June Is PTSD Awareness Month — Let’s Talk Mental Health, Join Us at the Forum

Posted: 11:13 pm  EDT
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Join us at the forum today at http://forums.diplopundit.net, noon – 2pm, EST

I’ve blogged about mental health in the State Department for years now (see links below). I know that a mental health issue affecting one person is not a story of just one person.  It affects parents, spouses, children, siblings, friends; it affects the home and the workplace. It is a story of families and communities. While there is extensive support in the military community, that’s not always the case when it comes to members of the Foreign Service.

I once wrote about a former Foreign Service kid and his dad with severe PTSD. A few of you took the time to write and/or send books to the ex-FS employee incarcerated in Colorado, thank you.

I’ve written about Ron CappsRachel SchnellerCandace Faber, FSOs who came forward to share their brave struggles with all of us. There was also a senior diplomat disciplined for volatile behavior who cited PTSD, I’ve also written about Michael C. Dempsey, USAID’s first war-zone related suicide, and railed about suicide prevention resources.  The 2014 Foreign Service Grievance Board 2014 annual report says that eight of the new cases filed involved a claim that a disability, Post Traumatic Stress Disorder (PTSD), or other medical condition affected the employee performance or conduct that resulted in a separation recommendation.

With very few exceptions, people who write to this blog about mental health and PTSD do so only on background. Here are a few:

  • A State Department employee with PTSD recently told this blog that “Anyone outside of our little insular community would be appalled at the way we treat our mentally ill.”  The individual concludes with clear frustration that it “seems sometimes the only unofficially sanctioned treatment plan encouraged is to keep the commissaries well stocked with the adult beverage of your choice.” 
  • Another one whose PTSD claim from service at a PRT in Iraq languished at OWCP said, “I can assure you that OER and State Med have been nothing but obstructions… as a vet, I have been treated at VA for the past ten months, else I would have killed myself long ago.”
  • Still another one writes: “VA indicates the average time between trauma and treatment-seeking is eight years. The longer it is undiagnosed and treated, the more difficult to ameliorate. I have a formal diagnosis from VA but could not even get the name of a competent psychiatrist from DoS. The bulk of DoS PTSD claims are still a few years away (2008/2009 PLUS 8), with no competent preparation or process.”
  • A friend of a State employee wrote that her DOS friend was “deployed/assigned to a  war-torn country not too long ago for a year. Came back with PTSD and  was forced by superiors to return to very stressful/high pressure work  duties while also seeking medical attention for an undiagnosed then, but eventually diagnosed (took about 6 months) disease  triggered by environmental conditions where s/he was last posted.”
  • Another FSO said, “I actually thought State did a decent job with my PTSD. After I was subject to an attack in Kabul, the social worker at post was readily available and helpful. He indicated I could depart post immediately if I needed to (and many did after the attack). When I departed post I was screened for PTSD and referred to MED here in DC. After a few sessions here with MED, I was referred to a private psychologist who fixed things up in a few months.”
  • One FSO who suffered from PTSD assured us that “State has come a very long way since 2005” and that it has made remarkable progress for an institution. Her concerns is that PTSD is widespread in the Department in the sense that people develop it in a wide range of posts and assignments. She cited consular officers in particular, who evacuate people from natural disasters and civil wars and deal with death cases on a regular basis, and are particularly at risk.

 

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June is PTSD Awareness Month. We are hosting a forum at http://forums.diplopundit.net for an open discussion on PTSD.

It’s not everyday that we get a chance to ask questions from somebody with post traumatic stress disorder. On Monday, June 29, FSO Rachel Schneller will join the forum and answer readers’ questions  based on her personal experience with PTSD.  She will be at this blog’s forum from noon to 2 pm EST. She will join the forum in her personal capacity, with her own views and not as a representative of the State Department or the U.S. Government.  She’s doing this as a volunteer, and we appreciate her time and effort in obtaining official permission and  joining us to help spread PTSD awareness. Please feel free to post your questions here.

Rachel Schneller joined the Foreign Service in 2001. Following a tour in Iraq 2005-6, she was diagnosed with PTSD. Her efforts to highlight the needs of Foreign Service Officers returning from tours in war zones helped prompt a number of changes in the State Department, for which she was awarded the 2008 Rivkin Award for Constructive Dissent.

