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PTSD, A COMPARATIVE STUDY ON THE CAUSES FOR CHANGE IN THE RELATIONSHIP BETWEEN PTSD AND SUICIDE RATES

By: Moz With the arrival of our countries heroes from countless battles over the past century it has now been widely accepted that the wounds of war are experienced for a lifetime in fear-provoking memories. The stigma around the innate temperament of these men and women has been slowly changing in that instead of being referred to as cowards our servicemen and women are now to an extent accepted as having taken on disabling mental injuries in the form of post traumatic stress disorder. To understand its haunting nature we must look to our history and understand how our society has influenced our perspective on: death, the preaching of violent behavior, and the psychological repercussions of violence. We must also look at how soldiers are trained to cope with the stresses of battle. Only then may we make judgments as to the power and adhesive quality of the trauma they endure. At this point we may truly justify our views as to how our soldiers should be treated and how we can prevent the weight of mental disability on our troops. Modern society has been plagued with an epidemic of violence and killing that has seemingly caused damage beyond repair. From our city streets and local businesses to the terror enriched streets of Iraq and Afghanistan violence has grown to be something tremendously and unnecessarily evident in our day to day lives. Over the past hundred years violence has been on the rise in our city streets and it seems as though it is something that is merely turned a blind eye to. From the mob killings through the great depression, to the serial killings up through the seventies and onward into the 21st century carrying hundreds of relentless gangs with it, violence has grown to be a rapidly spreading disease that will soon become irrevocable and undeniable. To gain perspective as to how the idea of death and killing has progressed and how changes in society and technology have led to the development of a people lacking respect or knowledge for the enormity of death and its traumatizing nature we must reflect upon these past two centuries and the fundamental changes that have come with industrialization.

Industrialization has made for a life of swift production and extreme development that has provided for an undoubtedly more exciting lifestyle. What over the past decade mainstream society has begun to understand is that with rapid technological advance in the pursuit of wealth there is much room cleared for moral dilemma. More often than not in North American society our success is put before what is ethical and this has resulted in many undesired consequences. Within the past several years it has been widely accepted that there is a relationship between industrialization and global warming. More recently with the steady progression of violence in society and our isolation and fear of death we have grown to be increasingly ignorant as to the value placed upon our dead. The media has been quick to share their definitive obsession and incontrovertible inspiration around violent behavior. With the spread of the media s and in turn the public s appreciation for violence they have failed to share the intensity of the emotion associated with hatred and aggression. This in turn has led to unbearable trauma. The trauma associated with violence has most severally impacted the men and women serving in our countries militaries in the form of Post Traumatic Stress Disorder or PTSD. Post Traumatic Stress Disorder or PTSD is an anxiety disorder commonly diagnosed among war veterans and victims of rape and/or abuse. PTSD is brought on by experiencing a traumatic event of great visual, auditory, or physical disturbance that can be inflicted upon the individual or a related party whether it is a close friend, passersby or other third source. People with PTSD often feel alienated in social situations and are unusually anxious, irritable, easily startled, and appear to be completely numb in an emotional sense. Victims of PTSD often times find themselves having to dissociate from their prior lifestyle due to relative events to that which initiated the trauma, causing recurrent memories of the inflicting experience. Victims of PTSD are frequently startled by such things as loud noises and physicality and therefore find it difficult to join their families for sporting events, pass construction sites, or watch violent films in fear that it will trigger negative recollections of their experience. These daunting memories that haunt victims of PTSD are known as flashbacks and they most frequently occur through nightmares. Due to the enormous diversity of the burdens placed

