Military & Veteran Mental Health with Dr. Carl Castro

Join in and welcome back Dr. Carl Castro as he and Dan continue their conversation on military and veteran mental health.

Dr. Castro discusses the various aspects of veteran support, comparing the U.S. system to those of other countries, the unique status of veterans in society, and the impact of historical events like the Vietnam War on current veteran treatment. Dive into the complexities of the combat veteran experience, including the combat veteran paradox and the PTSD paradox, emphasizing the importance of normalizing feelings and experiences for veterans. 

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Chapters

• 0:00 Introduction
• 2:01 Comparing Veteran Support Across Countries
• 8:00 Military Service: Compulsory or Selective?
• 14:25 The Combat Veteran Paradox
• 22:48 PTSD: Symptoms, Stigma, and Support
• 32:00 Innovations in PTSD Treatment
• 38:48 Elderly Veterans and the Meals on Wheels Program
• 44:19 Resources for Veterans and Their Families

Transcript

0:00

[Music] Broadcasting from the most beautiful city in the world, I'm your host, Dr. Dan Cox, a professor of counseling psychology at the University of British Columbia. Welcome to episode number 34 of Psychotherapy and Applied Psychology, where we dive deep with the world's leading applied psychology researchers to uncover practical insights pull back the curtain and hopefully have some fun along the way. If you find the show useful, it'd be much appreciated if you shared it with someone else who might enjoy it too. T.I. couldn't be more excited to welcome back one of the world's authorities on military and veteran mental health. My guest is a professor and director of the Military and Veteran programs at the Suzanne Dwork Peck School of Social Work at the University of Southern California. Before joining the University of Southern California, my guest served in the U.S. Army for over 30 years, retiring at the rank of colonel. He completed two tours in Iraq, as well as serving on peacekeeping missions to Saudi Arabia, Bosnia, and Kosovo. He chaired numerous NATO and international research teams, and he has currently chaired the NATO Research Group on military veteran transitions and co-chair of a team exploring the development of military and veteran radicalization. He's been a full bright scholar and a member of several Department of Defense and Veterans Affairs Advisory Boards. In this part of our conversation, we discuss several aspects of military mental health, including the combat veteran paradox, PTSD paradox, stigma, innovative approaches to PTSD treatment, veteran suicide, and much more. This episode begins with my guest responding to my question about what he thinks the countries are doing to facilitate military to civilian transition that he thinks that America could learn from. So without further ado, it's my pleasure to welcome back my very special guest, Dr. Carl Castro. I will tell you this, and I sometimes get in trouble internationally, because I say this in other nations, there is no country in the world, none zero, that comes close to supporting veterans like they do in America, none zero. Not does that mean that America does a perfect note, but if you're going to start comparing, you know, what are the Joneses doing? What are the Smiths doing? Veterans are really, really taken care of in America compared to other countries by a mile. Other countries are India's of how well not only our nation takes care of veterans, but how veterans are embraced and looked upon. It's just really different. I would say probably the closest country to the U.S. is Canada, really, really positive as well. And getting better by the way, they're actually making substantive changes to help veterans. And most countries are, you know, in this come by the way in how veterans are defined. You talk about that, but most countries define a veteran as someone who served in combat. If you haven't served in combat, you're not a veteran. Canada does have that definition. America doesn't have that definition. The United Kingdom doesn't have that definition, but almost every other country. If you haven't been on an operational deployment or served in combat, you are not technically a veteran and you get no veteran benefits. So, it all comes down to definitions ultimately, right? I mean, that's what I always tell my students. I say, always pay attention to how things are defined because that determines who gets benefits and who doesn't. More importantly, it's the opposite. Who's included? Who's excluded? So, things like who's a veteran? Who's homeless? How is homeless? How is that defined? You know, oh, you're not homeless because you're living with your parents. But if you're living with your girlfriend or your boyfriend, then you would be considered homeless. Bizarre definitions admittedly, but that's just how they're defined. You don't have to be on the street to be homeless. You could just not have a home. Calp searchee, living in your car, staying in a motel. You would be considered homeless so that you're not on the street. I'm always fascinated by the Israeli military service since it's compulsory. And talking to folks about veteran, they don't really use the word veteran from what I understand because everybody served. So, yeah, I