I finally did it! After eleven long years, I finally attended a fireworks display with my kids! Guess what?! I survived not only the fireworks, but navigating the crowds with three little ones…by myself!
All in all, I actually enjoyed myself! The girls were able to play on the bouncy houses, get their face painted, and even stood in line for patriotically over-priced snow cones! The girls were able to get those twisted balloon things that end up being made into all kinds of things (one had an alien that rode on her shoulders, one had a sword, and one had a flower). Granted, none of the balloon characters made it home, but they were free, so I wasn’t terribly heart broken (especially since I’m allergic to the stupid things).
I had originally decided to attend because my teen invited me. I figured with her there, I’d be able to get through the fireworks. Well, she went AWOL with her friends and I only saw her once the entire evening. Thankfully, my best friend and her family showed up just minutes before the show started. Between her and Chauncey, they got me through. I purposely sat far enough away that I couldn’t hear them launching, and I enjoyed all but the absolutely largest shells. Those were the ones that I could feel the repercussion of their explosion in my chest and that would trigger me, but as I said, my service dog Chauncey (who did amazingly well with the fireworks) and my best friend saw me through.
I definitely think we will do it again next year. Perhaps I will be able to convince a couple of my fellow veterans to attend with me. Just showing up was a huge step for me and I hope I can share that with others next year.
Moral of this story: don’t be afraid to face your fears…you may be pleasantly surprised at the results. If they aren’t what you expected them to be, you will at least know that you tried. Perform an after action and see if there is anything you could do differently next time to improve the outcome!
Recently, I read “Neurobiology of PTSD” from Psychiatric Times (March 1, 2008) by John Medina, PhD. Below is a review (of sorts) of this article:
The search for a biological basis of Post-Traumatic Stress Disorder (PTSD), the study for the root cause is still relatively in its infancy. Psychologists are looking at the question of Nature vs. Nurture for a potential source.
There have been studies regarding whether PTSD can be explained by pre-existing conditions, thereby making it an issue of Nature (genetics) using monozygotic twins. Both showed an “alteration in hippocampal volume and morphology”. Though only one was exposed to “intensely stressful events (combat)”. Was this a pre-existing condition (nature) or a physiological change due to the stressor (nurture)?
This line of inquiry led researchers to look beyond the average member of the group and compared to the population distributions. Instead they began to focus on those animals that were at the opposite ends of the population spectrum. They began to study those who were appearing to recover much more quickly than the population from ‘fear extinction experiments’ and compared them to those at the opposite end of the distributions, the overly-reactive population. In doing so, scientists were able to identify two phenotypes within the overly-reactive population. These phenotypes are currently being researched in animals.
Some researchers are focusing on “certain regions of the mammalian genome [consisting] of short, repeated, noncoding sequences called VNTR’s (Variable Number Terminal Repeat), attempting to identify whether these variations could hold the key to how PTSD could be inherited through chromosomal sequences. One study found a VNTR variant in patients who experienced PTSD. Other studies have looked for associations between gene mutations in the glucocorticoid receptor and PTSD, others have focused serotonin receptors.
There are also arguments about how much ‘nurture’ plays a role in the development of PTSD after a traumatic event. There are questions of whether the physiological changes that have been demonstrated with PTSD are epigenetic or hereditary. Are they a physiological reaction to trauma or a pre-existing genetic mutation that predisposes a person to develop PTSD? Epigenetic studies have explored how much nuture effects development of the ability to regulate stress. Researchers have shown that environmental influences can cause “permanent alterations in hippocampal glucocorticoid receptor expression and subsequent hypothalamic-pituitary-adrenal axis”. This issue is currently the source of intensive research.
Not all studies are in agreement, however. There are theories of “methylation” and its molecular effects on genes. Hippocampal volume has also been studies; however, it is known to be able to change “as a result of environmental exposure, duration of certain illness, and even the age of the subject:. Also, it has been shown that hippocampal volume changes are not consistently shown in all age groups. While it can be present in younger patients, it is not generally associated with older patients.
