Music in Your Face for PTSD Awareness Month

There’s monotony about most “healing music” out there: it’s peaceful, serene and well, quite boring ... to me.

Yes, it’s relaxing, Yes, it’s all about alpha wave, right brain transformative experience. And let's be honest: yes, it SELLS.

But is that what we really need?

One of the hardest lessons I’ve learned in therapy is that stuffing the feelings I don’t want is destructive to my psyche and wellbeing. Before therapy, I was too good at doing that: keep a stiff upper lip; suck it up; forge ahead. But all that suppression wasn’t good for me.

Instead of that approach, it wasn’t until I learned to practice feeling emotions fully – in safety and with support – that I started to really transform. Everything up to that point was no better than using sticky tape and baling wire on an open wound.

Back to that mesmerizing music…

"Music has charms to soothe a savage breast,” wrote William Congreve in “The Mourning Bride” in 1697. There’s an enduring beauty to that phrase, and music certainly does have such power. But what’s not often remembered is the type of music Congreve must have imagined in his day.

Popular secular music in the early 18^th Century was quite unlike music in the 21^st Century. Back in Congreve’s day, unless you were in church, you’d hear a sackbut, a lute, possibly a hand drum and maybe some sort of whistle, accompanied by the sort of low, bowed string instrument that would become a modern cello. Hardly a peaceful orchestra, as anyone who’s actually heard an ancient sackbut can tell you. This sort of music is sometimes used in Shakespearian plays.

Perhaps Congreve was thinking more of the early vocal music just beginning to make its way out of the church into secular society – and there is some hauntingly beautiful late Renaissance vocal music out there. Henry Purcell’s compositions are great examples, and they are enchanting when performed by a modern orchestra. They must have been stunning in Congreve’s day, too, played on the best instruments available, which weren’t anything to write home about – by this time, Stradivarius would have made only a few dozen violins. Musicologists might debate the soothing values of Purcell’s most sublime works versus modern “healing” music but there’s an “apples to oranges” problem with doing so that pits the musical hoi polloi against, well, everyone else… and there goes any soothing effect.

One thing musical healers tend to forget is the psychotherapeutic fact that stuffing your troubles multiples their bad effects. Before one can get to any sort of soothing experience, it’s absolutely essential to let go of the traumatic stuff – the stuff that’s making you anxious, upset, depressed, whatever-the-feeling-that’s-not-what-you-want.

Playing a didgeridoo and Tibetan bowl for me when I’m all hopped up on posttraumatic stress is like adding kerosene to a fire. Not soothing. I understand the alpha wave science, but I don’t want to hear it at that moment. Instead, I need some heavy or def metal – Alice in Chains or Metallica – to help me feel the “bad” stuff fully.

So when I’m in that ugly place, I tend to reach for music that supports the ugly feelings I have. Those feelings – and the music I need – can be quite savage, so I make sure to use headphones so I can turn it up LOUD and listen in a safe place where I won’t hurt myself or anyone else (that is, NOT in the car or on my bike or in any other situation that requires me to split attention between the rage/anxiety/depression I’m feeling and the need to operate potentially dangerous equipment).

And then I listen to that sort of music until I no longer feel the rage/anxiety/depression of whatever triggered me. This speeds up the process of “getting it out” while preventing my acting out any of the feelings I don’t want in a destructive way.

ONLY then am I ready for something soothing.

I feel it’s a huge mistake to confront rage with “healing” music. At that moment, it does the rager no good to be met with some crystal-crunching anthem, and it could actually put the ragee in danger. I know: if someone gets in my face with “all there is is love” when what I’m actually feeling at that moment is anything but loved or loving, there’s going to be trouble.

Think about it: if you want to work out, you need physical support and pump-you-up music. When you are in the mood, you spin a sexy playlist. Eventually, your workout (or love-making) are over, and only then is it time for a different kind of music. So why wouldn’t you support feelings of rage/anxiety/depression with compatible music – for you – that lets you feel that stuff fully?

To recap:

1.     When traumatically stressed, use music to feel it fully in a safe place;

2.     Listen and feel that stuff until you can’t feel it any more;

THEN (and only then):

3.     Give yourself a “healing” music bath using whatever music brings you down easy.

Try it. Write and let me know how it goes.

And spread the word: June is PTS awareness month and every one of us needs to know how to use music to intervene – it’s easy and powerful.

Doing Something vs Doing Something Effective About Suicide

We all want to know that what we do is effective, right?