was just thinking about that when you're talking about definitions and those sorts of things. Well, did you make a good point? I have a lot of friends, a lot of colleagues who, a lot of her, a lot of generals say this, a lot of admirals say this. Military service should be compulsory. And it was-- Yeah, yeah, because it really has a positive influence on overall, even those who had a very unpleasant time in the military. When they reflect back, we'll say, yeah, one of the best times of my life. But here's the flip side of it and you alluded to it. If everybody served in the military, and everyone was a veteran, then veterans wouldn't be special. They wouldn't get these unique deals because we would all be in the same boat and you'd be like Israel. They wouldn't even talk about veterans because everyone's a veteran. And they wouldn't care about your war because we've all had our own wars, right? And what, when I was in, everyone always suffered more than the next person. But by having only this elite group of about 6-8%, who've served as adults, who've served in the military, that makes us unique. It makes us different versus if we're all the same than nobody's different, right? And people who advocate for this aren't really thinking through the long-term implication. It should not be that we say, well, despite that, we think everybody should serve. Well, okay, fine. But just keep in mind that a lot of these benefits and programs that are put in place to help veterans probably will go away. Because we'll all be in the same boat so you won't be disadvantaged over anyone else so you shouldn't get anything special. So those are, I always think about these kinds of issues that we're in a very unique, and the number is going to get smaller and smaller as the war war two in Korean and Vietnam veterans are dying. And they are really dying in the tens of thousands a month. It's just going to be veterans from an army of 425,000 or a military of 1.1 million, not the three or four million that we had. So the number is going to go down into the probably settle in around two or three percent of the population. I imagine somewhere in there of those who serve and that makes you unique because not everybody's even eligible to serve. I mean, that's also a thing that we don't talk about very much. Do you think that one of the reasons that the US is particularly mindful of veterans is in response to how civilians treated veterans coming home from Vietnam? Oh, God, yes. The guilt, the guilt. I mean, this is the 60th generation, right? They treated veterans from Vietnam poorly. Then they forgave themselves, right? So it's a generation that I've not quite got my hand around, head around, but I've never seen a generation who forgave themselves like the... The two are in their 20s and 30s during the Vietnam War. They forgave themselves for every bad thing they did. From the drugs, to the promiscuity, to how they treated veterans, they just globally forgave themselves. And I said, "Well, is that how you're supposed to do that? Are you supposed to ask for forgiveness?" And there are people we talk about forgiving yourself to heal those kinds of things. Yeah, we treated you badly, but I've forgiven myself on how badly I treated you. That's just a bizarre take in my mind. As a veteran, someone served in the military, I think that's a bizarre take. That you forgive yourself for how you treated other people? Yeah. But I think the guilt in is the benefits that veterans today are enjoying because of that guilt. Well, let's give them the... You know, the GI bill we have today is much, much better than the GI bill that the Vietnam Veterans had. It's not as good as the GI bill that the war were two veterans had, though. So, you know, it's a compromise. But in some ways, it's better, but in general, I would say it's not as good. The thing about the current GI bill, not only does it, of course, pay tuition and school fees, but you can also give it to your children. So it's called the forever GI bill. So you can give it to your children or your spouse, and they can enjoy the benefits if you don't want to use them as a veteran. So there's that aspect of it is really, really, really, really popular. But the monetary amount was at the highest the best during war two veterans. Could you talk about the combat veteran paradox? So the combat veteran paradox is simply stated is that anyone who has served in combat has changed, and talking about how they change can be beneficial. But oftentimes, the veterans themselves, the combat veterans themselves, don't know how they change. They think they're the same person, and it's usually other people around them will say, "Hey, you're different. You are not the same person before you left, the one that came back." And they're usually, you know, baffled by that, because they saw the change happening slowly. Sometimes the change happens much quicker, depending on the amount of combat and trauma they experience, it could happen really sudden. But they think they're handling it and processing it very well. You know, yes, I engage in fire fights, and I killed some people, but you know, I'm handling it very well. And they're not. They think they are, but they're not. What they see is they're not handling it worse than they're peered, they're a battle buddy. You