Missouri Gov. Eric Greitens and Navy Cmdr. Mary Neal Vieten have never met, but they share a common viewpoint: the U.S. military does many things right, but when it comes to preparing its personnel for reintegration into civilian life, well, not so much.
Greitens, a U.S. Navy SEAL, found that instead of being encouraged to become productive citizens, servicemen and women too often are told to apply for disability benefits when they are still able to function. Or, they repeatedly are given prescription pain medications and other drugs, often leading to dependence on them.
His observations formed the basis for The Mission Continues [TMC], the St. Louis-based nonprofit created to assist servicemen and women with re-entry into civilian life. TMC’s approach is to encourage veterans to participate in community projects, serving others as a way to regain their strength and rebuild their personal relationships and sense of purpose.
Vieten, a board certified clinical psychologist, made a similar conclusion, but took a somewhat different approach. Now the executive director of a privately funded program, Warfighter Advance, whose objective is to get “war fighters” – a term she often opts to use instead of “veterans” – on a path for resuming life in an environment much different from the often traumatic and horrific one they were trained to deal with in the military.
Warfighter Advance eschews the use of drugs to treat post-traumatic stress, a condition Vieten views not as a “disorder” but a nonetheless very real and normal human reaction, and one not limited to those with a military background.
Vieten, who served on active duty for 10 years and had two deployments as part of her ongoing service with the Naval Reserve, was the featured speaker at a recent Lake Saint Louis workshop on healing post-traumatic stress.
During the day-long session, she talked about the week-long retreats she directs, designed for both former and active duty military personnel. The agenda focuses on confidence-building, outdoor activities and group discussion in a relaxed and positive environment. Techniques for self-management of symptoms, stressors and responses are emphasized.
The program has been developed in partnership with the International Society for Ethical Psychology and Psychiatry and is offered at no cost to participants. Travel costs to and from the program site in Nanjemoy, Maryland, south of Washington, D.C., on the Potomac River, also are covered.
Vieten and her team have provided intervention services to more than 900 veterans since the concept was launched in 2003.
The program’s approach challenges what many may accept as conventional wisdom, including the TV advertising-enforced belief that there’s a pill for whatever ails you. Vieten’s concern is that drugs affecting the brain can come with their own set of issues, such as potential addiction and a host of other potentially harmful side effects.
What is normal?
The brain is an organ with many mysteries and unknowns still surrounding it, the Navy psychologist Vieten noted. On the other hand, the human mind is an idea, or what professionals in the field call a construct. To state with confidence whether and how the mind can be influenced positively and predictably by medicating the brain is simply not logical, she believes.
Placing the term “disorder” with post-traumatic stress puts a label – one often viewed in negative terms – on something that is indeed normal. The issue is more one of defining and understanding what normal is and why normal should not be equated with comfortable.
Grief, for example, is a normal human reaction in many circumstances and should not automatically be viewed as depression, which our society often tells us must be treated with a pill of one kind or another.
Similarly, the physiological responses associated with panic attacks are the same as those that accompany the normal fight/flight/freeze reaction humans experience when threatened.
Psychiatric diagnoses are not pinpointed by science, as is the case with a virus, bacteria or cancer cell, Vieten said. Instead they are determined by identifying clusters of symptoms. However, there are no objective tests or consistent measures involved and what one doctor interprets as significant may be viewed differently by another. Whether or not a condition is included in the profession’s “bible,” known as the Diagnostic & Statistical Manual of Mental Disorders [DSM-5 is the current edition], is based on a committee vote.
Theoretically, a person describing his/her situation to five different doctors could wind up with as many different diagnoses and a range of “drug cocktails” for treating them.
“Tell whatever story you want and the [healthcare] provider decides what’s wrong with you,” Vieten said.
While Vieten is outspoken, she is obviously not alone in her views.
“What we are talking about here is information that’s readily accessible in the public domain. It’s not about Dr. V. saying this or saying that. The focus should not be about me, but about the issue – the illusion of mental illness and drugging without fully informed consent,” the Navy psychologist asserted.
Angela Peacock, 37, of St. Charles, served almost seven years with the U.S. Army, including a deployment to Baghdad. She also attended the Lake Saint Louis workshop.
After leaving the military, Peacock noted that she was given medications without receiving complete information on their side effects or other alternative approaches. A year ago, when she decided to discontinue the drugs after 13 years, she said “it was like waking up from a nightmare.”
