Mental Health Inc

by Art Levine

  The VA continued treatment as usual, even after the public finally took some notice a few years later in Phoenix and Tomah. In stark contrast, a radically different approach was emerging under the direction of a former Navy psychologist in rural Maryland which avoided psychiatric medications for veterans with PTSD altogether, challenging everything the VA had done for years.

  CHAPTER 8

  Drug-Free PTSD Recovery

  BY THE TIME NAVY VETERAN PAUL WALTON PLANNED TO SHOOT HIMSELF in the spring of 2012, he could see no way out. A Maryland-based electronics specialist who had worked on anti-submarine aircraft, he was in a stupefied haze, feeling lost and broken from the thirteen different opiates and psychiatric medications he’d been taking, in part because of a series of back injuries that led to a medical discharge from the Navy in 2006. That was then followed by the stresses of working for years as a military contractor, sometimes in combat zones, culminating in a breakdown during his last tour in Afghanistan in 2011 that caused Walton to be shipped back home. Yet the roots of his emotional agony and PTSD went back twenty years, long before clinicians in the military, VA or civilian world finally diagnosed his psychological traumas.

  Fate saved Walton’s life, in the form of Dr. Mary Neal Vieten, a Navy veteran and innovative psychologist who rejects both psychiatric medications and the medical model for wartime-caused stress disorders. As part of her tough-minded but empathetic psychotherapy offered on a sliding scale or for free, Vieten brings an alternative perspective on PTSD, along with practical stress-reduction techniques that allow veterans to truly recover without drugs. Her private therapy work has been supplemented by the week-long rehabilitation retreats she and a Maryland nonprofit disabilities organization, Melwood, offered at no cost to “warriors” from around the country about six times a year.

  “Rather than serving their legitimate needs when they come back, we give them medications. I’ve spent my career taking them off drugs,” she says. “People do not deploy to the theater of operations fit for full duty and then return mentally ill. It absolutely defies logic that they would leave sane and come back insane. They come back traumatized, and this is not mental illness. This is normal.”

  Even with her reframing of PTSD as “operational stress,” veterans such as Walton still endure a lot of suffering. Well before he was shaken to his core by his wartime experiences and a bitter custody battle with his third ex-wife over custody of his son, he was haunted by his guilt over the rape and murder of a female subordinate while he was stationed in Guam in the early 1990s. She was a troubled young woman who was fouling up at work, and he was charged with improving her conduct and performance. She made steady progress under his direction, but on a night when they were supposed to have a friendly meal to celebrate her improvements, he got into a fight and didn’t show up in time to meet her. Somehow, she ended up being fatally attacked on that same night, and he never forgave himself.

  “My thought process going forward was that she was dead because of me,” he says now. “I took all the blame on myself.” The guilt unleashed turmoil that ravished him emotionally and physically, leaving him anxious, sleepless and angry, ready to fight anyone who got in his way—but he was too worried about wrecking his career to confide in anyone. It was especially risky to speak to a therapist in a military culture that too often scorns and drums out of the service many of those who seek help. He turned his anger inward by seeking out the most back-breaking physical labor he could find to punish himself—an environment, Walton now realizes, that injured him and left him dependent on opiates.

  The VA’s approach to Walton’s treatment only heightened his fears to the point of despair, and ultimately led him to a church early one evening in the spring of 2012—where he planned to make his peace with God and then go home to shoot himself. There, he stumbled into a support group of churchgoers that included Robert Nielsen, an ex-veteran who had kept his eye on Walton the whole time. “I immediately connected with him,” Nielsen recalls. “Without us saying a word, I could tell this man was hurting. And he had this military persona about him.”

  “Are you a veteran?” Nielsen asked him during a break. Walton confirmed it, and Nielsen said, “Dude, I can tell from the outside looking in, you’re going through some major stuff. You’ve got PTSD. I do too, and I understand what you’re going through. You’ve got to promise me you’ll give this doctor a call. She’s like no other doctor or therapist I’ve seen,” he said—and demanded a firm vow, veteran to veteran, that he’d meet with her before he did anything else.

  Walton called Vieten the next morning, and she made time to see him that day. Though overmedicated, he somehow drove himself over to her office. Even when he arrived, he was so woozy that he couldn’t even come through the door at first, bouncing instead against both sides of the doorframe before stumbling into a chair to face her. She built his confidence in her therapy by citing her credentials and military service—and then cursing freely. “She cussed, she talked like a sailor, which made me feel really good because that’s who I am: a sailor,” he recalls. And he was especially impressed by her no-nonsense approach to the initial therapist questioning he had endured so many times before.

  “How much drinking do you do?” she asked. “I’m not going to be naive: I already know you drink, so ’fess up.” She was, he thought, really in his face—and, surprisingly, he welcomed it. Most critically, he recalls, “She gave me a reason to want to go back; she doesn’t believe in all the medication.” Ultimately, even with serious back pain, he eventually stopped taking almost all his meds, exercised more, halted his drinking and went back to college for electrical engineering, encouraged both by her and his peers in a support group she established.

