Editor’s Note: As part of the Center for Deployment Psychology’s ongoing mission to provide high-quality education on military- and deployment-related psychology, we are proud to present our latest “Guest Perspective.” Every Tuesday, we will be presenting blogs by esteemed guests and subject matter experts from outside the CDP. This allows us to offer more insight and opinions on a variety of topics of interest to behavioral health providers.
As these blog entries are written by outside authors, one important disclaimer: all of the opinions and ideas expressed in them are strictly those of the author alone and should not be taken as those of the CDP, Uniformed University of the Health Sciences (USUHS), or the Department of Defense (DoD).
That being said, we’re very happy to offer a platform where we can feature these individuals and the information they have to share. We’d like to make this an ongoing dialogue. If you have questions, remarks, or would like more information on a topic, please feel free to leave comments below or on our Facebook page, and we’ll pass them along to the author.
By Suzanne Best, Ph.D.
“He was a good, honest officer. In fact, I would be very shocked if there were any truth to it… it would be unfathomable.” Such was the response made by a corporal when questioned during an investigation of his former platoon commander’s alleged embezzlement of hundreds of thousands of dollars. During my evaluation of the accused West Point graduate, he appeared equally astonished by his own criminal behavior. “It’s not who I am- who I was raised to be… I’m just different now.”
“I don’t know why I did it”
“It was totally out of character”
“It’s just not me.”
Over the past several years I have seen the same bewildered expression on the faces of numerous Veterans as they struggle to understand and explain their own actions. After several months of treatment, one such client was finally able to articulate, “It’s like there’s a switch in my head that suddenly turns on and it takes everything I’ve got to fight the impulse to do something crazy.”
These “crazy” impulses, if not controlled, lead to actions that are otherwise known by us mental health folks as “risk-taking”, “reckless” or “self-destructive” behaviors. While some may have the sudden impulse to speed or have an extramarital affair, others find themselves fighting an overwhelming urge to steal. Still others who have difficulty managing the anger that’s characteristic of posttraumatic stress find themselves struggling to suppress violent impulses that, as one of my clients described, are constantly “burning in his belly”.
The relationship between PTSD and criminal behavior was initially hypothesized and supported by Wilson and Zigelbaum (1983) in their research with Vietnam Veterans, just three years after the diagnosis of PTSD was introduced as a psychiatric disorder (DSM III; American Psychiatric Association, 1980). In the past few years there has been an increase in studies on reckless behavior and impulsivity in our recently returning Veterans. For instance, in 2012 Strom and colleagues found a relationship between PTSD symptoms and elevated rates of substance use, thrill seeking, aggression, risky sexual practices and firearm possession, with aggressive driving being the most frequently reported behavior. Theories proposed to explain this association vary to include information processing models and those based on the neurophysiological impact of PTSD on the HPA Axis (see Ben-Zur & Zeidner, 2009 for a review).
It’s not just PTSD that drives criminal behavior in Veterans. mTBI (Mild Traumatic Brain Injury), often referred to as the “signature injury” of the Iraq and Afghanistan Wars, can also lead to impulsive behavior, aggression and impaired decision-making. (In one study, Veterans with PTSD were found to engage in more frequent risk-taking behaviors, irrespective of TBI status (James, Strom & Leskela, 2014).) Because TBI often occurs in combination with PTSD, recent Veterans are at an increased risk for illegal activities, particularly when they suffer from the “trifecta” of PTSD, TBI, and comorbid substance abuse.
Yet in spite of our understanding of the link between these combat-related conditions and criminal behavior, it wasn’t until 2008 that a judge in Buffalo, NY recognized the need for a specialized Veterans Treatment Court. Similar to Drug Courts, Veteran Treatment Courts provide a combination of supportive services and supervised treatment as a means of reducing recidivism. In addition, Veteran Courts enlist and train other Veterans to serve as peer mentors to provide further support to those convicted of criminal acts. As Buffalo’s flagship Veteran’s Court reported a recidivism rate of zero during its initial two years, other municipal and county courts began to emulate Judge Russell’s model.
Because the focus of these courts is on treatment, the Veteran must plead guilty, be diagnosed with a mental health condition(s), which can include substance abuse, and be amenable to treatment. While the majority of these courts address only misdemeanor offenses such as DUIs and petty theft, some such as the recently established Veteran’s court in Multnomah County, OR serve only Veterans facing felonies, other than domestic violence and those that hold mandatory sentences (e.g., sexual assault, armed robbery, manslaughter).
“I didn’t want to hurt anybody. I just wanted to be left alone.”
“The best way I can describe it is that I was desperate. I figured I had two choices; jump off the nearest bridge or rob the credit union. Funny- I had never actually stolen anything before in my life and there I was holding up a bank.”
Across the board, Veteran Treatment Courts disqualify those who are accused of violent crimes. Because in the majority of Veteran’s Courts, the offender’s record can be wiped clean if s/he complies with treatment, the idea of allowing such offenders to reenter society without blemish makes many uneasy. But although some make a strong case for excluding, for instance, domestic violence cases from Veteran Treatment Courts (Kravetz, 2012), others contend that violent offenders, particularly those suffering from combat-related PTSD and/or TBI, should be eligible to receive the services provided by Veteran Treatment Courts as their aggressivity can simply be seen as a symptom of their condition (Cavanaugh, 2011).
