As we begin to survey the damage from Hurricane Sandy, a symptom of the global warming that has been religiously ignored in the course of the presidential debates, our thoughts turn toward the impact of trauma: Sandy’s trauma involves man’s influence on nature, but in war we have trauma that is purely the result of mankind’s inability to live in peace.
About 2.4 million soldiers have cycled through the wars in Iraq and Afganistan. One third or more of those returning from battlefields suffer from post-traumatic stress disorders (PTSD) or depression. Suicide has overtaken combat as the leading cause of death in the Army. [That stark statement is worth a second read.] To date, treatment of PTSD has centered primarily on cognitive processing therapy (CPT), a labor-intensive approach that places veterans in a one-to-one relationship with a therapist. But only 40 percent who enroll actually benefit from the therapy, and even if it were more effective, the vast numbers of soldiers in need would require thousands of additional psychologists.
Tina Rosenberg writes in the New York Times of new approaches to treatment. Instead of using the one-to-one model, these new therapies work in groups. And instead of rehashing the images that gave rise to PTSD, these therapies focus on the present moment, long after the trauma has occurred. The Washington-based Center for Mind-Body Medicine has designed a course that involves conscious breathing, meditation, mindfulness, guided visual imagery and biofeedback. Other therapies include acupuncture and yoga. The Center has a proven track record, working with Kosovo high school students and Gaza residents. The techniques appear to work: following the ten-week program, participants in Kosovo had significantly lower symptoms of PTSD than non-participants.
In Gaza, center staff trained over 400 group leaders, who were able to provide therapeutic interventions with 50,000 people. Because of its group approach and relatively short training cycle, large numbers of people can be reached quickly and at very low cost. And retention levels within the training are much higher than those for individual counseling.
Life Skills
In comparison to CPT therapy, the group approach stresses practical coping skills. While there may still be some social stigma attached to participation in individual therapy, there is no such negativity associated with group work – aside, perhaps, from its New Age aura. Most important, the tools being taught are universal: we all experience stress and some degree of trauma and we all need practical techniques to help us adjust to the pace of modern life. Teaching life skills such as mindfulness and meditation does not isolate PTSD sufferers from everyone else; to the contrary, the fundamental lesson is that we all experience suffering and we are all in this together.
Surely these same group techniques would be helpful to devastated citizens recovering from this week’s unprecedented natural disaster.
Teach Politicians to Breath?
I often wonder what would happen if our politicians were taught a few mindfulness exercises. Perhaps there would be more compassion in the world. Perhaps law and policy makers would pause a minute before they spoke, before they ridiculed their opponents or declared war on another country. Perhaps the elected officials who find life sacred at the moment of conception but insignificant once birth occurs would empathize with the plight of women compelled to carry a rapist’s child.
These are agitating thoughts, indeed. Time to take a deep breath, sit still for a moment, and just say “om.”
Posts Tagged ‘war’
Treatment for War Trauma: Just Say “Om”
Tuesday, October 30th, 2012Battlefield medicine: technologies that may yield benefits for injured workers
Monday, November 15th, 2010Last week, our nation honored its veterans for service rendered to the country. Although belatedly, we join in offering thanks. One could make the case that our nation’s gratitude should be a 365-day-a-year tribute rather than largely confined to a single celebratory day. On returning home, many veterans face an enormous hurdle, the day-in-day-out battle of finding employment, a formidable challenge for any vet but made even more difficult in the current economy. Beyond an expression of appreciation, there are many good reasons why employers should hire vets. The U.S. Department of Labor has collaborated with Office of Disability Employment Policy (ODEP), the Veterans’ Employment and Training Service (VETS), and other federal agencies to offer a Step-by-Step Employer Toolkit for Hiring Veterans.
In addition to their military service, there is another debt that we owe to our vets, particularly those who have been wounded physically or psychologically. It is one of life’s great ironies that war, which is responsible for so much death and destruction, is also a catalyst for the advance of medicine and medical technologies.
Just as weapons become more sophisticated, so too do the medical technologies designed treat the wounds that these weapons exact. From wars in ancient times to the present, civilian medicine has been advanced by battlefield medicine, first practiced on wounded warriors.
Wired Magazine has been one of the ongoing sources we turn to get our fix about battlefield advances in medical technology. A recent article – Military’s Freakiest Medical Projects – is a fascinating case in point, highlighting advances in prosthetic limbs, skin grafts, burn repair, bone cement, suspended animation, and more. The article’s intro explains that “Some of the Pentagon’s extreme medical innovations have already debuted in the war zone. And with myriad applications outside of combat, these advances in military medicine mean that revolutionary changes for civilian care aren’t far behind.”
Another recent article – Exoskeletons, Robo Rats and Synthetic Skin: The Pentagon’s Cyborg Army – focuses on technologies that foster recovery, such as neurally controlled prosthetics, or that enhance performance, such as wearable exoskeletons that amplify amplify troop strength and endurance.
