Everyone Take Note
May is Mental Health Awareness month in the United States. I make no secret on this blog that I struggle with depression and anxiety linked to Post Traumatic Stress (PTS). Just the opposite, I shine a light on those issues and their interplay with my pensionable career whenever practical. Furthermore, I try hard to discuss themes and subjects which I believe are common among anyone in a similar situation. I do that to foster conversation with other pensionable workers who might also struggle from mental health issues linked to their careers.
It’s also no secret that I’m retiring this year, which means I will soon become a veteran. As a result of my pending veteran status, and everything I just listed above, I spent some time researching veteran mental health statistics and issues. A portion of this article covers those findings, which I share in the hope that it prompts robust discussions in your professional and/or personal lives. The other part of this article discusses some of the steps I’ve taken to make sure my mental health issues don’t impede my retirement.
Some Depressing Facts
As of 30 September 2018, the U.S. Veteran’s Administration (VA) reported 1,035,269 veterans received compensation for Post-Traumatic Stress Disorder (PTSD). That’s across all living veterans from all wars since World War II. In their August 2015 report entitled “A Guide to U.S. Military Casualty Statistics: Operation Freedom’s Sentinel, Operation Inherent Resolve, Operation New Dawn, Operation Iraqi Freedom, and Operation Enduring Freedom” the Congressional Research Service reported that 138,197 service members from those operations received an official PTSD diagnosis from the military healthcare system. They even made a graphic with bars representing deployed and non-deployed diagnosis per year. I’ve cut and pasted it below:
I found some other banner numbers for veteran mental health on The National Council for Behavioral Health’s website. They set-up a page devoted entirely to veteran mental health. That said, not all of their points cite sourced data, so it’s hard to judge their accuracy. Taking them at face value, however, they paint a disturbing picture:
- 30 percent of active duty and reserve military personnel deployed in Iraq and Afghanistan have a mental health condition requiring treatment – approximately 730,000 men and women, with many experiencing post-traumatic stress disorder (PTSD) and major depression
- Less than 50 percent of returning veterans in need receive any mental health treatment
- Lengths of deployments are associated with more emotional difficulties among military children and more mental health problems among U.S. Army Wives
- The Veterans Administration reports that approximately 22 veterans die by suicide every day
More Depressing Veteran Mental Health Facts
The suicide numbers that the National Council cites are depressing but interesting since they imply a direct connection between mental health problems and suicide. In slight contrast, a 2018 VA commissioned study reported that while 6000+ veterans a year committed suicide between 2008 and 2016, not all were linked to mental health issues. In fact, according to the study, the 2016 suicide statistics showed that veterans suffering from (and seeking medical help for) “mental health challenges, substance use disorders, chronic medical conditions, and chronic pain” all ran an increased risk for suicide.
Thus, let’s not conflate the two issues (suicide and mental health) entirely. I’d rather acknowledge that the veteran suicide rate is uncomfortably high, and in some percentage of the cases, mental health and suicide are inextricably linked. As a result, it’s probably worth noting these other Veteran suicide statistics compiled by the VA:
An Unwanted Trifecta
Anyone here ever bet on horse racing? Well, there’s one trifecta that no Iraq or Afghanistan veteran should ever want to hit. Unfortunately, an unknown percentage will. As the VA webpage on depression notes:
A 2015 study by researchers at VA’s Translational Research Center for TBI and Stress Disorders at the VA Boston Healthcare System identified three such conditions that cause the greatest level of difficulty in Veterans when they occur together. The three conditions are depression, PTSD, and traumatic brain injury (TBI). Patients with those conditions, which the researchers call the “deployment trauma factor,” have higher disability scores than those with any other three-diagnosis combination. The disabilities measured include difficulty in getting around, communicating and getting along with others, self-care, and other daily tasks.
Given those findings, it seems reasonable to state that some cases of TBI are inextricably linked to veteran mental health issues like depression. That shouldn’t come as a surprise since physical trauma to the brain can impair any number of cognitive functions. As a result, it’s probably worth noting that the aforementioned Congressional Research Service report listed 327,299 TBI incidents between 2000 and the first quarter of 2015 among the U.S. military as a whole.
