Veterans and PTSD

August 21, 2011 11:15 AM

Army vet with PTSD sought the treatment he needed by taking hostages – but got jail instead. "Fifteen months of carnage in Iraq had left the 29-year-old debilitated by post-traumatic stress disorder. But despite his doctor’s urgent recommendation, the Army failed to send him to a Warrior Transition Unit for help. The best the Department of Veterans Affairs could offer was 10-minute therapy sessions — via videoconference. So, early on Labor Day morning last year, after topping off a night of drinking with a handful of sleeping pills, Quinones barged into Fort Stewart’s hospital, forced his way to the third-floor psychiatric ward and held three soldiers hostage, demanding better mental health treatment." [Via]

A Novel Court Model to Aid Veterans With P.T.S.D. "But something different happened in Mr. Eifert’s case. Headed for disaster, he was spared through a novel court program and an unusual coming together of a group of individuals — including a compassionate judge, a flexible prosecutor, a tenacious lawyer and an amenable police officer — who made exceptions and negotiated compromises to help him. If he takes advantage of the chance to recover his life, he is likely to avoid incarceration and receive the care he needs to move forward."

posted by homunculus (38 comments total)

This is a really troubling article for me. On one hand, I can see where what happened here is horrible, and needs to be addressed by the law. On the other hand, I can see being that guy.

I've gone through some of the rigamarole of trying to find help for a complex situation on the civilian side of the fence, and been shunted out and ignored. I can't imagine that gets any easier by throwing the military bureaucracy into the mix.

I think anyone who's seriously tried to get help for mental illness in the states when they don't have some -stellar- doctors and insurance has had fantasies of -making- the system cooperate.
posted by Archelaus at 11:27 AM on August 21, 2011 [6 favorites]

"While in custody, Quinones threatened the lives of President Barack Obama and former President Bill Clinton, making his already bleak situation worse. "

I... I hope this man gets help, but dear god, he's obviously got some right-wing hero worship if the man who started the war that caused his PTSD is exempt from his wrath.

And fuck the military for still, in this day and age, pushing an agenda that looks down upon those that need help as being "weak" and not giving the support they need (and educating fellow soldiers that it's not their fault -- I've heard that there's a culture like this in the military which leads to soldiers having a hard enough time to seek help when they need it).
posted by symbioid at 11:28 AM on August 21, 2011 [12 favorites]

I posted this in an earlier thread but it's more relevant for this one:

Drugs Found Ineffective for Veterans’ Stress

Drugs widely prescribed to treat severe post-traumatic stress symptoms for veterans are no more effective than placebos and come with serious side effects, including weight gain and fatigue, researchers reported on Tuesday.

The surprising finding, from the largest study of its kind in veterans, challenges current treatment standards so directly that it could alter practice soon, some experts said.

posted by Anything at 11:31 AM on August 21, 2011 [3 favorites]

The Agony and the Ecstasy: The Quiet Mission to Fight PTSD With Psychedelic Drugs
posted by homunculus at 11:34 AM on August 21, 2011 [4 favorites]

“Putting a guy like that in jail would be a travesty,” he said.

Letting someone get away with doing that would also be a travesty. I hope he gets the help he needs, and I'm glad to see this being raised in the Stars and Stripes, I hope the US Govt steps up.
posted by furtive at 11:37 AM on August 21, 2011 [1 favorite]

I was diagnosed with PTSD a couple of years ago, and if you think it's hard for vets to receive treatment, try getting help as a citizen. It barely exists. I've been told repeatedly that there are no drugs that can treat it - ateasr, no legal drugs. Somehow I doubt I'm eligible for the exotic ketamine and MDMA treatments we keep hearing about. I had to lie to my mental health care provider just to get counseling, as they refuse to admit patients with PTSD alone. I told them I suffer from clinical depression just to get my foot in the door, and luckily I found a sympathetic counselor once I got past the bullshit.