What can we effectively do about suicide? 

We can vote for politicians to “do the right thing” which normally means that THEY vote to spend more of OUR money … in the War on Poverty, or the War on Drugs, or government education … or suicide… 

Or... 

We can learn the skills to intervene when someone we encounter seems to be at risk for hurting themselves or taking their own life. 

--- 

We can give to a charity that “does something” about humanitarian issues like suicide in hopes that we’ve picked the best organization that will make the biggest difference with our money… 

Or… 

We can re-learn the interpersonal skills that give us authentic human connections with our family and friends and co-workers – connections that can intervene when the stresses of daily life grip us. 

--- 

We can assume that “something is being done” by behavioral health care professionals and try to ignore the fact that more people are taking their own lives today than ever before…

Or…

We can take a realistic, reasoned and educated look at our own communities and the organizations in them to learn which initiatives REALLY reduce suicide and why, then begin to replicate those efforts.

---

It is no longer enough to assume that “something is being done” about suicide when so much effort and money has already been spent without results. It’s no longer enough to assume that our favorite humanitarian organizations are able to get out in front of suicide. And it’s certainly high time we understood that government is NOT about doing what it right because government, while it is good at making and enforcing laws, has a decades-long expensive track record of failure at effectively getting out in front on humanitarian issues.

If you have a friend or family member who’s depressed, stressed and anxious, what are you doing to intervene? Is it working? If not, there are resources available to you – such as The QPR Institute and Mental Health First Aid – that will help you be more effective. If so, teach your family and friends how to do what you do.

That would be doing something effective…for a change.

Is Technology Undermining “Veterans First?”

We all know that patience with the VA wore thin long ago. One of the many remarkable results of that impatience is that Vietnam Veterans of San Diego created what is now known as Veterans Village of San Diego rather than wait for the VA to get its own act together and truly serve homeless drug-addicted combat Veterans. Fortunately, Veterans Village of San Diego has shown by example what can be done when Veterans truly come first.

Doubtless there are many remarkable individuals serving the VA, but it’s a shame that the VA’s own computer systems limit the effectiveness of the individuals working there. Part of my life was spent as an IT systems analyst, and I would like to offer insight and suggestions from my own experience of the Veterans Administration San Diego Healthcare System (VASDHS) over the last few months, seen from the point of view of a friend who is a disabled Veteran.

One example:

How is it that medical procedures at VASDHS can be cancelled last minute without notification to transportation services? My friend was told he had lost transportation privileges because a van came to pick him up for a procedure that had been cancelled. The cancellation computer failed to advise the transportation computer, which made more work the human beings serving the Veteran as well as the Veteran himself. That’s not putting Veterans first.

Another example:

Why is it that my Veteran friend can be called to an urgent appointment with less than 24 hours’ notice, requiring him to arrange his own transportation, only to wait hours for that care to be given after arriving on time as demanded? That doesn’t seem to be putting Veterans first.

Yet another:

How can the VA computer system cancel all transportation contracts for disabled Veterans without first checking to see if those Veterans have appointments on the books? This happened today at the VASDHS, and it put a number of excellent VA staffers into damage control mode. How can that be putting Veterans first?

Finally:

A Veteran trying to respond to chain yanking in any of these examples is told to call the “Primary Care Call Center.” The capable caring call center crew has only one way to put Veterans first: send an email message to the proper Primary Care provider. In this open-ended system, there is no guarantee that the Veteran will get a response, and the system is useless in some cases since the only response window offered by the call center is “two to three working days.” A disabled Veteran without transportation who must be at appointments with less than 24 hours to respond doesn’t have two to three working days. In this case, the only thing that is being put first is an open-ended broken system with no accountability programmed into it.

Some suggestions, free for the taking:

A)   Most industry-standard call center software has escalation capabilities that facilitate human intervention when necessary. It’s not hard to implement such features, nor is it hard to find capable managers and team members to use them effectively. Even the most backward third-world call centers can do this; let’s make it a part of putting Veterans first here in San Diego, and soon. An in-place escalation process would have smoothed out the response to today’s transportation cancellation issues.

B)   Require human review of computer-determined actions with a potential negative impact on ten or more Veterans. A human being could easily apply the brakes before such automatic actions become a train wreck. This could have prevented today’s transportation snafu, and would also help keep transportation from being wasted on cancelled appointments. Ultimately, the underlying deficiency in the computer systems must be corrected; until they are, let’s put Veterans – not computer systems – first.

