As a veteran, I am interested in what the VA does in providing healthcare. Suzanne and Steve have a great interest is how veterans are treated by the VA.
PTSD Is a Nightmare. A Fully Funded VA Can Provide Relief, jacobin.com, Suzanne Gordon and Steve Early
Post-traumatic stress disorder (PTSD) is the often-hidden wound of war.
Post-9/11 wars added hundreds of thousands of former service members to the patient rolls of the Department of Veterans Affairs (VA) — the nation’s largest public health care system — to get treatment for anger and depression, substance abuse, suicidal ideation, and past exposure to military sexual trauma. About 18 percent of returning Afghanistan and Iraq vets have been diagnosed with PTSD.
The importance of the VA’s specialized, high-quality care for nine million patients is well documented in Invisible Storm: A Soldier’s Memoir of Politics and PTSD, a new book by Army veteran Jason Kander, and a just-released documentary called Here. Is. Better. Directed by Emmy Award winner Jack Youngelson, the movie follows Kander and three other former soldiers as they seek VA retreat to improve their mental health.
The “invisible storm” in Kander’s title refers to the service-related condition they all share, which makes holding a job, getting an education, finding housing, or supporting a family very difficult for many veterans, even years after leaving the military. Youngelson and his documentary crew filmed all four PTSD sufferers during their interaction with family members, other participants in group therapy or peer counseling sessions, and their work with staffers of a VA-run residential treatment center in Cincinnati and the Veterans Community Project in Kansas City, which provides transitional housing and support services for homeless vets.
Not Feeling Disabled
While different in age, gender, and ethnicity, all four subjects of Youngelson’s film share a reluctance to seek professional help. In Kander’s case, he felt that his brief tour of duty in Afghanistan, as an Army intelligence officer, hardly qualified him to be a “disabled” veteran. “I didn’t feel like I did enough to earn it,” he writes. “I was just some jerk who went to meetings. To even consider I had PTSD felt like ‘stolen valor’” — the phenomena of veterans or nonveterans claiming military laurels they were not awarded.
After all, some soldiers who served in the same combat zone came back with traumatic brain injuries, amputated limbs, or spinal cord injuries that left them paralyzed for life. After he was discharged, Kander’s only problem was “bad dreams,” not even troubling enough to keep him from reading books or watching movies about war.
The other veterans who tell their stories in Here. Is. Better. — on a first-name basis only — similarly ignored or minimized their symptoms, while experiencing, like Kander, a considerable amount of survivors’ guilt. We meet Teresa and Tabitha, both post-9/11 war veterans, and John, a draftee in 1968 who won a Silver Star for his role in a firefight that killed 170 North Vietnamese and Americans. A helicopter door gunner in Vietnam, John returned home with traumatic memories of jungle warfare that he managed to suppress for fifty years, until he couldn’t find a way “to move beyond them.”
Teresa was a heavy equipment operator for the Army who never recovered from the impact of an improvised explosive device (IED) that rocked her convoy in Iraq. Recruited at age eighteen, Tabitha was sexually assaulted during her Marine training, like many other women in the military. She managed to complete tours of duty in Iraq and Afghanistan, but the scars of military sexual trauma (MST) made her a troubled single mother of two young children in later civilian life.
A High-Profile Crash
Kander’s mental health crisis is recalled movingly in both the film and Invisible Storm, but with more humor in the latter. When he entered the Kansas City VA Medical Center as a walk-in patient five years ago, the Georgetown Law School graduate and former Army captain was still a rising star in regional and national politics. He had been a state legislator, served as Missouri’s secretary of state, and, in 2016, ran a highly competitive campaign for the US Senate against a Republican incumbent.
After that narrow defeat, he formed a voting rights group called Let America Vote and went on a speaking tour that took him to forty-six states in a single year, including appearances in Iowa and New Hampshire. The grueling schedule — plus Barack Obama hailing him as the future of the Democratic Party — fueled speculation about an eventual presidential campaign. Kander’s next stepping stone in that direction was supposed to be city hall in Kansas City. By late 2018, based on polling and fundraising, he was far ahead in the mayoral race.
Then he suddenly dropped out. He informed supporters and the media that he had called a VA hotline, tearfully confessed to having “suicidal thoughts,” and checked himself into a VA hospital. As a new patient, Kander pulled a baseball cap down to hide his face because “the one place where you don’t want to be famous is in a psych ward.” Dressed in hospital scrubs, sitting in a bare room, with the psychiatric resident assigned to take his medical history, Kander confessed everything he’d spent years hiding from the world: “My night terrors, my consuming fear of someone hurting me or my family, my ever-present anger, my unrelenting guilt and punishing shame, my inability to feel joy, and my increasing dislike of myself.”