Maybe i'll take some hostages - oh yeah, nevermind.
posted by item at 11:43 AM on August 21, 2011 [3 favorites]

I had to lie to my mental health care provider just to get counseling, as they refuse to admit patients with PTSD alone. I told them I suffer from clinical depression just to get my foot in the door, and luckily I found a sympathetic counselor once I got past the bullshit.


This is pretty common and a direct result of letting insurance companies choose what they cover. Many counselors will help you pick a diagnosis that is covered.
posted by psycho-alchemy at 11:56 AM on August 21, 2011 [4 favorites]

[Member of underclass] with PTSD sought the treatment [s/he] needed by [committing crimes] – but got jail instead.
posted by facetious at 11:58 AM on August 21, 2011

This is pretty common and a direct result of letting insurance companies choose what they cover

That's a great explanation, but how do you exp[lain it away when the US government does exactly the same?
posted by buggzzee23 at 12:03 PM on August 21, 2011

Yeah, a friend was traumatized after being held hostage at gunpoint on labor day last year and developed some symptoms of PTSD. It's been really hard for him to find help.
posted by Authorized User at 12:10 PM on August 21, 2011

The other two soldiers held hostage that day also empathize with Quinones. They both have been in combat in Iraq and understand what it can do to a soldier. “I’m not really angry at him,” Anderson said. “I don’t think it was the right way to go about getting help, but I guess he just snapped.”

Henson was greatly affected by the incident. “He was upset about everything, but he views [Quinones’] side, too,” Henson’s wife, Tina, said. “He understands where he’s coming from and will stand up for him.”
After being held hostage by a soldier fed up with a broken system, Henson himself then ran into roadblocks getting mental health care to deal with the trauma he suffered. The runaround exasperated him and his family, showing them firsthand how the system fails soldiers.
“I hated the guy at first,” Tina Henson said of Quinones. “I don’t condone anyone pulling a gun on anybody, but I understand the frustration now.”

If that's not proof that it's broken... The level of ignoring the problem described in the article, I mean, it's not only sad and infuriating, it's also dangerous.

---------

Also re: "right-wing hero worship" (here):

After he was in police custody he revealed plans to assassinate the two presidents, according to the criminal complaint. His FBI and military police interrogators then asked him, “If given the chance, would you kill Presidents Clinton and Obama?” “Yes,” Quinones responded. “On a scale of one to 10 about being serious, I am a 10.”

From the beginning, Quinones has claimed he doesn’t remember anything about the hostage incident because of the alcohol and sleeping pills he ingested. He said he could barely recall what he did in the days before then. His only memories from that morning are of the flashing lights outside the hospital when he was in handcuffs, and snippets of the interrogation. It wasn’t until a day or two later when he regained full alertness in jail that Quinones said he realized something serious had happened and he was told the details... He said he is completely befuddled about the threats against the presidents. That kind of talk is way out of character for him, friends and family said.

Dude claims he was so out of it he doesn't even remember making the threats, so I don't know how much we can deduce about his politics or who he's blaming from this.
posted by flex at 12:15 PM on August 21, 2011 [7 favorites]

if you think it's hard for vets to receive treatment, try getting help as a citizen.

This. If you complain of these troubles as a civilian, you're a pussy and complainer, if a soldier, you get away with damn near anything it seems. Remember the guy who held up a bank to go to prison for health care, and he got demonized? No reason this guy should be able to do similar and be considered a hero. I've fought hard to get insurance, that covers squat, for issues that resulted from what i never volunteered for, and i've never broken a law to get coverage. I've done it legally, voting for people who support health care, spreading the word about how insurance treats the mentally ill, etc.

But hey, i'm sure if i get drugged and drunk, i can hold people hostage and threaten to kill two presidents, and not be tossed in jail... oh wait...
posted by usagizero at 12:47 PM on August 21, 2011 [2 favorites]

If given the chance, would you kill Presidents Clinton and Obama?” “Yes,” Quinones responded. “On a scale of one to 10 about being serious, I am a 10.”