probably isn't handling it well either. So your kind of your reference point is off, right? If your reference point is someone also who's struggling, you're going to say, "Why not struggling as much as that person? Therefore, I must be doing fine." And this is usually when it takes a third party. It's usually your supervisor, your spouse, the wife, saying,"If you don't get some help, I'm leaving you or if you don't straighten up, I'm firing you." And that's usually the forcing function that gets a veteran into serious health. But I think what we could do a much better job of soldiers, Marines, Airmen, coming out of combat is to begin normalizing how they're going to be feeling and thinking and behaving. Because then you don't think, as a combat veteran, that you're losing your mind, that you're the only one who feels this way. Because you don't know how to talk about how you're feeling, what you're thinking, even sometimes what you're doing. And of course, this gets layered on to the military culture, which is one of drinking. It's one of not admitting you have physical or mental health issues. We spend a lot of time talking about mental health issues and this stigma associating with that while we're serving. But there's a huge stigma associated with physical health issues as well, where veterans won't go in if they got a, you know, service members won't go in if they got a pertinere or bad back, especially at the officer level, because I'm not going to get picked to be the operations guy, if the general things that I'm physically hurt, they're going to give it to somebody else. And so you start self-medicating or you know, we'd go out on the civilian, get a civilian doctor to help and you just pay out a pocket because you didn't want that to be in your permanent record. So, you know, dealing with those kinds of issues are really, really important, especially coming back from combat where we know the physical health issues and the mental health issues are really, really prominent. In that you wrote this paper and you articulated a bunch of different paradoxes that veterans experience and it was it's a lovely paper and I just sort of this notion for the combat veteran paradox of, you know, that, that, like that, responses to combat are normal, but because they're substantial, oftentimes folks could benefit from counseling or therapy. And I think that that's it's, it's, I think for the therapists who are listening of people who are being trained to be therapists, I think that's, I think it's really helpful to keep it, particularly those who are less familiar with service that, you know, what you're saying, or at least what I read you saying is, there's nothing abnormal that's happening here. There's just a process and because the process is substantial and because there is no, it's not necessarily intuitive or obvious, it makes completely reasonable sense that service members, many of them will benefit to have someone who can sort of like, you know, the be there as a sounding board to talk about things, help process things as they go through that transition because this is a big change in the process. And change and even though everything is a normal reaction, it's still notable and maybe having a little bit of help would be helpful. Yeah, and it's, and it really is what the peer support is all based on. Why peer support, you know, other veterans helping other veterans, you know, having a mentor in any profession, having a sponsor in any organization, it's the same thing. They're trying to help you navigate these various challenges and it's just because people recognize I don't, I'm joining this work on boarding, you know, with the sponsor is about helping people understand processes but also to help them handle their anxiety and fears of starting into a job. I mean, that's not usually in the onboarding manual, but that's what what's happening because you're normalizing their feelings and you probably weren't about this, I worried about that too, don't worry about that. And those kinds of things, although that is just a normal process, but you know, when you have to give a diagnosis to help somebody, you know, then it becomes problematic because not everything deserves a diagnosis and some things do don't get me wrong. Some things can be very, very debilitating. Most of these symptoms that you see around combat that that we argue are very normal reactions and to a very highly stressful traumatic environment are not impaired. You're not impaired by them, right? You can still function. We know you can still function. I mean, most people with a mental health disorder, even those with schizophrenia or bipolar can function. But if you stigmatize it and make it sound like they can't do anything, then guess what? They won't do anything. Some of them won't do anything. And they'll take on that persona of someone who is suffering from post-traumatic stress disorder or some other kind of disorder. That then becomes their life, right? And it becomes who they are and that's what you don't want to have happen. You want everything to happen to say, this will pass. You're going to recover from this. You're going to move beyond this. You're going to get over this. What you're feeling now is quite normal and that's the whole normalizing and contextualizing. What you