‘Getting better is scary’: Women veterans with PTSD

For Erica Slone, the choice boiled down to a simple equation: Die. Or go to Fort Thomas.

In early July, she pulled into the parking lot of the Cincinnati VA’s Trauma Recovery Center in Fort Thomas. She stood outside studying the formidable brick building. She had a lot riding on this place.

Slone had arrived after years of suffering. In 2003, barely a year into her Air Force enlistment, another airman raped her. She told no one. She pushed on through her 6-year hitch, earning a rack of medals and serving in Iraq. When she got out of the service, she earned an art degree.

Through it all, she fought to block the memories, even as every moment of her life demanded hyper-vigilance.

At last, the trauma broke within, and the war against intrusive thoughts, anxiety and dread went badly. Slone ended up in a VA hospital planning suicide. Then a bed opened in the residential treatment program at Fort Thomas. She was doubtful. But she wanted to function in society again. So she walked inside.

In confronting post-traumatic stress disorder among military veterans, the Cincinnati VA Medical Center and its Fort Thomas Division stand as important battlements. Last year, more than 5,000 of the 43,000 veterans in Greater Cincinnati received treatment for PTSD at the medical center’s main campus, the Fort Thomas facility and six area clinics.

Psychologist Kathleen Chard directs the VA’s Trauma Recovery Center. She is bullish on bringing PTSD under control as she oversees three residential programs for veterans – for men, for veterans with traumatic brain injuries and for women.

When the Fort Thomas program for women opened in 2007, it was just the third in the nation. The main reason women veterans seek PTSD treatment is for enduring military sexual trauma – a VA term that includes rape, assault and sexual harassment while in service.

Recent research reveals the shocking level of military sexual trauma and the risk of suicide among female veterans. A study released in July of veterans of the Afghanistan and Iraq wars found that 41 percent of women and 4 percent of men experienced military sexual trauma.

In June, the VA released disturbing research showing that the suicide rate among young women veterans is nearly 12 times the rate of non-veterans.

No such thing as cure, but there is recovery

There is no cure for PTSD. But, “for 70 percent of the people who walk out of here,” Chard said, “their symptoms are relieved to the point where you can say they no longer have PTSD. And the other 30 percent are doing better overall.”

Chard and the Cincinnati VA bring to the treatment room an insistence on talk therapies with clinical results. Chard has trained psychologists now working across the country to use two proven techniques that can be adapted in almost a dozen ways not just for veterans but to help couples and children.

Prolonged exposure has the patient talk about the mortally dangerous situation over and over, desensitizing the brain. Cognitive processing therapy does not require a retelling of the event but an examination of high-alert responses: Does this smell really mean danger? Does that person really mean me harm?

“Cincinnati is distinctive in its use of, and integration of, evidence-based practices into clinical care,” said Paula Schnurr, executive director of the VA’s National Center for PTSD. “At Cincinnati, there has been a very thorough integration of these treatments into the programming, coupled with the use of validated structured assessment measures.”

Chard has been so successful that a year ago, she opened the UC Health Stress Center for civilians, financed by $750,000 from the foundation of Cincinnati Reds star Joey Votto.

The Fort Thomas residential program takes 10 women at a time. Most have finished their service, but some are on active duty. Last month, three women in the program agreed to talk to The Enquirer once a week, with Chard present. Bea Myers, 55, is from Martinsburg, West Virginia. Barbara Fleming, 59, came from Raleigh, North Carolina, and was on her second trip through the program. Erica Slone, 33, grew up near Cambridge but lives in Chicago.

“I’m still withholding judgment,” Slone said early on. “I’m still getting to know everyone.”

“And that’s important,” Chard said, “because too often, PTSD patients just right away see everyone is a threat. The fact that she’s withholding judgment? That’s exactly where I want her to be.”

A ‘quilt’ of emotions in the treatment room

Slone, Fleming, Myers and the seven other women in their cohort at Fort Thomas would undergo cognitive processing therapy in group and individual sessions. They did homework to challenge their triggers or “stuck points,” the mental hurdles that block their ability to deal with everyday events.

To start, the therapists asked the women to write words or draw pictures of their emotions on sheets of construction paper that were taped to the wall of the group room as a “quilt” of interior battles. On one piece of paper, Bea Myers wrote: “Angry. Sad. I don’t want to be here.”

In early interviews, Myers’ voice rarely rose above a whisper. Fleming’s gaze drifted around the room. Slone could not make eye contact. Their faces radiated pain. Even the people closest to them didn’t understand what was happening to them, the women said. An ever-present option had been suicide.

But they wanted to get well. And they wanted to speak out so that others could learn from them.

“There are a lot of people out there feeling terrible,” Myers said. “If this can do some good, then, I’m willing.”

Not long after Bea Myers joined the Army in 1980, other soldiers gang-raped her. She reported the assault, but no one believed her. She became pregnant but lost the child, and that sorrow filled her life. She was stern to her other children, sometimes used physical force with them. In her mind, the child she lost died over and over and over.

“I need to let go,” said a weeping Myers. “But how can I let it go, when I feel like I caused it, my child’s death? I didn’t mean to cause it. How can I trust someone, when somebody in authority did this to me? When I accepted what they did to me?”

Barbara Fleming once was a bubbly cheerleader type, the one who organized all the parties. She enlisted in the Army and served 13 years. She was raped by another soldier and intensely verbally harassed by others. She went into the combat zones of the Persian Gulf and Somalia. When she mustered out and went home to North Carolina, Fleming said, “I stayed locked up in my house all the time.”

“My sister, my family kept trying to get me to leave, but I couldn’t do it. I was sure that all men looked at me as a sex object, and I couldn’t stand it. I couldn’t trust any man. Not any single man.”