Not recognizing or knowing about him, the young doctor asked Kander if his postmilitary career was particularly stressful. “I’m in politics,” he explained, referencing both his Kansas City mayoral campaign and his eventual plan to run for the White House with Obama’s blessing. The puzzled doctor sat back in his chair, tapped his notebook a few times with his pen, and then pursed his lips. “Barack Obama told you that you could run for president?” he asked. “How often would you say you hear voices?”
The personal struggles of the other veterans profiled in Here. Is. Better. are more representative of what most service members, from blue-collar backgrounds, experience in civilian life.
After much prodding from her husband, Teresa joined an all-female cohort of veterans enrolled in a “last chance program,” as one participant calls it. They begin their seven-week stay at a VA residential treatment center beset with dark thoughts and doubts about its effectiveness. “I sat in my fucking shit for a lot of years, making it hard to be a wife and mother,” Teresa tells the group. Tabitha reveals that she’s in the program because “I’m a horrible person and a horrible mother,” who just “wanted to die.” We learn that, after her sexual assault, she was “yelled at for being a whore” and transferred to another Marine unit, while her attackers, per usual, went unpunished.
As the story of John, the Vietnam vet, unfolds, we find out that he first tried to get help from the VA, in the early 1970s. At the time, it was underfunded, understaffed, and unprepared for a huge influx of new patients, thanks to the Nixon and Ford administrations. “There was nothing there then,” he says.
John was able to find stability in his job and marriage but rarely discussed his combat experience with anyone, even his wife of thirty-six years. “What I saw, what I did, the loss . . . it all still plays on my head,” he confesses in the film.
After John retired and was nearing age seventy, he attended a retreat for older veterans, facilitated by a clinical social worker from the VA. This time, he found that he was not “alone in this search for a little more peace in our lives.” At the retreat and follow-up peer counseling sessions, he reconnects with one aspect of his long-ago military service that was more positive — namely, the mutual aid and strong sense of camaraderie that was essential to individual survival in Vietnam.
The VA’s Culture of Solidarity
Among those shown caring for John, Teresa, Tabitha, and Kander are clinical social workers, psychologists, psychiatrists, and peer support specialists. In that last job category — but others as well — are fellow veterans, since about one-third of all VA health care staff served in the military themselves. This helps foster a unique institutional culture of empathy and solidarity between patients and providers that has no counterpart anywhere else in the US health care system.
In addition, every VA employee is trained on how to better recognize and assist patients who are suicidal. Thousands of its mental health providers learn to use and then employ the latest evidence-based treatments for PTSD; outside the VA, studies show, only 30 percent of private sector providers employ such treatments.
In Here. Is. Better., one in-house VA caregiver says her biggest treatment challenge is “how to create hope.” The filmmakers report that participants in the residential program that Teresa and Tabitha completed have a 70 percent success rate, leading them to suggest that the model of “trauma-informed care,” used by the VA, could also help the millions of other Americans with a PTSD diagnosis.
The VA has long been a source of innovation in many areas of clinical practice, as well as developing new treatment tools — including the nicotine patch, the first implantable cardiac pacemaker, and the shingles vaccine — that now benefit all patients who need them. Numerous research studies also show the VA does a far better job treating veterans’ varied and complex wounds of war than private medical practices and for-profit hospital chains do.
Nevertheless, its medical research functions, major teaching hospital role, and provision of direct care have all been jeopardized by incremental privatization under Presidents Obama, Trump, and Biden. Since 2014, a bipartisan coalition in Congress has enacted legislation that opened the flood gates for costly and unnecessary VA outsourcing.
Already, tens of billions of dollars are being diverted every year from the agency’s direct care budget to reimburse private sector providers. As a result, an exemplary system of integrated and coordinated care is in danger of being defunded and dismantled, with much ongoing loss of highly trained and dedicated staff like the suicide prevention specialists and group therapists we meet in Here. Is. Better. and Invisible Storm.
Pitfalls of Privatization
Outsourcing advocates often point to the work of groups like Kander’s own community-based program for homeless vets as examples of how VA patients — in need of housing, health care, or emergency assistance — are better served by private sector initiatives than a big government agency. Yet the thousands of nonprofit and for-profit entities now vying for an ever-larger share of the VA budget invariably lack the institutional scale, resources, and experience necessary to meet the complex needs of veterans like those profiled in Here. Is. Better. or Invisible Storm.
In the latter, Kander confesses that he never dreamed, during his political career, of becoming a “poster child” for what he calls “post-traumatic growth.” Let’s hope that this former supporter of single-payer health care in the Missouri legislature will use his continuing “platform and influence” to help save our best working model of socialized medicine.
Because it was that health care system which changed his life for the better, along with the lives of many others who left the military never expecting to have personal problems or career challenges due to the “invisible storm” that eventually overtook them.