 

C)   Require human review of all computer-initiated appointment notifications where a Veteran is given less than 24 hours to arrive for care to make sure that the communication to the Veteran is clear and that any questions the Veteran has can be answered during the notification process. This may mean that the automated notification system won’t work in some cases; until that’s done, let’s put Veterans first.

 

It seems obvious that the human capital needed to implement these suggestions is available; I witnessed it today doing damage control and it seems obvious that excellent staff would be much happier re-deployed out in front of a problem rather than reacting to the fallout from one. It also seems obvious that if a third-party civilian like myself – and I’m not a rocket scientist – can notice such things, they must already be painfully obvious to many others.

How about it, VASDHS? Doable?

A Call for a New Reponse to War

Yesterday afternoon I attended a ribbon-cutting ceremony for the opening of a new exhibit at the San Diego Veterans Museum and Memorial Center:  Vietnam -- A Retrospective on the 50th Anniversary of the Vietnam War. I was the invited guest of a United States Navy disabled Veteran who served in the “brown water navy” and was awarded a Purple Heart for injuries he sustained March 1, 1968, when his PBR was blown up by a mine and hit by a rocket. I’ll call him Joe (not his real name).

There were many Vietnam Era Veterans in the audience, including three South Vietnamese nationals. When they were introduced, I had the first of many gut-wrenching responses that continue until today, some 24 hours after the event itself.

As I sat there, I felt such shame that the United States had brought dishonor to these three gentlemen and their homeland. Forty years after the fall of Saigon, and I was embarrassed for what my country had done to theirs – or failed to do for theirs, depending on one’s perspective. That shame has been gnawing at me.

So I did some research.

From another longtime Navy Veteran who served in Vietnam, I’ve learned that, back in the day, the San Diego Veterans Day Parade included French and Russian Veterans of WWII who were living in the area, and that today’s parade regularly includes Veterans of the South Vietnam military. The San Diego Chapter of the Vietnam Veterans of America has intentionally reached out to non-US Veterans of war as a gesture of goodwill and healing. This makes some kind of sense to me.

I’ve also learned that as a part of the US Vietnam campaign, a significant number of United States naval assets were turned over to the South Vietnamese Navy beginning in Fall of 1968. The South Vietnamese Navy, as it turns out, seems to have had some North Vietnamese sympathizers in the ranks – not uncommon based on other books I’ve read including John Stryker Meyer’s “Across the Fence,” – and some of these assets were turned against the United States.

Joe, my Navy Veteran friend, has knowledge of some of the events where American forces confronted their own ships and weapons in the hands of South Vietnamese forces they thought were friendly, so you can imagine his response to the presence of South Vietnamese Veterans in the audience.

The paradox is that offering dignity to our former brothers in arms is noble AND righteous resentment towards those of their countrymen who turned against us is warranted.

I just can’t square the two truths. That’s the second gut-wrencher.

The third happened when we were invited in to view the Vietnam exhibit.

My uncle was a B-52 pilot during most of the Vietnam Era. Although San Diego is primarily a Navy and Marines town, all branches of service are represented in the Museum’s Vietnam exhibit, and the Air Force was pictured with the usual photos of planes in flight and massed on the ground. For the first time I could picture where my Uncle spent much of his time during those years – years when he would record cassette-tape letters home to his family and mine.

Normally I wasn’t allowed to listen to those tapes, but one time when my parents were out I listened to one. My uncle describes a night bombing mission over Hanoi – probably one sortie from the famous Linebacker operations ordered by President Nixon that Christmas. Many of my uncle’s buddies were shot down by North Vietnamese SAMs (surface to air missiles) and it was obvious from his voice that his expectation of survival wasn’t great. He was so concerned for his crew; they had narrowly missed being shot down that night when a SAM flew within feet of the cockpit. I can’t recall anything he said verbatim, but I got a clear feeling that his emotional goodbye to my dad – his brother – might very well be his last.

There is a picture in the exhibit of more than a hundred B-52 crew members during a briefing. I strained to find my uncle in the photo and couldn’t – there were so many bombers operating at that time – but it brought back the memory of hearing his voice on that tape, and along with it, all friendships I have and have had with Veterans of that era. Were there people in the photo that knew my uncle? Were these some of the buddies he lost? It hit hard – the third gut wrench of the afternoon.