upon victims of PTSD an assortment of anxiety disorders result such as: alcoholism, depression, panic attacks, and drug use. The mental and/or physical disabilities linked to PTSD such as depression and alcoholism in many cases has led to suicide. Throughout our history man has been connected to the act of killing and death. Traditional lifestyles provided that society had a firm understanding of the power and meaning of both life and death. This can be understood by looking back to any time prior to the last century to half century where modern technology has isolated us from death. Children that would grow up in traditional families understood the respect needed to be taken when killing an animal for their food and were well exposed to the idea of death. They would see the seasonal killings and feel that it was something to be taken seriously and accept and respect the nature of death. People would kill, gut, dress, and cook all of their own meat from very young ages and understand how to manage the responsibility of having killed. Wives would bath their dead husbands bodies and the family would prepare the bodies and perform burials close to home as though the passing of a loved one was something to be cherished and dealt with personally. As history progressed the lines between life and death faded and killing became something dark and mysterious. With industrialization came refrigeration, hospitals, mortuaries and major advances in technology. The elderly would be put up in hospitals and their deaths would largely be hidden. Little personal responsibility or involvement would be taken in the death of relatives. Through the 20th century onward as we saw with the sexual repression, the absence of death and modern society ignoring its existence has provided once again a dark and mysterious attitude around its existence. With the presence of mystery around death once again society would take on an obsessive attitude. Society has been provided with two options to either repress or obsess around the idea of death and killing. Through this societal position people have generally accepted that death is something to be unseen and overlooked but other pieces of society wish to follow their suspicions and therefore are forced into going to desperate measures to oppose the general consensus. This combined with the dominant presence of media influence has provided idyllic circumstances for deviants to gain attention

hence the birth of subcultures such as gangs and Satanists and to birth of music such as Megadeath and Rob Zombie. The obsession with death can also be seen in film through countless movies some of the more violent being splatter movies such as: Kill Bill, Hostel, Saw, Friday the 13th, and the Texas Chainsaw Massacre. This along with modern media influence has provided a society that is clearly lacking a well needed respect for death. Given the public ignoring the act of death and killing those who have had to face it bear a tremendous amount of trauma. This notion is well captured by the following statement found in the novel On Killing by Dave Grossman, the quote is by A. M Rosenthal a reporter for the New York Times who put out an abundance of work out on the Vietnam War: The health of humankind is not measured just by its coughs and wheezes but by the fevers of its soul. Or perhaps more important yet, by the quickness and care we bring against them. If our history suggests unreason s durability, our experience teaches that to neglect it is to indulge it and that to indulge it is to prepare hate s triumph. Due to the neglect of the issue behind death and the trauma that has risen out of it, the people among society in a position to kill have been put at a disadvantage. This shortcoming when it develops into a disabling mental condition is PTSD. War is a major contributor to the many cases of PTSD across the globe. The Vietnam War and Operations Iraqi and Enduring Freedom have been the largest conflicts since the disorder was identified in 1980 (Morefocus Group, Inc) and therefore have been the forefront of PTSD studies. The images depicted by the media do not even scratch the surface of what a soldiers experiences. General Romeo Dallaire, the Canadian general leading the peacekeeping mission in Rwanda 1994 was hit heavily by the storm of PTSD and wrote a book titled, Shake Hands with the Devil to send the message of his experiences. It was a powerful account of the stresses associated with a lack of perspective around death and the immense impact on soldiers and leaders being put in a position where they must kill, experience tremendous hostility, and be mutually connected to both killing and death. General Romeo Dallaire expresses the rise of his PTSD in the following quote:

September 1998, four years after I had gotten home, my mind and my body decided to give up. The final straw was my trip back to Africa earlier that year to testify at the International Criminal Tribunal for Rwanda. The memories, the smells and the sense of evil returned with a vengeance. Within a year and a half, I was suffering, like so many of the soldiers who had served with me in Rwanda, from an injury called post-traumatic stress disorder. (Dallaire, 2003, p. xii) Dallaire manages to put great emphasis on the emotional weight war bears on its victims and many authors prior to Dallaire were unable to do so and as he puts it, the sounds, smells, depredations, the scenes of inhuman acts were largely absent. (Dallaire, 2003, p. xi) Dave Grossman a Lieutenant Colonel in the United States military and a psychology professor at West Point puts the immense power of PTSD into perspective by referring to its study as virgins studying sex. PTSD emerges as the worst of the many mental disorders that can arise within a soldier at war. Day after day the soldier is exposed to the elements whether it is rain, sun, or snow a soldier is weathering the storm. Soldiers are put through such tense conditions that they miss sleep for days on end alongside not having food for just as long. Sleep deprivation promotes the inability to think accurately, have a healthy immune system, and moderate stress and emotion. Amongst this deep exhaustion soldiers have to fathom such critical moral dilemmas as whether or not they should kill, and whether or not they deserve the right to take the life of someone so similar to them. This then causes a series of different stress promoting states. This combination of different responses to the stresses of sleep deprivation, malnutrition, and the constant tension of knowing they have to kill or be killed bring about a wide variety of mental states and reactions a few of which can described by Richard Gabriel in his book No More Heroes (Gabriel, No More Heroes: Madness and Psychiatry in War, 1988). Fatigue Cases are some of the most common cases and are generally the basis of the many other mental disorders that arise at war. In these cases soldiers are too exhausted to function both mentally and physically and therefore appear to put little to no effort into any task that may be demanded of them. They become extremely

