The Way I See It- Let's Make PTSD a Household Name.

PTSD or Post Traumatic Stress Disorder may not be a "household name" yet, but it soon will be. As our combat veterans return from Afghanistan and Iraq, we will be inundated, as a country, with cases of PTSD and TBI, traumatic brain injury. Are we equipped as a nation to meet the mental health needs of our veterans? It doesn't look good.

Our new president must priorititize the development of programs that address the concerns of this population which are unique to this era. As reported in The Therapist by Terry Nash MFT and Sharon Crane MFT, "Extended military action and the constant redeployment of troops, creating a schedule of limited visits home and continual return to the war zone, disrupts family life in a way not required in previous wartimes...perhaps the most traumatizing aspect for soldiers and their families was when their military contract was due to be complete and an honorable discharge was eminent. Stop-loss was often implemented by the Pentagon and soldiers were required to remain in the war zone."

I can tell you from personal experience that the symptoms of PTSD affect not only the soldier, but their entire family, their friends and often, their employers. Some of you may remember when the U.S. invaded Panama in the early 1990's. Most of you have probably forgotten that little skirmish, but select special forces troops like the Army Rangers were sent in. My brother, Jamie, was among them. He and others parachuted under the cover of darkness into the jungle.

After his return, my brother was never the same. He experiences bouts of uncontrollable anger which have contributed to the dissolution of most of his personal relationships, including ours. In addition, he suffered some profound changes to his personality, as though his moral compass went missing. After being lied to and stolen from by him on many occasions, I made the heartbreaking decision to eliminate contact with my brother. My father and the three mothers of his three children have made the same choice. My mother continues to believe in him and tries to help him whenever he is in trouble, which is often. This in and of itself has caused a tremendous strain on my relationship with her. As you can see, there isn't a member of his family that hasn't been impacted by his untreated PTSD, including his children. I truly wish that love alone were enough to heal his pain.

Of the concerns relating to veterans and their families, here's what Nash and Crane report: "One is the emotional impact of regaining family traction and a new homeostasis after the initial joy of reunion. Problems of displacement, unrealistic expectations, children feeling disengaged from their long-absent parent, PTSD symptoms from the stress of combat left untreated, and brain trauma or loss of limbs are some of the immediate distresses. Exacerbating these disturbances is the common trend of returning troops to deny mental and emotional difficulties when processed through re-entry prior to discharge for fear they will be detained. All they want at that point is to go home to be with loved ones...there is a frequent myth in the military that only weak soldiers have mental health issues after combat." It seems clear to me that in order to effectively evaluate the need for treatment, we need to start right here, the point of de-briefing. Let's bring in skilled counselors and therapists for this job, working alongside military personnel.

Let us not forget that trauma occurs not only from combat itself, but from sexual assault and sexual harassment while in the military. Current statistics show 23% of women report having been sexually assaulted while in the military, and 55% of women and 38% of men have experienced sexual harassment while in the military. The VA hospitals are overwhelmed and underfunded. Otherwise, I don't know of any effective government programs that are currently addressing this urgent concern. In the private sector there are wonderful organizations bringing their skills and talents to helping our combat veterans. One of them here in California is called The Soldiers Project of which I am a part. We are therapists, psychologists and social workers specially trained in treating PTSD who volunteer our time to seeing combat veterans in our offices. I am very new to this organization, and there have been many giving freely of their time for years now. But this is not enough.

We need a national commitment with money behind it to develop comprehensive treatment programs and education aimed at erasing the stigma of seeking therapy and treatment upon their return home. In our current state of economic crisis I fear these types of programs will be put on the back burner, but the way I see it is the cost of turning our backs on the needs of our military men and women, we are setting ourselves up for the same fallout that occurred after Vietnam, affecting millions of families and our society as a whole for generations to come. President-elect Obama, are you listening?

In a future blog, we will look at the ways in which life in combat and life at home are totally at odds with one another in order to give you a better understanding of the challenges these men and women face.

