“He was a very good
and caring person. He was just never the
same when he came back, because of all the things he saw. He tried to seek treatment, but it didn’t
work.”
-Matina Dwyer, wife of Army SPC. Joseph Patrick Dwyer
who died in
2008 by accidental overdose.
“When people asked how
John was, it was kinda like, ‘I don’t know.
I don’t know how John is because John’s not here anymore. It’s somebody else.”
-Mike Needham Jr.,
brother of veteran John Needham
who is accused of killing his girlfriend.
“This was a guy who
was doing all the right things, it seems like, and we lost him. If it can happen to Clay, then it can happen
to anyone. This should be a wakeup call
for America.”
–Paul Rieckhoff, executive director of Iraq and Afghanistan
Veterans of America,
speaking of Clay Hunt, Marine who pushed suicide
prevention
that took his own life in 2011.
-------------------------------------------------------------
It’s a familiar story being played out in the lives of veterans across the country. GI Joe returns home from war a completely different person. His friends and family are confused by the change in attitude and behavior, but are at a loss as to what to do or say to help. He begins to drink to numb his emotions, which causes more problems with family and work, if he was able to find a job at all when he returned back home. Relationships are strained at best, and even his spouse struggles to understand what he is going through. Anger and rage caused by PTSD leads to domestic violence. They end up divorced, possibly in an ugly custody battle, which causes him to self-isolate. Substance abuse, either by drinking, recreational drugs, or from dependence on prescription pain medication for injuries sustained in war land him in a legal system which has little knowledge of how to work with veterans. With his world crashing down around him, he feels like he has no way out and ends his life, possibly in a very public way. The media swarms and interviews family and friends who speak of a great guy who was proud to serve his country and help others. Rarely does it come out of left field and shock those closest to him. “He was never the same since he got back from Iraq/Afghanistan,” they say. You might also hear: “He tried to get help, but fell through the cracks.”
In the first article in our series, I explained what PTSD
is, how it can affect the brain and body, and common misconceptions and
stereotypes associated with PTSD. Next,
I shared what PTSD was like for veterans on an everyday basis, including common
triggers and reactions our veterans face daily.
Last week, I talked about Traumatic Brain Injuries and their possible
complications with PTSD. While it is
very important to veterans receiving treatment for their PTSD not to be labeled
or seen as monsters, I would do my readers a disservice if I didn’t go into
what can happen when PTSD is left untreated and things go from bad to worse.
SUBSTANCE ABUSE
One “symptom” of PTSD is substance abuse. Many veterans with PTSD try to numb emotions
or avoid dealing with them at all. Some
will turn to drinking, others to street drugs, and others can find themselves
addicted to the strong, narcotic pain medications doled out by their doctors to
help with physical wounds. Some do it
because they can’t fall asleep at night, so they feel that “passing out” is their
only option. Unfortunately, this adds
fuel to an already dangerous fire. With
their inhibitions lowered, the veteran now has a higher chance of acting out
their anger and rage than when they try to stuff down their emotions when
sober.
For those with PTSD and Traumatic Brain Injuries, it is a
double-edged sword. TBI can affect the
way the brain and body react to alcohol consumption or drug use.
“Alcohol will now have a double or triple whammy effect,”
says Marilyn Lash, brain injury specialist, author, and advocate. “It affects the brain differently after
injury. They will get higher, quicker
and more intensely with fewer drinks.
One drink can have the effects of three.”
Many veterans with TBIs have reported a lower tolerance to
alcohol than before injury. Whereas
before they could easily go through a 12-pack and still be considered “the life
of the party”, they can now only handle about 3 or 4 before becoming totally inebriated
and sometimes full of rage.
“Alcohol is a depressant.
It loosens inhibition, lowers judgment, increases risk-taking, and
affects balance and coordination,” says Lash.
“For those having problems with TBI in these areas, alcohol will only
magnify them.”
“This is also one of the hardest for the veterans to give
up,” Lash explains. “Drinking is
welcomed and sometimes encouraged at military get-togethers.”
Friends and family members might pick up on the substance
abuse problems and encourage their veteran to attend support groups like
AA. While AA is a good program and can
be helpful with those who suffer from PTSD, nixing the drinking altogether most
likely will not solve the problem. Many
vets cannot successfully become sober until the underlying issues of sleep
problems, nightmares, emotional numbing, etc. are addressed. What else will the veteran turn to if there
are not equipped on how to handle their emotions sober? Alcohol and substance abuse do not mean they
are a bad person; it means they are hurting and desperately trying to
self-medicate. You wouldn’t focus on
treating JUST a runny nose when a patient has the flu.
RELATIONSHIP PROBLEMS
When veterans feel like they are misunderstood by their
friends and loved ones, they can tend to isolate themselves, causing confusion,
hurt feelings, and even anger for their loved ones. Since their time in a warzone caused them to
stifle all emotions except for anger to get the job done, they have a harder
time expressing positive feelings and emotions when they return home. It may seem to their loved ones that they
just don’t care anymore.
One VA study examined the connection between the cluster of
avoidance symptoms, specifically emotional numbing, interfere with intimacy
(for which the expression of emotions is required) and contribute to problems
in building and maintaining positive intimate relationships.
Extended family members might not understand when a veteran
continually turns down invitations to family gatherings. The veteran might be trying to avoid being
triggered, but the family member or friend might feel slighted and bitter
towards the unreciprocated invites.
Loved ones might also feel like they are walking on
eggshells around their veteran, which in itself can be exhausting. This can also cause bitterness to build up
between loved ones and veterans, causing the vet to pull away even more. They want desperately to help, but just don’t
know how.