In addition, the vast majority of even violent offenders have no prior history of criminal behavior. While the national data on the numbers and characteristics of Veterans behind bars is far from current, smaller state and municipal studies reflect the fact that only a small minority of incarcerated Veterans had dishonorable discharges or even disciplinary records while serving in the military.
“I’m doing a lot more jail time these days,” I tell my mother when she calls. But my efforts to lighten up the details of my forensic work do little to lessen the impact of sitting in a barren locked room across from a once proud Veteran now hunched, eyes lowered, in prison orange. Invariably they address me as “M’am” and profusely apologize for their far from spit and polish hygiene. For those accused of violent crimes, I politely pretend to busy myself with paperwork as they struggle to sign the evaluation consent with shackled hands.
Still, rather than shudder each time I receive a call from a Public Defender’s office, I eagerly respond, knowing that my evaluation may well be used to lessen a sentence and perhaps more importantly, to assist a Veteran in receiving the services that he or she needs and deserves. These government employed attorneys, some of whom are Veterans themselves, are notable for the intense compassion and commitment that they bring to these cases. “I figure, we broke them, it’s our job to fix them,” one flatly stated in response to my appreciation.
And so I, too, do what I can to assist what I consider to be a largely unrecognized if not disparaged troop of injured heroes. Fortunately, revisions made to the most recently published diagnostic manual have made my job easier. While the DSM IV listed “self -destructive and impulsive behavior” as an associated feature of Posttraumatic Stress Disorder and the updated DSM IV TR described an associated “change from the individual’s previous personality characteristics” (American Psychiatric Association, 2000, pg. 465), it was not until the most recent diagnostic manual published in 2013 that “Reckless Behavior” was included as a explicit symptom of PTSD’s altered arousal and reactivity (American Psychiatric Association, DSM-V). Although I can find no writings that speak directly toward the impetus for this addition, I can only hypothesize that the DSM-V work group advisors, many of whom are esteemed VA and military psychologists and psychiatrists, were influenced by the growing evidence of reckless and impulsive behaviors in Veterans returning from the Iraq and Afghanistan wars.
“It’s like something comes over me and I suddenly have this irresistible urge to take the weirdest things. It’s not like I even need any of it. And then I leave the store and get out to my car and I can’t believe the stuff that I’ve jammed in my pockets. Dental floss, candy, a pair of socks. One time I even stole a cat toy- I hate cats!”
In addition to my forensic work, I am also honored to be able to support Veterans in my area through treatment. Some, like the cat lover above, are fortunate enough to acknowledge the impending threat of their own behavior and to seek treatment prior to falling head-long off the precipice. Often times these Veterans experience periods of uncontrolled anger that they fear will lead to physical violence or road rage. Others may simply recognize their increasing peril as they continue to push their motorcycles or bodies well beyond the limits of safety. For many, simply gaining an understanding of what triggers these reckless behaviors and identifying healthy coping strategies is enough to curb the impulses that could ultimately lead to arrest or even loss of life.
I believe that it is for us all- in particular those providing social, mental health, or legal services- to advance our understanding of the impact of warzone deployments on our Veterans and to support them, by whatever means possible, when their impulsive actions breech the boundary of criminality. It should never be too late to help these Lost Heroes regain the honor and respect that they deserve.
Suzanne Best, Ph.D., is a clinical psychologist and co-author of “Courage After Fire: Coping Strategies for Returning Iraq and Afghanistan Veterans and Their Families” and “Courage After Fire for Parents of Service Members.” For nearly two decades she has directed and consulted on numerous federally funded research studies of military veterans with a particular emphasis on developing and evaluating effective treatments and preventive interventions for combat-related PTSD. In her private practice based in Portland, OR, Dr. Best specializes in treating Veterans and their families as well as emergency services personnel and in providing forensic evaluations and expert witness testimony in both civil and criminal cases. She speaks regularly to mental health, legal and military communities on issues affecting returning Veterans and the loved ones who support them.
Ben-Zur H & Zeidner M (2009) Threat to life and risk-taking behaviors: a review of empirical findings and explanatory models. Pers Soc Psychol Rev, 13: 109–28.
Cavanaugh, JM (2000). Helping Those Who Serve: Veterans Treatment Courts Foster Rehabilitation and Reduce Recidivism for Offending Combat Veterans. New England Law Review, vol. 45, pg. 463 – 487.
James, LM, Strom, TQ, & Leskela, J (2014). Risk-Taking Behaviors and Impulsivity Among Veterans With and Without PTSD and Mild TBI. Military Medicine, 179, 4: 357.
Kravetz, P (2012). Way Off Base: An Argument Against Intimate Partner Violence Cases in Veterans Treatment Courts. Veterans Law Review, Vol. 4.
Strom, TQ, Leskela, J, James, LM, Thuras, PD, Voller, E, Weigel, R, Yutsis, M, Khaylis, A, Lindberg, J, Bolton, K & Holz (2012). An Exploratory Examination of Risk-Taking Behavior and PTSD Symptom Severity in a Veteran Sample. Military Medicine, 177, 4:390.
Wilson, JP & Zigelbaum, SD (1983). The Vietnam veteran on wal: The relation of post-traumatic stress disorder to criminal behavior. Behavioral Sciences & the Law, Volume 1, Issue 3, pages 69–83.