PTSD

Battle-weary troops find rare comfort in Buddhism: Religion sees huge upswing in number of soldiers practising

Buddhism is experiencing an extraordinary upswing in popularity in the armed forces.

Since 2005, the number of servicemen and women practising the religion has risen from 200 to 3,800. Around 2,800 are Gurkhas, whose home nation Nepal has pockets of Buddhism.

But the other 1,000 are British, with many converting since they joined the military.

According to spiritual leaders, the reason behind the phenomenon is that Buddhism allows service personnel to escape the stresses and strains of military life.

Sunil Kariyakarawana, the Buddhist chaplain for the armed forces, said: ‘Buddhism has a different perspective about things.

‘The military is a very stressful place. People go to war, that is one factor, and have to fight.

‘Personnel see a lot of suffering in theatre. People are finding that Buddhism can help with these mental agonies.
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‘It is laid back and they can practise their own way.’

Dr Sunil said Buddha, who lived 2,500 years ago, never ruled out force: ‘Sometimes you have to choose war as the least bad option.’

Lieutenant Colonel Peter Straddings, who heads up cultural diversity for the Army, said the society was ‘hugely important’.

He said: ‘British society today is hugely different from the Army I joined 25 years ago. Approximately 25 per cent of young people are no longer white Anglo-Saxon Protestants.

‘They are the future. They are the people who represented the country at the Olympics, at football and they are the people we need for the Army, Navy and Royal Air Force of the future.’

In 2005, Buddhist, Hindu, Muslim and Sikh chaplains were appointed by the armed forces for the first time.

The appointments reflect the increase in ethnic minority recruitment to the Army, Navy and RAF in recent years.

In a message to the society’s conference, the Dalai Lama said: ‘I believe that what makes a good soldier, sailor or airman, just as what makes a good monk, is inner strength.

‘Inner strength depends on having a firm positive motivation.

‘The difference lies in whether ultimately you want to ensure others’ well being or whether you wantonly wish to do them harm.’

(By Ian Drury, Defence Correspondent/ Mail Online)

US soldiers in Iraq can find stress deadlier than enemy

In the early hours of September 14, US sergeant Joseph Bozicevich allegedly drew his rifle, aimed and shot to death two of his superiors on a military base south of the Iraqi capital.

According to several US media reports, Bozicevich, 39, allegedly killed staff sergeant Darris Dawson 24, and sergeant Wesley Durbin 26, because he could not bear being berated by them.

A US military statement said that “a US soldier is in custody in connection with the shooting deaths. He’s being held in custody pending review by a military magistrate.”

Dawson’s step-mother Maxine Mathis later told newspaper in Pensacola in Florida that before the shooting he had complained to her and spoken of the impact the Iraq war was having on many young soldiers.

“Momma, I’m not so afraid of the enemy. I’m afraid of our young guys over there, because they’re so jumpy and quick to shoot,” Mathis quoted Dawson as saying.

Trauma, stress, fatigue, depression and tensions linked to family problems are taking their toll on US soldiers deployed in Iraq and are often more threatening than the Islamist insurgents they are expected to fight.

“We know that the stress of war, which includes repeated and long deployments, is having an effect on our soldiers and their families,” said Colonel Elspeth Cameron-Ritchie, a military psychiatrist based at US army medical command in Fort Detrick, located at Frederick, Maryland.

The wars in Iraq and Afghanistan have increased the number of US soldiers suffering Post-Traumatic Stress Disorder (PTSD), leading to higher rates of suicides and divorce, according to military reports.

Nearly a fifth of American soldiers deployed in Iraq suffer PTSD, according to the US military’s battlemind.army.mil website.

The cases of PTSD increased by almost 50 percent in 2007 among American soldiers who served in Iraq and Afghanistan, the US military said.

For Cameron-Ritchie “PTSD has gone up as the length of deployment has gone up, so we reported that to our leadership who has been able to reduce the length of deployment.”

The Bush administration has cut down the duration of deployment from 15 months at the start of 2007 to 12 months.

At the same time experts are examining ways of dealing with PTSD.

“We have a lot of programmes and strategies in place to minimise the effect of war. We made a commitment to raise the number of psychiatrists, social and mental health workers,” Cameron-Ritchie told AFP by telephone from her US headquarters.

An increase in the levels of divorce and suicide among soldiers are among the key concerns of the military.

A military report on the mental health of soldiers in Iraq and Afghanistan issued in May 2008 notes that “the suicide rate remains high on both theatres, higher than the normal rate in the army.”

The divorce rate in the US army at large rose from 2.3 percent in 2001 to 3.5 percent in 2008, according to military figures.

“Nearly 20 percent of soldiers deployed in Iraq say they have concerns or experience marital problems,” according http://www.battlemind.army.mil.

Specialist Shawn Woodward is among those whose marriage has collapsed.

“I’m going back to Massachusetts, to get a divorce, go back to college, start a new life,” Woodward said at the Speicher base north of Baghdad.

“There are many, many in this situation in the army. Deployments brings lots of stress on families.”

Of the nearly 4,490 US soldiers killed in Operation Freedom — in and outside Iraq — 862, or 19 percent were not killed by enemy fire, according to the independent website icasualties.com.

It did not specify if they were died due to accidents, illness, suicide or friendly fire.

Some killings of Iraqi detainees by US soldiers have also been linked to PTSD such as the murder in May of Ali Mansur Mohammed who was first shot to death and then his face badly burnt by an incendiary device.

First Lieutenant Michael Behenna and Staff Sergeant Hal Warner have been both accused of premeditated murder, assault, making a false official statement and obstruction of justice in connection with Mohammed’s killing.

The pair faced pre-trial hearings separately in September and now await a decision of whether they will face a court martial for murder.

US soldiers have alleged in testimonies that Mohammed was killed to avenge two men who were killed in an attack a month earlier.

“I didn’t know what to do. I was afraid, like you are afraid when you don’t control part of the situation,” one of Behenna’s deputies, Sergeant Milton Sanchez said.

A US officer, speaking on condition of anonymity, told AFP the case was “pretty clear.”

“It’s a classic PTSD that came after the bomb attack,” the officer said.

“The soldiers have so much stress and responsibilities, and they are so young, sometimes it just pops up.”

(AFP)

Preparing for the Next Crisis: When the Troops Come Home by Stephen Long

I sincerely hope the Government of Sri Lanka is looking past the destruction of the LTTE to the day when the troops finally come home. This will be a joyous time of celebration, no doubt, but it will also be a time of crisis: what are you going to do with the excess force in the military? You will reduce the size of your army, of course, but what are you going to do with the men and women who served you so valiantly and rid your country of terrorists?

This is a problem faced by all nations who find themselves in similar situations after the war is over. Julius Caesar faced it. In the last century America faced it four times, and is facing it again with the returning Iraqi war veterans. In the case of America, they botched it badly after Vietnam, and they are botching it again with Middle East returnees. Here in Los Angeles it is heartbreaking to go Downtown to the skid row area around 5th and Maple Streets and see the large numbers of homeless and drug-addicted men and women – many of whom were heroes in both Vietnam and in Iraq/Afghanistan.

I am well aware that the Government’s complete attention is on winning the war, as it should be. Victory over the terrorists is so close, and it needs to be the primary focus of the moment. But governing a country means looking beyond the immediate to the future – at least five years ahead, if possible. You’re probably going to have 100,000 troops returning to Colombo and the rural areas, and a huge percentage of them will be unemployed, maimed, traumatized, and maybe all three.

I would suggest immediately forming a task force that would examine this looming situation before it becomes a crisis. The finest minds in the country need to focus on creating jobs for these soldiers, planning for their rehabilitation, training counselors to deal with their trauma, and establishing programs that will help them re-enter the society for which they fought so bravely.

This is not an easy job, but it is imperative that the issue be addressed now – before the last battle bullet is fired and the final battle is won. The last thing you want is an angry mob of dissatisfied veterans protesting that the Government has nothing to offer them for their valiant service. Caesar was deathly afraid by the specter of his soldiers returning to Rome and staging a revolt. Such a possibility in Sri Lanka is not outside the realm of possibility if plans aren’t put into the works immediately. Imagine the morale-builder it will be for the troops if they know that their Government is thinking of their future – now. This will give them the will to fight harder and stronger for the peace that is just around the corner.

My second suggestion is to examine a very interesting phase of American history. When the stock market crashed in 1929 the bottom fell out of an era of party and prosperity. The then president, Herbert Hoover, did nothing to avert a crisis over the deep unemployment that ensued. He didn’t think the government should get involved in helping out during an economic crisis.

When one of my political heroes, Franklin Delano Roosevelt, stepped into the White House in 1932 he saw the potential disasters that could result due to the legions of unemployed. After all, the Russian Revolution wasn’t that long before, and it was still fresh in his memory. The possibility of revolution sent chills of angst through his gifted mind.

Roosevelt’s admirable solution was to create the New Deal, which was a large, powerful, and effective bundle of social programs designed to keep the unemployed working – and to use the down-cycle of Depression as an opportunity to build and strengthen America’s infrastructure. With the exception of Social Security, the Federal Housing Authority, and the TVA most of the New Deal organizations had a shelf life limited to the time of economic recovery, and were disbanded when no longer needed.

Here are a few successful examples of New Deal programs that the Government of Sri Lanka may want to examine for possible implementation in the motherland.

o The Civilian Conservation Corps (CCC) was established in 1933 in every state and territory in the US. This organization was made up of the sons of unemployed fathers – victims of the Depression. At its peak in 1935 it had 500,000 employees in 2,650 work camps. It provided labor for a wide variety of Government Agencies including: Department of Interior, Department of Agriculture, Army Corps of Engineers, National Parks Service, Bureau of Forestry, Soil Conservation Service, General Land Office, and others. Employees of the CCC put up telephone and power lines, built logging and fire roads, engaged in tree planting, bee keeping, archaeological excavation and even furniture manufacture. Evening classes were held in most camps, and courses were offered in general academics as well as vocational training. Congress ceased funding it in 1942 when it needed all those boys to fight in World War II.

o The Federal Housing Administration (FHA) was created to combat the housing crisis of the Great Depression. The FHA was designed to regulate mortgages and housing conditions, and still exists to this day.

o The Home Owner’s Loan Association was established in 1933 to assist in the refinancing of homes. Between 1933 and 1935 over one million homeowners were saved from foreclosure by this program.

o The Public Works Administration was another department set up to create jobs during the Great Depression.

o The Social Security Act was passed to protect America’s senior citizens from poverty.

o The Works Progress Administration (WPA) was created in 1935 and had a positive impact on the entire country. The WPA built roads, buildings, and other massive infrastructure projects. It officially ended in 1943 after keeping millions of men and women at work throughout America until they were needed for the war effort.

o The Tennessee Valley Authority (TVA) built dams for hydro-electric power and created lakes and parks for recreational use. Today the TVA still supplies more electricity than any other hydro company in the United States – keeping the growing Southeast in lights.

In addition to examining New Deal programs the Government of Sri Lanka should also consider the following:

o Worldwide Nursing Shortage. Men and women in Sri Lanka could be trained as nurses and medical assistants for the growing demand in America, Japan, Europe and other regions where the aging population has created a huge shortage of skilled personnel in this field. The compassionate, caring nature of Sri Lankans could be put to good use. Male and female returning soldiers would be perfect candidates for these important jobs.

o UN Peacekeeping Efforts. Skilled Sri Lankan soldiers could be sent by the UN to peacekeeping fronts in Africa, the Middle East, Eastern Europe, and other areas where they are sorely needed and where they could put their high-level skills in warfare to excellent use.

o Middle East Labor. Unskilled labor is sent by Sri Lanka, Indonesia, Philippines, Thailand and other countries to the Middle East, which currently has an insatiable need for humans due to high economic growth rates and an enormous construction boom. Sri Lankans go abroad with no training whatsoever, which puts them at risk for employee abuse, neglect, rape, and other violations of their human rights. Domestic servants don’t even know how to clean house or answer the telephone, which makes their employers angry. We don’t want to hear any more stories of cruelty – like sending maids to the desert to tend goats. Pre-emigration training programs would be a great help to assist these unfortunates who find the need to leave their home country to survive. Our last wish would be for returning soldiers to spend their lives as construction laborers and domestics in the Mid East, but if they decide to go abroad, please prepare them appropriately for their work.

o Other Labor Shortages. Look abroad and find out what other skilled labor shortages exist in the world, and set up training programs accordingly.

o Overseas Investment. Identify industries and specific companies from abroad that could be attracted to Sri Lanka to build factories and take advantage of the countries abundance of both skilled and unskilled labor.

The think tank I am suggesting could develop a number of projects that would benefit returning troops as well as Sri Lanka, but there is an urgent need to act quickly. No one would want to hear about the soldiers on the front prolonging the war for fear of losing their jobs due to peace. Let them know you are planning for their return, and announce projects now that would give them an incentive to fight harder and end the conflict sooner. Give them the good word that their Government is going to provide for them with employment opportunities, and chances to better their lives after the war.

Programs in the New Deal cost American taxpayers a lot of money at a time when they could least afford it. The Government of Sri Lanka will have to be creative and figure out how they will get their similar programs financed. In spite of the global economic crisis funds are still available overseas for assistance from both private and public sources. Get your new programs designed and written up now so you can apply for quick funding. It takes time for governments in the United States, Japan, Korea, and others to get them through the bureaucratic red tape and approved. Let’s not forget our NGO and INGO friends and hold them to their peace-loving word. Let them go to work on new projects that involve the returning soldiers for the country’s benefit. When the war is over and they’re back on the side of the Government, give these organizations a good reason for staying in Sri Lanka.

You have to act now to bring these ideas “down to the ground” and make them a reality. Think smart and stave off a potential disaster. You owe it to your men and women of the armed services to reward them for putting their lives at risk for their country. Welcome them home with honor and hope for the future.

(Asian Tribune)

Combat related PTSD in Sri Lanka by Dr. Ruwan M Jayatunge M.D.

Psychological and Sociological Aspects

Sri Lankan society is shattered by hate and brutalization as a result of the 20 year conflict. Combatants as well as a large numbers of civilians including members of the LTTE have undergone a tremendous amount of stress for the last two decades. There hve been large military operations where the combatants were directly exposed to hostile conditions. Exposure to extreme stress is unavoidable in combat. Some were physically as well as psychologically wounded. The shock wave of combat echoes the Sri Lankan society. The war trauma has been sublimated in to the society. Attention must be paid to the psychosocial scars of the war.

There are no empirical data that directly address the prevalence of PTSD among the Sri Lankan combatants. But the 3 year study (2002-2005) done by the author with the Consultant Psychiatrist of the Sri Lanka Army Dr. Neil Fernando reveals that PTSD is emerging in Sri Lanka. In one separate study which was done with 824 Sri Lankan combatants, full blown symptoms of PTSD was found among 56 people. in other words 6.7% of combatants were severely affected by the combat stress. This may be the tip of the ice burg that is still able to be seen. This sample was referred to the Military Hospital Colombo for various psychiatric as well as stress and anxiety related conditions. Although this was not a randomly selected field sample it includes combatants who were exposed prolonged combat trauma.