As exciting as these developments are, not all effective treatments rely on advanced technology – some are reassuringly “old-school.” A case in point is this heartwarming story about vets with PTSD who train service dogs as companions for vets in wheelchairs. The dogs do double duty, serving as therapy dogs for those with PTSD while they are being trained, and later as helper dogs for those confined in wheelchairs. You can learn more about this most excellent program at Paws for Purple Hearts.
And if you doubt the healing and restorative power of dogs, we leave you with this evidence: an incredible compilation of clips of dogs welcoming home soldiers. One warning: have a box of tissues nearby!
(Cannon) Fodder for a Friday: The Fate of Foreign Interpreters in Iraq
Friday, December 18th, 2009How would you like a job that pays $12,000 a year, where 1 percent of the workforce is killed annually and hundreds of others are seriously maimed? I didn’t think so. You would probably take a pass on working for Titan Corporation (now part of L-3) as an interpreter for the U.S. armed forces in Iraq. The L-3 website promises that “as a member of the L-3 Communications team, you will be exposed to the most exciting career adventures situated on the cutting edge of technology.” Alas, it’s not just the technology that is cutting edge. The roadside bombs cut pretty deeply, too.
We read in the Los Angeles Times about the sad fate of translators in Iraq. There are about 8,000 in all. Over the five year period from 2003 to 2008, 360 were killed. Those who were lucky enough to survive were often shipped to Jordan for treatment. The workers comp benefits fell under the Defense Base Act and were administered by AIG, among others. (See our previous blog here.) According to some of the wounded, they were offered a stark choice: accept a proposed settlement (which absolved the insurer of any future costs) or be shipped back to Iraq, where retaliation and death awaited former employees of the U.S.
The Times article describes the life of Malek Hadi, an Iraqi national who lost a leg and several fingers in a roadside bombing. He now struggles to survive in Arlington, Texas. At first, he was unable to collect any benefits:
Internal AIG documents indicate that a claims examiner withheld Hadi’s benefits in an effort to force him to accept the lump sum. Hadi was “clearly entitled” to benefits, a different AIG examiner wrote in a memo dated August 2008. The company had not paid because the previous examiner “was trying to get the claimant to decide whether to settle his claim,” the memo said.
Malik now receives the maximum monthly disability benefit – a whopping $612 per month. He has been diagnosed with post-traumatic stress syndrome, but AIG has refused to cover any treatments. Perhaps they are waiting for a second opinion from the company shrink? Meanwhile, Malik will just have to deal with it!
Former insiders at AIG describe how the game is played:
“If you’re missing one piece of documentation, you got denied,” said Colleen Driscoll, who oversaw the handling of interpreters’ insurance claims for L-3. “These guys get murdered coming and going to work, and AIG turns them down because they don’t have a letter from the insurgents.”
Driscoll, a former United Nations refugee official, left L-3 in 2007. She said the cause was a dispute with company executives over treatment of injured interpreters.
She and another former L-3 official, Jennifer Armstrong, said their experience suggested that 10% to 20% of the company’s Iraqi workers who should have received benefits were denied.
AIG stock is currently trading at the equivalent of about $1.40 a share. It would be nice to think that this was the market’s judgment on the way things are being handled in Iraq, but that, of course, has nothing to do with it. The market, not exactly known for its humanitarian concerns, is punishing AIG for financial – not ethical – sins. Indeed, the market might well approve of the way the injured, the maimed and the dead are being squeezed in this mockery of a benefits program. After all, indemnity and medical expenditures are being kept as low as possible and that can only help support AIG’s battered bottom line.
Risk Transfer without Risk
Monday, June 22nd, 2009The Defense Base Act (DBA) was enacted in 1941, to cover the injuries to civilian employees – primarily a few hundred engineers – during the second world war. The act might have worked then, but it certainly is not working now, nearly 70 years later. As we have blogged in the past, the DBA is a boondoggle, generating huge profits for a small number of insurance carriers and routinely devastating both the civilian workers wounded or killed in war zones and their families. There are over 10,000 claims filed each year: the medical only claims are usually paid; the indemnity claims are dissected, inspected, detected, and ultimately, rejected. A handful of insurers (AIG, CNA among others) are making big bucks at the expense of the wounded and the dead.
NOTE: As bad as the situation is for U.S. citizens wounded and killed in Iraq, it is far worse for foreign nationals.
The Domestic Policy Subcommittee of the House Oversight and Government Reform Committee held a hearing last week on the DBA. The title of the hearing betrays an (understandable) prejudice: “After Injury, the Battle Begins: Evaluating Workers’ Compensation for Civilian Contractors in War Zones.” The hearing focused on the handling of workers’ compensation insurance for federal contractors working overseas, specifically on the inordinate delays in compensation running parallel to the enormous profits for insurers. Among those testifying were Deputy Labor Secretary Seth Harris; Timothy Newman, Kevin Smith and John Woodson, former civilian contractors in Iraq; Kristian Moor, president of AIU Holdings, Inc., a division of AIG; George Fay, executive vice president for Worldwide P&C Claims, CNA Financial; and Gary Pitts of Pitts and Mills Attorneys at-Law.