Her research on veterans with experiences similar to hers has convinced Peacock that “there’s an epidemic out there.” She said she had read about Vieten and her work before attending the workshop and hopes to follow in her footsteps. She anticipates graduating from Washington University in St. Louis this spring and plans to work toward a graduate degree.
While Vieten rejects a reliance on drugs for treating perceived mental issues, she warned that no one should simply decide to stop taking them cold turkey. If a person is on one or more such drugs, withdrawal must be carefully supervised to avoid unpredictable consequences.
Vieten objects to the approach used by the Department of Veterans Affairs’ compensation and pensions department, likening the operation to an insurance adjuster whose goal is to pay out as little as possible. She has no objection to war fighters being compensated for post-traumatic stress.
“It is a problem, but not necessarily a medical problem,” she said. “The spirit of the Compensations and Pensions side of the VA is to compensate veterans for what would not have occurred had they not signed up.”
Equating post-traumatic stress to a disability reinforces and motivates illness and places the veteran in the position of having to repeatedly prove an idea or construct that can’t really be proven, she said. At least part of the issue is that behaviors that help those in the military stay alive and functioning properly in that environment often are viewed as an aberration in a civilian setting. Sleep and anger issues, an inability to tolerate errors, obsessive-compulsive actions, vigilance taken to what can appear to be an extreme, a highly active “startle response” to an unexpected noise or other stimulus all are things military personnel do to adapt in a war zone. Back home, unlearning those reactions can be difficult.
But the tendency when the war fighter does return home is for doctors to take those operational adaptations and classify them as symptoms requiring medication. The reality is that some of the drugs frequently prescribed also can have harmful side effects, including thoughts of suicide. Other veterans may resort to alcohol as a means of escape.
The danger of labels
Research from the Department of Veterans Affairs published last year shows about 20 veterans a day commit suicide nationwide. Although the data revealed a figure below an earlier and oft-quoted estimate of 22 such deaths daily, the more than 7,400 veterans who took their own lives in 2014 accounted for 18 percent of all suicides in America. Veterans make up less than 9 percent of the U.S. population.
The labeling of someone as being in this or that category, based on “symptoms” a healthcare provider has identified, also troubles Vieten. “You should be frightened by anyone having the power to put a label on you,” she said. “Labels can follow you the rest of your life.”
Vieten noted that if you use insurance for a medical visit that results in your being labeled, correctly or incorrectly, as suffering from a mental disorder, that information goes into a database to which others may have access.
Dr. Daniel Carlat, himself a psychiatrist, has written extensively about his profession and its relationship with the drug industry, often referred to as “Big Pharma,” Vieten said. Referring to Carlat’s observations, she said chances are fairly good a primary care physician a patient sees with complaints about conditions perceived as symptoms of a mental disorder, the drug the doctor likely will prescribe is the one recommended by the drug company representative who most recently spoke with the physician.
An editorial cartoon Vieten used in her presentation describes the relationship between the psychiatric profession and Big Pharma as being akin to Siamese twins joined at the hip. In the cartoon, a doctor, apparently a surgeon, looks at the conjoined twins and observes, “We could attempt a surgical separation, but it’s doubtful either one of you would survive alone.”
“I am not trying to take on all of pharmacology,” Vieten told Mid Rivers Newsmagazine. “What I am trying to do is emphasize the importance of a patient giving fully informed consent before being handed a prescription.”
Vieten also was critical of psychiatric and psychological drug research, urging that it be viewed carefully for information on who paid for it, potential conflicts of interest, the quality of methods used, how interview and interpretation categories are established and other factors that can reflect on the legitimacy and objectivity of the results.
There are alternatives
Alternatives to drugs are emphasized at Warfighter Advance and include interventions that are free, if not always easy. Included are:
- Exercise, listed first because of its effectiveness, Vieten said.
- Decreasing central nervous system stimulants such as caffeine and nicotine.
- Sleep hygiene and dream management.
- Skills for dealing with panic/anxiety attacks.
- A proper, regular diet.
- Relaxation, breathing techniques and meditation.
- Emphasizing the importance of a daily routine, staying busy.
- Returning to or increasing spiritual practices.
In an analysis of six treatment protocols used for patients with various symptoms considered to be mental disorders, a well-known and highly regarded psychologist found that all were successful. What was shown to have the biggest impact on positive results was the relationship the doctor had with the patient, Vieten observed.
The study served to underline an adage Vieten referred to frequently during the workshop: “The only cure for an injury to humanity is humanity.”