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| "The War Room" by Robert Bridgens [https://www.stockvault.net/blog/photography/30-war-and-suffering-themed-photographs/] |
Picture this:
A man in his mid-twenties hesitates when his girlfriend asks him to take out the trash. He feels his heart racing, his hands get sweaty, and he feels like he should tell her something. He doesn't though.
She looks at him closely, watching and waiting for his response. It comes quietly, "Um. Okay. No worries."
She's relieved. She never really understood why he was so anxious when asked to take out the trash. Ever since he came back from Afghanistan he seemed on edge, but he never wanted to talk about it...
A man in his mid-twenties hesitates when his girlfriend asks him to take out the trash. He feels his heart racing, his hands get sweaty, and he feels like he should tell her something. He doesn't though.
She looks at him closely, watching and waiting for his response. It comes quietly, "Um. Okay. No worries."
She's relieved. She never really understood why he was so anxious when asked to take out the trash. Ever since he came back from Afghanistan he seemed on edge, but he never wanted to talk about it...
What's he thinking? Well it could be that improvised explosive devices (IED's) were hidden near or inside trash cans when he was on tour. It could be that his anxiety, although useful for him when he was in combat because it kept him on edge and alert, was becoming to be a burden when he found himself back home. Little things like taking out the trash, driving under bridges (given the anxiety of an insurgent marking his car with his AK-47), or any other such seemingly everyday circumstance that we take for granted as doing without any hint of anxiety, are riling him up. He doesn't want to be this way, and upon his arrival he really didn't get as much information as he would've liked - or maybe he was ignoring the information he was given - on management and treatment options of post-traumatic stress disorder (PTSD).
IS that what he's got? He doesn't know. He's heard a little about it, but not enough to inform him that he could be a prime candidate for this diagnosis. But even if he was diagnosed, wouldn't that just make others label him negatively? Or feel sorry for him? No. He wasn't going to go there. 'It's not like anybody understands?'
IS that what he's got? He doesn't know. He's heard a little about it, but not enough to inform him that he could be a prime candidate for this diagnosis. But even if he was diagnosed, wouldn't that just make others label him negatively? Or feel sorry for him? No. He wasn't going to go there. 'It's not like anybody understands?'
The above is just one of the circumstances many (but not all) of our veterans find themselves in after returning from a military tour (or two, or three, or more) in a war zone. Circumstances that trigger symptoms that could fall into the ever so complicated syndrome identified in the Diagnostic and Statistical Manual of Mental Disorders (or DSM, currently in its fifth edition) as PTSD. What are these symptoms? In what sense is it a disorder? And what can they and we do to help those that have fought, died, and suffered for the country we live in?
This is what this post is about.
This is what this post is about.
People that find themselves diagnosed with PTSD have suffered or witnessed singular or multiple traumatic events at some point in their life (the DSM-5 distinguishes between children, aged under six years, and adults suffering from PTSD). It is a very complex disorder where a person relives, in a sense, the trauma experienced in a number of identifiable ways.
Be it recollections of the event that are accompanied by emotional, sensory or physiological components (such as we have seen in the example above); dissociating from lived experience only to relive the traumatic events in the form of flashbacks; avoiding certain places or stimuli (say, discussion about the event) so that the person does their best to rid themselves of potential confrontation; negative thoughts that can affect day-to-day functioning related to the traumatic event; exaggeration; detachment from others; losing interest in things they once loved; and despondence. These symptoms are some of those present in someone that has been diagnosed with PTSD and can be quite debilitating for some people.
This isn't to say that all people that have experienced combat will present with these symptoms, and it isn't to say that people that haven't experienced combat won't experience these symptoms (e.g. take the case of Mr. Yates in the DSM-5 Clinical Cases Handbook where he was a transporter in Iraq and although he didn't experience any combat he was still diagnosed with PTSD given his fulfilment of certain criteria such as avoidance of bridges (given the potential for conflict at such a location while he was in Iraq), hyperarousal, and other symptoms; Barnhill, 2013).
