Spiritual Pathways

Steven Reuben's 25th Mechanized Infantry unit is ambushed while working its way up a Vietnamese mountain. A rocket-propelled grenade blows through his legs. His body goes one direction, his weapon another. He lies wounded and bleeding, undetected and unable to fight. He listens in horror as his fellow soldiers are slaughtered by North Vietnamese troops just a few feet away.

This is the scene Reuben cannot shake, a nightmare that started in Southeast Asia in 1969 and has yet to end. He came home to the Nez Perce Reservation in northern Idaho with shattered knees, shattered eardrums and a shattered soul. By the early 1990s, he was checking into his third VA treatment program. And like many of the 21 other American Indian veterans he joined for that final round of post-traumatic stress disorder treatment, nothing quelled the memories, the flashbacks, the relentless dreams. Two of the other veterans in the program committed suicide, and nine fled before the inpatient program was finished. "The Indian veterans didn't trust the counselors," Reuben says. "Therefore, they couldn't bring their problems out."

A handful of VA staff with combat experience shared the same frustration. They knew decades of cultural misunderstandings and mistrust - marked by some VA workers turning away veterans with the suggestion they get their medical care from the Indian Health Services - had created a seemingly insurmountable rift. "Nobody was dealing with PTSD," says Dave "Coyote" Mann, who saw action in Vietnam and worked as a veterans service officer for his people on the Yakama Indian Reservation. "They were just shoving it away."

As a result, in 1992, Mann and three VA staff members created a program that blends modern psychology with ancient spiritual healing. Today, Camp Chaparral is the nation's most well-regarded program for treating Indian veterans with PTSD and showing VA health-care providers the power of ancient spiritual healing. "This is the only place I've ever found honor," Reuben says. "It's the only place I've ever found healing."

Camp Chaparral brings VA health-care workers and veterans together on a sacred section of the Yakama Indian Reservation in central Washington that is traditionally closed to non-tribal members. Here, amid the towering ponderosa pines, veterans and VA health-care workers sweat together, share their thoughts in group counseling, and conduct traditional Indian ceremonies and dances. From the first early-morning sweat-
house session to the last lingering campfire conversation, the veterans share their battles with PTSD and give VA staff and other sufferers the opportunity to experience spiritual medicine.

Despite 15 years of unmatched success and the need to serve nearly 200,000 Indian veterans, VA reduced its support for Camp Chaparral soon after the wars in Afghanistan and Iraq began. The number of VA staff permitted to attend has been cut in half, to 40. Admission, once open to VA health-care workers across the country, now is restricted to staff in Oregon, Washington, Idaho and Alaska. Funding was slashed from $50,000 to $25,000 two years ago, forcing the camp to shrink from seven days to four days. And VA provided no financial support at all in 2004. That year's camp would not have been possible without emergency help from the Yakama Tribal Council.

VA says it's had little choice. Doctors, nurses and social workers are so busy at regular facilities that they can't be spared to attend Camp Chaparral, according to department spokespersons. And when VA's budget is strained, as it was in 2004, decisionmakers choose to use their resources differently.

"It is challenging for facilities, especially for our smaller sites, to have large numbers of staff away at the same time," VA spokeswoman Megan Streight says. She maintains that VA will never stop funding Camp Chaparral. "Camp Chaparral is recognized as an extremely valuable event in our network. We are fully committed to supporting it."

Mann is skeptical. Given VA's shifting priorities in recent years, tight budgets and attitude toward Indians, he doesn't expect the camp to be around another year.

"It's a problem getting VA to understand that Camp Chaparral is very important to our people," Mann says. "If they don't want to give money, that's one thing. They should at least allow people who work at VA to attend."

This is no time to cut back on PTSD treatment, Mann insists.

"We're going to get an influx of Iraq and Afghanistan veterans, and we're not prepared for it," he says. "They've got to get their mental-health programs up and running. I've got a son in the Army in Afghanistan. He's going to have problems when he gets home."