Is PTSD genetic or environmental? Could it be both? The studies, while in their infancy, don’t seem to universally come to a singular answer. How do twins both show physiological changes with PTSD, though only one was exposed to trauma? That would be ‘nature’. Yet, how is it that who people can experience the same trauma but only one goes on to develop PTSD? From the things I have read, I am beginning to believe it is both. There has to be some genetic element to cause the physiological changes that have been documented to occur with PTSD. Yet, you cannot discount the influence of ‘nature’. Individuals who experience multiple traumas throughout their lives are more likely to develop PTSD than those whose lives were sheltered from trauma. Having personally experienced multiple traumas, I developed PTSD. Others who deploed with me, who experienced the same elements of combat but did not have the previous lifetime traumas, did not develop PTSD. Yet, for how little I experienced in compareson to other combat veteran, how did I develop PTSD, when others who experienced much worse and emerged apparently unscathed?
There have been many studies related to memory issues related to Post Traumatic Stress Disorder. This particular study, a literature review by Kirstin W. Samuelson entitled: “Post-traumatic stress disorder and declarative memory functioning: a review” looks at the association between “everyday memory problems with emotionally neutral material”.
Studies have shown that many PTSD patients complain of memory problems, aside from those symptoms that are part of the diagnostic criteria (intrusive thoughts, difficulty remembering parts of the trauma, etc.). This study focuses on declarative memory – that is memories that can be consciously recalled, like facts and knowledge. This type of memory can be broken down into two aspects: semantic memory which stores factual information and episodic memory which includes specific personal experiences.
The author notes “It should be emphasized that overall, decrements in memory performance due to PTSD are subtle, […] still, the findings are clinically meaningful when they represent a change in functioning before and after trauma”. She goes on to say that “the pattern of memory deficits reveal that PTSD most significantly impacts the initial acquisition and learning phases of memory, as opposed to the retention phase”.
In plain English this is a great big “duh!” to those of us with PTSD. We deal with this every day. We forget the simple things, we give up on school because learning seems so much harder than it used to be before…before our world changed. Things that once seemed a piece of cake are now complicated and hard to remember.
We’ve been busy… Chauncey and I just finished our Associates Degree and now we’re taking the summer off to recharged for university this fall! Its amazing to me…other than military schools, I have never had the pomp and circumstance commencement thing.
I will readily admit that I over did it this semester. I took 18 credit hours trying to get my degree finished. This was on top of my other life responsibilities like parenting four children and taking care of a household…and Toastmasters, of course. By the end of the semester, I had to stop attending Toastmasters to focus on my classes and everything else suffered too. Unfortunately, when you have PTSD multi-tasking becomes a lot more challenging. Remembering what is due, when, in which class, which kid has a parent-teacher meeting, take out something for dinner, write a speech, write a paper, read… yea right! I had myself so overwhelmed that I was forgetting assignments and I couldn’t read more than a paragraph at a time without forgetting everything I had just read. Needless to say, we will NOT be doing that again!
Now that we are finished with this semester, Chauncey and I are trying to regroup, recharge, and redeploy to our next mission. I am looking forward to relaxing, reading something because I *want* to, and reconnecting with my Toastmasters friends (something that I really do find relaxing, oddly enough). I will be refocusing this summer and sharing some of the research I’ve done over this last semester regarding PTSD’s physiological and psychological effects.
Its amazing how much something as simple as a little tassel can mean. When you go from being terrified to interact with another human outside your house to earning a degree at age…well…we’ll just say I was one of the more mature students!
Stay tuned! I’ll be sharing lost of information very soon!
By the way…we graduated Cum Laude!
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I am a 40 year old mother, wife, and disabled veteran of the US Army. It has taken me a long time to get to the point where I could share this story. This may be triggering for some, and I apologize, but it is something I need to get out of my head.
I was a medic in the Army, as such, while I never had to pull the trigger; I had to see the aftermath of war. It didn’t matter what side they were on out there…once they came through the doors of our hospital, we had to treat them all the same. It didn’t matter whether they were combatants, innocent bystanders or children who were caught in the crossfire, when they came through our doors, they were a patient. Period. It’s the children who stay with me. I can still see their sweet faces, along with all the medical accoutrements that were needed for their individual medical needs. They have never aged. In my mind they are still the same now as they were then…sweet, innocent, and in need of our help. For all the varying opinions of what we were doing in Iraq and why, the one thing I can say is that I made a positive difference. I did my best to harm none and other than one altercation (with another soldier), I never laid an angry hand on another person.