To meet DSM-IV criteria for PTSD, the soldier must have been exposed to an “extreme” stressor, and the soldier’s response to that stressor must include a specific number of symptoms from each of three broad categories: re-experiencing, avoidance/numbing, and increased arousal.

Human response to trauma is universal but the cultural context of the trauma is an imperative dimension. The meaning of trauma is often culturally specific. Cultural factors may also influence the manner in which PTSD symptoms are manifested. Therefore culture based assessment had to be introduced. In addition, the specifications of the Sri Lankan conflict were taken in to considerations. These specifications were prolonged exposure, lack of psychological first aid soon after the combat, the usage of traditional healing methods, the impact of religion and social support systems etc.The American Psychiatric Association (2000) discusses risk factors that affect the likelihood of developing PTSD. Among the risk factors the severity, duration, and proximity of an individual’s exposure to the traumatic event are the most important factors affecting the likelihood of developing this disorder. There is some evidence that social supports, family history, childhood experiences, personality variables, and preexisting mental disorders may influence the development of post traumatic Stress Disorder. This disorder can develop in individuals without any predisposing conditions, particularly if the stressor is especially extreme

One can point out several risk factors that affected the Sri Lankan combatants and which played a crucial role in developing PTSD. The authorities have not identified combat stress as a vital factor that should be dealt with effectively. Lack of experts in military psychology as well as the lack of funds has made psychological trauma management painstakingly difficult.

Some of the socioeconomic factors too contributed high rates in PTSD following combat related stress. During the height of the war youth from the lower socio economic levels joined the Army and some of them have faced severe economic hardships, affected by the Middle East syndrome (maternal I paternal deprivation) or subjected to childhood trauma. Their psychological makeup has been changed negatively and they were psychologically vulnerable. In one study among the 56 Sri Lankan combatants who suffered from PTSD 30 of them had experienced childhood trauma.

As Lt. Gen Gerry D Silva- former Commander of the Sri Lankan army points out that Sri Lanka army is the only army in the world whose full binate strength has been mobilized for two decades. A large numbers of soldiers have served in the operational areas for 10-15 years with short intervals. This factor too has increased psychological casualties in the military. In addition two insurrections occurred in the South that crippled the nation. The first youth unrest in 1971 caused direct clashes with the military and police. The results were traumatic. More than 18,000 youth from the South were killed. According to K.M. de Silva a renowned historian 1971 JVP insurrection perhaps the biggest revolt by young people in any part of the world in recorded history.

The second uprising took place in 1987 and continued until 1988. In 1987 a group known as the Patriotic Liberation Organization emerged. They forced service personnel to give up their jobs by issuing death threats. Some soldiers and their family members were massacred by the Patriotic Liberation Organization and soon the military defended themselves with arresting suspected youth. Some got killed. During this social turmoil a considerable amount of soldiers became psychologically affected by committing and witnessing atrocities.

Combatants suffering from combat stress easily go in to negative stress coping methods like alcohol abuse and violence. Alcohol and substance abuse is evident among the combatants suffering from war trauma. Those veterans who experienced prolonged exposure to heavy combat are especially vulnerable. Soldiers abuse substances such as drugs, alcohol, and tobacco for varied and complicated reasons When we interviewed 56 combatants with full blown symptoms of PTSD we found five (8.9%) of them are severely addicted to alcohol. They were found positive with alcohol related symptoms and their liver function tests were affected. They consumed large amounts of alcohol in order to avoid sleep disturbances and eliminate scary nightmares. The heavy drinking may also seem to relieve anxiety and block out intrusive memories associated with combat events. But the truth is excessive drinking can disturb the natural sleep process, interrupting REM dream patterns; the veteran may become more vulnerable to the symptoms of PTSD.

Family violence is a widespread problem that occurs among the combatants with PTSD. They use force to inflict injury, either emotional or physical, upon their wives. Many combatants sublimate their rage. Domestic violence is a form of sublimation and transformation of anger.

Out of 56 soldiers with PTSD 13 of them frequently physically abused their spouses. Beatings and house property damage were common among them. Their anger and rage were focused towards their wives. They were irritable and hostile in family affairs. There are many types of abuse that take place as part of domestic violence. These are emotional abuse, physical abuse and verbal abuse.

They have gradual withdrawal from day to day activities. There are marked personality changes which affect their function as an active member in the society. Often they break family commitments, both major and minor. They become impulsive, numbed and inhibited. These features affect to have a successful family life and positive parenting. Men with PTSD commonly have sexual dysfunctions. This may be due to the anxiety and depression that they suffer. A part from the illness long term use of antidepressants also can cause erectile dysfunctions. Some males become suspicious and have sexual jealousies. This factor too escalates family violence.

Many combatants with PTSD admit that when they go in to tantrums they over punish their children. Children often live in fear and despair. The physical abuse take place inside the family system and rarely mothers admit that the beatings were done by their husbands. When the children are hospitalized for physical abuse mothers always conceal the physical beatings in order to evade child protection laws.

Once a soldier with PTSD went in to flashbacks and he strangulated his little daughter. The girl was choking and luckily neighbours came and rescued her. In another incident a PTSD father became annoyed when his eight year old son could not solve mathematical sums and he beat his son with a cricket bat. Later the child was admitted to the hospital and treated for three weeks.

Soldiers who suffer from PTSD have occupational problems. Their productivity is weakened. They are detached from co workers. Soldiers with combat stress have dysfunctional infractions at the work places. Traumatized soldiers develop their own peculiar defences to cope with intrusions and increased psychological arousal. One officer who was diagnosed with PTSD felt uneasy and often manifested startling reactions when soldiers come and halt with a salute. The noise made him frightened. Therefore he used to be away from others. Another soldier who had trepidation of uniforms felt uneasy when he comes to the camp. The irritability and spontaneous rage make them more socially isolated. They deliberately keep away from people in order to avoid confrontations. They easily get provoked. Some have homicidal tendencies.

Most of the combatants with PTSD have psycho somatic ailments that prevent them from strenuous work. They easily get tired. Following fatigability their can not fulfill duties like good old days. This phenomenon was described in the Old Sergeant’s Syndrome where brave and physically strong men became frightened and weak soldiers.

Some traumatized individuals have a compulsive urge to expose to situations reminiscent of trauma. Professor Bessel A. Van der Kolk in his outstanding publication on Traumatic Stress (Gilford Press 1996) gives numerous examples. This is a common feature among the Sri Lankan combatants too. Many combatants believed to be suffering from combat trauma have joined the private security firms, working with politicians and engage in violence during election periods, or working with the mob. Repetition cause further suffering for the victim and for the people around them. (Van der Kolk 1996)

For treatment procedures of combat related PTSD in Sri Lanka medications and psychotherapy are used. Therapeutic relationship with the patients is the often the foundation of effective treatment. Therefore therapists maintain good rapport with the patients. Drug therapy is an essential component of PTSD treatment. Serotonin Reuptake Inhibiters like fluoxatine! paroxatine are often used. These drugs provide symptomatic relief
CBT or Cognitive Behaviour Therapy plays a key role. CBT is an approach that focuses on improving mood by modifying dysfunctional thinking and behaviour. CT for PTSD typically begins with an introduction of how thoughts affect emotions and behaviour. Early treatment, new skills to identify and clarify patterns of thinking are taught using techniques such as recording thoughts about significant events, identifying distressing trauma-related thoughts, and converting such dysfunctional thought patterns into more accurate thoughts.

The recent studies lend empirical support for the use of cognitive-behavioral therapy (CBT) and EMDR in treating combatants with PTSD. EMDR or Eye Movement Desensitization and Reprocessing is a psychotherapy treatment that was originally designed to alleviate the distress associated with traumatic memories (Shapiro, 1989a; 1989b).EMDR facilitates the accessing and processing of traumatic memories to bring these to an adaptive resolution (Shapiro, 2001). EMDR is considered to be an effective treatment for PTSD and Sri Lankan combat veterans (uncontrolled study; 18 males) showed significant improvements from pre- to post treatment following EMDR.

Group therapy deals with “isolation, alienation, and diminished feelings Also it helps the survivor” feelings in participants. In group settings the combatants are able to discuss their pent up feelings and able to realize that they are not isolated and that others have similar experiences and problems.

(Daily Mirror)

Blinded by war: Injuries send troops into darkness By Gregg Zoroya

Two days before a 10-mile race here, Army 1st Lt. Ivan Castro is explaining how he will run tethered to another soldier — one who can see.

As he speaks, his wife lovingly extends her right hand to Castro’s face, fingers outstretched. But Evelyn Galvis pauses inches away.

“I used to be able to reach out and touch him, caress him, without telling him first, ‘I’m going to touch your face,’ ” she says. Now, “if I just reach out and touch him, he’ll startle.”

Castro, 40, a paratrooper with the 82nd Airborne Division, is one of more than 1,100 veterans of Iraq and Afghanistan — 13% of all seriously wounded casualties — to undergo surgery for damaged eyes. That is the highest percentage for eye wounds in any major conflict dating to World War I, according to research published in the Survey of Ophthalmology.

It’s a reflection of how eye injuries have become one of the most devastating consequences of a war in which roadside bombs, mortars and grenades are the most commonly used weapons against U.S. troops. Brain injuries and amputations have long been the focus of the damage such weapons are inflicting, but the Army has acknowledged in recent weeks that serious eye wounds have accumulated at almost twice the rate as wounds requiring amputations.

Body armor that protects vital organs and the skull is saving lives. But troops’ eyes and limbs remain particularly vulnerable to the blizzard of shrapnel from such explosions.

Each explosion unleashes large metal shards and thousands of fragments, says Army Col. Robert Mazzoli, an ophthalmological consultant to the Army surgeon general. “Those small missiles are generally innocuous if they hit the (protected) forehead, face (or) chest but are devastating when they hit the eye,” he says.

Surgical facilities are kept close to the fighting, so troops can be treated in minutes. Partial or total vision has been restored in most cases involving eye injuries, military statistics show. But hundreds of troops have been left with impaired vision, and dozens have been blinded.

Troops in Iraq routinely wear protective eyewear, but it doesn’t always work. When a roadside bomb in Baghdad blew a hole through the heavily armored vehicle carrying Army Sgt. Luis Martinez last April, the force from the blast stripped off his helmet, headset and goggles. After the dust settled, Martinez, 38, could see nothing out of his left eye and only streaks of blood in his right. He waited for help, terrified about the damage to his eyes.

“That was the first thing I asked” hospital personnel, the National Guard soldier recalls. ” ‘Am I going to be blind?’ ”

Surgeons later restored vision to his right eye, although bits of glass are embedded there. He remains blind in his left.

“At least God was kind enough to protect me, to keep my right eye and see my family,” says Martinez, of Vega Alta, Puerto Rico, who is married and the father of three.

Formidable challenges await troops who return home blind or with serious eye injuries. In the most severe cases, they will struggle to cope emotionally and financially.

About 70% of all sensory perception is through vision, says R. Cameron VanRoekel, an Army major and staff optometrist at Walter Reed Army Medical Center in Washington. As a result, the families of visually impaired soldiers wrestle with a contradiction: The wounded often have hard-driving personalities that have helped them succeed in the military. Now dependent on others, they find it difficult to accept help.

Because the Pentagon has no rehabilitation services for the blind, the path to recovery often leads directly to the Department of Veterans Affairs. The VA operates 10 centers across the country for blind rehabilitation that teach visually impaired veterans how to function in society. The centers have 241 beds, and it takes an average of nearly three months to get in. Iraq and Afghanistan casualties go to the front of the line, says Stan Poel, VA director of rehabilitation services for the blind. So far, 53 have enrolled in the blind rehabilitation programs, the VA says.

The department plans to open three more centers beginning in 2010, Poel says.

‘He has no light in his life’

Even now, more than a year after her husband’s return from Iraq, Connie Acosta is taken aback to find her home dark after sunset, the lights off as if no one is there.

Then she finds him — sitting in a recliner in their Santa Fe Springs, Calif., house, listening to classic rock. Sgt. Maj. Jesse Acosta was blinded in a mortar attack 22 months ago. He doesn’t need the lights.

That realization often makes Connie cry. “You kind of never get used to the fact that he really can’t see,” she says. “He has no light in his life at all.”

The tiny piece of shrapnel that blinded Acosta, 50, an Army reservist, father of four and grandfather of three, was precise in its destruction.

On the morning of Jan. 16 last year, Acosta led soldiers on a 3-mile fitness run across Camp Anaconda in Balad, Iraq. Suddenly, insurgents attacked the camp with mortars.

Acosta remembers that he stopped, turned to yell at his soldiers and then dived for cover.

“Bam! That was it,” he recalls. “Lights out.”

An explosion about 60 feet away sent a piece of shrapnel — perhaps three-quarters of an inch long — through his left eye. It struck his brain and came out his right eye.

“It was a perfect hit,” Acosta says.

Rushed to the Air Force Hospital at Anaconda, he spent seven hours in surgery. Army Maj. Raymond Cho, an ophthalmologist, removed Acosta’s right eye and carefully reassembled his left one.

“I didn’t want him waking up missing both eyes and wondering for the rest of his life, ‘Gosh, could they have saved at least one?’ ” Cho says. “So he knows that we did everything we could.”

Acosta regained consciousness as he was being returned to the USA. In Germany, a doctor told him that his right eye was gone and his left eye, although stitched together, likely would never see light.

“He said, ‘You’re going to have to start a whole new life from here on,’ ” Acosta recalls.

“I go, ‘So I won’t be able to see my kids? My grandkids? Nobody? I won’t be able to see blue skies?’

“He said, ‘Nope.’

“I just sat there. What could I do?

“A lot of things went through my mind,” Acosta says. “Am I going to be accepted this way? Am I going to be rejected? I was pretty independent all my life, and I did everything. So it was pretty tough.”

VA plans more clinics

Pentagon doctors can rebuild eyes, reconstruct eye sockets and nurse casualties back to health, but soldiers with serious vision problems who want to learn how to adapt into civilian life must rely on VA centers that also serve the elderly and other veterans.

The VA plans to invest $40 million this fiscal year to create 55 outpatient clinics across the nation, providing rehabilitation for veterans learning to cope with partial vision, says James Orcutt, the VA’s director for ophthalmology.

The department also is taking part in two clinical trials focusing on artificial vision, says Ronald Schuchard, director of the Atlanta VA rehabilitation research and development center. The trials involve implanting silicon chips in eyes. The chips act as receptors that can transform light into electrical signals that can be transmitted to the brain. It is cutting-edge research, Schuchard says.

However, Orcutt says, “I think we’re a long way from a practical use of some of these.”

At the VA’s rehab centers for the blind, specialists teach orientation and mobility skills. Visually impaired veterans learn to use a white cane, public transportation and perform daily routines. They also are offered computer instruction and the use of special scanners for reading text. They are assessed and treated, if necessary, for psychological readjustment to their sight loss.

