The battles after war

One woman’s struggle for a PTSD diagnosis and how a now-suspended veterans program helped her

Two veterans at a Womens Wilderness Institute retreat.

The list of symptoms of PTSD — hyper-vigilance, sensitivity to noise, difficulty sleeping, irritability — was a checklist for Mary Swan’s complaints after she came back from active duty in Afghanistan. But because she never came under direct fire and never saw corpses or body parts, it took two years, two stays in a mental health hospital and four 90-minute interviews with Veterans Affairs staff before she was diagnosed with PTSD, assessed as disabled and unemployable and given VA benefits. And moving forward with her future started with a week-long stay at a wilderness retreat program that has since lost its funding.

Swan had put in 14 years of weekends and two-week stretches for the Air Force National Guard when she was called to active duty shortly after Sept. 11, 2011. For the first seven years of her active duty, she worked mostly from her home in Great Falls, Minn. Then, with just six months of experience after cross-training to public affairs, she was sent to Bagram, Afghanistan. Because of her rank, she became the deputy public affairs officer — second in command of an office that was the international headquarters for military operations in Afghanistan and included 32 public affairs personnel from around the world covering 8,000 troops.

“I was in way over my head,” Swan says. She was also the only Air Force person in the public affairs office.

“Everybody else was either Army or Marine Corps, so they have a whole different way of doing business,” Swan says. “They chew their people up. You make a mistake, they’ll get in your face and they’ll just rip you a new asshole. … Because of my rank and because of my service — because I was Air Force — they didn’t feel like they could get up in my face and rip me, but they ostracized me. I think that was even harder than getting ripped.”

She sucked it up, she says, and learned a lot, but calls the 100 days she was in Afghanistan the loneliest of her life.

“I felt like I might as well be on the planet Mars,” she says. “I mean, just alone and separate and fearful and yet trying so hard to look capable and competent and ready. It takes a lot of energy to keep that façade up, and, you know, I knew kind of right away when I got home that I was having some difficulties because I couldn’t bear any noise.”

Listening to children playing in the yard was enough that she’d nearly come unhinged.

“My mom would look at me like, ‘What the hell? What happened to you while you were deployed?’ and I’d say, ‘I want to go out there and beat those kids,’” Swan says. “I started just going off on people. I mean, like I didn’t have any tolerance for people’s selfishness or their self-absorbed-ness and their petty complaints. Like, ‘Oh, I’m not going to eat this because it doesn’t have the right kind of mayonnaise on it,’ and I’m like, are you fucking kidding me?”

But she approached the Department of Veterans Affairs to apply for disability benefits with some hesitation. Those benefits applied to people who lost limbs and faced enemy fire, she says, and she kept thinking she should just suck it up in favor of people who came under fire.

At her initial meeting, an hour-and-a-half long exam with a VA psychologist, to determine the level of disability and the monthly benefits she would receive based on that disability, that was his response as well. He asked if she’d come under fire, and she talked about the scud attack that required evacuating from their tents and taking cover, and then the time an unexploded ordnance was found under her tent, but no, no one had ever shot at her. And no, she’d never seen body parts or corpses.

“It just kind of went from bad to worse because I’m thinking, this guy just thinks I’m trying to pilfer money from the VA and I’m thinking, this guy’s an asshole,” she says. “And he said, ‘Then you don’t have PTSD.’ And I said, ‘OK.’”

She had returned home from Afghanistan and retired from the service in time to care for her parents, who were in poor health and died in successive years. It was right after their deaths that she really hit her limit.

“When I retired, I felt like I didn’t have any more meaning or identity,” she says. “I just, completely — I mean I completely fell apart. So I was hospitalized there at Fort Sheraton, which is the regional hospital for veterans with mental health issues, and I was treated there for two and a half months.”

After she was hospitalized, she went through another exam. Then she was hospitalized again, and had to do another exam — in two years, she took the 90-minute exam to determine if she had PTSD a total of four times. At her last exam, despite the thick case file on the desk in front of him, the examiner asked her to start from the beginning and explain why she was there.

