Can Spiritual Therapy Ease Your PTSD Symptoms?

A male wearing a BDU jacket speaking with a male counselor.

A researcher associated with the Augusta VA is exploring the potential role spirituality might play in therapy given to Veterans suffering from post-traumatic stress.

How big a role might spirituality play in helping Veterans cope with the ravages of post-traumatic stress? The VA would like to know.

Wounded Souls

“Young people go into combat and see their friends getting killed,” said Dr. Nagy Youssef, a psychiatrist with full clinical privileges at the Augusta VA in Georgia and an associate professor of psychiatry at Augusta University. “They might have to kill enemy combatants. They face very difficult decisions, sometimes life and death decisions that must be made in fractions of a second. This can take an enormous toll on them. Some feel they’ve done something terrible for which they can never be forgiven.  We call it moral injury.”

Youssef and several colleagues recently touched on the complex subject of moral injury in a paper they published in The Journal of Nervous and Mental Disease (Volume 205, Number 2, February 2017).  In it they note that many Veterans have deeply held spiritual or religious beliefs that could increase their vulnerability to moral injury.

Dropping Out

“I’ve treated a lot of Veterans with PTSD,” he said. “Often we treat our Veterans and Service Members with medication to help reduce symptoms like flashbacks or nightmares.  We give them prolonged exposure or cognitive processing therapy with or without medications. These help a good portion of patients… but not all.”

“Studies show that a good percentage of patients believe in some kind of spiritual life.”

The 44-year-old researcher said about half of Veterans with PTSD have a good response to standard therapy while the other half experience mixed results.

“At least a third do not respond to conventional therapies and medications at all,” he said. “A number of them simply stop going to therapy. Some find that it does not address the spiritual wounds and inner conflict they feel.  Others see it as not holistic enough. So they drop out.”

Dr. Nagy YoussefDr. Nagy Youssef

Youssef wants to know if incorporating a spiritual aspect into trauma-based therapy — for those patients interested in such an approach — might keep more Veterans coming in for treatment. To find out, he and his team are conducting a survey.

“So far we’ve interviewed about 40 Veterans,” he said. “We’re hoping to interview at least 125.  The results of the survey will tell us whether or not we should proceed with a larger study concerning spirituality and its value in the healing process.”

Duke University and the Durham VA are collaborating with Youssef on the project.

Different Strokes

The psychiatrist said the larger study, should it proceed, would incorporate aspects of each patient’s religion or spiritual beliefs with a particular emphasis on love and forgiveness.

“We would customize the therapy,” he said, “because everybody is different. Everybody has their own unique concept of what spirituality is.  So the therapy we provide needs to reflect that.  The religious or spiritual material we incorporate into the therapy must have special meaning for each Veteran.”

The researcher said the concept of forgiveness is a major element that can be found in all the world’s religions and would thus be a central theme in spiritual therapy.

“Some Veterans suffering from PTSD sincerely believe that God, or whatever they perceive to be their higher power, will never forgive them for what they’ve done,” he said. “I doubt if these feelings of shame and guilt can ever be fully addressed with standard therapy or medication.  We need to give these patients evidence —from the Bible, the Torah, the Koran or whatever they believe in— that they can be forgiven, that there’s always a second chance.”

A female therapist comforting a female Veteran.Many Veterans have deeply held spiritual or religious beliefs that could increase their vulnerability to moral injury.

He continued: “We hope this approach turns out to be highly motivating for the Veterans in our study.  If they find this spiritual approach to be meaningful, and helpful, they’ll keep coming to therapy.  That’s the key:  showing up for treatment.”

Youssef emphasized that introducing a spiritual element into treatment is not meant to be a replacement for conventional therapies, but an enhancement for those Veterans who may find it beneficial. “We do not advocate at all quitting standard therapy,” he said.  “This is meant to be a holistic approach that simply works at a different level . . . a different dimension.”

To learn more about how VA is helping Veterans with PTSD, visit the VA National Center for PTSD Website at


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Important Office that Most People Have Never Heard

Surgeons looking at x-rays of patient

Patient Safety is Job One

It’s VA’s National Center for Patient Safety (NCPS), and it has:

  • Contributed to an 82 percent decrease in deaths from suicide in VA inpatient mental health
  • Helped reduce major fall-related injuries by five per month since 2012
  • Fostered a strong culture of safety throughout the Veterans Health Administration
  • Created a five-step process for Ensuring Correct Surgery, including a timeout for safety before an invasive procedure or operation

“We work with some of the brightest and most passionate people who are completely dedicated to reducing and preventing harm to our Veterans,” said Dr. Robin Hemphill, VHA chief safety and risk awareness officer.

Patient safety is the prevention of inadvertent harm or injury to patients. It includes the identification and control of hazards and vulnerabilities that could cause harm to patients.