Any Good Mental Health News for Veterans?
There is some good news. A 2015 Palo Alto VA Health Care System study of 6577 male veterans, aged 50 years or older, found that the Veterans were no more likely than non-Veterans to suffer from depression or anxiety. In fact, the anxiety and depression rates for the 50+year-old veterans were slightly lower than the non-veterans. However, within the 50+year-old veteran cohort, Vietnam vets were twice as likely as Korean and World War II vets to suffer from anxiety or depression. The study, unfortunately, did not cover OEF or OIF veterans.
Depression is a tricky and particularly dangerous issue. Several medical risks are linked to depression through either causal or corollary factors. Top of that list is a 40% higher likelihood for heart attacks among depressed vets. The good news here is that proper diet, regular exercise, and abstinence from tobacco can all help to combat heart disease and depression.
One other note of good news is that the VA, the Department of Defense, and the nation are dedicating a lot of resources to mental health diagnosis and treatment for both its veterans and active duty members. That doesn’t mean everything is great, or that everyone in need gets the help they need. In fact, anyone who read part 1 of my lessons-learned article about the first phase of my retirement preparations will remember the long list of issues that continue to plague the VA. But, people and organizations are trying to make a difference.
As with most health issues of this magnitude I’m sure they could always use more help, resources, and support. If you’re interested in helping, check out this site.
What Led Me to Research All of This?
You may find this hard to believe, but I didn’t just start researching the above-cited statistics for fun. Nor did I do it just because May is Mental Health Awareness month. I did it because Grumpus Familias (i.e. my family) has been all too aware of my mental health status since January. That’s the month my latest attempt to permanently wean myself from psychotropic medication failed.
It doesn’t matter how many cups of coffee you drink, the research I just did wasn’t any fun.
No one panic! The process took place under proper medical supervision. I’m not talking about Chevy Chase and Dan Akroyd “Spies Like Us” medical supervision either. No, I had the real deal, a late 20-ish to early 30-ish military psychiatrist on her second tour in the military — which actually is a good thing. A doctor that young isn’t nearly as jaded as older military doctors. Quite the opposite, my doctor is full of enthusiasm and concern for her patients. It’s not her fault that I didn’t get the result I wanted. In fact, she duly cautioned me on the low chance of success when I began the weaning process. It’s just unfortunate that my efforts inflicted so many negative effects on my family.
It’s not like the weaning process progressed without warning signs. At every step down in dosage, I experienced my old (pre-medication) behaviors slipping back on the scene. Uncontrollable mood swings. Check. Overwhelming anxiety. Check. Sudden onset of sadness. Check. Grumpiness. CHECK! And, the worst, my quick flash anger. Double check.
I’ll be honest, these little fellers probably had more success weaning than I did.
The Home Front
Despite that, I completed the process without total emotional and mental self-immolation. However, once I was entirely off, it was perfectly clear to me (and everyone who lived with me) that my PTS-linked mental injuries had not healed. Don’t be fooled, that observation isn’t based on some great introspective feat. The signs were easy enough to spot. And, in case I missed those the signs, Mrs. Grumpus was there with daily reminders like “when are you going back on medication again?”
Just kidding, she only asked me three to four times a week during the first part of January. It only turned into daily questioning after I decided to repaint the kitchen one Saturday morning by smashing a milk jug against the floor … and the wall … and the refrigerator. Sigh. What can I say to explain that behavior? Nothing other than I’m sorry.
Back in the Red
By nature, I’m a quiet guy, and fairly unassuming. If you walked past me on the street, you wouldn’t pay me any mind. However, after my traumatic events, but before starting medication, bubbling just underneath the surface was a raging maelström of emotions. When my anger switch flipped, I literally saw red. If you were on the receiving end, you would’ve known it.
“I will come at you like a spider monkey, Chet!”