The VA does not provide guide dogs, but it helps link veterans with guide-dog schools that commonly provide a dog and training virtually free to veterans, Poel says.

Iraq veterans sometimes find the VA blind rehab programs, which cater largely to elderly veterans, to be a poor fit for a younger generation. Army 1st Lt. Castro says he felt somewhat out of place during rehab at a VA facility in Augusta, Ga.

After the Army sent Jesse Acosta to a VA center for the blind in Palo Alto, Calif., for rehabilitation in January 2006, he and his wife became unhappy with the facility, describing it as having a “nursing home” atmosphere. It is a five-hour drive from his home.

“It did not fit my needs,” Acosta says.

He left the VA after a few months and was accepted, free of charge, into the Junior Blind of America rehab program near his home in Santa Fe Springs. Last month, he completed training with his new guide dog at The Seeing Eye school in Morristown, N.J., and now has Charlie, a German shepherd.

All that is left, Acosta says, is figuring out the rest of his life.

He has fought a medical discharge from the Army until his medical care is complete. Ultimately, he will earn disability income for his wounds. Acosta was an energy technician with Southern California Gas before he was called to active duty.

He is still with the company, though unpaid, and a different job awaits him — one tailored to his disability, Connie Acosta says. It’s unclear whether Jesse will want it, she says.

“We’re hoping for the best,” she says. “He’s the type that constantly has to be kept busy. We always have an agenda. I have a calendar going constantly with things happening.”

It begins when they wake, and he wants to know the weather and the color of the sky, she says. Nothing in the house can be moved; he’s memorized the location of every chair and table.

He has his routines and chores, including weightlifting in the backyard or fiddling with the fuel pump on the 1969 Dodge Dart. (He fixed it.) Daughter Brittany, 14, is mustered into duty to operate the computer for her father until she pleads for a break.

“Taking care of Jesse has been an experience,” Connie Acosta says. “He’s a sergeant major in the Army, and they’re tough people. He’s a tough person to live with and then, worse, being blind.

“Sometimes, he can be demanding. And I deal with it. I’m used to making sure that everything’s in line. That he’s got everything. And that’s basically all I’ve got to do.”

‘I want to feel productive’

Castro thought he knew how his life would play out.

A former Army Ranger who had worked his way out of the enlisted ranks to earn an officer’s commission, Castro commanded a scout reconnaissance platoon and dreamed of becoming a Special Forces team leader.

Instead, the last thing he would ever see was the colorless expanse of an Iraqi roof in Youssifiyah, Iraq.

A mortar round landed a few feet away from him there on Sept. 2, 2006. The blast killed two other soldiers from the 82nd Airborne Division and sent shrapnel tearing into Castro’s left side. The explosion damaged a shoulder, broke an arm, fractured facial bones and collapsed his lungs. Doctors amputated part of a finger.

The blast also drove the frame of his protective eyewear into his face. When Castro regained consciousness days later at the National Naval Medical Center in Bethesda, Md., his wife, Evelyn, sat at his bedside. She told him his right eye was gone, but doctors hoped to salvage vision in his left.

The surgeons later removed one last piece of shrapnel from that eye. When they took off his bandages and flashed a light for Castro to see, he thought the eye was still covered. “That’s when he told me, ‘Ivan, you’re not going to be able to see again,’ ” Castro recalls. “I swore (it was like) I was standing between the World Trade Center and the two towers had just come down on my shoulders.”

From that moment on, through convalescence and rehabilitation, Castro would struggle to regain a measure of independence.

Castro has become an advocate of rehabilitation funding for the blind, visiting members of Congress. After the 10-mile race in October, he ran the Marine Corps Marathon three weeks later, finishing in 4 hours and 14 minutes.

He concedes that he needs his wife’s help. Evelyn Galvis gave up her career as a bilingual speech pathologist in Fayetteville, N.C., to help her husband. She supervises his medical care and drives him around.

She guides him through crowds, keeping him aware of raised edges in the walkway and steps. She reads his menu in restaurants and tells him where the food sits on the table. She watches him memorize his hotel room, starting from the doorway and circling within the four walls to keep account of beds, the tables, the wastebasket, the bathroom.

“My husband used to be a very independent individual,” she says.

Castro hopes to stay in the military.

The Army has let several amputees stay in the ranks as well as one blind captain, who will be an instructor at West Point Military Academy after completing post-graduate education. Castro awaits word on his future; the Pentagon won’t comment on his situation.

“There’s a world in front of me I can’t predict or envision because I haven’t been there yet. I haven’t lived this yet. I haven’t lived blind,” he says. “All I ask is to stay in the Army and finish out my years … I want to feel productive.”

The only good news for now is when he sleeps, Castro says.

“I’ve had dreams where I know I’m blind and, guess what? I’ve regained my vision,” he says. Reality floods back each morning.

“There’s not a night that I don’t pray and ask God, when I wake up, that I wake up seeing.”

BRAIN INJURIES ALSO DANGER TO VISION By Gregg Zoroya

Glenn Minney lost most of his sight from a combat explosion. But it wasn’t just the injuries to his eyes that cost him his vision it also was damage to his brain.

Minney, then a Navy corpsman, was wounded when a mortar landed near him in Haditha, Iraq, in 2005. The blast threw him 30 feet. His back struck a metal railing, whipping his head backward. He lost his right eye. Vision in his left eye is impaired from physical injury and brain damage, he says.

An emerging threat from the fighting in Iraq and Afghanistan is damage to the brain that affects vision, Pentagon and Department of Veterans Affairs medical researchers say. This type of injury could mean that there are thousands of veterans with undiagnosed vision problems, says Tom Zampieri, of the Blinded Veterans Association.

Doctors didn’t find Minney’s neurological damage until after he left the military and was screened for brain injuries by the VA. “The public doesn’t know the true extent of these (brain) injuries,” says Minney, 40, married and the father of two. He’s now a patient advocate for the VA in Frankfort, Ohio.

Concerns about eye injuries have prompted federal legislation that would create a $5 million Pentagon-based center for research and treatment of injured eyes. It also would create a registry to track eye wounds.

Minney suffered severe vision loss. Researchers are finding that less-severe vision problems also can occur among troops who suffer minor brain concussions from combat, particularly exposure to a blast. “There are a lot of patients who have suffered mild to moderate brain injuries. Upon initial examination their eyes looked healthy, but they were still reporting problems with their vision,” says R. Cameron VanRoekel, an Army optometrist at Walter Reed Army Medical Center in Washington.

Gregory Goodrich, a research psychologist at VA facilities in Palo Alto, Calif., had similar findings in a study of 101 Iraq and Afghanistan war veterans with mild traumatic brain injuries. Many are still in the service.

Goodrich found that 40% to 45% of the patients suffered vision loss even though their eyes were physically healthy. The biggest problem was an inability for both eyes to operate precisely together. This can lead to eye strain and blurred vision.

Left undiagnosed, it can also hamper vocational or educational training and aggravate depression and post-traumatic-stress disorder, Goodrich says. Veterans may need an eye care specialist and corrective eyewear, he says.

But Goodrich fears that routine eye examinations may not uncover the problems. “In many cases, we’re seeing active-duty troops, and they want to get back and join their units,” he says. “So they don’t want to hear that there’s something they need to go get treated for.”

(USATODAY)

How to Use Meditation to Treat PTSD

Scientists say that meditation can improve blood pressure, diminish insomnia and keep the mind sharp. When you are triggered and began reliving your trauma, having an established meditation practice is wonderful tool. One of the greatest benefits of meditation is learning to “quiet the mind,” which can be especially difficult when fear strikes. This is why meditation can be such an important practice. There are many different ways to meditate. We are going to use a visualization that will come in helpful when you start to panic.

Instructions

1. Find time to meditate everyday, such as when you first wake up in the morning or right before bedtime.
2. If you are a beginner, you will want to start slow. If you live with someone, let them know you will need 5-10 minutes to yourself A gentle reminder, such as a sign, isn’t a bad idea either.
3. Prepare your space. If you choose, light incense, candles and put on some soft music. Dim the lights. While this is not necessary, having a ritual associated with your daily meditation help prepare your mind for what’s to come.
4. Minding your posture, sit on a chair or cushion. Keep your spine straight and head tilted slightly forward. If you can, try to maintain a half-smile on your face.
5. Close your eyes and breathe in deeply through your nose, filling your belly with air. As you breathe in, let go of any tension you have in your muscles. Take ten slow deep breaths.
6. Imagine that you are walking down a flight of steps, with a door at the bottom. Each time you take a breath, you descend one step.
7. As you come to the bottom of the steps, you try to open the door and realize its locked. You look down at your chest and notice that you are wearing a key around your neck.
8. Using the key, you unlock the door and step inside. You are in your favorite place. When you are here, nothing bothers you and you feel powerful, safe and protected.
9. You sit here for as long as you feel comfortable. When you are ready, you walk back out the door and lock the door behind you, making sure the key is safely around your neck.
10. As you ascend the ten steps home, you notice that a calm has washed over you. You take one step per breath as you climb, opening your eyes when you get to one.
11. Give yourself a couple of minutes to stretch and slowly readjust yourself to your surroundings. Hang on to the feeling of calm you have acquired, always remembering that you carry the key to unlock that door anytime you like.

Tips & Warnings

1. As a beginner, it will be difficult to keep your mind from wandering. Don’t get frustrated. Just start again. Everyone’s mind wanders. The important part is to keep at it.
2. Even if you can’t “see” what you’re imagining, keep at it. It takes time to develop these skills.
3. You may want to tape this meditation and listen to it so you don’t have to read it every time.
4. Use a shorter version of this meditation when you are triggered. You may want to change the number of steps or have the door sitting wide open when you arrive. Do whatever feels comfortable.
5. Don’t give up! Go gentle on yourself.
6. Do not try to force yourself to stop thinking. This will only make you think more. When you realize you are lost in thought, simply start counting again and bring your focus back to your breath.
7. Don’t give up if you get off-track! Just start back as soon as you remember.

User perspective of the effectiveness of meditation in treating Post-Traumatic stress disorder

Meditation has helped the most Meditation was difficult for me to learn, but has ultimately been what has helped me the most.

It was difficult for me to start meditating because I suffered from panic, anxiety and depression related to PTSD. I needed a lot of help–I took the Mindful Meditation class at Kaiser (offered at many hospitals), and that gave me the support I needed to start.

Meditation helps because when I’m having a flashback of the trauma, I am no longer in the present. Meditation helps me to return to the moment, to be aware of what is going on now.

I have to do lots of self-care–massage and bodywork, support from other people, therapy. But I feel meditation is the key to everything–what helps me remember what is good in my life now, and what it is that I really need in order to heal. Sometimes it’s so hard to get through the moment when I’m feeling emotional–I just focus on my breathing and use the meditation skills to return to the present. It’s taken practice for me to get to a point where I can do this.

I see meditation as a long-term tool that I feel will help any one suffering from PTSD–just be patient, and know that it may take some time to really experience the benefits.

Trauma of war hits troops years later

In internet chat rooms, veterans ask if anyone else is having a similar experience. “I had an incident where a small Iraqi boy had his leg blown off. His screams haunt my thoughts. Is what I am experiencing normal?” asks IraqCowboy. “They gave me sleeping pills, but it doesn’t stop the nightmares,” says Chucky. “The doctor says my husband has PTSD,” posts Sam. “Does that count as a combat-related illness?”

What is now known as PTSD, or post-traumatic stress disorder, was called shell shock back in the days of the first world war. Sufferers have harrowing flashbacks, and alternate between emotional numbness and outbursts of rage, guilt and depression. Previously well-adjusted soldiers suffer impaired memory and attention, insomnia and anxiety, and are more likely to take drugs and alcohol later in life. That much is well recognised.

What is less well known is that PTSD can trigger physical as well as psychological ill health. And as the US agonises over how long its soldiers should stay in Iraq, New Scientist has pieced together evidence showing that veterans will be paying the price of combat for decades to come. Recent and soon-to-be published research reveals that soldiers who fought in theatres as diverse as Vietnam and Lebanon are not only more likely to die from an accident on their return, but are also twice as likely to develop cardiovascular disease, diabetes and even cancer later in life. And these problems are particularly likely to afflict troops who experience the close-quarters fighting taking place in Iraq.

Last year researchers from the US Centers for Disease Control and Prevention (CDC) revisited more than 18,000 Vietnam veterans who had been subjects of a detailed health survey in 1985, to see who had died and how. For the first five years after their return home, men with combat experience appeared more likely to have died of accidents, overdoses and the like. After that, they seemed no more at risk than comrades who had spent the war in non-combat roles (Archives of Internal Medicine, vol 164, p 1908).

The CDC study took no account of whether the soldiers were suffering from PTSD. But now Joseph Boscarino of the New York Academy of Medicine has re-analysed the 1985 data to assess which men were suffering from the condition. That analysis, to be published in Annals of Epidemiology, reveals stark differences in death rates persisting 30 years after the end of the Vietnam conflict. All men with PTSD, whether from combat experience or not, were more likely to die from “external causes” such as accidents, drugs or suicide. But men who developed PTSD as a consequence of combat were also more likely to die of heart disease and, surprisingly, various kinds of cancer.
“The link between combat stress and cancer risk surprised us, and it isn’t explained by differences in smoking”

“Other studies have found a link between heart disease and stress, but this is the first time there has been such a direct association with PTSD so many years later,” Boscarino told New Scientist. “The cancer surprised us, and it isn’t explained by differences in smoking.”

People with PTSD may experience long-term changes in various immune reactions, and in levels of the stress hormone cortisol and chemicals such as adrenalin and dopamine that underlie fight-or-flight reflexes, Boscarino says. He found a direct relationship between the amount of combat exposure and the reduction in cortisol levels. “The excess deaths in both PTSD groups show that stress can kill,” he says. “But the much greater effect among the combat veterans shows there is something especially bad about that.”

He is not alone in his conclusion. In March this year Yael Benyamini and colleagues at Tel Aviv University in Israel reported that among Israeli veterans of fighting in Lebanon in 1982, those who developed PTSD are now twice as likely to have high blood pressure, ulcers and diabetes, and five times as likely to have heart disease and headaches, as those who did not develop the disorder (Social Science and Medicine, vol 61, p 1267). “PTSD is the key mechanism that leads from the trauma to poorer health,” they say.

“Iraq is similar to Vietnam, with roadside bombs, ambushes and the civil insurgency”

Other studies have found clear associations between war-related PTSD and cardiovascular disease in veterans of the second world war, the Korean war, and recent conflicts in Croatia and Lebanon.

Last year, a study by US army scientists at the Walter Reed Army Medical Center in Silver Spring, Maryland, concluded that some 18 per cent of US veterans from Iraq could be affected by PTSD, which would translate to around 60,000 people so far (The New England Journal of Medicine, vol 351, p 13). And the more firefights Iraq veterans experienced, the more likely they were to have PTSD.

Boscarino is a Vietnam veteran, and he predicts that levels of PTSD in Iraq veterans will be similar to those seen in troops who fought in Vietnam. “It’s a similar war, with the roadside bombs, ambushes and the civil insurgency.”