Valuable Tools Designed to Keep Veteran Patients Safe

NCPS measures and reports trends to leadership in an effort to create a strong culture of safety in VHA.  It created the Patient Safety Culture Survey, parts of which are also used by the Agency for Healthcare Research and Quality (AHRQ) as part of its patient safety survey.  This enables VHA facilities to compare their patient safety culture to those outside the VHA.

The Mental Health Environment of Care Checklist, created by NCPS in 2007 to evaluate and improve the safety of inpatient mental health units, has contributed to an 82 percent decrease in deaths from suicide in VA inpatient mental health units throughout the United States.

A Toolkit to Help Prevent Falls

Falls are regularly one of the highest categories of sentinel events reported to The Joint Commission. To address this patient safety issue, NCPS developed a Falls Toolkit. The Toolkit has contributed to five major fall-related injuries avoided per month since 2012.

“Passionate people completely dedicated to reducing and preventing harm to our Veterans.”

The Daily Plan® enhances patient safety by involving patients in their care. Veteran patients receive an itinerary, or road map that lets them see what will occur on a particular day. The plan encourages patients and family members to ask questions if something seems different than expected. This can help reduce potential errors and give Veterans and their caregivers’ peace of mind.

Communicating Clearly in Critical Situations

Clinical Team Training (CTT) was developed by NCPS to provide clinicians with the tools and strategies to practice effective teamwork behaviors and to communicate clearly, especially in critical situations.  CTT employs Crew Resource Management (CRM) principles, developed in the airline industry, to improve team leadership, assertive communication, situational awareness and clinical decision making.  Establishing a fair and just culture is critical for a thriving atmosphere of safety. My Voice Matters offers coaching, support and training for VA leaders on their journey to high-reliability through the establishment of a fair and just culture.

NCPS’ five-step process for Ensuring Correct Surgery has been presented to countless numbers of patients, VA staff and residents rotating through VA hospitals. This process includes 1) verification of proper informed consent, 2) standardized patient and procedure identification, 3) marking the procedure site, 4) reviewing relevant medical images, and 5) conducting a “timeout.” The “timeout” is a discrete pause for safety in the action prior to an invasive procedure or operation where the team confirms the above information.

PSA Banner

For Veterans Having Surgery

We have information that will help you to understand what will happen before your surgery and how your doctors and nurses will make sure that everything goes as planned.

If you are a Veteran or medical professional interested in a health care system that places a high priority on patient safety, look no further than your local VA Medical Center.

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Ten Ways to Eat Wisely – A Focus on Nutrition

Fruit and Vegetable bowl

Eat Wisely – VA’s MOVE! Program

VA’s National Center for Health Promotion and Disease Prevention encourages Veterans and their families to jump start the spring season by using the following Eat Wisely tips.

1. Establish regular meal times.  Try not to skip any meals because skipping meals leads to over-eating later in the day or evening.

2. Read food labels when you are purchasing food items.  Pay attention to the portion size, the number of calories in each portion, and the amount of saturated and trans-fat in each portion.

3. Make small substitutions in your diet to cut calories.  For example, drink water or unsweetened iced tea instead of high-calorie drinks.  Choose low-calorie versions of salad dressing, cheese, sour cream, and mayonnaise.  Go easy on fried foods –bake, broil, poach, or grill your food instead.

4. Plan meals and snacks, and make certain to have healthier food choices on hand.  This makes it easier to resist trips to the vending machine and unhealthy, unplanned snacking.

5. Portion your servings to control the amount.  For example, plate your meal in the kitchen using portion control.  Bag snacks, such as potato chips or cookies into single serving sized containers or zip-lock bags. When you have a craving, eat the serving size only.  Remember to pass on seconds. 

Here are some videos from VA’s MOVE! Program to help you lose weight.

6. Control calories when dining out.  At fast-food restaurants, “down-size” food and drinks instead of “super-sizing” or better yet, try new restaurants that offer interesting healthier food choices.  You can always check restaurant websites for nutrition information to select the healthiest options.

7. Share an entrée with a friend or family member. Do order a personal salad or side of vegetables.  Ask restaurants to: “Please, “put the sauce on the side” (and try not to use it all), “hold the cheese”, “use low-calorie dressing” and as always, try to avoid fried dishes.

8. Identify your “guilty pleasures” such as ice cream, cake, cookies, or potato chips.  Continue to enjoy them by trying the low-calorie versions or by eating less of the regular versions.

9. Avoid places and situations that trigger eating.  For example, if walking past the bakery causes donut cravings, try changing your route. Replace candy on your desk with fruit and steer-clear of the office candy bowl.  Avoid eating while watching television, reading, working on the computer, or driving. Many people do not recall all they have eaten while doing other things.

10. Be ACTIVE!  Try substituting other activities for eating.  For example, take a walk, walk with a friend, or dance to some music. Other activities allow you to avoid extra calories and can be more satisfying than eating.