I have friendships that have lasted till this very day. We have become sisters. We have been through so much together and have helped each other become stronger in the process. They are the reason that I will never regret my service. It is the hardest thing I have ever done, the one accomplishment of which I am the most proud….but the one thing I will never do again (even if I were physically able).
The reason I would never serve again is simple…the culture which permeates throughout the entire military complex is one in which women are objects. If we are lucky, we are seen as “one of the guys”. We are told from day one that we are not “females”, we are “Soldiers/Marines/etc.”. This should have been my first clue, but I was too proud that I was continuing the family tradition of service. During my first enlistment, I had an NCO who would verbally berate me, wrote me up for the slightest infraction, and literally made my life hell. Within thirty minutes of arriving to work, this man would have me in tears. One day, I finally worked up the courage (or was pissed off enough) to ask him outright, “Why do you hate me so much?” His reply was “Because you’re a female in that uniform!”. Needless to say, as soon as that day’s ass-chewing was over, I asked to take a break and instead of getting something to eat, I went straight to the Chief Wardmaster’s office and told them everything that had been happening. He was immediately escorted from the ward and received a 72 hour psych discharge. I had incidents with other male NCO’s but none as severe as this and all were seemingly karmic-ly returned to the perpetrator.
Unfortunately, my commander in the National Guard who was a problem as well. At first he was a little too friendly…when the level of friendliness was not reciprocated, his demeanor changed. By the time it was all said and done, I had the sworn statements of my entire squad, platoon sergeant, and several other members of my platoon stating that the commander had been singling me out for punitive reasons. I took all of these to the Battalion Commander. Since this was a very new unit, I was (in my opinion) nice enough to ask for an Honorable Discharge from the National Guard in exchange for not pressing Sexual Harassment charges against him. It was granted.
After 9/11, I reenlisted in the US Army. I was stationed at Ft. Campbell, Ky. in the 86th Combat Support Hospital. Four months after I went back to active duty I was sexually assaulted by another NCO (not in my unit). I had met him online and had talked for several months. During an ice storm, he had even crashed in my barracks room and was a PERFECT gentleman (he even folded up his blankets after sleeping on the floor and left without waking me up). The night of the assault (Friday), I had been the designated driver for some new members of the unit. I ran into him at the club and he was obviously intoxicated. After ensuring that he was not driving, he said he had nowhere to crash. I told him if he couldn’t find anywhere safe to stay, he was welcome to crash in my room again. Thinking he would be the same gentleman who I had helped before, I foolishly left my door unlocked.
I was still recovering from a pretty bad case of bronchitis and had taken some medication with Codine and fallen asleep. When I awoke, he was on top of me. Every time I protested, he would bite me. Eventually, he pinned my arms above my head with the pillow over my face. I was too petrified to scream anyway. I did not want everyone else in the barracks to know what was happening to me. I was ashamed and mortified. I don’t remember most of the rape. I do remember that when he was finished, he rolled over and fell asleep. I don’t know how long it was before I attempted to move. I was terrified. Eventually I was able to get out of my bed, but instead of going and telling someone, or simply calling the police myself, I fell asleep in the corner of my room on the floor.
On Monday I tried to go to work, teaching a combat lifesavers course. I couldn’t concentrate on what I was doing; I couldn’t focus on the material I had known like the back of my hand. At lunch, I told one of the other soldiers that I was going to go talk to our platoon sergeant. He could tell something was terribly wrong, and eventually I told him I was raped. My platoon sergeant was a good man who always had my best interests in mind…the real definition of a leader. By regulations, he had to report the assault. I spent the next several hours at the ER and then at the CID office being interrogated. Yes, interrogated…as if I were the one who did something wrong. The next day, I was brought back to the CID offices and interrogated again. By the time it was all said and done, it was beyond obvious that they were not going to prosecute my rapist. Exhausted, exasperated, and defeated I uttered the words that I knew would make the interrogations end. I told them “Fine, he didn’t rape me. Can I go home now?” I was allowed to go. I was so humiliated that I couldn’t even look my platoon sergeant in the face. The way I was treated by the CID agents (male and female) made me feel far worse than my rapist
The next day my unit informed me that I was to report to JAG…CID wanted me prosecuted for attempting to make a “false sworn statement”. Thankfully, the JAG lawyer listened to my story and was immediately swayed to not only choose not to pursue charges against me, but to fight on my behalf. She was a bull dog! She went up her chain of command, which then went DOWN the CID chain of command. The soldier who raped me said it was consensual…but he was married. JAG wanted him charged with adultery (there are still regulations against adultery in the Uniform Code of Military Justice). However, CID and his unit did nothing. He wasn’t punished in any way. Needless to say, it shattered my faith in the military justice system. I tried attending the rape survivors group on base. Of the seven other women there, six were assaulted on base and every single one of them had the same exact experience with CID. None of our attackers were prosecuted.
