The Pathway Home Makes Inroads in Treating PTSD

An innovative California facility offers hope to combatants with post-traumatic stress disorder and brain injuries

  • By Robert M. Poole
  • Photographs by Catherine Karnow
  • Smithsonian magazine, September 2010, Subscribe
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Pathway Home residents
The Pathway Home encourages its residents to go into the community. "The real test is when you go outside," explains program director Fred Gusman. (Catherine Karnow)

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They went off to war brimming with confidence and eager for the fight in Iraq and Afghanistan. They returned, many of them, showing no visible wounds but utterly transformed by combat—with symptoms of involuntary trembling, irritability, restlessness, depression, nightmares, flashbacks, insomnia, emotional numbness, sensitivity to noise, and, all too often, a tendency to seek relief in alcohol, drugs or suicide.

“Families and friends are shocked when one of these guys comes back,” says Fred Gusman, a social worker and mental health specialist now serving as director of the Pathway Home, a nonprofit residential treatment center in Yountville, California, where active and retired service members suffering from post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI) are learning to make the hard transition from war to civilian life.

“The guy who looked like G.I. Joe when he left home comes back a different person,” says Gusman, a Vietnam-era veteran who pioneered treatment for warriors suffering from stress-related illness in the 1970s. “We called it post-Vietnam syndrome back then,” Gusman adds, noting a link between combat and mental trauma that dates to the Civil War. That war produced an anxiety disorder known as “soldier’s heart”; World War I gave rise to shell shock; World War II and Korea produced battle fatigue.

Each clash of arms spawned its own array of psychic injuries, with striking similarities to those haunting thousands of combatants from the current wars. “You get the 10,000-mile stare,” says Gusman. “You shut down emotionally except when you’re raging with anger. You are hyper-vigilant because you don’t know where the enemy is. You look for signs of trouble in the line at Wal-Mart, or when someone crowds you on the freeway, or when there’s a sudden noise. They are very, very watchful. This kept them alive in Iraq and Afghanistan, but it becomes a problem when they come home. It’s not like a light switch you can turn off or on. I tell the guys they have to play detective, to figure out why they’re angry or anxious and unravel it. We give them the tools to realize when they’re spinning and need to stop. They learn to modulate their emotions.”

Since opening his facility on the grounds of Yountville’s Veterans Home of California in 2008, Gusman and his staff of 18 have treated almost 200 wounded warriors, many of whom had found only frustration when they sought treatment at military hospitals or V.A. centers.

“There’s no compassion. I felt constantly ridiculed,” says Lucas Dunjaski, a former Marine corporal diagnosed with PTSD in 2004 while serving in Iraq. Returning home, he ran into marital difficulties, drank heavily and sought treatment at the V.A. Hospital in Menlo Park, California, which specializes in PTSD care. He gave up after two one-week hospital stays a year apart. “It wasn’t a healing environment,” he recalls. “I tried to commit suicide. I just couldn’t pull it together.” (Since Dunjaski’s V.A. experience, the Department of Veterans Affairs announced in July that it is easing the process for those seeking disability for PTSD.) For his part, Dunjaski enrolled in the Pathway program last spring, which handles as many as 34 patients at a time. “I came here thinking it was my last option. I would be dead if I didn’t have this program,” says Dunjaski, now 25. Finishing treatment in July, he felt that things were finally looking up: he had just moved into a house with his new wife and had hopes for the future. “I know I’m going to be OK.”

What differentiates Pathway from standard facilities? A seasoned staff with military experience, few patients, a high tolerance for emotional outbursts and eccentric behavior, the collegial atmosphere of a campus instead of a hospital setting and a willingness to try anything. Realizing that Pathway could treat a mere fraction of the 30,000 veterans returning to California each year, Gusman resolved to create a model program that the V.A. and others could adapt. One such program, the recently opened National Intrepid Center of Excellence for treating TBI and psychological ailments in Bethesda, Maryland, takes a holistic approach to treatment, inspired, in part, by Gusman’s program.

The Pathway team carefully monitors medications, guides veterans through treatment for substance and alcohol abuse, encourages regular morning walks in the hills and watches for signs of TBI, a head injury that produces short-term memory loss, difficulty with speech and balance problems. “Many of our guys have some TBI on top of PTSD,” says Gusman. “The two conditions overlap, so you’re not going to know right away if it’s TBI, PTSD or both. It takes a willingness to ride the waves with the guys to help figure out what’s agitating them. Other places don’t have that sort of time. I think that’s why traditional institutions struggle with this population. We’re open to anything.”

