June is PTSD Awareness Month, so during this month, all my Military Monday posts will focus on Post-Traumatic Stress Disorder. I will preface this series by saying that in NO WAY am I an expert on this subject. I have no formal training in it – all I have done is read books and online articles, watched educational videos, and observed. So this is not meant to be an academic treatise on PTSD, but a way to bring awareness to it because many do not have an accurate understanding of what it is. It is something in which I am constantly educating myself, so these posts will be a learning experience for me as well. (Disclaimer: if there is anything I write that is inaccurate, please let me know!)
Needless to say, there is a stigma surrounding PTSD, especially in the military. Because it is classified as a “mental disorder,” many of our warriors are extremely hesitant to admit that they struggle with it. They are supposed to remain strong, right? They aren’t supposed to have something “wrong in the head,” right? However, PTSD is so much more than a mental problem. It is actually a physiological condition that stems from being exposed to a traumatic event. As Dr. Charles Hoge (a retired Colonel and M.D.) says in his book Once a Warrior, Always a Warrior: “Physiology is the science of how the body works, including how the brain and the rest of the nervous system functions…PTSD is a contradiction, a paradox – a collection of reactions that are both normal and abnormal depending on the situation…” (p. 2)
So what exactly is Post-Traumatic Stress Disorder? Basically, it is a collection of symptoms stemming from experiencing a traumatic event. The American Psychiatric Association has “diagnostic criteria” with which to official diagnose PTSD. A complete overview can be found HERE, through the Veterans Affairs website, but in short there are six factors:
1) The stressor: A warrior must have experienced a traumatic event where he felt that his life or others’ lives were in danger, or there was actual death; and his response included feelings of helplessness, fear, or horror. In combat, this could be a myriad of things: being involved in a firefight, being in a vehicle that was blown up or was in a rollover accident, witnessing others dying, etc. It is also important to note that what might be traumatically scarring to one person might not be the same to another. It is different for everyone.
2) Intrusive recollection: The traumatic event will be relived or re-experienced in some fashion. For example, some warriors will have flashbacks of the event, as if they were actually there again. Others will have nightmares, and still others will become psychologically distressed by a “trigger” that reminds them (even unconsciously) of the traumatic event. A trigger could be a smell, sound, dates (like the anniversary of the event), words that are spoken, or situations (like being in a crowd).
3) Avoidance/numbness: The veteran will consistently avoid situations or stimuli that remind him of the trauma, and will also experience numbness of some fashion. The official diagnosis requires that at least 3 symptoms are exhibited, so for example: the warrior could feel detached from others, have numbed emotions (like being unable to feel loving or sympathetic), and make the effort to avoid conversation or recollection of the trauma.
4) Hyper-arousal: The warrior’s senses and reactions to stimuli will be extremely heightened and at least 2 of these symptoms must be present. So for example, he could have outbursts of anger and have trouble sleeping, or be hyper-vigilant and suddenly startled by seemingly minor things.
5) Duration: Symptoms from #2, 3, and 4 must persist for more than one month. It is normal upon returning from combat to experience disturbed sleep, hyper-vigilance, and angry outbursts. These things are what kept the warrior alive in the combat zone, and so they are completely normal to experience in that environment! But once they come home, reintegrate into civilian or garrison life and these symptoms continue for more than one month or so, it becomes abnormal.
6) Finally, these symptoms must cause marked distress or impairment. Oftentimes the wife or loved ones will be the first to notice that something is “off,” partly because they are the “soft targets.” They get blamed for problems, they get yelled at, they are the ones who have to endure the warrior’s hyper-vigilance and avoidance of normal situations such as family gatherings. The symptoms also may cause impairment on the job.
According to the Wounded Warrior Project, approximately 400,000 veterans of the Afghanistan and Iraq wars suffer with Post-Traumatic Stress Disorder. But how many of us realize this fact? It is one of the “invisible wounds of war,” along with Traumatic Brain Injury (which I wrote about here and here). It’s not something that we can see, yet invisible wounds are just as valid and hurtful as the wounds we can see.
While there is no “cure” for PTSD, it is possible for healing and progress to take place. Many veterans will struggle with PTSD in some degree for the rest of their lives, but they still have hope for a bright future and a full, fulfilling life! Next Monday we will explore this aspect and what kind of healing resources are available.
On Combat: The Psychology and Physiology of Deadly Conflict in War and in Peace by LTC Dave Grossman
Once a Warrior, Always a Warrior by Charles W. Hoge, MD, Colonel (Ret.)
www.ptsd.va.gov – the Veterans Affairs website on PTSD