McRoberts (left) teaches veteran Guy Naylor to fly fish. Photo by Stuart Isett
SeattleMag.com | October 17, 2011
Beyond two locked security doors on the seventh floor of Seattle’s Veterans Affairs hospital (VA) on Beacon Hill, patients are treated for some of the more severe cases of posttraumatic stress disorder (PTSD) and a web of other issues. Some of them are depressed, some are suicidal, and some are simply not functioning because of substance abuse or other psychological disorders.
The recreation room on “7 West” (named for its location) boasts a wall of windows that offers a panoramic view of Elliott Bay and downtown Seattle. But most patients in the room are looking in the opposite direction, at a large television on the wall. No one is talking. That is, until Jim McRoberts and members of the Project Healing Waters Fly Fishing club arrive, unpack their rolling cabinet of tools, spread a rainbow of marabou feathers across a long table and ask anyone within earshot if they want to “tie flies.”
“Sure,” answers an older man with tattoo sleeves. “I’m not doing anything else.”
Using a vice, a bobbin and short hackle pliers, a diverse group of veterans sit quietly winding small pieces of feather and chenille around tiny fishing hooks. The work is meticulous and proves too tedious for some. But McRoberts and the other instructors are helpful and patient. They buzz from one student to the next, making sure no one is left idle for too long.
One patient, Jon, a Marine in his 60s who has been here about 45 days, is especially into it. He has already been on one of Healing Waters’ fishing trips and caught a rainbow trout, which he was excited to share with his family. He says that fly-fishing is relaxing.
Healing Waters is a national nonprofit organization, founded to help disabled active-duty personnel and veterans by helping them, at no cost, to relearn fine motor skills and connect with other veterans, simply by learning the art of fly-fishing. It’s an example of the kind of out-of-the-box thinking that is going into battling the devastating psychological effects of war. Some Healing Waters participants are in wheelchairs, missing limbs or just struggling with the transition to civilian life. Some suffer from PTSD, a condition that many say is like reliving hell.
PTSD is an anxiety disorder brought on by a traumatic, life-threatening event. It is prevalent among combat veterans, but can also be experienced by civilians, including survivors of assault, rape, terrorist attacks, natural disasters and even extreme car accidents. Experts sometimes refer to it as the “signature wound” of our current conflicts in Iraq and Afghanistan, although statistics on the number of soldiers with PTSD remain vague. Studies report that it can occur in anywhere between 5 and 35 percent of soldiers returning from combat—or “theater” as it is referred to in the military. In 2010, 171,423 deployed Iraq and Afghanistan war veterans were diagnosed with PTSD out of 593,634 patients treated by the VA—nearly one-third of them. And it’s likely that diagnoses will continue to increase due to current soldiers experiencing multiple deployments—and thus, potentially longer exposure to trauma.
PTSD is characterized by three major symptoms: reliving a traumatic event over and over again in the form of memories or nightmares, which are so vivid they can be difficult to distinguish from the present; avoidance of typical activities and intimacy with other people; and hyperarousal—extreme irritability or persistent states of high stress.
“You don’t trust people,” says Perry, a retired “special ops” military officer and patient at the Seattle VA. “Can’t go to movie theaters. Can’t go shopping. You have nightmares—night sweats. You’ll wake up just soaked.”
Another Vietnam vet, “Al,” who served in the Marine Corps and the Army, is also a patient at Seattle’s VA. “In combat under heavy conditions, you see a lot of death,” he says. “It continues daily. So you build a wall around you mentally. When you get back into civilian life, that wall is around you.…You can’t make friends...You’re just by yourself in a shell.”
PTSD can unravel an entire life. Marriages fail, families are broken, and bars, television and very dark rooms become lonely sanctuaries and eventually barriers to treatment. But the military has come a long way in dealing with PTSD. The “gold standard” for treatment is a form of psychotherapy called prolonged exposure (PE) therapy. In private or group counseling sessions, patients are encouraged—at a slow pace—to recall memories of their trauma over and over again in order to eventually habituate to the memory and ultimately reduce anxiety. But for some veterans, facing this therapy is unfathomable. According to a RAND Corporation study, almost half of military personnel who screen positive for psychological health issues following deployment do not seek care, either because of social stigmas or because they don’t want to confront their symptoms. “There’s always some avoidance, frankly” says Dr. Miles McFall, chief of psychology at the Seattle VA. “Trauma memories are painful; there is a natural tendency to want to avoid coming in to see mental health providers. Also, many patients don’t understand what treatment is. They fear it’s going to be too distressing for them or they’re going to be forced to talk about traumatic experiences, when, in fact, that’s not the case.”
Thanks to the efforts of a few pioneering local thinkers, there are now more options than ever for PTSD patients. Innovative local programs are serving as a complement to (not a replacement for) traditional psychotherapy, helping veterans to cope better—and even bringing them hope.
At the National Center for Telehealth and Technology (T2), the busy corridor of offices and conference rooms is playfully referred to as “geek alley.” Headquartered at Joint Base Lewis-McChord near Tacoma, graphic designers, Web developers and psychologists are collaborating to develop useful tools for “the next generation of warriors.” Since launching in 2007, the center has developed five mobile applications for smartphones, including self-diagnostic tests and tools that coach users through breathing exercises; three interactive websites (including afterdeployment.org), and dozens of peer-reviewed articles in the areas of PTSD, traumatic brain injury (TBI) and suicide prevention.