Comments

[waitforme]

It is very good that this is written. And I am glad some trauma-trained therapists are volunteering their time to help returning military with PTSD. In addition to the problems of getting money to these therapists, there must be problems getting soldiers to therapists. As a trauma-trained therapist I was disheartened to hear an Army man discussing this on the radio and he referred to PTSD as 'mental illness' repeatedly. Hearing this, who would identify themselves as 'one of those'?

PTSD is simply a brain imbalance which has resulted from 'A NORMAL RESPONSE TO AN ABNORMAL SITUATION', whether war experiences, natural disaster or sexual abuse or any other trauma. -- There was a study done some years ago, by the way, which showed that individuals have a more intense reaction to trauma when they have had medical procedures in their childhood or babyhood, including circumcision. This may be one reason why some people have stronger reactions to similar situations.

See EMDR by Francine Shapiro, a psychologist who developed a deeply effective therapy approach and she and others have trained thousands of therapists in it, from all psychotherapeutic disciplines. PTSD sufferers MUST see therapists specifically trained in trauma. See ISTSS, a professional organization for trauma therapists.

[itolduso]

In a grocery store on Florida's west coast, there is a beautiful sculpture on display. It is a figure of a man, dressed in tattered fatigues and worn combat boots, standing with his thumb outstreched. The sign on the sculpture's base gives the title "Homeless Warrior" and says... Extended and repeated combat tours have resulted in increasing numbers of suicides, substance abuse, anxiety, depression, and broken families among our veterans. This year, hundreds of veterans will seek food, shelter, and counseling from our local social service agencies. With your help, we can care for every one of them. Please give to the Community Coalition on Homelessness..... There are donation bins next to the sculpture and brochures that give contact information for local social service agencies. The public has repeatedly filled those bins ....they care, awareness is all that was needed. The sculpture was created by artist Ed Miracle, a veteran.

[OtayPanky]

Unfortunately most therapists don't have a clue about how to help clients deal EFFECTIVELY with PTSD, because they don't understand it themselves. They tend to apply treatment modalities that make the problem worse, rather than better - or they try to squelch symptoms with meds, which doesn't help much long term.

There are a few therapists who have specialized in this work, and done groundbreaking research that has created a lot of good outcomes. Google "Peter A Levine PTSD" and then follow through to amazon.com.

[DEFuning]

We are working on a similar project in NC--The Community Area Resource Team --in conjunction with the VA, Area Mental Health, the County gov, and other public /private entities to fill in the gaps in services. I am glad to read that there are efforts going on in other places. The bad news is that the Traumatic Brain Injury hospital in Texas is about to be shut down due to mismanagement http://www.statesman.com/opinion/content/editorial/stories/12/12/08/1208vanboven_edit.html

Efforts to dilute the impact of PTSD and "normalize" it, so that everyone could qualify on the less sensitive measures of the injury makes PTSD normative and therefore not a service connected injury. The many pharmacological approaches are interesting and horrifying. To take a whiff of DHEA to inoculate oneself against the development of any memory is too close to RoboSoldier for my ethics.
We are largely unprepared for the tsunami of TBI and PTSD. Even in professional training sessions with military trainers, the clinical picture of TBI is downplayed . They do not discuss the dementia, impulsive violence, sexual inappropriateness and acting out, decay of the ability to do activities of daily living (like feed oneself) . It was like a concussive brain injury is just a really bad headache with a little PTSD thrown in for spice.
We sat on our hands when they got sent to war and so we are all responsible for lending a hand to them when they return.

[colleenperry]

Thank you for your comments as you are much closer to the "front line" of treatment than I am. I value your experience and perspective. For instance, I had forgotten all about the DHEA you mentioned and had no idea the military was proposing that as treatment.

[waitforme]

I only know dhea as a hormone which is needed by some. You can take pills of dhea and they are bought over the counter. What in the world is 'a whiff' of dhea? And why would someone use it as any kind of 'treatment' for PTSD?

