From Las Vegas comes news of another tragedy that may be due to a soldier’s PTSD. Although unconfirmed by the Air Force at press time, sources who knew the couple say that Airman Jason Matthew Klinkenberg was the soldier who held what was described as “about 100” SWAT and police officers at bay outside of his apartment before he shot and killed his wife and then himself yesterday morning.

A friend who said he served with Klinkenberg in Iraq said that Klinkenberg battled post-traumatic stress disorder and had back problems that required him to have several surgeries.

The friend, who declined to give his name, said Klinkenberg was traumatized by an incident with a rocket propelled grenade and, later, when a man set himself on fire in front of him.

This information could not be independently confirmed Friday.

Klinkenberg was just 25 years old; his wife, 23. The authors of the report in the Las Vegas Review-Journal, Maggie Lillis and Lawrence Mower, wrote that a Nellis Air Force Base psychologist said last year that the base “doesn’t have a specific program to deal with post-traumatic stress disorder among active duty troops.” The base apparently relies on troops’ voluntarily reporting their illnesses and seeking help.

I guess that’s working out for them.

Some days are filled with pain and sorrow. And some days you find out about a great organization like Puppies Behind Bars, an organization in New York that puts dogs into New York state prisons for a year to be specially trained by prisoners as service dogs for law enforcement and the disabled.

Puppies Behind Bars has recently begun a special program for U.S. veterans of the Iraq and Afghanistan wars brought down by combat stress. The dogs are taught special commands so that they can act as buffers between their people and other human beings when the vets are experiencing difficult times. Coloradoan.com tells a story about a vet who is already getting the benefit of a puppy’s love:

In addition to the usual “shake” or “sit,” Samba and Frankie also know how to get in front of strangers ready to approach Hill or Bang-Knudsen. The dogs act as buffers, particularly when the two men aren’t ready to open up about what’s bothering them. The dogs clearly also provide much-needed companionship.

“When (the owner) begins to feel anxious, we teach them to let that anxiety go down their arms and into their hands. They can then pet their dogs, and the anxiety can go straight into the dogs,” said Bayless.

…This week alone, he says he’s already started to notice a difference. His wife has already told him when he’s around the dog he reminds her “of the person she married.”

I love this program, not just for what it does for my fellow sufferers but for what it does for the prisoners as well. From the Puppies Behind Bars web site:

Not only do inmates have unlimited time to spend with the puppies, but they benefit from the responsibility of being puppy raisers in ways that are especially important to their rehabilitation: they learn patience, what it is like to be completely responsible for a living being, how to give and receive unconditional love, and — since puppy raisers take classes and train the dogs together — how to work as a team.

Make a donation to Puppies Behind Bars

Research done by the Department of Defense on the physical mechanisms of post-traumatic stress disorder (PTSD) are beginning to bear fruit. Research presented at the Warrior Resilience Conference in November by Dr. Steven Southwick, deputy director of the clinical neurosciences division of the National Center for PTSD, has demonstrated how the chronic, unremitting stress experienced by PTSD sufferers damages the complex neurological system that regulates our response to stress. 

One of the key misperceptions about stress, something also commonly misperceived about allergies, is that exposed people build tolerances to what they are exposed. Nothing could be further from the truth. Increased exposure to stress does not build up some kind of super muscle so that the next time you experience stress, you can combat it like Wonder Woman. It actually breaks down the mechanism so that you over-react to the stress, the same mechanism that happens when you are over-exposed to an allergen. The allergen strips your ability to fight against it, and the next time you are actually more sensitive, and more sensitive, until you are hyper-sensitive.

Here’s what happens: Animals, who only experience physical stress, can easily turn off their stress response when the cause of stress has passed on. But humans can feel stress from thoughts and feelings, as well as physical threats. The experience of unremitting stress activates your “fight or flight” response, pushing out increased levels of cortisol and noreprinephrine. Dr. Southwick’s research has shown that PTSD sufferers push out excess cortisol, impairing the hippocampus’ ability to regulate it and turn off the cortisol, causing even more cortisol to be produced in a vicious cycle. Next thing you know, you’re pacing, or rocking, and pulling your hair out (or whatever anxiety actions you take, those being mine).