petulant and will have fits for even what seem to be the most insignificant reasons often resulting in the acceptance of their condition and breaking into tears. Confusional States occur when a soldier is so exhausted and horrified that his/her mind will be relentlessly fighting to dissociate from their surroundings. Soldiers end up in a state where they appear to be completely emotionally numb and off in a world far from war. In these states soldiers emotions vary greatly from deep depression to being fully enlightened. This sense of rising out of depression is known as Ganzer syndrome where soldiers will be overly happy, make jokes and act out in hopes of masking their true feelings. In a state of Conversion Hysteria a soldier will find them self wandering aimlessly and completely unaware of where they are or what is going on around them. This often occurs during blasts at war or under the pressure of other stressors such as nearby gun shots leading to near death experiences. The symptoms may occur either at the time of trauma or several years down the road alongside PTSD. As soldiers are evidently under extreme anxiety in battle they can lead into an Anxiety State In this state of anxiety soldiers experience fear and are constantly worried about their death. They fear so much that they cannot sleep or concentrate on anything because they are so preoccupied by the fact they or the troops around them could be killed. This over the long term may lead to emotional hypertension where the victims blood pressure rises dramatically and symptoms including sweating and general nervousness arise. Closely related to conversion hysteria, Obsessional and Compulsive States can develop where the soldier realizes that their symptoms are due to their fear. They are well aware of their condition yet they cannot do anything about it and the victims end up both impulsively shaky, and on edge. Character Disorders are also a reality to PTSD victims because soldiers often times following serious trauma may follow a series of odd personality alterations where they may fall into a state of paranoia, become constantly worried, or engage in peculiar activities often times leading themselves into isolation from the rest of society. Society needs to accept that upon return from war soldiers are in a hectic search to grow comfortable with their emotions and cope with the traumatic experiences seen and committed at war. In the media portraying violence as something to be commended they are also causing soldiers to dissociate from those around them. Soldiers often feel a powerful guilt for what

they had seen and done overseas and in the public praising the fact that they have killed only cause s soldiers to dissociate with those who cannot relate nor understand their situation. Not only does the media fail in that it celebrates violence but it also fails by portraying members of the military as emotionless and/or fearless. This message fully contradicts the fact of the matter and makes for soldiers feeling the need to contain their guilt. In not sharing the stigmata around what they have seen and done only deepens the psychological impacts of war and prolongs the issue of PTSD victims not seeking care. PTSD and the many other mental disorders that come with the experience of war are so intense that anyone who hasn t experienced it couldn t possibly fathom the colossal weight it bears on its victims but merely understand and accept that they have done what they had been trained and pressured to do. Society must accept the idea of death and grow comfortable with it to truly understand where our nations have gone fundamentally wrong in our praise of violence. It has gone wrong in that people have been enabled to kill and exposed to violence yet it remains something of absolute mystery and is to be unheard of. People need to understand and accept that despite whether or not they believe in killing at war there are far more victims of mental disorder than there are of killing. There were 800,000 troops classified unfit to fight but despite this process of filtering out those who were incapable there were another 504,000 military losses due to psychiatric collapse (Gabriel, 1986) during World War II. Given that there were 416, 837 (U.S. Army Battle Casualties and Non-battle Deaths in World War II: Final Report, Table, p. 8:"Battle casualties by type of casualty and disposition, and duty branch: 7 December 1941 -31 December 1946", 1953) military men/women who were actually killed while serving compared to the notably higher rate of mental disorder, the mainstream public needs to accept the atrociousness of the mental outcomes associated with violence. In all, there need to be adjustments in society that make for a more reasonable understanding for the history and significance of life and death. If they can not grasp the great power it bears, soldiers for generations to come will be largely unable to communicate what time after time has been eating them from the inside out.