did in a combat environment was necessary for you to survive. You don't need to do that now that you're back in peacetime society because if you behave that way, that will cause some relationship issues. And you could get into some legal issues. You know, if you're still taking risks with drinking and drugs and gambling and how you drive and if you're aggressive because we know combat, one of the things that in this is across every culture. When combat veterans return home, they're more angry. They're more violent. You see that in every country I've looked at, you see this slightly more disproportionate number of folks who. You get a little more aggressive over little things over little things, right? And that's another paradox. I understand what's important in life. You know, I know how to appreciate the important things, but they let the little thing get a man. This is the which I find humorous. I said, well, you understand what the big important things are relationships family. Your relationship with God or a higher meaning. But then you're going to let someone who cuts you off on the interstate be the thing that defines who you are when you ram into them and get in trouble for that. So that's the learning to let the little things go. So it's one thing appreciating the big things, but it's another thing letting the little things go. And you know, just let it go. It does not matter in the big scheme of things. You know that every combat veteran knows that that a guy cut them off doesn't really matter. Doesn't matter at all. Does mean I can get angry, but that's kind of learning to let the little things go. And that's really hard to do. It's really hard to let the little things go, especially when you're in this culture of when you see something screwed up, you speak up like people coming late to meetings, for example. Yeah, yeah. So you I had to let that go, right? I had to let that go. It took me a while, but I now let it go. I don't make a comment about it. Sometimes it doesn't even bother me. Sometimes it still does bother me, but I, you know, but this is part of the transition. And I also tell folks that you will always be transitioning. You think I'm transition. I've been on the military now for 11 years. And there are still little things that I say, damn, I did that in the military. Why am I still doing that? My wife. So I have this annoying habit of, you know, when I have lights up my shoes, I unlace my shoe, take my shoes off, and then I lace it back up because that's what I learned the basic trading. You just play your shoes in your clothes like you're wearing that. So I button my jackets up my shirt, your all button. That's crazy that I'm still doing that, right? That's crazy. It looks nicer. I mean, it does look nicer. You see my shoes and you'll say, oh, he takes his shoes off without entying them. No. And that's what I hope people think because that's less bad. No, I actually untie them. And then I take them off and I retie them. I put them to the side. So it's one of those like, what would you rather be thought of somebody who's so obsessive, compulsive that they lace their shoes, they're not wearing or tie their shoes, they're not wearing or takes their shoes off without untying them. See, that would be bad in the military to take your shoe off without properly enticing it. So I still can't wear a jacket comfortably if it's not all buttoned up. And people will come up to me and they'll say, you know, you're not supposed to button that last button on your jacket. You know how you're supposed to leave that last button done. And I said, yeah, I know. I don't say anything else. You know, but the funny thing is I looked up. Why do we leave that last button and done. And most people don't know the reason why the reason why this custom of leaving the last button of a jacket undone was because King George the third was so fat. King of England was so fat he couldn't get all of his button buttoned up. So he had to leave the last one undone and everybody else wanted to curry favor with the king. So they started leaving their button and then it became a fashion. Wow. 100, 200 years later, we're still doing it. So I don't feel too bad when I button on my jacket because I know the history behind the button. I know why I do it and I know why you, you, I know why you're leaving the last one undone. You probably don't even know why you do it. But I do. But it's in his fashion in it. But anyway, I still struggle with that. I have to have my whole jacket open. I got a button all off. So anyway, it's. And that's so I should be able to leave that last button undone but I struggle with that. I think it's worth mentioning the PTSD paradox because I think that this sort of you know that your paradoxes and sort of then you have about a dozen of them that you list out. But that I think this is getting to the larger issue for the practitioner who's working with a service member or veteran who's like like helping them figure out. Okay, when is something a problem that needs an intervention to be addressed and one is just something normal adaptive. And we can sort of like help more of the adjustment process process versus attending to the problem, you know, trying to make the problem go away. So I wonder if you could just speak for a minute about the PTSD