“So I went off on the guy, I just, like, I’d fucking had it, I went off on him, and I said, ‘You guys, you don’t even take the time to read the file,’” she says. In a previous interview, she’d been asked if she was having trouble in her marriage, though Swan is single.

“So he said, ‘So what’s your deal, do you have PTSD?’ And I said, ‘Well, I think I do, but the boys from the VA think I don’t because I never saw any mangled body parts.’”

He asked about symptoms — did she prefer to sit with her back to a wall instead of a door, was she hyper-vigilant, did she avoid situations that reminded her of combat? Yes, to all of the above.

She came away with a disability rating of 70 percent.

When she went to apply for individual unemployability — that she couldn’t do the job she’d done before her time in combat — again, she says, she was told she didn’t qualify by the “redneck good old boys” who worked at the office. She told him he had a job because of her, not the other way around, and filed anyway, just to see what the VA had to say. Her rating went from 70 percent to 100 percent and she received full disability benefits.

Mary Swan during her time in the service | Courtesy of Mary Swan

“Here’s how it reads: Because of what I experienced while I was on active duty I have social, emotional, psychological fallout, which makes it literally impossible for me to return to the line of work for which I was trained,” she says. “It’s not saying I couldn’t get a job, but I could not be successful in the kind of job for which I was trained.”

She continued to go to the veterans center for counseling and support. At the point when the VA counselor she was seeing mentioned The Women’s Wilderness Institute’s veterans retreats to her, she was still so anxiety-prone and hyper-vigilant that she would go three or four days at a time without leaving her house.

“She said, ‘They’re having a women’s wilderness retreat in Colorado and the VA will pay for it,’ and I said ‘No, thanks,’” Swan says. “She kept presenting it, and I kept saying ‘No, thanks.’ I hit some kind of wall shortly before the retreat was offered … I was between a rock and a hard place and I needed some help. So I went to see her and I said, ‘That offer of Colorado, is that still on the table?’ and she said ‘Yeah.’”

So, she applied for the Women’s Wilderness Institute Women Veterans Retreat, an all-expenses-paid wilderness retreat offered by the Boulder-based organization at locations around the country.

Swan after her retirement

When she arrived at a camp near Buena Vista, she found herself sizing up the other women and the staff, expecting to hang out, do some outdoor activities, and if one of the women wanted to talk about combat, good for her.

“Because the event was being sponsored by the VA I thought, ‘Well, these counselors will be well intended, but they won’t be very competent, because it’s the fucking VA.’”

As the retreat unfolded, however, she found herself surrounded by staff well prepared for the issues facing female veterans, for how withdrawn they might be, for handling their hyper-vigilance and for setting up the situation so they were willing, and comfortable, to share.

The retreat blended practical advice on occupational and financial counseling with theory and practice on stress reduction and conflict resolution.

“We taught some classes to help participants understand what PTSD and military sexual trauma, MST, really are and what the physical and biological impacts are on a person and their brain, as well as the emotional ones,” says Shari Leach, executive director of the Women’s Wilderness Institute. “Then we taught tools for how to manage those impacts and how to change the impacts they were having on your life.”

Subsequent days put the participants in low stress situations, like a rock climbing wall, that allowed them to practice those tools.

“They’d probably experience either some fear or some stress, and we could have a conversation about, ‘OK, how does that feel in your body? What are some of the tools that you think might work for you? Do you want to try to work with that fear or that stress in a different way?’” Leach says. “So giving them opportunities to truly practice using tools that affect how the PTSD and MST affect their daily lives.”

The approach is pretty nontraditional, Leach says.

But the program also set itself apart by being available only for women. Typically, when a female veteran goes to a veterans office, she’s surrounded by men who both fill the waiting area and provide her services. In an all-female environment, Leach says, women can share experiences men might not have had, like being afraid to go to use the bathrooms on the base at night out of a fear of being assaulted or attacked on the way.

