Part 1- "PTSD: Vets Battle Symptoms and Stereotypes"

When war-weary troops returned from Vietnam, they were not prepared for what waited for them at home.  Instead of applause and the ticker-tape parades that their fathers had received after World War II, they were spat on.  They were called “baby killers”.  Worst of all, they were forgotten.

Decades later, people have come to recognize the disservice to those veterans and have tried to make amends by supporting our troops.  I’m sure you’ve heard the saying, “You can protest the war, but support the troops.”  As a child, I remember a classmate’s father coming to speak to us about the Gulf War.  I didn’t understand what it all meant, but I remember he showed us MRE’s (the ready-to-eat food packets the troops ate that still gross me out to this day) and that we tied a lot of yellow ribbons on everything.  I didn’t really know what was going on in the world, but I knew that our troops were heroes and we supported them!

After September 11^th, 2001, that same rallying cry of “Support the Troops!” could be found everywhere.  T-shirts, billboards, posters, bumper stickers.  Someone out there probably retired from the profits off of those yellow ribbon magnets that were on every other car on the highway.  As the war dragged on, folks were less vocal about it, until a local soldier would come home.  The press would show up with their cameras, supporters would come with signs and banners, offering cheers and “thank you’s” instead of the insults cast at so many Vietnam veterans.  Yes, this is indeed progress.

But what happens after the homecoming party?  What happens after that same soldier comes home for good, trying desperately to fit back into a civilian world so different from the military lifestyle he or she has grown accustom to, especially after seeing the horrors of war firsthand?  What happens to them and their families as they try to get back to “normal” following two, three, or even five or six combat tours overseas?  While they were robustly welcomed home by a grateful nation, some are being forgotten all over again as the demons of the past stir up and begin to haunt the service member and their families.  While people are patting themselves on the back for being so supportive of the troops, they are not seeing the epidemic that has slowly begun to chew away at our military families.  That “thing”, that unseen force that is tearing families apart and driving our troops to end their own lives at an alarming rate is PTSD, post-traumatic stress disorder.

The Invisible Wounds of War 
This is a deeply personal topic for me to write about.  Many of you know that my husband is a veteran who served two tours in Iraq.  Some of you might even know that he was a combat medic and that his unit was one of the first to cross into Iraq in 2003.  Extra points to those of you who know he was also in the 82^nd Airborne and was a part of the Surge of 2007.  But what you might not know about my husband is that he is a disabled veteran.  That might come as a shock to many because he looks just fine.  He is not missing a limb.  He is not in a wheelchair.  He is not one of the burn victims seen on the Wounded Warrior Project advertisements.  While he does have physical disabilities rated by the VA for various neck and back issues, most of his disability rating is from PTSD and traumatic brain injuries (TBI), which are becoming known as “the invisible wounds of war”. 

If you were to take one PTSD veteran and put them in a line up with non-PTSD veterans, you most likely wouldn’t be able to pick them out.  What many people don’t realize is the magnitude of the problem.  Reports are now being published on the latest statistics of PTSD veterans, and it always seems like the numbers are changing, and what is scary, they are getting higher.  As more veterans exit the military and re-enter the civilian world, they are starting to come forward with their problems.  Most studies say 1 in 5, but a recent study claims 1 in 4 veterans will develop PTSD at some point.  How many veterans do you know?  To the younger generation: How many kids you went to high school with joined the military and were deployed?  Can you name five?  Chances are, at least one of them is struggling with PTSD.

If nothing else catches your attention, maybe this frightening statistic will:

For every soldier killed on the battlefield this year, 
about 25 veterans are dying by their own hands.

An American soldier dies every day and a half, on average, in Iraq or Afghanistan.  Veterans kill themselves at a rate of one every 80 minutes.  More than 6,500 veteran suicides are logged every year— more than the total number of soldiers killed in Afghanistan and Iraq combined since those wars began. (“A Veteran’s Death, the Nation’s Shame”, Nicholas D. Kristof,NY Times, April 14, 2012)

Those heroes whom we all claim to support are falling through the cracks at home, and we as a nation owe it to them to get educated, reach out, and put a stop to the loss of so many of the bravest and brightest of this generation.     

History of PTSD 
PTSD is not new.  Dr. Charles W. Hoge lists in his book Once a Warrior, Always a Warrior many of the different names PTSD has gone by through the years.

“The reactions that warriors experience after coming back from war have been given labels through the generations, including “Nostalgia” (Napoleonic Wars); “Da Costa Syndrome,” Irritable Heart” (U.S. Civil War); “Effort Syndrome,” “Shell Shock” (World War I); “Battle Fatigue” (World War II); “Acute Combat Stress Reaction” (Korean War); “Agent Orange Syndrome,” “Substance Abuse,” “PTSD” (Vietnam); and “Gulf War Syndrome” (Gulf War 1).”