Informal, Intense. Steven Reuben knows firsthand the weight of mental-health baggage a combat soldier often carries home. He had never been off the Nez Perce Reservation when he left for basic training in 1968. His first firefight, a few days after arriving in Vietnam, was the Tet Offensive. "They gave us a one-day combat refresher and sent us into the shit," Reuben says.

He was trained as a mechanic, but Reuben was never ordered to use those skills overseas. "They took my wrenches, handed me a gun and sent me out," he says. That continued until the night-patrol ambush that has never quite ended in his mind.

Reuben didn't drink or smoke in Vietnam, but he developed a ferocious appetite for alcohol once he returned. He eventually overcame his drinking problem. The PTSD was a different story, despite multiple attempts at VA treatment.

Then Dave Mann invited Reuben to participate in the first session at Camp Chaparral.

VA mental-health professionals and veterans are assigned to families of between 15 and 20 people at the camp. Each is led by at least one American Indian combat veteran and tribal elders.

During daily sessions, the Indian veteran talks about the trauma of war and, with the assistance of the elders, the spiritual medicine that helped him deal with PTSD and resulting substance-abuse problems. VA staff and veterans participate in sweats in the early morning and late evening, building trust and breaking down barriers.

"We decided the best way to train the counselors, doctors, nurses and other VA people was to sensitize them to our culture," Mann explains. "And we are trying to expose them to how veterans really feel. It doesn't make them instant experts, but it does make them more accepting."

Camp Chaparral also addresses cultural problems that prevent Indian veterans from getting the help they need. One of the first steps is persuading VA health-care providers to abandon an assembly-line approach to medicine, turn away from their computer screens and listen to their patients.

"The individual has to feel safe in order to share the deepest, darkest part of their struggle - before they can begin dealing with the PTSD," explains Steve Tice, one of Camp Chaparral's founders, who dealt with PTSD both as a combat veteran and a VA counselor. "To take that first step and find safety, for a combat veteran, is very difficult. Making a person feel safe is, in part, about culture. You need to understand what they bring into treatment."

Reuben remained a quiet loner in Camp Chaparral's family sessions for the first five or six years he attended. Hearing other Indian veterans talk about their experiences and sharing sweats and other ceremonies gradually gave him the confidence to deal with his own trauma.

"It helped me with the memories of the firefights I was in," Reuben says as he cleans the war bonnet he'll wear for the powwow during the event's final night. "It helped me with the memories of comrades who were wounded and crying out."

Now Reuben leads a family group and sweat lodges at Camp Chaparral. Helping other veterans, and helping VA health-care workers understand both the trauma of combat and the power of Indian spiritual practices, is strong solace. "This gives me confidence and helps me cope with the outside world," he says. "Before, I couldn't go out without looking behind my back."

"You never get over it," says Jake Mann, Dave's brother and an Air Force veteran who served four tours in Vietnam attached to the Marines and other units. But Camp Chaparral gives veterans "a way of releasing and learning how to live with it."

Beyond helping them understand and treat American Indian veterans, Camp Chaparral helps VA employees deal with the personal stresses of their work. "We're trying to get them to better understand themselves," Mann says, "so they can better understand their clients."

That's critical, says Suzanne Williams, an Air Force combat nurse during the Vietnam War who is now a social worker and therapist in the PTSD treatment program at the Spokane, Wash., VA. For 35 years, Williams couldn't talk about her war experiences - until she came to Camp Chaparral.

"You come (to Camp Chaparral) thinking you are going to get a training on working with Native American veterans. I didn't realize I was going to be asked to talk about my own experience and begin my own healing journey," Williams says. "If I hadn't come here, I would never have been able to work with veterans."

Some VA doctors and nurses say Camp Chaparral is the best and most meaningful PTSD training they receive.

"Many people who suffer from PTSD hold things pretty close to their chests," says Dr. John Osborn, who has treated patients at the Spokane VA Medical Center since 1983. "You don't develop a sensitivity to PTSD without this sort of experience. And in medicine, if you don't suspect a diagnosis, how are you going to make it?"

Ken Olsen is a freelance writer who lives in Spokane, Wash.