Maybe Veterans Administration was right to shut down a clinical trial of service dogs for people with Post-Traumatic Stress, but it’s clearly wrong to keep stiff-arming the service-dog idea rather than embracing it. Back in 2008, before I was an official blogger at the RBC, Mark wrote about my efforts on behalf of NEADS (I’m on the board) to get the VA to consider helping with the cost of service dogs for wounded combat veterans.
Now the Atlantic has a piece about service dogs in the treatment of soldiers’ post-traumatic stress disorder. Apparently the VA suspended their study with a Tampa charity providing this type of dog to veterans. NEADS is mentioned prominently, since we have completed a pilot program in providing specially trained dogs to assist in the treatment of PTSD (our veterans dislike the term, so we call the program “TAD,” for trauma-alert dogs) in combat veterans. I know absolutely nothing about Guardian Angels Medical Service Dogs, Inc., in Williston, Florida or the suspension of its relationship with the James A. Haley Veterans’ Hospital in Tampa, and I wish to stress that nothing here is intended to disparage either organization, but I am quite concerned about the scattergun, reactive approach that seems to be the VA’s response to efforts to supply veterans with service dogs.
The role played by dogs in the treatment of PTSD (regardless of origin) is easily understood at its core. In 1990, I experienced a home invasion.  I was not physically injured, but the experience was profoundly terrifying. Psychotherapy got me over an initial period of acute symptoms, but for years– literally years– I suffered from hyper vigilance and sleep disturbance. I found it almost impossible to sleep anywhere other than at my own home, and even then I woke up many times at night, obsessively checking window and door locks. The symptoms stopped, though, when I had a houseguest named Bear, an enormous obedience-challenged longhaired German Shepherd who belonged to friends. Bear came to me when his people were out of town and I found that within a few visits, I slept right through the night. Bear could hear an actual person in the hallway outside my apartment. He got up and waited at the door, head cocked, until he was satisfied that there was no threat. I might jolt awake at the sound of a branch scraping the roof, but Bear was not fooled. He raised his head, but did not get up. It did not take long for my subconscious to learn that Bear was on the job and much better at it than I. So I slept when he was with me. I borrowed him when I needed to go out of town and stay in a motel. Theory proved: I slept. And an aside, driving long distances can be a nasty experience for a woman alone. When night descends, those highway rest areas are magnets for creepy people. I used to avoid drinking (anything) to avoid the need for a bathroom break. Ladies: try hopping out of your car with a well trained German Shepherd at your side and watch the creeps scatter. Ah, the empowerment. This restroom is mine!
Bear was not a service dog. He was what I later came to call a reasonable accommodation pet, in the sense that a landlord subject to the ADA could be required to suspend a no-pet policy if it could be medically established that I needed him for basic life functions. Service dogs are different because of public access. Service dogs actually perform tasks to assist a disabled person do things. The person needs the dog just as he might need an assistive device, so where he goes, the dog goes.
Which brings us back to the TAD program. It was born because of the expertise of my colleague, Cynthia Crosson, Ph.D., and the experience of NEADS in providing regular service dogs to combat veterans with physical disabilities. One of our veterans told us that he used to be plunged back into combat mentality every time he left a building because he could not stop himself from looking up to check for snipers on rooftops, and that brought him right back into the trauma. His service dog was not trained for this, but dogs are brilliant interpreters of human behavior. It did not take long for the dog to put it together: human walks through door, looks up, develops a bad mood. So when the veteran and his dog walked through a doorway, the dog bumped his head into the man’s leg, distracting him long enough that he forgot to check for snipers. Problem solved.
The TAD program is hugely time-consuming for Dr. Crosson and the staff members who assist her. We have a rigorous screening program that requires thorough investigation of the client’s psychiatric history and current status to ensure that he or she is well enough to care for the dog as well as symptomatically in need. NEADS TAD dogs are individually trained to perform services tailored to mitigate the veteran’s symptoms of PTSD.