paradox. Well, you know, one of the things that when you look at the symptoms of PTSD, they all look pretty bad, right? Because they're explained in bad language right in the negative language like like your daughter is very aggressive. And I told her school, I think she's just being assertive. So is it aggressive or assertive being assertive? Is that a bad thing? No, being aggressive. Yeah, yeah. Okay. So it's just the words you use to describe exactly the same behavior like we call you know being startled the startle response. What do we call that hyper hyper alert? Right. But another word is hyper vigilant, which is very adaptive in a combat environment where someone trying to kill you. You want to be hyper alert or hyper vigilant. And so in one context, it makes perfect sense in another context, you look strange, right? And so you always have to ask yourself, what is the impairment part of it? What are you now not able to do? What are you conveying to others that's maybe embarrassing to you or disturbing for them? And I think that's the important thing that we often miss with all mental health symptoms, not just post-traumatic stress disorder. I would argue with all of our symptoms and reactions that we have. And it's not that we shouldn't try but you know, you always keep in mind when you do a diagnosis, you have a whole bunch of symptoms and you have to meet certain criteria. But one of the criteria for all of them is that the very bottom is as it causes an impairment, right? And your social, some relationship, occupational functioning. So and that's where we don't really focus enough attention on, I would argue, is like, what is the nature of the impairment? What is it that you cannot do or you cannot do as well because of these symptoms? And if you can't really articulate that and make that linkage, then I would like that's minor, we can not focus on some fails, not that we can't circle back to it. But how is that impairing your abilities? And you know, the one I think is the biggest one just in life and with all of the diagnoses is relationships. I'm a big, big believer that our relationships are the most important. You know, of course it probably doesn't surprise anyone who's read anything. I see relationship as multi level. So first, your relationship with you, how do you feel about you? How you are? What you've accomplished? Right? The proverbial, can you look yourself in the mirror? So your relationship with you, your relationship with your partner, your spouse, your wife, your husband, relationship with your family, relationship with your boss at work, which we don't talk enough about having a good relationship with your boss at work is absolutely critical in every occupation, whether it's the Dean, your department chair, your platoon leader, your manager of the whatever your relationship with your boss is critical relationship with your co workers and then your relationship with your community. I would even also argue your relationship with your higher being, your spiritual aspects, your religious aspect is also important. Those are all relationships and we can get relationships right with all of those relationships were good. We'd all be happy, content, we wouldn't have any real complaints. We could, you know, maybe not get the car drive the car we want, have the latest fashion designer clothes we want, but we'd be happy because what makes us really happy as people as human beings are our relationships. But it begins with our self, how are you with comfortable with you now you may be I'm very comfortable with myself, but everybody around me doesn't like me. Okay, that could be a problem, right? You are comfortable, but what are you doing to impact your relationship with other people usually you're doing something. Right, and in some times you don't care, that's called the old curmudgeon, you know, who just go through life, not carrying oblivious to others and then others all I didn't mean to do that, right? So you're sensitive and you're trying to change. So with relationships are really, really important in everything we do. So I would focus on that on I always begin there, you know, in all of my assessments when I work with clients, I want to know how are their relationships because that will tell me more on how their symptoms are impacting their well be if I understand that relationship. Yeah, this is this reminds me I just had a conversation with Uly Kramer and we were talking about who who does a lot of personality disorder stuff in Europe. And so with the new ICD that they changed it where personality is like the primary criteria is impairment. So it's that's the move is and he said it's been you know a year or two that it's been since it's been deployed and he said that you know everybody was like I don't know how's going to go and he said it's been great because you can you're you're primarily focusing on that impairment not the not categorizing the disorder but the impairment that's what what you're saying is this what's popping my head. That's this is not a novel concept I mean people have appreciated that you can have and I jokingly say this I said how many of us have worked with people had bosses who we thought had a mental health disorder and I think it's every one of I mean every hand goes up in the room when I asked that I