While most patients leave Pathway after a few months, Gusman has treated some for as long as a year. “What do you do?” he asks. “Throw them away?” Because of Gusman’s willingness to experiment, the Pathway program has an improvisational quality, which includes family counselors, yoga instructors, acupuncturists, service dogs and twice-weekly follow-up text messages to support graduates and monitor how they are faring.


They went off to war brimming with confidence and eager for the fight in Iraq and Afghanistan. They returned, many of them, showing no visible wounds but utterly transformed by combat—with symptoms of involuntary trembling, irritability, restlessness, depression, nightmares, flashbacks, insomnia, emotional numbness, sensitivity to noise, and, all too often, a tendency to seek relief in alcohol, drugs or suicide.

“Families and friends are shocked when one of these guys comes back,” says Fred Gusman, a social worker and mental health specialist now serving as director of the Pathway Home, a nonprofit residential treatment center in Yountville, California, where active and retired service members suffering from post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI) are learning to make the hard transition from war to civilian life.

“The guy who looked like G.I. Joe when he left home comes back a different person,” says Gusman, a Vietnam-era veteran who pioneered treatment for warriors suffering from stress-related illness in the 1970s. “We called it post-Vietnam syndrome back then,” Gusman adds, noting a link between combat and mental trauma that dates to the Civil War. That war produced an anxiety disorder known as “soldier’s heart”; World War I gave rise to shell shock; World War II and Korea produced battle fatigue.

Each clash of arms spawned its own array of psychic injuries, with striking similarities to those haunting thousands of combatants from the current wars. “You get the 10,000-mile stare,” says Gusman. “You shut down emotionally except when you’re raging with anger. You are hyper-vigilant because you don’t know where the enemy is. You look for signs of trouble in the line at Wal-Mart, or when someone crowds you on the freeway, or when there’s a sudden noise. They are very, very watchful. This kept them alive in Iraq and Afghanistan, but it becomes a problem when they come home. It’s not like a light switch you can turn off or on. I tell the guys they have to play detective, to figure out why they’re angry or anxious and unravel it. We give them the tools to realize when they’re spinning and need to stop. They learn to modulate their emotions.”

Since opening his facility on the grounds of Yountville’s Veterans Home of California in 2008, Gusman and his staff of 18 have treated almost 200 wounded warriors, many of whom had found only frustration when they sought treatment at military hospitals or V.A. centers.

“There’s no compassion. I felt constantly ridiculed,” says Lucas Dunjaski, a former Marine corporal diagnosed with PTSD in 2004 while serving in Iraq. Returning home, he ran into marital difficulties, drank heavily and sought treatment at the V.A. Hospital in Menlo Park, California, which specializes in PTSD care. He gave up after two one-week hospital stays a year apart. “It wasn’t a healing environment,” he recalls. “I tried to commit suicide. I just couldn’t pull it together.” (Since Dunjaski’s V.A. experience, the Department of Veterans Affairs announced in July that it is easing the process for those seeking disability for PTSD.) For his part, Dunjaski enrolled in the Pathway program last spring, which handles as many as 34 patients at a time. “I came here thinking it was my last option. I would be dead if I didn’t have this program,” says Dunjaski, now 25. Finishing treatment in July, he felt that things were finally looking up: he had just moved into a house with his new wife and had hopes for the future. “I know I’m going to be OK.”

What differentiates Pathway from standard facilities? A seasoned staff with military experience, few patients, a high tolerance for emotional outbursts and eccentric behavior, the collegial atmosphere of a campus instead of a hospital setting and a willingness to try anything. Realizing that Pathway could treat a mere fraction of the 30,000 veterans returning to California each year, Gusman resolved to create a model program that the V.A. and others could adapt. One such program, the recently opened National Intrepid Center of Excellence for treating TBI and psychological ailments in Bethesda, Maryland, takes a holistic approach to treatment, inspired, in part, by Gusman’s program.

The Pathway team carefully monitors medications, guides veterans through treatment for substance and alcohol abuse, encourages regular morning walks in the hills and watches for signs of TBI, a head injury that produces short-term memory loss, difficulty with speech and balance problems. “Many of our guys have some TBI on top of PTSD,” says Gusman. “The two conditions overlap, so you’re not going to know right away if it’s TBI, PTSD or both. It takes a willingness to ride the waves with the guys to help figure out what’s agitating them. Other places don’t have that sort of time. I think that’s why traditional institutions struggle with this population. We’re open to anything.”

