National Alliance on Mental Illness
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The Role of Service Animals in Recovery
by Kim Puchir, NAMI Communications Coordinator
When General Patton met a soldier hospitalized for “shellshock” in 1942, he called him a coward. Anxiety, nightmares and anger—which can affect anyone who has experienced a traumatic event—are now known to be symptoms of posttraumatic stress disorder, or PTSD, which affects an estimated 15-20 percent of veterans. The military is finally starting to take PTSD seriously—in fact, the chairman of the House Veterans Affairs Committee recently asked Pentagon and Veteran’s Administration officials why they have been slow to try out alternative treatments for the disorder. Service dogs, one of the treatments under investigation, are already being used by veterans as a unique way to cope with symptoms of PTSD.
A person living with PTSD is overwhelmed by stimuli. Something as simple as walking from one aisle to the next in the grocery store can put all senses on red alert for someone like Jim Stanek, a retired staff sergeant with the U.S. Army who completed three tours in Iraq. “That space you can’t see between the aisles, in the army we call that dead space. It’s a potential threat.”
Brain regions like the amygdala and the hippocampus that deal with fear and memory seem to function differently in people living with PTSD. One of the researchers studying brain functions and PTSD, Dr. Jasmeet Pannu Hayes of Boston University, said that the overactive fear response in someone living with PTSD “is not permanent. It can change with treatment.”
Brain imaging studies have shown that people living with PTSD are more distractible—both by neutral stimuli and those that remind them of the trauma they suffered. This contributes to the hypervigilance that many people living with PTSD report experiencing. Barry Morgan, who retired from the Navy in 1995, says that what started out as adaptive behavior—being in tune with the changing noises in his submarine—has turned into a problem for him as a civilian. “I have a big problem with paying attention to every little thing that’s going on around me,” he said.
Cognitive behavioral therapy has long been the first line of treatment for PTSD, but Dr. Yehuda, professor of psychiatry and director of the Traumatic Stress Studies Division at the Mount Sinai School of Medicine in New York City, has suggested that PTSD arising from repeated exposure to something like combat trauma may need a different approach.
This is where service animals come in. Unlike a therapist, a dog is by the veteran’s side 24 hours a day, helping him or her navigate daily stressors.
Stanek says his wife has noticed changes since he acquired his service dog a year ago. “Recently we were out at a restaurant and for the first time I had my back to the entranceway. My dog, Sarge, was watching the door for me. And my wife looked at me and she said, ‘This is so nice. I finally got my husband back.’”
Dr. Joan Esnayra, founder of the Psychiatric Service Dog Society, is a biologist who has performed research about the efficacy of psychiatric service dogs, or PSDs. She calls the feedback loop between owner and animal a “cognitive intervention.” Angela Peacock, a former U.S. Army sergeant and Iraq veteran, uses a dog trained first by the American Service Dog Association. She and her dog, G.I. Joe, have developed a sense of trust together, “I look at his instincts. I can trust him in the situations where I’m thinking the worst.”
The high cost (up to $20,000) and long waiting list for a trained service dog put them out of reach for many people. “Currently, the VA is providing service dogs for everything but psychiatric conditions,” said Esnayra. In response, the recently enacted Service Dogs for Veterans Act will provide 200 service dogs to veterans with physical and psychiatric disabilities as part of a pilot study.
Several organizations have also stepped up to try and fill the demand. Stanek founded Paws and Stripes to connect veterans with service animals so that they can be in charge of the training process themselves. “You can’t tell someone with PTSD, especially out of a combat zone ‘okay, we know this might help you, but you have to wait a year to five years before we can get you help,’” he said. Stanek, like Esnayra, favors the self-training model because it is cheaper and encourages handlers to customize their commands.
Acquiring a service dog means going public about being someone living with a disability—and dealing with some of the public misconceptions about PTSD. Morgan, who lives with non combat PTSD, has had some discussions with veterans who developed PTSD from combat. He often chooses to say that his dog, Katsu, helps him with physical symptoms.
Peacock prefers to say, “my disability is on the inside” when challenged about bringing her dog, G.I. Joe, into public places. She said that many people don’t realize that women veterans come back with PTSD, too. “They think we sit behind desks. That’s not true. I drove convoys in Baghdad with no armor on my truck. I could have died any day.” Stanek, on the other hand, feels like it is his duty to answer questions and educate people about mental illness and PTSD.
The one occasion in which service dog owners are required to disclose their diagnosis is when they produce a letter from a doctor so that they can bring the dog on an airplane. The Air Carrier Access Act makes this requirement applicable only to psychiatric service dog owners, who must also call ahead when flying, unlike those who use service dogs for other conditions.
Esnayra pointed out that air travel is not the only area where double standards exist. “No other disability group has been required to conduct peer-reviewed research in order to prove that their service dogs work for them, beyond their own credible testimony,” she said. Psychiatric service dogs fall under more scrutiny “because our testimony is not viewed as credible because we are mentally ill.”
Posttraumatic stress disorder is not the only psychiatric condition that can be helped by service dogs. To hear the list of activities that Warren Gillis is involved with—volunteering at hospitals and homeless shelters, visiting people in the hospital, working part time as a mental health support worker—it is hard to believe that 10 years ago he had a hard time leaving the house because of schizophrenia and bipolar disorder. Like people living with PTSD, Gillis says of his service dog, Lurch, “The biggest thing is he helps me focus on the external and not the internal, what’s going on inside my head, hearing voices and racing thoughts.”
Services for veterans have come a long way since 1995, the year Morgan left the military. At that time, he was discouraged from talking about his psychiatric symptoms. Still, not every veteran living with PTSD even knows about service dogs or any of the other supports that might improve their outlook. Recovery from PTSD is possible. As Gillis says with his dog at his side, “My definition of recovery is that you’re comfortable with yourself again.”