Prior to war a variety of factors influence how a soldier will react to the atrocities seen on the battlefield. The military over the past century has done a brilliant job of enabling the soldiers ability to kill. In the first and second world wars the firing rates were minimal at only 15 to 20 percent of soldiers being able to take up arms (Grossman, 2009, p. 3). Research and a steady push from military leaders pushed this rate up to 95 percent in Vietnam (Grossman, Aggression and Violence, 2000). From a military perspective this is a major achievement yet unfortunately it has led to a massive influx of soldiers with an abundance of different psychiatric disorders and most notably led to the identification of PTSD. S.L.A. Marshall was a chief combat historian from the Second World War and onward to both Korea and Vietnam. Through Marshall s experiences he was able to generate the first statistics on non-firing rates and later developed the conditioning techniques used to this day. Marshall put out a huge amount of literature on these firing rates and therefore provided that soldiers would no longer fire at bulls-eyes but fire at realistic targets. Since the acceptance of his ideas the military has completely altered training techniques to replicate war scenarios as close as possible. Soldiers now go for days without food or sleep to replicate war scenarios. The United States military has gone as far as developing a 1000 sq. mile training center featuring 13 Iraqi villages in the Mojave Desert where soldiers have to engage in realistic battle experiences. In this battle simulation soldiers use replicas of body parts that have been picked up at war and doctors that have experienced the war to set up realistic fragmented bodies. As well as having gruesome body parts in the simulator there is also the persistent use of blank bullets and explosives. It is these modern techniques that teach solders to kill. On the other hand it is also the cause of a dramatic increase in PTSD rates as soldiers are now trained to overcome the fight or flight reflex to respond in killing and challenge the instincts instilled in them from birth. Soldiers at war are faced with the idea that they are killing men who are in their same position and by killing others they are in turn killing a piece of themselves. In many cases of PTSD soldiers relate their experiences at war to the occurrences of day to day life and the fact that they have killed puts them in a position where they question all that happened at war and it truly

becomes a part of day to day life. Dissociation is very real in PTSD victims as they do not want to engage in any activity that could possibly trigger flashbacks. This leads to soldiers that lack the ability to enjoy the delicacies of life as at any time they could be reminded of the atrocity experienced. When a person is stimulated by fear they quickly change their reaction from the part of the brain generally used in thought processing and judgment (the forebrain), to the use of our emotional center which controls fear, anxiety, and anger known as the midbrain. This response in soldiers has been conditioned in such a way that come a time where they are threatened they have been trained to react violently. This part of the brain is one involves very little conscious thought and relies heavily on trained reflexes. Unfortunately this puts PTSD victims in an uncomfortable situation as they are often in a state of fear and confusion which may in turn cause them to commit immoral and/or dangerous crimes. A soldier at war is often confronted with this reality will constantly be having to deal with confrontation which in turn leads to them killing their attacker. After this occurs countless times along with a lack of sleep or food soldiers grow traumatized. Soldiers seem to have an innate resistance to the killing of their own man yet there is one thing that time after time has deeply impacted a soldier s mentality that being the irrational aggression and blatant hostility brought about by up close and personal combat. Despite the natural conscience a soldier has to overcome to come to terms with killing someone of the same circumstances it is dealing with aggression and hostility. This clearly impacts a soldiers mind when they are already questioning the act of killing yet now they absolutely have to kill as well as cope with the profound hatred coming down on them. While at war soldiers are constantly associating with their sympathetic nervous system which utilizes all the bodies energy in preparation for emergency and therefore causing all unnecessary systems to shut down. This in some of the worst cases leads to soldiers defecating and/or urinating uncontrollably. When this system shuts down after long periods the body enters the parasympathetic phase where the body returns to normal and this leaves soldiers exhausted. This experience leads to soldier to remain in a state of deep fear of combat and