In contrast, when I took the full dosage of my earlier medication, that anger switch figuratively moved from being a big red button on my chest, to somewhere on a wall, in a dark room, that I was unfamiliar with. I could only find the switch with concerted searching after constant prodding from external forces. Once I was off the meds though, that big red button moved back to the center of my chest. Maybe it was a little rusty at first, making it a little harder to push, and maybe the response was a little less mean-spirited than previous, but not by much.
So yeah, as I ramped off the meds, I could absolutely feel shit slipping. Slowly, the mellow guy that I believed I had matured into over the past two-and-a-half years, faded; only to be replaced by that quiet but explosive personality waiting to go off. My fight, flight or freeze response was stuck in fight, and everything seemed like an attack.
That’s not a good thing! It meant every little thing that happened, especially in my family life, triggered a fight response. Kids cry = get angry and yell. Wife argues with me = get angry, yell, and smash milk jug. Someone at work disagrees with me = get angry and act mean.
Lesson(s) Learned
Yeah, but for how long?
Let’s look at the bright side, at least I wasn’t in jail or divorced at the end of January 2019. Also, I knew exactly where I stood from a mental health perspective as my last 8 months in the military started. Sound weak applause here. Actually, determining the severity of my condition was one of my stated goals for the experiment that was weaning myself off of medication. Just to prove it, and much like Austin Powers, allow myself to quote myself (from my Work, Mental Health, Disability, and Retirement Planning post):
On the other hand, if the ramp down doesn’t work, or if it turns out the original diagnosis was wrong, then I need to know that as well.
As I already stated, my current shrink prepared me for this potential outcome when I started to ramp down. While commending me on the effort it took to start the weaning process, she warned me that my case was probably worse than originally diagnosed. In other words, that D for disorder might actually apply to my case. Turns out she was right. Again, cue weak applause here.
The Back-up Plan
Fortunately, since she had anticipated the outcome, she and I had crafted a plan if I hit (psychological and emotional) rock bottom. That plan involved a different medication, with fewer side effects than my earlier medication. She also selected a medication that would help with my back and neck pain management efforts. Win, win!
As a result of that plan, by the end of January, even though I was mentally crashing and burning, I was already ramping up on new meds. I’m happy to say that this new medication is working as advertised. While my doc and I are still dialing in the best dosage, it’s already made a tremendous positive difference with both my mental and physical symptoms.
Let’s Write About Our Feelings Class
It’s important to note that there’s more to my pre-retirement mental health treatment plan than just the drugs — I mean meds. The way I see it, the meds provide the ability for my injured brain to operate (more) normally. They give me space and clarity I need to work through my issues in therapy. As a result, it came as no surprise when my psychiatrist referred me to a psychologist to begin Cognitive Processing Therapy (CPT).
This is my second round of talk therapy related to my PTS symptoms, but my first round of CPT. For those who don’t know, CPT is supposedly the gold standard for treating PTS. Or, at least that’s what I read on the American Psychological Association’s (APA) website.
To date, my CPT has involved a lot of homework — which, if you’ve ever been through therapy, then you know there’s always homework. For CPT, that homework takes the form of writing about your trauma. You also write about how you feel and act as a result of that trauma. Little does my psychologist know, but I already do that! Many of the original posts for this blog started as a release mechanism to discuss my PTS related issues. I’m totally going to ace this course.
You Down with CPT? Yeah You Know Me
Who’s down with CPT? Every last Homey!
All jokes aside. I’m truly looking forward to going through the entire CPT process. Not only do I hope to learn a thing or two about myself and my injuries, but I also hope it sets me up for a much happier and healthier retirement. That’s the whole point really. I don’t want retirement to suck. Nor do I want to be miserable, or make everyone around me miserable.
I view this new round of therapy much like I view my efforts at the pain management clinic. I’m trying to do everything in my power now to take care of the long-term medical problems that may impact me in retirement. I don’t want to carry them into retirement without developing effective tools and methods for dealing with them. Healthy methods and tools that is. I could take meds for both my mental and physical issues for the rest of my life and may have to, but I don’t want that to be the default option.