PTSD was first proposed as a diagnosis in 1980 in the third edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM for short).  Part of the push for creating the definition of PTSD was the generation of veterans from Vietnam, as well as the history of conditions described after previous wars, such as shell shock.  This is again very telling for the Vietnam veterans.  When many returned and sought help for their problems, they were not taken seriously by a civilian medical world who simply could not fathom the effects of the horrors of war.  They were told it was all in their head, or worse, that is was their fault because of substance abuse.  The addition of PTSD to the DSM was groundbreaking for veterans.  It validated their claims and gave their struggles some form of legitimacy.  People began to realize that PTSD was a normal reaction to abnormal trauma.

What is PTSD?- Symptoms 
Symptoms of PTSD* can include intrusive thoughts and memories of the traumatic even (flashbacks), emotional numbness, avoiding reminders of the trauma, and hypervigilance (overly alert) to possible dangers.  These are some of the most common symptoms, but not everyone experiences all of them or to the same degree.

Intrusion- Intrusive symptoms include nightmares, “daymares” or flashbacks which feel like the trauma is happening all over again.  This may include “seeing” the trauma or feeling the sensations and emotions that accompanied it.  Memories and thought about the trauma keep popping up, making it hard for the person to focus on life or get to sleep at night.

Numbing- Intrusion phases tend to mix with periods of numbness.  Feelings of being disconnected from life or from family and loved ones may be present when nightmares and intrusive thoughts are not present.  People in this phase often feel depressed and empty.  Some people respond to these feelings by becoming thrill seekers to feel alive again.

Avoidance- People often begin avoiding situations or objects that remind them of the accident or traumatic event.  Many things can be “triggers” for flashbacks including smells, places, people, weather, etc.  As the individual attempts to avoid all these triggers, the person’s world contacts into a smaller and lonelier place.

Hyperarousal- Regardless of whether they have intrusive or numbing/avoidance symptoms, people with PTSD may startle easily and more dramatically than before.  They tend to be anxious and overly vigilant or on alert to dangers, particularly dangers related to the traumatic event.  The worrying may seem out of proportion, even paranoid, to friends and family members.

(*Excerpt from the PTSD Tip Card written by Nadia Webb, Psy.D., ABPdN and published by Lash & Associates Publishing/Training Inc.  They offer lots of resources on PTSD and Traumatic Brain Injury. © 2011)

Looking Beyond the Symptoms 
PTSD is complex and sometimes even contradictory.  To fully understand it, you have to look beyond the generic symptoms and learn what they mean and why the body reacts the way it does.

In his book, Dr. Hoge says, “Virtually every reaction that mental health professionals label a ‘symptom,’ and which indeed can cause havoc in your life after returning home from combat, is an essential survival skill in the war zone.”  This means just about “symptom” is a learned reaction that became imbedded in the warrior’s mind during long durations of high-stress and dangerous situations.  Dr. Hoge does an excellent job explaining how and why these reactions affect the brain, and I will try to summarize the main points.  All italicized portions are excerpts from his book, followed by the page numbers where they can be found.  (For more in-depth information, get a copy of Once a Warrior, Always a Warrior.  This has been the best book I have read so far on the subject, and the easiest to read by far.)

“Under prolonged stress, the stress “thermostat” is reset to a different level.  … Deployment to a war zone, which is a form of prolonged and severe stress, can change the way in which the body adjusts to or responds to normal everyday levels of stress. …  Warriors develop remarkable observational skills and reflexes.  However, post-deployment, they sometimes overreact to things in a way that leads to strained relationships and problems at home or work.” (pg. xiv)

“Neurobiological research has helped us to understand that PTSD is not an ‘emotional’ or ‘psychological’ disorder, but a physiological condition that affects the entire body, including cardiovascular functioning, hormone system balance, and immune functioning.  PTSD can result in physical, cognitive, psychological, emotional, and behavioral reactions that all have a physiological basis.”  (pg. 3)

The limbic system, known as the “reptilian” (reptile-like) part of our brain is responsible for what is known as the “fight-or-flight” reaction.  “It processes danger, threat, and reflexes, and expresses basic emotions necessary for survival (anger, hurt, fear). … [It] is designed to make sure you never forget any memories having to do with serious danger or disaster that affected you personally.  …  The job of the limbic system is to ensure that you survive by not forgetting anything that happened during dangerous o threatening situations.” (pg. 29-30)  This is one of the reasons veterans get so frustrated when people tell them to “get over it” or insinuate that enough time has gone by that they shouldn’t be reacting a certain way.  The brain holds on to these graphic memories as a survival tool, and even little things like certain smells, sounds, images, or situations can trigger them, even when they are in a safe environment.