Eating healthier doesn’t mean changing your entire eating pattern overnight. Small changes, made over time, can add up.  March is National Nutrition Month. VA’s National Center for Health Promotion and Disease Prevention urges everyone to start small – one forkful at a time. “

Whether you’re planning meals to prepare at home or making selections when dining out, always “Put Your Best Fork Forward” to help find your healthy eating style.

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Marine Continues to Serve by Serving Veterans

VAMC Director Isaacks visits with Veteran patient

VAMC Director Isaacks visits with Veteran patient

Dad’s Message to Future Hospital Director

It was a May morning in 1997, and 19-year-old David Isaacks was up before the sun.  Today was the big day, perhaps the biggest day of his life, because he was setting out on a life-changing adventure.  

In the pre-dawn darkness, his dad handed him a going away present.

“It was just a small, simple, green address book that my mom had pre-populated with addresses of family and close friends,” Isaacks said. “At 4 in the morning, I didn’t think much of it when my dad handed it to me. He told me that my mother had filled it with people I should write to while away.

“Of course, I didn’t have to be at the Military Entrance Processing Station in Kansas City until 5 a.m. but my dad, being a Marine himself almost two decades earlier, was never late to anything.”

And so father and son began their short road trip together, departing their home in Topeka and heading across the state line to Kansas City, Missouri.

“The VA is purposeful in ensuring and advocating for Veterans who cannot advocate for themselves.”

“I could tell my dad was proud of what I was about to accomplish,” Isaacks said. “I didn’t speak much, but I listened intently to the short stories my dad told me about boot camp and about his time in the Marine Corps. That cool May morning was the day I reported to Marine Corps boot camp in San Diego.  I knew it would be a long day and, after hearing the stories of the footprints from my dad, I knew that the first 48 hours would be a true test.

We’re Not in Kansas Any More

“After a couple weeks in Marine Corps boot camp, I finally had some time to write home,” Isaacks said. “And even though I knew my parents’ address, I cracked open that small, green address book. As indicated by my dad, my mom had diligently filled in several addresses in alphabetical order. Even though I only had enough time to write one letter, it felt good to know that all those people were placed in that book for me.

“As I flipped through the book, I quickly came to the end and noticed something that has always stuck with me. In my dad’s handwriting, he left me an important note. It read, ‘Son, I am proud of you and I want you to remember one thing.  No matter what, you should always protect those who cannot protect themselves.’

David Issacks and his dad, John David Isaacks and his dad, John

“To me, this is something I constantly think about while caring for America’s Veterans, and it is why I continue to serve,” Isaacks said.

Today this Marine continues to serve his fellow Veterans as director of the Harry S Truman Memorial Veterans Hospital in Columbia, Mo., a job “Oftentimes, when our lives intersect with health care needs, we are at our most vulnerable,” he observed.  “The health care needs of American Veterans are unique, and the Veteran population that VA cares for can be vulnerable due to the complexity of medical conditions that result from military service.”

He continued:  “This population is also vulnerable to homelessness, poverty and mental health issues.  The VA stands to protect them, especially when they cannot protect themselves. The VA is purposeful in ensuring and advocating for Veterans who cannot advocate for themselves.”

Director Isaacks Greeting a VeteranDirector Isaacks Greeting a Veteran

Twenty years after he and his dad set out together on that pre-dawn road trip to Kansas City, Isaacks now finds himself in a job he describes as much more than just professionally satisfying.

“I am filled with gratitude at the opportunity to care for American Veterans,” he said.  “I find myself in an occupation that is a privilege.”

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Can Yoga Ease Your PTSD? VA Wants to Find Out

Lead Yoga Therapist Nancy Schalk.

Veterans in the yoga study group work on perfecting a pose under the gentle guidance of Lead Yoga Therapist Nancy Schalk.

Photos by: Anegla Taylor, Indianapolis VA

A VA psychologist in Indiana is exploring the effects yoga might have on Veterans suffering with posttraumatic stress disorder.

“There’s just not that much research out there yet about the effect of yoga on PTSD symptoms,” said Dr. Louanne Davis, a clinical research psychologist at the Indianapolis VA and an associate scientist in clinical psychology at the Indiana University School of Medicine.  “But we know that yoga is soothing.  Yoga is very meditative and emphasizes being aware or mindful of your breathing and how your body feels moment to moment. This type of practice stimulates the calming branch of the nervous system and helps to reduce the hyperarousal that is one of the symptoms of PTSD.”

“Yoga sends a message to the brain that all is well.”

She added: “I hope the results of our study will help inform VA policies down the road in terms of what we can offer Veterans who are suffering with PTSD.”

Fight or Flight

According to VA’s National Center for PTSD, about 8 million adults in the United States are dealing with PTSD during any given year.

