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Could Community Service Be the Answer for Veterans Looking to Treat PTSD?

By helping others, Michael "Doc" Piper has finally found a way to cope with his anger, nightmares, and flashbacks.
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Thousands of veterans suffering from post-traumatic stress disorder rely on the Department of Veterans Affairs for relief. They might be better served, however, if they tapped the hard-won wisdom of incarcerated Vietnam veteran Michael “Doc” Piper.

Piper knows, though the VA has yet to acknowledge, that community service could be the most effective treatment available for PTSD, a debilitating condition marked by nightmares, anxiety, flashbacks, pain, anger, self-blame, alienation, and depression.

Despite his confinement in Soledad Correctional Training Facility, a California state prison, 67-year-old Piper is a professional volunteer. From a 106-square-foot former broom closet with no Internet access, Piper helps fellow incarcerated veterans access VA benefits. By helping others, Piper says he’s been able to cope with his anger, nightmares, and flashbacks. But he’s not the only one who understands the power of community service.

Mission Continues, a St. Louis-based organization, is generating national attention, including a June 2013 Time cover story, for its success helping veterans who served in Iraq and Afghanistan integrate into society. It’s a dire need: The VA has treated nearly 300,000 veterans from those conflicts for PTSD symptoms, according to a November report. Mission Continues, which was founded in 2007 by a group of veterans, places veterans in six-month service fellowships in community organizations across the country.

Volunteering could cheer up sufferers and increase their motivation by providing social support and helping veterans create meaningful lives.

Fellows paint hospital walls, collect food donations, and plant gardens, developing career and life skills in the process. And although in-depth studies are lacking, an investigation (PDF) by Washington University in St. Louis social scientist Monica Matthieu, found that Mission Continues helps.

Matthieu and her team surveyed 27 Mission Continues fellows, many of whom have been diagnosed with PTSD. Following their fellowship, 71 percent continued their education and 86 percent were able to find employment.

The VA currently assaults PTSD with a grab bag of treatments. It recommends (PDF) a combination of drugs, most commonly anti-depressants, and therapies including individual and group psychotherapy, hypnosis, and meditation. The department’s 2010 guidelines also recommend social and family skills training, job training, education, and spiritual support. VA therapists even teach stress-tolerance techniques.

For example, a therapist might ask a patient to discuss a particular memory repeatedly, lessening its emotional intensity, or to recall many memories concurrently to practice coping skills such as breathing calmly.  The VA also recommends a practice known as eye movement densensitization and reprocessing, or EMDR, that involves focusing on a traumatic memory while following a therapist’s moving hand, according to VA treatment guidelines. Heralded as a breakthrough when it was proposed in 1989, studies show EMDR can reduce anxiety although researchers continue to debate how it works.

But community service isn’t on the list. And National Center for PTSD spokeswoman Diane Keefe says she couldn’t find experts who could address its potential efficacy.

Dr. Josef Ruzek, who directs the training division of the VA’s Palo Alto, California, branch of the National Center for PTSD, says that might be because community service addresses problems associated with PTSD such as social functioning and community connection. Treatments that attack traumatic memories and guilt and teach stress management are more effective for PTSD, he says.

Nonetheless, Ruzek believes volunteering could have treatment value. It could cheer up sufferers, he says, and increase their motivation by providing social support and helping veterans create meaningful lives. The VA does help veterans volunteer and socialize through programs including a community chorus.

Research is scant, however.

According to unpublished research by a team led by Yale psychiatrist Steven Southwick, other PTSD therapies don’t address “existential struggles,” including guilt, loss of control, and a lack of meaning and purpose.

In a 2005 poster presentation, director Robin Gilmartin and social worker Alison Sherrick Went, both with the VA’s PTSD Residential Rehabilitation Program in Connecticut, presented two case studies—veterans “William” and “Derek”—to illustrate the benefits of community service.

After maintaining sobriety from alcohol and cocaine, Vietnam veteran Derek’s PTSD symptoms increased. The VA residential program connected Derek with a nursing home where he could volunteer twice a week. At first, Derek couldn’t ride a bus to the nursing home due to his hypervigilance. Although he encountered difficulties, through support, at the end of the three-month program Derek was considering pursuing training as a nurse’s aid and had gained enough confidence to take the bus to McDonald’s for a milkshake, according to Gilmartin and Went’s paper, “Application of Volunteer Work in the Treatment of Veterans With PTSD.”

Fellow vet William also learned to address PTSD through his work tutoring first-graders, they wrote. Gilmartin and Went acknowledge their research has limitations—they didn’t follow veterans after their release from treatment, for example—and additional research is needed. But volunteerism can help PTSD, they argue, because it allows veterans to practice coping skills, tolerate their guilt, and challenge their sense of fatalism.

Piper had a similar experience, although he achieved his success while incarcerated and without the support of a VA program. He struggled—and denied—his PTSD for years before committing the crime that merited his 34-year sentence. (Piper wouldn’t reveal his conviction, and a prison spokesman deemed it confidential.)

Piper previously dealt with his PTSD the same way he’s done most everything else: the hard way. Abandoned by his parents, he was raised by an aunt and uncle on an Indian reservation in mountainous northeastern California. After a few years of college, he was wooed by the seemingly sizable salary offered by the military. “I was young and dumb,” Piper says now. He was soon sent to Vietnam.

Bright, with an aptitude for medicine, Piper became a medic in a Marine Corps surveillance unit (where he earned his nickname). In his 28 months of service, Piper was doused with Agent Orange and struck by shrapnel. The smallest in his elite nine-man squad, Doc squirmed through the tunnels that laced the hills to search for North Vietnamese troops. Most traumatically, he endured a 77-day siege during the Battle of Khe Sanh, months of incessant combat with no access to supplies or support. It earned him a Presidential Unit Citation.

When Piper left the service in April 1969, the war was the last thing he wanted to talk about. Vets were viewed as baby killers and PTSD, not recognized as a medical condition until 1980, was known as shell shock. So he suffered through the flashbacks, nightmares, and anxiety alone.

After a period of “soul searching,” during which he he sought solace in everything from sweat lodges to motorcycles, Piper landed on his feet and finished school, earning a B.A. in physical science from an Oregon university and finding a job as a firefighter in Nevada. Nonetheless, he “could never get to close anybody or let anybody get close to me,” Piper says. “I can’t relate to anybody.”

He went through three marriages and, in 1995, earned his decades-long prison sentence. “I didn’t realize how much (PTSD) did affect my life,” Piper says. “It led in part to being in here.”

He continued to struggle behind bars. Smells and sounds can “take me back 40 years,” Piper says. He’s suddenly in the jungles of Vietnam. Helicopters, crowds, loud voices—almost anything can set him off.

Piper has suffered from physical pain as well, including three bouts of cancer. He had half of his face reconstructed following his second eye cancer. Yet these maladies he calls “nothing major.” Nothing since has rivaled the horrors he experienced in Vietnam, Piper says.

In prison he learned about PTSD. He tried many treatments and found some relief from meditation and a therapy that works to alleviate pain from traumatic memories using side-to-side eye movements.

But in 2004, he and fellow veteran Ed Munis founded the only Veterans Service Office behind bars, which was featured in a November Salinas Californianarticle. Through hours spent at the VSO, lovingly nicknamed Bunker #1, they’ve helped hundreds of incarcerated veterans from across California, and 13 other states, obtain VA benefits.

“I’m doing something good. This is my therapy—[the VSO slogan] ‘Helping ourselves by helping others’—defines a truism,” Piper says.