Noreprinephrine, or NE, is the hormone that regulates arousal. In Dr. Southwick’s terms:

“NE helps humans selectively attend to those stimuli in their environment that are critical for survival. It’s also important for vigilance and cardiovascular response. It’s a critical part of the alarm system in my brain… . NE can become sensitized, so that the next time a stressor comes along, an individual releases more stress hormone [than is really needed],” Dr. Southwick explained.

Hence, the car alarm goes off, and we jump ten feet in the air.

There is hope. Southwick and his colleagues have identified soldiers with high resiliency against stress to have high levels of an amino acid known as NPY. NPY is released with NE when the sympathetic nervous system is activated. NPY inhibits the continued release of NE so that the sufferer doesn’t “overshoot” NE, causing the person to be hyper-aroused for extended periods of time.

Identifying something like this could be one more small step to finding effective treatment therapies not only for people with combat and serious injury PTSD, but complex PTSD like mine.

The Associated Press reported on January 29, 2009 that at least 128 U.S. Army troops committed suicide in 2008, the highest number recorded since the Army began keeping suicide statistics in 1980. The number may even be higher; at least 15 additional suspicious deaths are under investigation which could be ruled suicide. Hope by Ahmed Al-Shukaili of Muscat, Oman courtesy stock.Xchng

The new data surpasses recent numbers:

• In 2006, 102 Army troops committed suicide
• In 2007, 115 Army troops committed suicide
• The current members calculate to a suicide rate of 20.2 per every 100,000 soldiers
• In 2006, the suicide rate among male veterans aged 18-29 was 46 per every 1000,000 — more than double the current active duty suicide rate
• Yearly increases in the suicide rate have been recorded since 2004

Based on numbers from the Centers for Disease Control and Prevention, the Department of Veterans Affairs, which tracks suicides of veterans as well as active duty troops, has estimated that as many as 18 veterans a day take their own lives.

To combat this life-or-death situation, the Army is conducting a stand-down for one month beginning February 15th in which all soldiers will be taught how to recognize suicidal behavior and intervene at a one-to-one level if they think someone they know is suicidal.

The Suicide Prevention Action Network (SPAN) USA offers two downloadable action cards that list warning signs and risk factors for suicide. They have also just released a brochure especially for military families. I offer links to those documents here:

• Download PDF: Suicide Prevention for Military Families: What You Need to Know about Warning Signs and Getting Help
• Download PDF: Warning Signs of Suicide
• Download PDF: Risk Factors for Suicide

 I have mentioned many times here in this blog that I lost a dear friend and ex-Special Forces warrior to suicide which I believe was a result of his post-traumatic stress disorder (PTSD). I don’t know if Robin would have sought help if it had been available, but I know he looked everywhere for help when he was alive, and if his beloved corps had offered it to him he would have taken it without question. Help has to come from the warriors. They have to take care of their own. Or more and more, and more and more, and more and more, will end up like my friend Robin did: with their brains blown out on the wall behind them.

Recently I discussed the recurring nightmare memory that led me to a realization of what my “problem” is: Complex PTSD as a result of childhood sexual trauma and abuse, with what I believe was delayed onset prompted by a series of horrific car accidents. My realization did not come in one big shaking “Eureka!” moment; it came rather in a series of “aha!” incidents that gradually piled up into a crushing mass, and one day I opened the door to that mass to let it in, and attempted suicide.

Suicide was not the solution, but it was through my suicide attempt that I received a diagnosis. I think if there was ever any “Eureka!” moment in my life it was my diagnosis, because hearing it was the day that crushing mass fell from my shoulders in a heap, and I realized that, once and for all, I was no longer carrying the burden of … everything. Of not knowing what the hell was wrong with me. Of not knowing if what had happened to me was real. Suddenly I knew; I had recognition. I could look at my diagnosis and I could see myself, and I could say, yes, that is me, that is what I am. Finally, there were no more missing puzzle pieces. I was whole. I was not perfect, I was not an elegant picture of the perfect 21st century modern put-together woman, but I was me. Everything clicked into place.

