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During the eight years I spent as a front-line psychologist working with a panel of hundreds of veterans, I never lost a patient to suicide, until Dustin (not his real name).
Dustin died by suicide six months after I had moved on from my position at the VA. Broad-shouldered, heavily muscled, and covered with tattoos of the grim reaper, he scared a lot of providers. He radiated anxious energy and had difficulty controlling his rage when his anxiety spiked, which happened with minimal provocation.
Despite his intimidating appearance, like many of the veterans on my caseload, Dustin had been bullied in his early life. It is no coincidence that individuals who have been bullied as children are often drawn to military service.
For many who enlist in the military, the promise of becoming a professional-grade fighter is an alluring defense against hidden feelings of vulnerability. Many have explained to me that the military also offered the promise of an environment with predictability and clear rules and expectations. In other words, they are seeking safety in the structure and shared ethos of warriorship.
When a service member with a history of bullying or childhood abuse lands within a healthy chain of command, the military can be an ideal place to chart a new, more self-empowered path in life. However, in the presence of toxic leadership, where they encounter bullying, hazing, or sexual abuse, this further trauma can lead to profound psychological damage. They were seeking safety and, like Dustin, they learned that there seems to be no safe place.
Unfortunately, we see it all the time—a leader who abuses his or her power. And of course, this behavior is not confined to the military: Abuses of power are frequently reported among leaders, politicians, and other authority figures within every sector of the population.
In my observation, veterans who are subjected to personally directed abuses of power rarely tell anyone about this. Shame makes these kinds of injuries more invisible, and more insidious, than other “invisible” injuries we associate with military service—for example, combat trauma exposures.
These patients suffer immensely, often with no support from behavioral health providers, who fail to build the level of trust that would lead to the disclosure of these experiences. It's likely the case that this is also true for many civilians who have been exposed to personally directed abuses of power.
Even if these types of traumas are disclosed, they can still be very challenging to treat. Dustin, like others on my caseload who had suffered in similar ways, didn’t trust most people, wouldn’t go to group therapy, and declined multiple offers to engage in therapy that would require him to mentally re-live the traumas at the root of his anxiety. I talked him down from crisis situations on multiple occasions—he even wrote a letter to the Director of the VA System where I worked, which said this:
“My PTSD and substance abuse issues have nearly cost me my life on numerous occasions. Dr. Springer has been my Doctor for almost six years now. She has intervened on my behalf on numerous occasions to see that the best care was made available to me when it came to navigating through the mental health system. When I was in crisis, she always returned my calls and helped me avert what could have ended up in a very bad situation. I truly believe that if it were not for Dr. Springer, I would not be alive today.”
If stellate ganglion block (SGB) had been available at the time when I knew Dustin, it's possible that he might still be alive today. While he refused traditional talk therapy, he did engage in biomedical interventions. SGB is a quick injection administered to a nerve cluster in the neck, which shows real promise for individuals with traumatic stress exposures. (Here is a brief article and very short video clip by the Wall Street Journal that describes Stellate Ganglion Block.)
Dr. Eugene Lipov is the leading national expert on the use of SGB for symptoms related to trauma. After Lipov pioneered the use of SGB for trauma-related symptoms, it has been deployed for some time at select military bases—such as Ft. Bragg and Tripler Army Medical Center Hawaii. I was on the front lines during the deployment of this procedure within the VA Northern California Health Care System, a story which was covered in a televised program called Veterans Voices. In a follow-up episode, the hosts and I interviewed Dr. Lipov and Dr. Brian McLean, a physician who has provided SGB to scores of soldiers at Tripler Army Medical Center with positive outcomes.
I have stood next to several of my patients in the operating room while they have had a stellate ganglion block procedure. Within minutes of the injection, they have said things like: “I feel like myself again, for the first time in over 20 years,” or “it’s like having a thousand-pound weight lifted from my chest," or “I can’t remember the last time I actually felt calm and happy.” As a theme, in the months following this procedure, they say that SGB has given them “a second shot at a happy life.”
Although I became aware of stellate ganglion block through my work with veterans, SGB offers promise for giving people exposed to trauma—from all causes—a second shot at a happy life. It’s a new frontier of trauma treatment that could be game-changing for many who suffer, and for this reason, it is something that those of us in the mental health professions should become aware of.
Stella Center is a resource for learning more about this promising new approach.