“The link between combat stress and cancer risk surprised us, and it isn’t explained by differences in smoking”

Timely psychological help might mitigate the problem. Yet The Walter Reed group found only a third of Iraq veterans with PTSD were getting help from a mental health professional a year after their return. British soldiers get no routine mental health screening before or after deployment, though 1 in 10 troops airlifted out of Iraq for medical reasons had mainly psychological problems.

In February, the General Accounting Office of the US congress reported that the Department of Veterans Affairs had not fully met any of the recommendations its own advisers have been making, in some cases since 1985, for improving treatment of PTSD, such as checking whether screening and counselling are being implemented.

(New Scientist magazine)

Post Traumatic Stress Disorder (PTSD – War Trauma)

It has been estimated that 30% of Vietnam war veterans, 10% Gulf war veterans, 6% to 11% Afghanistan war veterans and 12% to 20% of veterans of the Iraq war have suffered from Post Traumatic Stress disorder. This is an anxiety disorder that can develop after exposure to one or more terrifying events.

The history of PTSD date back to the early 1800’s where military doctors began diagnosing soldiers with “exhaustion” following the stress of battle. This “exhaustion” was characterized by mental shutdown due to individual or group trauma. Around this time there was a syndrome in England called ‘railway spine’ or ‘railway hysteria which bares a resemblance to what we call PTSD today. This was found by people who had been in the catastrophic railway accidents of that time.

In World War I and II the term ‘shell shock’ and combat fatigue’ were terms to describe veterans who exhibited stress and anxiety after being in combat. The official designation of “Post Traumatic Stress Disorder” did not come about until 1980 when the Third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) was published.

This anxiety disorder occurs when you are afraid and your body activates the fight or flight response. This reaction to fight releases adrenaline, which is responsible for increasing your blood pressure and heart rate as well as increasing glucose to muscles (to allow you to run away quickly in the face of immediate danger). However when this danger has gone your body begins to go through a process that shuts down the stress response and this process involves the release of another hormone known as cortisol. If your body doesn’t generate enough cortisol to shut down the stress reaction you may continue to feel the effects of adrenaline. Trauma victims who develop post-traumatic stress disorder often have higher levels of other stimulating hormones (catecholamines) under normal conditions in which the threat of trauma is not present. These same hormones kick in when they are reminded of their trauma.

Military Post Traumatic Stress Disorder is a very serious disorder with symptoms such as self harm, anger, violence and drug addiction as well as depression. All of these are common symptoms of Military Post Traumatic Stress Disorder and sadly affects thousands of soldiers every year who have serviced in the armed forces. Treating Military Post Traumatic Stress Disorder is done through psychotherapy and basic counselling but can take a lot of time and patience.

Sadly a number of people who are experiencing and suffering from Post Traumatic Stress Disorder, also known as ‘war trauma’, is said to hugely increase in the next few years due to the number of soldiers who are fighting in areas such as Helmand and Basra. There are concerns that the Iraq war is producing more cases of Post Traumatic Stress Disorder than any other conflict in decades, one of the main reasons for this is that the violence has been so widespread and exposure to it so constant over long periods of time. The suicide bombers, roadside mines and the constant threat of attack within the Iraq war poses a unique challenge to the mental health of the soldiers who are serving in it.

If you are one of those suffering and are thinking of claiming compensation for you suffering then you should do so right away. It is your civil and legal right to claim compensation for injuries psychological and mental. No-one should suffer in silence.

(www.articlesbase.com)

Not Specific to Combat, Research Project Studies Use of Tibetan Meditation to Treat PTSD

Although not specifically directed towards combat veterans and PTSD, a research study is currently evaluating whether Tibetan meditation has benefit for PTSD sufferers. Miami and Ohio State university researchers will use an ancient technique to address a modern problem. With a $98,000 grant from the Ohio Department of Mental Health, Deborah Akers, Miami visiting assistant professor of anthropology, will work with co-researchers from Ohio State on a project titled “Treatment of Trauma Survivors: Effects of Meditation Practice on Clients’ Mental Health Outcomes.”Akers and co-researchers Moyee Lee, professor of social work, and Amy Zaharlick, professor of anthropology, will investigate the impact of Tibetan meditation on victims of post-traumatic stress disorder (PTSD). The project began this month and will continue for two years.

Researchers will work with a group of women diagnosed with PTSD who live in Amethyst House, a women’s treatment program for alcohol and drug addiction in Columbus. Tibetan monk Geshe Kalsang Damdhul of the Institute of Higher Buddhist Dialectics in Dharamsala, India, will assist as a meditation instructor. “Participants will be taught specialized meditation techniques and will be guided through meditation for a period of six weeks,” said Akers. Results could then provide a new option for treating other victims of PTSD, such as combat soldiers returning from war or victims of natural disasters such as Hurricane Katrina. “This project charts new ground, bringing a holistic perspective to the treatment of PTSD,” said Akers. She added that though meditation has been used in a variety of therapeutic settings in the West, such as reducing stress and coping with pain,its application in the treatment of mental illness, including PTSD, has not been extensively explored.

“Whereas in the West treatment of PTSD may require years of prescription medicine and counseling, the Tibetan approach has been successful within one to two years by focusing on the spiritual connection between the mind and the body that seems to allow the patient to process the trauma more effectively,” said Akers. “Moreover, unlike Western medical therapies, meditation is free and can benefit individuals who cannot afford extensive therapy or medicine over long periods of time. The Tibetan approach is empowering, as it offers PTSD patients an alternative and less invasive form of therapy and enables them to participate in their own treatment.” The project grew from a Miami summer field school program, “Peoples and Cultures of Tibet,” conducted in Dharamsala, the residence of the spiritual leader of the Tibetans, the Dalai Lama, and location of the Tibetan government in exile. During the field school, Akers and Miami students learned about how Tibetan monks minister to political prisoners and victims of torture who suffer from PTSD. Several Miami pre-med and anthropology students will assist in the Columbus project, gaining hands-on research experience.

“The PTSD research project and the summer field program in Dharamsala exemplify Miami University’s continuing interest in South Asia,” said Akers.

(www.healingcombattrauma.com)

Portrait of a US combat casualty

For Spc. Brett Christian, the morning of July 23 began ordinarily enough. He brushed his teeth and shaved. Then, climbing into the cab of his 21/2-ton diesel troop carrier not long after sunrise, the young soldier pulled into an Army convoy headed west out of the northern Iraqi city of Mosul.

Specialist Christian’s mission was routine. He and a couple of dozen other troops from the 101st Airborne Division were bound for a firing range to zero their weapons. As was his habit, the gregarious 27-year-old was trading jokes in the cab. In the turret behind him, the machine gunner scanned flat brick rooftops and dusty streets.

The five-vehicle convoy rumbled past some charred chassis and artillery shells cluttering a scrap-metal dump – the kind found on the outskirts of many Iraqi cities – and began rolling up a hill.

Then, mid-joke, Christian’s world exploded.

“As we crested the hill, I felt myself get hit with a bunch of glass and debris,” says Lt. Christopher Wood, who was sitting next to Christian in the cab. “I thought we were getting ambushed, so I turned to tell Christian to put on the gas. He was already dead.”

A standard mission. A sudden blast. A soldier lost – and no enemy in sight.

This is the kind of faceless battle that tens of thousands of US troops are bracing for in Iraq each day. For infantrymen like Lieutenant Wood who fought their way to Baghdad to topple the regime of Saddam Hussein, today’s terrorist-style ambushes are in some ways worse than major combat, when the enemy was more visible and predictable. More than 52 US servicemen have died in hostilities since heavy fighting was declared over on May 1.

“There’s a tangible air of frustration,” says Wood, whose hearing was impaired and left eye injured in the ambush. Six other soldiers suffered shrapnel wounds.

Fighting flares up
The Mosul region, after a period of relative quiet, has experienced a spate of attacks since the 101st joined with other US forces to surround and kill Uday and Qusay Hussein on July 22. Military intelligence officers are unsure exactly who the enemy is, but say strikes have grown in sophistication. That some motivated by cash or revenge are willing to attempt the attacks is no surprise, they say. As in many places in Iraq, this city of 2.3 million people is home to thousands of unemployed young men and ingrained patterns of violence: Gunfire erupts here nightly and residents fish in the Tigris River using hand grenades.

To be sure, US forces are aggressively flushing out weapons, money, and potential attackers while also scrutinizing their methods. In recent days, for example, soldiers with the 101st foiled a rocket-propelled grenade (RPG) ambush and uncovered caches of missiles and hundreds of RPGs and rounds of ammunition. Troops are also becoming more skilled at identifying and disabling the kind of improvised explosive device that killed Christian. For every deadly attack, many more fail.

Meanwhile, soldiers such as Wood who survive close calls are carrying on with their jobs – driven variously by duty, resentment, and the knowledge that they have no choice.

Inside a heavily fortified Mosul hotel that was gutted by looters before his infantry company moved in, Wood speaks about the attack – even its first desperate moments – with a tone of detached resignation.

Moments after the makeshift blast – most likely from artillery shells planted in the road median and ignited remotely by a waiting enemy – Wood struggled to see clearly and get his bearings. The troop truck kept rolling forward but Wood could not reach the brakes.

“We gotta get out of here!” the gunner yelled, kicking Wood in the back. So Wood bailed out and with the rest of the troops took up fighting positions. The gunner, in a state of shock, sprinted from the scene and off the road. Other soldiers found him 50 meters away, and he was later evacuated from Iraq – a casualty of mental more than physical trauma.

‘What are we doing here?’
Indeed, two days later, a group of Christian’s comrades from the 2nd Battalion, 502nd Infantry Regiment met for hours with a combat-stress team sent to help them vent their grief rather than bottle it up. “For them, it was like losing a family member,” said Lt. Col. David Lonnquist, a combat-stress expert with the 113th Medical Company.

Some soldiers cried, and others raised doubts. “There were a lot of questions like ‘What are we doing here?'” Colonel Lonnquist said. “That’s not clear to some people, whereas it is clear in combat.”

Back home in Cleveland, Christian’s mother, a single parent, was mourning, too. On hearing a radio report of the attack, Tess Christian knew intuitively her oldest son was gone. “It’s such a gut-wrenching feeling,” she told a local newspaper. He died on her birthday.

The attack also weighed on the minds of Wood and his men as they set out soon afterward on a night foot patrol in an anti-American neighborhood of Mosul. Wastewater ran in gutters through the narrow streets, and children emerged from dim alleys to throw rocks at the soldiers. Once, orange tracer rounds flew up from behind a building. Nearby, a man on a rooftop peered down at the patrol.

“That makes me uncomfortable as hell,” Wood said as he glanced around, his one eye bloodshot from the attack.

“I never trusted the population before and I’m even less trustful now and somewhat resentful,” he says. “We removed a totalitarian regime and are trying to set up a democracy, and still people want to do us harm.

“I can’t understand it. But,” he added, “it’s not for me to understand.”

It was already hot at 8:00 a.m the next day, when Christian’s fellow soldiers gathered at their Mosul camp to bid him farewell. Sunlight filtered through a camouflage awning, dancing on their shoulders. Before them stood a shrine of Christian’s boots, rifle, and helmet, along with his Bronze Star and a snapshot of him in his truck.

“We shouldn’t put question marks where God puts periods,” said Chris tian’s company commander, Capt. John Yorko, as if reading the men’s minds.

One of Christian’s closest buddies, Spc. Nathan Galante, recalled his friend’s infectious humor as well as his bravery, shown when he took the lead in a convoy of trucks that came under small-arms fire during the war. “We love you, Brett,” he said.

Then the company’s burly first sergeant led roll call, summoning Christian by his new rank of sergeant. He was due for promotion Aug. 1.

“Sergeant Christian….” he called out hoarsely.

“Sergeant Brett Christian…..

“Sergeant Brett Thomas Christian….” Shots broke the silence, and the sound of taps rose over the rooftops of Mosul.

(The Christian Science Monitor)

Basic Overview of Post Traumatic Stress Disorder  by Jim Loughrey

Histories of the Vietnam War are beginning to abound more than two decades after our nation’s involvement in the conflict officially ended. Historical analysis is most often subjective to some extent — and always dependent on available information. History, as it is recorded, may change when new facts come to light. It also may change more subjectively when the times change and the opinions involved in the writing reflect a different view-point.

Think for a moment about how the veterans of the Vietnam War have been portrayed. The picture depends on who does the writing and when. Every Vietnam Veteran is a part of history — as nameless as any of us may always be, we did have a part in the making of this part of history. But as a group, how were and are we being pictured?

I think most people will agree that for years we were not portrayed very favorably at all. In movies and books and on television the initial, main role of the Vietnam Veteran was that of a psychopath and social misfit — a man brutalized and warped by a war most Americans had little use or respect for. When the writers needed a character who was insane, completely antisocial, dangerous to society, drug and/or alcohol addicted, guilt-ridden and vengeful, etc. ad nauseam, the Vietnam Veteran filled the need. If one needed a character who would evoke pity, the beaten, weak, suffering Vietnam Vet served once more –because our song was, many agreed, “When Johnny Comes Slinking Home”. Like the new guy in Hollywood, we had to start at the bottom with all the bad guy roles.

Why? Why wasn’t it like it was with our World War II and Korean War brothers? How come we weren’t allowed to start out playing the good guy, the hero, the indomitable spirit? The roles we were given in fiction were the same ones we played in reality as far as our news media were concerned, and hence, as far as our people were given to know. Headlines reporting Vietnam Vets shooting from rooftops were more saleable than those which would tell of veterans of our era forming businesses, getting professional degrees, or otherwise benefiting themselves and society. It was as if the World War II Veteran was one who went off to the terrible task of war and took along with him morality and honor, while the veteran of the Vietnam War was somehow something less who went off to war and brought back immorality and dishonor. In any event, if despicable or pitiful, we had become, at least, interesting. But while some people who write the news might be given to exploitation and a certain degree of selective myopia, there usually is at least something of truth or reality in the reporting as an element of justification. Wasn’t it true that some of us did, indeed, do some of the things we as a group became famous for?

Certainly. But few asked why. It is apparent that very few people wished to know what caused the difference in behavior, compared to that of veterans of other wars, or wondered if such behavior might be attributable to only a very small segment of the Vietnam Veteran populous. A very tired and disillusioned America was not yet recovered enough from Vietnam to deal with the problems of its youngest war veterans; or countrymen felt they had difficulties enough of’their own, perhaps, or they simply were not aware that the problem was any more complex than it seemed. The result was that the seemingly obvious was taken as explanation enough. Hence, when anyone needed an explanation at all, we were known to suffer what became known as Post-Vietnam Syndrome. The term — which had no scientific meaning — was adopted by both veterans and the public.