said so you can actually be high functioning with a lot of symptoms and and you may say whether impaired here they're impaired there you know because life is multi-dimensional as I just mentioned. And you want people fundamentally to be happy with who they are you know one of my things that people want somebody ask me what do you lose sleep over at night around veteran issues and they thought I was going to say something like the number of cuts in this budget or cut that the thing I worry about the most is these folks who have served our country and I hear I'm talking sort of more the elderly. Going to their whole life suffering and they go out suffering when we could have helped them you know this needless suffering I you know what drove me to you know becoming you know the research I do it's all focused on saving lives and preventing unnecessary suffering because there's a lot of suffering that we're never going to be able to control but we should try to control the unnecessary suffering and I don't like to see anybody suffer unnecessarily and I certainly don't like to see people dying unnecessarily and so those are things I really focus on and I said if you think about it a lot of the grants that we write they always talk about how much suffering this problem is that I'm going to address right so whether or not we recognize that as being the most important it is what drive funding you know it drives you know it drives you to the most important programs we need a program for this why because somebody suffering how many are suffering what is the nature of the suffering it's why suicides are so important in preventing because people die from those so people are dying from it then it gets our attention if people aren't dying from it well then there better be a lot of severe suffering if you want me to put resources on it so whether or not we acknowledge it explicitly I just can just be explicit about what we're trying to do here we are trying to save lives and prevent unnecessary suffering and I think those are pretty noble professions and whether you're social worker or psychologist or psychiatrist or nurse or dog any of those I mean all of these helping professions where they help they're helping save lives and prevent unnecessary suffering and it's not complicated now how would go about doing those things can get really complicated but are overall approach you can see the military and me what's our mission saved lives prevent unnecessary suffering you do that and you're going to be successful no matter what you do people are going to say you've lived a great life if you even reduce suffering just a tiny bit and what I don't want an ever sees a veteran go out having suffer needlessly that is just I don't even like it even if it's needless suffering I just don't like see people suffering full stop but sometimes there's just nothing we can do but those where we can help we need to help what are your thoughts about PTSD treatment while folks like on while folks are deployed in a combat zone you know this is an issue that that Alan Petersen really led the charge on during our latest wars in Iraq and Afghanistan and there's this whole belief that you can't treat for post-traumatic stress disorder unless you're in a safe environment and if you're in a combat zone then you can't do that but then other people point out well we have prisoners who are suffering post-traumatic stress disorder they're not in a safe environment but we still treat them we have victims of assault and rape who maybe live in in the same place where they were raped and assaulted who are being treated for post-traumatic stress disorder the few the little bit of work that's been done in this area shows it can be successful and of course it makes sense that it could be because really if you look at the at least the cycle therapies around post-traumatic stress disorder we're trying to normalize symptoms and reactions we're trying to get the client to think a little bit differently about what they mean and what their experience is met I'm not sure you need to do the the re exposure aspect of it they're going to be re-exposed perhaps later in that same combat environment but just the way they take in the experiences will be hugely helpful for them even later if you think re exposure needs to be be implemented but I think that there's no point in delaying simply because or during this combat environment before you can't do this intervention I don't think there's any data that supports that it's really more I don't even think there's a theory that says that the one theory that said that was that you needed time to cognitive restructure your experience right this was the idea why you could only do one session a day but with the research with mass sessions will you do multiple shows that you don't need all that time and so that argument kind of is weak and I won't say it's completely dismissed but it's significantly weak and when it turns out that you could probably do a successful PTSD treatment intervention with re exposure probably in one to two weeks I think that's that what you're talking about that's something that I'm that started coming out several years ago that work and I think it's something that I should probably do a better job of it I should find somebody who's doing that work and