As we left the Museum, Joe told me how proud he felt to have been a part of the afternoon – the group photo of the Vietnam Era Veterans, the camaraderie of being with buddies he hadn’t seen in years, the bonds that tie combat-wounded and battle buddies together for a lifetime. There were tears in Joe’s eyes when he told me how good it felt to finally be accepted for what he is and has done.

Fourth gut-wrencher.

Joe emailed me today saying that he hadn’t slept as well as he did last night in years.

I, on the other hand, couldn’t sleep. It’s been 24 hours of hellish confusion – mental and emotional.

I’ve talked with a few people about it including Joe. There’s not much sense to make of such things.

Vietnam, and perhaps all United States military excursions since, seem to be futile. Maybe it’s about an old-fashioned response (war) to a new-fangled problem, but even the problem escapes the boundaries of clarity. We can bemoan the political mushiness behind such campaigns, or rankle against the possibilities that things aren’t what they appear to be (how did World Trade Center Three actually collapse, let alone the twin towers?), but that seems wrong-headed in the light of history.

While the United States had some objectives in Vietnam, one of them was clearly NOT defending our homeland on our own soil. Our South Vietnamese brothers, on the other hand, were doing precisely that, and might have been successful with our assistance had not the United States media projected as fact what was mostly fiction. But even that perspective is debatable. As are many facts and fictions in military operations since, right up to today.

All of this does nothing to relieve the pain in my gut.

The only way I can resolve this is to offer words from someone wiser. Among his other contributions, Albert Einstein observed: “Insanity is doing the same thing over and over again and expecting different results.” Without punning on military intelligence (which I do NOT feel is the issue) or political stupidity (which might be), is it not time that we paid some attention to Einstein’s notion of sanity?

We – that is, most of the “free” world – isn’t doing so well responding to the brutal hurtful people who live here. For many reasons, our response to the brutal and hurtful must be meted out politely instead of dealt decisively. That response is, by Einstein’s definition, insane.

It’s been more than 50 years of insanity, actually.

Peace? Overwhelming force? I don’t know.

I don’t know what the sane response must be, but I do know that another 50 years of what the free world is doing in the Global War on Terror (or whatever we are calling it these days) won’t stop the thugs from looting and pillaging, whatever their reasons for doing so.

What I do know is that I don’t want to sit beside people who once fought alongside me – from my country or another – with shame in my heart for having failed the mission. I don’t want to find myself an enemy by association. I prefer to wage peace with strength, but my real impact extends only as far as my family and friends.

I will do what I can. Perhaps if you do so as well we can make a difference. We aren’t the first ones to think so and we won’t be the last, but isn’t it past time that we made the effort?

STEM vs STEAM: a Proposal for an Uncommon Core

Be warned: rant ahead.

I promise there's also a solution at the end. 

The STEM vs STEAM Rant

The tail is wagging the dog again. Some committee who's most certainly well-intentioned has determined that science, technology, engineering and math (STEM) are the ways that government schools ought to approach education, as this government website says, "for global leadership." Right.

If anyone wanted to recall the Renaissance, or perhaps in more recent memory, the various world leaders who could actually perform convincingly on a musical instrument (here's video of Bill Clinton playing the sax on Letterman) the notion of STEAM might be more interesting, since  including art (the A in STEAM) in a curriculum has been proven to magically enhance the rest of those cerebral pursuits. Evidence for this goes back, well, several thousand years. There was a time in ancient China, for example, when powerful respected politicians were also poets and sometimes artists.

This is no time to belabor the dismal record America's government schools have accumulated teaching the arts in primary and secondary education (they have none). Government education offloads that responsibility (yes it is a responsible part of education to at least expose kids to the arts!) to government-subsidized colleges and universities when it's too late to have an impact on a formative young mind.

(This is not a blog about how eliminating the arts from government education may have resulted in some of the poorest test scores in generations, except to say that "common core" (more about that here) can only hope to realize common mediocrity by senselessly excluding the arts. No secret about where I stand on this issue!)

We're also not discussing the abundant evidence in most of Western and Eastern Europe and Asia for a more, er, benevolent focus on the power of a solid arts curriculum. It doesn't take a STEM scientist to look around and take note of the nations who have excelled in STEM since the 1960s: that last major STEM government program America has to offer is still named NASA but its exploits have been eclipsed by the technological prowess of such nations as Japan, South Korea and China, not to mention private companies who can hire STEM folks from oversees. Even our good friends in the former Soviet Union still recognize the value of government-supported arts academies. It doesn't matter that American companies like Apple have built convincing sustainability at the intersection of technology and liberal arts because of the ignorance of that fact at the United States Department of Education.

