03 March, 2015

Patient Profile #1: The Survivalist

This story is part of a series called "Counseling on the Battlefield" where real-life excerpts of counseling sessions  that were conducted during the Iraq war in 2004-2005 were documented in my travel journal, with actual clients remaining anonymous through random, unrelated patient numbers to protect confidentiality.  While serving in Ar Ramadi, Iraq, in addition to serving on Team Lioness, I was also the Camp Ar Ramadi Combat Stress Control Non-Commissioned Officer In-Charge - which translates into be being the clinic supervisor while the staff psych nurse disappeared for most of the day. To read all the patient profiles and the adventures (and really terrible misadventures), pick up a copy of my book, "Quixote in Ramadi" to truly dive into the bizarre world of military mental health and combat stress control. Enjoy.


While we had a steady flux of patients coming into the clinic, many of which were cases we were taking over from the 587th, there are only a few I have chosen to focus on so you could have a decent idea of the multiple issues that were faced and the diversity of problems one can undergo in a combat theater. On average, I could say each of us saw about two to three patients a day, seven days a week. We could see groups of five to a few hundred for briefings. We had no days off as directed by CPT Jack despite the Major’s suggestion to do so as he did for his team.

This was my first interview with a patient in Ramadi, one of SGT Daniels’ patients. “You’re going to love this guy, just fucking hilarious!” said Daniels enthusiastically as we waited for Patient #1 to roll through the door. Since I can’t use names for various reasons, I’m simply going to number those we saw to avoid any confusion and to protect their privacy. Along the same lines of privacy, there are a few things I’ve changed from each person’s story to make them unrecognizable to those who currently work with them. I know it seems sterile as every one of these patients are real people with real names, but with the other patients I’m going to mention, it will be much easier to keep track.

Patient #1 casually strolled through the door, Daniels introduced us, and each of us grabbed a fold-out chair and followed Daniels to the roof. Well, Daniels was right, this kid was a riot. As I was sitting with Daniels, trying not to laugh at how animated this guy was, he told me quite an amazing story of what life was like for him on a daily basis outside the wire in Ramadi. Outside the wire is a term meaning anywhere outside an encampment or military base.

Some people go their entire deployments without ever going outside the wire. Daniels asked him to tell his story since I’d be taking over as his new counselor and the clinic supervisor so he did just that, but in the most entertaining way possible. Although the theatrics weren’t needed, being such an incredible story, you could tell this was a person who could be destined for stand-up comedy who now just happened to be wearing a US Army uniform.

He spoke with a voice of both rage and irony, seasoning each sentence with laughter and frustration of all the asinine things he’s seen from incompetent leaders to the most dangerous mix-ups in communication. One in which almost cost a fellow soldier’s life in a firefight out in town.

During a patrol through the streets of Ramadi, Patient #1 and a few Soldiers from his unit were ambushed and driven to the inside of a bombed-out building to take cover and return fire. To make matters worse, on the other side of this firefight, a Marine unit started firing in the opposite direction, streaming bullets in not only the path of insurgents but this Army unit as well. While the opportunity was present and the enemy was suppressed, everyone jumped into the track vehicle and high-tailed it out of there in order to catch up with the rest of their unit.

At the very last moment upon reaching their company, they realized everyone wasn’t accounted for: one of their soldiers was missing. This battle buddy who was left behind, realizing the danger grew exponentially for him as he was left on his own, ran down street after street looking for anyone from a US military unit, but was apparently out of luck.  He immediately took refuge in a field of tall grass as groups of insurgents performed what looked like a manhunt for the odd guy out. He then seized a moment when the insurgents passed and commenced to make a mad dash for the front gate of Camp Ramadi, which was miles away. He succeeded in making it to less than a mile outside the gate before his company finally picked him up.

The reason why Patient #1 was here? He confronted, and quite possibly threatened bodily harm to his commander for repeated poor decisions much like the one that put them in unnecessarily compromising positions, causing them to fight on their own with no outside support and poor communication that caused Marines, who were unaware of their position, to fire at them.

He came here for anger management, but mostly I saw this as his opportunity to vent instead of taking out his frustrations on people who could certainly charge him for insubordination on a criminal level. I could understand anyone in such a situation could react like that, and he was willing to accept responsibility for his fully-forgiving, abandoned battle buddy.