Kristian Moore defended AIG’s decisions and motives, pointing the finger at a lack of Labor Department oversight and a system overtaxed with cases. “We are doing everything we can do,” suggested Charles Schader, senior vice president and chief claims officer for AIU Holdings. Yeah, everything you can do to make money.
At the conclusion of the hearing, Dennis Kucinich (D-Ohio) warned AIG executives that he plans to demand copies of internal memos and documents that will link claims denials to the company’s profits. Most of us do not get terribly excited by the prospect of reading claim files, but these will undoubtedly provide some compelling reading. While I doubt that the subcommittee will find a direct, written link between denials and profits, the rationale for the individual claim denials – in the face of compelling evidence of compensability – should prove riveting. Was it incompetence or was it greed? Something cruel, heartless and cynical took place in the back rooms of carriers with responsibility for civilian claims. If you like Edgar Alan Poe, you’ll love the claims files of AIG and CNA.
Risky Job, Risky Work
Seth Harris, the new deputy secretary at the U.S. Department of Labor, is in charge of this mess for the government. He’s been on the job for 3½ weeks. Congratulations on the new job, Seth! (You might want to keep your resume circulating.) Seth has been working less than a month, but he has already figured out that the system is in need of fundamental change.
The work of insurers usually involves risk transfer. Under the perverse incentives of the DBA, the risk is absorbed by taxpayers, the pain falls on civilian workers and their families, and the profits – running from 37 to 50 percent of premiums – are pocketed by the carriers. Risk without transfer. It’s amazing that AIG can generate this level of profit in one division and still only trade at $1.40 a share. I guess that they have been looking for risk in all the wrong places.
Return to work and disabled vets
Wednesday, March 12th, 2008The Iraq and Afghanistan theaters of war represent the largest deployment of civilian soldiers since WWII. Of the 1.5 million troops that have served, approximately one in every four is a National Guard member or a Reservist. While the Uniformed Services Employment and Reemployment Rights Act offers legal job protections, the road back will not be an easy one for many veterans. Many have suffered profound and life-changing physical injuries; many also face less obvious wounds – Iraq and Afghanistan Veterans of America estimate that about one in three Iraq veterans will face a serious psychological injury, such as depression, anxiety, or PTSD:
These psychological injuries exact a severe toll on military families. Rates of marital stress, substance abuse, and suicide have all increased. Twenty percent of married troops in Iraq say they are planning a divorce. Tens of thousands of Iraq and Afghanistan veterans have been treated for drug or alcohol abuse. And the current Army suicide rate is the highest it has been in 26 years. One of the goals of any disability program is to help the injured party to recover and to return to their normal lives, including return to work. This is true whether the injury occurred in the workplace, at home, or on the battlefield. Work is not only vital for economic security, for most of us it is also a core part of our identity, an integral part of our lives. A good return to work program can be restorative on a financial, emotional, and psychological plane. Both in the short term and over the longer term, employers will play a vital role in helping veterans readjust to civilian life. This requires that employers have awareness of the many challenges that veterans face and the willingness to provide the resources to support a successful transition.
Enter the Workplace Warrior Think Tank, a coming together of The Disability Management Employer Coalition, several of the nation’s premier insurers, employers, and military and veteran participants with the purpose of helping veterans to ease the transition from the war to the workplace. The group examined challenges and opportunities facing returning employees and identified employer-based resources and strategies. The end product is a useful guide for employers, Workplace Warriors: The Corporate Response to Deployment and Reintegration Highlighting Best Practices in Human Resources and Disability Management (PDF). The guide includes a list of best practice recommendations to help returning vets reintegrate in the workplace. These include such things as celebrating the employee’s return to the workplace, recapping changes that occurred while he/she was gone, and training supervisors to be aware of certain red flags that might indicate a problem. The group also emphasizes that the availability of effective EAP services can be critical to successfully helping veterans to face the many psychological problems that are common in the aftermath of war service.
It’s great to hear about the efforts of the think tank and their recommendations for employers – please help to distribute the guide and raise the issue because as the report notes, “Repercussions and delayed effects of the war experience will be felt in the workplace for decades to come.” Hopefully, this will be the first step in many by leaders in our industry to dedicate resources and attention to this important issue.
For more information and resources:
The Corporate Response to Deployment and Reintegration – this is the full report from Workplace Warriors, available through DMEC.
Wounded Warriors is a blog that collects veterans coverage from the McClatchy Washington Bureau, McClatchy Newspapers, and other sources. It’s a good source of news for items that affect returning vets and their families.
Resources for returning veterans and their families – from the Substance Abuse and Mental Health Administration.
Veterans and Military Health – from MedlinePlus
Iraq and Afghanistan Veterans of America – since 2004, the nation’s first and largest group dedicated to the Troops and Veterans of the wars in Iraq and Afghanistan, and the civilian supporters of those Troops and Veterans.
