Hidden Battles on Unseen Fronts

by Patricia Driscoll

  No more than sixty years ago, a serious mental illness was frequently regarded as a permanent disabling condition. Custodial care and stabilization were mainstream treatments. Veterans with serious mental illness were often admitted to long-term psychiatric hospitals. These hospitals were state-of-the-art and the care was compassionate. However, from today’s vantage point, the scientific methods to treat mental illness at that time were limited, and the notions about mental illness in popular culture were often not helpful or respectful. Knowledge creates power. Our current knowledge about psychosocial rehabilitation and recovery in mental illness comes from science; and it comes from the lived experience of men and women—veterans and civilians—who have mental illness.

  There is a range of severity in the experience of mental illness. Some individuals have a rough period, but with counseling or life changes, they bounce back and move ahead in life readily. For others, mental illness can be a profound and life-changing experience. At times, for those with serious mental health problems, it can seem like an outside force has taken control and it cannot be shaken. Nearly every aspect of life and even the sense of self can be affected. In addition, no one should assume that any person with a mental health diagnosis has “lost their mind” or that they cannot handle the everyday stresses and challenges of life. For those individuals who do have a tough time, mental health professionals are ready to help them find their way to a path of recovery and a meaningful life.

  The onset of serious mental illness can come without warning. It occurs among service members, veterans and civilians. Serious mental illness is often defined by the presence of a psychiatric diagnosis such as schizophrenia, bipolar disorder (manic-depressive disorder), or major depression. However, the severity of any illness can only be determined by knowing about the experience of the person coping with it. Other mental health disorders, including PTSD, may lead to periods of severe impairment in everyday social, occupational and interpersonal functioning. Unlike many other health care problems, mental illness is often unseen or unnoticed by others. That may be due to the absence of any physical sign, or it may be due to a perceived need to hide mental illness based upon a sense of shame or guilt. Personal battles with mental illness are frequently hidden, occurring when home alone, perhaps late at night, or within a self-imposed isolation by persons and families trying to cope with something feared and misunderstood.

  I think it is most unfortunate and mistaken that mental illness is sometimes seen as a sign of weakness, a defect, or a loss of positive expectation and future dreams. No one is at fault for having a mental illness; no one should ever be discouraged or ashamed. The hope and promise of psychosocial rehabilitation with mental health recovery is real, and it happens every day. All persons with mental illness can have meaningful, productive lives of their choice and in the community of their choice. Individuals and families coping with mental illness can speak openly and be respected and supported as friends and neighbors. Persons with mental illness can live, work and contribute alongside all others in the community. There is tremendous opportunity.

  Individual, person-centered care is the core principle of psychosocial rehabilitation and recovery. The person, the veteran, must be a full and active partner in all aspects of care. This typically begins with identifying the life goals that the mental health problem has challenged or interrupted. No one knows about this better than the person trying to cope with it. That individual needs to be involved in every aspect of planning and decision-making about the mental health services that are provided. The best outcomes are born from collaboration between mental health service providers who have the latest and best scientific knowledge and the person who is the expert on life as they know it and wish it to be. This partnership is essential, and the partnership typically includes other health care professionals, family members, peers who are in recovery, and other individuals and agencies in the community. What Joe experienced is a good example.

  Joe is in his late twenties. He was in the Army Reserves and his unit was activated for duty in Iraq. About a year after the unit returned home, life reached a critical point for Joe and he was discharged from the service. He blamed his commander for his discharge, but Joe’s behavior in civilian life was unpredictable and unreliable as well. He could not keep a job or relationship. Reluctantly he agreed to meet with a psychiatrist for an evaluation. He was diagnosed with bipolar disorder (manic-depressive illness).

  This was difficult for Joe to accept, and eventually he was admitted to a psychiatric unit at a VA hospital for several days for his safety. In what he felt to be his darkest moment, he told the hospital staff that his life was over. He saw the diagnosis of serious mental illness as a barrier to all he had hope for—things like a steady job, friends, and perhaps marriage someday. The treatment team told him about an approach called supported employment. Joe soon discovered that he could have a job even now, a job of his choice. He could receive follow-along support services from a vocational rehabilitation specialist as long as he needed them. The team asked Terry to see Joe while he was in the hospital. Terry is a veteran who struggled with serious mental illness for many years. Terry is in recovery now and is employed as a peer support technician by the VA.

  Joe was encouraged by his conversation with Terry, but the next few months were rough. Joe started a new job, but he needed inpatient psychiatric care for another week. He chose to reveal his psychiatric illness to his employer, who worked with Joe and the vocational rehab specialist to adjust his schedule. The three of them together ensured his success. Several months later, he told the treatment team that having a job was a life-changing experience. It helped him focus on his life in spite of his psychiatric illness. In the process it had also helped him manage his illness more effectively.