Patient #1 wasn’t the only one who came to our clinic complaining about their ineffective and hopeless commander. In fact, his Army Engineering unit ended up being our #1 customer at the Ar Ramadi Combat Stress Clinic. It appeared that this particular company, and their steady stream of clients, was not a mere anger management group or those in need of positive coping mechanism instruction; this was an ongoing homicide prevention campaign in which the incompetent commander was constantly the target.

After the 587th left, Patient #1 and I continued our talks on the roof despite the occasional interruptions of hurdling rockets and mortars that pounded our camp daily. He liked the roof, as did I. It was more private and even when IED’s were going off at the gate which was within our view; it still managed to be oddly tranquil. Perhaps it was seeing the cold blue sky and doves flying around, as opposed to the cramped and sandy clinic interview room right below us, that was comforting.  He talked, I listened. As we delved further into his story and his life, it was soon my turn to go outside the wire, which forever changed both of us.

16 February, 2015

Between a Rock and a Car: A Childhood Memory on Racism

When someone disrespects you to your face or about you behind your back, you don’t have to accept it. You have to agree with that perception before the idea becomes a part of you. You always have to ask, “Who are you to tell me who I am?” What happens when you tell a child, over and over that they’re stupid, worthless, and unloved? They’ll grow up believing it, and they will act in accordance with who they think they are, no matter how erroneous that negative commentary was. Here is a childhood "flashback" from my book, "Quixote in Ramadi".

After moving from Key West at age four to Edgewater, Florida, we bought a house that was located in a small development that was filled with retirees. One woman across the street, Mary, who was an Irish immigrant, was quick to greet us and we instantly took a liking to her. She would dote on my sister and I and spend hours chatting with my mother about how life was in Ireland and my mom would openly and comfortably discuss her life growing up in Saipan.

However, not everyone in the neighborhood was so welcoming. The neighbor to our right, named Rose, was an elder German immigrant, and while she invited my mother over a few times to chat, she became openly militant about immigrants in this country. This was quite hilarious to my mother as her islands were owned by the US and she was therefore an American citizen from birth as well as an indigenous Chamorro and here was this angry woman from Germany, shouting about foreigners.

While my mother initially brushed off her racist remarks, it didn’t take long for her to put Rose in her place. Soon  after, Rose began burning trash in our back yard then calling the fire department and police on my parents, claiming we should be removed from the neighborhood.

One evening as my older first cousin, Ramona and her husband were visiting from South Carolina, we caught Rose dumping garbage onto our front yard as we sat outside. My mother then launched up from her chair, followed by my cousin Ramona, and walked over to Rose. I ran after them, feeling the need to protect them.

“You know, if you hate it here so much, why don’t you go back to your country? If anything, you’re the annoying foreigner who’s bothering everyone,” my mother said, seemingly ready and willing to give her another dose of her own medicine.

 “You disgusting fucking n***er! Go back to where you came from, you goddamned monkeys! This is a white’s only neighborhood!” Rose shrieked as she threw her lit cigarette at my mother.

In a split second, my cousin Ramona, who’s barely five feet tall, but a spunky Chamorrita, reached over the small, rickety wooden dividers on our lawn and grabbed Rose by the hair and began punching her in the back of her head.

“NO, MONA, STOP IT! SHE’S AN OLD WOMAN!” by mother cried as Ramona held the sobbing Rose in her left hand and pointed in her face with her right.

“You say one more word and I’ll kill you,” Ramona said to Rose while my mother now was pleading with Ramona to stop as my father, Ramona’s husband, and my sister raced toward us to calm Ramona’s temper.

 “Please, let her go, it’s not worth it,” my mother begged Ramona, who then pushed Rose back onto her own lawn.

“You want to fuck with Chamorros, you old Nazi bitch, that’s what you get! You might’ve gotten away with that bullshit when you were Hitler’s whore, but you’re sure as fuck not pushing us around!” Ramona laughed as Rose held her battered face, glaring back in defeat.

“Who’s Hitler?” I asked my sister, who then elbowed me and told me to just keep quiet.

While Rose fled to her house, my parents and Ramona’s husband consoled Ramona and advised her that Rose could call the police and instigate even more problems that none of us wanted. The police were, of course, called and two cars showed up with black and white male officers. When we explained what happened, the police surprisingly did nothing to Ramona and instead reaffirmed that Rose’s continued harassment of our family was going to cost her if it didn’t end today.

