Chief says Army needs to replicate Bliss PTSD program
July 18, 2008
FORT BLISS, Texas (Army News Service, July 18, 2008) -- Army Chief of Staff Gen. George Casey visited Fort Bliss July 13 and said that an innovative program there to treat post-traumatic stress disorders ought to be replicated at other locations across the Army.
The "Restoration and Resilience Center" at Fort Bliss is a specialized treatment facility for Soldiers with PTSD who want to remain in the Army. The center is run by Dr. John Fortunato, a Benedictine monk, Vietnam veteran and clinical psychologist.
"Unfortunately you can't package John Fortunato and move him around and it really takes someone with that passion to drive these kinds of operations," Gen. Casey said, "but there are some of the elements of this that are clearly exportable, and we will do that."
Fortunato opened the unique treatment facility one year ago in July 2007. It all started when he worked at the Soldiers' outpatient clinic at Bliss, treating servicemembers who were coming back from deployment and diagnosed with PTSD. Their treatment consisted of medication and group counseling and very little individual counseling, due to insufficient staff. If, in the course of three months Soldiers were not fit for duty, they had to be medically discharged.
"There were two things about that, that didn't seem right," Fortunato said. "I got tired of Soldiers crying in my office, telling me they did not want to get out, that the Army was their life, and that's all they knew, and all I could say is, 'Sorry, we have to discharge you.' It tore me up."
The other thing that didn't seem right to him was signing paperwork stating Soldiers had derived "maximum benefits on inpatient and outpatient treatment."
"I thought, that is not true, because we haven't really tried hard enough to rehabilitate them. There were so many issues we were not addressing."
Fortunato said during his sessions with the Soldiers at the clinic, his intuition helped him realize they needed more than just psychological treatment. As he counseled them, he noticed their hands and feet constantly tapping and shaking through entire sessions. Spiritual questions and isolation were other symptoms he observed. So he came up with the idea to build a place where physical and psychological aspects could be treated to help Soldiers who wanted to remain in the military.
The task would not be easy, as the center he had in mind was not a typical Army facility. Nevertheless, he persisted and pleaded and finally got the funding and square footage to open the center.
His first instinct was to design a place where Soldiers could go and feel comfortable. He did not want them isolated in their rooms because he said, Soldiers diagnosed with PTSD are easily over-stimulated and don't want to be around anybody.
"Only - we can't leave them there," he said. "So I had to sort of seduce them out of their rooms."
So Fortunato decided the center would have to look like a lodge at a ski resort. The entrance to the facility is equipped with oversized leather, mission-style chairs, wood floors and the sound of trickling water from a cascading fountain that sits in the lobby has a calming effect. At the end of a hallway, is an Asian-looking room with background therapeutic sounds, called the meditation room.
"This room has a purpose," Fortunato said. "You can sense the music playing, which is based on breathing, and if you spend three minutes in this room with the door shut, without anyone talking you, you will find that your mental state has changed."
Fortunato said that during treatments, Soldiers have to stir up memories they don't want to remember, but that are necessary in order for them to work through them. This procedure arouses them, and by going inside the room, the ambiance helps them calm down again, he said.
"So there is a lot of traffic in and out of this room," he said. "You will sometimes find four Soldiers just sitting here, and we want them to do that.
"And let me say that regardless of what your faith is, there is always something that makes our life meaningful," Fortunato added. "We all have some notion about why relationships are important and who we are. All those issues are questioned by Soldiers in war. They come home and they have to deal with questions they usually don't have the ability to handle ... And I'm not offering any particular answers, but God have mercy, we have to help Soldiers answer those questions ... so that they can get on with their lives."
A group of therapists and a chaplain help Soldiers raise painful questions so they can get through the grief they have been holding on to, which he said is one of the things Soldiers resist most.
"In theater if you lose a buddy, here is what you do: drink water, stuff it down and go back out on the road," Fortunato said. "Because you don't have time to grieve, and that is what a Soldier has to do. But when you come back and you have done that for a whole year, you have a load of grief you haven't done."
Another issue Fortunato said the military was not addressing before was the physical aspect. He said many post-deployment Soldiers constantly tap their feet and hands.
"In order to stay alive, their bodies have been hyper-aroused for so long, that they come back and cannot turn it off," he said. "Their body doesn't even remember how to relax again, and because of that they don't sleep and are irritable."
Therefore, servicemembers have to learn how to relax again. And to acquire the relaxation mode again, Fortunato designed a therapeutic program, which includes massages, acupuncture, Tai Chi, Yoga, Reiki, power walks and visits to the mall.
"You would think that going to the mall would be fun, but it is not fun for a post-deployment Soldier," Fortunato said. "There are too many people, too much noise, which sets them up for panic attacks. But we can't leave them there, so we teach them relaxation techniques to modulate stress and we take them to the mall."
The staff then ups the outings by taking them to a simulated indoor range, where Soldiers can fire real weapons. They start out with insurgent silhouettes, which then build up to ambush scenarios, which can be very challenging for some Soldiers, Fortunato said.
"But we have to challenge them if they want to stand up and be warriors again," he added.
Fortunato said there are reasons why servicemembers get PTSD that have nothing to do with character. A recent finding of a strong genetic predisposition is a factor that puts people at risk.
A 5-HTT gene serotonin transporter, which regulates anxiety and depression in the brain, contains "alleles," which can either be short or long. He said people with one or two short alleles become depressed more often after stressful events than individuals with two long alleles. Research is underway on combat-related disorders and some possibilities include deploying Soldiers with short alleles on medication, which will help inoculate them from getting PTSD.
"We are in the process of doing a research protocol with 400 Soldiers," Fortunato said. "WBAMC is considering that research protocol. And if we can show that it is true, then we move to the next step. The Army is very interested in doing the best thing for the Soldier and if we find that's what we need to do then we will do it."
Another of the many therapies in the program is the cognitive rehabilitation, which treats stress hormones that, if too high, can damage part of the brain that controls thinking, especially memory. By using the brain-train treatment at the R&R center, Soldiers can regain all their functions.
"It just takes work," Fortunato said. "It is like a muscle - you have to work it to make it better."
The program includes three phases: In the first three months, Soldiers receive 35 hours of treatment per week. Then it drops to 21 hours a week for another three months. After that, they go back to their units, but with seven-hour-a-week after care. So far, 12 out of 37 Soldiers have graduated and are back in their units.
Fortunato said he wants to deploy to Iraq in the future with a Combat Stress Control Unit as their unit psychologist.
(Virginia Reza writes for the Fort Bliss Monitor newspaper. Stephen Baack of the Monitor also contributed to this article.)