It’s National PTSD Awareness Day and in honor of this important day I am posting the second half of my “In Their Boots” blog pertaining to the “PTSD: And Returning Veterans” seminar I attended a couple weeks ago in the DC area led by Dr. John Mundt, a psychologist at the Chicago, VA.
Unlike my first post of “In Their Boots” this one will primarily be a listing of facts and statistics presented by Dr. Mundt as well as a couple of anecdotes as told by him. Some of the facts might seem random as I culled all of these from the 7 hour seminar and picked which information I found the most interesting or useful.
I want to start off by stating that what I list below is information gathered at one seminar on PTSD and veterans from one psychologist. If you would like more detailed information on any statistics, therapies, medication etc., I have a list of various resources here, that talk to these things in more detail.
- 70% – 80% of OEF/OIF veterans who have deployed to the war zone 4 times or more are likely to present with mental health issues.
- 50% of OIF/OEF veterans are Reservists or National Guard
- In 2008, 50% of active duty Army suicides were related to breakups or family disputes.
- In WWII 3% of active duty military were married, now over 50% are married.
- 30%-35% of OEF/OIF (not all veterans) will present with PTSD
- The number of troops who died in Vietnam has been surpassed by the number of veterans who committed suicide after Vietnam.
- Hyper-vigilance is one of the most common PTSD symptoms in veterans. This is the constant scanning of ones surroundings and the need to be as aware as possible. A veteran with PTSD is not going to be comfortable:
- In a crowded theater
- Caught in traffic
- At a crowded concert
- At a fair or festival
- They are not comfortable in a place where there is no easy way to get out.
- In Theater soldiers survive by learning to adapt, by being hyper-vigilant – this is what they are trained to do. This technique is incredibly difficult to just “turn off” when troops return home.
- The highest risk time for a veteran with PTSD is in the first few days or weeks when they get home.
- PTSD is the experience of re-living an event – NOT distortion of an event.
- PTSD can lead to feelings of intense guilt:
- Rational or irrational
- “Survivor guilt” or being “intact”
- Multiple losses with no time to grieve
- Affective numbing, anger or feeling of needing revenge.
- Leaving the service can lead to a loss of self-esteem, loss of purpose, loss of direction.
- Someone could have a lot of responsibilities while in theater; be responsible for other men and women’s lives, make hard decisions in life or death situations. And when they come home they go to work at a 7-11. That is an incredibly difficult physical and mental transition to make.
- COSR – Combat operational stress response. This is the immediate reaction after a traumatic event that subsides after a few days. This is different from PTSD.
- Programs for military families are not the main focus for the VA and there are not many official programs for them.
- Of the 600,000 children of OEF/OIF active duty military, approximately 80% are in public schools, therefore not going to schools on military bases. Which means they may not be getting the same kind of support as the children who are going to school on military bases.
- Caregiver burden – living with someone who has severe PTSD can transfer the symptoms to other people living in that household.
- Many VA’s are trying to make a concerted effort to bring in the family members or significant others so they can educate them on what PTSD is and what to expect.
- Many older veterans are “triggered” by younger family members serving; this is a reminder of their own service.
- A “trigger” is something that sets off a memory or flashback transporting the person back to the event of her/his original trauma.
- All the senses can play a part in “triggers.”
- Anecdote: “A Vietnam veteran had open heart surgery, when coming out of sedation the nurses were talking Vietnamese. He thought he had been captured by the Viet-cong. He jumped up out of bed with all the tubes still coming out of him and proceeded to take his IV stand and swing it at the nurses.”
- Anecdote: “ A Vietnam veteran was at his in-laws for Thanksgiving. The turkey was cooking in the oven with a turkey thermometer. When the turkey was done the thermometer popped. This triggered the Vietnam veteran to throw his mother-in-law over the back of the couch, breaking her hip, to “protect” her. The thermometer popping had reminded him of the sound of stepping on a booby trap trigger.”
- A vehicle trigger is a common trigger for OEF/OIF veterans. Many are trained to drive aggressively and defensively in theater which translates to dangerous driving on American roadways.
- Drugs that are sedating can intensify hypervigillance and anti-depressants are often associated with more vivid, lucid dreaming which can be negative for people who are prone to nightmares.
- Some troops/veterans who’ve sought treatment while in the Army have been given a drug cocktail like “the double V” Valium and Vicodin, but have not received any actual psychotherapy.
- “Polymdedicating” is piling meds on top of meds and there are some psychiatrists who have this approach/style.
- From a report in 2008, 11% of active duty Army in Iraq were on a sleeping pill, anti-depressant or anti-anxiety medication. (Time Magazine, “Our Medicated Army”)
- From a report in 2008, 17% of active duty in Afghanistan are on a sleeping pill, anti-depressant or anti-anxiety medication. (Time Magazine, “Our Medicated Army”)
- Many veterans are self-medicating with alcohol or drugs to hide/treat the symptoms of PTSD. So, when they get treatment for the drugs or alcohol all the PTSD symptoms come out.
APPROACHES TO TREATMENT
- Formal psychiatric treatment for active duty is much more widely available now then ever before.
- Shortly after the Vietnam War there was little to no effort or thought put into trauma therapy. There was a lot of variability from hospital to hospital. Now, the VA has very rigid rules and regulations that are across the board, which can be good and bad. Not individualizing treatment from patient to patient or client to client can be ineffective.
- The VA therapists and case workers are often faced with tough ethical issues when they treat active duty military because whatever they put in their chart can be accessed by DOD. For instance:
- What do you do with the client who wants to go back into theater but shouldn’t? – According to Dr. Mundt – unless they are unable to perform their duties you should let them go. They joined knowing the risk.
- Here is a list of different types of treatment for PTSD. To find out more details about each one go to: http://www.ptsd.va.gov/public/pages/treatment-ptsd.asp
- Cognitive therapy
- Exposure Therapy
- EMDR (Eye Movement Desensitization and Reprocessing)
- Group Therapy
The therapies listed below are the lesser-known therapies but have also proven to be successful:
- ACT (Acceptance and Commitment Therapy) – http://contextualpsychology.org/act
- Somatic Experiencing – http://www.traumahealing.com/somatic-experiencing/
- Psychodynamic therapy – http://psychcentral.com/lib/2006/psychodynamic-therapy/
- Imagery Rehearsal Therapy – http://sleepapneadisorder.info/2010/07/27/imagery-rehearsal-therapyturning-nightmares-in-to-dreams/
I hope you have found this blog post informative and/or interesting. I know I found the seminar incredibly enlightening and valuable and I hope I was able to convey even just a small amount of that to you in these 2 blog posts. Please read my 1st “In Their Boots” entry as it speaks much more personally to the significance of raising awareness and understanding of what our veterans go through at war and when they come home.
It’s National PTSD Awareness Day – what are you doing to help raise awareness today?
Thanks for reading,