Wednesday, November 11, 2009

Our veterans and combat stress

In 1996, I was working at Barrow Neurological Institute in Phoenix, helping out with the cognitive assessments of patients in an Alzheimer's clinical trial. Because the patients came in often over a period of a year we got to know them pretty well. One patient and her husband became particularly close to my colleagues and me (I will call him John). He was a World War II vet and they had been married for a gazillion years. A few years later, I was living in Massachusetts and had just seen "Saving Private Ryan" and realized with regret that I never asked John about his experience or thanked him for his sacrifice. We exchanged Christmas cards (his wife was now in a nursing home and he had moved near by so he could go see her daily) and I said something about this in my card. A few weeks later my phone rang, it was John, he had sat down at his typewriter to type out his story to me and realized it would be much easier to just tell me. We were on the phone for two hours and he told me the story of his time in the military and his combat experience in the South Pacific as a pilot. He said that he rarely spoke of some of his experiences (the more horrifying ones) but it had become a bit easier as he got older. It was a profound experience. I lost touch with John over time, I know that his beloved wife is no longer with us. John had very few symptoms of Post-Traumatic Stress Disorder(PTSD) at that point, but told me it took years for him to be able to sleep well at night and for the constant anxiety to die down. He was able to go on to become a successful business man, a father, a devoted husband, and enjoyed a great life.

As you may or may not know, that is not necessarily the experience of all. In fact the statistics of those who come back from combat with PTSD are sobering, at least to me. Approximately 20% of the veterans of our current war have PTSD, and with each deployment the chances for PTSD go up. For those that are deployed for a third time, their chance are between 30-50% that they will return with PTSD.

Let me say a little bit about what PTSD is.......PTSD is a cluster of symptoms that fall under three categories, re-experiencing, avoidance, and hyperarousal. Those with PTSD may have flashbacks, where they are literally re-experiencing the traumatic event. It is not that they are thinking about the event, their brain has taken them back there. Nightmares would fall under this category. One might also get triggered by something in their environment and their brain associates it with the trauma, they then may experience severe anxiety or distressing feelings. For example, the sound a chopper blades can be a trigger for many Vietnam vets. Dust blowing in one's face can take a Desert Storm vet right back to Kuwait. These flashbacks, nightmares, and associated anxiety are not voluntary and often very difficult to intervene on. The brain has been changed by the horrors experienced and it is very difficult treatment wise to get it back in balance. The avoidance symptoms are in place because the mind and the psyche will do what it takes to not trigger the systems of the brain in charge of re-experiencing so one's life may become paralyzed by the desperate attempt to "not go there." The hyperarousal is based on the fact that sometimes the fight or flight system can't be turned off, or it gets turned on way too often. These symptoms are going to involve insomnia, inability to concentrate on daily life as one is in "survival mode), irritability, constant anxiety or the feeling of being "amped up."

Can you imagine living with these symptoms and trying to pursue a career? Parent a child? Have a fulfilling relationship? Enjoy hobbies? It can be a devastating syndrome. It leads one to pursue any means to alleviate the tormenting symptoms so drug and alcohol abuse are common, as is depression.

There are new treatments for PTSD that have proven to be helpful (EMDR, Somatic Experiencing therapies, group therapy, and medications) but we haven't figured out a way to cure this.

So, on this day when many honor the heroes and the mind of the country goes to the men who stormed Omaha beach, to the Pat Tillmans of the world, to those who provide the blanket of protection, please allow it to extend to those who continue to struggle with the impact of their sacrifice. He may be the homeless man in the downtown of a urban area, he may be the alcoholic in a local AA meeting, those whose "weakness" is often viewed with disdain by the same who originally honored their intention. Honor the living vet that have given his life, have a voice for him or her when they may not be able to have a voice for themselves, know that many die for this country but that it just may happen years after their combat experience is over.

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