Dr. Gregory Gahm, director of T2, says the pairing of technology with psychology is crucial. “It used to be that you’d see all soldiers with a pack of cigarettes. Now, soldiers come with their own smartphones [approximately 60 percent of them, T2 reports]. This is their connection, whether they’re deployed or at home. They’re downloading other stuff; why not have our stuff be available to them?”
“We’re trying to find ways to make it comfortable for people that are experiencing PTSD, to answer their questions, raise their awareness and perhaps in the best-case scenario, motivate them to go talk to someone who can make their life better,” explains Joe Jimenez, T2’s public affairs officer and a Vietnam veteran himself. “There is no reason to continue on in silence.”
The center is also in the process of developing transportable “Telehealth” units—mobile booths that can be installed in combat areas to connect soldiers with mental health practitioners via video conferencing, in the hopes of catching PTSD in its early stages. Studies show that the earlier PTSD is identified, the more successful treatments can be—crucial in making lives better and even preventing suicide.
Imagine you are riding inside a Humvee, looking out through the windshield onto an empty street in a small Iraqi town. Women fully covered in burkas pass on the sidewalk. You hear the sounds of people talking and someone singing in Arabic. The engine rumbles as your vehicle creeps up the empty street, passing closed doors and dark windows. Something explodes. The windshield cracks. You see a red flash, then black. Smoke billows. You hear the sounds of screaming.
This is one of the more dramatic scenes in another high-tech PTSD tool—IraqWorld, a virtual reality experience (VRE) created by Hunter Hoffman, Ph.D., and his team at the University of Washington Human Interface Technology Laboratory. IraqWorld grew out of a collaboration with Dr. JoAnn Difede in which a VRE was used to treat people who developed PTSD after witnessing the 9/11 attacks.
A patient dons a special headset to enter the virtual world of IraqWorld and experiences enveloping sound, vibrations and images, making recall of the traumatic experience more vivid during therapy sessions—and thus, hopefully, make their habituation (and potential for improvement) much stronger. And for people with extreme anxiety or phobia, these tools have been highly effective in helping reduce anxiety symptoms.
In a studio in Seattle’s Central District, one woman is pioneering a decidedly low-tech weapon against PTSD: yoga. “We all have access to breath, but we all don’t know how to use it,” explains Molly Lannon Kenny, founder of The Samarya Center and vice president of the International Association of Yoga Therapists. Kenny developed Integrated Movement Therapy, a form of cognitive behavioral therapy for special populations that blends yoga with philosophy and clinical experience. She has used it to help patients with anxiety, depression, addiction and degenerative diseases, but says veterans dealing with PTSD are especially fragile.
So Kenny remains very flexible. Movement is very gentle, and the work never pushes beyond comfort levels. She begins by just chatting with veterans for a while; she sees her most important role as being an accepting and loving presence. She says it wasn’t easy to get yoga into the VA. “It doesn’t really work for them if you say you just want to be an accepting and loving presence,” she jokes. But with the help of a few members of VA staff, she was able to get in earlier this year. Now her center is leading several weekly classes at the VA at no cost to veterans.
“If they had just taught me how to breathe 30 years ago, my life would have been a lot different,” says Nick, a patient at the VA who’s taken another class at the VA called mindfulness-based stress reduction (MBSR). Nick says his PTSD went undiagnosed for 25 years. After participating in an eight-week MBSR course, Nick and other veterans reported significant improvement in their symptoms. Created by Dr. Jon Kabat-Zinn at the University of Massachusetts Medical School and inspired by Buddhist teachings, MBSR courses lead students in a series of structured meditation and low-impact exercises—like yoga—to relieve tension. “It’s better than a pill,” Nick says. “Nothing is a magic bullet; it’s something you have to work at. At least I have a great new tool in the toolbox to help me with this serious, invisible injury. I’m proud to have served my country and would do it again if called.”
“It’s changed my life,” says Calvin, a Vietnam vet from Seattle. “I don’t do churches. I don’t do Buddhism. But [with MBSR], they’ve kind of extracted the part of Buddhism that is palatable for me.…This is 2,500 years of science; it works.”
And, in the battle against PTSD, when something works, it’s a victory. “We’re in the midst of a 10-year war,” says Dr. Skip Moe, chief of staff at T2. “Vietnam was a 10-year war. We are still taking care of veterans of the Vietnam War who have PTSD that—without intending any real criticism—wasn’t treated effectively at the time….Now we’re able to treat it, really, very effectively. Unless we do something about this, we’re going to have the same phenomenon of veterans just hanging on and having problems…forever.”
Where to Get Help for PTSD
If you are in crisis, call 9-1-1, go to your nearest emergency room or call the Veterans Crisis Line at 800.273.8255 (Español, 888.628.9454).
The following services are intended as complements to—not replacements for— traditional treatments.
Movement-based stress reduction at Seattle VA Hospital
Samarya Center yoga
Project Healing Waters Fly-Fishing
Meets every Tuesday, 10–11:30 a.m., and Wednesday, 3–5 p.m., at Seattle VA
Download T2 mobile apps for PTSD: t2health.dcoe.mil/mobile-apps
For general information on the wide variety of health services, support groups and classes provided by your local VA hospital, visit www.pugetsound.va.gov or call 800.329.8387.
To learn more about PTSD and related issues in strict confidence, visit afterdeployment.dcoe.mil