continued until the officer and then Hero Doe were wounded.

Hero Doe has almost no memory of the entire event. He is now in jail awaiting trial on several felony counts and, if convicted, will spend the rest of his life in prison. He has been assigned a public defender with little knowledge of PTSD who has only seen his client twice in the months since he was assigned the case. The public defender has effectively dismissed the possibility of a PTSD-related defense... mostly because of his lack of knowledge or willingness to properly defend Hero... a person he sees only as a villain who went on a rampage.

Hero's wife (lets call her Loyal Doe), has struggled since his arrest to make sure her husband continue to receive proper medical care. Their family faces $50,000+ in medical bills and charges for property damage to surrounding structures. She has been left alone in a community of people who are ignorant of PTSD... some of whom say really kind things like "the cops should have turned him into dog meat," or "he should be taken out in the middle of no where and executed Hoffa style." Loyal has forced herself to keep going... to keep fighting... but her days are full of fear and longing. Her husband's service to his country has required a steep price.

I don't know if you are aware (I was not until we began helping this family), that Ativan carries with it warnings of violent behavior in people with existing psychiatric conditions as well as causing amnesia in many patients. There is a VA Staff Psychiatrist (Jonathan Shay) in Boston who even has Ativan listed under the "Things to Avoid" section of his article on PTSD medications for exactly this reason (http://www.dr-bob.org/tips/ptsd.html#Things%20to). Hero was also taking several, high-level steroids for conditions caused by an adverse reaction to immunizations he was given prior to deployment. Because of these medications, he is considered "steroid dependent" (thus a prime candidate for possible Steroid Psychosis). But, Hero could have been given Lithium to offset the likelihood of Steroid Psychosis.

It would seem that this tragedy, the breakdown of a hero with no criminal record, was caused not only by PTSD but the unmonitored use of prescription drugs.

So now - I challenge those who say PTSD-related defenses are simply an "excuse" to convince me that Hero Doe chose to be given too much of a bad medication... that he chose not to receive adequate care and intervention when he asked for it... that he chose to do something that would cause him to be separated from the family he loves (perhaps for the rest of his life).

But, I also challenge those of us who know better. We're dealing with an obviously broken system, one which is not prepared to properly treat our heroes. So, what will we do?? Will we stand by and let other Heroes be villianized and destroyed?? Or, will we reach out, stand up, and demand that Hero Doe and all others suffering from PTSD receive adequate, timely, top-notch care for the wounds they received while defending our country? And, that when their wounds cause them to enter the Criminal Justice system, they are provided the passionate, well-educated defense they deserve?

Thursday, November 6, 2008

PTSD Across the Generations...

It's funny the things that you suddenly see clearly at the oddest moments...

An older member of my husband's family who served in WWII as a Navy "Frogman" (the precursor to the Navy Seals), and his wife have always been talked about as being... let me put this kindly... shall we say eccentric? He follows a very set routine, hates to go new places, has met more than one family member at the door with a shotgun, and is angry and withdrawn most of the time. His wife is often forgetful and has become increasingly irate herself. They have a marriage that on its best day (at least to the outside world) seems strained and unkind. And, none of these attributes are new... they've lived a lifetime together (since the man's return from WWII) this way. And, unfortunately, their children (now grown) have been marred by the hostility, anxiety, and paranoia within their home.

I don't know why I suddenly had an "Ah-hah!" moment just a few days ago... even in typing this blog the answer seems obvious...

What is the answer?? This man, a Veteran hero, has been struggling with PTSD (Post Traumatic Stress Disorder) for most of his adult life. It's gone undiagnosed, untreated, and thus has been allowed to fester and spread throughout his entire family.

Of course, this isn't really his fault... at the end of WWII it wasn't acceptable to admit you were struggling with "Shell Shock". You (especially men) were expected to move on, get to work, care for you family, and keep going.

So, what can we, as part of the "new" generation of Veterans and families from OIF & OEF learn from this story?

#1 - Seeking treatment for PTSD isn't just about helping yourself... it's about safeguarding the hearts, minds and futures of your entire family.

#2 - The consequences of not providing diagnosis and treatment for the 300,000+ Veterans of the wars in Iraq & Afghanistan will be far reaching and will last for generations.

#3 - We are fortunate to live in a time when PTSD is something you can talk about. I'm not saying there isn't still a stigma attached at times... but it is at least a topic we can bring up & address.

#4 - If we want our marriages to be filled with love, kindness, and tenderness, we have to fight for them now. We can't let things sit & fester!

So, as the wife of a brave OIF Veteran who has stepped up and sought help in his struggles with "Beastie Boy" PTSD, I have to encourage you, our other returning heroes to do the same.

You have to choose not to let PTSD destroy you, your loved ones, and your future. Your wife, children, parents, etc., can only do so much. The steps to coping and healing are yours to take.

I'll leave you with a paraphrased quote from a friend over at The Veterans Benefits Network...

"PTSD is a sickness reserved only for survivors. It takes courage to survive and it takes courage to deal with PTSD."

So - take heart, dear hero - and get started in the journey to make the rest of your life all it is supposed to be!