Here in my own backyard, Qualcomm, the biggest single employer of STEM-savvy folks for miles around, can't find any of them at local universities. No DoE STEM edict is going to change that overnight, or even in this generation. There's a reason that search for the origins of matter is taking place at CERN (Europe) rather than a stone's throw from Silicon Valley at SLAC (California).

Another mistaken fascination with STEM has to do with buzzwords like "interdisciplinary" or "multidisciplinary." It's trendy right now to look at the fractures between subjects as taught in government schools and attempt to recombine them simply by saying that they are now interconnected (by what magic did that happen?) and that all teaching staff will teach a holistic curriculum that crosses all disciplines. How to accomplish that without art has yet to be explained, but since no one currently making the rules really seems to understand the value of an arts education, it's probably to be expected.

A Possible Solution

What's the answer?

We've been throwing more and more money at government education for so long without results that perhaps it's time for a cat wrangler.

That is, we know there's no shortage of teachers for music, fine art, dance, theater, poetry and creative writing. There are probably plenty of successful STEM folks out there with more than a passing interest in the arts (how well did Albert Einstein play the violin?). Let's bring some of the leaders in the STEM world into contact with the leaders in the Arts world and let them drive a convincing wedge into the boneheaded government bureaucrats behind "common core." Let's explain, using little words, how learning Art develops young brains better than any other curriculum known to man. Imagine where Steve Jobs could have taken Apple if he had stayed with his early music lessons, or where any ADHD kid might be able to go in education if instruction from an accredited Suzuki music teacher was made mandatory (did you know that most professional, working drummers are ADHD?).

Music

(I know music, and this is in no way meant to slight the other arts, but rather to encourage you to write your point of view from whatever artistic discipline you inhabit.)

If you look carefully at the intersection of arts and technology, you're going to find an incredibly talented resource pool: music therapists. Most of the board-certified music therapists with an active practice today could also be deployed into primary and secondary education to great effect. Why music therapists? They have the training to know how to marry people skills with musical ones to serve the purpose of advancing a patient's health and well-being. Think of the at-risk kids you might know stuck in government schools: are any of them autistic? Music therapists are excellent at dealing with autistic kids.

Do you know any kids with learning disabilities? Music can be adapted to teach facts, improve memory and speed up the learning process. Then there's the amazing brain-building capabilities music has that integrate movement, sight, hearing, thinking and touch like no other educational tool can do. Learning music can teaches science through vibration, technology through recording and editing, engineering through either theory, composition or mastering a satisfying recording and mathematics through rhythm, time signatures and note values. And that's just off the top of my head. Fine artists, poets and writers probably have a few insights on this as well.

There are some amazing humanitarian organizations filling up the government school's missing arts education gap. There are probably more than a handful close ot where you live. Would any of those NGOs be interested in helping put the A into STEAM? You bet they would!

Am I making my point? Are you beginning to see the magic of STEAM and the fallacy of STEM?

Let's get this snowball rolling downhill. It's time to put ART back at the core of education.

Preventing Veteran Suicide with Connectedness

It’s hard to consider all the aspects of suicide without recalling the very public self-immolation of Thich Quang Duc, the Buddhist monk who sacrificed his life to protest government mistreatment of Buddhists in 1963. This symbolic and ancient act of defiance inspired many others during that era, including a few who used suicide to protest the war in Vietnam.

We are all aware of the astonishing frequency of Veteran suicide these days, but did you know that, in some cases, the Veteran intended his or her suicide to be an act of protest? In most cases, however, Veteran suicide appears to be an act of frustrated desperation.

What if one aspect of Veteran suicide is the martyrdom of war?

While it may feel noble to want to prevent one from taking his or her own life, I would like to boldly suggest that preventing all Veteran suicide may be misguided hubris.

Logically, if we truly intend to end all Veteran suicide, we ought to end all war. Clearly, while threats such as ISIS exist, there’s no way to end all war.

So how do we embrace both the desire for an end of war and the reality of its existence? How do we both stand up for peace and pay the cost of battle? How do we attempt to prevent some types of suicide while allowing the pathos of “suicide as protest” or “physician-assisted” end of life? The costs of war are as old as war itself: post-traumatic stress, sexual trauma, traumatic brain injury, loss of limbs, and loss of life itself. Normal human responses to such things include suicide and even “assisted” suicide (whether by physician or peace officer), just as they always have.

And, in some parts of the world, the peaceful human protest of oppression and war also includes suicide, just as it always has.

