Chris recently introduced us to two female veterans, Lisa and Jo, who had completed the Peer Employment Training (PET) class he teaches at Recovery Innovations (formerly META Services). They taught us much about what it means to fight for our country, as well as what it's like to come home feeling empty and disconnected. We want to share their stories and advice with you so we all can make strides toward helping our returning troops rejoin our communities.
The PET class Lisa and Jo attended was sponsored by the Department of Behavioral Health in San Bernardino County, California, through a partnership with the VA hospital at Loma Linda. The PET class is packed with 80 hours of training on personal development, skill development, and tried-and-true methods for joining the behavioral health workforce.
“I've held a civilian position for the past 17 years while also being an active member of the Air Force Reserve. I have a national registration as an emergency medical technician and have been deployed five times—the most recent time was for Operation Enduring Iraqi Freedom.
“My assignment in Saudi Arabia was the most difficult, and also was the point at which I began to suffer from PTSD [post-traumatic stress disorder], even though at the time I didn't know what it was. During this assignment the barracks I lived in were bombed by terrorists, resulting in 19 casualties and over 450 injured. I worked over 40 hours straight as did other residents, both medical and nonmedical, treating the wounded. The people we were treating had massive injuries and, not knowing their outcome, [images of them] stayed in my mind, rolling over and over again. I wondered if they'd be able to have any kind of quality in their lives after what they'd been through. I still think about them and dream about them.
“While I worked tirelessly along with others, I began to feel mentally and emotionally disconnected and fearful. I began to sleep partially dressed with my weapons close at hand. I was hypervigilant and perpetually worried for myself as well as others. When my tour was over and I had to return home, I felt guilty leaving. There was so much to do and not enough people or expertise to do it.
“When I returned home, some friends questioned me about my well-being. Was I alright? Was I scared? Could I do my work? Did I need help? It wasn't until I had an automobile accident and ended up being treated at the VA hospital that I was diagnosed with PTSD, and was offered help and treatment for it. I agreed to the help, and I also joined a women's combat support group at the VA hospital in Loma Linda, which turned out to be very helpful.
“When I heard about the Peer Employment Training class being offered in my area, I was motivated to sign up. I saw this as a way I could learn to help other returning veterans to recover from PTSD and other side effects of trauma. I hoped it would relieve the guilt I had about having to come home before others, and the feeling of not helping enough.
“I had to take two weeks of vacation time from my job in order to attend PET, but I was willing to do this because I wanted to help others recover. The class was very helpful for me in my own recovery, and also in learning how to support the recovery of others. The courage of the other students to face their issues and work on their recovery made a big impression on me. The stories of their lives and struggles, and how they have managed through tough times, gave me renewed hope. I learned a lot from the class and from my classmates. For me, one of the most important things was to learn how to cope with feelings of helplessness and hopelessness. This was the first time I heard that I could recover from the PTSD that was ruling my life. I started to hope for the first time in a long time.”
“I enlisted in the regular Army in December 1990 after graduating from high school. I wanted to get away from the life I was living, and also wanted to earn money so I could go to school.
“Boot camp was different in those days. It was physically and emotionally challenging. Humiliation and insult were two of the main training tactics. This may have made me more vulnerable to PTSD later on. I had already had practice at dissociation growing up in a family that was riddled with the constant arguing and fighting between my parents.
“I completed my eight-year contract by doing a combination of active duty and serving in the reserves. I reenlisted because I was enjoying my job on the base. I was close with the people in my unit that I worked with. I was inactive until September 11, 2001, and then I went active because I wanted to do my part and help. I was deployed to Afghanistan and later to Iraq.
“When our time was up we were looking forward to going home, but the war was in full force, and we were told we had to stay for an indefinite period of time. I was there for the first bombings. Our camp was bombed every night for two weeks. Most of the bombs were intercepted, but we had to be ready for the worst to happen. This meant sleeping in all our gear, which was very hot.
“I think the hardest part for me was the bombings and interceptions. When the bombs were intercepted, the force was so strong it knocked us out of our bunks. Between the constant, intense fear, and not getting any sleep, my pattern of dissociation was constant, and the only way I knew to survive. My adrenaline pumped 24/7. We were never safe and relaxed. After awhile, when I heard the warning siren go off, I wouldn't even take cover any more. I even started smoking.