Despite that, the chronic issues may not go away completely, and I need to make peace with that reality. Most likely, I will never be the person I was before all this happened. Objectively, that’s OK. I chose to serve, which means I knowingly chose a career that ran the risk of permanent injury. Just because my injuries are mental, instead of physical, doesn’t mean I should treat that decision any differently. I’ll be honest though, I have yet to square that circle completely. While I tell myself that I have it way easier than a lot of service members, it doesn’t help that much. I waiver daily as to whether that makes me a bad person or just a person.
A New Hope
My sincerest hope is that as I transition into retirement from a military career in which 18 of my 20 years were spent at war, my PTS will fade. I hope retired life proves less stressful. All my jobs while in the military, save one, have directly contributed to the war effort. In fact, there’s no doubt that my current levels of stress, whether caused by the real or imagined pressures of my current job, are not healthy. Whereas some people line up a ROAD (Retired on Active Duty) job for their final tour in the military, I did not. Or, more accurately put, I decided to retire before lining my ROAD job. That isn’t to say that I hate my current job. In fact, I love it. I help to solve issues that will impact the nation continually over the next decade or more.
That said, I’m just not able to perform at the highest levels anymore. To put it in terms of a sports analogy, I’m literally retiring from the Yankees or Manchester United during a year that they make a run for the trophy. I’ve come to the realization that I’m no longer able or willing to perform at a level where I can contribute effectively to the cause. Thus, for the best of the team (i.e. my service), and the player (i.e. me), it’s time we go our separate ways. No hard feelings, it’s just the way of things.
Last Comments
Finally, let me make my standard mental health plea before I sign off. If you think you might have mental health issues, seek help. I speak from experience when I say that I fully understand the stigma placed on mental health issues in some pensionable career fields. Some people view asking for help as a weakness. That’s their problem, not yours.
Your problem is that you feel overwhelmed, bewildered, lost, angry, unsure, hurt, or any number of other inexplicable emotions. That’s understandable and not abnormal. Don’t let other people’s preconceived notions, or your own for that matter, interfere with getting the medical treatment you need. Do it for yourself or for your family — whatever motivates you — just get the help you need.
Don’t give up either. It takes work to heal. No one said it is easy, but it is worth it. Take my situation, I’m a work in progress with a long way to go. I keep slogging because I know it’s in my and my family’s best interest. That doesn’t make it easier in the moment, but it does make it worth it. With that in mind, I’ve listed some resources below if you don’t know where to start.
Resources
If you think you need mental health help: https://www.nimh.nih.gov/health/find-help/index.shtml
If you’re active duty or a veteran who needs mental health help: https://www.mentalhealth.gov/get-help/veterans
If you’re a veteran or active duty and you need inspiration or motivation to start: https://www.youtube.com/user/VeteransMTC
If you want to volunteer and help people with mental health issues: https://www.mentalhealthfirstaid.org/
Wow, what an amazing post. THANK YOU for shining a light on this national dilemma, my heart breaks for all of the Patriots of this country who struggle with PTSD and related issues. Too many don’t talk about it. Your transparency is invaluable, and I applaud you for your courage. Both in writing about what you’re going through, and for tackling your challenge with the right attitude. A sincere prayer that you’ll come through a better person. Thank you for your sacrifice for this country, I wish the country would better serve those who have served her. God Bless you and your family, enjoy your well-earned retirement.
Thank you for the sincere wishes Fritz! I try hard to fight the stigma that surrounds mental health issues. I do that by talking and writing openly about them. Little do you know, but you directly contributed to this article. I was struggling to write it, and the different themes weren’t coming together in the way I wanted. Then I read your post with your rules for blogging. It inspired me and gave me the direction I needed. It still wasn’t an easy post to write, but it came out much better because of your advice.
@Fritz, I just listened to your Choose FI interview. It was really good. I never heard of your site before, and then I hear the interview and see you here.