I have not been wowed by efforts of the VA to incorporate service dogs into the treatment of veterans. At the time of the VA’s response to traditional service dogs, the organization seemed profoundly misinformed about the issue. With the current news about the suspension of the relationship between it seems possible that the VA jumped the gun in its haste to recover from its initial blunder. As I said in my 2008 letter to the VA, so long as the efforts of legitimate charities like NEADS are disparaged and forced to scramble for cash, a shadow industry in bogus service dogs will thrive.
Part of the TAD program requires out clients to participate in follow up surveys so we can track the actual effectiveness of the program. We hope that data will bear out my own experience in actual measurable terms. In the meantime, it sure would be nice if the VA got its act together on a national level.
Lots of smart people and groups develop assistive technology designed specifically for people with disabilities, and the results are often wonderful. Good AT can solve a problem and make a huge difference in quality of life. However, we tend to forget that the world is far more complex than the one problem-one solution paradigm suggests. For example, dogs are not a technology, nor are they designed by people to solve particular problems. People and animals develop complex relationships which can be mutually beneficial, and these relationships have existed for millennia. A movement in architecture, called UDL (Universal Design for Living) and then appropriated in education (Universal Design for Learning) makes this fundamental assumption: making the world more accessible for people with disabilities can benefit people without disabilities, often in interesting and unanticipated ways. Ramps are essential for people who use wheelchairs and walkers, but they are also useful for parents with strollers and people with wheelie suitcases. Books on tape are great for folks with no vision or poor vision, for people with dyslexia, and for people disabled by their commutes. Service dogs are also a great example of UDL. They provide more benefits than their trainers or owners anticipate, and the benefits extend beyond the person the dog is trained to help. For instance, service dogs attract lots of positive attention and break down barriers between people with disabilities and those of us who are temporarily able-bodied. They can help people with fears of animals get over those fears. They can facilitate social connections. They can provide, as Big Bear did with Lowry, an emotional benefit as well as a layer of security and practical help with navigating the physical world. The VA is overwhelmed by the needs of veteran, both physical and psychological. Their refusal to embrace the use of service dogs by veterans and to explore the unintended consequences of these arrangements, is ironic and sad.
Have the veterans’ advocacy groups been at all engaged on this issue? If an organization such as the Disabled American Veterans were to speak out, that would carry great weight at the Department of Veterans Affairs.
I think a big part of the issue is that we’re not really used to the idea of service animals — or other technology for that matter — for assistance with cognitive issues. Human beings are the top of the cognitive heap; we think and direct, and others do. Delegating something like watchfulness, or deliberately allowing oneself to be distracted, just seems wrong. And if, on the other hand, we couch the discussion in terms of improved emotional state with a service/accommodation animal, then the whole Calvinist streak comes into play.
Of course, as the population ages and so forth, cognitive assistance is going to become more of an issue, and the technological fixes are not nearly there. Companion animals have the one huge advantage of being able to recognize when their attempts at communication aren’t being acknowledged.
Calvinism.
The same reason we give hospital patients nasty, inedible food.
The same reason we have denied ourselves health insurance that every other civilized country esteems its citizens enough to arrange for.
The same reason we have such shitty, short vacations, and no mandated sick leave.
Service dogs also have the benefit of forcing people out of their homes and into friendly, social environments with a social lubricant at the end of the leash. I’m living in a high-crime area now and host a dog at my house a few days a week. She brings a psychological element of safety to our house that extends to our downstairs neighbors, too. And it does so in a way that fake “ADP” signs and barred windows can’t match.
Maybe the VA isn’t moving towards dog-involved policy, but San Francisco is taking steps. Lowry, have you heard of the WOOF Program? SF seems to believe that animals and people can help each other move towards psychological balance and feelings of safety. Dogs are lent to homeless people (along with a small stipend) providing they have stable homes and aren’t panhandling or using drugs. It strikes me as a shot-in-the-dark to combat San Francisco’s endemic homeless problem — but on the basic logic of “dogs makes people happy and vice versa,” seems like a good idea.