I write this with great sensitivity to those of us who have a personal belief that suicide is “wrong;” I myself believe that violence is wrong, especially violent death, whether or not it is self-inflicted.

However, if we suspend judgment for the purpose of a thought experiment, and allow the paradox of both “good” and “bad” suicide, perhaps we can reach a new kind of compassion for those who are suicidal, regardless of whether we agree with their choice of death or not.

Evidence suggests “connectedness” is a factor in preventing suicide. My understanding of “connectedness” is the kind of one-to-one association you might have with a peer, colleague, mentor, friend or, perhaps, a therapist or religious leader or teacher.  This is in contrast to the deeper kind of “connectedness” in a committed relationship such as marriage, but let us keep our thought experiment at the more detached level of “human connection.”

We know that members of a military unit are highly connected, both for task and support purposes. This high degree of purpose-driven “connectedness” changes dramatically when warfighters become civilians, and to a lesser extent when combat deployment ends, since the original purpose for the connection (war) is missing. One could conclude that becoming disconnected from one’s fighting unit is itself a risk factor – but not the only one – for suicide.

As loving and connected as some military families are, the family cannot replace the connectedness of the military unit. A family clearly has a different purpose, and its human connections serve that purpose as opposed to the purpose of war. A highly connected family helps minimize suicidal risk in its own way, but does not remove the risk.

As one who has thought carefully about suicide – both in terms of taking my own life and as a survivor of those who have taken theirs – I want to say how grateful I am for having a loving and supportive family around me. I also want to note that, at my most vulnerable, I had no desire to share this with my family. That feeling of utter aloneness, for me, was the riskiest place in my journey. Like the warfighter returning from deployment or the newly minted Veteran, at my most vulnerable I felt cut off from everything I needed most to keep going.

I am also grateful also for the talk therapy I had. Fortunately, I was having therapy before and after my moment of crisis. Sadly for many suicides – people who may have been helped by talk therapy – reaching out for help doesn’t always happen. Even with the therapy I had, when my moment of crisis came, I did not pick up the phone and call anyone, let alone my therapist, and I suspect that process of isolating oneself is typical of many in the same position.

There is evidence supporting the fact that suicide rates are dramatically lower when a therapeutic modality is in place.

For active duty soldiers, a recent study found that the cognitive behavioral therapy (CBT) modality reduced suicide attempts among high-risk patients [sic] by 60% over a two-year follow-up period. (Another citation of that study can be found here). (While such post-trauma studies are necessary, I suspect a more powerful therapeutic intervention for suicide would be possible if we could find a way to introduce CBT tools to high-risk warfighters before they encounter stressors.) The question, to me, is not so much the modality, but whether offering this form of one-on-one “connectedness” to the “patient” was of itself the reason for the drop in suicide attempts.

Here in the San Diego County, California, Veterans Services world, we find peer mentoring to be a powerful indicator of a program’s potential for success, whether the objective is expunging a DUI in Veterans Treatment Court, successfully serving time in a Veterans-only cell block in a jail without recidivism, being treated for addiction in a Veterans-only residential facility, or training a newly-hired Veteran using the buddy system. This makes sense; peer mentoring is a powerful reminder of the military unit where both mentor and mentee enjoy common success in pursuit of shared goal.

It’s possible that, since Veterans are highly trained human connectors, removing the “connectedness” factor from a Veteran’s day-to-day increases his or her risk factors. Instead, if a program provides a framework for a high degree of human connectedness, Veterans thrive. So how do we get out in front of the risk factors, perhaps even before a new recruit goes to boot camp?

There are a number of programs with a focus on resilience already at work on military bases and in the National Guard and Reserves. This is absolutely necessary! There are also several programs training civilians to better interact with Veterans professionally, therapeutically, and as co-workers. One of my favorites is Psycharmor. Conversely, there are also programs that teach or remind Veterans of the nature of non-military civilian “connectedness” such as The Reboot Workshop. Why do these programs exist? To teach all of us how becoming more effective connectors – as peers, mentors or friends – improves the success of our endeavors.

Returning to our thought experiment, let us ask: how effective we are as peers, mentors or friends? If you or I were to grade ourselves on the scale of the “connectedness” we offer, how would we measure up? Let’s be clear: we aren’t interested in the number of digital connections we have on Facebook, LinkedIn, Instagram or the latest behavioral healthcare app on our mobile devices. We are talking about real live one-on-one human beings sitting across a table from each other, maybe not saying anything, but sharing some sort of authentic bond.