  Like Joe, Rachel found help when she needed it. Rachel was well on her way to a successful career in the military. She advanced quickly in her first six years of service, but then she experienced a sudden onset of schizophrenia. Her initial care was at the base hospital. After careful consideration Rachel was discharged from service. Her mental illness was determined to be service-connected, but Rachel struggled with everything. She found it very difficult to accept help from the local VA medical center other than repeated, brief psychiatric hospitalization following a crisis. She was developing a reputation as an unwelcome tenant in the community.

  Rachel was referred to a program providing intensive case management and close support for managing her medications. These services were provided by a small team of VA mental health providers directly where she lived in the community. It took a few weeks for Rachel to accept the nearly daily contact by members of the team, but she gradually developed trust. Through their collaborative effort, she had only one hospitalization in the next fifteen months. She also reported that the landlord seemed to respect her and she began to work a few hours a week at a senior center that was a block away.

  Like Joe and Rachel, Phil wrestled with his mental condition alone, but once he connected with the VA found the help he so badly needed. Phil suffered serious burns to his legs from an IED explosion. His wounds responded well to the medical care, and he completed the prescribed physical therapy and rehabilitation. Phil decided to leave the service.

  He had been a good soldier, but he had problems with command. He questioned some decisions and sometimes felt uncertain about his role and contribution. A few months later he had a minor traffic accident, and was arrested for driving while intoxicated. He was assigned to treatment and was able to arrange it through the VA. He anticipated that this would be the easiest way to fulfill his obligation. Phil asked the therapist about the best way to fulfill the court’s requirements. After an unexpected pause, the therapist suggested to Phil that he consider what was in his own best interest instead. The therapist noted that this might be quite different from what is easiest or shortest from the perspective of the court.

  Phil was stunned, but he was also grateful for the therapist’s invitation
. Phil was drinking too much; that was the obvious problem. However, he was using alcohol to escape from the sadness he felt nearly all the time. He had little energy except to drink. He had thought it was best to keep that secret. In addition, Phil felt that his decorated combat service and successful rehabilitation did not mean much now that he was back at home. The VA therapist worked with Phil and engaged him with a team of mental health providers. They addressed his substance abuse, his depression, his employment and his relationships—all at the same time. His care was integrated and he was in the driver’s seat. Members of his family were invited to participate.

  Recovery from mental illness is not a status awarded after careful scrutiny by an independent panel or attained only after completion of measured steps over a long period of time. In line with the national consensus statement about recovery, it is in the present, it embraces the whole person, and it is guided by the individual. Recovery is based upon hope, respect, partnership, responsibility and strengths. The course of recovery is not linear, and challenges are new opportunities for learning, not failures or steps backward.

  Psychosocial rehabilitation and recovery are the fundamental work of VA mental health providers such as myself. The care and safety of the veterans who seek our services are paramount to every action, and our commitment to the public trust and professional standards demands full attention. Providing comprehensive, evidenced-based psychosocial rehabilitation and recovery services promotes both the well being of veterans and our professional responsibility. These fit well together and support the highest quality care possible. The critical factors for simultaneously meeting the needs of veterans and professional obligations are partnership and open communication. Under this model, mental health providers work in close collaboration and have open communication with the veterans served and with fellow providers in the VA system, as well as veterans’ family members, and community partners.

  Having a mental health problem can be particularly challenging to service members and veterans. The men and women in the United States military are strong and faithful in their service, and they are rightfully honored as veterans. Pride in strength and faithfulness to duty are in no way diminished by mental illness. One’s duty is fulfilled by engaging with the mental health service system. I have seen that strength comes in partnership with mental health providers, peers and family members. The journey of psychosocial rehabilitation and mental health recovery among those who have served in the military contributes to the good of all and of our society. It is a mission of strength and of hope. It is my duty and the privilege of VA mental health providers to offer the hand of partnership, evidenced-based mental health services, and a fully confident hope of recovery to all.

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  A FAMILY AFFAIR

  The Story of Army Sergeant John Weinburgh and Lindsey Weinburgh

  “When I got home from Iraq, it was great but it was also uncomfortable. I couldn’t sleep. We were living in the country where there were a lot of hunters, and every time I’d hear a gunshot, I’d pull down the shades and pull the kids down with me on the couch. I tried to make it a game but they knew there was something wrong with Daddy.”

  The day-to-day routines of John Weinburgh and his young family make the stress and anxiety of his year-long deployment in the heart of Baghdad pale by comparison. As a C5 quadriplegic with PTSD and TBI since February, 2007, John is confined to his bed and wheelchair at home in Belleview, Nebraska, and requires three shifts of nurses to care for him. Care includes cleaning, bringing his meals on a tray and changing his catheter. Meanwhile his wife Lindsey takes their three children off to work with her. She drops Mary Sue, age six, off at the local elementary school. Then she drives thirty minutes to Glenwood, Iowa, where she drops off James, age four, and Ashley, three, at the YMCA daycare center before going to her full-time job as a Medicare Fraud specialist for the state.

