The Lonely Road Home
Veterans struggling to adjust to civilian
life discuss the natural therapies they use
to fight post-traumatic stress disorder.
By Allan Richter
War correspondent and former Marine David J. Morris, in his book The Evil Hours (Houghton Mifflin Harcourt), says one of his favorite therapies for combat post-traumatic stress disorder (PTSD) is an ancient Polynesian tradition called haka, an ancestral war cry of intimidation voiced before battle that has been adopted by sports teams in New Zealand. Also embracing haka is the Royal New Zealand Infantry Regiment, whose interpretation includes facial gestures and dance-like moves, and is sometimes used to mark the end of a long deployment or the return of soldiers from combat.
No cathartic ritual exists for soldiers returning home to North America, Morris observes. Indeed, American veterans clearly have a tough road leading to and upon their return home. An existence full of adrenaline-fueled combat, and expectations for it, morphs into a sense of isolation, deep depression, hypersensitivity and intense stress for many when they try to work their way back to the lives they knew before their deployment.
When PTSD was first identified with that designation in 1980 in the third edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, it was not just a fancy term for what had been called shell shock, battle fatigue and scores of other names. For the first time, what was now called PTSD was recognized as a condition that could have as its source any number of traumas, including rape, a car accident or an earthquake, says Spencer Eth, MD, a psychiatrist who oversees mental health programs at the Miami Veterans Administration hospital.
Researchers could then draw upon each of those traumas to develop better therapies. “What we know is if you follow people with PTSD over time,” Eth says, “about half get better if you don’t do anything, but the other half continue to suffer severe symptoms that could be not only personally painful but affect relationships, affect employment, have a devastating effect on a person’s life. There’s an imperative to treat it because that can really alter a person’s life trajectory.”
Veterans face a number of roadblocks en route to successful treatment, however. Unlike other traumas, veterans endure repeated shocks and distresses. And, among many veterans, a stigma has long been attached to a PTSD diagnosis, a perception of weakness in someone whose role by definition is built on strength. The September 11, 2001, terrorist attacks went a long way to change that perception, as millions of television viewers watched teary-eyed first responders do their difficult jobs.
Also lifting PTSD from the shadows is Army Major General Mark Graham, who has spoken openly about the 2003 suicide of his son, Kevin Graham, an ROTC cadet at the University of Kentucky, at age 21.
Repeated deployments and an inability to get access to adequate care also rear their heads in making elusive a solution for veterans afflicted with PTSD. The latter came to the fore last year, when news emerged that veterans were enduring excessive wait times for treatment at VA hospitals in Phoenix and elsewhere.
Challenges in accessing care have pushed some veterans toward alternative therapies. On the following pages are the stories of veterans who are working hard to adjust to civilian life as they struggle with finding purpose, peace and health through some of these alternative approaches.
While the first three profiles involve veterans of more recent wars, the fourth profile is a story of a Vietnam veteran that highlights, as each profile does to some degree, perhaps the most basic and accessible therapy of all—the human touch.
Finding Healing in Four
Legs and a Nuzzle
The dream was familiar and haunting. Five years since she left Afghanistan and three since she left the Marine Corps, Amanda Donald was dreaming, as she often did, about her friend, Corporal Christopher Monahan Jr. The last time Donald saw Corporal Monahan alive he was about to be deployed to Afghanistan and told his friend he did not think he would survive. He was killed in action in November 2012.
During Donald’s restless sleep on a recent fall night, as she sweated and twitched and her breathing grew heavy, her faithful five-year-old pit bull Roxy began to stir next to her from her own sleep. Roxy, sensing Donald was in anguish, put her nails into her owner’s shoulder and woke her.
Donald, 25, with dark hair framing a freckled, pretty face, is upbeat, the mother of two young children, and, except for the tattoos crawling up her arm, looks as if she walked out of a soap commercial. Behind the smile and wholesome appearance, however, is a young woman in turmoil. Two weeks into her deployment to Afghanistan in 2009, Donald was in a convoy on her first assignment driving a truck to bring supplies to combat infantry and surrounding military bases when a roadside bomb exploded two trucks ahead of hers. It was the first of some 70 roadside bombs that detonated near convoys she was in during her seven months overseas.
No soldier sustained major injuries in those explosions, she said, but the blasts did take their toll. Her deployment left her with ringing in her ears, and neck and back pains from sometimes driving more than 30 straight hours, along with PTSD, and the mistrust and thoughts of suicide that can accompany it. Roxy is the chief calming force in Donald’s life. Not only does the 90-pound, dark grey dog with blonde stripes rouse Donald from her nightmares, she is at her owner’s side whenever stress sets in. Where another dog might rest its head in its owner’s lap or lick his hand for attention, Roxy exhibits that behavior not for self-gratification but to calm Donald down.
“They can smell our anxiety,” Donald says in her Sound Beach, New York, home, on Long Island. “They know when we’re going to have a panic attack. Sometimes it’s when we’re in that high-alert stage. They do it as a calming method or as a precaution: ‘Hey, you’re starting to get tense, your heart is starting to race.’ We’ll be able to tell by the way our dogs are acting, for example, if they get antsy or push their bodies next to ours, if maybe it’s time to leave the situation. Or we’ll look down at the dog, pet the dog and just calm ourselves down.”
Donald is seated on a living room lounge chair, and Roxy, a handsome animal who wears a red vest labeled “service dog” and a pouch containing a certification card, is wrapped around her owner’s waist like a shawl. “If she could crawl into my skin, she would,” Donald says of the animal that never leaves her side.