A Veteran buddy whose job is peer outreach was assigned a particularly difficult case: a recent, young Veteran who had many unseen combat wounds. Every week for more than a month, my buddy met his “case” at a coffee shop for an hour. Normally, my buddy told me, the “case” would just sit there, avoiding eye contact and messing around with his smartphone. It took many weeks before the “case” even looked up. One week, the “case” looked up at my buddy, made eye contact, and said: “You know, you’re OK.” That was the moment when effective connectedness became possible. If we are to believe the evidence, that was also the moment when the “case” took a step away from risk and towards reward. The lesson here is that sometimes it takes a lot of “showing up” before any useful opportunity for change can happen.

I hope this discussion helps crystalize the potential for each of us to become better connectors. I happen to believe that listening to or making music together helps improve connectedness. Other powerful examples include structured groups, be they faith-based, therapeutic or “12-step” style. What do you believe? Can you use your beliefs to strengthen your skills as a connector?

Your skills are useful far beyond someone “at risk” of becoming a “case” – the world needs you to use those skills now, with everyone you know and everyone you meet. I think you will find that being a better peer, mentor or friend has rewards that go well beyond lowering the suicide rate.

At least one highly responsible military leader agrees with this approach. Army General Martin E Dempsey, Chairman of the Joint Chiefs of Staff, recently signed a letter to all transitioning service members in which he encourages them to become leaders in their communities. I would like to share that short letter with you because it shows great sensitivity to the issues Veterans face that is the nexus of the points we have been discussing here. It also has the welcome expectation that civilians such as you and me will do our part as well.

2 February 2015
To All Who Have Served in Uniform Since 9/11,
          You and your families stepped forward as volunteers when our Nation needed you, and you excelled. For over a decade of war, you demonstrated the courage, resilience, and adaptability that are the hallmarks of the American military. Thank you for wearing our Nation’s uniform.
          Your dedication to those serving on your right and left has been unwavering, and your commitment to a cause greater than yourself has been inspiring. Be proud of what you have done for your country and for those people in other countries who share in the dream of a better future.
          Over the last 13 years, you have written a new chapter in American military history while honoring the legacy of the generations of veterans who served before you. Their sacrifices paved the way for our welcome home—we build our legacy on their shoulders. It is appropriate to recognize and thank them as we join their ranks.
          It is also appropriate to follow the example they set when they took off the uniform. Those previous generations of veterans understood that they had an opportunity—and a responsibility—to continue serving. Your generation will also help guide our country’s destiny.
          While the transition to civilian life brings new challenges, the American public stands ready to welcome you home. As a veteran, your country still needs your experience, intellect, and character. Even out of uniform, you still have a role in providing for the security and sustained health of our democracy. No matter what you choose to do in your next chapter, you will continue to make a difference. The opportunity for leadership is yours.
          We trust that you will accept this challenge and join ranks with the business leaders, volunteers, and public servants in your communities. You have made your mark in uniform and represent the strength of our Nation. We know you will do the same as veterans, setting the example for the next generation of veterans to follow.
          We thank you and your families for your service and for your continued dedication to the United States of America. It has been our greatest privilege to serve with you, and we look forward with pride to what your future holds. We know it will be extraordinary.

Sincerely,
Martin E. Dempsey, General, U.S. Army, Chairman of the Joint Chiefs of Staff
James A. Winnefeld, Jr., Admiral, U.S. Navy, Vice Chairman of the Joint Chiefs of Staff
Raymond T. Odierno, General, U.S. Army, Chief of Staff of the Army
Joseph F. Dunford, Jr., General, U.S. Marine Corps, Commandant of the Marine Corps
Jonathan W. Greenert, Admiral, U.S. Navy, Chief of Naval Operations
Mark A. Welsh III, General, U.S. Air Force, Chief of Staff of the Air Force
Frank J. Grass, General, U.S. Army, Chief of the National Guard Bureau
Paul F. Zukunft, Admiral, U.S. Coast Guard, Commandant of the Coast Guard

Suicide and Compassionate Care

For the last three years I’ve had the honor of being a personal advocate for a Vietnam Veteran and good friend. There have been a number of, well, “questionable” circumstances at the Veterans Administration Medical Center (VAMC) with regard to his care. By that, I mean that someone who is more knowledgeable than me would question the care my friend has received. But this post isn’t about that. It’s about something else – a larger issue that encompasses both health care and compassionate care.

