Chapter five: Young vets put back the pieces in group therapy - Military News | News From Afghanistan, Iraq And Around The World - Military Times

Chapter five: Young vets put back the pieces in group therapy

PUEBLO, Colo. — Army Spc. Ashley Morris leaned low toward her notebook, her voice wavering as she read from it. “Amani,” she read. “I hear her name often in my dreams.”

Morris, 22, stumbled over the words. But sharing her painful memories with other young vets haunted by war helps her heal.

The beautiful, 10-year-old Amani had come to the Baghdad emergency room where Morris worked as a surgical tech. The young Iraqi girl had been set on fire — apparently by her own parents. The burns damaged the girl’s leg beyond saving.

“We see her muscle,” Morris read, her voice growing stronger. “It’s dead. I hand the doctor the saw and hold her leg. I hear a snap and feel my hands get heavier. I feel I am throwing away her innocence.”

Morris came home with anxiety and nightmares. Medication and other types of therapy and support programs did not work for her. While many cared for her, no one understood, really understood, the things she had seen. She grew increasingly despondent, then suicidal.

But in this room full of strangers at a new inpatient facility just for this generation’s war veterans, she finally found others who had been there.

At last, she had found hope.

Every time she tells her story, she said, “It feels like a weight is lifted off my chest.”

When she arrived here at Haven Behavioral War Heroes Hospital, she struggled, like most combat vets who have post-traumatic stress disorder, to do the work her injury required.

But at Haven, she is part of a new program that handles the military’s toughest PTSD cases among young veterans of the wars in Iraq and Afghanistan.

For service members with mental health issues, a common treatment scenario might be a week in a psychiatric emergency setting — along with military family members with schizophrenia, retired Vietnam veterans with 40-year-old cases of combat stress and newbie recruits freshly diagnosed with bipolar disorder.

But at Haven, Morris would spend almost a month amid only veterans of her generation who have been diagnosed with PTSD, and working with doctors and therapists who all have military backgrounds.

This kind of specific segregation is unusual for PTSD treatment, but retired Army Col. Harry Silsby, the program’s founder and leader, strongly believes in it.

“If you didn’t do anything else but put the soldiers together, that’s curative,” said Silsby, who served as an aviator and flight surgeon in Vietnam before a long career as a military psychologist.

The concept may seem like an obvious way to treat psychological injuries in combat veterans, but for the Veterans Affairs and Defense departments, resource constraints all too often demand a one-size-fits-all approach.

Realizing a dream

Until last summer, Haven existed only in Silsby’s mind as a dream of how best to take care of combat veterans such as himself; he sleeps in a separate room from his wife because his startle response is still so strong from his combat experience.

Until he launched Haven, he ran a geriatrics center in the same ward at St. Mary-Corwin Medical Center, often working with World War II veterans. That center was moved to Denver to make room for his new group of patients; Silsby then began to select a staff of veterans, military spouses and nurses.

Silsby built his program on evidence-based medicine: cognitive processing therapy, prolonged exposure therapy and individual psychotherapy, using guidelines from the National Center for Post-Traumatic Stress Disorder and Walter Reed Army Medical Center.

Then he went further, adding mandatory substance abuse classes alongside the PTSD treatment — just as experts in alcohol and drug abuse say must be done, because veterans with PTSD tend to self-medicate with drugs and alcohol.

In one recent class, Silsby asked how many of the patients had abused substances. Almost every hand went up.

Indeed, 70 percent of Haven patients abused alcohol or drugs as they tried to deal with PTSD. “We did after Vietnam, too,” Silsby told them. “We didn’t know what else to do. But you probably ended up feeling worse.”

He emphasizes that for their therapy to be effective, they must first get clean and stay clean.

Silsby also requires twice-daily physical training — he puts the troops on a bus and sends them to a gym to encourage interaction with people outside the hospital and to release endorphins, a group of brain chemicals that naturally reduce pain and stress.

And he educates them. In a warmly wallpapered classroom in the hospital, troops gather to learn about chemical changes in their bodies as a result of exposure to a traumatic event and how trauma affects some people more harshly than others, possibly because of previous difficult life events. Of those at Haven, as many as 90 percent faced some kind of abuse.