“To be in a group and to have other women say, ‘I know just how you felt,’ was really moving,” Leach says. “It really helped women reconnect with their experiences and then to be able to make decisions about where they were going to go forward.”

The Wilderness Institute created a “circle of safety,” with a few basic rules for active listening. The women sat down together with an agreement to be completely present for one another.

“It was pretty magical to look around the circle and see that seven other women were poised and respectful and listening, or at least they appeared to be listening,” Swan says. “It was transformational — it was the beginning of transforming.”

The message was: You are worth listening to, she says. It lifted a burden.

“People were encouraged to share whatever level they were comfortable with of their experience, and I’ve got to tell you, I was stunned by the women’s willingness to share, and I was stunned by the level of abuse these women had suffered at the location they were deployed, everything from rape to a threat at knife point, to even being sexually violated back home, here at their home units, by people who were in positions of authority,” she says. “While it was hard to hear, it was also reassuring to hear that hey, I’m not the only one.”

Women, who make up 14.5 percent of active duty forces, face pressures to compete with predominantly male peers that leave them with a sense of needing to just suck it up. They turn, instead, to coping mechanisms that range from substance abuse and sexual promiscuity to cutting.

For the first few hours, Swan says, she thought she’d just fake it and wait for the moment it became clear the event facilitators didn’t really know what they were doing. Instead, she says, it seemed like the people running the group were always one step ahead of the veterans.

Veterans practice teamwork, communication and stress management in a group exercise at a Women’s Wilderness Institute retreat. | Photo courtesy of the Women’s Wilderness Institute

“I would think, ‘Oh I just want to kind of let go,’ but I wasn’t going to allow myself to let go because it’s just too hard and it’s too risky and if I do this, I might not be able to pull myself back together,” she says. “There’s so much crap in there that it just busts loose. This could be a mess.”

She paid close attention — to the facilitators and the risks other women were taking.

“I just kept thinking, you know, I’m not doing myself any favors by sitting on the sidelines and watching everything and thinking, ‘I can’t,’” she says. “If I’m going to get any measure of relief, I’m going to have to take a little risk and just see where it goes.”

High in the Colorado Rockies, away from daily distractions, without televisions or radio and only limited cell phone access, it became easier to settle in.

“You could see people just kind of unfolding,” Swan says.

Counselors met fidgety, over-amped women with techniques for calming down and sleeping — and practiced them with the women.

“It wasn’t like the VA method — they’ll just give you something on a hunk of paper and say ‘This has been shown to work,’” Swan says. For the first time since before her deployment, she slept not just to avoid how she felt while she was awake.

“Just that much was like a pretty serious victory,” she says. “Another huge thing was, they were so grateful for our military service. … That resonated with me, because it’s nice to be thanked, and it’s nice to have that sacrifice acknowledged, instead of, ‘Well, women don’t really belong in combat. You were just an administrative puke over in the desert, you never really fired a shot, therefore you shouldn’t really have trauma.’ To be with women who were sensitive and really grateful, that went a long ways with me.”

Building a community for women, who culturally value relationships over the skills-based competitions their male counterparts turn to, has been a driving force for The Women’s Wilderness Institute, based on the research of its founder, Laura Tyson. Tyson personally directed the veterans program.

The institute ran six six-day retreats total, three in 2011, one of which included Swan, and three in 2012 at locations in California, Colorado, Connecticut and New Mexico. All of the expenses associated with attending, including airfare, were paid for through the Caregivers and Veterans Omnibus Health Services Act of 2010, which allotted $2 million each year for a retreat program for women who had recently separated from the armed services. A total of 134 women participated.

The results they saw, Leach says, were dramatic.

“We did a pre-test, a post-test and then a two-month-after post-test, and what we saw was dramatic reduction in PTSD and improved quality of living for vets across the board,” she says. Their measurements were taken using a symptom checklist and a psychological wellbeing scale that were both developed outside the organization. “To have those things continue for two months or more after the end of a retreat is really significant in the psychological findings. It’s easy to change someone’s life for a day. It’s harder to change their life.”