  He did all that in large part so he could be a better father for his son. “She kept me focused on my son; she put the carrot before the horse. She knew that was my hot button, being a good father. He’s twelve now, and a lot of his being in my life is due to therapy,” he says, his voice choking up briefly before he can continue. “I would not have my kid if it wasn’t for Vieten,” he declares.

  After sessions with Vieten, Walton became a new man, learning how to confront his disabling anxieties. “I learned to recognize the onset of a panic attack and learned to meditate,” he says. Still, with his years of addictions and stress not so far behind him, “Every day is a struggle,” he says, but at least he now has new coping skills. Under Vieten’s tutelage, he not only rid himself of his addictions, but educated his son about his condition by passing along a book for kids on dealing with a parent with PTSD, which Vieten had recommended. That made a huge difference in Walton’s relationship with his son.

  Walton reinforced his progress and new way of life by joining “Operation: Tohidu,” the groundbreaking program launched by Vieten in 2014 at the 108-acre Melwood nonprofit retreat in southern Maryland. “Tohidu” is a Cherokee name for peace of mind, body and spirit. A quarterly, intensive ninety-eight-hour experience, the program has several vital elements that work together. It not only involves reawakening the camaraderie of military life through such outdoor challenges as high ropes balancing, horseback riding and wall climbing (all of which help these wounded warriors relax and trust each other), but includes frank group discussions and in-depth education about the root causes of their PTSD symptoms as a normal adaptation to war; this is supplemented with education about the hidden dangers of the medications they’ve been prescribed. “We actually have the veterans over the week live the wellness model,” Vieten says. “We want the veterans to select those things that will work for them and fit into their ambitions of going back to work.” Equally important, “We educate veterans on operational stress, the dangers of pharmacology and what they can do in place of pharmacology, and empower them to change their lives.”

  (After running eleven sessions aiding 250 veterans through May 2016 under the sponsorship of the Melwood disability organization, she left to form a new nonprofit, the Warfighter Advance, focused solely on vet
erans and active-duty military. It runs essentially the same program eight times a year, now called “The Advance 7-Day Training Op,” at another campground near Melwood.)

  For Walton, among the most exhilarating and daunting of the “experiential exercises” involved navigating on ropes between trees. Soldiers are also asked to traverse beams of wood suspended high above the ground between two poles, protected with harnesses as teammates on the ground keep the beams level by adjusting wires. As Melwood recreational program director Dora Fleisher noted, “Our idea is that if we take someone, and we get their body and mind in motion at the same time, we start to notice trends in the way we think, the way we react, and the way we problem-solve and communicate when we’re under stress.”

  Former Army specialist Scott Barber was one of the participants seeking a new balance in his life while balancing himself during the exercises. Just a few years earlier, his heart stopped and he flatlined from all the medications, including Seroquel, that he was taking under a VA doctor’s orders. When I visited the program in the winter of 2015, Barber had taken a new direction in his life after seeing Vieten, and now was starting his walk across a cable just six inches off the ground between the tall fir trees. As he alternated grabbing high and low ropes between the two trees, he was surrounded by group members who pressed their hands against him to help him steady himself. The ropes started out high, then became lower, then rose up again as Barber reached the end, a living metaphor for his military experiences. As Fleisher pointed out, “When they are up high, we ask them to consider: ‘What was the high point of your military career?’ As the guys are walking across the cable, they’re saying it: ‘It’s when I got that award,’ or ‘When I was kicking in doors and calling in helicopters.’ As you’re walking, the rope starts to get low and we ask them to consider what are some of the low moments,” and some cite the loss of fellow soldiers or a sense of isolation when they returned.

  “Then the rope starts to get up high up again and we talk about what are the things that are going to bring you back up,” Fleisher observed, such as family or faith. Two days later, they did the same exercise, but on a high ropes course way above the ground, and there weren’t any spotters to keep their balance as Barber, wearing a helmet and dark winter jacket, as well as the others, made their way across the ropes to a tree with a platform. He finished by sliding a zip line, exultantly, back down to the snow-covered ground.

  “The idea is to remember that when you’re low, you’re going to get high again,” Fleisher, beaming with enthusiasm, pointed out about the ropes courses.

  Later, wearing a green Melwood-issued Operation: Tohidu sweatshirt with his military rank on it, the thirty-seven-year-old SPC Barber, a formidable presence with his close-cropped hair and piercing blue eyes, declared, “The experiential learning is unbelievable. It gets everyone working together, gets you out of your own head, it really focuses you.”

  He’s glad he is still alive to focus on anything at all. After four tours of duty in Iraq ending in 2009, the hyper-alertness that served him well in battle transmuted into nightmares, sleeplessness and a paranoid vigilance that makes any trash or item on an American roadside seem like a potential IED. “They train us to be soldiers on high alert 24/7, deployed for years and years, and we’re warriors, then after that they ask us to reintegrate into the civilian population,” he notes. When he said he was depressed and anxious, starting with the Army and then the VA, “They gave me a goody bag of drugs”: tranquilizers, sleeping pills, Depakote, then Seroquel. “I felt like a guinea pig.”