“When you have PTSD, traumatic memories and reminders constantly stimulate your nervous system, preparing you for fight or flight,” Davis explained.  “This cycle can lead to reoccurring anxiety and stress.  It’s exhausting, both mentally and physically.  It also has a lot of negative impact on your immune system.  And it can lead to other mental health problems, like depression.”

Davis said each Veteran in her study is assigned to one of two groups: either a class where participants practice nothing but yoga, or a control group where participants go for walks and engage in other health-related activities.  Both groups meet once a week for 90 minutes.

Veterans engage in a yoga pose designed to stretch their muscles, release tension and focus their thoughts


“My dad was a WW II Veteran,” said Nancy Schalk, the lead yoga therapist on the yoga teaching team. “His tool for coping with his PTSD was alcohol.  It’s much more empowering if we can learn and use some other tools.”

Schalk said she’s been practicing yoga for more than 40 years, starting when she was a teenager.

“Through yoga we’re giving our brain a healthy experience, over and over, that gradually helps us feel safe again,” she said. “For example, the breathing exercises we do purposely shift your nervous system from the ‘fight or flight’ side to the ‘rest and renew’ side.   It’s like your brain is saying, ‘Oh….this is how we breathe when we feel safe.’  You do this over and over, and you train your brain to change, to feel safe.  Yoga helps change your brain back to its pre-trauma state.”

Schalk said one of the hallmarks of PTSD is a tendency to isolate, which only makes matters worse.

Lead Yoga Therapist Nancy Schalk helps a Veteran with his posture during a yoga pose.

Spiraling Downward

“Isolation is a downward spiral,” she said. “We think yoga helps reduce the need to isolate by lowering general anxiety.”

The yoga therapist also noted that the simple act of attending a yoga class is — in and of itself— an isolation-killer.

“One of our study participants told me she just wanted to stay inside her home, but that going to yoga class has given her incentive to leave her house and interact with people. Also, Veterans trust and relate to each other, so just the act of participating in the yoga class with other Veterans is beneficial.”

One of those Veterans, Debra, said she was initially skeptical about the potential benefits of yoga.

“I think I wanted to be in the control group, not the yoga group,” she admitted. “I really wasn’t excited about the yoga thing, because I’d never done it before.”

Debra, who spent 22 years in the Army National Guard, said she began to lose her skepticism about one month into the study.

“Maybe around week three or four I realized I was getting excited, looking forward to my yoga day. I ended up really liking it.  I think I get the most out of the deep breathing; it helps me relax when something stressful happens.  I’ve tried therapy, and medications.  It helped some, to a point.  But I think yoga is the best thing for me.”

In addition to 90 minutes of mindful breathing, Debra said she’s also come to appreciate another aspect of the class.

“One of the best parts comes near the end,” she said. “That’s when you’re lying down with your eyes closed, and the instructor is talking to you in her quiet voice, and you’re almost asleep because you’re so relaxed.”

Dr. Louanne Davis

To learn more about how VA is helping Veterans with PTSD, visit the VA National Center for PTSD Website at

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VA's National Salute to Veteran Patients

Concert, band playing on the stage

Concerts, Valentines, and a lot of Americans saying Thank You…all part of VA’s National Salute to Veteran Patients.

This week is the 40th annual observance of VA’s National Salute to Veteran Patients, an opportunity to pay tribute to America’s heroes – the men and women we proudly care for and serve. VA facilities across the nation are honoring these men and women, who have given selflessly to protect the freedoms we hold dear, by reflecting on our obligation to serve those who have served us.

Each of us who are privileged to live in this nation has a special place in our hearts for these defenders of freedom. That is why VA takes time during the week of Valentine’s Day to encourage our community to express affection and respect for those we admire.

During National Salute Week, many American citizens visit Veterans to thank them for what they have done for our country in the past and support them in the challenges they face today. They come face-to-face with the cost of our freedom and see for themselves that freedom is not free. It is earned with their valor, commitment and undying patriotism, which is worthy of our time, energy and appreciation.

Everyone has the opportunity to make a positive difference in the lives of Veterans receiving care at VA facilities and in the community. Hundreds of thousands of Valentines cards and letters from people of all ages are pouring into VA hospitals addressed “Dear Veteran.”

Celebrities and civic officials at national and local levels are visiting VA hospitals and Veterans community living facilities. Civic leaders and community groups are also showing their support.

Many VA Medical Centers around the country have concerts to celebrate Salute Week. Singer Tracy Lawrence will perform at the Poplar Bluff VA. The Manhattan Dolls will entertain Veterans at the Tucson VA. The Richmond VA has a musical performance scheduled every day this week.

Volunteers Provided 11 Million Hours of Service

Personal contributions of time and care are the National Salute’s hallmark and the foundation of VA Voluntary Service (VAVS). VA volunteers epitomize the one-to-one sharing and caring that is a core value of our Nation. Last year, over 76,000 VA volunteers gladly gave more than 11 million hours of service to Veterans.