So they asked about those presidents, specifically? Ignoring Bush? Wow, that's interesting. And by interesting, I mean fucked up.
posted by emjaybee at 12:50 PM on August 21, 2011 [9 favorites]

This is pretty common and a direct result of letting insurance companies choose what they cover

That's a great explanation, but how do you explain it away when the US government does exactly the same?

That's pretty common and a direct result of letting insurance companies choose what the US government covers...
posted by vorfeed at 12:56 PM on August 21, 2011 [1 favorite]

This op-ed in the NYT today by the (always conservative and controversy-baiting) Sally Satel addresses treatment vs. disability determination, but it seems like we're not even succeeding at getting guys lined up for either at this point.
posted by availablelight at 1:08 PM on August 21, 2011

We ask so much of our armed forces and yet the system to help them is broken and has been broken for a good while, especially when it comes to mental health issues. I think the military still scoffs at mental health diagnoses, which is why it is insane to put these decisions in the hands of the chain of command rather than doctors.
posted by UseyurBrain at 1:27 PM on August 21, 2011 [2 favorites]

I think the military still scoffs at mental health diagnoses

I think so, too, and find this amazing, depressing, and dangerous. And enraging. A lot of things.
posted by sweetkid at 1:29 PM on August 21, 2011 [2 favorites]

This is pretty common and a direct result of letting insurance companies choose what they cover

That's a great explanation, but how do you exp[lain it away when the US government does exactly the same?

Its not explained away...its par for the course now.
posted by hal_c_on at 1:44 PM on August 21, 2011

In all fairness, it's hardly limited to the military scoffing at mental health diagnoses.
posted by Archelaus at 1:44 PM on August 21, 2011 [1 favorite]

Dude claims he was so out of it he doesn't even remember making the threats, so I don't know how much we can deduce about his politics or who he's blaming from this.

John Hinckley was equally willing to take a shot at Jimmy Carter, so...figuring the motives of nutcases is a losing proposition.
posted by jonmc at 2:16 PM on August 21, 2011

Dude claims he was so out of it he doesn't even remember making the threats, so I don't know how much we can deduce about his politics or who he's blaming from this.

I agree, however this makes me pause (from the CNN report of his arrest):

After he was taken into custody and during interviews, Quinones "expressed his plans, preparation and intentions to kill President Obama and former President Clinton," according to an affidavit filed in federal cour. "Quinones detailed his studies of Secret Service protocols, sniper techniques and means of disguise and weapons concealment to implement his assassination plans."

A search of his residence resulted in the discovery of 11 long guns, four pistols, multiple rounds of ammunition and dozens of bayonets and knives, according to the affidavit.

Authorities also found books and manuals about FBI hostage rescue teams, Osama bin Laden, Oklahoma City bomber Timothy McVeigh, the Russian Mafia and other topics, according to the affidavit signed by FBI and Secret Service agents.

I would guess that any threat he made should have been taken seriously. He was medically discharged from Joint Base Lewis-McChord, which had made the news for their medical discharges, care of people with PTSD, suspicions that people were making up symptoms to extend leave, and refusing people access to WTUs. After an official investigation, Obama nominated, and the Senate approved, a new base commander.
posted by Houstonian at 2:23 PM on August 21, 2011 [1 favorite]

I find myself walking on eggshells as soon as I discover I'm around someone on or off active duty in our military. It's almost like I'm expecting them all to have PTSD. And why shouldn't they? The club they belong to is a meat-grinder that glorifies the brutality they wage and despises the ones who are damaged by it, even when its their own.
posted by fartknocker at 3:03 PM on August 21, 2011 [7 favorites]

I think psychedelics could be a very effective prophylactic for combat induced PTSD if they could be administered, under appropriately structured conditions, to the President, Cabinet and Chiefs of Staff before they got into the damned war.
posted by carping demon at 4:12 PM on August 21, 2011 [7 favorites]

“I hated the guy at first,” Tina Henson said of Quinones. “I don’t condone anyone pulling a gun on anybody, but I understand the frustration now.”