Rose’s repeating the N-word to the white officers didn’t help her case either to say the least. My father and Ramona’s husband then laughed at the insanity of Chamorro women and how they taught Rose a new lesson in world history in a few swift punches. A week or so went by and Ramona and her husband drove back to South Carolina and there wasn’t another peep out of Rose.

Weeks after the Chamorro-German brawl, one day after school when the bus dropped my sister and I off near our home, Rose’s granddaughter, Shannon, came up to us, pulled my braided ponytail and called me the N-word again. It’s crazy that even at that age, I had become so familiar with such a profane racial slur and it came out of these people’s mouths so easily, like it was part of their breathing.

The walk from the bus stop to the house was a hundred fifty meters maximum, but she did this just ten steps after the bus pulled away. My sister dropped her backpack and began to chase Shannon into the woods, yelling at her for being a coward. I ran back to our house as fast as I could and screamed for my mother who then ran with me out of the house and towards Janice. Shannon apparently went hiding in the woods and Janice, who seemed to have fallen over a tree stump, came walking out, dusting herself off from the dirt and pine needles. 

My mother asked what happened and was furious. We stood there for a few minutes as she dusted Janice off and then we began walking back toward our house. That’s when Shannon immediately sprung from the woods and ran into her grandmother’s house. Rose came out in no time, got in her car and drove as fast as she could past us.

“I’m getting really, very sick of that woman,” my mother grumbled.

All of a sudden, we heard a screech behind us, then an engine revving louder and louder. Rose was driving toward us as fast as she could. Just in time before we could be hit, my mother picked up my sister and I and threw us to the side and into the dirt. Rose, thankfully, missed. In a state of rage, my mother grabbed rocks and started hurling them at Rose’s car and screamed obscenities in Chamorro.  I'll always remember that moment.  No matter how many rocks my mother threw at the machine and the white supremacists operating it, it was never enough.

Rose peeled away with Shannon and disappeared for hours. Mary, and other concerned neighbors, came out to ask what had happened and were appalled by Rose’s persistence in menacing our family. The police were called, yet again, and another report was taken followed by another visit to Rose’s home when she returned. It wasn’t too long after the incident that my father accepted orders to relocate. This time, it was Alabama.

For the rest of this story, read "Quixote in Ramadi".

30 January, 2015

Army Suicide Prevention Quiz

As I go through old military mental health files, I'll continue to post different training materials, presentations, and fact sheets to assist you in understanding various military and civilian mental health issues (but, with updated statistics).  If you have any requests for any specific military or veteran mental health related topic, please comment below.

For more information on the US military veteran suicide epidemic, click here.

Suicide Prevention Quiz 
Take this quiz to test your knowledge.

Circle “T” for true, “F” for False. 

1. Of any 10 persons who kill themselves, 8 have given definite warnings of their suicidal intentions. T F
2. Spring and Mondays are have the highest numbers of suicides. T F
3. A history of past suicidal attempts is sad, but not useful in predicting future attempts. T F
4. Suicide rates are higher among the 15-24 year old age group. T F
5. Suicide is not ranked in the top ten causes of death in the United States. T F
6. There are three attempts at suicide for every one completed suicide. T F
7. Individuals who attempt to kill themselves are suicidal for limited time periods only. T F
8. Improvement following a suicidal crisis means that the self injury risk is over. T F
9. Studies of hundreds of genuine suicide notes indicate that although the suicidal individual is extremely unhappy, he or she is not necessarily mentally ill. T F
10. Suicide rates are higher in the military than civilian sector. T F
11. Women attempt suicide as often as men in the United States. T F
12. At one time or another, almost everyone contemplates suicide. T F
13. Most suicidal persons who die did not have mixed feelings about living or dying. T F
14. Almost no one commits suicide without letting someone know about their intentions. T F
15. All verbal indications of suicide intent should be taken seriously. T F
16.If one suspects that a person is thinking about suicide, asking about it may cause the person to commit suicide. T F

To Discover Your Score, Read On!

Adapted From: American Association of Suicidology and NIH Pub# 82-2308, Aug 81, “Suicide Prevention”.