Everyone has the opportunity to make a positive difference in the lives of Veterans.

The human connection is essential to providing great clinical care. Without volunteers, the quality of our services and programs would be lessened.

Our volunteers do what it takes to make their heroes feel at home. They read to patients, provide recreation transportation, entertainment and training. They offer respite for caregivers, coaching, friendship, or sometimes the value of a volunteer is as simple as the offer of a sympathetic ear.

This personal dimension of kindness and concern goes to the heart of VA health care. We are blessed to have volunteers who make life better for those who gave selflessly of themselves.

As we treat increasing numbers of Veterans at VA, our reliance on community support and involvement continues to grow.

Actor Lou Diamond Phillips, a dedicated Veterans’ advocate, is VA’s 2017 National Salute Chairman. In 1993, he was the recipient of the Oxfam America Award for his dedication to ending world hunger.

Want to Volunteer? Here’s how.

The VAVS program is a key link between Veterans who seek care with VA and their communities. It is an avenue through which every citizen and organization can show our Veterans, young and old, that America cares and remembers.

You can volunteer to show your support and commitment to the men and women who preserved our freedom yesterday and serve freedom’s cause today. It is through the sincere dedication of volunteers and trusted partnerships that allow us to live up to the VHA mission of “Honoring Service and Empowering Health” of Veteran patients nationwide.

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A Journey to Vietnam, and Reconciliation

Steve and Ron with Ky, who invited them into her home as they were walking by

Steve and Ron with Ky, who invited them into her home as they were walking by

What happens to soldiers’ hearts when they return home from the battlefield?  Recent research suggests that Veterans, especially Vietnam Veterans with posttraumatic stress disorder (PTSD), are at a higher risk for heart disease.  Veterans who have experienced the atrocities of war also are at great risk of being morally wounded.

While PTSD and moral injury are often connected, they arise from very different sources and have different symptoms.  During deployment, Veterans can be placed in military situations that severely compromise and violate their moral code of values.  Soldiers must kill to survive and often innocent civilian are harmed during conflict battles.

Unfortunately, treatment for soul repair from moral injury is not always available due to limited services, lack of information about the problem, lack of clinician understanding and indecision about the best treatment.  Reconciliation around moral injury issues can be healing when the Veteran can safely explore deep emotions with a supporting community.

“You are either numb or embrace your entire emotional experience. You can’t unfreeze half an ice cube.”

This month a group of Veterans, VA providers, and academics met in Vietnam for a spiritual pilgrimage to process recovering from the Vietnam War.   The team traveled from the United States with the non-profit organization Soldier’s Heart (

The tour guide, Song, was a South Vietnamese soldier who was imprisoned for 2½ years and who was the bridge to translate the war experience between the Americans and the Vietnamese.  Their reasons for voluntarily committing 16 days of travel varied, but all members wanted to support each other in achieving a sense of peace, forgiveness, and acceptance.

The Veterans came to revisit the country that was destroyed by their actions and to make amends with local Vietnamese for long due atonement.   Those who were witnesses to the reconciliation journey of the Veterans hoped to offer consistent emotional support, new friendship, humor, enjoyment, honesty, and comradery.  Both Veterans and civilians explored how to share and carry the burden of the impact of war.

The joint pilgrimage allowed the Veteran to share the moral burden with civilians who had a symbolic part in sending soldiers to war and were impacted by the war at home.  All members of the therapeutic community could work through their grief about the war, but the primary goal of the community was to share the pain and burden of loss and grief due to the Veteran’s wounded soul.  By using this model, no one person would be crushed with the suffering.

Facing the Enemy

Veterans who returned to Vietnam had been stationed in the Mekong Delta, had served in the Saigon region, had operated their base camp above the Cu Chi tunnels, and had wandered through the A Shau Valley during the period when the battle of Hamburger Hill was fought.  Feelings of anger, guilt, shame, and grief had long been carried by these Veterans.  Upon returning to Vietnam, all Veterans required great courage and resilience to prevent from being drowned by the return flood of painful emotions.

The Veterans were committed and willing to be vulnerable and to embrace the entire reconciliation process, despite the emotional pain it involved.  The witnesses were committed to being fully present to the process of healing and dealing with unexpected circumstances that may not occur in a typical therapy room or session.  As Dave, the VA psychologist said about the emotional process, “You can’t unfreeze half an ice cube.”

Some Veterans such as Bob, who toured in the Mekong Delta and Saigon in the infantry, had already weathered tough roads towards inner peace.  He acted as a leader to assist other Veterans to see the truth about working with anger, hate, and resentment when he counseled with such statements as “Rage and violability comes from me not being able to handle my emotions.”  He was integral to the process when he shared his wisdom by summarizing “Acceptance is the answer to all my problems” and “Until you look at it differently, the feeling ain’t gonna change.”