22 daily suicides by veterans. I would not think we have that many in the whole US. Thanks for posting this information.
Regarding children and spouses having difficulties, I can see it. I only deployed once, but was regularly in the field or some other assignment, and we assumed I was going away one more time. Prior to my wife’s military retirement, I was living away for more than a year. Add in her stress factors (job change, major relocation, having had a baby the year before, financial issues between my then low-paying job that was not very secure, marital stress from me working a second job, and who knows what else), and I may as well have been deployed the previous 14 months. Granted, I was an accountant in NY, not a marine in Iraq, but it was a lot of time to be apart, and wasn’t good for any of us.
A question for you: Was writing this helpful for you? If so, is it the actual writing, the heightened awareness of your situation, or perhaps that you can look forward in a different way after looking at how far you came?
Chris, I’m sure if you looked at a scatter plot of U.S. veterans by age there’d be a huge bell curve surrounding Vietnam era vets. You’re talking about a time in our country’s history when the draft was still in effect, and the U.S. military commitment in that country was almost 15 years in length. It probably makes the amount of U.S. personnel who served in Iraq or Afghanistan pale in comparison.
As far as time spent away from family, I think it sucks no matter the cause. I’m not deploying anywhere anymore, but I still hate going TDY back to CONUS from Hawaii. With kids that are young, any time spent apart seems like too long for me.
Was writing this article helpful to me? I guess in some ways, yes, all my writing is helpful. As I say on the front page of the blog, my writing is cathartic.
This specific article though only took on its true form, and therefore its particular meaning, once I started CPT. After CPT began, and I started to study stuck points, I realized that the original tone of the article was all wrong. By that I mean I was too judgemental of myself. It turns out that (no surprise) I’m my harshest critic. Therefore, a lot of the language I used in the original version of this article was counterproductive.
Not only that, but the original article centered too much on me, without the tie-in to the larger issue of mental health for vets, or for people working pensionable jobs. I wasn’t lying when I told Fritz that his article on the art of blogging helped me out. His lesson about making articles more about the reader, as less about the writer, found me at the right time. It helped transform the post for the better because I was able to rescope to address the larger issue of mental health, as opposed to strictly talking about “my” mental health.
Does that make sense? More importantly, does that answer your question?
Regards,
GM
Thanks. Yes, it does.
That’s a great post, thanks for your writing. It’s great to hear you’re thinking of New Zealand as a destination – suicide and mental health is something we have been grappling with down here. We are trying to talk more about these issues and I think it’s starting to change attitudes; I was meeting with some NZ farmers yesterday and we had a discussion about how depression and anxiety has impacted us. That would never have happened 5 years ago.
These sort of stories make a huge difference to people opening up and realising they are not alone in the darkness. Thank you.
Kia Ora, Mr. Simpleton, and thank you for liking the blog! I hope we get to meet someday soon. Sounds like you and I share some common interests, especially in the realm of helping people out. Please share my story if you think it will help, it’s the whole reason I write.
I just re-read this post again. I hope your symptoms have gotten better since then. I wanted to let you and your readers know about an exciting new treatment for PTSD that has demonstrated high effectiveness for PTSD – MDMA assisted Psychotherapy. It’s currently in Phase 3 (the last phase) of FDA approval. It has been shown to reduce symptoms in all those diagnosed with PTSD and for over 60%, completely eliminate the symptoms. Approval is set for 2022 or 2023, but it’s almost assuredly coming. You can read more about it here https://maps.org/news/media/8190-press-release-mdma-assisted-psychotherapy-may-have-lasting-benefits-for-ptsd,-results-published-in-psychopharmacology The first studies were done on combat veterans like yourself and first responders. It consists of three pretreatment sessions, then an MDMA session with two therapists, then 3 ‘integration sessions’ where you discuss what you learned with the therapists. This is followed by 2 more sets of medicine and integration sessions. MAPS has clinical trials that have restarted now and there are a few limited therapists who can do ‘early access’ sessions. Go to https://maps.org for more information. You deserve to feel well again. And thanks for writing this blog!