Prior to joining the U.S. Department of State, Rachel served as a Peace Corps volunteer in Mali from 1996-98. She earned her MA from the Johns Hopkins School of Advanced International Studies (SAIS) in 2001. We have previously featured Rachel in this blog here, and here.

The forum, specifically created for PTSD discussion is setup as an “open” forum at this time; readers may post questions without registration.  We’re hosting, same Privacy Policy apply.

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Below are some of our previous blog posts on mental health, PTSD, security clearance and the State Department’s programs:

What to do when different voices start delivering multiple démarches in your head?]

USAID’s First War-Zone Related Suicide – Michael C. Dempsey, Rest in Peace

State Dept’s Suicide Prevention Resources — A Topic So Secret No One Wants to Talk About It

Former Foreign Service Kid Writes About Dad With Severe PTSD  (Many thanks to readers who took the time to write and send books to Tony Gooch! We appreciate your kindness).

Ron Capps | Back From The Brink: War, Suicide, And PTSD

Rachel Schneller | PTSD: The Best Thing that Ever Happened to Me

Senior Diplomat Disciplined for Volatile Behavior Cites PTSD in Grievance Case, Fails

Pick the Long or Short Form, But Take the Post-Traumatic Stress Disorder (PTSD) Screening

On the Infamous Q21, PTSD (Again) and High Threat Unaccompanied Assignments

Ambassador Crocker Arrested for Hit and Run and DUI in Spokane

Quickie | Running Amok: Mental Health in the U.S. Foreign Service

Former FSO William Anthony Gooch: No Mercy for Broken Men?

Post-Traumatic Stress Disorder: The Ticking Bomb in the Foreign Service

Clinton issues note on mental health; seeking help a sign of maturity and professionalism

EFM shouldn’t have to see three RMOs, do a PPT presentation and wait 352 days for help

Join the Petition: Revised Q21 for the Foreign Service

State Dept’s WarZone Deployment Incentives, Programs, Training and Medical Support

DMW: Mental Health Treatment Still a Security Clearance Issue at State Department

Insider Quote: Returning to the Real World

What’s State Doing with Question 21?

 

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Rachel Schneller | PTSD: The Best Thing that Ever Happened to Me

Disclaimer: The views expressed in this article are those of the author, and do not necessarily reflect those of the U.S. Department of State or the U.S. Government.  Read more about Rachel here ~ DS

PTSD: The Best Thing that Ever Happened to Me

by Rachel Schneller

PTSD felt like the worst thing that had ever happened to me. I came back from Iraq in 2006 feeling damaged, like the FedEx package in the movie Cast Away that arrived at its final destination beaten up beyond almost all recognition. I didn’t know I had PTSD, I just knew that something was wrong. Everything and everyone felt like a threat. Everything made me angry and want to fight. I oscillated between sheer rage and numbness, because feeling angry all the time left me exhausted. But I couldn’t sleep much, which also made me angry.

Photo from Private Collection (used with permission)

If I had not sought out treatment for PTSD, I believe I would have wound up dead, in prison, or homeless and unemployed, carrying a sign on a street corner somewhere raging against the world. Best case scenario, I would have managed to continue to somehow drag my bitter mess of a self to work each day, where I would have made the lives of everyone around me absolutely miserable.

Don’t get me wrong, there were parts about being completely lost in my traumatized self I enjoyed. The rage and anger resulting from my experience in Iraq made me feel more alive than I had ever felt before. I was completely focused and driven and could work insane hours at high intensity like a superhero. Everyone around me seemed slow and crippled by worry, whereas I felt no pain and absolutely no fear (I also felt no joy).

After six years of rigorous treatment for PTSD, I feel now like I am both healed enough to engage with the rest of the world in a healthy way, and still aware that I went through a life-altering experience that left a permanent mark on me. I am bilingual and bicultural in PTSD. And honestly, I would not have it any other way. My service in Iraq was important and one of the most meaningful periods of my entire life. My experience with PTSD has made me more sensitive and compassionate toward other people. My treatment for PTSD helped me grow into a better person than I ever could have become without Iraq and without PTSD.