While most patients leave Pathway after a few months, Gusman has treated some for as long as a year. “What do you do?” he asks. “Throw them away?” Because of Gusman’s willingness to experiment, the Pathway program has an improvisational quality, which includes family counselors, yoga instructors, acupuncturists, service dogs and twice-weekly follow-up text messages to support graduates and monitor how they are faring.

Gusman and his staff preside over anger management sessions, prod patients for details of their prewar history and coach them on how to navigate the V.A. system. They gradually reintroduce the men to life in Napa Valley, where Rotary Club members and others from the community have adopted Gusman’s ragtag band of brothers: veterans go bowling, tour the countryside on bikes, learn fly-fishing—all Gusman’s way of keeping them busy and breaking their sense of isolation. “The real test is when you go outside,” he says. “That’s why we encourage them to get out into the community.”

Inside, patients talk about their wartime experience in group meetings known as trauma sessions, which are at the core of the Pathway program. In these arduous talkfests, warriors relive their days on the front lines, recalling scenes they would rather forget—the friend cut in half by an improvised explosive device, the comrade killed because he could not bring himself to shoot the enemy who used a child as a shield, the young warrior who lost one leg in an explosion and awoke as the other was being amputated, the Navy corpsman working frantically to save severely wounded Marines as bullets whizzed by his head and hope slipped away.

“No movie begins to portray the horror, the shock, the emotional aspect of being there,” says that Navy corpsman, retired Senior Chief Trevor Dallas-Orr. Like others who have been through the Pathway program, Dallas-Orr, a decorated veteran of the first Gulf War and Iraq, credits Pathway with saving his life.

“I lost my family, my job, my home, my identity,” recalls Dallas-Orr, 45, who was living out of his car when he vainly sought treatment in the V.A. system. “Fred’s team opened me up and I started to realize, ‘Hey, this is a good thing.’ If it hadn’t been for this place, I’d be dead. I would’ve just melted away.”

After almost a year of treatment at Pathway, Dallas-Orr returned home to Southern California this past spring. He still struggles with nightmares, insomnia and outbursts of anger, but he has learned to manage them, and he has re-established contact with his two estranged sons. He recently spoke to an audience of several hundred people in San Diego for Operation Welcome Home, an event organized by Gov. Arnold Schwarzenegger to honor returning warriors. “No way in hell I could have done that before,” says Dallas-Orr.

Sitting across the table, Gusman credits Dallas-Orr and his fellow warriors with their own revival. “Well, I always say you guys are doing it yourselves,” says Gusman. “It’s your courage that pushes you forward. Our joy is seeing you being successful in your own right. That’s how we get our goodies.”

Gusman’s program faces an uncertain future, however. Pathway’s one-time initial grant of $5 million ran out in August. The center is raising funds to keep its doors open.

Robert M. Poole is a contributing editor. Photographer Catherine Karnow is based in Mill Valley, California.


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Comments (23)

I saw the piece about your work on NBC Nightly News and you are almost out of funds. Your work is too important to our vets and their families and to us as a people to close your doors. I am not a fundraiser and do not participate in social media sites, but I will send $100.00 and I know that other people reading this know how to get the ball rolling. Please, people!! This organization changes not only the lives of our returning vets; it changes society as a whole!! Let's put some funds where it counts. Please be sure to let me know when the fundraiser is up and running as I work for Social Services and can at least put it up on our Bulletin Board and try to get some donations. Somebody get a fundraising site up and running!! and don't let any grass grow. Make sure the money goes straight to the thepathwayhome.org at their legitimate website. We are not falling for any scams!! Sheryl

Posted by Sheryl on June 26,2011 | 11:56 PM

There is a book put out by the Brain Injury Hope Foundation for Our Wounded Warriors and their families on MTBI and PTSD, Please check this out.

Posted by Suzanne A. Griffin on February 11,2011 | 05:57 PM

THANKS PATHWAY HOME FOR ALL YOU DID FOR ME !! FRED KATHY AND REST OF STAFF

101st airborne - combat medic

Posted by GIBERT on November 28,2010 | 03:28 PM

Finally our troubled vets are finding some hope to go on! My husband was a Vietnam veteran, diagnosed with PTSD and was never really able to get past it. 9-11 hit him hard, going into Iraq was another blow and then when the vets began coming home to welcome parties, news coverage, etc., I think this put him emotionally over the edge. I say, "I think" because I will never really know for sure--he gave his life away in December of 2004. I know the government programs are getting better about reaching out but we still have a LONG way to go...