“Having her there has made my life so much more positive,” she continues. “I always feel like people are out to get me. I always feel like the center of attention, but with Roxy there, maybe I am the center of attention but it’s in a positive way. People see Roxy, and all the attention is on her. Knowing that I have Roxy there, I know I’ll be okay.”
The Donald household is contending with not just one but two cases of post-combat stress. Donald’s husband, Casey, 28, is also afflicted with PTSD. He served in the same platoon as his wife before the two married. His service dog, Axle, is a five-year-old pit bull and, like Roxy, has a brindle color pattern but with orange stripes against a smaller black body.
Both Roxy and Axle were on the job and in top form when the Donalds went to see the war-themed movie “Max.” War movies trigger stress in veterans with PTSD through true-to-life reenactments of gunfire and explosions, but can also be discomfiting by invoking guilt in veterans who feel they should be back on the battlefield with their fellow soldiers, an issue Amanda and Casey Donald have wrestled with. But “Max,” about a dog that helps Marines in Afghanistan before returning to the US, was too close to home for the Donalds to pass up.
Dark environs like theaters leave Amanda Donald with the jitters. “There’s a lot of people in the theater and people behind me,” she says. “I cannot go to movie theaters.” As Amanda's palms became sweaty and she cried at the sad story unfolding on the screen in front of her, Roxy put her front paws and her head on her owner’s lap while nudging her to pet her to help ease the tension. Casey Donald was likewise uneasy during the movie, prompting Axle to settle into the next seat and nestle him.
Early Military Ambitions
Friends who knew Amanda when she was younger would not have pegged her as a likely candidate for the military. “I would curse out teachers,” she recounts. “Stupid, immature stuff, where I thought back then I was being bad, and I was just an idiot. I guess I thought I was tough when I was a kid so I got myself in trouble. I thought nobody could beat me.” Later, she became a cheerleader and gymnast, and was seen as too girlish. “Everybody said, ‘Yeah, you’re not going into the military.’ As soon as I turned 17, I did.”
“I’m signing up,” she told her friends. “See you guys later.”
In fact, she had wanted a military career since she was six years old. That’s when her family buried her paternal grandfather, Norwood Knepper, a Marine, at Calverton National Cemetery on eastern Long Island. Young Amanda’s eyes widened at the sight of the Marines in their crisp, formal “dress blues”—midnight blue coats pulled in at the waist by a white belt, blue trousers with a scarlet stripe down each side, polished shoes, and a handsome white cap.
“To this day I remember the 21-gun salute,” she recalls, “and in the lineup there was a female Marine. And I remember watching her and wanting to be like her.”
From the time she hit boot camp, she knew she made the right decision. “I’ve always been kind of the bad one. I got in trouble in school. I got in trouble at home. But when I was in the Marine Corps, I fit in,” she said. “I fit in with everyone.”
She even found beauty, though it was combined with sadness and tragedy, in Afghanistan when deployed two years later. “It’s amazing over there. It’s not a pretty place, but at night there’s no light pollution and it’s just so beautiful because I’ve never seen so many stars in my life,” she says. She marveled at the primitive dirt-and-mud huts villagers built. One of her jobs was to engage women villagers for information because the Muslim culture forbade contact with men, and she was moved by the young children who approached her.
“They didn’t have shoes over there, and if they did they were falling apart. Little kids,” she said. “We saw little kids probably two or three years old with makeup on, almost as if they wanted to sell them to us. It’s like they were putting on a show so we would take them and bring them back here so they wouldn’t have to live that life.”
Those tender moments were few and far between, however, and were overwhelmed by the ceaseless roadside explosions she and the other soldiers encountered, as well as the constant state of heightened alert in which they found themselves because they were surrounded by mountains and could be the targets of sniper fire at any moment.
Casey Donald didn’t see the local Afghani children with the same sympathy as Amanda. “Whenever we were surrounded by kids they were stealing stuff and we had to be on our toes. The little kids would steal everything you had,” Casey Donald says. To this day, he says, groups of children trigger his stress, though he acknowledges that, as a father, that is “counterintuitive.”
At Home, Dreaming of War
Amanda Donald left Afghanistan seven months after her deployment, and one month early, after a door was slammed on her hand in a Humvee she was working on. Back at Camp Lejeune, the Marine base in Jacksonville, North Carolina, she was out of the war zone. But the war hadn’t left her.
“Getting home, it was a lot to take in,” she says. “The first few days I would go to sleep and I would hear machine-gun fire. I would wake up, and think, ‘Oh my God.’ There would be nothing going on. I would be in the barracks and it would be completely quiet. That still goes on. My husband and I both have that.”
The bad dreams came nightly. “Sometimes it wasn’t even nightmares,” she says. “It was that I was there, and I woke up and realized I was here, and thought, ‘I need to get back there. Someone send me on a plane right now because I have unfinished business to do.’”
Casey Donald soon joined his wife back at Camp Lejeune, and the couple had their first child, a son, Brayden, now 4 1/2. “We had our son, and it was hard,” Amanda Donald says. “He would be crying in the middle of the night. There was a lot going on. It was hard to have so much going on in my mind, and then try to take care of a son and all that.”
When she first returned from Afghanistan, Amanda did not want to speak with anybody about her state of mind—until she was about to leave the military two years later. “I didn’t want to get help,” she reflects. “But then when I was getting out, I was like, ‘I’m not going to have the other Marines as my support system anymore. I need to get help. I need to talk to somebody.’” She was referred to a civilian doctor, who diagnosed her with depression. Then when Casey got a job in a Louisiana oil field and the couple moved, the Lafayette, Louisiana, Veterans Administration hospital diagnosed her with PTSD, the same diagnosis her husband received a year earlier.