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| "Off to War" by Steve Hill [https://www.stockvault.net/blog/photography/30-war-and-suffering-themed-photographs/] |
What we as the general population must understand is that we must be there to help our veterans when they return from their deployment rather than expect them to re-integrate into society without the slightest fuss. For example, in a 2013 news article by the ABC, the voices of frustrated Australian veterans were heard in that they did not receive enough support in their reintegration, especially in terms of counselling.
Just last week the Minister for Veterans Affairs, the Hon. Michael Ronaldson declared that the Government is attempting to prioritise mental health services for veterans right now and into the future. What shall come out of it remains to be seen, but it's comforting to see that in Australia this issue is a priority.
Listening to the "Military PTSD" podcast of Psychology in Seattle (which can be found free of charge on iTunes) it was interesting to hear that when we juxtapose warrior tribal reintegration from around the world (presumably from years ago) there is a very apparent contrast to how we reintegrate veterans in various western countries today.
It was said that upon returning from combat, tribal members would have to undertake intensive re-initiation and therefore certain rites and purification rituals were performed upon their arrival. These were done away from the tribe. Only after these rites and rituals were performed were they re-integrated back into the tribe. Upon their return to their home tribe, each member was given the opportunity to tell their story. This story was now not their own story, but the tribe's story.
What an encouraging situation!
We today are often disengaged from the experiences of those that join the military and return broken people. Obviously we can bring into focus the difference in culture between collectivist cultures and individualist cultures and how these factors might influence our response, but that'll make this post much longer than it needs to be... What we can make reference to however is the part that we can play as a people to those that have returned from combat
What can we do?
1. Instead of seeking to understand all the 'juicy' details of the veteran's deployment we should meet them where they are. Provide a supporting environment where they can discuss what is on their mind and let them tell their story. This, in turn, can help us understand that although there are many stories individual to be told overall, there is a metanarrative that needs to be understood. We are all part of this metanarrative and we'll do well to understand that.
2. Don't be quick to label a veteran as having PTSD and asking them to go get help. Assigning a diagnosis will do little to the esteem (self and other) of that person and could potentially make them unwilling to seek help. Seeking help must ultimately stem from him. It can be guided by the loving concerns of the family and loved ones, but it's only when help is sought by the client that the therapeutic process is most advantageous.
3. Don't be afraid to be involved in the process. When we tell our veterans that they need to go and see someone and remain disengaged from this process, we are creating an environment for there to be dips and flows, and sporadic increases and decreases in their reintegration. Just as when a drug addict relapses after he's attended rehab and came back clean to an unchanged environment, a veteran can feel as though he's on his own when his environment hasn't changed. We must change along with our veterans for the process of healing to take place.
4. Familiarise ourselves with PTSD and do our best to understand treatment methods. As stated before, it's not beneficial to label somebody and then ask them to see someone; it's a much better strategy to talk to the person in such a way to allow them to be honest about what they went through (along with our own understanding of any disorders that could accompany that person) and go on from there.
Treatment Opportunities?
I'm not going to dwell on this section long, because there are many other places that can run through interventions much better than I can in a brief blog post. What I will say is that there are great initiatives around the world which provide potential for helping the veteran in the long-term. One of these is virtual reality exposure treatment (VRET). Many veterans are hesitant to engage in therapy for any number of reasons. As one Marine put it, "I didn't want it put on my military record that I was crazy" (Halpern, 2008, as cited in Butcher, Mineka & Hooley 2013). When engaging treatment methods are formulated, there can be a higher willingness for veterans to actually initiate the search for personal growth.
VRET works by simulating battle conditions. The veteran experiences "trauma related cues such as vibrations of the ground, the smell of smoke, and the sound of AK-47 fire." (Butcher et al., 2013). Treatment is usually short-term (roughly a months duration) and the veteran undertakes up to six 90-minute individual sessions.
This type of therapy significantly reduces PTSD treatment and improves overall functioning (Gerardi et al., 2008; Reger & Gahm, 2008, as cited in Butcher et al., 2013).
This is a great method, among others, that caught my attention and thought I would share...