Today we speak of PTSD in Vietnam Veterans. Today veterans are getting help and getting better, all because they suffer from a medically recognized condition: PTSD. But for far too many people — veterans and non-veterans of the Vietnam War — “PTSDII is nothing more than a substitute for IIPVS”. The problem has been given the legitimacy of official and professional recognition, but that has not necessarily led to any more understanding — either by veterans of Vietnam or by their countrymen. As in the days of IIPVS”, many veterans do not know what their problem is or what they need or can do to solve it, nor do other Americans understand what PTSD really means and why it exists. Consequently, too many veterans are still blamed for things that are not at all their doing or fault. They are still sometimes looked down upon when in reality they deserve to be praised and honored. And America cheats itself as long as it erroneously and unjustly rejects a part of itself.

We need to concern ourselves with PTSD for everyone’s ultimate benefit. But first it is necessary to know and comprehend what PTSD is, means, and does. Following is a brief discussion of PTSD that does not require a professional degree to understand. It only demands one care enough to read it and do so with an open mind, not with comfortable bias.

And what’s required of the Vietnam Vet who is having serious emotional and mental problems is something even greater: courage. The courage many of us already know he had in his war. To heal will demand courage because healing is change. Sometimes even hell can get to be comfortable and change will look like just too much to ask. Too much to try. But that is what is necessary and there is no other way.

Many of us suffer from a disease that perpetuates itself with a vicious cycle effect: the disease is one of a lack of change and part of the disease itself is an unwillingness to seek change. There is a similarity between this disease and the disease of alcoholism. Alcoholics, many believe, suffer from a type of insanity; the insanity makes them drink and the drinking affects the brain, hence the mind, and causes insanity. The disease we’re discussing here is called PTSD.

PTSD stands for Post-Traumatic Stress Disorders. Put simply, this is a set of disorders common in people who are reacting to severe trauma with the reactions occurring or continuing after the stressful event. PTSD is not, therefore, a set of mental disorders found only in Vietnam Veterans. Who suffers from the disease is determined by what was the stressful event or trauma. Survivors of rape or a life of child-abuse or some catastrophe as well as veterans of combat and associated experiences all may well eventually experience PTSD.

Our concern here, though, is PTSD as it relates to us, the veterans of the Vietnam War. And it’s only been in recent years that the term PTSD has been applied to the mental disorders many of us have been suffering. PTSD has been applied to us only since 1980 when the disorders were first included in the American Psychiatric Association’s DSM III — “Diagnostic and Statistical Manual III”.

The DSM serves as the text, the bible, for American psychiatrists and psychologists. The first Manual appeared in 1952; the DSM II with its new entries and revisions was available in 1968. PTSD as a term and a concept wasn’t documented until the DSM III.

There’s an old joke in chemistry: If Lavoisier discovered oxygen, what did people breathe before he discovered it? Similarly, from what did veterans of combat suffer before PTSD was discovered? Before Lavoisier, of course, people were breathing oxygen but just didn’t know what it is or what to call it. The history of combat veterans’ illnesses and maladjustments reflects a similar situation. One difference is that many labels have been used to describe the effects of combat on men and women over decades. Also, oxygen was, is and always will be just oxygen no matter what it is called. However, what was “wrong” with veterans of combat has been a matter of who judged the problem and when.

At first there were no specific explanations for Vietnam Veterans’ having the myriad problems they did; problems like a suicide rate described as 33% greater than the national average, disproportionately high incidences of chemical abuse and criminal convictions.

People who were against the war could point to the returning veteran who suffered such problems as proof of the veracity of their viewpoint: the Vietnam War was a disgusting and useless mess to which we had sent some of our most disgusting and useless people. The nature of the war was created by the nature of those who waged it. But more often we encountered antiwar sentiment that reversed this so that the immoral and disgusting war was the creator of immoral and disgusting people.

Likewise, supporters of the war used our condition to further their aims. We were proof positive of the Communist brutality and dirty tactics — all the more reason for our country to believe in the morality of its position. The war was disgusting because the enemy made it so and we were its gallant victims.

Sociopolitical motivations aside, people began to label us as sufferers of “Post-Vietnam Syndrome”. This label seems to have appeared sometime during the late sixties to early seventies.

PVS was more or less a term of convenience. It was a nebulous concept that purported to describe the ailments of the combat veterans of only this particular conflict. It was unique to us as if our behavior had never been seen in other veterans. As the war dragged on and this country wearied of the internal strife and lack of a victory, PVS began to be a derogatory term, especially as younger veterans and counterparts from other wars became less and less able to identify with each other.

The term Post-Traumatic Stress Disorders came about only after the effects of combat were truly studied scientifically and for the first time. So, before analyzing the nature of PTSD as it relates to combat veterans, a little history of its evolution would be informative.

Jim Goodwin, PhD reported in POST-TRAUMATIC STRESS DISORDERS OF THE VIETNAM VETERAN (Disabled American Veterans, 1980): “It was not until World War I that specific clinical syndromes came to be associated with combat duty. In prior wars, it was assumed that such casualties were merely manifestations of poor discipline and cowardice. However… during ‘The Great War’, the concept evolved that… exploding shells caused actual physiological damage, precipitating the numerous symptoms that were subsequently labeled -shell shock’. By the end of the war, further evolution accounted for the syndrome being labeled a ‘war neurosis’.

Until World War I, then, any soldier negatively responding to the stresses of combat would have been labeled just a coward. The studies done during that war, though, did not do much to alter opinion that it was somehow the fault of the soldiers that they ended up displaying mental disorders. Even though psychiatrists began to recognize combat as capable of producing such symptoms, it was still assumed that something had to be wrong with the soldiers character before combat stresses could have adversely affected him. Even though we’d moved from basic cowardice to “shell shock” and then on to “war neuroses”, the thinking continued on into World War II that a soldier had to have been “predisposed” toward such reactions … in other words, had to have had basic character defects.

According to Dr. Goodwin: “During the early years of World War II, psychiatric casualties had increased some 300 percent when compared with World War I, even though the preinduction psychiatric rejection rate was three to four times higher than WW I. At one point in the war, the number of men being discharged from the service for psychiatric reasons exceeded the total number of men being newly drafted-”

World War II thinking suggested that, if we’re going to assume that men had to possess “predispositional factors” in order to break down in combat, then we had better expect not too many to be immune. According to a 1944 Inspector Generalls report: “If screening is to weed out all those likely to develop a psychiatric disorder, all should be weeded out.,,

Therefore, the belief that war neurosis could only grow in the fertile ground of a defective character had outlived its usefulness. Psychiatrists now began to look into the “intrinsic qualities of the combat situation” for the reasons for the breakdown and the blame was beginning to shift from the shoulders of the fighting men to the conditions of battle themselves. Basically, war itself held the capacity to exhaust anyone.

What changed during the Korean War was the way the men were treated. Terminology had now progressed from “war neurosis” to “combat exhaustion”. But soldiers were no longer so readily discharged from service when they showed signs of mental disorders attributable to combat. Rather, doctors began treating men immediately and close to the front. A very good rate of return to duty was achieved.

Vietnam, however, was a vast surprise for everyone. Military psychiatrists were prepared for the same situations as seen in past wars, but these did not develop. Battlefield breakdown in Vietnam was “at an all-time low: 12 per one thousand”.

Were the men fighting in Vietnam staunchier than their predecessors? If so, why then were Vietnam Veterans so severely criticized? How could they have been statistically so much better able to endure combat than their predecessors and yet have been at some points nearly universally considered inferior and the reason the war was lost?

The answer is that the basic package was really the same; it was the wrapping that differed….

Most of our problems surfaced after our return from combat. We succumbed as did our older brothers, but we did so alone and thus did not lend ourselves as much to being battle statistics. Furthermore, the differences in our respective homecomings contributed to the apparent disparity.

By virtue of their coming home together and on long journeys that allowed for mutual sharing of the war experience, older veterans were able to lay to rest much of their horror. We were forced thereby to carry ours with us into life after our war. Additionally, the initial recovery of WW II veterans was greatly aided by their country’s reception: very warm and appreciative. The negative homecoming we received — the rebuke, disdain, criticism, blame, and forced silence and isolation — not only helped retard recovery but actually very severely added to the stress we had to overcome.

Another characteristic difference between Vietnam and other wars was the personal involvement and ability to understand and relate to the public.

Our countrymen were bludgeoned daily with the horror of our war, which received mostly negative and biased press. Our war’s purpose was not clear-cut and our people at home were not encouraged to feel a part of it. And despite the vast coverage graphically displayed to them, the American people were really not made privy to the actual experience of their soldiers on the battlefield.

During the second World War, conversely, it had been unthinkable to present the fighting men’s efforts in anything but a positive light and the nation received primarily reports which cultivated a sense of unity, purpose, conviction and optimism. Our soldiers were aware of the nation’s constant sacrifices and the people were made aware of the soldier’s sacrifices — and each shared the other’s respect as well as experiences.

Ultimately, then, our nation and its servicemen suffered together during World War II, bled together and healed together. Vietnam? –The factors created an environment socially that demanded veterans recover on their own and with fewer of the tools required for such recovery.

Hence PTSD.

Post-Traumatic Stress is a consequence of extreme or severe trauma. The reactions to it do not often appear until after the fact. The victim may have come through the traumatic situation apparently relatively intact only to ultimately exhibit the symptoms that characterized the PTSD condition.

PTSD is diagnosed according to two categories. These, according to Dr. Erwin R. Parson, are:

ACUTE PTSD — The onset of symptoms occurs within six months of the trauma and the symptoms last for less than six months.

CHRONIC or (a) The onset is at least six months DELAYED PTSD — after the trauma (DEIAYED).

(b) Duration of the symptoms is more than six months (CHRONIC).

Chronic/Delayed PTSD would, thus, be the condition of those of us now exhibiting the symptoms. Following are the generally accepted symptoms of PTSD:

Depression Isolation Rage Intrusive thoughts Alienation Survivor guilt Sleep disturbances and nightmares Anxiety reactions

Depression may include feelings of worthlessness, feelings of helplessness, suicidal thoughts, etc. Isolation is the inability to get close to others (veterans of combat often have very few friends and tend to feel they cannot relate to most people and vice versa). Others often see such a veteran as “cold” due to the symptom of Alienation in which the veteran does feel “emotionally dead”. Anxiety Reactions include the tendency to overreact to certain stimuli — being acutely startled by loud noises or feeling extreme discomfort in the open or when people are behind the veteran (there is a tendency to identify the stimulus with combat and/or to react to it as one would have to combat). Rage is an uncontrolable urge to lash out at people, often suddenly and without apparent reason, with the veteran being himself frightened by the rage response. Survivor Guilt causes the veteran to recount the death of comrades with a sense of guilt over not having been able to do anything about it; the “why wasn’t it me” attitude can drive some to self-destructive behavior. Sleep Disturbances & Nightmares — the sufferer has much difficulty in falling asleep and maintaining sleep; there is a tendency even to avoid and postpone sleep or the use of drugs or alcohol where the veteran feels he needs sleep; and the nightmares are often of a recurring nature with the same scenery, events and situations.

The above symptoms may also be indicative of other conditions and that a veteran may be suffering from one or two of the above is by no moans to be taken as a sign that he does indeed suffer from PTSD. Only a competent, professionally-made determination should be sought; and it should be noted that not all veterans suffering PTSD exhibit all of the given symptoms.

But who does suffer from PTSD and how is the determination made?

Determination of PTSD cases is something that should be done only by the professionally qualified who also have specialized experience with and knowledge of PTSD in combat veterans. Any veteran presenting himself for such a determination should fully be aware of the fact that the process must necessarily be lengthy and involved.

One reason is this: PTSD as an ailment of combat veterans qualifies the sufferer for compensation from the government. There are, unfortunately, some who may not really need treatment and who merely want to exploit the system for personal gain. Dr. Jim Goodwin states this: “When a veteran appears in an interview wanting something from us (the VA) other than treatment, there is a manipulative flavor to the interview. I am then immediately alerted that issues other than PostTraumatic Stress may be involved.”

Some time must be spent by the psychologist in ascertaining the honesty of a prospective sufferer not to save the government money. The main reason is a seriously practical one: The number of qualified doctors available to veterans is limited and dishonest and undeserving veterans who are permitted to undergo counseling and treatment detract from the total available help for those having serious problems.

Even more critical is that the initial interviews and exams must attempt to distinguish possible PTSD-sufferers from those afflicted with other mental ailments whose symptoms often may be confused with those of PTSD.

Schizophrenia is not uncommon and the disorder is one often confused at first with PTSD. For example, decreased productivity, certain types of amnesia, and hallucinations are common to both disorders. On the other hand, many aspects of each disorder are completely different, some even opposite. Medication indicated for schizophrenia will do no good for the PTSD-sufferer and vice versa. Schizophrenics respond well to the phenothiazines, which have no effect on PTSD patients. Conversely, tricyclic antidepressants work well in PTSD cases, but have no effect at all on schizophrenics.

Veterans who finally present themselves for evaluation and treatment often become impatient with the evaluation process. They see no need for the psychologist or psychiatrist to “waste time” with tests and questions that do not readily seem pertinent to their service experiences. The veteran usually is convinced from the start that he suffers from his combat experiences and wants only to discuss war-related matters, all else in his opinion being irrelevant. What has the doctor’s question concerning his grade school years got to do with the time he had to crawl into a VC tunnel in Vietnam? Why should he submit to hundreds of questions on the Minnesota Multiphastic Personality Inventory — which seem to be designed more to determine if he’s lying than to determine if there’s anything abnormal about him — when he knows that the only thing wrong with his personality is whatever was changed by war experiences?

This attitude of some of-us is quite understandable. Many or most of us do not seek help until we’ve essentially reached the end of our rope — either just unable to endure it alone anymore or are in some sort of serious trouble. So, there is a deep sense of urgency and we are in no frame of mind to sit back and let someone drag us down those “dead-end roads”. Moreover, many veterans have developed a tendency to distrust authority and, should we be seeking aid at the VA, some of us might even assume that the doctor is looking for ways to deny that we have any war-related problem.

We simply have to understand that no competent psychologist can make snap decisions or diagnoses if the intention is to provide proper help. Misdiagnosis of mental/emotional disorders can be just as dangerous and detrimental as misdiagnosis of physical ailments. It isn’t merely a question of whether the wrong medication will help or do no good at all; the wrong medication in some cases can do severe harm. Medication aside, the course of treatment for various mental disorders is to be considered. The incorrect approach here may also do damage, not just be ineffectual.

Complicating the situation for the doctor and the patient is the fact that a veteran may not be suffering from only a single condition. PTSD does not necessarily push aside other possible problems by its presence. one patient may suffer PTSD and have a tendency to drink too heavily because of it — without being an alcoholic. Yet, another veteran may suffer from both conditions. Still a third may be purely alcoholic and characteristically blaming his troubles on a condition he does not actually possess, in this instance PTSD.

The course of treatment for PTSD is not identical to that preferable for alcoholism. In fact, treatment of the veteran’s PTSD may have little or no effect on his alcoholic tendencies — but if the veteran should join Alcoholics Anonymous and truly embrace its Twelve Steps program for recovery, the new way of life and advantages available to one dedicatedly working this program may actually alleviate the PTSD symptoms considerably.