My bottom-line message on PTSD is to get treatment.  To get treatment, you need a diagnosis.  To get both the diagnosis and the treatment, you need to see a professional.  You should do all these things because they will make you a better person.  Be brave and undeterred in your mission.  Since speaking out on PTSD several years ago, I have been approached by numerous people who are suffering symptoms of PTSD and ask for advice on what to do.  I tell them all the same thing: get treatment.  Some worry that seeking treatment might impact their careers or families.  What I always say is that untreated PTSD is much more likely to ruin your career or family than seeking treatment.  Some worry about stigma attached to a diagnosis, or that they will be limited in overseas assignments.  My response is: don’t worry about things outside of your control, such as what other people think and where you might be in a year or two.  Shift your attention to the here-and-now and do what needs to be done today.

I would love to design a compassionate, comprehensive program for people with PTSD.  I daydream about doing this, where several years ago my thoughts reverted back to helicopters, rocket attacks, and endless expanses of concrete barriers.  My ability to focus has been honed through years of yoga and meditation, practices I found particularly helpful in my treatment of PTSD.  I still feel no fear, and still have limitless energy to fight for the things that are important to me.  But now I also feel joy.  And finding joy and beauty in life after surviving a horrific event is to experience joy and beauty in a deeper, more meaningful way than ever would have been possible before.  Although I could not see it at the time, PTSD was the best thing that ever happened to me.

Post-Traumatic Stress Disorder: The Ticking Bomb in the Foreign Service

Rachel Schneller joined the Foreign Service in 2001, serving in Skopje, Conakry and Basrah, where she was a Provincial Action Officer from 2005 to 2006. In the January 2008 issue of the Foreign Service Journal, she wrote a piece about her personal struggle with PTSD  (See Recovery: When  Surviving Isn’t Enough, FSJ, p. 35). That same year, she was awarded the William R. Rivkin Award for Dissent. The excerpt below is from her 2008 FSJ article:

Since returning from Iraq over a year ago and being diagnosed with the disorder, I’ve gotten a crash-course on the subject. So perhaps I can contribute to the dialog in a way others cannot, by describing what it is like to recover from PTSD.

My PTSD came about due to the conditions I endured while on assignment with the State Department, but State left me to fend for myself when it came to seeking treatment. In June 2006, after having worked in Basrah for several months, I took leave to return to Washington for a few weeks. A Foreign Service National employee in my office had been murdered, and I’d dreamed of hanging myself from my office light fixture.

During leave, I asked the Medical Services Bureau for help and they referred me to an in-house social worker. While telling him about the whole horrible situation, including the dream about killing myself, I broke down in sobs. The social worker was nice but offered me no actual treatment. He did not refer me to a psychiatrist for an evaluation; he did not offer me medication for my depression; and he did not address my thoughts of suicide. Disappointed, but fearful of being labeled a “quitter” or worse, I chose to return to Iraq.

When I think about how poorly State treated me when I sought help, I am outraged. After all, I was in no condition to make decisions about my own well being, any more than an alcoholic can make a well informed decision in a liquor store. Any competent, qualified mental health care provider would have known this. I had requested help but found only more danger. It was as if the ambulance coming for me in my elevator dream not only did not stop for me, but ran over me in the process. I — and everyone else  serving our country in a war zone — deserve much better.
[…]
In any war zone, some people going through the experience will likely come out of it with PTSD. But if the State Department is going to post its employees to war zones, it should be prepared to deal with the mental health aftermath and offer treatment to those who need it.

I completed my Iraq tour at the end of July 2006 and returned to Washington, where I began my next assignment, long-term training at the Foreign Service Institute. After all I’d been through, I was grateful  to be home alive and in one piece, reunited with family and friends. But soon I just stopped functioning normally. I was unable to sleep. I started getting lost on my way home from work, waking up in a sort of fugue state blocks away from my apartment in Georgetown. I don’t remember precisely how, but I burned myself several times so badly that I scarred — yet I didn’t feel it. I only noticed the burns the next day. Rage overwhelmed me. I nearly attacked another person in one of my FSI training classes, but walked out of the class in time and had a meltdown in the bathroom. (That poor woman had no idea how close she came to being strangled by me for making a completely innocent comment.) I couldn’t keep up the  pretense of being normal any longer.

Regions of the brain affected by PTSD and stress.
National Institutes of Health

Last week, I posted about a grievance case by a Senior Foreign Service Officer who claimed PTSD and whose suspension was affirmed by the Foreign Service Grievance Board. In its FSGB filing, the State Department contends the following:

“Grievant served approximately one year in [REDACTED], [REDACTED] and returned to the U.S. on August 11, [REDACTED].  He served nearly seven months at the [REDACTED] without incident, and then, on March 2, [REDACTED] was assigned as Office Director to the Bureau of [REDACTED] and his misconduct began. Grievant waited until almost six months after he was removed from [REDACTED] to seek any medical advice.”