association with those around them in fear of being accused as a coward. This disengagement from battle deepens the trauma of war as soldiers become aware that they cannot function to the point of doing what they have been conditioned to do. This can carry into civilian life after long periods of service and cause soldiers to remain in a constant dissociative state. As a PTSD forum member from eastern Canada states, I want support, understanding, and treatment and that is something our people have largely failed in doing. Fortunately, where the public has failed to treat our veterans appropriately the government has provided exceptional treatments to compensate. In spite of the tediousness of the application process, the United States has provided a substantial range of treatment options available to the public. Veterans have access to: bereavement, individual, group, and family counseling to cope with their experiences of PTSD and it has proven largely effective. In a comparison between PTSD to suicide rates between Iraq and Afghanistan and The Vietnam War it was found that there was a 5.5% drop in suicides among Iraq and Afghanistan War veterans despite Iraq and Afghanistan War veterans experiencing a rate of PTSD 16.3% higher than that of Vietnam War veterans. Additional services provide: outreach education, medical referral, homeless veteran service, and employment VA benefit referral to ease the transition between military and civilian lifestyles. These services are put in place to firstly serve the soldier in maintaining a tangible mental condition and secondly to provide that they can live a lucrative lifestyle. In addition to these services provided members eligible receive a long list of benefits some of which include the following: Disability compensation, pension, vocational rehabilitation, vet success programs, education assistance, survivor benefits, home loans, life insurance, traumatic injury insurance, mental health residential rehabilitation treatment programs, nursing home care, worldwide emergency care compensation, and lastly burial and memorial services. Online services include: suicide prevention, PTSD consultation, and public health referrals. In short there is no lack of services provided. There is a vast expanse of treatment options available for PTSD the most effective and one that has been tested through both wars is that of which is done by means of psychology. There is a thorough collection of methods available to psychologists in the treatment of PTSD and all very

dependent upon the patient. The most commonly used treatment is cognitive behavioral therapy (CBT) and the most common CBT methods used are: cognitive restructuring, exposure therapy, group treatment, stress inoculation training, and family therapy. Cognitive restructuring is the process of redeveloping the mind in such a way that the victim will learn to counter their cognitive misconceptions and evidently polluted thinking, in hopes of counteracting their illogical thoughts with reasonable ones. Exposure therapy works in around the idea that victims are dissociating from what has caused their stress reaction and by exposing them to it they learn fundamental coping methods to overcome their stress. Group treatment works by bringing together veterans that have shared similar experiences and allowing them to share what it is that has been troubling them. Stress inoculation training is where as explained by Mathew Tull a PTSD specialist, the therapist helps the client become more aware of what things are reminders (also referred to as "cues") of fear and anxiety. In addition, clients learn a variety of coping skills that are useful in managing anxiety, such as muscle relaxation and deep breathing. (Tull, 2008). Finally, family therapy is also used to help the victim s family cope with the many behavioral changes that arise alongside PTSD such as: depression, alcoholism and drug use, irritability, and emotional numbness or general hysteria. Alongside these treatments there are also many more on the way including what has already been implemented into some psychologists treatment regimes known as virtual reality treatment which is a form of exposure therapy using stress provoking imaging. What is lacking in the system is the ability for soldiers to actually receive immediate treatment for their PTSD and other mental disorders. Soldiers discharged from battle are sent home to receive treatment yet little do they know they will have to endure months of waiting before even being looked at. As Larry Provost an Army reservist who was given a two month wait time puts it, I m not going to take a shot at the administration or the Democrats, it s just a problem that needs to be fixed, it s an American problem (Vlahos, 2007). A veteran of the Persian Gulf War and a spokesman for Veterans for America also expressed his concern in an interview with Fox News saying, the biggest message I want to say besides it s a tragedy for this guy asking for help and not getting it, is there are going to be more veterans having the courage to go for help

and not getting it , this was speaking in reference to the St. Cloud case where Marine Jonathan Schultze hung himself on account of Minnesota VA services turning him away due to waiting lists. During a lawsuit against the VA by the Veterans for Common sense Paul Sullivan the executive director of the advocacy group stated, there are long waits to see doctors, 25 percent wait more than one month, according to VA s Inspector General, and even longer waits to receive disability claims the average wait is a staggering six months, according to the Veterans Benefits Administration. (Leopold, 2008). There have been many cases in which soldiers have committed or attempted suicide in the months of waiting leading up to what would be their diagnosis. In many cases victims subject themselves to alcohol and/or drug abuse and may take on a series of additional mental illnesses that may not have otherwise presented themselves. Now more than ever the media and public need to understand the nature of soldiers stress reactions to war and the facts as to how soldiers truly feel about the act of war. Soldiers most definitely appreciate society looking to them as power and influential individuals who can handle anything and will take these compliments to hear t as they deserve all the appreciation they can get. Yet in the public seeing them as powerful people who can take on the most gruesome of tasks they need to understand the implications of such tasks on the mind. People need to understand that victims of war also carry trauma. Studies of returning veterans have proven soldiers are not willing to convey their trauma, in United States veterans returning from Bosnia researchers found that 61% of veterans with mental illness stated that by exposing their fear their careers may be at risk. Another study of American service members showed that soldiers would not share their stress in fear of being seen as weak or not being accepted by their unit (Tull, 2008). In people having a sensible understanding as to the reality of war it would allow for soldiers to communicate more openly as to how they truly feel about going into battle. If society truly makes an effort to cure the emotional trauma that has plagued the heroes of our
countries they would be able to accept that it is not abnormal to be uncomfortable with the acts