“The primary emotion of the limbic system is anger.  Fear is also present, but warriors learn to control this by falling back on their training.  Anger helps to control fear.  Emotions other than anger are generally shut down.  While the speed of processing information increases, the ability to be self-reflective or consider things in a rational sequence diminishes.  In times of danger, a moment of reflection may make the difference between life and death.” (pg. 55)

Nightmares and difficulty sleeping are very common in veterans with PTSD.  The lack of sleep, or even just repeated nights of poor quality of sleep, can wreak havoc on their nerves and emotions.  Imagine how bad (cranky, even) you feel when you don’t get enough sleep.  Imagine endless cycles of little to no sleep. 

“Five to six nights with only four hours of sleep each night has been shown to have the same effect on cognitive ability as a full night of no sleep or a blood alcohol level of 0.1 percent—legally drunk.  After this level of sleep deprivation, a person doesn’t have coordination problems and can still walk a straight line; however, their ability to think is impaired.  There is also a vicious cycle that veterans can fall into: Sleep deprivation reduces the ability of the medial prefrontal cortex to keep the limbic system under control.  This can lead to feeling irritable and revved up, which in turn causes the medial prefrontal cortex to not function well, making things even worse.  Many veterans feel like they live constantly in a state of fight-or-flight, with little to no rest in between.  Rational thought and reason get compromised.”  (pg. 57)

While these reactions can be quite disturbing to the public, it is the PTSD stereotype that prevents many veterans from seeking help.  It is also endlessly frustrating to those veterans and their families who are constantly working on managing their PTSD with the many treatment options available.  They are tired of being seen, and treated, as monsters.

BREAKING THE HOLLYWOOD STEREOTYPE 
Unfortunately, Hollywood has a done a horrible job at perpetuating stereotypes for veterans with PTSD.  The media hasn’t helped by sensationalizing stories that paint PTSD veterans as crazy, out of control, and violent.   

Dr. Phil had a show this year entitled “PTSD: From Heroes to Monsters” and featured some of the worst cases I had ever heard of, including a man who set his wife on fire.  Dr. Phil, like most of the media, thrives on sensationalism.  They picked out the worst of the worst to get attention and viewers.  It’s all about numbers.  The more eyeballs they can get, the more money they get from their advertisers.  This is not the case for the majority of PTSD sufferers, and therefore PTSD has carried with it a stigma that many veteran families try desperately every day to overcome.

Dr. Paul D. Whittaker with the Amarillo VA agrees that it is one of the biggest misconceptions the public has about PTSD.

“When they hear that term, they may affiliate it with someone who is dangerous or out of control,” said Dr. Whittaker.  “The vast majority of veterans I work with are actually trying very hard to control their emotions.  In fact, those who have not sought out treatment sometimes will become avoidant of others, of certain jobs or places because they don’t want to be perceived in that negative light.”

He likens PTSD to someone being diagnosed with diabetes.

“What happens if a diabetic isn’t treating their condition and eats a lot of chocolate cake?  If someone doesn’t have their PTSD treated and is engaging in behaviors such as drinking or seeking out fights or altercations, it is like a diabetic eating chocolate cake.  It will worsen their condition and it will begin to cause other problems,” he explains.  “That is the vast minority.  The work we do here at the VA really helps prevent that a huge extent.”

Veterans with PTSD have been making the news with horrible cases of abuse or violence.  These are usually the culmination of not seeking help or not being given help when they did seek it.  It is almost always a case of prolonged and worsening stress with little to no treatment, followed by a catalyst, such as divorce, loss of a job, death of a loved one, or even a sudden change of medication that was not properly supervised.  While this kind of “publicity” make us cringe, they are usually bringing to light a legitimate problem that needs to be addressed somewhere.  

Yes, PTSD veterans can and have done some awful things, but so have perfectly “normal” people.  There is also workplace violence, school shootings, and horrible acts of domestic abuse perpetrated by the civilian population making headlines every day.  Stories with veterans seem to catch a lot of attention as we see more troops coming home from over a decade of war.

So no, most veterans with PTSD are not likely going to dive behind the produce at a supermarket, screaming and lobbing imaginary grenades.  They are not “trained killers” destined to snap at any time.  PTSD is not a death sentence; it is manageable.  Those getting treatment should not be feared; they should be applauded.  Most importantly, they are not second-class citizens.

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By Jessica Montgomery
Published in the Nov. 9, 2012 issue
of The Claude News, weekly newspaper serving Claude, Texas
(c)2012, All Rights Reserved