What has her husband been doing for work? Baking cakes?
posted by pompomtom at 4:28 PM on August 21, 2011 [2 favorites]

The Army is a really fucked up culture of picking on, torturing, and drumming out those perceived to be weak or slack. It's not quite like the vids of the Russian paratroopers on youtube, in which every single recruit is brutalized, but it's very close sometimes.

While I don't condone that stuff, I understand why it exists. In some units the pressure and the load are so immense that you just cannot have slack and so it's eliminated using every means available. I don't dig it, but I get it. I've been there.

What I don't get is how a seasoned professional soldier can be denied so many fucking times. Can those dumb fuckers not see the difference between a guy who's trying to play the system for some leave time and a guy who really needs help?

I guess that's the point though, the Army, ha, Army of One?, doesn't really, and never has, cared about individual soldiers.

This would break my heart, but it's already been broken for the many thousands of Vietnam vets, like my Dad, for whom the VA is running down the clock and denying requests until the the vets are terminal and the VA can simply write a check for hospice till death.

I'll shut up now before I start getting all stupid about it sharing vet stories.
posted by snsranch at 4:58 PM on August 21, 2011 [4 favorites]

emjaybee: "If given the chance, would you kill Presidents Clinton and Obama?” “Yes,” Quinones responded. “On a scale of one to 10 about being serious, I am a 10.”

So they asked about those presidents, specifically? Ignoring Bush? Wow, that's interesting. And by interesting, I mean fucked up."

Yeah that's pretty much my line of thinking. Hrmm... :\
posted by symbioid at 5:11 PM on August 21, 2011

The only problem that can exist in interpreting this story is the conflation of facts.

The fact that he was in need of help; and the fact that the military, the government, and, face it-- psychiatry-- failed him, are totally separate to pulling a gun on uninvolved people.

The only way we might get confused is if we believe that his PTSD, or whatever, caused him to take hostages; specifically, that some component of the illness affected his reason to such an extent that it was nearly impossible for him not to take hostages, or, at the very least, not understand what he was doing was wrong. If the article is to be taken as fact, he rationally executed this hostage taking, for a specific purpose, under no defect of reason and under no necessity.

We might understand his behavior in the context of frustration, disenfrachisement, abandonment; we may sympathize, but it doesn't excuse his behavior at all.

Entirely separate from this issue is the larger one about whether PTSD is an aberrant consequence of powerlessness/trauma in war; or if the current style of war doesn't make PTSD the expected, logical consequence. I cite three factors:

1. the absence of clear lines between "soldier" and "civilian" (e.g. coming back to base after killing 50 enemy combatants and within ten seconds logging on to facebook or calling home to hear the spouse complain about the lawn);

2. a command "double bind": assume everyone is the enemy because they may well be; but do not engage them until they prove they are enemy;

3. the superiors' total lack of graduated response to "trauma"-- a binary protocol; i.e. it is either entirely ignored as normal or escalated to Defcon 4 and made into a psychiatric (read: medication) issue.

Any of those three factors alone would be sufficient to increase the expectation of "PTSD" reactions to a traumatic event. The three together guarantee it. The only question policymakers need to ask is whether they will continue to allow this to be a psychiatric illness or will restructure the criteria to require considerably more significant pathology. Which ends up being exactly the same question as: whether they end the wars, or they don't.
posted by TheLastPsychiatrist at 5:15 PM on August 21, 2011 [1 favorite]

A question for The LastPsychiatrist, do you think that there may be a problem with diagnosis and nomenclature? For example, I wasn't able to be treated for PTSD, but when I changed that up to "anxiety disorder" I was able to get meds...paxil and ativan, and counseling.