Making Peace

Steve, an army medic who was also a conscientious objector, was disillusioned about the purpose of the war and the ultimate destruction that occurred over a decade and struggled with guilt and shame.  He served in the battalion that fought in the battle of Fire Support Base Ripcord and his area of operations was close to the Battle of Hamburger Hill in the A Shau Valley.  For his reconciliation time, he chose to reflect on American and Vietnamese lives lost and especially on his comrades who were not spared in battle.

After reading a poem he wrote, he lit incense to honor the fallen soldiers as a blessed ritual.  Kay, a VA licensed clinical social worker immediately supported his pain by offering a hand-sized rock from the A Shau Valley as a symbol for working with guilt and shame differently.

Steve, who served in Vietnam as an Army medic, and a rock taken from Hamburger Hill 

He chose to allow the rock to be carried each day by a team member as he continued to work on his healing process throughout the trip.  This embodiment and metaphor of the burden of his pain was symbolic and healing for Steve, other Veterans, and the supporting community at large.

Steve was able to receive this community gift at his AO, which had been transformed into a sacred space.  As Steve softly cried, Kay reminded him to remember he was a courageous, caring soldier with good moral values and that he still walked with those same, consistent values.  She chanted for all souls to hear “Don’t lose that. Don’t lose that piece of you, despite all you lost.”  Susan, a VA nurse practitioner realized after witnessing the ritual and community support that “Tears of sorrow can form tears of laughter and joy when transformed with healing.” 

Later in the day, Steve mentioned he planned to learn the art of sculpting in order to work with the pain of guilt and shame using his hands to transform it.  This example illustrated the ability of a Veteran to reset a past experience into a new framework within a community that willingly offered acceptance and forgiveness.  It also demonstrated that being “stuck” with trying to process moral injury can be used to learn to do something differently.

Reconciliation and VA Care

The reconciliation work done by the Veterans in Vietnam mirrors the clinical therapy offered in some VA clinics called “Acceptance and Commitment Therapy (ACT).”  As Steve mentioned to the group, “You can’t hate someone else without hurting yourself.”

Deep emotional wounds such as hate can be painful to process but using a model such as ACT can assist with being able to sit with unpleasant feelings, and looking at truthful responses.  This process ultimately allows the Veteran to choose to live a life of value that matters to the individual, despite the experiences or emotions existing around them.  Practicing acceptance and forgiveness in a supportive community can assist the Veteran to learn how to sustain this behavior throughout a lifetime and create a different way to live with the trauma experiences. 

In addition to forgiveness, other Veterans such as Bob found healing because he “was putting away my survivor’s guilt and processing my grief.  I was seeing things from a human side on both sides of the war.”

As the literature suggests, Veterans with moral injury also struggle with feelings of guilt and shame.  The reconciliation trip to Vietnam Veterans from the Vietnam War, Veterans from other military war zones, and VA service providers from many parts of the country was proof that connecting with empathy, building relationships, listening to personal narratives, and working with an open heart are key treatment ingredients to the reconciliation process.

A Vietnamese civilian mentioned at a conference in Saigon, “Karma brought us together in the war but karma can join us together for healing and peace.”  The reconciliation and healing process is about being willing to look at a perspective and move to an internal place of acceptance.  This internal shift is often followed by willingness to experience and release emotions and ultimately may bring a different kind of peace.  This healing process can happen where the moral injury occurred or in a clinic setting.  The Veteran and committed witnesses need to form a supportive community for the process to lead to miraculous change.

A Vietnam prisoner of war remarked “You have got to learn to have a good heart.”  Hearts can be under attack, physically or emotionally during war but heart healing along with the soul requires a village of peaceful, loving individuals.

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Army Veteran Spends His Days Comforting the Dying

Images of Julian Scadden at the bedside of a dying Veteran.

Army Veteran Julian Scadden provides a comforting presence to Veterans on the Denver VA’s hospice unit.

Photos by Daniel Warvi, Denver VA Public Affairs

Julian Scadden, by his own admission, was not always all that likable.  He had some rough edges.

“I didn’t use to be a nice guy,” he said. “In fact, I use to be a bouncer.  I would take out my frustrations by throwing guys out of the bar.  I’m 5-foot-4 and I just loved throwing big guys out of the bar.”

But that was a long time ago.  The 67-year-old Vietnam-Era Veteran now spends his days doing quieter work.  He’s a housekeeping aide at the Denver VA’s Community Living Center. But his custodial skills are not his primary contribution to the hospital.   Over the last nine years Scadden has developed another skill:  comforting Veterans in their final hours.

Good Instincts

“Julian is an incredibly important part of our care team here,” said Dr. Elizabeth Holman, a palliative care psychologist who works with Scadden. “He has an instinct for what people need when they’re nearing the end.  Sometimes they just need his quiet presence.  Sometimes they need words of encouragement.  He’s just so ‘present’ with these Veterans.  He makes them feel safe.”