like bring them on here to talk to him about it but like I think that's something that therapists every like we don't talk about enough because like the implications like starting with PTSD makes sense but then can you extend that to other problems can you you know because the idea of if I can get somebody if I can increase somebody's functioning that much faster there's so much value for that person for the people in their lives for the society in general that if we can make what took six months if we can get there in two or three or four weeks I mean that's there's a huge benefit I mean you're talking about relieving suffering I mean just you know that really makes a difference I mean anybody who's had a headache if you have a headache for an hour versus a headache for two days oh my goodness. Well you know one of the things and not to brag because you know I don't like those but I I'm the one who initiated that research when I was on active duty because from a practical standpoint now this is where it becomes practical I said well why is it ten or ten or twelve weeks and and can we do mass sessions because in the military a commander will let somebody go for two or three weeks to get better but they're not going to somebody go for three months to get better. So just from a practical level it fit more into an operational and so I'm the one now as you point out the work it just came out a few years ago but it was fun to the decade ago that's just how long these trials take sometimes but that whole line of research and I think we need to do this why and also when someone is suffering they want to see some immediate improvement right and you're more likely to get an immediate improvement if you're doing these intense sessions over a week or two versus why not seeing any improvement so they drop out the drop out rate becomes higher because I'm not getting better and I mean that's just only one of the reasons for drop out but it's one of the key ones is I'm not seeing any I'm not getting better why am I wasting my time and then just from a military I can just order you Castro your job for the next two weeks is to get better go I'll see you in two weeks by mission pretty clear get better right and and if we have an evidence based intervention that does that that's the key we want evidence based intervention we just don't want to do it you know we need to make sure works and and I was just I'm I was not surprised because just the way I think about these trauma and how to face yeah there's nothing magical I mean you probably couldn't do it in a day but I didn't think it needed 12 you know three months right I need it well and I you know we're talking about two weeks but if you take three months and turn it into a month and a half that's a huge I mean that's a gargantuan win I mean two weeks is like a panacea but like you know to take it from three months and cut that and I mean yeah anyway I always think that this this area is it's super exciting and it's you know and I will say this ed Defoe and Patty recent to they said yeah let's do this they were not wedded to oh no you need some people or you need time to process and the so what do you think is happening you think like a veteran is just sitting around processing they're not doing that I mean they don't even do the bloody homework you give them so it's I mean let's just be practical here and to see if just combine it with into intensive individual therapy sessions group therapy which you know unfortunately there being some bs have stopped doing because group therapy for PTSD is not evidence based and but I still think it's beneficial only because veterans say I really benefit from this I think the biggest benefit is that normalize is how they're feeling they can engage that's what that's what they're getting out of it I think that's an important element to recovery it's sustaining your recovery as well as having these support groups that are helping you sustain it so yeah I think that's yeah that so just I should we should probably wrap up because I've taken so much of your time but I either one or two other projects that you either supported or or part of that you're really proud of you know I think I the way my brain works is the ones that I'm the most disappointed because it tells me where we were there's still a lot of suffering and you know I alluded to my role and I didn't do any of the research in these these you know compressing the timeline for treating PTSD but but I'm very happy that you know I was a part of funding it and coming up with it look let's do this the thing that I my group it failure and I don't want to end on a downer and that is all of the research that we have put in to preventing and caring for those who are suicidal has not it's not worked and that's a big I think about this problem all the time because we've been at it for decades literally decades and it's gotten worse it may have stabilized I don't know if it's coming down it seems to be stabilizing may best case perhaps so that I just encourage anyone who's listening gifts and think what can we do differently break out of the old paradigm of whatever it is we're doing is not working and I know there's those who argue well we want to do anything it could be a lot worse that's not evidence based I mean it could be a lot