Forgive me if this is derailing, but it's important if the two different diagnoses are interchangeable and if something as simple as nomenclature or diagnoses are the difference between being treated or not. I'm considering both military and civilians.
posted by snsranch at 5:39 PM on August 21, 2011

Well of course the Army is trying to cover up the problems of broken men coming back. It's the worst part of war, IMHO. Sure we can count the dead bodies on both sides. Their tortures are over. But we've turned a generation of our own people into haunted souls, with no peace this side of the grave. Our country is at war with itself.
posted by charlie don't surf at 6:26 PM on August 21, 2011

I can't help but hear that dark little voice in the back of my head cheering this guy on. Unfortunately, the bureaucracy of mental health care suck. After fighting for my medications to be covered, almost monthly, and sometimes for up to a week, I have had fantasies of hostage situations and explosions.

I don't think I'd ever actually *do* anything with those fantasies, however, I'm not a trained war vet. I don't have the same instincts, training, or fight-or-flight responses. I'm lucky to have a decent support system and have only been dealing with this bureaucracy for a year. I can only imagine how crazy it would drive me to be denied my meds.. yet again.. and have to continue fighting, every month or two... a few years in the future. Hopefully, I'll have a job and "real" medical coverage soon, but the diagnoses may prevent that anyway.
posted by MuChao at 7:34 PM on August 21, 2011

jonmc, Hinckley gunned down Reagan, not Carter - unless you're living in some kind of alternate universe, one where the Dictators score Spielberg movies and Playboy bunnies still look look they did in 1978.

If so, you mind telling me where the wormhole is? I think I could learn to deal with the Dictators thing.
posted by item at 7:56 PM on August 21, 2011

“I guess that’s the only thing I can think of,” he said. “ ‘I’m going to get this help and whether you want to help me or not, you’re going to help me.’ ”

This is what happens with a system that breaks a person down as an individual and reassembles them as a weapon, and then doesn't bother to do the reverse once it's time for the weapon to be a person again.

It's heartbreaking. And it's sick.
posted by cmyk at 9:59 PM on August 21, 2011 [5 favorites]

jonmc, Hinckley gunned down Reagan, not Carter - unless you're living in some kind of alternate universe, one where the Dictators score Spielberg movies and Playboy bunnies still look look they did in 1978.

item, I know. According to most accounts I've read, he hatched his plan to assassinate a president when Carter was in office. He wanted kill a president, he care which one.

one where the Dictators score Spielberg movies

Speilberg movies? I dunno, although I could oddly see "The Next Big Thing" in a pixar flick.
posted by jonmc at 6:31 AM on August 22, 2011

Huh, I never knew that about Hinckley. I need to read up on the man. I spend too much time on Lee Oswald, and since I've moved to his old neighborhood it's gotten a little out of hand.

The rooming house he lived in at the time of the shootings is still a rooming house, owned by the same family. I'm tempted to get a room there, though my girlfriend has said that it might not be too great for our relationship. End of derail.
posted by item at 8:45 AM on August 22, 2011

I find myself walking on eggshells as soon as I discover I'm around someone on or off active duty in our military. It's almost like I'm expecting them all to have PTSD. And why shouldn't they? The club they belong to is a meat-grinder that glorifies the brutality they wage and despises the ones who are damaged by it, even when its their own.

That's funny! Because I find myself walking on eggshells when civilians find out I was in the military, lest they assume all sorts of shit about me and what I'm like because I served in Iraq and Afghanistan.
posted by lullaby at 11:16 AM on August 22, 2011 [2 favorites]

Sgt. Q
What are the odds?
That's funny! Because I find myself walking on eggshells when civilians find out I was in the military

In Soviet Russia!... oh, wait, they just kill you. Yeah. Same thing really.
Here they kill you from the inside.

The dance with the military/VA and social response to PTSD in U.S. society is Kafkaesque. It's almost like AIDS was in the 80s, there's this heavy moral facet attached to it.