I have since been through countless hours of “therapy”, numerous medications, diagnosed with PTSD, and now have a service dog. I have recently returned to college and I’m slowly gaining my life back, though it will never be the same. I still distrust authority, being questioned by them causes immediate flashbacks, and I still have intimacy issues. I am working on them, as best as I can.
Someday, I’ll share more about my life…but for now…this is something I’ve never shared publically. This is my fight against PTSD. Getting it out of my head and productively written out is a step for me. I am still proud to have served in the United States Army; I know I did good things that changed lives, even if I will never know the full outcome of those changes. But I will never forgive those in power who prey on the victims while rapists walk free in their ranks.
In a nation who has been at war for more than a decade, the rate of service members diagnosed with Post-Traumatic Stress Disorder (PTSD), Traumatic Brain Injury (TBI), and the frequency of suicide, has radically risen. The backlog of veterans waiting to receive benefits has also dramatically increased. This is leading to longer waiting times for diagnosis and treatment. To date, no authority seems able to find a viable and expedient solution to any of these problems. Yet, nationwide, some veterans are finding a solution. They have discovered the healing power of a service dog. While this is not a cure for PTSD or TBI, it is extremely beneficial to those who have chosen to utilize this tool in their recovery.
Since the attacks on the World Trade Center and the Pentagon on September 11th, 2001, the United States has been at war. To date, approximately 1.64 million (Rand) U.S. service members have deployed in support of Operations Enduring Freedom (OEF, Afghanistan) and Iraqi Freedom (OIF, Iraq), many have deployed multiple times. Of the nearly 60,000 U.S. casualties, 6,778 have lost their lives (iCasualties.org). This means approximately 50,000 have returned home with injuries from minor to catastrophic. Many of these casualties would not have survived in previous wars but thanks to better protective equipment, medical advances, and the ability to rapidly evacuate the injured to medical facilities both in country as well as in Europe and the United States, service members are routinely surviving wounds that would have formerly been fatal. This decrease in fatalities is leading to an increase in veterans returning with traumatic amputations of one or more limbs, TBI’s, and PTSD seeking compensation and treatment through the Veterans Administration.
PTSD and Traumatic Brain Injury (TBI) have been called the signature wound of the War on Terror. “Although these invisible wounds would appear less severe than the amputations inflicted by the IEDs, they affect many more service members and can have as much impact on the casualty’s future as the loss of limbs” (Kreisher). According to a recent report, nearly 30% of OEF and OIF veterans are being diagnosed with PTSD (Reno). Compare this number to The National Center for PTSD which has “estimated the lifetime prevalence of PTSD among adult Americans to be 6.8%” (Gradus). Part of this massive difference is likely due in part to many service members serving multiple combat tours in their careers.
PTSD is a condition that has been around since the invention of war. It has been called many names: Nostalgia, Homesickness, Soldier’s Heart, Neurasthenia, Shell Shock, Combat Stress, and finally in 1980 the American Psychiatric Association called it Post-Traumatic Stress Disorder and added it to the Diagnostic and Statistical Manual of Mental Disorders. PTSD is comprised of a set of symptoms which include re-experiencing the traumatic event, avoiding places, events, or objects that remind one of the trauma, and hyperarousal. Most people feel many of the symptoms of PTSD after a traumatic event, but those symptoms fade with time. To be diagnosed with PTSD, the symptoms must last longer than 6 months.
PTSD can be extremely debilitating, leaving veterans homebound and isolated, suffering from co-occurring mental health issues and addictions (generally caused by self-medicating their symptoms). Add to these issues a Traumatic Brain Injury and you have a recipe for disaster. TBI’s can range from mild to severe, even resulting in death. The symptoms include loss of consciousness, memory or concentration problems, headache, dizziness, sensory problems, fatigue, convulsions, and emotional disturbances. “According to a Rand study, about 19 percent of troops surveyed report a probable TBI during deployment” (Williamson). Many symptoms of PTSD and TBI mimic each other, making definitive diagnosis difficult for some patients. How much of the patients symptoms are related to PTSD and how much to TBI? Patients and doctors are often left in a guessing game as to whether the symptoms require therapy, medication, or both.