better if we didn't do anything too we could be one of my big fears is we're normalizing suicide suicidal behaviors by talking about it all the time. That we may inadvertently be normalizing it in the sense of getting people to think about doing something they never would have thought about and I only have anecdotal stories about that most people are not suicidal full stop right thank goodness and but we need to do a lot a lot lot more work there and what are the things I am also you know I'm an in this on a positive note I was involved in a project tangent funding the project at Wives at USC a pilot study of supporting meals on Wives program for elderly veterans now often people don't think about elderly veterans needing meals on wheels but this program was actually instituted because these were elderly veterans who their partner had died their wife had died and they were living alone and they wanted to live alone but they were lonely we know loneliness and it's a social issue with mental health issues is is serious issue but the meals on wheels program actually provides these elderly veterans with not only a nutritious male which is the whole point of it but also these social contacts that you know once a day twice a day they're going to see another human being and for the relationship with them and in the process this person who's dark and off the mill can do kind of a wellness check that make sure that the veteran is not looking uncapped and have some kind you know so I would love to see that program be expanded to keep veterans in their homes because we know there's not enough homes for them to be and they need to be in their own homes most veterans want to be in their own homes because they're independent and all of and most people want to be in their own homes but I think the meals on wheels and that always comes under attack as not being necessary but I think it has all of the elements that we would want in an intervention food relationships wellness check early interventions all of those elements that could be very very powerful for all of our aging population not just in the US but around the world but anywhere else stop there but I think that's one that has a lot of potential that has only the surface being scratched to really maximize what it can contribute to the end of life for veterans and as I mentioned that's you know it's really how you go out you don't want to go out and pain and and you know embarrassment and so that I'd like to see is to spend a little more time and attention to well just I'm just thinking about what you're saying the social context and also just like you're saying you're able to actually go to the veterans home right so that you you're you just just like going into you see what's happening right which is so much more accurate than them reporting to you and that that just provides so much insight it makes a lot of sense and it's so it's so benign I guess right and it's not stigmatizing necessarily but so before I let you go one other thing I wanted to ask you is are there one or two resources that you would suggest that I can sort of link to for folks who want to learn more about what you're doing and you know her interested in we have we have a website and I wish I could tell you I knew that you would if you can if I can what's the what would I Google so if you Google University of Southern California military veteran programs you would you hit our website and and that we we try to post all of our publications all of our reports things were working on initiatives that we have going for folks to become familiar with that's that's at the USC level the you know for veterans who need help and and I'm by the way I have no monetary but the calling veterans network has 23 22 23 24 they're always adding more clinics they're all around America all around the US they provide care mental health care behavioral health care to any veteran and active duty any family member children spouses parents cousins uncles free of charge free of charge and and I mentioned that because you can go it's very it was set up by veterans for veterans it's free it doesn't cost anything it's you could still go to the VA and go to the Co-inventory Network it's you can still see your private doc and go there for behavioral health care you go here for your physical so it's a wonderful wonderful resource that and I don't know anything like it that's completely free doesn't do any income based testing it doesn't matter how much money you have or don't have you can go there for free and your family can go there for free that's the important part and and because oftentimes you know to be able to take care of veterans and maybe a family member if it helps the veteran here they'll help you as a family member regardless if you the veteran benefits when you're getting help so it's just a different model that I really really like well that that's great I'll link I'll link to both of these in the show notes so people can so that they can just click on that okay perfect thank you so much ladies and gentlemen dr. Carl Castro that's a wrap on our conversation about military and civilian mental health as I noted at the top of the show it'd be much appreciated if you could spread the word to anyone else who you think might enjoy the show until next time[Music][Music]