“He’s so humble…he doesn’t realize the tremendous value of his services, and of his heart.”

She continued:  “It makes such a difference, to spend your last moments with someone who is kind and caring. And it’s such a comfort to family members, knowing that their loved one wasn’t alone when they died.” 

“I didn’t think I would be any good at it,” Scadden admitted. “I didn’t think I could handle it. But they give you training.”

Scadden’s training, however, got off to a rough start.  At one point his trainers began to wonder if he really had the ‘right stuff’ to become a member of the Denver VA’s Compassion Corps  —the volunteers who spend time with dying Veterans. 

“They had their doubts about me,” he said.  “During training they told me I was doing everything right except one thing.  I said, ‘What’s that?’  They said, ‘You have to learn how to talk to people!’”

It was a sad truth.  Scadden’s people skills had become a bit rusty.  He had plenty of compassion, but it was hidden somewhere deep inside where no one could see it.

“I had to learn to be polite,” he said. 

And so he learned. 

Images of Julian Scadden at the bedside of a dying Veteran.

Of Ducks and Water

“I’m glad they were patient with me during the training,” said the Army Veteran.  “Once I completed the training they just put me out there and I took to it like a duck to water.  And it’s made me a better person, to be honest with you.  I think this is my calling.  This is what my higher power wants me to do.”

But not all patients — even those who are dying — believe in a higher power.  And that’s okay with Scadden.

“My very first patient didn’t believe in a higher power,” he recalled. “But about a week before he died, he told me to thank my higher power for allowing me to be there with him.” 

Scadden said that during his nine years of hospice work he’s seen some patients get very angry at what’s happening to them.  Some get mean.  Some get abusive.

“You see every kind of scenario,” he said.  “Some of them are just scared, or confused.  They don’t want to die. They’ll ask things like, ‘Why me?’   They feel like they’ve led a good life, and they don’t understand why they have to go through all this suffering.”

Other patients, as the end nears, slip quietly into a coma.  Scadden said this can be unsettling for some family members, who feel they can no longer communicate with their loved one.

“Just because their eyes are closed doesn’t mean they can’t hear you,” he said.  “I try to explain that to the family.  I tell them, ‘Talk to him, tell him you love him, because he can still hear you.”

To learn more about how to become a volunteer at a VA near you, visit

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VA Giving Strength to Couples in Crisis

Image of a group therapy session featuring both men and women.

Group therapy sessions allow Veterans enrolled in the Baltimore VA’s Strength at Home Programs to talk about their emotions in a safe place.

Are you in a violent relationship?  Are you scared of your significant other?  Or is your significant other perhaps scared of you?

If so, VA has a program called Strength at Home that may be able to help you.

“Veterans appear to be experiencing higher rates of physical or verbal abuse in their relationships,” said James Haskell, a social worker and group therapist with the Baltimore VA’s Strength at Home Program.  “The military trains you to react quickly to a threatening situation when you’re in combat.  But in a relationship, reacting quickly isn’t always the best option.”

Anger in a Bottle

Haskell said Veterans can sometimes have a hard time counting to 10 before saying or doing something they’ll regret later.

“Stigma associated with this problem prevents many men from coming forward and seeking help.”

“Chances are you have a short fuse because you’ve been bottling up all your emotions in an effort to maintain control,” he explained. “But then something triggers you —an argument with your spouse tends to be a major trigger— and so you experience a sudden and sometimes violent loss of control.  Our Strength at Home counselors teach you how to communicate more effectively, how to open up and share your feelings before they overwhelm you.”

Haskell said it can be difficult for men to admit they’ve engaged in any form of intimate partner violence, which is why Strength at Home group therapy sessions are so valuable.  “When they’re in a safe place, it becomes easier to talk about it,” he said. “And once they open up, their anger and frustration gives way to a feeling of hope.  They feel hopeful because they’ve begun the process of changing themselves.”

Dominate and Destroy

Kirby, who served 18 years in the Air Force, said his military training left him ill-equipped to explore his feelings and share them with others.  “Problem-solving in a relationship is different than problem-solving in combat,” he observed.  “The goal of combat is to dominate and destroy.”

A recent graduate of the program, Kirby said he now feels he has the tools to lead a calmer life, which means calmer relationships.  “The best part of the Strength at Home program, for me, was having a roomful of six or seven other Veterans I could talk to,” he said. “We could share our stories with each other, encourage each other, learn from each other.  I felt very supported.”     

    Julia Caplan

Julia Caplan, who runs the Intimate Partner Violence Assistance Program at the VA Maryland Health Care System in Baltimore, said there’s a big difference between a relationship with communication issues and a relationship with violence.  “They are very different experiences,” she said.  “While poor communication is one aspect of violence, the problem is much larger, more pervasive and more insidious with elements of fear, intimidation and control.”