End Thoughts
So one thing we have to realise is that it's up to us to support those that have returned from combat and are suffering from the psychological wounds that go with the territory. Only through psychoeducation, a loving and caring environment, and if the need be, therapeutic measures can we hope to best assist our veterans.
It was said that upon returning from combat, tribal members would have to undertake intensive re-initiation and therefore certain rites and purification rituals were performed upon their arrival. These were done away from the tribe. Only after these rites and rituals were performed were they re-integrated back into the tribe. Upon their return to their home tribe, each member was given the opportunity to tell their story. This story was now not their own story, but the tribe's story.
What an encouraging situation!
We today are often disengaged from the experiences of those that join the military and return broken people. Obviously we can bring into focus the difference in culture between collectivist cultures and individualist cultures and how these factors might influence our response, but that'll make this post much longer than it needs to be... What we can make reference to however is the part that we can play as a people to those that have returned from combat
What can we do?
1. Instead of seeking to understand all the 'juicy' details of the veteran's deployment we should meet them where they are. Provide a supporting environment where they can discuss what is on their mind and let them tell their story. This, in turn, can help us understand that although there are many stories individual to be told overall, there is a metanarrative that needs to be understood. We are all part of this metanarrative and we'll do well to understand that.
2. Don't be quick to label a veteran as having PTSD and asking them to go get help. Assigning a diagnosis will do little to the esteem (self and other) of that person and could potentially make them unwilling to seek help. Seeking help must ultimately stem from him. It can be guided by the loving concerns of the family and loved ones, but it's only when help is sought by the client that the therapeutic process is most advantageous.
3. Don't be afraid to be involved in the process. When we tell our veterans that they need to go and see someone and remain disengaged from this process, we are creating an environment for there to be dips and flows, and sporadic increases and decreases in their reintegration. Just as when a drug addict relapses after he's attended rehab and came back clean to an unchanged environment, a veteran can feel as though he's on his own when his environment hasn't changed. We must change along with our veterans for the process of healing to take place.
4. Familiarise ourselves with PTSD and do our best to understand treatment methods. As stated before, it's not beneficial to label somebody and then ask them to see someone; it's a much better strategy to talk to the person in such a way to allow them to be honest about what they went through (along with our own understanding of any disorders that could accompany that person) and go on from there.
Treatment Opportunities?
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| A U.S. soldier trying out VRET [http://www.fastcompany.com/1728656/virtual-iraq-helps-soldiers-overcome-ptsd] |
I'm not going to dwell on this section long, because there are many other places that can run through interventions much better than I can in a brief blog post. What I will say is that there are great initiatives around the world which provide potential for helping the veteran in the long-term. One of these is virtual reality exposure treatment (VRET). Many veterans are hesitant to engage in therapy for any number of reasons. As one Marine put it, "I didn't want it put on my military record that I was crazy" (Halpern, 2008, as cited in Butcher, Mineka & Hooley 2013). When engaging treatment methods are formulated, there can be a higher willingness for veterans to actually initiate the search for personal growth.
VRET works by simulating battle conditions. The veteran experiences "trauma related cues such as vibrations of the ground, the smell of smoke, and the sound of AK-47 fire." (Butcher et al., 2013). Treatment is usually short-term (roughly a months duration) and the veteran undertakes up to six 90-minute individual sessions.
This type of therapy significantly reduces PTSD treatment and improves overall functioning (Gerardi et al., 2008; Reger & Gahm, 2008, as cited in Butcher et al., 2013).
This is a great method, among others, that caught my attention and thought I would share...
End Thoughts
So one thing we have to realise is that it's up to us to support those that have returned from combat and are suffering from the psychological wounds that go with the territory. Only through psychoeducation, a loving and caring environment, and if the need be, therapeutic measures can we hope to best assist our veterans.
...
Lest We Forget!
References
Barnhill, J. W. (2013). DSM-5 Clinical Cases. Arlington, VA: American Psychiatric Publishing.
Butcher, J. N., Mineka, S., & Hooley, J. M. (2013). Abnormal Psychology. New Jersey, NY: Pearson Education.
Other references are linked throughout the body of the blog post.
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