But let’s consider medication within the same scenario-: A PTSD sufferer may indeed benefit from the use of prescribed antidepressants or, for the anxiety-ridden, tranquilizers. Suppose that the PTSD sufferer is also alcoholic. Alcoholism is a disease involving an addictive personality. Therefore, it may be dangerously inappropriate to treat one drug addition as if it were some sort of “Valium deficiency” — prescription of tranquilizers may only serve to feed the inherent need for drugs.

During the evaluation stage, the patient will also be classified according to veteran status: non-veteran, V.E.V (Vietnam Era Veteran — one who served during the conflict period, but not in Vietnam), or V.V. (Vietnam Veteran). The likelihood of the patient’s suffering from PTSD is obviously greater if he did serve in the war zone. It is still greater if he did actually see combat.

As Dr. Goodwin states: “One proven indicator of the intensity of the disruptive symptoms is the extent to which the veteran was exposed to actual combat.” Thus VV’s,are further classified as “noncombat” and “combat” veterans… and as we’ll see, combat veterans are still further assessed as low- and high-combat veterans.

Combat — and the degree to which it was experienced — is a major factor in the diagnosis of PTSD. Dr. Woodwin says, “In developing a diagnosis of PTSD, chronic and/or delayed, it is particularly important to be empathetic to the horrors of the combat situation. Many veterans have struggled endlessly to suppress these feelings, in part because of the refusal of society to even acknowledge their existence.”

Many of us who saw heavy and prolonged combat never had the opportunity to rid ourselves of the concomitant and associated emotions as did veterans of the other wars. It is generally acknowledged now that the Vietnam Veterans endured the same and similar hardships that other veterans did. Why we fell prey to resultant disturbances to a greater degree is at least in part due to major differences in the homecoming experiences.

The Vietnam Veteran came home to a vastly different climate. He went from battlefield to Main Street in less than 48 hours and did not receive the distinct and recognized advantage of long weeks aboard troopships with the chance to share experiences with others who had endured the same things. Further to his detriment, he found himself rejected and severely criticized — even blamed for what people saw as wrong with his war. Veterans benefits were often much less and more difficult to obtain. Society was in turmoil and many veterans found themselves the object of ridicule by fellow citizens in their own age group. And so on.

Dr. Goodwin maintains this: “When the (Vietnam) veteran finally returned home, his fantasy about his DEROS date was replaced by a rather harsh reality. As previously stated, WW II veterans took weeks, sometimes months, to return home with their buddies. Vietnam vets returned home alone. Many made the transition in less than 36 hours. Most made it in under a week. The civilian population of the WW II Era had been treated to movies about the struggles of readjustment for veterans (i.e., THE MAN IN THE GREY FLANNEL SUIT, … PPIDE OF THE MARINES, etc.) to prepare them to help the veteran. The civilian population of the Vietnam Era was treated to the horrors of the war on the six o’clock news. They were tired and numb to the whole experience … some were even fighting mad … WW II veterans came home to victory parades. Vietnam Veterans witnessed protests. For WW II veterans resort hotels were taken over and made into redistribution centers to which the veterans could bring their wives and devote two weeks to the initial homecoming. For Vietnam Veterans there were screaming antiwar crowds and locked military bases where they processed back into civilian life in two or three days.

In STRESSES OF WAR: THE EXAMPLE OF VIETNAM by Arthur Blank, MD (1981, THE FREE PRESS, MacMillian Pub. Co.), there is this assessment of wars and how Vietnam compared:

I. Stresses Typical for All Wars:

A. Miserable living conditions B. Fatigue C. Sensory assault D. The fighting itself E. Wounds F. Special stresses of the combat situation:

1. Capture and torture 2. Isolation 3. Acute survivorship (only narrowly escaping death when others were killed) 4. Authoritarian organization 5. Command incompetence 6. The observers (fighting while others merely watched)

II. Unusual Stresses Peculiar to the Vietnam War:

A. Guerilla warfare B. Lack of clear objectives C. Limitations on offensive actions D. Terrorism (“All of Vietnam was a combat zone; what varied was only degree.” E. Climate and topography F. Miscellaneous bizarre physical dangers G. Tropical diseases H. Immersion in an extraordinarily poor Third World society I. Chaos and confusion

III. Psychological Stresses Secondary to the General Political Character of the War:

A. Experience of absurd waste B. Government deceit and misjudgment C. Massive national conflict D. Defeat

From the above it is evident that stresses were much greater for those who actually participated in the fighting. Those who treat PTSD cases are well aware of this, but many veterans assume a need to explain more than they need to. That may have been necessary or a good idea several years ago but much has been gained by the professional since — via the enlightenment provided by the many veterans who have been so far treated.

In the beginning of evaluation and treatment, this might be important for the veteran of heavy combat, since he is the least likely to want to recall bad experiences. It does take time for proper rapport with the psychologist to develop. As Joel Osler Brende, MD states in COMBINED GROUP THERAPY FOR VIETNAM VETERANS, “Even though every combat soldier has been traumatized and harbors the residual effects of that trauma within him, he will be unable to disclose his pain until the right circumstances allow,’and then only gradually.”

Therefore, a determination of the degree of combat a patient has seen not only makes the psychologist aware of the degree of probability that this patient may suffer PTSD but helps him design his approach to dealing with that veteran. Some doctors may choose to employ what is known as The 13-Point Combat Scale.

The scale is a set of ten questions designed to determine how extensive the veteran’s combat experience were. The test/scale was prepared by Drs. Mark Gallop, Robert Laufer, and Thomas Yeager. Although the test is called The 13-Point Combat Scale, a total score of 14 is actually possible. It is, however, highly unlikely that a given veteran would score 14, unless he happened to have been in combat with both the artillery and another combat arm, primarily the infantry. (When the scale was being tested, no veteran scored more than 13 points.)

The test, shown below, simply requires a YES or NO answer to each question. Each question has been assigned a certain numerical weight.

THE 13-POINT COMBAT SCALE

COMBAT EXPERIENCE WEIGHT

1. Served in an artillery unit which fired on the enemy 1 2. Flew over Vietnam in an aircraft 1 3. Was stationed at a forward observation post 1 4. Received incoming fire 1 5. Encountered mines and boobytraps 1 6. Received sniper or sapper fire 1 7. Unit patrol was ambushed 2 8. Engaged VC in a firefight and/or engaged NVA in a firefight 2 9. Saw Americans killed and/or saw Vietnamese killed 2 10. Was wounded 2

MAXIMUM SCORE 14

An answer of NO to all questions results in a “noncombat” classification of the veteran. A score of 1 through 6 is rated as “low combat” while one of 7 through 14 is regarded as “high combat”. A linear, graphic scale may be drawn to visualize where one places according to his combat-experience rating:

—high combat—–

7 8 9 10 11 12 13

0– /– /– /– /– /– /– /– /– /– /– /– /– /– 14

1 2 3 4 5 6

—low combat ——

(The 13-Point Combat Scale is taken from LEGACIES OF VIETNAM: COMPARATIVE ADJUSTMENT OF VETERANS AND THEIR PEERS. This study was done for the Veterans Administration by the Center for Policy Research, Inc. of New York and is copyrighted 1981. The text consists of five volumes with two appendices.)

A high score on the scale does not always indicate that a given veteran will suffer PTSD, nor does a low score rule out that possibility. In general, the more combat, the greater the probability of PTSD and the higher one places may predict a greater severity of the disorders.

There are, in fact, some indications that veterans scoring in the “low combat” grouping may be better adjusted than not only high-combat veterans but also noncombat veterans. In LEGACIES a study of arrests shows that, of men of the same age group, 24% of high-combat veterans and 17% of Vietnam Era Veterans were arrested after service, while only 10% of those in the low-combat group were arrested. As a matter of fact, 14% of nonveteran men of the same age had been arrested — still more than the low-combat veterans.

Some studies reflect another phenomenon: some veterans who served in Vietnam, but saw no combat, apparently returned with more guilt feelings than they who had seen combat because they felt they “didn’t do their part”.

Possibly more surprising is the report that some former war protesters today experience guilt-feelings over not having served. Some admit to admiration for those who served in Vietnam. An example is given by Myra MacPherson in her excellent book, LONG TIME PASSING: VIETNAM AND THE HAUNTED GENERATION (Doubleday, 1984).

She reports that one protestor evaded induction by the inhalation of canvas dust “to revive a childhood case of bronchial asthma.” Years later he is haunted by ambivalence: ” … as I survey my friends and acquaintances who have served, I notice something disturbing that makes me want to rethink the issue. To put it bluntly, they have something we haven’t got. It is, to be sure, something vague, but nonetheless real, and can be embraced under several headings: realism, discipline, masculinity (kind of a dirty word these days), resilience, tenacity, resourcefulness … I’m not at all sure they didn’t turn out to be better men — in the best sense of the word.”

Post-Traumatic Stress Disorders, like most other illness, are not only to be found in veterans of this or that station in life. PTSD is no respecter of education, intelligence, race, creed, socioeconomic level or whatever. Tom Williams, Psy. D. by his experience can represent those veterans who went to war with better-than-average intellect and the attainment of or potential for advanced education, for example. From his case history: he ‘ attended the US Naval Academy and served as a Marine Officer for eleven years, which includes two tours of duty in Vietnam. He has been married and divorced and has remarried. He obtained his master degree, worked in mental health for five years and then obtained his doctorate.

One experience with PTSD symptoms that Dr. Williams had was reported in POST-TRAUMATIC STRESS DISORDERS OF THE VIETNAM VETERAN:

” … (in the winter) of 1979, I was overcome by a wave of poor judgment and saw the movie, THE DEER HUNTER. It was hard to watch the movie, but I white-knuckled it through. The sound of helicopters and the realistic battle scenes were disturbing, but not as disturbing as the metaphor of Russian roulette used to symbolize the constant stresses of combat in Vietnam. I was reminded of the guerilla nature of the war, especially of the continued and heavy use of booby traps by the enemy. The movie brought up more memories and overwhelming emotions than I could handle. At the end of the movie, I was unable to talk. As I walked out, I hoped that someone would jostle me or some kid usher would tell me to go out a different exit than I intended so I could express my rage at him.

“When my wife and I arrived at the car, I got in the passenger side, knowing full well I couldn’t drive, and cried deeply and uncontrollably. All I could say was ‘those poor fucking kids’ over and over again between my sobs. My wife made an excellent therapeutic inter-vention by taking me to a loud bar and buying me a taco and a beer. We talked. It helped, but I remained confused about being so completely overwhelmed by such a multitude of emotions.”

The date of the quotation tells us that Dr. Williams’ reaction to war stresses is delayed. His reaction was, typically, brought on by war related stimuli: the sound of helicopters, realism in battle scenes (and sounds), and even the symbolism of the guerrilla warfare. He experienced rage. His emotions became unmanageable. There is probably survivor guilt evidenced by his feelings about the children. He also experienced the common temporary loss of the ability to function (couldn’t drive).

Dr. Williams could not be classified as an average person, yet he does share the common experience of PTSD symptoms as described. But the doctor who evaluates the prospective sufferer of PTSD will also concern himself with differences as well as similarities his patient exhibits with relation to other veterans.

Again, a big difference among us is whether or not a veteran has seen combat and this difference has certain implications. From page 43 of LEGACIES: “Our findings demonstrate that Viet Vets exposed to combat generally feel the war had a negative psychological effect. Of the majority who feel the war had a positive effect on their lives (a mating effect, for example), many still emphasize traumatic wartime experiences. Most important, we find that combat vets continue to have significantly more psychological and behavioral difficulties than Vietnam Era Vets, Vietnam Vets not exposed to combat, or nonveterans.”

The same source also states that “only one-quarter of Vietnam Vets believe the war had little,or no effect on them. Vietnam Veterans not involved in combat are much more likely to make this assessment.”

How one recalls military life is also dependent, in general, on the category to which the veteran belongs. From page 30, vol. 1 of LEGACIES: I’VEVs recall service primarily in terms of pleasant experience (78.8%), while 70% of Vietnam Veterans recall the negative primarily, especially combat, and the greater the involvement in combat, the more likely memories of battle would be cited.”

No veteran is a perfect “classic” PTSD case. Whether one will suffer PTSD experiences and to what degree is dependent on many factors –basic personality and life experiences must be taken into account as well as combat service and its intensity. Because of factors other than combat, then, it is possible for the veteran of extreme combat to survive the war and the aftermath with even fewer adjustment difficulties than will some veterans who saw much less action. The reverse is also true. Family histories do enter the picture.

LEGACIES reports (p. 47, vol. 1): “Men from the most stable families are likely to develop stress reactions in response to heavy combat. Men from average families are more likely to develop stress reactions after exposure to even low amounts of combat. Men from the least stable families may develop stress reactions simply in response to daily life stressors, exposure to combat does not greatly affect their level of stress reaction.”

Further (p. 48, vol. 4 of LEGACIES): “We have found consistently that men who were sent to Vietnam, but were not involved in combat at all, score lower on the Stress Scales than any other men in our sample. This holds true regardless of race, most levels of family stability, and parental class. We reason that such men found clerical and bureau-cratic positions well removed from the possibility of being subjected to hostile fire. In their terms — though perhaps not in the terms of the military — they were a ‘success’. Further, when they compared their distress to that of other men they knew in Vietnam, they had to judge themselves as being much better off. Similar findings with respect to ‘relative deprivation’ were reported in the classic study of World War II troops in THE AMERICAN SOLDIER (Stouffer et al, 1949).”

There is this with regard to race: Myra MacPherson reports, “By the mid-sixties the racial and class inequities of the Vietnam war were scandalous. Gen. S. L. A. Marshall… commented, ‘In the average rifle company the strength was 50% composed of Negroes, Southwestern Mexicans, Puerto Ricans, Guamanians, Nisei and so on. But a real. cross-section of American youth? Almost never.”‘

MacPherson goes on to say, “In 1965 blacks accounted for 24% of.all Army combat deaths. As black leaders publicized the plight of blacks in Vietnam, the Department of Defense reduced the minorities’ share of the fighting — to 16% in 1966 and 13% in 1968.11

Some psychologists have established that blacks who experienced a degree of combat equal to that of whites tend to suffer fewer PTSD-type problems or possess them to a lesser degree. The explanation offered is that blacks who came from more deprived areas and lives were most accustomed to handling trauma. Yet this seems incompatible with the findings which deal with family stability.

Another finding that seems to run contrary to the common sense expectation is the prevalence and severity of PTSD in the severely wounded and disabled of the Vietnam War. These men tend, as a group, to suffer less from PTSD.

This is the finding offered by Dr. Goodwin: “It is important to note an interesting trend… it has only been on rare occasions that we have interviewed significantly disabled veterans, suffering the loss of a limb or another wound that required months or even years of hospitalization. … We have concluded that significant numbers of severely disabled veterans received much more comprehensive care after their combat experiences. In particular, this included close emotional support from other veterans on the hospital wards regarding their own combat emotional experiences. This, in turn, helped the seriously disabled veterans find some final solution to their feelings about Vietnam. It also included a more empathetic understanding of the physically wounded veteran by the VA, which had learned about wounds and their concomitant psychological problems in WW II. Subsequent support and training to help these veterans to readjust,to their losses was also provided. The veteran who was not seriously physically wounded had no such resources, hence the apparently smaller incidence of post-traumatic stress, chronic and/or delayed, in severely disabled veterans of Vietnam.”