Participant feedback forms submitted to Women’s Wilderness included the following comments:

“Attending this retreat made me realize that I am not alone with my PTSD. My anger does not control me, I can control it any way I feel fit to.”

“The stress management skills, tension release exercises, and methods of thinking about ourselves are useful tools for helping me get through my days at a time in my life when I’m very confused about what I should be doing now and what the future holds for me. I now have new, more positive ways to channel my fear, negative thoughts, apprehension, and depression.”

“This retreat has given me a chance to share things that I have kept to myself for a long time. It has also taught me how to care for myself. I have neglected myself for so long. I forgot how to laugh. I have found myself again and I feel much happier. I feel I am actually ready to plan my future.”

The report on the pilot program filed by the VA’s Readjustment Counseling Service Western Mountain Regional Office, which oversaw the program, was similarly positive.

“We felt it was extremely successful for the women,” says Donald Smith, the technical representative with the VA responsible for monitoring the contract given to the Women’s Wilderness Institute to run the program. “They felt that they benefited from just being together as a group. That’s kind of hard to do for female veterans in the military because it’s 80 percent male and 20 percent female, so there’s not an opportunity for just female veterans to get together a lot of times, and this was where they were together for a total of six days in a retreat setting. … It’s important for any group that has experienced trauma to be able to get together with other members of that group and just to be able to get together and discuss their feelings.”

His report has been sent on up the lines at Veterans Affairs, and will eventually be reviewed by the Veterans Affairs committees in the House and Senate — the same groups that funded the pilot program in the first place. Until the committees make a decision and allocate additional funds for the program, the Women’s Wilderness Institute Veterans Retreats are on hold.

“Since sequestration has happened and because it was a two-year pilot, there’s currently no funding available for anyone to do any kind of work like this that we know of,” Leach says.

“It was a pilot program funded for two years, so when the two years was up, that was it,” Smith says. He would recommend it for additional funding, he says, but whether it gets that funding is in other hands. Sen. Patty Murray (D-Wash.) was chair of the Senate Veterans Affairs committee when the legislation funding the retreats passed, and she had spearheaded the issue. Murray has since been replaced as chair by Sen. Bernard Sanders (I-Vt.).

“All I can say about the future is everything depends upon congressional legislation, and we don’t control that,” Smith says.

A report by the Army’s Mental Health Advisory Team concluded that women soldiers are no more likely to see their mental health affected than men, but other studies have come to different conclusions. A study on Gulf War soldiers showed female soldiers twice as likely to meet the diagnostic criteria for PTSD, and a RAND Corporation study that focused on differences between genders during service in Iraq and Afghanistan also found women at higher risk for developing symptoms of PTSD and major depression. The fact that until recently women have been prohibited from serving in assignments with a primary mission of engaging in direct combat on the ground, according to the RAND Corporation, may actually have a greater effect on whether female soldiers advance in command than whether they develop PTSD.

Since completing the Veterans Retreat with The Women’s Wilderness Institute, Swan has returned to school and is now halfway through a master’s program in organizational management with an emphasis in criminal justice. Both her physical and mental health have improved, she says, and moving from VA to Medicare health care has brought the cost of psychiatric appointments down from $300 to $35 per hour, so she can see someone in private practice.

Things, now, are good, she says. “They’re different than I ever thought they would be, but they’re good.”

Despite the ongoing need for programs to ease the transition for veterans, particularly women veterans, from military to civilian life, the veterans retreats are suspended until at least 2014.

“Our greatest concern is that clearly there’s a need for programs like this, and that there’s no government funding available, so we are just beginning to explore the possibilities of foundation or private funding to try to continue work like this because we think it’s so valuable,” Leach says. “We’re just saying, we’re sorry, we can’t run the program right now. We’re just starting to accept that reality that we think the government funding is a long ways off.”



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