The Foreign Service Grievance Board in affirming the suspension writes:

“The year and a half referred to by the social worker encompasses the first seven months after his return to the U.S. from [REDACTED] when grievant served at the [REDACTED] apparently without incident. Grievant has not stated what he did in {REDACTED]  or what experiences he had that could have caused PSTD. He has presented no testimonials from others at the [REDACTED] or prior to his service in [REDACTED] to support his claim that PTSD accounted for his “out of character” behavior afterwards. There was no evidence that the claimed PTSD impacted any other aspects of the grievant’s life beyond the threatening and demeaning and bullying behavior that formed the basis for the discipline in this case.”

See, nothing happened in seven months, so how could he possibly have PTSD?

I don’t know how knowledgeable is the FSGB about PTSD, including an occurrence described as Delayed Onset PTSD, which can happen anywhere after six months to four years of the traumatic event. Or much longer than four years in some cases.  In fact, according to the LA Times, just a few weeks ago, Tech Sgt. Stanley Friedman, 92 was finally compensated for PTSD by Veterans Affairs (it was called shell shock or battle fatigue when he served nearly 70 years ago) for his service during World War II.  Our Foreign Service folks have not only served in war zones but have been subjected to  terrorist attacks, natural disasters and other traumatic events overseas.  I fully expect that the FSGB will be called on many more times in the foreseeable future to adjudicate cases relating to PTSD in the Foreign Service.

There is no question that the State Department needs to do a better job at screening for PTSD in the Service rather than its “cursory 3 hour High Stress Debrief session” plus handouts or one-day High Stress Assignment Outbrief Program, MQ-950 (which appears to be available only to employees and not/not to family members).  And by the way, spouses/partners who may be working in high-stress posts will not necessarily be working when they are back in the U.S., so they would presumably fall under the Non State Employee category.  The tuition rate for that category for taking MQ-950 is $260.

Rachel commented about the grievance/PTSD blog post, which I am highlighting below.

My heart goes out to everyone involved in this case. The employee having served in a PRT in what must have been extraordinarily difficult circumstances. The bewildered employees who felt threatened by the disturbing behavior of their boss. The State Department system, which has so little capacity for dealing with situations like this, which will only become more prevalent as more and more of us serve in combat zones. And come back.

A couple of things- a diagnosis of PTSD is your best defense, and can only be made by a qualified professional. A social worker cannot diagnose. If you have served in a combat zone and come back acting weird, please do everyone a favor and go see a psychiatrist or psychologist who can actually give you a diagnosis. You will not know you have a PTSD when you come back. You will just feel different and angry all the time. Trust me, get diagnosed. It is the only way to get good treatment.

Second, PTSD is a ticking time bomb. It is completely to be expected that someone with PTSD will come back from their service in a combat zone and be able to hold it together for a while. Luckily for me, I lost it only a few weeks after coming back and so was able to get treatment quickly. But in many cases, someone will not “lose it” for months or years afterward. You get triggered by something and BAM! You are right back in the war zone. That trigger may happen soon or it may not happen for a long time.

Third, you are an adult and so even if you have PTSD, you still are responsible for not attacking people or otherwise breaking the law, and you can and will be held responsible. PTSD is not a license to break the law. It does not make yelling at people OK. The soldier who “lost it” and killed all those innocent Afghani civilians a few months back? He probably had major PTSD, but he also killed a bunch of innocent people. Getting suspended from State is a good thing, because if you have PTSD you need to get treated, and this is your wake-up call.

And State, this sort of situation is going to keep happening. We need to do a better job of handling this sort of PTSD situation. It is only a matter of time before someone comes back and instead of yelling at their employees, actually does someone, or themselves, physical harm.

While I do believe that the State Department has the responsibility for conducting more effective PTSD screening for returnees, I also agree with Rachel’s point that mental health is an individual responsibility.  As she puts it plainly, “if you wait for State to get its act together on PTSD, you will be crazy for a long time.”

Wednesday, June 27 is PTSD Awareness Day. DiploPundit will be blogging about this topic the whole week.

Domani Spero