Full disclosure: my relationship to my friend is not regulated by the Health Insurance Portability and Accountability Act since I have no legal responsibility nor active role in “protecting” his privacy, and this post has been written with his full understanding and cooperation.

Not once in the three years that I’ve been close to my friend’s situation has anyone ever said to him “I’m so sorry.” Those three words are just missing from the lingo of government health care professionals. Let me give you an example.

I was able to make a referral for my friend to the director of our local Vet Center. Because I’m familiar with the many issues for which my friend needs care, I provided a high-level summary of some of the questions my friend is attempting to answer as he nears end of life, strives to provide adequate care for his wife (who suffers dementia and Alzheimer’s disease and has been physically abusive to the point of breaking most of the bones in my friend’s lower left leg), and does his best to continue to receive care from the VAMC.

The local Vet Center, which is one of the best in the nation, simply offered my friend referrals to other sources of assistance. I understand that this is how things are done, but the fact is that at no time did my friend receive any kind of empathy.

Sadly, it seems that a lack of empathy from our government has reached epidemic proportions. It’s not hard to say “I’m sorry” and really mean it. I do it a lot…and I’m just a piano player. Seems reasonable to me that highly trained professional caregivers with lots of letters after their names ought to be able to say it too. But no: that’s not what my friend experiences. Not from the VAMC; not from his Congressional Representative’s Veterans liaison; not from the Vet Center; not from the folks caring for his wife; not from the folks checking up on him (he’s presumed to be “at risk” for suicide); not from the various other people engaged in my friend’s other numerous public assistance issues.

Granted, my friend will probably die from a number of things most of us will never encounter – complications arising from exposure to Agent Orange for example. Although he’s in his mid-sixties, he will probably die sooner than most of those in his generation. That alone, to me, is a cause for compassion. Even as I honor his military service in a terribly mistaken conflict, I’m very sorry that my friend will probably pass away before his time. I’ve told him this. I feel that someone needs to.

So let me offer a few tips to the pros, staff and volunteers in government (and "non-profit") health care who may have missed class when such things were discussed. These few words go a long ways toward making your inability to provide assistance less insulting.

• If there’s nothing you (or your department or organization) can do, please begin every explanation of this fact with these words: “I’m so sorry: I wish there was something I could do to help….”
• If you (or your department or organization) can only offer limited assistance, please begin every explanation of this fact with these words: “I’m so sorry: there’s not much I/we can do….”
• Finally, if you are the bearer of really bad news, please please please begin every conversation with your patient as follows: “I’m so sorry to be the bearer of bad news….”

This is not hard, doesn’t require an advanced degree, and takes a lot of the bite out of being a government caregiver with a huge waiting list trying to do his/her best. Those of us on the outside feel your pain too.

The point is that, in many ways, offering one’s humanity to another appears to be a lost art. When we had education in etiquette such things were simply part of the skills most humans learned; these days, not so much. It’s as if our whole vocabulary for being human beings has been corrected politically, or legislated out of use (by HIPAA, for one example) or simply ignored in the face of overwhelming demands to do more with less. Clearly this is unacceptable.

Human beings are, first of all, human. We are not numbers. We do not fit into neat cubbyholes labeled with various diseases, disorders and issues. In case anyone hasn’t noticed this recently, take a look at social media. You will find there that most of the many billions of us who are online and don’t care who knows that we are all distinctively unique.

I understand that government is trying hard to be compassionate when it comes to health care, especially for Veterans. I also understand that there are limitations on government, since it must do its best for the most and cannot by its very nature respond to each of us on a personal level. If you have any doubts about this, write to a few of your elected officials – for any reason – and take note of how you are treated. If you are invited to have a one-on-one coffee talk with any of them, you are a very lucky individual.

When it comes to caring for Veterans, there seems to be one thing that works: mentoring. Mentoring, at its heart, is human kindness. It is one human being caring enough about another to extend a genuine, compassionate connection. That simple act, offered consistently over time, has done more for the Veterans with issues than any other program offered by a government agency or humanitarian program ever will. Why? Because simple human kindness offers meaning to someone who might not have much meaning left in his or her life.

We know from solid psychological evidence over the centuries that people with a reason to live won’t kill themselves, and will have a hard time permitting needless killing of others to take place. This could be an insight in the current trendy effort to “end Veteran suicide.”

We ought to know that removing compassion from care also removes a reason to live from the cared-for. I feel that’s criminally neglectful. Don’t you?