Playing For Change

BZZZZZ. BZZZZZ. BZZZZZ. The alarm next to your bed is ringing. It makes the pain in your head even worse. What do you do? [[Turn it off]] [[Let it buzz]]

You hit the off switch, but accidently knock over the bottle of benzodiazpenes your doctor described to help with insomnia. They spill across the floor. Do you want to take one? [[Yes]] [[No]] (Lakshmi Ravindran at the University of California San Diego Department of Psychiatry and Murray Stein at the VA San Diego Healthcare System provide an overview of the pharmacotherapy typically used for veterans, which includes antidepressants, anti-adrenergic agents, anticonvulsants, benzodiazepines, atypical antipsychotics, and novel agents (Ravindran and Stein 2009).

BZZZZ. BZZZZ. BZZZZ. You can't get back to sleep because the pounding in your skull won't let you. You should really [[Turn it off]]

You pop one in your mouth and swallow. This is one of a number of treatments given to you to help with anxeity, insomnia, and irratibility you've felt since coming back from Afghanistan. They help calm you down. Sometimes. By the time you get dressed, you've missed [[the first bus downtown]]. (Recent work suggests that despite the recommendation against their use, prescribing of benzodiazepines for Veterans with PTSD remains above 30% in the VA, suggesting a gap between guideline recommendations and actual clinical care (Lund, Bernardy, Alexander,and Friedman, 2012).

You sweep the pills under the bed. They are one of a number of treatments given to you to help with anxeity, insomnia, and irratibility you've felt since coming back from Afghanistan. Haven't helped yet, and you don't think they will today. By the time you get dressed, you're late for the [[the first bus downtown]]. (Recent work suggests that despite the recommendation against their use, prescribing of benzodiazepines for Veterans with PTSD remains above 30% in the VA, suggesting a gap between guideline recommendations and actual clinical care (Lund, Bernardy, Alexander,and Friedman, 2012).

It'd be nice to drive yourself, but since the headaches have started you've felt your mind wandering more and more. Safer to take the bus. While on the bus, another car weaves into the lane and the bus stops abruptly, honking. You realize you are gripping the arm of the man next to you. You mutter "Sorry..." and get off a few stops [[before the VA hospital]]. (Nina Sayer, of the Center for Chronic Disease Outcomes research, reports in her study that 25% to 56% of combat veterans who use VA services reported “some” to “extreme” difficulty in social functioning, productivity, community involvement, and self care domains. At least one third reported divorce, dangerous driving, increased substance use, and increased anger control problems since returning from deployment. Almost all (96%) expressed interest in services to help readjust to civilian life (Sayer et al. 2010, 594).

The VA is packed. A man in a wheel chair almost collides with you. He stops and looks at you. "Crowded, huh? What are you in here for?" [[Picking up a friend]] [[Looking for treatment]]

You lie. There's no friend, but you're pretty sure you might know some people here and you want to keep a low profile. "Well, good luck" the man says, and moves off. There's a massive line to get checked in. Guess you better [[wait]]. (Tracy Stecker and Brian Shiner at the Psychiatric Research Center at Dartmouth Medical School designed studies around the low utilization rate of mental health apparatus around the country for veterans of OEF/OIF, and found that “...stigma, including self-stigma, public stigma, and stigma within a service member’s unit, is a major factor in low treatment utilization (Stecker et al. 2015, 280)).

You could lie, but you don't. You tell him you're looking for some help. What's the point of keeping a low profile here? Everyone is in the same boat. "Well, good luck" the man says, and moves off. There's a massive line to get checked in. Guess you better [[wait]]. (Tracy Stecker and Brian Shiner at the Psychiatric Research Center at Dartmouth Medical School designed studies around the low utilization rate of mental health apparatus around the country for veterans of OEF/OIF, and found that “...stigma, including self-stigma, public stigma, and stigma within a service member’s unit, is a major factor in low treatment utilization (Stecker et al. 2015, 280)).

You wait. Ahead of you, you can hear a woman talking. She says she was denied VA benefits because of a non general discharge caused by trauma. She's come back to make her case again. [[Wait some more]] [[Leave]] (From a recent report by Swords to Ploughsahres: Not all who have served are “veterans” in the eyes of the Department of Veterans Affairs. If the veteran has less than a General discharge, the VA creates obstacles to getting health care, benefits, homeless resources and other services. The VA’s own discretionary policies unnecessarily deny hundreds of thousands veterans benefits, who are often those most in need of the VA’s support.)

You walk out of the building. On the way out, you pass a sign that advertises a new session starting this afternoon at 3:00 PM. They are looking for vets to participate in what's called "an expressive therapy workshop." Painting, writing, even music. You're not much of an artist, but something about it appeals to you. [[Take the ad]] [[Leave the ad]] (Healthcare professionals from the Art Therapy Journal posit seven key findings related to ways in which art therapy may assist veterans of OEF/OIF: reconsolidation of memories, progressive exposure, externalization, reduction of arousal, reactivation of positive emotion, and enhancement of emotional self-efficacy (Collie et al. 2006)).

You take the ad as a reminder, and decide to come back at 3:00 PM. You sign in, and the teacher puts a paint brush in your hands and a blank mask made of paper in front of you. She says, "Paint your brain." You start to paint. THE END.

You leave the ad where it is, but decide to come back at 3:00 PM. You sign in, and the teacher puts a paint brush in your hands and a blank mask made of paper in front of you. She says, "Paint your brain." You start to paint. THE END.

You wait. The line doesn't move. Maybe you should just [[Leave]] and come back another time.