No one wants to talk about their feelings especially not to a therapist whose office is a plywood shack in the middle of Afghanistan.
Psychological wounds are becoming an increasingly prevalent concern among returning veterans and their doctors, with traumatic brain injury a wound that is not visible and often goes untreated, but can leave a victim a shell of his or her former self being described by some military medical professionals as the signature wound of America’s War on Terror.
But the stigma that, for decades, has trailed psychiatrists and therapists often deters servicemembers whose military culture emphasizes strength and courage from seeking help. About half of the Iraq and Afghanistan veterans who report symptoms of post-traumatic stress disorder or depression seek treatment, according to a 2008 study by the Rand Corp., a nonprofit research organization. The condition affects about 20 percent of servicemembers who have served in Iraq or Afghanistan, according to that report, which included 1,965 servicemembers from across the country.
One Navy psychiatrist has found a weapon to break down that barrier acupuncture.
“I used to say ‘Come for the needles, stay for the therapy,’” said Navy Capt. Robert L. Koffman.
Koffman, 58, of Silver Spring drew men and women to his hospital cot in Afghanistan with the promise that a few carefully placed needles would help them relax, release tension and sleep better. It was an offer too good to turn down “Nobody sleeps in Afghanistan,” Koffman said.
Koffman found that if he could get his patients to return for two or three visits, they would begin to talk about what was really bothering them, once he relieved their physical aches and pains.
“I blended the relief of suffering with help,” he said.
Now, Koffman is pricking patients at a new facility at National Naval Medical Center campus in Bethesda. The National Intrepid Center of Excellence, which began seeing patients in October, is designed to take a new approach to treating psychologic and stress disorders, such as post-traumatic stress and traumatic brain injuries. The Intrepid Fallen Heroes Fund paid for the $65 million, 72,000-square feet facility, which was later transfered to the Department of Defense.
The center operates like a retreat patients return daily for two or three weeks and receive treatment for between five and eight hours a day. And that treatment is unlike any other available on campus: yoga, breathing exercises, art therapy and heart math control (a way to control anxiety by controlling your heart rate), are among the standard offerings.
The center’s treatment options aim to empower patients, by helping them identify problems and teaching them ways to manage their pain.
“The holistic approach is looking at the person as to how each of the different things fit together. Instead of just treating neurology today, physical therapy tomorrow, it’s blended,” said James P. Kelly, the center’s director, a neurologist and expert on concussion treatment. “It’s actually very unlike what people associate with the military.”
Convincing people that different is good is not always an easy sell, but the benefits patients experience if they take a chance has kept them coming back. The center has helped about 100 patients since opening, Kelly said.
“A lot of the things you’d think they’d be resistant to or blow off are exactly the things they find they benefit from the most,” Kelly said.
Koffman is familiar with that struggle knowing his patients need help and knowing how to help them, but unable to if they don’t reach out first.
In Bethesda, Koffman sees about four patients a day for 20 minutes each. The rest of his day is consumed with administrative responsibilities that come with his title of deputy director of clinical operations.
Koffman talks about whatever his patients say is troubling them a phantom limb, a sore neck. He can only hope they will open up about what bothers them where his needles won’t reach. He knows the pain is there.
“No one goes to war without being changed,” Koffman said. “War traumatizes everyone in different ways.”