Posted by Brett Hodson on November 6,2010 | 07:16 PM

Please have Mr. Fred Gusman contact me personally as I have additional information that he may find useful. We have had great success treating PTSD/TBI over the past year with the HBOT Protocol.
We have at least one clinic here in South Florida that will provide pro bono treatment using this protocol. As a former US Navy Deep Sea diver, I know the benefits of oxygen under pressure. I have been involved with a few PTSD cases and to see them before the start of treatment and the person that departs after a successful 30 treatment cycle, is unbelievable! As the CEO of a newly formed Florida, nonprofit organization, US Vet Net, we are trying to stop the DOD from discharging any active duty military member returning from combat without been screened for PTSD/TBI. If they test positive, they should remain in service until set therapy goals are met.
Additionally, we are trying to raise the awareness of PTSD/TBI in the communities where these brave young men and women are returning to. In this process, we actively seek out corporate support as well as contributions to be used to defray the cost of housing, transportation and meals while under treatment here in South Florida.
I will be happy to share the medical results as well as brain scans of some of our veterans.
Thank you for what you are doing to assist our brave soldiers affected with this treatable condition.
Best regards,
Ken Soule
CEO – US Vet Net, Inc.

Posted by Ken "Deep Sea" Soule on September 29,2010 | 03:02 PM

I would like to recommend the "Rewind" technique used by the Human Givens Institute
http://www.hgi.org.uk/archive/trauma.htm
It is a brief, highly effective and specific instrument for treating PTSD.

Posted by Richard Lawson on September 28,2010 | 01:31 PM

I read your article in the Sept 2010 delving into the effects of shell shock. Now we call it PTSD.
I would like to add my experience.
As a Vietnam era conscript right out of college, I refer to that period of my life as my Robert McNamara Fellowship for Southeast Asian studies.
My duty assignment took me to the Republic of Korea for a thirteen month tour. We were undermanned. Many of the most competent NCO’s went to Vietnam. We had the rest.
There were many instances where US troops came under fire. Men were killed.
As I approached the end of my tour, I learned that if you returned stateside with less that ninety days left to serve (subsequently raised to one-hundred-fifty days) you would be separated. I extended sixty days in country to return to the US with eighty-eight days.
I re-entered the US, known to us as the land of the big PX and all night generators, literally with the mud of Korea still on my shoes.
With a forty plus year retrospective view, I now realize what a mistake that was. Returning from a combat zone requires decompression. Had I returned on my normal rotation date and spent those five months somewhere I could feel safe and ease my way back into a world where I did not have to be almost continuously armed my adjustment would have been much easier.
I can surely relate to those men who found normalcy at Lennel in the company of Lady Clementine.

Posted by Rich Scudero on September 22,2010 | 07:35 PM

What an amazing program for our beloved warriors. I pray that the funding continue and that each community develop a special place like Pathway House. The best way of dealing with PTSD is through innovative and comprehensive programs for combat or traumatic situations. God Bless You.

Posted by Sylvia Munoz Schnopp on September 18,2010 | 09:31 PM

I take my hat off to all those who fought unnecessary wars driven by sheer madness of rulers !
I think that Governments should allocate an amount of the national budget so as to help those brave combatants !

Posted by Freddy Rojas Garcia on September 7,2010 | 02:30 AM

An interesting aside to this topic can be found in the book "Janes Fame: How Jane Austin conquered the World" by Claire Harmon. (hardcover edition page 146 second paragraph Henry Holt and company publishers)

"The therapeutic potential of Austen's novels in wartime (WW1)was recognized on a wider scale when they were chosen as "salubrious reading for the wounded" and prescribed as an aid to convalescence for the most severly shell-shocked soliders." The author continues "(Austins works) appeared as the top of a graded "Fever Chart" drawn up..by a Oxford don ...H.F Brett Smith"
Perhaps this could make an interesting article in a further issue ?

Posted by Paul on September 2,2010 | 06:29 PM

I hope any developments in the treatment of PTSD can also be applied to some of the most innocent victims: those who've been raped and survived the trauma. Domestically, women (and some men) deal with PTSD, but their hurt is invisible to most people.