This last finding does seem to encapsulate the conditions that made PTSD so rampant among our returning combat veterans of Vietnam. Very simply put, the lack of caring coupled with the inability of the veterans to rid themselves of their emotions at an early date provided very fertile soil for the growth of severe problems.

With this understanding comes a solution. Proper treatment in light of the causes. Such assistance is available in several forms. But it is up to each veteran to recognize his situation and acutely seek help, whatever program he may eventually choose.

(VVNW, Inc.)

For Some War Veterans The War  Never Ends – PTSD

Post Traumatic Stress Disorder is a mental disorder. I was first diagnosed with PTSD in 1994, but it wasn’t until a psychotic episode in 1999 that I finally had to admit…admit that I had a mental disorder.

The traumas that cause PTSD are as unique as the individuals suffering from the disorder. A friend of mine just recently survived a terrible auto accident. She currently complains about living in a fog, that nothing makes much sense to her right now, and that she has trouble concentrating. These are all symptoms of Post Traumatic Stress Disorder.

Any fearful trauma can produce symptoms of PTSD. I remember being in a tornado a few years back, and for the longest time, any wind, and I mean any wind, would send tremors through my body.

PTSD can be either acute or chronic; the acute phase occurring directly after the trauma, while the chronic phase can come along much later. In the acute phase, PTSD is said to be treatable and curable. In its chronic phase, it is only treatable. One must learn to live with it and to cope with it.

This paper is designed to demystify this newly named disease (it’s been around for centuries, but named and recognized by the American Psychiatric Association in 1978 as an official mental disorder, allowing patients to receive the treatment they needed), to list some of its symptoms, and to help you to help someone else, should you suspect they have a problem. This last part, helping someone, is not meant to be construed that you can help cure them, but rather you can direct them to caregivers who can help them. A person with a mental disorder is usually the last to know. Greater than one third of Vietnam Veterans suffering from PTSD were diagnosed after being released from jail.

Some of you will see yourself within these paragraphs. Enjoy the liberation.

This paper is also very personal. Some of what I’ve learned about this disorder pertains to all PTSD sufferers, but most of what I’ve learned pertains to the trauma of war. I am a Vietnam Veteran. I flew Cobra Gunships in Vietnam. After a recent episode in which I had been turned into a babbling, stuttering idiot and locked up at the local Veterans Hospital, I spoke with my sister-in-law. She told me that I was the only returning Nam Vet she knew who laughed at it all; who made jokes of it. When I look back, it seems that that was how I dealt with it, how I’d stuffed it.

My family doesn’t know this, but on my first Thanksgiving in civilian life I attempted suicide. I had attended a party with some friends from high school. It hit me that evening that they were all still in high school while I was a few generations older. On my way home, I had my first anniversary reaction (I will explain these later); while listening to the heavy marketing for Christmas on the radio, I couldn’t shake the thought of all those kids who were going to get “daddy in a box” for Christmas this year, and all those kids who got “daddy in a box” on previous Christmases, and I unlatched my seatbelt, sped up to 60 miles an hour on a city street and aimed for a tree. The curb bounced me back onto the road, I spun around a g’zillion times in the thick new snow, jumped the curb, and hit a tree nearly one block away from my original target. I totaled my car and bumped my head. After that, figuring that I had survived that for some unknown reason, I went on with my life and “stuffed” it. Some twenty years later though, it slapped me upside the head, and now it’s here to stay. However, and this is a very important point, I have PTSD; PTSD does not have me.

So before we take a look at the symptoms, the results of this disorder, you might first like to view a few facts about war related PTSD that I’ve gleaned from the past five years (of therapy).

What is learned in combat is never, ever forgotten.

PTSD was once called Shell Shock, something soldiers got from battle, or from “being shelled.” It wasn’t until the eighties, when the name changed to Post Traumatic Stress Disorder, that others who had not been in battle, but had been the victims of car accidents, domestic abuse, rape, incest, or other traumas that these people finally got the help they needed and the disorder was clearly defined and studied. What is learned in trauma is never forgotten.

Per capita, more Vietnam Veterans suffer from chronic PTSD than from any other war. There are lots of theories as to why this is, including the simple fact that we fought an unpopular war and were never given the welcome home other soldiers received, at least not until recently. It was the first war America had lost, and many Vietnam era veterans received initial scorn from veterans of previous wars. However, there were fewer cases of acute PTSD in Vietnam, attributed to the fact that every soldier knew the day he was coming home, thus the countdown (“Short” meant the soldier had a short time left in country) to the day he’d return, and the subsequent “stuffing” of their trauma while counting down. Following a battle in WWII, 17% were afflicted with acute PTSD, while in Vietnam only one percent were afflicted, debilitated.

In WW2, soldiers fought a battle, on the average, twice a year. In Korea, our soldiers fought a battle, on the average, between two and three times a year. In Vietnam, our soldiers fought a battle every three weeks.

People with PTSD are famous for self-medicating (drugs, alcohol), however, ex-soldiers have an additional addiction that often lands them in trouble, or jail: an addiction to adrenaline. We love danger, even when trying to avoid it. Deep down inside, we love adrenaline. I remember an ex kissing me goodbye (the old last kiss) and sending me out into weather I wouldn’t send an enemy into: deep snow, I lived in the country, no chance of finding a plowed thruway. The average person would have gone to a motel, but not I; to me the entire ride home was the most exhilarating ride I’d taken in years (I had no cell phone, there was no other traffic on the roads, I didn’t even have a thick jacket, the storm had hit unexpectedly). I was so high from the adrenaline (knowing that every turn could be my last) that it took me 6 hours to come down after the ride home.

It has recently been learned that prolonged stress actually changes a person’s brain chemistry. PTSD is a physical disease. There is no escaping it. Even if most of the symptoms are suppressed, a person with PTSD will make all his/her decisions through the veil of this disorder, simply because one’s brain chemistry determines one’s thought patterns.

The Time Bomb

Inside every person with PTSD is a time bomb. It is merely a matter of time before symptoms begin to show up. One might exhibit all manner of symptoms in nearly everything s/he does, and still live what appears to be a normal life. However, it doesn’t take much to bring out full-blown symptoms of a full-blown case of PTSD.

Retirement: the kiss of death. Many World War II soldiers lived nearly normal lives, up until they retired. Within weeks of retiring, many WWII vets suddenly started showing up at the VA hospitals exhibiting symptoms of PTSD. Keeping busy (like writing this paper) keeps the symptoms down. Free time (and worry) exacerbates PTSD symptoms.

Additional Stress: Stress kills; we know this. Additional stress in the life of a PTSD sufferer will bring out their PTSD symptoms. Even good stress can increase one’s symptoms; good stress such as a birth, or a new love, or a promotion at work. Anything that wobbles the apple cart—little changes, big changes, good changes, bad changes—will promote PTSD symptoms. Then there are the huge stressors; the larger the stressor, the more virulent the PTSD symptoms.

Reminders: anything that reminds the PTSD sufferer of the original trauma will pique symptoms. This includes odors, sounds, and sites. Additionally, the anniversary of a trauma will cause a rise in PTSD symptoms. Many soldiers dread holidays, for during their service, some of the days they remember most vividly were the holidays (sometimes, it was only on a holiday when a soldier knew what day it was). If a woman was assaulted near an elevator, elevators will trigger her symptoms. If she remembers the date of her assault, as the anniversary approaches, symptoms increase.

Now, let’s take a look at the actual symptoms and results of PTSD.

Anger

I know of no more disagreeable situation than to be left feeling generally angry without anybody in particular to be angry at.
Frank Moore Colby

Persons with PTSD hold in a lot of anger. It is a free-floating anger with no real target and very subtle causes. It simmers below the surface and can jump out at inappropriate times, aimed at the wrong person for the wrong reasons (displaced anger).

Following a rape, the rape victim is filled with rage. The specific targets of this rage are quite obvious: the rapist, the system that puts the victim on trial, the doctors for their insensitivity, and the list can go on depending on the ordeal the rape victim endures. However, years later, this anger can still exist, simmering just below the surface. And though many argue that the cues to the anger have changed, that the original incident has softened in the mind of the sufferer, that this, that that—it’s all “neither here nor there” because there is no logic, no reasoning in a mental disorder: with chronic PTSD, everyone and everything is the cause, and the nearest person or object can be the target.

Flashbacks/Hallucinations

A hallucination is a fact, not an error; what is erroneous is a judgment based upon it.
Bertrand Russell

Common to all PTSD sufferers are flashbacks. The longer the trauma lasted or the more powerful the trauma, the more intense the flashbacks. Hollywood flashbacks and real-life flashbacks are very different from each other. Whatever you see coming from Hollywood, is just that, a creation of Hollywood. In real life, it’s hard for someone suffering PTSD to explain their flashbacks, and since they do not conform to what is viewed in the movies, they are not easily identified as flashbacks. Personally, I oftentimes have auditory flashbacks: I hear the jet engine whistle. When I see helicopters, I smell the JP4, the fuel.

Hallucinations and flashbacks are related, though one can have hallucinations that go beyond flashbacks. When Christmas comes around, my anniversary, I begin to see muzzle flashes off to the right in the periphery. Additionally, I’ve heard screaming “Receiving fire! Receiving fire!”

After a while, one gets used to these flashbacks and hallucinations. Doctors put us on anti-psychotic drugs to eliminate them, however, the side effects of the drugs are horrible, and the actual hallucinations, after a time, really amount to nothing; in fact, we get used to them. At a class on Grief and Loss, I was once told that I might have to deal with loss one day when the hallucinations went away. It seems ludicrous, but we get used to them, and miss them when they are gone.

Fear

There is no terror in a bang, only in the anticipation of it.
Alfred Hitchcock

For a long period of time after I had lived through a tornado that ran its course directly over my head, the slightest wind sent shivers through my blood stream. A rape victim suddenly has half the population to fear as every man becomes a potential rapist.

However, years after the trauma, the fear still exists, and like the anger, it has no specific cause. Fear of fear of fear of….

Having studied the martial arts and feeling sufficiently skilled to defend myself in any situation, I have conquered a specific fear. I fear no man. Once a fear is conquered, it never returns. However, a PTSD sufferer lives in constant fear and oftentimes this fear is diagnosed as paranoia; it is a general fear that never goes away and sits insidiously beneath the surface.

It can be argued that fear is the basis of one’s anger; that it is the basis of all other symptoms. Perhaps, but most important is knowing that every decision, every action of a person suffering from PTSD has some fear in its motivation, in its execution.

Dread

It is a time when one’s spirit is subdued and sad, one knows not why; when the past seems a storm-swept desolation, life a vanity and a burden, and the future but a way to death.
Mark Twain

Once during a group session, one fellow said, “I have the feeling that I’m going to die in six months.” Eyes throughout the room widened; you could even hear the hard swallows. I spoke up: “My God, I’ve felt that way for years!”

Because soldiers know death intimately, we are consumed with death. A friend or a lover calls and says s/he’ll be over in fifteen minutes; when s/he is five minutes late, the PTSD sufferer is convinced s/he is dead on the highway.

There is a French phrase: Partir c’est mourir un peu. To part is to die a little. Whenever I went away, I assumed I would never see my loved ones again. This wasn’t a conscious, active thought, just something packed away nicely down under the surface. I’m going to die, they’re going to die, we’re all going to die; we will never see each other again.

Every little pain is cancer. Heartburn is a heart attack. A skin rash is skin cancer. A sore throat is actually throat cancer, a burgeoning tumor about to cut off my air supply and viscously choke me to death. I will not make it six months. I’m going to die.

Having thoughts like these can cause some very dangerous behaviors. I am reminded of a sixties TV program called “Run For Your Life” starring Ben Gazara. He’s told by his doctor he has two years to live and so he vows to live every remaining moment of life to its fullest, risking everything; afraid of nothing: he races cars, climbs mountains, etc. Well, imagine, just imagine all the Vietnam Veterans out there with adrenaline addictions who believe they have six months left to live: check out your jails and prisons; that’s where they’ve landed. This is a very deadly combination, producing some very dangerous behaviors.

Hyper-Vigilance

My apprehensions come in crowds;
I dread the rustling of the grass;
The very shadows of the clouds
Have power to shake me as they pass:
I question things and do not find
One that will answer to my mind;
And all the world appears unkind.
William Wordsworth

It is very hard to get some of my friends to go out in public with me. Veterans suffering from PTSD feel unsafe in crowds, especially Vietnam Veterans, since the enemy was all around. During the day they cut your hair; at night they cut your throat. At any moment, at any place, someone could walk up to you and drop a hot grenade in your lap. Those soldiers who’ve had to secure an area and watch for “Charlie” will never, ever stop watching for Charlie.

My situation is different from those who were in the infantry. I too am hyper-vigilant and somewhat paranoid (always checking out the window for intruders), but I’m not as security conscious. In my job as a gunship pilot, if I found something I didn’t like, I killed it. Infantry people sometimes never saw the enemy; never saw the muzzle flashes of the bullets whizzing over their heads. Their fears were ubiquitous and overwhelming at times, as all they saw where the bodies of their buddies being ripped apart.

If you walk up behind an ex-infantry person and tap him on the shoulder, you’ll see him leave the ground. Most of my friends sit near a wall or right up against it. They sit near exits. They are constantly on guard; their “startle reflex” is heightened. Danger lurks everywhere.

Anxiety

In a world we find terrifying, we ratify that which doesn’t threaten us.
David Mamet

Add up the fear, dread, and uncertainty, mix in a few flashbacks and hallucinations, and you have yourself the groundwork for some full-blown anxiety attacks. However, on the positive side, one’s anxiety level can be a determination of what else is happening inside of the person suffering from PTSD.

We learn in Symptom Management classes our own individual symptoms, which ones to watch, and what to do if they increase. One chief symptom (common to everyone) is our overall anxiety level, for this can be a barometer of our PTSD in general. When anxiety attacks are frequent, all our PTSD symptoms are on the rise. Thus, being aware of one’s anxiety level is one good way to keep one’s PTSD in check, or know when to check into a hospital for help.

Intimacy Issues

It is impossible to go through life without trust: that is to be imprisoned in the worst cell of all, oneself.
Graham Greene

Again I must repeat: What is learned in combat, is never, never forgotten. Who can a soldier ever trust as much as he trusted his buddy with him in that foxhole? Or that pilot, who knows that the enemy is dangerously close, yet his deadly fire is accurate, on target, and no friendlies need worry?

And who can I ever trust as much as I trusted my wingman, or my co-pilot?

In real life, if someone says they’ll be over in fifteen minutes, who cares if they’re a half-hour late? In combat, seconds count. No pilot is fifteen minutes late on target. No artillery is fifteen minutes late on target. And if a buddy doesn’t show up in fifteen minutes, you go after him.