[Janet45]

Thank you for bringing much needed attention to this issue. As a psychiatric nurse who works on an inpatient unit I see the stigmatization of "psych" patients with depressing regularity. Even during the orientation that all employees must go through the HR presenters made jokes about the psych unit, and attendees dozed through the presentation on domestic violence services. Understanding that fear is often what causes the insensitivity helps me to have some compassion, but you are right to warn of the coming epidemic. This is supposed to be the Decade of the Brain in the field of psychiatry - let it be so. I wish you and your family strength on this unasked for journey of loss. May your brother get the help he needs to lay down the false armor he put on to distance himself from the horror he witnessed and was forced to participate in, and may you someday have the joy of experiencing his real return to you, at peace and whole once again.

[colleenperry]

Thank you for your compassion and well wishes for me and my family. That was wonderful to read! My heart is heavy whenever I hear other "professionals" stigmatize and label their own clients. It happens with, as you said, "depressing regularity". I'm thankful for you, and that wherever you are working, your patients have an advocate!

[waitforme]

But he will have to go to therapy, but find a trauma-trained therapist who can help. I recommend EMDR, Eye Movement Desensitization and Reprocessing, with someone who has been trained in Trainings I and II and who uses it regularly. I, myself, have been trained in EMDR and used it in my practice for the last ten years. Also, I was a client with EMDR therapists and had many past traumas resolved, leaving me calmer, with no more temptations toward depression, and tougher in my ability to withstand later stresses and traumas.

In EMDR therapy, unlike with 'ordinary' talking therapy, one brings in a list of any and all traumas one can remember experiencing. In former therapies, those which took years until a trauma was 'uncovered', the therapist often feared getting at memories too soon. But trauma therapists are tough, know how to contain possible break-throughs of too-much emotion; if necessary the person can check themselves short-term into a locked psychiatric unit of a hospital -- and the therapist can see them there -- if the therapist and client both think resolving certain traumas might uncover others which would overwhelm the person; this might be done when there is a history of violence, frightening hallucinations or temptations toward suicide. Otherwise, a great deal can be resolved, in far less time than years, maybe one or two sessions, maybe a few weeks or months.

[lilygc]

Wonderful stuff. Thank you.

[ilona]

I think I can count on one hand -- and still have at least 4 digits left -- how often President Bush uttered 'PTSD' (...about as often as Reagan uttered 'AIDS' ...). Obama, on the other hand, has dragged PTSD out of the closet.

In the Senate, he called for oversight when we learned that troops were being deployed, diagnosed w/PTSD and medicated for it, to the combat zone. Obama also called for an Army Mental Health Services investigation when it was reported troops at Fort Carson were being stigmatized and kept from seeking help for their PTSD and reintegration difficulties.

Obama also introduced the Lane Evans Act and the Dignity for Wounded Warriors Act, and supported other military-friendly legislation.

Judging by his comments on PTSD today while presenting Shinseki as his choice for VA Head, we -- and our military families -- are in better hands now than we've been in years. There's a lot of work to do, no doubt about it. But, for the first time in almost 4 years of following and reporting on this issue, I'm really hopeful. We have someone who cares about this issue at the very top. (It's also wonderful to know that the lady most intimate with the President, Mrs. Obama, has taken up the cause of helping our military families.)

Keeping your family in my thoughts. I can't imagine how difficult the decisions you've made have been. Thank you for your wonderful post, and looking forward to your continued coverage.

[colleenperry]

Thank you Ilona for your support and for all of the new information you have provided me. I will learn more about the new legislation you mentioned, and I too, feel hopeful for our combat veterans' future. Ready to fight the good fight!!

[waitforme]

This is very good news.
I can't imagine how chemicals could solve anybody's PTSD; rather, it could make them worse. Drugs do not solve an imbalance. They are not like a vitamin, needed because they lack it. Nobody lacks drugs and so has to have it to survive.

To follow your news about how insensitive military people can be -- the stigmatization of PTSD: I heard a couple of years ago about a sergeant who belittled and punished soldiers who complained of symptoms of PTSD. Finally, he realized he, himself, had PTSD and went to therapy; he was chagrined but relieved as he admitted it. His soldiers would no doubt be relieved also.