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Authors: Charles W. Hoge M.D.

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Let's hope that my somewhat cavalier summation turns out to be a gross
exaggeration for you, but nonetheless, be prepared to be caught in some
variation of the above catch-22 if you embark on this process. The effort may
be worth it to you in the long run, but don't automatically assume that this
will be the case. The process itself can take a toll. Although the disability and
compensation system is there to help you, it can trigger a lot of frustration
and anger, negatively affect your transition experience, or become a way of
life. If you know the expression "a dog being wagged by its tail," this is how it
can feel. All of this is okay, as long as you understand the risks. It also helps
to remember that you're not the one who is nuts here.

SUMMARY

In summary, this chapter attempts to cover the very broad topic of how to
navigate the medical system, advocate for yourself, get help, and find the
best formula that works for you. It provides information on what treatments are available, what to expect from treatment, and how the various
treatments work. The subject of navigating the medical system could fill
a complete volume, so please take my advice only at its face value. There
was a lot left out, such as many of the side effects and risks associated with
medications. It's strongly recommended that you get additional advice as
needed from fellow warriors, veterans, veterans' organizations (of which
there are many excellent ones), and your health-care providers. The
most important goal is good health, and the health care system is there
to help you. Also, this chapter illustrates the importance of keeping your
sense of humor and objectivity in dealing with very complex health-care
issues.

Enjoy First Sergeant Mike Schindler's personal story of his mental
health treatment:

After many years of outrageous adventures and behavior, I finally stopped
running away from myself. InJuly of 2002, I mentally, physically, spiritually, and soulfully crashed and burned, thirty years after returning from
Vietnam and four years after retiring from the Army. My second marriage
was in its final months, my son and daughter had moved away from our
home in Maui to escape my insanity, and my brother had decided that I
was a complete asshole-as in whole ass.

Luckily for me, my other "brother, " a close friend and fellow Vietnam
veteran, noticed my mood swings, depression, anger, hopelessness, lack of
social skills, and general piss-poor attitude toward life. He had suggested
many times in the past that I seek help for PTSD and I always blew him
off, thinking to myself that I did not have PTSD; I'm a combat warrior
and I am a strong man.

Wrong. Not only was I a "carrier, "I was also an active transmitter of
the disease, as in contagious, infecting loved ones around me. Somehow my
friend finally managed to convince me, at last, to get some help. On that
fateful day in July of 2002, my brother warrior called the local VA clinic
and spoke with his psychiatrist, Dr. K, about me. After a few moments he
handed me the phone and ordered me to speak.

My face went blank. I felt scared and confused. I knew that it was
now or never and that I could no longer run away from myself. I managed to say aloha (hello in Hawaiian). Dr. K then asked why I wanted to
talk with her. My answer surprised me. I said that I was burnt out, worn
out, and tired of feeling alone, angry, hopeless, and a failure. My first of
twice-a-month therapy sessions for the next five years was scheduled for
August 6, 2002.

Thus began my painful personal commitment to regain my true self.
The hardest part was admitting that I needed the "system's" help. By "system, " I mean the VA or green machine that had ground me up and spit
me out-the system I distrusted and hated, or so I thought, for many years
while running away from myself.

The next most difficult thing was actually showing up for my first
scheduled therapy appointment. I changed my mind hundreds of times
in the few weeks prior. I had a hard time admitting to myself that I had
some serious issues to deal with, such as anger, distrust, hopelessness, life,
relationships, social behavior, substance abuse, and inability to live as a
happy, productive person with joy in my heart.

I was ready to bolt and run. During the two to three weeks prior to
my first therapy session, I analyzed myself constantly. I finally decided
that if I could survive combat in "Nam, " I could at least show up for
therapy "once. "At last the day arrived: August 6, 2002, my first session
with a "shrink. "

I drove down the mountain to the VA clinic in Kahului, Maui, thinking of at least a hundred reasons not to go. Then all of a sudden I was
there in the parking lot. I parked, turned off the engine, got out of my car,
walked to the door, and hesitated. I was one second from bolting and running. I took a deep breath, opened the door, and walked in, pushed the
elevator button, took another long deep breath, got in, pushed the button
for the third floor, and broke out in a cold sweat.

Thinking to myself what a chicken shit I am to feel this way; after all,
I am `just" going to see this shrink "once. " I can do this. I'm a combat
warrior, piece of cake, easy stuff. I envisioned my therapist looking like a
female doctor Franken-Mean-someone who would not be of any help to
me. After all, she was part of the "system" that I distrusted and hated. You
know, "the green machine, " the one that chewed me up and spit me out like
a piece of meat. But I could see her "once. "

The elevator stopped. I got off and walked into the waiting room, signed
in, took a seat, and went through my usual threat-assessment-escape-routeweapons-check routine that I had been doing since the `Nam. "Decided that
no threat was active, checked out the two visible exits, looked around to see
what could be used as a weapon-saw several objects: large glass vase, watercooler glass bottle, two-inch wooden dowel curtain rods. Feeling relieved, I
settled in for the inevitable long VA/military hurry-up-and-wait.

As I watched everyone coming and going, I noticed a nice-looking
woman enter the room from behind the check-in counter, look at the sign-in sheet, turn around, and to my surprise call my name. I was
shocked. First off, the wait was short; second, she was nice-looking
(definitely not a doctor Franken-Mean), and third, she smiled. The
nice-looking lady introduced herself to me as Dr. K and invited me to
follow her to her office.