Though Casey Donald says having a spouse with PTSD helps because she can sometimes alert him to potential triggers—by veering off in a different direction if they are about to encounter a crowd in a mall, for instance—both Donalds say the situation is more cause for confrontations between the two. After they had their son, they separated for a short time but reunited and had their second child, Aria, now 2.
In addition to PTSD, both Casey and Amanda Donald were both diagnosed with severe concussions, or traumatic brain injury (TBI). One night in the Afghan desert, Amanda’s convoy was “in blackout,” meaning it had to proceed with lights off. Infrared screens showed drivers the terrain but not depth, and the trucks ended up in a dry riverbed, or wadi. Donald injured her head, resulting in persistent headaches. In a separate incident, Casey Donald struck his head on an armored car door when a nearby roadside bomb exploded.
A traumatic brain injury tends to make people impulsive and unable to take that split second needed to choose an appropriate response to, for example, someone impolite, says Mary Lee Esty, LCSW, PhD, founder of the Brain Wellness and Biofeedback Center in Bethesda, Maryland. “When the wiring is right, we get a moment—it’s not long, but it’s enough—to decide, ‘Am I going to say something back? Am I going to be polite?’ Your brakes work.” With the brain injury, “you’ve got this inability to use your brakes.”
The brain thinks it is under constant attack because that is what it has adjusted to, even after one traumatic strike, Esty says. The combination of PTSD and a traumatic brain injury, she adds, is “a very volatile mix.”
When the Donalds moved to Long Island last year, the stress was still evident. Both Casey and Amanda were disturbed by the daily noon fire siren, and Amanda’s mother, Patricia Knepper, noticed her daughter was quieter and more reserved than before she was deployed. “She didn’t like going to the stores,” Knepper says. “She used to be a shopaholic before she went into service. She was always in a store buying this outfit or that outfit.”
Amanda’s mother also noticed her daughter’s new quirks. Amanda grew uneasy when they drove by garbage bags put out by the sidewalk for trash pickup, for example, because it brought back images of garbage bags in which the Taliban had hid roadside bombs.
Life improved dramatically after the Donalds accompanied their pit bulls Roxy and Axle for training sessions so the animals could be certified as service dogs. The training, given through the organizations Guardians of Rescue and Paws of War, avoids rewarding the animals with treats but focuses on creating a strong bond between owner and dog instead.
“It’s a lot of leash handling,” Amanda Donald says. “If I want her to sit, it’s the way I move the leash, the collar, and she knows to sit. It’s all with the leash.” Approval is given verbally or by rubbing the dog’s neck.
At a summer maintenance training session in an industrial area in Bohemia, New York, the Donalds, Roxy and Axle, and six other veterans and their dogs were learning that verbal cues, of approval or otherwise, should be kept concise. “You don’t want to telegraph anything,” Vincent Trent, a dog handler and owner of WrknDog.com, the training company, told the veterans. “You want to eliminate all the extras. ‘Come on. Will you just sit? Please.’ The conversation isn’t going to exist like that when there’s an emergency.”
Trent attributes Roxy and other service dogs’ ability to detect their owners’ stress to the animals’ keen sense of smell. When people get nervous, they sweat; the dogs can smell the change in body odor coming off that sweat, he says. “We smell the stew in the pot,” Trent says. “The dog smells the carrots, celery and beef stock.”
That theory is supported by some preliminary research at University of Florida’s College of Veterinary Medicine showing that dogs may be able to alert their owners before the onset of a seizure because they smell a change in a person’s body odor when it is triggered by activity in the nervous system.
Research is inconclusive, however, about the link between a dog’s sense of smell and its ability to alert its owner to a seizure or nightmare. But science shows that being with and touching a dog—and sometimes simply making eye contact with the animal—can reduce cortisol levels and raise oxytocin levels, says Alexandra Horowitz, PhD, who teaches canine cognition at Barnard College in New York and is the author of Inside of a Dog: What Dogs See, Smell, and Know (Scribner).
The Donalds’ service dogs have brought dramatic improvements to their lives, though the arrangement has created some new challenges. More than a few times, restaurant patrons have confronted Amanda to question why she needs a service dog if she is not blind, while Casey’s Axle attracts people who pet the dog while the animal is on the job.
“People don’t understand that’s your lifeline, that’s what’s keeping you calm, and sometimes it’s inconvenient because everyone just wants to come up and pet him,” Casey Donald says. “But that’s not what they’re there for. No, you need the dog to get through the day sometimes.”
He says he has been trying to slowly wean himself off of relying on Axle. “It’s not convenient when you need a dog to do everything with you just to get through the day. I was never like that before, but because of my disabilities I now need that sometimes. But having the dog is a lot better than being on medication and having side effects, and then taking more medication to counteract those side effects. It’s a terrible cycle, and you don’t need that with the dog—they are your medicine.”
Despite the challenges, both Donalds are sanguine about their future. Amanda Donald, finding comfort in helping others, was at the bedside of a friend who gave birth while the new mother’s husband was deployed overseas. And she has trained and fostered two service dogs for local veterans. Casey Donald, meanwhile, says four years after he received his PTSD diagnosis and struggled to get help with Veterans Administration clinics in North Carolina and Louisiana, he finally got the counseling help he needed this year through the VA in Northport, New York.
Both Donalds have settled on careers to help veterans and emergency first responders, she as an occupational therapist for other vets and he as a paramedic with firefighters. Casey expects to get his associate degree next year, and Amanda hers the following year; both expect to continue their schooling.