Extremely interested in this, JP. Thanks for letting me know! My symptoms have improved but not disappeared since retiring. Stress and I still don’t get along, but replacing military caused stress for academic caused stress was a move in the right direction.
Good day,
I listened to you on the ChooseFI podcast. I have a federal pension that vested a couple years ago. Also in my 2nd year as a federal employee I spent 6 months on FMLA with a new schizophrenia diagnosis. I’ve had to go on FMLA a couple more times and have been federally employed for 8 years. After another 7 years I should reach my FI number. I may also try to get SSDI and see if I can pull from my pension through the disability clause. Medicine does really well for me but it leaves me a ball of nerves and I’m also on anti-anxiety meds so I don’t want to work too many more years than I have to. However I might be too high functioning to receive disability from SSDI or my pension at this point but I could always go downhill later. That is why I’m saving and investing as much money as possible.
Brandon,
That sounds like a rough situation, far worse than mine. I’m sorry you’re having to go through it. While I’m glad you’re functioning with medication, I can understand why you would not want to work longer than necessary. I don’t know what line of federal service you’re in, but many of those jobs can be highly stressful. A stressful job probably doesn’t mix well with your diagnoses. It sounds like you have a good plan, though. How does medical disability work with FERS? Do they “own” all non-pre-existing medical diagnoses made while a worker is in government service?
Regards,
GM
To make things even more confusing I have an army naf pension which I ported. However the way I understand it, I can use the disability because I was diagnosed after I was emergency loved there. The policy documents are out there but it is funded past 100%. The formula is 1,2 times years times high three. So for me it would be approximately 1.2%(15)(80000).=14400.
Thank you for writing such an insightful post. That is some truly powerful stuff. Your ability to blend such sobering statistics with your own personal struggles while somehow managing to infuse humor, is truly impressive.
Personally, I wandered to your site because I remembered you were a good resource on pensions. Like many, I heard you on the ChooseFI podcast, as I was doing my deep dive into this FI world. I had burnt out teaching that year and needed to find an alternative. I took a year of leave, and am heading back with a renewed hope that FI will set me free way earlier than the 18 years I have left for a full pension (instead I think I have 5 left).
But I veered off and landed on this post and it also instilled me with a very healthy dose of perspective as well. And while I remain incredibly frustrated/concerned with the state of education (I’m not going to get started, but like you, I have started writing about it and found that to be quite cathartic), reading about your challenges shines a new less-intense light on mine.
Thank you and keep up the important work (on all fronts) that you are doing!
Thanks, Mister D!
After seeing your comment pop up, I re-read this article, and I agree, it’s powerful stuff — even though it’s three years old. In fact, the article may be the best I’ve written about pensionable career-related mental health issues. I’m glad it struck a chord with you, and hope it helps you in some small way to navigate your final years of teaching. You’re certainly not the first teacher I’ve interacted with who burnt out, and given the pandemic cause interruptions of the past few years, I doubt you’ll be the last. That said, I’m happy to hear that you opted to take time off in order to recuperate. I think time and space are two great methods for overcoming the anxiety created by the Golden Albatross conundrum. Employing the FI mind-set is also another great way, because it will get you out of the pensionable career earlier. In short, it appears you’re doing everything you can to effectively turn this situation to your advantage, so keep up the good work. Nonetheless, I’m here to help if you have any more questions or concerns.
I’m happy to say that my life is much better now that I’m retired. A lot of that has to do with lower amounts of stress in my life. A certain part of that stress relief is also due to a pension that provides for almost all of my family’s need. However, I also attribute a large portion of my current well-being to the work (i.e., therapy) that I undertook and described in this article. That work allowed me to navigate the first two years of retirement abroad, including a return to post-graduate studies, with few mental health relapses. I’m not perfect by many means, but I am better than before. At the moment, it certainly feels like remaining for my pension was worth it.
Regards,
GM