Lacking trust places barriers between us and our partners, and there is still another barrier: we learned that we lose those we get close to.

There are two immutable rules to war:

People die.
You can’t change rule # 1.
So when we get home, we have trouble getting close again, because eventually the people we get close to will die.

Your wife will die; your kids will die; everyone eventually dies. Normal people accept this intellectually, but can never feel it as personally or as immediately as a combat veteran does.

It is very difficult for combat veterans to be intimate again, very much like a victim of rape. Fearing intimacy and needing intimacy can lead to superficial relationships, one night stands, multiple partners, and extra-marital affairs.

It’s all very complicated, very ingrained, and very hurtful to someone who does not understand, someone who wants to throttle the PTSD patient and scream at them: “Hey! Get over it!”

We all wish it were that easy, believe me.

Drug and Alcohol Abuse

Addictions do come in handy sometimes: at least you have to get out of bed for them.
Martin Amis

It seems much easier to deal with a problem when you’re stoned out your mind. At least it seems so. In reality, one’s PTSD symptoms are aggravated using drugs and alcohol. Your best psychologists cannot deal with or work with someone who’s been drunk or stoned for a month; the patient is unresponsive and unmotivated. Chemical Dependency classes are in order before any sort of talk therapy will do any good.

One unique facet to the war in Vietnam was the number of addicts and alcoholics who returned to the states only to have to deal with this problem. Most soldiers pick up an adrenaline addiction that can cause some very dangerous behaviors, however, a drug or alcohol problem is another slow and painful death, whose process exacerbates and stimulates all other PTSD symptoms. Alcohol, drugs, and adrenaline are the deadliest of combinations. Graveyards, jails, and prisons are full of Vietnam Veterans who’ve suffered these addictions.

Avoidance/Immersion

Of all the…alternatives, running away is best.
Chinese Proverb.

Diagnosing PTSD means determining the patient’s attitude toward the original trauma. A soldier with PTSD will do one of the following: he will either avoid everything that has anything to do with the military, the war, etc, or else he will immerse himself in those very same things.

I have an acquaintance who comes home every night and plays the video Platoon. Myself, after one visit to a VFW club and a less than warm reception, I never went to anything remotely associated with the military or the war until my diagnosis 5 years ago. However, it was certainly always on my mind, for someone once pointed out to me, not long before I was diagnosed, that I had issues with Vietnam because within five minutes of meeting me, people knew I was a Vietnam Veteran.

Of both behaviors, immersion is the least healthy. It can aggravate symptoms, cause flashbacks, and send one right back to the war (in their heads). Those who avoid those things reminding them of their experience are much healthier, even though this is a symptom of their PTSD; it is a healthy symptom.

Sleep Disorders

Sleep is a reward for some, a punishment for others.
Isidore Ducasse

Psychologists working with wives and partners of combat veterans usually caution them about their method of waking the veteran. From across the room, is usually the best way. We don’t want to startle a sleeping combat veteran, especially since most veterans return to combat in their sleep.

Many combat veterans need to sleep in separate beds, sometimes in separate rooms. They fear they will hurt their loved ones during a terrible dream. Personally, I’ve been lucky here. Having been a pilot, I never slept in the bush, was always on a base with good security, and only once when I wasn’t, I was lucky enough to come down with a migraine headache and the corpsman administered a hypo that knocked me clear of reality (on a night we were expecting to be overrun). Personally, I sleep better with a partner in bed with me, or at least someone in the house making noise.

Infantry soldiers are acutely aware of security. Many combat veterans have trouble falling asleep or staying asleep when they do fall asleep. There are many sleep aids prescribed for these disorders, and since every drug affects every person differently, it is best not to self prescribe or use someone else’s medication.

Even when a PTSD sufferer gets to sleep, normal sleep is no guarantee; they suffer night terrors, nightmares, and night sweats. I have gone two weeks sleepless, only to grab a couple of hours when the housekeeper arrived and banged pots around in the kitchen. I guess I felt that someone was there to watch over me and I could at least grab a couple of hours.

Any possible night time disorder you can think of has occurred to a patient with PTSD. Though I was never an infantry soldier, escape and evasion was always in the back of my mind as a pilot, and twice in recent years have I awoke, naked, and crawling in the snow. I’ve been forced to lock my doors and take other measures to keep myself from freezing to death on a nighttime excursion.

Guilt

Guilt always hurries towards its complement, punishment; only there does its satisfaction lie.
Lawrence Durrell

During war, we do things we are not proud of. Some soldiers have done things they can never mention, even to their therapists, because they seem so horrible. Guilt is an interesting emotion, for it even shows up in rape and incest victims, as if they were somehow the cause of their abuse. This fits into the frame of the above quotation; for many victims of abuse feel as if the abuse was their punishment for doing something (some unnamed thing) wrong.

The question is this: Can a person kill someone and walk away guilt free? Sure, we can rationalize our actions: we were only doing our duties (doesn’t seem to work for war criminals); we were actually saving American lives; it was him or me; etc. etc. etc.

What if we enjoyed killing, much like the quarterback enjoys the game, that feeling of success when he puts that pigskin on the numbers? As soldiers, we were highly trained killing machines. We performed like well oiled machines, proud of our expertise, proud of our skills. The war demanded results and we each kept track of how many confirmed kills we could rack up. Can a person kill 50 enemy, come home, sit at a desk, and go on working as if nothing ever happened? (For an essay on this subject, read “It’s Only a Game.”)

In the movie “The Meaning of Life” by the Monty Python group, one soldier, lying across the barrel of a cannon, slightly wounded, but having just killed 15 Zulus states: “Back home they’d hang me, but here they gimme a fuckin’ medal!”

Another form of guilt, one which I denied for the past 5 years, that is until some 30 year old repressed memories came back is Survivor’s Guilt (Survivor Guilt). “Why did I, with no wife, no kids, make it out alive when my friends who had wives and kids didn’t?”

Or what about those who, out of 30 or 60 men, were the only ones standing after the battle? Why were they singled out to survive?

When something lousy happens to a combat veteran, a car accident, a job demotion, a failed marriage, it all fits into the big picture; the veteran feels he deserves such lousy luck, such lousy outcomes, because he feels guilty.

Memory Loss/Cognitive Dysfunction

The effectiveness of our memory banks is determined not by the total number of facts we take in, but the number we wish to reject.
Jon Wynne-Tyson

Memory loss, the inability to “think straight,” the feeling that one is lost in a fog: these are the most salient features of PTSD, the most common complaints. Right after the trauma, the fog rolls in and it is at this time that the patient must seek immediate help, because it can only get worse.

In group, one common thread, one common expression is: “Did it really happen, or did I dream it.” The war is far away now. What we all did there is far away. Did it really happen? Pieces, huge chunks are missing. There isn’t a one in my group who doesn’t complain of CRS (Can’t Remember Stuff) on a regular basis.

Additionally, should one of us lose it, go off and have a psychotic episode, memory loss is a given and subsequent cognitive losses can also occur.

This was brought home recently to your author, who, after having a particularly bad anniversary reaction, wound up in the VA hospital, a babbling, stuttering idiot. While there, I’d forgotten I’d had a fiancée, the woman who a month earlier, I had intended on marrying. I’d forgotten nearly everything associated with her. I’d forgotten my own phone number, and when prompted for my Military Signature, I had to ask, “What’s that?” I was told that it was my signature with a middle initial (yes, I remembered when told). I began writing my signature, and stopped. I looked up, shaking, “What’s my middle name?” I pulled out my wallet and looked at my driver’s license; the nurse asked, “Well, what’s your middle name?” to which I responded, “Apparently, it’s Bruce.”

A few days later, in the computer lab, I found an IQ test. I took it, answered all the questions to the best of my ability, summed her up, and whammo, a kick to the groin: my temperature was a half a point higher.

In a recent test, my IQ has risen somewhat. I expect to get most of it back, most of my cognitive ability back, but there will always be some loss, I am told.

Though memory loss and cognitive dysfunction are common to sufferers of PTSD, how it affects us, when it affects us, and to what degree it affects us varies from person to person. I brought up in group once that I’d sat down to pay my phone bill at 9:00 o’clock in the morning. At 5:00 o’clock in the afternoon I’d stuffed it in the mailbox. The entire day was spent trying to pay the bill because I had gotten off on a tangent. I had MCI (5 Cent Sundays) as my long distance carrier. I’d made one call to Virginia, under a minute, and the total bill was $5.96. I spent the day contacting long distance carriers, talking to friends about long distance carriers, and at one point, totally exhausted, I had to take a nap. After relating this story to the group, the psychologist who ran the group stated that this is a common theme in PTSD. We often spend more time on the periphery of a problem than on the problem itself. This is one reason many of us are unemployable.

Memory loss is sometimes a good thing, especially when the memories are painful. However, they don’t always last forever. Repressed memories can eventually come back, though they don’t hurt as much as we’d expect and oftentimes help us clarify our experience. It has been said that God never gives us more than we can handle. This is a good thing, I am sure.

Sometimes it is hard to understand why this memory or that memory is lost. Especially when the incident is not significantly harmful and sometimes it is absolutely benign. I recently met with a woman I’d dated during my first large anniversary reaction, the one preceding a trip to the VA and a subsequent diagnosis of PTSD. We had lunch together. I had to tell her that I did not remember her at all. She told me how we’d spent the New Years; watching a movie (that I to this day want to see), and playing the guitar. I just do not recall a single second of our time together and perhaps never will.

Because we tend to “stuff” our feelings about something, a common masculine trait (though women under stress will do the same), we also, eventually, forget what it is we stuffed and why we stuffed it. There are techniques used by psychologists to pull these memories back to consciousness, however, this isn’t always as productive as it would seem. Some things are just better left forgotten, or left to return in their own time. But as my ex-fiancée’s coffee mug states: Of all the things I’ve lost, I miss my mind the most.

Intrusive Thoughts

Once upon a midnight dreary, while I pondered, weak and weary,
Over many a quaint and curious volume of forgotten lore,
While I nodded, nearly napping, suddenly there came a tapping,
As of some one gently rapping, rapping at my chamber door.
“‘Tis some visitor,” I muttered, “tapping at my chamber door-
Only this, and nothing more.”
Edgar Allen Poe

This symptom of PTSD really belongs above under Cognitive Dysfunction, for intrusive thoughts are an underlying cause of cognitive dysfunction: How can a person maintain a line of thought when constantly being bombarded with unwanted, intrusive thoughts?

The frequency and intensity of intrusive thoughts can be a barometer of a PTSD sufferer’s overall mental health, and the patient (and those around him) should be aware of any changes as this might call for a trip to the doctor. The frequency of intrusive thoughts can increase during anniversary periods, after watching a movie that brings back memories, after a flashback, or after anything that revives unwanted memories in the patient’s mind.

Interestingly enough, the content of the intrusive thought need not be from the original trauma, though most of the time it is. Like the ex-smoker who takes up chewing gum and is suddenly a gum addict, a patient with PTSD can substitute, at a subconscious level, a whole slew of ideas, imaginings, or obsessions aimed at keeping away those original traumatic thoughts. This has caused the PTSD patient to oftentimes get an early diagnosis of   Obsessive/Compulsive Disorder or OCD; the substituted thoughts have completely taken over; masking the original thoughts and tricking even the patient into thinking they are no longer the problem, but that these new intrusive thoughts are. If these new obsessions are delusional, the patient is teetering.

Patients with solid families and healthy therapeutic techniques picked up from classes such as Symptom Management, when hit with these thoughts can usually pull themselves out (with a little help), by merely changing what they were doing when the thoughts came on. A wife can suggest a walk, or a trip to the Mall or, a night out together. The patient might suggest a trip to the park with the kids to play in the sun, or slide down some slopes in winter time. The secret here is to find something else to focus on, something else to do. Keeping busy is very healthy.

Depression

My depression is the most faithful mistress I have known—no wonder, then, that I return the love.
Søren Kierkegaard

Given all of the above, is it any wonder that most people suffering from PTSD also suffer from depression?

Luckily, depression is very treatable, and can be controlled with drug therapy, talk therapy, and a loving, safe environment.

Summary

Chronic Post Traumatic Stress Disorder is treatable but not curable (though this is debatable). One learns to cope with it, learns what stimulates and exacerbates the symptoms, and learns what to do when the symptoms get out of check, hopefully before they get out of check.

There are many ways of learning to cope with PTSD whether you suffer from it or your partner/spouse suffers from it. As a spouse or partner of a PTSD patient, learning love and patience is the first step to helping your partner: you didn’t cause it nor can you cure it, but you can support your partner and lead your partner on the right path to healing.

Partners should attend everything associated with PTSD they can. There are not as many classes available to the partners of patients as there are for the patients themselves, but if you look around you will find them.

For the patient, taking classes in Symptom Management, Anger Management, and attending rap groups is a way of keeping one’s symptoms at bay. Knowing when to reach out for help, is a second strategy; one to fall back on when the others don’t work.

Practicing Bio-Feedback, relaxation, Tai Chi, meditation have an enormous healing power for the PTSD sufferer. I’ve often told people that if it wasn’t for Tai Chi and meditation, I’d have off’d myself long long ago.

EMDR is showing some promise; studies are currently being conducted at the VA hospitals and as soon as the findings are released, we will post them here along with an article explaining/discussing EMDR.

Many new treatments are being studied as I write this. But the simplest and most straight forward means of dealing with PTSD is to be aware of one’s own mental condition, have a place to go, and have a friend to call when everything seems to go wrong.

References:
All quotations: The Columbia Dictionary of Quotations is licensed from Columbia University Press. Copyright © 1993, 1995, 1997, 1998 by Columbia University Press. All rights reserved.

Normal people get warm, then angry, then angrier, and progress to a state of rage if the stimulus to the anger is not abated. A PTSD sufferer can go from A to Z immediately, especially if s/he’s an ex-soldier. Soldiers are taught to react. They are not taught to think, deliberate, or discuss. They are taught to react, because during war, the distance between life and death is measured in milliseconds and centimeters. When anger strikes, it quickly turns to rage.

Anger Management classes are usually prescribed for PTSD patients, however, the patient might still never arrive at the cause of this anger, as the original cause has faded, leaving only the anger. Learning to deal with this anger is much more productive at this juncture than trying to discover its cause or causes. In a good Anger Management class, the PTSD sufferer can learn that one cannot control one’s initial feeling about something aggravating, however, s/he can control her/his reaction.

Being the target, displaced or not, of this anger is one of the major causes of “secondary PTSD,” the disorder suffered by those close to the PTSD sufferer. Oftentimes families walk on eggshells to avoid doing anything to upset the PTSD sufferer. Children, wives, and lovers tend to withdraw and avoid any and all possible confrontation. Ironically, simply talking about it; sitting down to have a family discussion and bringing their issues to light often relieves the tension PTSD has caused. Partners of PTSD patients must keep alert and note when the anger outbursts increase in intensity and the intervals between them shorten. This is a sure sign that there is something else occurring within the patient and a trip to the therapist is needed.