They learn how medications work: that the drugs may cause them to overeat, spark strange dreams - even cause suicidal thoughts. They learn that those drugs cannot treat PTSD as a “syndrome,” but they can treat symptoms — depression, sleeplessness and nightmares.

They learn PTSD can cause anger problems and memory loss, and that it often goes hand-in-hand with traumatic brain injury, which has been diagnosed in about half the patients at Haven.

They talk about survivor guilt, anger management, intimacy issues and relaxation techniques.

They learn that even if, like Silsby, they never completely erase their symptoms, they can control those symptoms and live happier lives.

Haven’s patients are all active-duty service members, mostly from nearby Fort Carson, but many come from Fort Leonard Wood, Mo., or Andrews Air Force Base, Md., where primary caregivers don’t have enough local mental health resources and are willing to use civilian resources.

Silsby’s crew hopes to create a similar center on the East Coast. Fort Bragg and Camp Lejeune in North Carolina “need help something bad,” said retired Army Command Sgt. Maj. Michael Munn, military liaison for Haven. He said those bases are looking for a facility to house the program.

The Pueblo facility has 23 beds for severe cases of PTSD, with a 1-to-5 ratio of staff to patients at all times — and a waiting list. Tricare pays for the treatment, and the doctors at Haven stay in close contact with the cadre at the Army’s Warrior Transition Units, where most of the troops are assigned.

Because Haven is so new, mental health experts are leery of judging it. But an internal study conducted by Silsby and his staff using a PTSD checklist from the American Psychiatric Association found that symptoms decline by an average of 30 percent by the time patients are discharged.

‘Something wasn’t right’

Army Spc. Andrew Trotto, 22, came to Haven after his third suicide try. A rocket-propelled grenade blast in Iraq left him with an undiagnosed traumatic brain injury.

He had 42 confirmed kills in the combat zone: “I’ve killed a ton of people,” he said. “I’ve seen little kids killed.”

He began hallucinating while in Iraq, he said — hearing things that weren’t there — and not sleeping. He was cutting himself, trying to match the inside pain with something real on the outside.

“I love doing what I do, but something wasn’t right,” he said. “I was hearing voices. I wanted to kill everyone in sight.”

After months of asking for help, he was sent to Fort Carson’s Warrior Transition Unit, but one hour a week with a counselor was not enough. He went to the Denver VA for counseling, but his group consisted mainly of Vietnam veterans.

“I’m 22 years old,” he said — young enough to be the grandson of his fellow patients. “That lasted about three months.”

Initially he feared the “lockdown” feeling of Haven, but he found himself welcomed and felt so comfortable that he extended his stay.

He wrote down his experiences and read them to the group. “It’s extremely hard talking about it, and I have nightmares, but the repetitiveness helps,” he said.

Weekend marriage counseling offered through Haven saved his relationship, he said, and he has learned to control his anger.

“I hate digging it up,” he said. “But getting it out helps. It’s going to take time. I’ll always have PTSD.”

For patients, such digging often comes about through tough love from “Dr. Evil” — the affectionate nickname bestowed on Haven staffer Carrin Harper, a former Air Force psychologist and flight commander.

“I was in a rut, and Dr. Harper told me to get my head out of my ass, so I did,” said Morris, the surgical tech.

Morris didn’t want to forget Amani, the little Iraqi girl who lost her leg. She wanted to remain angry at the Iraqi soldier who took up so many war-zone hospital resources and smelled like his bullet-riddled intestines, which she had to empty as part of his treatment. She clung to the pain created by 497 emergency cases in six months at the 10th Combat Support Hospital in Iraq.

Haven was her third cry for help, but the first two didn’t work. Until now, she said, she was so drugged that she lost her ability to think.

“I was getting counseling, but I don’t really remember it because I was a zombie,” she said.

She began to find her way back, Morris said, after asking her case manager whether she could try longer-term inpatient care at Haven.

There, she wrote down all the stories she could recall from Iraq, though she hadn’t written since being forced to in school. Like the others, at first she felt worse when she told her tales — especially about Amani.

And Morris wondered why, if she was working so hard, there were days when she felt worse.