of war. This in ideal circumstances would provide that victims of PTSD would not have to wait

months to be able to share what they could with the public and their families much more immediately. We as a society need to provide universal awareness for PTSD and accept the failures of promoting violence and the act of killing. Awareness as a mechanism for prevention is something that has clearly been overlooked in the war against PTSD. Our governments need to invest in the promotion of accurate knowledge of war and the mental disorders that often result. That will provide for a more understanding society and in turn lead to a decreased demand for VA services. This would in the long run allow for the government to invest a large sum of money elsewhere. These moral values could be instilled in the public through government funded advertising and government funded media coverage of PTSD cases and the research that entails. We need to stop denying that this is an issue and accept that these people need help. Senator Patty Murray addressed the issue and made the following statement on the senate floor back in 2008, Time and again, it has taken leaks and scandals to get the Administration to own up to major
problems at the VA from inadequate budgets to rising suicide rates. And its response to rising costs has been to underfund research and cut off services to some veterans (Leopold, 2008). Instead of investing in lawsuits against our veterans and cutting corners in their treatment to compensate,

PTSD needs to be accepted and addressed right from the start and an effort needs to be made from both the public and our countries leadership to help these people. Funds for the time being should be moved from recruitment to treatment and jobs need to be opened in VA healthcare system to aid the victims of war appropriately. Those who have served our countries need to be embraced by a public who can truly appreciate their sacrifice and provide them with the care they deserve. In making an effort on all fronts to raise awareness we can make a difference in the hundreds of thousands of PTSD victims across the countries lives. Our people need to culture themselves to establish an intimate respect for death and understand the ignorant nature of our vested interest in violence. There need to be more victims seeking help and everyone whether it be military, civilian, or a government figure, needs to accept that our military has the right to seek

treatment and should be encouraged to do so when the necessity of treatment has now put before of all of us. The statistics presented and the memories that sit in our countries heroes are indisputable; it is clear that PTSD is a trend and should by no means be hung by the burden of stigma.

Bibliography
Dallaire, R. (2003). Shake Hands with the Devil. Toronto: Random House. Gabriel, R. (1986). Military psychiatry: a comparative perspective. New York: Hill and Wang. Gabriel, R. (1988). No More Heroes: Madness and Psychiatry in War. Grossman, D. (2000). Aggression and Violence. Retrieved May 4, 2010, from Killology Research Group: http://www.killology.com/article_agress&viol.htm Grossman, D. (2009). On Killing . New York: Back Bay Books. Grossman, D. (2009). On Killing. New York: Back Bay Books. Leopold, J. (2008, August 14th). Army Vet's Suicide Raises Questions About VA's Treatment of PTSD Cases . Retrieved may saturday, 2010, from http://www.atlanticfreepress.com: http://www.atlanticfreepress.com/news/1/4525-army-vets-suicide-raises-questions-about-vastreatment-of-ptsd-cases.html Tull, M. (2008, October 9th). Stigma From PTSD. Retrieved May 8, 2010, from PTSD.about.com: http://ptsd.about.com/od/treatment/a/Stigma.htm U.S. Army Battle Casualties and Non-battle Deaths in World War II: Final Report, Table, p. 8:"Battle casualties by type of casualty and disposition, and duty branch: 7 December 1941 -31 December 1946". (1953). Office of the Adjutant General. Vlahos, K. B. (2007, February 13). Concerns Mount Over Waiting Lists at Veterans Affairs Mental Health Centers. Retrieved February 14th, 2010, from http://www.foxnews.com: http://www.foxnews.com/story/0,2933,251580,00.html