DOMESTIC VIOLENCE
Domestic violence is one of the touchiest subjects for
families struggling with PTSD and one of the main reasons some choose not to go
public with the diagnosis. No one wants
to be branded with the “violent vet” stereotype. Again, not all veterans act out in violence,
and spouses fear what increased scrutiny can do to their vet and their
families.
There is a reason, however, that domestic violence is part
of the PTSD stereotype. Just like in the
“normal”, everyday world, it happens.
Veterans with PTSD can have a short fuse. That is documented fact. The difference is the treatment or coping
skills used to help when anger begins to surface.
Without treatment, veterans can bring home the military
mentality. They can bark orders, treat
their spouses and children as soldiers, and get frustrated when “orders” are
not followed to the letter. In combat,
orders were to be followed immediately and without rebuttal or there could be
accidents, injuries, or deaths. This is
why some vets can seem to “snap” over something that, in reality, is small and
trivial.
In war, fear and intimidation are sometimes used to
accomplish a mission. Veterans can use
intimidation and manipulation at home without realizing it. That’s just what they were taught to do to
get their point across or to get the desired result. If there is resistance from the spouse, the
veteran can then “lock on” and see them now as a threat.
Another way violence can spill into a marriage or family is
through flashbacks. Again, not all
veterans experience flashbacks, and most aren’t the Hollywood-type flashbacks
seen in films. But yet, it can happen.
“There is no way under normal circumstances that my husband
would ever intentionally hurt me,” says a veteran’s wife who wished to remain
anonymous. “But I have been thrown to
the ground when he was having a flashback.
He threw me down to ‘protect me’ from sniper fire and twisted my arm
behind me so I wouldn’t get up. He thought
he was saving my life by keeping me down.
It was terrifying. I thought for
sure he was going to dislocate my arm.”
DIVORCE RATE
Military couples have almost always faced divorce rates
higher than their civilian counterparts.
Numbers are still coming in for the most recent wars, but a study by the
VA on marital adjustment and divorce rates for Vietnam veterans shows that PTSD
can be even more damaging to marriages.
Approximately 38% of Vietnam veteran marriages failed within six months
of the veteran’s return from Southeast Asia.
The National Vietnam Veterans Readjustment Study sound that rates of
divorce for veterans with PTSD were two times greater than for veterans without
PTSD, and veterans with PTSD were three times more likely to divorce two or
three times.
Many times following a divorce, the veteran can “fall
through the cracks”. With no one else
there to see the symptoms and encourage the veteran to get help, he or she can
lose hope or even stop trying. From
there, things can snowball quickly.
LEGAL PROBLEMS
Due to substance abuse, violence, or divorce, veterans can
find themselves trapped in a never-ending legal battle. In a 2002 Bureau of Justice report, 9.3% of
the prison population is veterans. That
same report indicated that 70% of incarcerated veterans were in jail for
non-violent offences. In Travis County,
Texas, the top non-violent offense was for DWI.
Veterans Courts are being set up around the country to deal
with veterans having readjustment issues and find themselves in trouble with
the law. Veterans Courts combine drug
courts with mental health treatment to encourage veterans to a better way of
life. They use innovative techniques to
encourage veterans to a life free of addictions with stable, long lasting
relationships. Veterans Courts utilize
resources from the VA Healthcare System, veteran volunteers, and veteran family
support organizations.
Currently, there are 40-50 Veterans Courts nationwide, and
the prospects of one to service Randall, Potter, and Armstrong Counties are
being discussed. Veteran advocates feel
the benefits of prescribing treatment and rehab for problems cause by PTSD far
outweigh the convenience of throwing the veteran into the prison population
where their symptoms could multiply and cause worse problems later on.
SUICIDE
Unfortunately, many veterans give up and choose to end their
own lives. The suicide rates for active
duty and veterans have made headlines recently.
In a study this spring, it was announced that a veteran commits suicide
every 80 minutes. That is roughly 18
suicides a day. The number of suicides
by veterans back at home has surpassed the total number of service members
killed in Iraq and Afghanistan, combined.
For those who came home with PTSD to unemployment in a bad economy,
divorce, substance abuse, and legal problems, death starts to look like the
only way and is sometimes fueled by survivors guilt for making it home when
their battle buddies did not.
HOW TO HELP
The first way to help a veteran with PTSD is to get
educated. Just by knowing and
understanding the symptoms and reactions of those with PTSD, you can make it
that much easier for the veteran to reach out to and trust you.
Many spouses and family members feel helpless if their
veteran is in denial or refuses to get help.
They can feel blocked by the very source who is there to help, the VA,
when they are told that the veteran must first register himself and sign a
release before they can speak to family members. It can be confusing for the veteran to do it
himself, but even more so when a civilian family member tries to get more
information to help them get treatment.
The VA has recognized this problem and has created a program
called “Coaching Into Care”. Through the
program, friends and family members can learn the procedures and requirements
for enrolling their veteran for VA care, how to talk to their veteran about
getting help, what to do if their veteran is enrolled in care but no longer
attends appointments, and learn what to do if there is a crisis. This is all about educating loved ones and
giving them the tools to successfully encourage their veteran to seek help with
their PTSD. If they are ready and
willing when the time comes that the veteran hits rock bottom and asks for
help, they will be less likely to fall through the cracks. And remember, the name is “Coaching Into Care,”
not “Nagging Into Care.”
Coaching Into Care website: www.mirecc.va.gov/coaching
Hotline: 888-823-7458
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