Answers to the Quiz: 
1. True.
2. True. 
3. False. A history of past coping behaviors (including suicide attempts) is a good indicator of future coping behavior. 
4. False. Suicide rates are highest among those over 65 years old. Their rates tend to be more than 50% higher than the national average and that of 15-24 year olds. 
5. False. Suicide ranks in the top ten causes of death. For 15-24 year olds it is third following accidents and homicides. 
6. False. Estimates vary, but generally there are 8 to 20 attempts for every completed suicide. 
7. True. 
8. False. Often the person is at greater risk of suicide when they appear to be improving. For depressed people, as they improve they now have the energy to act on their depressed feelings. 
9. True. However, mental health diagnoses (e.g., depression, schizophrenia, alcoholics, and panic disorders) are associated with greater risks of suicide. 
10. False. The suicide rate in the military is generally the same as in the civilian sector. However, over the past 8 years it has risen from 11.7 per 100,000 to 14.2 per 100,000. 
11. False. Risk of attempted suicide is greater for females and the young. Females generally make 3 to 4 times as many attempts as males. Males tend to choose more lethal and successful methods.
12. True. Given enough stress, almost all of us consider suicide as an option. 
13. False. Most people who are suicidal are unsure about whether to live or die. 
14. True. One of the commonalties of suicide is the communication of intent. 
15. True. Especially higher functioning individuals are less likely to convey their intent. Any hints should be taken seriously. Do not be afraid to ask! 
16. False. Instead, asking the person and expressing concern may save their life. 

Spring, the season of new life is when most suicides occur. Suicide is one of the top ten causes of death in the United States. It ranks as the second leading cause of death among those 15 to 24 years old. In 2013 alone, over 41,000 persons killed themselves; that is one suicide every 12.8 minutes. Almost everyone has thought about suicide, but no one needs to die by their own hand. Suicide is preventable, if you watch for the warning signs, stop to ask a few questions, and take the time to help.  For more information on up-to-date US-based suicide statistics, click here.

Here are a few key points to help guide your questions and some suggestions on how to help.

Don’t be afraid to ask!
People attempt suicide for a number of reasons. Those who are at the greatest risk of self-injury are emotionally upset over work problems, a relationship that is in trouble, or a major life change. They may blame themselves and allow self-hate, self-blame, guilt and shame to fester. They withdraw from others and outside activities. They develop tunnel vision as their hope narrows--all they can see is continued suffering. Finally, there is the thought that ceasing to be would stop the pain.

What are the Signs of Suicide? 
Most people who attempt suicide really do not want to die. They are asking for help. Eight out of ten people who commit suicide have indicated to someone their intention of killing themselves. As a rule, if you can lower the emotional distress that has led someone to consider suicide, you will also lower their risk of committing suicide.

Watch for these Warning Signs: 

  • Confusion Financial Reversal or Loss of Social Status 
  • A Family History of Suicide 
  • Previous Suicide Attempts 
  • Feelings of Failure 
  • Talk About Death or Committing Suicide 
  • Lack of Roots or Social Relationships 
  • Over Emphasizing a Lack of Suicidal Thoughts 
  • Withdrawal from Others and Outside Activities 
  • Recent Break-up of a Significant Relationship 

Suicide Prevention Tips 
You can help prevent a suicide by asking a few important questions. 
1. What is going on?
2. Where do you hurt?
3. What would you like to happen?
4. What do you feel that you have to solve or get out of?
5. Do you have any plans to do anything harmful to yourself and what might you do?
6. What would it take (to keep you alive)?
7. Have you ever been in a situation like this before, what did you do, what happened, and how was it resolved?

For More Information and Help 
If you need help or you are concerned that someone you know may be at risk of suicide, there are caring professionals who are there to help. Please contact your nearest qualified mental health professional, go to the Emergency Room, or call 911. There are people who care.

Summing it Up 
The American Association of Suicidology advises:
  • Believe It. Take any signs or threat of suicide seriously. 
  • Listen Carefully. 
  • Keep the lines of communication open, ask questions, and talk calmly. 
  • Be sympathetic. 
  • Don’t be judgmental or give false assurances that everything will be all right. 
  • Get Help. Call a suicide prevention center, mental health clinic, physician, chaplain, or other qualified mental health professional. 
  • Be There. Be supportive and show that you care. 
  • Do not leave him or her in a crisis. 
  • Follow up by staying in touch and encouraging him or her to continue treatment.

For more information:
Directory of AAS-Accredited Crisis Centers
Don't see a local number?
The National Suicide Prevention Lifeline can connect you to a local crisis line 24 hours a day, 7 days a week.
1-800-273-TALK (8255)