The great influx of veterans returning home from the current conflicts has caused a massive backlog for the Veterans Administration. Currently, “401,000 claims remain officially backlogged, meaning the applicants have been waiting at least four months” (Glantz). Many of these are waiting a year or more for appeals related to service connected disabilities. This means veterans, who are too injured to continue their military service and unable to achieve successful and meaningful employment in the civilian work force are waiting for their disability compensation for a year or more, putting them and their families in financial peril. The stress of dealing with gathering the enormous amount of information required to fill the claim, the aggravation of having your claim misplaced, delayed, or denied only adds to the problems already being endured by the veteran.
The stress of dealing with PTSD and fighting the VA’s red tape backlog is lending itself to the suicide epidemic plaguing our veterans. Senator Bernie Sanders said, “Without being overly dramatic, let me state that we are losing 22 veterans every day from suicide. This is a tragedy that we must address. I know that no one in the VA, no one on this committee, wants to add to that tragedy, because of unnecessary delays that could extenuate the problems that veterans express” (Johnson). In 2012, the suicide rate of active duty personnel outpaced combat fatalities. “Access to care appears to be a key factor, […] once a veteran is inside the VA care program, screening programs are in place to identify those with problems and special efforts are made to track those considered at high risk” (Maze). The veteran suicide rates are outpacing that of the civilian population. In reports from 48 states, the suicide rate among veterans is 30:100,000 compared to civilian rates of 14:100,000. This is more than twice the rate of the average American citizen and is increasing at double the rate (Hargarten). Traumatic Brain Injuries can increase the propensity toward suicide, as can the overwhelming symptoms of Post-Traumatic Stress Disorder. According to Hargarten, “concussions also are a chronic risk factor leading to suicidal thoughts, […] because head trauma makes people more vulnerable to suicidal thoughts” (Hargarten).
Over the years, countless studies have been published promoting the health benefits of owning a pet. Pets can, lower blood pressure, encourage exercise and socialization, improve mood and reduce stress. Is it any wonder they are being trained to assist disabled veterans struggling with the effects of PTSD and TBI? Training dogs to assist with disabilities is not a new concept. Most people are quite familiar with service dogs for blind or wheelchair bound individuals. However, those with invisible disabilities can also benefit from a service dog.
Psychiatric Service Dogs can be trained to assist their handlers in many ways. They can be trained to retrieve assistance during a disabling episode, either a nearby person or by using a special K-9 rescue phone to dial 911. They can be trained to answer the door and lead first responders to their handler. They can provide balance during episodes that potentially cause dizziness and help their handlers up off the floor. These dogs can be trained to alert to increasing anxiety levels so their handler can more effectively handle the symptoms before they become overwhelming and disabling. They can pull their handlers from dissociative episodes, or flashbacks, wake their handlers from nightmares, provide deep pressure therapy during panic attacks, and give their handlers a sense of ‘crowd control’. In short, these animals are giving back to veterans something they lost when they left the service…a battle buddy – someone who has their back twenty-four hours a day.
The legal definition of a service dog, according to the Americans with Disabilities Act, is a dog that is “individually trained to do work or perform tasks for people with disabilities” (ADA). These dogs and their handlers are granted public access by federal law, meaning they must be allowed wherever the handler would normally be allowed without the presence of their dog. There are some restrictions such as sterile environments, such as operating rooms or burn units, and private property. They are allowed in stores, restaurants, hospitals, and anywhere else the general public goes. This protection enables veterans who had previously been home bound to return to the world without the crushing effects of PTSD plaguing their every movement.
United States Marine Corps Captain Jason Haag, credits his service dog Axel with saving his life. “I’ve led 150 Marines into combat three times. I couldn’t walk out of my […] house to buy a pack of gum. I couldn’t go to sleep without a gun underneath my pillow. That’s how bad my PTSD was” (HLN). Captain Haag states that after returning from Afghanistan he began drinking heavily, having angry outbursts at his family, unable to leave his basement and on 32 different medications. “Axel hit the reset button for me” (HLN). Since graduating from K9s for Warriors more than a year ago, Captain Haag has radically decreased his medications – to 2 per day, he now regularly participates in family activities, and has even been to Capitol Hill, advocating for service dogs for veterans with PTSD (Haag).