She added: “VA can help you whether you’re the partner experiencing violence or the partner using violence.”

The Arguing Type

Aaron, who was discharged from the Army after being wounded in Afghanistan, said he was in a dark place after returning home to the U.S.

“My wife and I were both the arguing type,” he admitted.  “I never got violent with her, but we argued a lot.  I felt like I was out of control.  It was very hard on her.  One day she told me that we weren’t going to be together anymore if something didn’t change.”

Aaron said he began isolating himself so much from his family that his daughter Leah, only one-year-old at the time, barely recognized him as her father.  “She wouldn’t look at me anymore,” he said.  “I felt lost.”

Strength at Home counselors teach Veterans how to communicate what they are feeling before those feelings become overwhelming.Strength at Home counselors teach Veterans how to communicate what they are feeling before those feelings become overwhelming.

It was right around this time that Aaron’s wife received a call from the Baltimore VA and learned about the Strength at Home Program.  “I let my wife take the lead and sign me up for the program,” Aaron said.  “I saw right away that it was a very good thing.  I felt like the other Veterans in my group were supporting me.  They were going through the same thing I was.”

With his anger now in check and some new communication strategies under his belt, Aaron has been able to begin mending his damaged family relationships.  “It’s like night and day,” he said.  “And I have my wife to thank because she’s the one who got me in the program.  She’s my hero.  She was very brave because I was a tough case.”

To learn more about Intimate Partner Violence and how VA can help, visit the National Center for PTSD at or go to

If you are in a violent relationship and in need of immediate help, contact the Veterans’ Crisis Line at 1-800-273-8255 or the National Domestic Violence Hotline at 1-800-799-7233.

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Honoring the Voices and Experiences of Veterans

Writer-Editor Rebekah E. Rickner interviews Veteran Richard Brye

Writer-Editor Rebekah E. Rickner interviews Veteran Richard Brye

The “My Life, My Story” project lets Veterans share what they would like their VA care team to know about them as a person. After a story has been approved by the Veteran, it is added to their VA medical record. Here is Veteran Richard Brye’s story.

“Somebody boil some water!”

Following college, I enlisted in the Army and was selected for a top-secret mission in a new unit within the Defense Department. 

“I was presented with the Chief’s crossbow and arrows which I still have.”

I was assigned to an operation in Vietnam where I developed a cover as an agricultural advisor. I was able to establish a covert intelligence collection operation working with an indigenous, primitive, mountain people called Montagnards who also provided security at my compound.

In December of 1966 a dental technician was sent to treat some of our personnel. A few days before Christmas, when the technician was to leave, monsoon rains developed and prevented him from returning to his ship. On Christmas Eve, we were getting ready to shut down operations. I had already prepared some vodka gimlets and put those in the fridge, when my interpreter informed me that a clan of Montagnards were heading toward our compound bearing a litter with a girl who was attempting to deliver a baby in the breach position.

When the chief of the clan said he needed my help my first thought went back to my younger days when I used to watch cowboy movies. Whenever a woman was about to give birth they always said, “Somebody boil some water.” That was really the first thing I thought. I was stuck. Then I remembered the dental technician. We frantically got on our shortwave radio to contact his ship. We were told we would have to perform a cesarean section but the only equipment we had were several scalpels and a little bit of Novocain.  

We agreed to attempt an episiotomy. Our generator didn’t have an extension that would allow us to use it in the annex where the girl was so we had to use flashlights. While the technician was performing the procedure I had to run back-and-forth, between the annex and the radio, relaying information. Eventually she delivered a little boy. For antiseptic I used the contents of a half a bottle of vodka.

A Ceremony to Thank Me

A month later the entire Montagnard clan was heading up towards the compound. The men were dressed in full military regalia. They wanted to perform a ceremony to thank me for assisting with the birth of one of their clan’s people. More specifically, the chief wanted to make me a blood brother by slitting both his wrist and mine and co-mingling our blood. There was no way I wanted that to happen because my first thought was of contracting any of the diseases they may have – the hepatitis alphabet came to mind.

I asked if he would consider an alternate ceremony whereby we would place several drops of our blood into the soil of the compound’s garden.  Luckily he agreed and removed his ceremonial sword, slitting his wrist and mine. He then removed an arrow from his crossbow’s quiver and stirred our blood together in the soil. I said to him, “This way, my blood and your blood will forever remain in the soil of your homeland.” 

As a token of their appreciation, I was presented with the chief’s crossbow and arrows, which I still have to this day. 

We were essentially sent to South Vietnam to eliminate an enemy.  I never once thought I would be sent there to assist in helping to deliver a baby. That certainly was an unexpected consequence of war. 

Writer-Editor Rebekah E. Rickner: The primary goal of My Life My Story is to honor the voices and experiences of our Veterans by sharing their stories with their VA care team and families. 

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