Soldiers return to past military trauma in nightmares and flashbacks. Constantly on the alert, they often feel jittery, irritable, even enraged. Others describe themselves as emotionally numb, avoiding social contacts and situations that might trigger memories.
These lingering demons of war afflict the tens of thousands of U.S. troops coming home from conflicts in Iraq or Afghanistan with post-traumatic stress disorder (PTSD). It's a population that some say struggles to find adequate care in the veterans' health system despite reform. Concerns over service members' mental health have received renewed attention following the mass shooting at Fort Hood in November 2009, which left 13 dead and 29 wounded.
"While we've seen some advancements, those advancements have not been as rapid, thorough, or comprehensive as they actually should be," says Devin Byrd, department chair of behavioral sciences and associate professor at South University. Byrd speculates not only that the incidence of service-related PTSD is on the rise but, further, that health care is failing to keep pace.
"We often have what we call 'the walking wounded,' where folks are dealing with problems that start small and balloon and continue to grow over a course of years," says Byrd, who has treated PTSD sufferers including veterans of conflicts from World War II to Vietnam and the Gulf War. "Often they're not aware it's a problem until people start moving away from them – spouses, children, friends – and it gets to a point where folks are almost at the end of their rope. That's when they tend to come in for help."
Lasting despair, physical symptoms, and employment problems are typical. Destructive behaviors, such as alcohol and drug abuse, may have begun years before the traumatic event, but worsen afterward. "A lot of it also has to do with trying to cope and self-medicate," Byrd says.
But it's unclear whether PTSD rates are any higher now than they have been during past wars, says Dr. Antonette Zeiss, deputy chief in the U.S. Department of Veterans Affairs (VA) Office of Mental Health. An April 2008 study by Rand Corp. claimed that nearly one in five service members today returns from duty with symptoms of PTSD or major depression. Zeiss says this estimate likely is "in the ballpark."
About 46% of veterans returning from Iraq or Afghanistan have turned to VA to receive health care, Zeiss says. Of those who've done so, 47% have been diagnosed with at least a possible mental health problem. And of those, about half – 53% – have a firm or possible diagnosis of PTSD.
"We believe that, in fact, veterans are selectively choosing to come to VA if they have a mental health problem because of the quality and extent of services we provide," she adds. "We've worked very hard to do outreach and ensure that we reach those with mental health problems."
Whether rates are rising is probably impossible to determine for sure, Zeiss says, because PTSD didn't exist as an official diagnosis before 1980, and wasn't tracked closely until years later. Depictions of PTSD-like symptoms can be found in writings from conflicts ranging from the Trojan War to the U.S. Civil War and beyond.
If the documented incidence of service-related PTSD is increasing, as some believe, however, several explanations are commonly offered. Byrd says the uptick could be a function of better detection, greater numbers of health care professionals, and protective military equipment and medical advances that are allowing soldiers to survive more traumatic injuries than ever before.
Perhaps the leading explanation is the increase in length and number of multiple deployments. Certainly, in Vietnam some soldiers saw two or three tours of duty. But soldiers today routinely are deployed five or six times, Byrd observes, noting that many mental health professionals view this practice as "re-traumatizing" soldiers in ways that can have long-term effects.
"What we know from research is that the highest risk factor for developing PTSD is the intensity and total frequency of exposure to the kinds of experiences that are overwhelming and terrorizing," Zeiss says. "I'm not saying that the amount of combat exposure is the only predictor, but there are some concerns that the extent of combat exposure may tilt towards a higher rate."
Some worry that the actual rate of PTSD is higher than is reported, due to the stigma surrounding mental health treatment and the military culture's taboo against admitting vulnerability.
"If soldiers identify themselves as having problems, there's a fear that there could be backlash," says Byrd. "So it's a double-edged sword. On one hand they do need the help. But if they receive the help, there is a chance that their duties could be cut or they could be suspended."
The choice to seek help can be especially difficult for highly trained soldiers, such as Special Operations troops, who identify closely with their military function.
Because the potential loss of that identity poses such an overwhelming threat, some soldiers are unwilling to take the risk, Byrd says. Fearing a cut to their duties, some service members attempt to address problems without tapping the benefits to which they're entitled, opting instead to seek outside help and pay out of pocket, Byrd notes.
Alternately, there is hope that vets experiencing PTSD find a more enlightened culture today than in the past.
"People are getting the kind of social support and caring and welcome home that the veterans from Vietnam did not receive," Zeiss says.
In addition to VA's special PTSD programs, VA has a system of assigning a permanent primary care provider and linking each veteran to an appropriate clinic for follow-up visits. Service members entering primary care are screened for conditions such as PTSD, depression, problem drinking, military sexual trauma, and traumatic brain injury, Zeiss says. A positive screen results in careful follow-up and diagnosis. "People get the strong message that these are problems that can be treated, and that life can be better, and that we want to take care of you," she adds.
VA provides PTSD evaluation, education, and treatment services – including assessment, medications, psychotherapy, family therapy, and group therapy – at hundreds of medical centers and specialized programs nationwide. And with high-ranking soldiers going public with their own stories of seeking treatment for PTSD, officials such as Zeiss are optimistic. She points to the example of Army Maj. Gen. David Blackledge, for example, who has publicly discussed his own harrowing experiences in Iraq, sought psychiatric counseling to address wartime trauma, and encouraged other members of the military to do the same.
"Since 2005 we've been well funded by Congress, and we have added 6,000 mental health professionals and support staff to bring our full mental health core staff up to almost 20,000," Zeiss points out. "We're also training the staff to deliver the evidence-based psychotherapies that have been shown to be the most effective for treating PTSD. We have a PTSD mentoring program run by the National Center for PTSD that works with all the sites to ensure that state-of-the-art care is being provided."
Even Byrd, who harbors concerns, sees promise.
"We're doing better," he says, "at understanding that people can experience all sorts of conditions and do need help and can benefit from it. It's a matter of continuing to educate individuals on the type of care they need."
Written by freelance talent for South Source.