Captain Haag’s story is not an anomaly. Most graduates have returned to a new ‘normal’ of doing the everyday things that most take for granted, such as walking through the grocery store or visiting their children’s school.
K9s for Warriors is just one of many non-profit organizations who are training service dogs for veterans with PTSD and TBI. These organizations train and place service dogs with disabled veterans, often at little to no cost. They are filling a gap left by the Veterans Administration, when they discontinued a congressionally mandated study on the efficacy of service dogs for veterans with PTSD.
There is still reason for optimism, though. Two bills have been introduced into the House of Representatives this year with the intent of expanding the availability of service dogs for disabled veterans. H.R. 183 – “Veterans Dog Training Therapy Act”, introduced on January 4th, 2013 directs the VA to begin a pilot program to research the efficacy of service dog training and handling in the treatment of PTSD. H.R. 2847 – “Wounded Warrior Service Dog Act” would direct the “Department of Defense and the Veterans Affairs to jointly establish the K-9s Companion Corps program for the awarding of grants to assist nonprofit organizations in establishing, planning, designing and/or operating programs to provide assistance dogs” (govtrack.us). Should these bills pass, perhaps in time the studies will confirm what those veterans who already have service dogs know.
According to Sandi Capra, the Director of Development for K9s for Warriors, of their more than 100 graduated teams, 92% of graduates had reduced or eliminated their need for medications, and 94% have reported reduced symptoms of PTSD (according to the Harvard PTSD standards). At one year from graduation, 95% of teams recertify successfully. These achievements are not an isolated occurrence. A simple online search of service dogs for PTSD returns more than 286,000 results. You will find countless news stories about homegrown veterans reclaiming their lives thanks to their new ‘battle-buddy’, veterans attesting to the lifesaving partnerships they’ve found in a service dog and web pages for scores of organizations who train these dogs for our disabled veterans.
These stories are not the ‘too good to be true’ paid endorsements for the latest fly-by-night “cure” for PTSD. They are not random coincidences. They are the stories of recovery from a devastating and debilitating invisible injury. These dogs are not a cure. They are a tool in their handler’s arsenal for coping with and overcoming some of the obstacles associated with PTSD and TBI. There is a reason they are referred to as “man’s best friend”. They are the heroes on four legs and they are giving a new ‘leash’ on life to veterans who suffer from the invisible wounds of war.
Capra, Sandi. K9s for Warriors. Director of Development. Personal interview. 13 November 2013
Glantz, Aaron. “Overtime, New Computer System Put Sizable Dent in VA Benefits Backlog”. The Center for Investigative Reporting. 11 November 2013. Web.
Gradus, Jaimie L., “Epidemiology of PTSD.” National Center for PTSD. n.d. Web. 24 November 2013.
Haag, Jason. Personal Interview. 13 November 2013.
Hargarten, Jeff, et.al. “Suicide Rate for Veterans Far Exceeds That of Civilian Population”. Center for Public Integrity. Web. 30 August 2013.
“HLN Stories of Courage – K9s for Warriors”. Headline News. Television. 11 November 2013.
iCasualties.org, Coalition Casualties by Year, n.d. Web. 24 November 2013
Johnson, Bridget. “Sanders: VA’s Massive Claims Backlog Could be Contributing to Vet Suicides”. PJ Tatler. PJ Media. Web. 13 March 2013.
Kreisher, Otto. “Biding the ‘Invisible Wounds’.” Brainlinemilitary Brainline.org. n.d. Web. 24 November 2013.
Maze, Rick. “18 Veterans commit suicide each day” Army Times. Web. 22 April 2010.
Reno, Jamie. “Nearly 30% of Vets Treated by V.A. Have PTSD.” The Daily Beast Presents: The Hero Project. The Daily Beast. 10 October 2013. Web. 24 November 2013.
“Service Dogs.” ADA.gov. Web. 12 July 2011
Williamson, Vanessa and Mulhall, Erin. “Invisible Wounds – Psychological and Neurological Injuries Confront a New Generation of Veterans”. Iraq and Afghanistan Veterans of America. Issue Report, January 2009. Web.