Dr. John Fortunato, chief of the Fort Bliss Restoration and Resilience Center, interviews May 1 with the traveling journalists for Secretary of Defense Robert M. Gates at the Centennial Club in Biggs Army Airfield. Photo by Virginia Reza.
Center promises bright future for PTSD servicemembers
“I’ve just had a tour of an amazing facility: the Fort Bliss Restoration and Resilience Center,” said Secretary of Defense Robert M. Gates in a Department of Defense DefenseLink News Transcript May 1.
The center is a specialized treatment facility for Soldiers with post-traumatic stress disorder who want to remain in the Army. It is the only center of its kind in the Department of Defense. The program is voluntary for servicemembers diagnosed with PTSD.
“It has to be (voluntary); you can’t make a Soldier come to this program,” said Dr. John Fortunato, chief of the R&R Center. “Motivation has to be high, because it’s a hard program. They have to deal with painful stuff.”
Fortunato, who came up with the idea for the unique treatment facility, which opened July 2007, is also a benediction monk, Vietnam veteran and clinical psychologist.
It all started when Fortunato worked at the Soldiers’ outpatient clinic here. He was 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 of 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 overstimulated 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.”
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 and 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-themed 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, who Fortunato says can do pastoral work with Wiccans, 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, because you don’t have time to grieve, and that is what a Soldier has to do,” Fortunato said. “But when you come back and you have done that for a whole year, you have a load of grieving 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 that includes massage, 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 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 under way on combat-related disorders and some possibilities include deploying Soldiers with short alleles on medication, which will help inoculate them against 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 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 volunteered and is scheduled to deploy to Iraq in June. He will be deploying with the Combat Stress Control Unit from Seattle as their unit psychologist.