When she first returned home from Afghanistan, Amanda tried to enroll in college but was too consumed by her stress to continue, and she dropped out. More recently, both Amanda and her husband have made the dean’s list—Casey’s on the honor roll as well—at nearby Suffolk Community College.
Amanda says she never did well in school because she was too unfocused, that is, until she joined the Marines. Now she is ready to put on another uniform of sorts: a cap and gown.
“I’ve never walked across a stage for graduation,” she says. “I have my high school diploma, but I had to go to summer school for it. I can’t wait to wear a cap and gown and walk across a stage with Roxy by my side.”
Under Pressure of Pure Oxygen,
Pressure of the Battlefield Gives Way
In March 2004, when Kevin McKim returned from Iraq to his home at Fort Bragg in Fayetteville, North Carolina, the signs of stress from his nearly yearlong deployment were evident.
“He was on edge. You couldn’t try to wake him from sleep because you would probably get punched in the face,” his wife Karen recalls. Once, when he was driving the family car, the McKims’ toddler daughter threw a toy and it hit the car window. Kevin was so startled he almost drove off the road but was able to pull over to compose himself. “He was breathing rapidly and his hands were trembling,” his wife says. “It was like a bomb went off.”
Eight months later, McKim was redeployed to Iraq for another year. When he returned this time, McKim and his wife say, his mounting physical ailments compounded his nervousness and stress. His feet burned with pain from neuropathy, a condition resulting from damage to nerves in the toes. He was hospitalized with heatstroke and had TIAs, also known as transient ischemic attacks or mini-strokes because blood flow to the brain is blocked. Doctors, military and civilian, treated him with pharmaceutical drug upon drug. He suffered from rhabdomyolysis, a breakdown from muscle tissue that his wife believes came from taking statins.
“When I came home from the first deployment, they had to put me on sleep meds and stuff because I wasn’t sleeping,” McKim, 44, recounts. “My nerves were all shot. I couldn’t drive. My wife said I wasn’t the same. Then I got redeployed again. When I came back from that she said it was even worse. I was on edge and couldn’t go into stores.” Because the family lived on the North Carolina base, hearing training sessions with explosives in nearby fields exacerbated his condition. “When the mortars go off and they do training at Fort Bragg, you hear the boom,” he said, “and it would just trigger something.”
Despite the PTSD, he tried to stay fit, bench-pressing more than 500 pounds at one point, and remained hopeful. “I was working out in the gym all the time. I was a gym rat, constantly staying in shape and settling in my military career,” he says. “Even though I had all these crazy thoughts I just focused on the job. I was looking at a lifetime career goal in the military. I fast-tracked seven ranks in seven years. I made sergeant first class.
“I thought I was doing well,” he said, “until I had that injury.” He was referring to what he said was a “massive heatstroke.” He was an instructor at the non-commissioned officers’ academy on base, running a two-mile track event as part of a physical training test when he began vomiting. “The next thing I know I woke up in the hospital. The heatstroke was the kicker that kind of knocked everything out of whack.”
McKim attributed hallucinations and thoughts of suicide to the increasing number of medications he was prescribed as the months and years went on. At one point he counted 25 different drugs, among them Percocet, Fentanyl patches and Oxycontin. “I was on a med to keep you calm, a med to keep you happy, all these mood disorder pills, plus pain pills. It just got out of control,” he says. “I couldn’t take it no more.”
He thought to himself, “‘Why do I have to be through all this pain? Why me? I’m the man of the house, and I can’t work, I can’t do this, I can’t go out to eat, I can’t spend time with my family.’ One thing led to another thing led to another thing, and it just put me in a big depression.”
McKim’s biography is on his body. Tattoos run up both arms up to his shoulders. They are splashed across his chest and stomach. Some tattoos punctuating his legs tell the tale of his PTSD and his shifting temperament. He’s got a face with a smile on one knee, and one wearing a frown on the other. “I wouldn’t say I was bipolar or multi-personality,” he says, “but any day I could be in a good mood or a bad mood. ‘Pick a knee,’ that’s what I would say. ‘Am I feeling good today or angry?”
After his more debilitating illnesses, he saw that members of a motorcycle club he had joined didn’t visit him or try to find out about his health. He quit the club, began spending more time with his family and had “RIDE FREE” tattooed above the knuckles on each hand.
A Novel Approach
While McKim was struggling with his health challenges, across town in Fayetteville, John and Denise Mercado were running an agency that provided aides for households with children with disabilities when they began thinking about launching a business offering hyperbaric oxygen therapy (HBOT). They were eyeing a spot in a strip mall that housed a coffee shop, pet supply store and movie theater for the clinic.
The Mercados’ eldest son is a Special Forces diver, and they knew divers use hyperbaric chambers to treat decompression sickness brought on by deep dives. They had also met parents who had taken their children with developmental disabilities such as autism and cerebral palsy to hyperbaric clinics. “We researched it and realized a lot of people in our area were traveling out of town to get the service,” says Denise Mercado, now the chief executive of Fayetteville Hyperbarics.
The Mercados opened Fayetteville Hyperbarics in that strip mall in March 2013, and the clinic soon began attracting another clientele. Members of the US Army Special Forces, also known as the Green Berets, who had suffered from traumatic brain injuries were coming to the clinic for help. Some of the Green Berets also had PTSD.
“We started seeing great things happening,” Denise Mercado says. “They were on less medicine and their headaches were going away. They would say their mental fog would lift and their cognitive ability came back. They were sleeping better and their quality of life was coming back.”