  With diagnoses varying from bipolar disorder to PTSD, he was still following his doctor’s orders on a Christmas Eve in 2012. He was playing Pictionary with his family when he went up to the board to draw an image and his sister suddenly noticed that his clear blue eyes had turned black—and he was bleeding out of his nose. Then he fell unconscious. The next thing he knew, paramedics were leaning over him in the ambulance and saying, “Stay with us, buddy,” and applying defibrillator pads to shock his heart awake. At the local hospital where he recovered for a week, the doctor reviewing his medications declared them a “recipe for death.” But after he returned to the VA, they kept sending him drugs without changing their treatment plan after he nearly died. He tried tapering off on his own, but could still barely function even on relatively lower levels of meds.

  Then he learned about Dr. Mary Neal Vieten.

  Like Walton and Barber, most of Vieten’s patients have failed elsewhere and come weaving into her office in a psychotropic-fogged haze. Many active-duty soldiers she sees keep their treatment secret from commanders so they won’t be stigmatized as “nutcases” unfit for military careers, while some other veterans go through the motions of seeing conventional drug-oriented doctors and the ill-trained therapists at the VA in order to keep their benefits—while seeing her on the side so they can make a real recovery.

  After joining the Navy as a Ph.D. psychologist in the late 1990s, she says, “When I started in the military, I had total buy-in to the medical model and the medical response to post-traumatic stress.” She eventually transferred to the Naval Reserve in 2008 as a commander, and opened a private practice, though she could still be deployed. But realizing what worked for her in helping her deal with her own stressful postings, and after treating thousands of soldiers, sailors and veterans in a nearly twenty-year career, she now says, “I’ve come to realize that the medical model for treating trauma and for treating post-deployment issues and operational stress issues is just not valid. I haven’t given a medication referral in over ten years.”

  Vieten first developed the model for the Tohidu program in 2003 when she was chief psychologist at a naval hospital in Puerto Rico, and needed to assist a small medical clinic at a nearby army base, Fort Buchanan, swamped by returning soldiers with assorted psychological damage, twenty-one of them with full-blown PTSD in need of immediate treatment. Using a military taps-to-reveille structure, the week-long program combined well-known, non-medication approaches to stress, wellness and recovery. In a 2004 paper in Navy Medicine, Vieten and her co-authors (which included Navy medic Paul Quilado, who eventually partnered with Vieten in establishing Tohidu) reported that the twenty-one enrollees saw a 20 percent reduction in symptoms in just seven days’ time.

  Though the Tohidu model—now The Advance—hasn’t been replicated in studies by the military or VA so far, her Warfighter organization is in talks with two major research universities to formally measure outcomes. Early signs are very promising: Out of all the active-duty service members enrolled in the retreats—about 20 percent of those served by the program—fully 100 percent of them, virtually all on their way to being mustered out of the military because of their severe PTSD, have returned to active duty, with many going back to war zones. “They realized they weren’t mentally ill and could work with their operational stress without needing medication,” she says.

  Vieten’s approach to treatment earlier proved itself successful in a top-secret prison posting overseas in 2008 during the Iraq war. There, she slashed the forced psychiatric discharges of her mentally ill and PTSD-suffering guard patients to zero, returning them to full duty and winning a Navy commendation for her accomplishments. “I ‘normalized’ and supported them and was very pro-active on prevention,” she says. She helped them to understand that they were in a “crazy” environment that stressed them out, while offering, in response, caring therapy and instruction in coping skills—and she also reduced stigma by employing roving psych techs who casually counseled patients while handing out snacks to them while they were on duty. All that was in sharp contrast to her predecessor, who declared all the patients mentally ill and plied them with huge amounts of meds, then kicked them out of the military and let them fend for themselves as civilians navigating the VA maze.

  Vieten doesn’t believe she has a secret recipe for her successes. Instead, she sees herself as a psychotherapist in the tradition of Carl Rogers, whose humanistic, “person-cente
red” approach emphasizes “genuineness,” joined with unconditional empathy and support that builds a true rapport between patient and therapist. Such rapport is a critical ingredient in any therapeutic improvement, almost regardless of the technique used, as confirmed by such researchers as University of Scranton psychology professor John Norcross. Vieten is just applying what good therapists should be doing, but in the culture of poorly-trained, unaccountable and swamped VA clinicians, such compassionate, individualized care is rare, worsened by the obstacle course facing veterans seeking access to treatment. “It’s cheaper for the government to pay for a casket than treatment,” she points out.

  For Army Reserve Staff Sergeant Jacob Towner, a friend of Andrew White who saw him deteriorate and die under the VA’s medication assault, two visits to the Operation: Tohidu retreats helped him grapple with his own stresses that were driving him to drink and isolating him from his family. He learned relaxation skills from yoga to breathing exercises that help steady him. The thirty-three-year-old Towner also says, “I never clicked with the people in AA, but Tohidu creates a place of so much more transparency and honesty with people who cared about you.” In one group sharing exercise that encouraged frankness by having people switch seats, “I opened up to everyone in the circle.” He left to call his wife in tears: “I was so relieved to get that weight off my chest: the brothers and sisters I lost in my war experience, and the loss of people after PTSD and medications,” among other traumas.