“After three months we were sent home. I didn't know about PTSD. I just didn't want to be around anyone or talk about what had happened. I withdrew. I developed a lot of gastrointestinal problems and went through lots of tests trying to figure out what was wrong. Finally a social worker told me that I might have PTSD and gave me some Zoloft to take for 6 months. It may have helped, I'm not sure. There was never any follow-up.
“I moved to the country, got a job, and thought maybe I was OK. I couldn't sleep and was always exhausted. I was also overly sensitive and hypervigilant. I came to believe that my coworkers were trying to sabotage my work. I wore myself out by being anxious, and would recover by staying in bed all weekend. When this stopped working, the anxiety was so intense that I quit the job. I tried another job but it didn't work out either, because I had so much fear and anxiety. I had insomnia because I was afraid to fall asleep and dream. The only way I knew to deal with this problem was to disconnect.
“Finally I found my way to the trauma recovery center at Loma Linda, and began to get the help I needed in individual and group therapy for women in combat who suffered from PTSD. Once I had a name for what I was experiencing, I was able to find better solutions. I realized how disconnected I was when I tried to explain how I was feeling and had no idea. I had to use a sheet of ‘smile/frown’ faces to get some clues.
“I heard about the Peer Employment Training class from my psychologist at the VA hospital in Loma Linda. I wanted to take it because I wanted to be able to help other returning veterans. The class provided a safe environment for me to learn—there were no wrong answers, which helped me thrive and grow. I felt safe emotionally, and it also gave me a way to connect with other people, which I haven't been very good at. After feeling lost for so long, I now know what I want to do. The class helped me sort out a career direction. I know that helping others with their recovery will also help me with mine.”
What We Learned
Jo and Lisa, as well as the other folks in the PET class, reminded us of some of the best things that must be done to truly promote recovery. First, we were reminded of the value of providing peer training to all types of people, including veterans with PTSD. It not only prepares people to help others, it helps people to help themselves. Here are some other things Jo and Lisa taught us:
Seeing people who have PTSD or any mental illness not as being “less than” but as being complete and whole people is fundamental to support recovery. We need to start looking for the best and strong parts in people so those parts can be pulled forward. Changing from the “what's wrong” to the “what's strong” perspective ultimately will have a dramatic impact on how people see themselves. Moreover, when behavioral health service providers change their perspective, it has a transforming effect on how they deliver those services.
By creating meaningful peer employment opportunities in the behavioral health field, more people will be able to see that recovery is reality. Peer employment gives peers a chance to give and receive. As Lisa said, “I know that helping others with their recovery will also help me with mine.”
Providing recovery education opportunities such as the PET class results in collaborative healing and learning. The classroom environment must be loving, safe, and learning-centered. When given educational opportunities, peers gain key strategies for enhancing their own wellness, as well as specialized competencies for supporting others in their recovery.
Helping veterans see the best and strong parts within themselves clears the way for recovery to begin. A lot could be said here, but it boils down to not seeing oneself as a victim but as a hero who has survived. An important part of this is dealing with a veteran's internalized stigma around mental illness. As Jo told us, “I know a lot of veterans who need help but refuse to get it because of a lack of knowledge and the stigma associated with mental illness.”
In summary, we learned that some of the same programmatic ingredients that help people with serious mental illnesses to recover are the same things that help veterans with PTSD to recover. Focusing on strengths; giving people meaningful training opportunities; providing a warm, caring environment for learning; and dealing with stigma about mental illnesses can help a veteran with PTSD to recover.
Special thanks to Jo and Lisa, as well as all the other veterans who served our country by giving their personal best.Lori Ashcraft, PhD, directs the Recovery Education Center at Recovery Innovations, Inc. (formerly META Services) in Phoenix. William A. Anthony, PhD, is Director of the Center for Psychiatric Rehabilitation at Boston University. Chris Martin, MA, is Director of Training and Consultation at the Recovery Opportunity Center (ROC) at Recovery Innovations.