“It gets worse before it gets better,” Harper said. “We’re scratching at it and we’re digging at it and it’s a big gaping hole. That’s a good thing.”

Bernadette Santistevan, Haven’s director of nursing, said patients help push each other. Those who have been there awhile reach out to the new arrivals to reassure them that the therapy will work — if they let it.

But the key, she said, remains Silsby, who sees every patient, every day.

“The fact that Harry has PTSD says everything,” she said. “They know he cares.”

Letting it all out

Harper has an open-door policy because she figures people will be more likely to talk if they come in while they’re thinking about a particular problem, rather than at an assigned time.

She said it’s important that they open up and deal with their bereavement and guilt and fear.

“They feel they’re dishonoring the deaths if they don’t carry the pain around,” Harper said. “You have to give them both: It’s OK to remember, but you don’t have to let it ruin your whole day.”

Before new patients arrive, Harper calls their commanders to learn about who they were before they were exposed to a traumatic event, and who they’ve become since. She calls her patients the “cream of the crop” because they’ve already shown they want to get better.

That decision, at least in part, comes with a commitment to work hard. If they’re slacking, or if they don’t come to talk with her, she hunts them down.

“I call them on their bull----,” Harper said. “That’s the other reason they call me Dr. Evil. If you’re working hard, that’s when my soft side comes out.”

Some patients need help just getting to a place where they can do the work. “Most of them have been medicated,” Harper said. “They take anxiety pills every time they feel anxious.”

She stops them: “Let’s talk about it. What have you done to cope?”

Often, they don’t know how to cope, so doctor and patient work on breathing techniques or other ways to return to normal.

Some cases, of course, take more work than others.

“Jimmy failed detox several times,” Harper said of Pfc. Jimmy Wolfe, 37, who had been at Haven for about 2½ months. “But he’d had no previous PTSD treatment.”

Wolfe said he joined the Army infantry at age 37 after quitting drinking. Then he spent several months in Kandahar province, Afghanistan.

“The war gives you a real good excuse to start [drinking] again,” he said.

While home on leave, his girlfriend noticed he would get up in the middle of the night to duck into a corner, or would begin running in bed.

“I’ve seen a lot of blood,” he said. “I saw a 6- or 7-year-old who had been cut against the abdomen, holding his innards in. It’s unexplainable.”

He would spend a week in a tired slump, and then weeks without sleep and without being able to sit still. He was diagnosed with bipolar disorder along with his alcohol abuse and PTSD. He also tested positive for TBI, probably from a mortar attack soon after he arrived in Afghanistan.

His first few days at Haven “were kind of difficult,” he said. “I’m a very to-myself person, and it took a little while to open up. Dr. Harper made it easy to talk in her classes. She’s tough.”

The staff prescribed chemical dependency classes, Alcoholics Anonymous meetings and psychotherapy. Wolfe also said telling his stories made it easier to think about his experiences without always getting stuck on a negative emotion.

But his substance abuse added another dimension.

“Before AA, I thought I was the only one in the world with this trouble,” he said. “Then, coming here and the feelings I have about the war — everybody else has them, too. What you see, what you smell, what you experience.”

Wolfe said he had his last beer Jan. 24.

“Some of the things [Silsby] has experienced show he knows what you’re trying to say,” he said. “They do this because we’re veterans. They truly love us.”

Most of the patients will not continue their military careers. They have already begun the process of medical retirement, often after months of too many drugs, too little therapy and too little support from chains of command who see inpatient therapy as the loss of a slot on the deployment roster.

Harper said one of the biggest issues is that commanders don’t send their troops for help early enough. By the time they get to Haven, most are already in the Medical Evaluation Board pipeline that will lead to separation.

“The way the commanders look at it, everyone they’ve sent to mental health hasn’t come back,” Harper said.

Getting them help sooner would boost their chances of returning to active duty. “But the commanders are stuck between a rock and a hard place,” she said. “There aren’t enough people.”

Still, she said she sees people making more progress at Haven than in any job she has had. She credits the resources and time devoted to their care, as well as the therapists with military experience who understand them.

Most of all, she credits the troops. “They have to be ready to change,” she said. “There’s nothing magical in what we do here. The magic is with the patient.”