Military: "Just ask for help."
SM: "Ok, help me"
M:"No, sissy."
SM:"Uh, what? Seriously I need help."
M:"No, fuck off."
SM:"Well fuck you!"
M: "Hey, hey there, why so defensive?"
Civilian: "Ahh! He's crazy dangerous!"
M: "Weak too."
Both: "Isolate him!"
SM: "Man, I feel isolated."
Both: "Aah! He's crazy!"

Think about why PTSD is so prevalent in U.S. combat troops vs. other countries.
For one there's not this schizophrenic attitude towards returning vets (oh, historically there's always been tension, but it's not this "I love you/I'm afraid of you/fuck off and die" maniac response that seems unique in U.S. society)

The nature of the responses both hero worship and seeing vets as victims and/or warmongers naturally isolates an individual by placing them away from society rather than as part of it (whether elevated or lowered depending on the support for the war). So reintegration almost never happens.

Karen Seal (et.al.) wrote something in the Journal of Public Health a year or so ago about breaking the stigma associated with combat related stress.

Neil Greenberg (Academic Centre for Defence Mental Health at King's College London) wrote this year that rates of PTSD among British troops was 4 percent whereas in American troops it was upwards of 30 percent.
So, yeah, more.

Interestingly though Greenberg (et.al) reported more alcohol abuse and other mental disorders such as depression among British troops.
So what's that? Not PTSD?

The VA seems to have a "walk it off" attitude towards having some issues, until they completely explode.
Quinones' case is a logical response to the broken system. "I don't feel well" "You're fine" "It's getting worse" "You're fine" "It's vastly worse" "You're fine. Here, have lots of medication. But stay off 'drugs.'" "I don't want drugs." "Medication. And they seem to solve all of OUR problems. But you're fine." "I'm not fine and I'll take hostages to prove it" "Oh, ok, you're not fine. Perhaps you'll feel better in jail."

The big Magilla though (wherever cultural expectations lay) is multiple deployments. Nothing says you're an "Army of one" like no one else showing up to relieve you. And there again, you're an "army of one" so you're a big hero, with all the weight that expectation carries.

And socially, we don't seem to feel any responsibility to participate in large scale collective social endeavors (perhaps by design. Post 9/11 "Anything we can do to help? Want some blood? Anything?" "Go shopping.")
Whether a given war is justified or not (lots of people against genocide, want to lay odds on how many people would volunteer to go overseas to stop one?) or even the military itself aside.
Most of the movements in the U.S. are small minorities of very dedicated people. For good or ill. Most people can't be bothered to vote (although again, I'm sympathetic to the idea that this is by design).

And too, Greenberg (if I remember correctly, it was the British Medical Journal) doesn't take into account the deployment differences, e.g. no deployment longer than 12 months in 36 for British troops. Whereas U.S. troops get 12 on 12 off, the numbers of deployments differ as do being put in combat.
Also, once out, after 6 months British troops aren't part of the military health care system, so the data there might be skewed.
And troops in the U.S. who are marked as unsuitable to return to combat - might be a good idea to, y'know, not send them back again and again.

And perhaps that's where the social response creates the environment in which this occurs. The attitude that one can disavow war or something one disapproves of by demonizing a segment of society and/or one can promote war (enhancing one's own heroism perhaps) or something one approves of by deifying a segment of society.

The result is the same, isolation and a refusal to acknowledge the genuine reality that segment represents while forcing them to repeat the role/identity in which they're cast.

Habituation to a war environment becomes magnified because of the expectation to be a representative (for good or ill or whatever) of that environment.
posted by Smedleyman at 2:35 PM on August 22, 2011 [1 favorite]

Facing Ninth Deployment, Army Ranger Kills Himself. 'No Way' That God Would Forgive Him For What He'd Seen, Done, He Told Wife

Army Ranger's Widow Dragged Out Of Book Signing After Confronting Rumsfeld
posted by homunculus at 3:24 PM on August 29, 2011

California, Others Cut Veterans Courts From Budget
posted by homunculus at 7:33 PM on September 1, 2011