Other veterans wanted the service, too, but the Green Beret Foundation only funded treatments for the Special Services vets. The Food and Drug Administration has not approved HBOT for TBI or PTSD, so insurance does not cover the cost. Fayetteville Hyperbarics charges $150 for each hour and a half session, an hour of which a patient spends at “depth,” a reference to the hyperbaric chamber’s simulation of diving under pressure but in 100% oxygen. Some treatments can require 60 or more dives.
The Mercados had trouble finding funding, so they created Chambers for Hope, a non-profit.
When another clinic heard about it and asked to join, the couple decided to build Chambers for Hope into a network. Now a year old, Chambers for Hope has seven affiliated clinics in six states, and each location is hosting fundraisers and identifying donors to support hyperbaric therapy in its area.
Diving Into Renewal
Kevin McKim’s wife Karen is a licensed massage therapist at a local wellness center, and her friend had visited Fayetteville Hyperbarics. She recommended that McKim look into it, and his name was put on a Chambers for Hope list of candidates for subsidized treatment. “I came up on the list,” Kevin McKim says with a wide smile. “It was awesome. It was like hitting the lottery.”
This past spring, one month after the last of his 40 treatments in the oxygen chamber at Fayetteville Hyperbarics, McKim is seated in a conference room near the chambers. He is calm, mostly relaxed but at times slightly robotic in a military way; he responds to some questions by a reporter with a hasty, “Yes sir.” He occasionally stumbles over a word or has to search for one, but he is mostly clear-headed and alert. It is a vast improvement over his demeanor before he began the dives, he and his wife say.
“When I first started, I came out here, did the dives and I was exhausted,” McKim says. “I would go home and I would just sleep. It would knock me out. I was like, ‘I really don’t feel nothing.’” John Mercado, the facility’s certified hyperbaric technician, EMT and safety officer, encouraged him to give it more time. “So I would say 10 or 12 treatments into it I had my energy back,” McKim continues. “I used to be cherry red all the time, and my wife said my complexion came back. I was not repeating myself over and over. My overall mood started to change.”
McKim was very uncomfortable in the chamber at first. Though much of it is glass, it can be claustrophobic. In the early dives he couldn’t sleep in the tube, so McKim, a former correctional officer, watched some of his favorite prison shows, “Oz” and “Orange is the New Black,” that the facility would stream. “As the treatments continued and I was feeling better, I was more relaxed and I could doze off and fall asleep,” he says. “They would play soothing music, or the sounds of the oceans or the forest.”
As the dives progressed, McKim cut back on his many medications until he was down to an over-the-counter pill for acid reflux. He had more energy, slept comfortably at night and the burning pain in his feet from the neuropathy began to subside. With a 10 rating the most painful, McKim said his pain ranked an 8 or 9 in the beginning. “I couldn’t bear it,” he says. “It was my feet, and I was getting headaches. I had lower back pain and my muscles were hurting.”
Midway through the treatments he rated his pain a 4 or 5. “By the time of the last 10 dives I had no pain. I felt great. I wasn’t tired in the tank,” he says. “I left here and I was productive all day, instead of just going home and laying around and avoiding people.” He started cooking some of his favorites again—homemade mozzarella, chicken parmigiana and fresh cheesesteaks. “I started doing things I used to like to do.”
McKim felt that dramatic change because treatments in a hyperbaric chamber deliver 18 times more oxygen to tissue, particularly in the brain, than normal, says Pete Stevens, MD, director of the Hyperbaric Therapy of the Low Country Clinic in Hilton Head, South Carolina. “That’s what does the healing,” Stevens says. “It’s the increased oxygen.”
The oxygen and glycogen, a type of sugar, combine in the mitochondria—structures in a cell’s cytoplasm responsible for energy production—and boost the body’s energy levels, Stevens says. The influx of oxygen also curbs cell death. Stem cells that are damaged in a traumatic brain injury “come back to life” when treated with the added oxygen, Stevens says. “It actually promotes the growth of stem cells in the brain.”
A 2013 Israeli study, published in PLoS ONE, found that HBOT significantly improved the quality of life among 56 mild TBI patients by repairing chronically impaired brain functions.
Stevens said his facility typically starts a patient on 40 dives, then adds a five-dive tune-up if the patient’s condition regresses. “We’ve dived patients a total of 60 to 80 times, and we don’t hear from them again,” he says. “They’re doing fine. One of the reasons for this is that the hyperbarics restores the neural pathways. It actually creates new capillaries in the brain, and this is a permanent thing.”
After McKim’s 40 dives, the pain started returning to his feet and he received another 20 dives at Fayetteville Hyperbarics. He later found himself on multiple medications again, his wife says, and underwent a surgery called a spinal nerve cutting to relieve the pain, but the procedure’s effects wore off as the nerves were restored.
Stevens concedes that peripheral neuropathy is “a little harder to treat. They may have to continue tune-ups. They may have to have five dives every couple of months to continue the remission.”
In the meantime, McKim is forging ahead with other options. He is seeing a therapist and has tried acupuncture. “I’m hopeful. I stay hopeful that he’ll get past this stuff, and get off the medicine and be able to feel productive and that he has a purpose,” Karen McKim says. “It’s just trying to accept the limitations and the struggles on a daily basis. He says he feels like he became an old man overnight.
“I know he’ll get through it and will be all right,” she adds. “Sometimes we have setbacks.”