I found her office to be bright, cheerful, and inviting-not a dark,
old, stuffy, dungeon-like room with two goons in white jackets waiting outside. Dr. K invited me to sit in a comfortable chair facing her. I sat down,
looked at her, and waited. She sensed my confusion as to what to do next
and encouraged me to talk about whatever I wanted to. That was all the
opening I needed. I unloaded, spilled the beans, let the white tiger inside
of me loose.

I initially spoke of my reasons for seeking therapy: that "things" were
not right and I was tired of faking it, that I had become discontented with
life and family; my multiple job losses and disdain for authority. The session included my feelings of how Vietnam combat veterans who served in
the "Nam" before 1970 minimized my service because they believed combat
actions had stopped by then. My point here is that I talked about whatever
I wanted to that day-my service record, family, war experiences, multiple
job losses, authority issues, failures, and fellow veterans.

In a future session I spoke of my anger concerning the singular treatment of returning Vietnam combat veterans and how we were vilified and
thought of in less than a heroic manner by the American public and previous generations of veterans from the Korean War and World War II-like
we Vietnam veterans didn't matter, and neither did our war.

This kind of treatment toward Vietnam combat veterans angered me
and still causes some residual bad feelings toward the American public
and older veterans from previous wars; also, a little bit of jealousy toward
recent generations of returning veterans, who have been welcomed home
as heroes-which they are. It's a wound that has not healed for many
Vietnam vets.

While talking, I observed Dr. K sitting in her chair and looking at
me in such a way that I knew for the first time that I was going to be all
right-that I was not alone. I felt such relief that I could have talked for hours. I began to shed tears of relief-which felt good; a burden of such
magnitude was lifted from me that the tears just poured out. I apologized
many times for crying. Dr. K said it was okay and I knew it was.

I also spoke about my feelings of anger, distrust, hopelessness, life, relationships, social behavior, substance abuse, and what in later sessions I
labeled as my inner white tiger that can be ferocious, uncontrollable, angry,
and unpredictable. After a long emotional hour she said the time was up.

Before I left, Dr. K informed me of the therapy process and the personal
commitment to therapy. She also explained that my behavior patterns and
feelings are "normal, " that fight-or-flight is a skill that I used in combat
that is hard to stop when you are trying to transition and readjust to civilian life. She also gave me the first of some tools to use, like a "blueprint. "
She asked me to remember the words `frequency, " "intensity, " and "duration. " She explained that whenever I feel anger, distrust, hopelessness, or
the inner white tiger wanting to get loose and cause some damage to me,
family, friends, or anybody, to practice keeping the frequency low, the intensity mild, and the duration short. This practice became and still is my
mantra and way of life.

I walked out of her office after one session feeling so damn happy that
I was smiling from ear to ear. My inner white tiger had been put in the sun
for now and was purring. I felt that there was hope for me, and maybe, just
maybe, joy would return to my heart.

My therapy sessions lasted for five years. Therapy helped me to understand why I was behaving in negative and destructive ways; why I was
feeling angry, disconnected, helpless, hopeless, lost, scared, and just wanting to go away and hide from the civilian world. Therapy helped me realize
my desire to live, love, and laugh. Before I chose therapy, substance abuse
and dangerous jobs were my "blueprint. " Bad choices on my part. The
results were devastating to me, my family, and my friends.

During the years after starting therapy I would also talk with other
Vietnam combat veterans. This type of "therapy" has many benefits, such
as venting, a sense of camaraderie, and a feeling of safeness and connection talking about common experiences. Warrior discussions are fun, and
rewarding. After all, these are your brothers and sisters in arms, so embrace them; the camaraderie is good. However, these warrior discussions at times
also fueled the fires of anger, distrust, and substance abuse. So I would
say that warrior discussions are necessary, but be careful to accentuate the
positive whenever possible.

Therapy gave me the tools to process and deal with my traumas of
combat and war. We are all different and will develop our own working blueprint. A psychiatrist or therapist can help you to find your way
"home, "and there are many options forgetting help. My psychiatrist, Dr.
K, became a valuable "tool "for me as I created my blueprint, by enabling
me to use my own strength as a warrior to find joy, happiness, love, and
purpose of life.

Transition and readjustment may sound scary. Well, to do nothing
and not get help is even scarier. Trust me-been there, done that. As one
combat veteran to another, it's okay to feel alone, angry, confused, helpless,
hopeless, and lost, and to have a sense of not belonging to the "real world. "
Well, guess what? You are "normal. " These feelings are skills that you
learned and used to survive the horrors and absurdity of combat.

There are many ways to get help. Getting help from the VA worked for
me, and they offer several different ways to get help, through clinics or Vet
Centers. This book provides useful information, but is not a substitute for
talking with a "shrink" if you need to. Commit to yourself, and find the
right blueprint that works for you, even if this means talking to a therapist.
I know firsthand that this is a daunting and unpleasant task. The VA
system is over-bloated with bean counters, bureaucrats, fools, idiots, and
politicians. So are military treatment facilities.

No matter,, you must use and work the system and not let the system
use and abuse you. There are many good people who care within the walls
of VA and military offices, medical centers, and Vet Centers. Seek them out
and talk with other veterans. Never give up. Somehow navigate your way
through and within the system. In the end you will be glad that you did.
The results are joy, happiness, and living a positive life.

My therapy sessions became a source of normalcy. What helped the
most was being able to have regularly scheduled therapy sessions with the
same psychiatrist. Because of this routine, my doctor and I gained trust and respect for each other. This helped me feel safe and secure that what
was being said was between us and only us, warrior to doctor. Trust was
important to me. I had to feel and know that I was safe from betrayal by
the system that I felt had ignored me.

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