Erica Slone enlisted as part of “the poverty draft” to escape the hardship of southeastern Ohio. With her art degree, she used her creativity to explore her own story. She won a fellowship at the National Veterans Art Museum in Chicago. Yet her anger deepened. At the NATO summit in Chicago in May 2012, she joined a demonstration by Iraq veterans and threw her medals away.

Her PTSD kept her on high alert. “All the time, people would be doing ignorant things, and I would be scared that they’re using the equipment wrong, or standing in a water puddle. Yeah, big red flags, safety issues. When I’m driving down the road and there’s a tree or a bush obstructing a stop sign, I flip out.”

The price of being human, and when it is too high

Post-traumatic stress is the price of being human. When a threat arises, a region deep in the brain called the amygdala directs the first response, without conscious thought: flee, fight or freeze.

After the acute crisis passes, the brain’s executive processor, the prefrontal cortex just above the eyes, adapts to new conditions, puts the threat in context. The fear response decreases. Life goes on.

But in some people, the amygdala overrides higher-level decision-making. PTSD locks in a constant loop of flee-fight-freeze, a crippling condition as the sufferer avoids anything that could amplify the anxiety. Avoidance can last years, and the effects cascade through the body, in depression, high blood pressure and cardiac problems.

“The problem for many people,” said Chard “is that they don’t like the option that the amygdala chose. So they’re very upset that the man froze on the battlefield, or the woman didn’t fight back. Part of what we’re doing is having to teach society that this really isn’t a conscious choice. It’s the amygdala responding.”

Breakthroughs in PTSD research are now appearing at the genetic level. The Cincinnati VA Medical Center and Chard are on the forefront there as well.

With the help of Mason biotech company Assurex Health, Chard is leading VA efforts to learn whether there are genetic reasons that some people develop anxieties that last for years, and some do not. Last year, the VA announced that it would pay for veterans to use Assurex Health’s GeneSight test. Developed in Mason, the test can determine, using a patient’s DNA, which of 38 psychoactive drugs work best.

Assurex Health donated 100 tests to the Cincinnati VA, and in time, Chard hopes to use the results for deeper research about the genetic component of PTSD.

Facing the life to come, outside the program

Weekends at Fort Thomas constituted free time, and therapists encouraged the women to get out into the community. Myers found a hair salon that she liked.

Fleming got on a bus that crossed the Ohio River and dropped her off at Fountain Square. She worried about the crowds. But as she sat in the heart of Cincinnati, she examined her stuck points and realized, “This is fine. I can handle this. This isn’t bad.”

Slone painted with watercolors. One weekend day, she, too, got on a bus, and spent much of the trip watching a woman standing in the aisle, holding onto a bar, swaying as the bus moved. Later, Slone talked about her anxiety for that woman’s safety.

The widespread prevalence of the acronym after the wars in Iraq and Afghanistan leaves a false impression of a PTSD epidemic. Chard said in fact, more people, particularly Vietnam War veterans, have realized that they’ve avoided dealing with their traumas for decades and at last are seeking treatment.

As their stay in Fort Thomas neared an end, Myers, Fleming and Slone said they knew they were improving. Fleming felt refreshed in her certainty that she could face life, and she decided to move to Fort Thomas. In her last week of treatment, she rented an apartment. She hung the keys on the lanyard around her neck and proudly jingled them.

“I was sitting on a bench right out here” – Fleming gestured toward the strip of shops on South Fort Thomas Way – “and I said hello to people. I realized that not all men see me as a sex object. This is going to be an adventure for me, and I’m really looking forward to being by myself.”

For her final interview, a smiling Myers arrived at Chard’s office with a fresh hairstyle and a notebook. She had written a letter to her dead child. She had discovered that, for all the tears over that death, she had never faced the trauma of the rape. Through talk therapy, she said, that event no longer controlled her.

“I didn’t think that book stuff that you read about was true,” she said. “But (the rape) was something that was buried for many, many years. And my children had to deal with that, too. My son who is living said he didn’t think that I loved him. We’ve been talking a lot. We’ll be fine.”

The program, Myers said, “definitely works. Because I was a hard cookie to crack.”

Erica Slone let herself feel confident. But she wasn’t sure what that would mean for her. “Getting better is scary. At first, it feels like I’m being negligent, or irresponsible. Eventually, I realize that it’s closer to normal, to not be worried all the time.”

On graduation day, the group therapy room filled with the women who had made a journey together. Bea Myers pulled down her piece of construction paper where she had first written “I don’t want to be here.” On the other side, at the end of the treatment, she wrote: “Congrats 2 Everyone.”

Barbara Fleming read a letter she had written to her “friend,” PTSD: “I can live without you. I’m healed, and I’m ready to show the world.”

The therapists praised the women for their courage and handed out completion certificates. The women hugged, wished each other luck, promised to stay in touch. Erica Slone gave away her watercolors. She loaded her belongings in the truck of her car. She took one more look around. Then she drove away.

On Monday, another group of 10 women veterans arrived at the big brick building in Fort Thomas and went inside, looking for the way to stay alive.

Resources for PTSD sufferers

Experts say that post-traumatic stress disorder is present when someone is experiencing these symptoms that last longer than three months, cause great distress and disrupt home or work life: reliving the event; avoiding situations that remind you of the trauma, having negative changes in beliefs and feelings and feeling keyed up.

For help, call:

The Veterans Crisis Line: 1-800-273-8255, press 1 (text 838255) or Confidential Veterans Chat with a counselor

The Trauma Recovery Center, Fort Thomas Division, Cincinnati VA Medical Center: 859-572-6208.

UC Stress Center: 513-558-5872