After Mortars and Mines,
Peace On the Water
After launching his yellow kayak from the shores of Oleta River State Park in Miami, Rudy Watt gently paddled his way around the giant claw-like roots of the thick red mangroves hugging the shoreline. Watt reached a remote nook, rested his paddle on the kayak and settled for a moment. Sunlight poked holes through the mangrove canopy overhead and bounced from the water back to the leaves like a mirror ball flashing thousands of shimmering reflections.
A mullet darted from the water, breaking the silence and stillness. The fish startled Watt, and he quickly turned to the direction of the noise. Then he continued paddling to the open waters of Biscayne Bay.
You’d be hard-pressed to find Watt, 54, a burly Army veteran with just a hint of an accent from his native Jamaica, anywhere else but on or in the water. He scuba dives to make his 6-foot, 1-inch, 265-pound frame weightless, kayaks to be as close to the water as possible when he’s above it, and fishes for peacock bass. The water is where he forgets his woes; for Watt, there is no PTSD by the water.
“It’s calming. It brings me tranquility,” he says, seated in the front of a two-man kayak while paddling into the thinning wake of a distant speedboat in the bay. “It’s like all the burdens wash off of everyday life. Diving relieves joint pain; there’s no gravity putting stress on them. The kayak is so low it gives you the feeling of being in the water. You’re surrounded by wildlife and you become more at home. When you’re home, you’re relaxed.”
Watt’s need for stress relief is the culmination of nearly two decades with the military police, on stateside bases and overseas in deployments to Bosnia, El Salvador and Iraq, where his unit operated alongside infantry troops and saw combat. He was also deployed to the Grafenwoehr and Vilseck military bases in Germany to help fill in for military police sent to Afghanistan after the September 11, 2001, terrorist attacks.
Watt is calm, soft and measured in his speech, though his stress was evident one sunny afternoon at the Oleta River Park. He avoids dirt paths and sticks to paved walkways, an after-effect of the year he spent in Bosnia, one of the most landmine-populated war zones in modern warfare, where he helped provide security on patrols and protect VIPs.
Though his most life-threatening encounter in Bosnia was when a bullet bounced off the hood of his Humvee when he was escorting an officer, Watt had unsettling dreams about mines when he returned home to Miami. During out-processing upon his return from Bosnia, he saw a psychiatrist but never told him about the dreams because the doctor never specifically asked, and Watt was too focused on his physical ailments, a weak shoulder and knee.
During Operation Iraqi Freedom, Watt said, he nearly stepped on a mine near Tallil Air Base, about 200 miles south of Baghdad and just southwest of Nasiriyah. One day he saw minesweepers near a taped-off area on a path he had just walked. “I said, ‘What’s up?’ and he goes, ‘You know you were right ahead of us, right?’ I go, ‘Yeah.’ And he says, ‘You just stepped right over that landmine that was sitting there.’ From that time I don’t take paths that I’m not familiar with.”
When he returned home, he says, his bad dreams from Bosnia “were replaced with dreams from Iraq.”
Tears for a Friend
Schools were out that afternoon in Oleta and it was a particularly noisy day in the park, at least on land. Watt, seated at a picnic table near the bike rental concession stand, jumped each time a bicycle skidded nearby or someone dropped something heavy in a garbage barrel.
The trauma of mortars and mines isn’t the only source of stress for Watt; he suffered painful losses, too. Days before he and his unit were to fly out of Camp Anaconda, a large base near Balad Air Base in Iraq, Watt hunched over a trash barrel violently ill. He was taken to a mobile hospital, examined and scheduled for emergency surgery; on the way there his appendix burst. After the operation he was evacuated to Landstuhl Regional Medical Center in Germany.
As he was recuperating, Watt heard that a friend from his unit, Sergeant Arthur Mastrapa, had been killed. “He was supposed to leave the following day,” Watt says. “He was over by a makeshift PX bazaar, and there was a mortar attack.” Watt takes a long pause as his eyes well up behind his sunglasses.
When Watt made his way back to Miami in the summer of 2004, he found himself with a doctor he had seen at the local Veterans Administration hospital before his deployment. “He started asking little questions here and there, and he said to me, ‘I’m putting you down to go and see somebody in mental health.’ He started asking me if I was having nightmares and what was going on with me. ‘Am I sleeping through the night?’ Stuff like that. At that point I said, ‘Yes, I’m having nightmares.’ He was the one who sent me to get analyzed, and that’s when it was explained to me what this whole PTSD thing was.” Mortar attacks were filling his nightmares, only now Watt was facing them alone. He was despondent.
Fueling Watt’s sense of isolation was a “Dear John” phone call from his fiancé while he had been recuperating from his appendix surgery at Eisenhower Army Medical Center at Fort Gordon in Georgia, one of his stopovers en route home. “The phone call,” Watt says, “was the usual…‘It’s not you, it’s me.’
“I’ll be real honest with you, have I had thoughts of suicide? Yeah. But have I acted on them? Not really. There were times when things happened, and I just gave up and thought, ‘You know what? I’d be better off gone.’ Then I kind of kick myself and say, ‘That’s not who you are.’”
Watt says he drew much of the fortitude he needed to fight through those weak moments from his father, a strong figure who oversaw security at ports back in Jamaica and was well-versed in counterterrorism measures. “He always raised us to be very strong people,” Watt says.
“‘Don’t let people take advantage of you,’ that kind of stuff. And we went to church over there, and it was one of the things that was pounded into you, that suicide is a sin.”
His father’s death in 2009 shattered him, and in the same year, Watt was the victim of identity theft. He was feeling more vulnerable than ever and having violent thoughts. The therapy sessions he had attended at the Miami VA didn’t seem enough. He got more intensive therapy and started regular group sessions, including a group dealing with anger.