  At around five o'clock, unless she has to stay late for an audit, she reverses the process, getting home in time to make dinner for the family. Once the children are in bed the Weinburghs tackle the mountains of paperwork associated with John’s Veterans’ benefits since he hasn’t been formally discharged from the Army and there’s still a lot to be negotiated. The dining room table holds the equivalent of a campaign map; the conversation is all about strategy. The outcome of these sessions will determine the quality of this family’s life for decades. Yet despite the unrelenting stress, Lindsey, 27 and John, 31, remain energetic, resilient and surprisingly optimistic. For them life may not be fair but it certainly is full.

  A high school dropout (he would later earn his GED), John joined the Army in 1996 at age 19 after his mother died of breast cancer. “Even though my parents were divorced, my father promised he’d be there for us when my mom got sick but he never appeared. I was mad at him and at the world, and the Army offered a way out.” After basic training at Fort Benning, Georgia and a short stint at Fort Stewart, he deployed with Delta Company 29 as part of the 2nd Infantry Division at Camp Red Cloud in South Korea. “It may sound odd but Korea was a good fit for me. We were always training as if we were about to go to war. It was different being in a foreign country. And when I think back on it, I needed the structure, the sense of purpose. My buddies over there were like family.” John has two younger brothers, Army Captain Joseph Weinburgh and Army Staff Sergeant William Weinburgh. Both deployed to Iraq in 2007.

  By 2000 John had been promoted to E4 and was back at Fort Benning as part of the 3rd Infantry Division, but again feeling lost and lonely. “A buddy of mine who was dating a University of Nebraska student sent my photo to his girlfriend who taped it onto the bedroom door of her best friend, Lindsey James. It wasn’t long before they sent us a video, and in it there was this gorgeous girl saying, ‘John, you’re cute.’” They talked on the phone every night for two months before finally meeting in person. “We were like two peas in a pod,” John recalls. “She was the angel who came into my life.” Lindsey agrees about their similarities. “We were so much alike, it was uncanny. We both wanted children right away. We both liked the Army life. Most important of all, we made each other laugh.” In May 2001 they were married and moved to Barstow, California next to Fort Irwin and the Mojave Desert. Three years later, just after they found out Lindsey was pregnant with their third child, John was deployed to Iraq.

  For a year, January 2005 to January 2006, Battalion 464 was tasked with securing the Green Zone. As part of Charlie Company, John was one of the soldiers manning the three main checkpoints into and out of the headquarters complex in central Baghdad. “We were shot at but it wasn’t like combat. Our main problem was trying to determine who to allow in and who to keep out. A car would come toward me, and something would stand out or look funny and I’d say to myself,’ Is this going to be the guy who blows himself up? Is this going to be the car he does it in?’” The stray rounds could come from anywhere. “Someone would start shooting down the street and we’d ask each other, ‘Is that guy going to keep walking and shooting straight for us or turn the corner?’ We were always walking a thin line between not wanting to be a jerk but at the same time getting sort of mean about who we let pass and who we kept out.”

  Charlie Company first camped out on wood bunks on the first floor of a nearby palace where local contractors were already at work plastering up bombed-out walls and ceilings. For John the first winter was brutally cold, but when the seasons changed, adjusting to 130degree heat wasn’t so difficult after living on the Mojave Desert. Later on he would live in a trailer inside the Green Zone a few yards away from the Baghdad Highway. Besides manning checkpoints, John’s unit was sent into the neighborhoods of Baghdad to search and clear houses. “We’d kick in the door never knowing what was on the other side. We had to swallow our fear. We were always jazzed, on edge. We were never alone or sitting still for very long.”

  When Charlie Company returned home, they were deployed back to Fort Stewart, where Lindsey had already moved with their two toddlers and new ba
by girl, Ashley. She’d gotten a job as a teaching assistant to bring in much needed extra income. Once he was out of the adrenaline rush of being deployed to the streets of Baghdad, John gradually became aware of his PTSD symptoms.

  “When I got home from Iraq, it was great but it was also uncomfortable. I couldn’t sleep. We were living in the country where there were a lot of hunters, and every time I’d hear a gunshot I’d pull down the shades and pull the kids down with me on the couch. I tried to make it a game but they knew there was something wrong with Daddy.” In fact any loud noise made him jumpy. “My buddy and I were in town one day and a power transmitter blew. We immediately pulled the jeep over to the side of the street, jumped out and took cover. When we realized how stupid we must have looked, we started to laugh, but it’s not always funny.” He is terrified of closed doors. “Any closed door freaks me out. Even if I’m not in the room and I know the door is closed, I want it opened.”

  On February 28, 200,7 John was training with Charlie Company 464 for deployment back to Iraq. He was now staff sergeant, and as platoon leader was riding in the turret of a Bradley at the front of the convoy toward a mock village on a mission to search and clear houses. They were driving fast cross-country on new terrain. Suddenly his driver swerved to avoid a boulder in the road, lost control of the vehicle and hit a tree. As it fell it hit a second tree which split in half and landed on John, who was still in the open turret. It hit his back, crushing his spine and knocking him unconscious. For a short time he stopped breathing. Someone performed CPR. “My driver and gunner weren’t hurt. I keep telling them, don’t feel guilty, it was an accident.”