One of those first realizations — and I can’t say it was the first, because I don’t really remember now which was the first, if there was one — was after I found my father again, at the age of 31. After not even lifting a single finger to find my father, it only took me a few minutes on the internet to locate my father’s address in Staten Island, New York, and a few more minutes to type up a letter, address it and put it in the mail. I soon received an e-mail from my father’s brother’s wife that my father had received my letter, was extraordinarily happy to hear from me and would be writing soon. We immediately began a lengthy correspondence, and after a few weeks of writing I finally called my father and talked to him on the phone.

Hearing his voice on the phone was a strange experience — like coming home and opening up a maw into my unknown fears at the same time. I would be very happy while talking to my Dad, but afterwards I would feel very numb, and then I would sink into strange depressions that lasted several days. After a couple of short phone calls, I had a full day off of work, a rarity at that time when I was managing a retail drug store without an assistant and commonly had to both open and close the store, every day.

This particular day I called my father about ten in the morning and ended up talking to him for over twelve hours about every little thing you can imagine — my cats, my time in college, all my friends, and on and on and on. On that call we approached the subject of abuse, and my father steadfastly denied every hitting me, putting me in a closet or doing anything else to harm me. He insisted that all of the things my mother told me had happened were patently untrue.

I remember bawling like a little child, unable to form any coherent words, because in that moment I knew that my father was right. And also wrong, because I knew he was lying about the abuse, too.

I couldn’t explain how I knew, and I still can’t. I knew that my mother had most definitely exaggerated the scope and length of time that my father’s abuse of me had occurred — and please understand, my mother never admitted that my father had sexually molested me, but only that he had locked me in closets, beat me with his belt, neglected me by locking me up and leaving my sisters in the apartment for hours without food or water, failed to change my sister’s diapers, broke furniture and plates in horrible rages — but I also knew that my father had definitely touched me in a way that was inappropriate, because the day before our phone call, my father had sent me another long letter telling me the story of his life, and in it he had enclosed a picture that he said reminded him of me, that he wanted to share with me.

The picture was of a Penthouse centerfold, fingers spreading her labia apart.

You could say that incestual moment was a revelation, too. Eureka.

Dr. Jonathan Shay, a psychiatrist who has worked with the VA clinic in Boston, spoke at the American Psychoanalytic Association Meeting today and stated his belief that removing the word “disorder” from the name of the condition, “post-traumatic stress disorder,” or PTSD, would help remove the stigma that prevents many wounded veterans from seeking treatment for their pain. His argument was pretty striking to me.

“I want to get everyone thinking like a trauma surgeon rather than an internist,” he said.

For example, if a soldier loses an arm in a roadside bombing incident, “he wouldn’t be diagnosed with ‘MAD,’ or missing arm disorder,” Dr. Shay said.

In treating such a soldier, the first step would be to control hemorrhage, then look to prevent infection — a complication that manifests much more slowly, much as the lasting effects of PTSD, Dr. Shay said.

A study led by Pia Heppner, Ph.D., psychologist with the University of California, San Diego School of Medicine and Veterans Affairs of San Diego, VA Center of Excellence for Stress and Mental Health (CESAMH), has found that veterans with PTSD are more likely to also meet the criteria for metabolic syndrome, a currently controversial diagnosis that includes elevated BP, higher waist-to-hip ratios and high fasting concentrations of HDLs, glucose and triglycerides. Metabolic syndrome is associated with obesity, high blood pressure, cardiovascular disease, and diabetes, otherwise known as the diseases fat people get.

So that explains it. HA!

In their press release, researchers concluded:

“Our research indicates that stress and post-stress responses are related to long-term health outcomes,” said Heppner. Studies show that veterans, prisoners of war and individuals exposed to severe trauma have higher rates of disease and increased use of health care, she continued. “Our findings suggest that metabolic syndrome provides a useful framework for assessing and describing the physical burden of PTSD and can be used prospectively to evaluate health risk that may be associated with combat exposure and PTSD.”

If they can’t kill you one way, they’ll try another. Sometimes it seems there is no respite anywhere.