Healing Through Water
Watt had been a passionate scuba diver since 1992 and was certified as an assistant instructor in 1995. When he returned from Iraq, however, he lost interest in diving; in fact, he was depressed and had lost interest in just about everything.
Three years ago, Watt’s recreational therapist at the Miami VA introduced him to Branson Rector, who had retired from the Army as a logistics officer in 2009 and created Veterans Ocean Adventures, a non-profit group that helps veterans with PTSD adjust to civilian life through water sports.
Captain Branson, as the veterans know him, told Watt about his Discover Scuba program. He gave Watt a grant to get his Handicapped Scuba Certificate so Watt could help veterans who had lost limbs feel free of their disabilities underwater.
At the same time, another group donated a kayak to Watt, who says they stipulated that it had to be a two-man kayak because too much solitude could work against his health by feeding his PTSD.
The benefits of being in and around water have been studied for hundreds of years. In 1750, the English doctor Richard Russell published “A Dissertation on the Use of Seawater in the Diseases of the Glands, Particularly, the Scurvy, Jaundice, King’s Evil, Leprosy and the Glandular Consumption.” He promoted using seawater to bathe in and drink, and his work is in part credited with giving rise to seaside resorts. More recently, the marine biologist Wallace Nichols, author of Blue Mind (Little, Brown), has been researching the connection between humans and water in an emerging field dubbed neuroconservation.
But Watt’s potential for healing is not just coming from the prospect of spending his days around water, but from doing work he is passionate about. Watt’s introduction to Rector of Veterans Ocean Adventures was exactly the kind of life-changing turning point those who work with veterans afflicted with PTSD say they need, because the work gives the
“For veterans, who have been in this service- and mission-oriented purposeful type of work for so long, to not have that leaves them unmoored and sort of looking for a purpose and not sure how to grab it,” says Margaret K. Glenn, EdD, CRC, associate professor and coordinator of the clinical rehabilitation and mental health counseling program at West Virginia University in Morgantown. “All of a sudden they have no structure, and they need a mission.”
Veterans who receive vocational counseling through the school’s programs seem more eager to get to work, and have more zeal and focus than, the average undergraduate, observes Glenn, who co-authored a 2013 paper, “Mission Critical: Getting Vets With PTSD Back to Work,” published in the journal Workplace Safety and Health. “These guys don’t want to waste time or money,” she adds. “They want to see results faster. They’re doing things that are putting themselves in motion.”
Back in Miami, Watt, who retired from the Army in 2013 after 22 years and is living on a monthly VA check, has begun volunteering 20 hours a week with Veterans Ocean Adventures to help bring diving to fellow veterans as he pursues his dive instructor certification.
“I’m working with soldiers again,” Watt says. “They finished their time in uniform, but they’re still soldiers. It really does feel great. Instead of laying on the couch and watching TV and sleeping most of the day, I have something to get up and do. It gives me a reason to get up in the morning. It’s something to look forward to.”
Family, Support Group Nudge Vietnam
Vet from Three Decades of Silence
As an Air Force technical sergeant in Vietnam, Charles Brown serviced and inspected F-100 Super Sabre fighter jets, a sleek aircraft with a low-set wing and tail that flew more combat missions in Vietnam than any other. After a year there, Brown returned to his rural Lumpkin, Georgia, home. The day after he returned the phone rang, triggering the first of many panic attacks to come; he thought it was a call for air support.
He began having recurring nightmares and became depressed. “I woke up with suicide on my mind, at 22 years old. Scared the daylights out of me. I had no warning,” Brown says at the kitchen table in his Spanish-style home in Henderson, Nevada, just outside Las Vegas.
He didn’t talk about what he was feeling for more than 30 years.
“It would have been impossible to tell anybody I had suicidal thoughts back then,” Brown says. “They would have thought they had to send you to a funny farm. They would have thought you were crazy, and a lot of people said that: ‘These guys are crazy coming back.’ They didn’t talk about PTSD. There was a stigma associated with it, a stigma of being weak. The military from what I gather didn’t know as much about it.
“I recall going to the hospital for other reasons, and sometimes I would find myself over by mental health. I think I was asking for help but just didn’t have the courage to go in there or I felt it would be perceived as a weakness.”
Brown has been finding help only in recent years. He is part of a group of veterans that meets weekly at the Las Vegas Veterans Administration hospital to share their stories and learn coping strategies. Many in the room are Vietnam vets like him, who once shuddered at the thought of opening up this way but who have finally found camaraderie in a safe-enough setting to lift the stigma and talk. Their symptoms continue, but they are handling them better. “It’s like having a toolbox of tools to help,” Brown says.
Brown links his agitation at the sound of his home phone ringing to the heightened state of vigilance he was in at Phan Rang Air Base near the Vietnam coast. When he was on “alert duty,” he had to prepare jets for takeoff on a moment’s notice to support troops under fire in the field. The signal came in two rings—one to reach the base and then a long ring that “became synonymous to ‘help,’” he says. “It was like an S.O.S. to us.”
He and the others at Phan Rang often found their base in the enemy’s crosshairs. Brown recalls an attack when he could not get to his station in time. “I was inspecting some jets, getting them ready to fly, and I was way down in the flight line, and they were loaded with bombs and fuel. I was down there in the dark, by myself, and the base came under attack,” Brown recalls. “I went to the back of the aircraft and just squatted down. If they would have had a hit on that aircraft, they would have found nothing.”