Posted by Rhea on September 2,2010 | 10:57 AM

Unfortunatly our grant which was originally given by a private donor ended in June 1 2010. We are currently looking for donations from every corner. It is important and was in the presidents address that the soliders returing from iraq have only started thier journey and the government and citizens need to ensure that we do not have anther vietnam on our hands they served and now need to be served.if you do the home work we are one in a handful of ptsd programs. to treat a population that may grow to 17 - 20 % of returnee do the math

thepathwayhome.org give a little it makes a difference and will keep our doors open. We don not recieve government funding.

Posted by kathy on September 1,2010 | 08:28 PM

Would like to try and contact someone at Pathways re. information about program. Can you provide me with a name, email, or phone #. Thanks in advance.

Patti Immel
SEIDCON, Inc.

Posted by Patti Immel on September 1,2010 | 11:29 AM

To answer Reggie's question: The original money for the Pathway program came from an anonymous donor, who provided financing for the first few years.No government funds were involved, except that the California Veterans' Home in Yountville agreed to lease a building to Pathway for $1 a year. The setting itself, tucked in the wine country of the Napa Valley, is tranquil and healing--a factor several of the residents mentioned when I spoke to them for the Smithsonian article.

Posted by Robert M. Poole on September 1,2010 | 10:13 AM

I would like to make a donation to "Pathway Home". I am impressed with the work being done for soldiers returning from combat who suffer post traumatic stress disorder. Would it be possible for the author, Robert M. Poole, to send additional information about this important project and an address where I could send the donation. Thank you for putting me in contact with this organization.

Ferrill Gunter

Posted by Ferrill Gunter on August 29,2010 | 06:12 PM

Hopefully other organizations (like the VA) will take PAthway Houseup on the programs they are creating. There are so many wounded vets out there that need help. I saw a movie called Hidden Battles the other day that really helped me understand what soldiers are dealing with. If you want to check it out go to www.hiddenbattles.com.

Posted by Lila Yomtoob on August 25,2010 | 04:23 PM

Do you know who funded the program originally? I'm wondering if it was a federal or state source, and if the program might be able to apply for sustainment funding.

Posted by Reggie on August 25,2010 | 02:37 PM

Pathway Home is a fantastic program. The ingenuity and the level of committment that Fred Gusman and the rest of the staff have shown toward helping to solve the problems that our service men face upon returning home is exemplary. Funding is tight but I hope and pray that this program has a chance to continue and grow. Our vets deserve this kind of attention.

Posted by Gina Stutchman on August 24,2010 | 05:57 PM

Pass this article on to your friends and family to show how important programs like this are in every community. Yes, funding is important! When communities are aware of programs like this, donors come out of the woodwork to make things happen sometimes. Just as these Veterans are blessed, programs like this recieve blessings as well. I have been to the Yountville Veterans Retirement Home and what wonderful place to heal and reside nestled in Napa Valley!!

Posted by Molly on August 24,2010 | 04:15 PM

This is one amazing place. My husband and I were at the end of things and this program brought so many things to us. It gave us tools to deal with the severe PTSD he has. We were able to deal with so many of the dark issues. I would tell anyone who has a marital problem and is on the edge GO! You wont regret it.

Posted by Renee on August 24,2010 | 11:44 AM

Sounds like a fabulous - and much needed - program. As a workforce professional having worked with the Veterans community for quite a number of years, I also know how important a role employment can play in the recovery and rehabilitation of our wounded warriors returning home - and learning to live with TBI and/or PTSD.

I wanted to bring your attention America's Heroes at Work, an anti-stigma public education campaign geared to employers, and a free resource sponsored by the U.S. Department of Labor. The goal of the initiative is to help ensure the success of Veterans and returning Service Members living with TBI and/or PTSD as they enter or reintegrate into the civilian workforce. The project features a website (AmericasHeroesAtWork.gov), where fact sheets, training tools, success stories and other resources are provided to help employers, Veterans and those who support them understand both injuries - and how to work together to put effective workplace accommodations in place to ensure a successful transition into the civilian workforce.

I hope this information is helpful!

Posted by Lisa Stern on August 24,2010 | 09:49 AM

I have the honor of supporting the staff at Pathway Home and I can say with certainty that they are literally saving lives others have given up on. If anyone reading this has personal or professional networks that might include potential funding sources, please be in touch with them and/or Mr. Guzman. It would compound a tragedy if this innovative and effective program was forced to close.

Posted by Judi on August 23,2010 | 05:36 PM

What an awesome program. I don't know who funded it but I certainly hope it doesn't close. God Bless our Veterans.

Posted by kathy on August 23,2010 | 01:03 PM



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