At 67, the bespectacled, soft-spoken Brown is still trim in grey Army pants, an Air Force cap and a black T-shirt revealing muscular arms. A two-inch scar peers from the gray hair above his right temple. To accommodate his hypersensitivity to sound, Brown keeps a television set, barely audible, tuned to a news station. He has wanted to confront neighbors who are making noise in the evenings and spends hours wearing earplugs in the closet on the Fourth of July to evade the fireworks blasts.
Sometimes Brown is compulsively neat. Catherine, his wife of 41 years, looks around the house and says her husband would not consider it neatly kept; yet except for one or two cups on the counter near the kitchen sink, the rooms are in good order.
Brown suffers from sleeplessness, staying up late into the night on his computer. “He will get up through the night and he’ll go to the computer, turn it on, and he thinks I’ll be asleep, but I’m not,” says his wife, a quiet woman with high cheekbones and close-cropped hair. “He’ll sit there for a while, and then he’ll turn it off. He might come downstairs to get something, then he’ll come back and he’ll lay back down. He’ll sleep for maybe an hour, a couple of hours, and then he’ll probably get back up again, go to the computer, and I’m lying there trying to get some sleep. I don’t get a full night’s sleep, not like that. It’s practically every night, unless he’s really, really tired.”
Kindness from Military Families
Brown is the second-youngest of five children. His first contact with the military came through his father, a chauffeur who drove Army personnel and their families to Fort Benning to the north of Lumpkin, and his mother, who did housekeeping for Army families in addition to her own housework. His mother earned only a few dollars a day, but the families added to it by giving the Browns clothes, furniture and food. “I can’t speak highly enough of the Army officers and their wives, and the love that they showed to us,” he says.
But the close-knit Browns were also self-sufficient and grew much of their own vegetables and staples. When he was old enough, Brown used a one-horse plow to harvest peanuts on their land and fished for trout. Lumpkin is famous for Providence Canyon State Park, known as Georgia’s “Little Grand Canyon,” and the simplicity of life reflected the scenic beauty of their rural town. For the first seven years of young Charles’ life, the family lived in a house with no running water and relied on a nearby pond.
When his father was jailed for selling whiskey, his mother became the main caregiver.
“We saw how hard our mother was working,” Brown says. “She worked five days and then Saturday was just another workday, washing, getting the water from the fish pond. Until we moved to the house with the well she was out there on the washboard. The money she made came to us. She’d bring us little trinkets.”
The nurturing environment led Brown to graduate high school one year early. He followed his sister to Washington, DC, where he got a promising job in the US Government Printing Office when he was drafted.
When Brown returned home from Vietnam, it was his mother who first recognized that something was amiss with her son.
“When I finally arrived at my house I remember the trip was long and I had lost weight, was tired, and I probably didn’t look that well, like many of us. My mother looked in my eyes, and it was a deep look, it was a look of concern. She said, ‘Sit down, baby. Sit down.’ She saw something.”
Years later, the women in Brown’s life—his wife and daughters—would similarly come to his aid. It was in 2003 or 2004, and they encouraged him to seek therapy. But reaching out to someone after all these years was a huge step, and Brown remembered that his one effort to speak to a doctor years earlier had been a disaster.
Sometime in the 1970s he was at a medical office for a physical visit when he saw an opportunity to open up about his emotional problems. When he did, Brown recalls, the doctor pushed back his chair, leaned back and looked at Brown like a principal staring down a student who had been brought in for pulling a hallway fire alarm. “I knew something unhealthy was taking place with me,” Brown says, “and I guess that was the one time that I brought it up. The response from the doctor, his body language, was unwelcoming so I stopped talking about it.”
Mentally, it was a solitary existence. Vietnam veterans weren’t talking about their condition even with each other. “Basically if you met someone it was just, ‘Were you in Vietnam?’ They would tell where they were from or where they served over there and how long they were there,” Brown says. “They wouldn’t go into depth.”
Which is why families play a critical role in helping their loved ones cope. Andrew DiSavino, PsyD, the PTSD Program Manager at the VA Medical Center in Las Vegas, says families of veterans with traumatic stress can make the difference when a veteran is contemplating suicide. Many veterans with PTSD who took their own lives lacked a support system, DiSavino says. In contrast, for those with loved ones, he adds, “one thing that brings them out of it is recognition of what it’s going to do to their family.”
Strength in Numbers
About five years after Brown’s wife and daughters suggested he get professional help, Brown went to see a psychiatrist. Last year, he started attending weekly group therapy sessions at the Las Vegas VA hospital.
The sessions have given him coping skills and more shoulders to lean on. His wife has been able to turn the TV volume up a little, though Brown still spends Fourth of July holed up in a closet with his earplugs. Group therapy, however, has provided him with the comfort of knowing he is not alone—each year as July 4th approaches, he said, one veteran in the group heads to the Utah mountains to escape the holiday noise.
The pastor at Brown’s church used to startle Brown right out of his seat when he delivered a fiery sermon, but now Brown knows he has options. If the minister gets too raucous, Brown heads to the door until things settle down.
And Brown is not wandering the house at night as much as he used to, though he said his sleep is still disturbed by odd dreams of spirits. Because he was punching and kicking during his sleep, he now sleeps on an air mattress on the floor so he won’t disturb his wife.
“I’ve learned how to cope better,” Brown says with just a hint of pride. “You know when you need to be by yourself, and you know when something’s going to happen to you. I don’t look upon myself as being sick because I’m spiritual. I know that I’m not what I used to be, but I can be all I can be in this condition, you know? We live. We live.”