Context:
The unhappy effects of Post Traumatic Stress Disorder on the future social fabric of the United States can hardly be overestimated.  Recently, the journal Military Medicine has featured several articles on the condition; the news is full of stories about servicemen who are receiving inadequate care (or the shaft) in regard to treatment of all kinds.  Last of all, the current conduct of our military engagements are guaranteeing that this disease will increase in incidence and severity among the populace. 

Psychiatric disturbances have always been the stepchild of American health care.  For the military, PTSD, like all diseases, demands to be treated as part of the social compact the state has with its military personnel (e.g., the Veteran’s Adminstration).  Yet it has proven difficult to isolate the need for treatment from a military culture-inspired demand for mental toughness.  Furthermore, most treatment methods are at odds with very real issues of tight security.  This ambivalence toward treatment has tended to lead to a poor psychiatric treatment policy. 

A PTSD sufferer meets many barriers to treatment, and those in the military have extra barriers.  First, the sufferer often finds it difficult to ask for help. Second, a diagnosis of PTSD adversely affects perceptions of the affected individual’s fitness for combat, promotion, further service, and other reputational issues.  While this might be appropriate for the short-term, it penalizes the sufferer’s reputation and career over the long-term.  Third, the circle of appropriate people to discuss issues with seems to be very small, given the nature of the experiences that need to be explored.  

Incidence, studies, and amateur definitions
 A transcription of the official Diagnostic Standards Manual (DSM) definition of PTSD is available here.  What follows is my impressions in lay terms and a few beginning statistics to look at:

PTSD affects people who have been under traumatic stress of all kinds.  The Harvard Mental Health Letter cites studies of general populations that PTSD results from adult sexual assault or repeated child abuse, neglect, and sexual assault, combat stress, and other factors.  Furthermore, people of high IQ are more likely to suffer PTSD. 

From what I understand, this stress disorder usually is composed by one or more of the following: a moral dilemma and accompanying guilt; personal injury; personal exhaustion in that environment of high anxiety and stress; repeated physical violation or sensate exposure (unlike the movies, to smell, touch, see, witness, be the victim of) horrific events. 

In sum, I would say that individuals with PTSD have experienced life events that overwhelm the conventional physical and moral fabric upon which we can generally rely.  The result is a kind of mental exhaustion, from which repeated additional stressors never allow one to fully recover.  Instead, one continues to borrow strength and will, calling up extra psychic and spiritual reserves.  Eventually, those reserves diminish, leaving one with less strength to call upon for mental healing in the long term.  In other words, a person who suffers this disease is also left with less resources to fix themselves, and depression, mental exhaustion, and a lack of connection to society results.  The severity of the disease becomes more marked as its sufferer meets repeated misunderstanding, denial, platitudes, and uninformed assumptions, because it increases the disconnect with society at large. 

There is considerable belief that combat-related PTSD, however, has special characteristics and intensities that require slightly different responses than other types of PTSD. 

In April, Military Medicine found in a small sample of VA patients (120 persons) that Iraq and Afghanistan veterans had a 12% rate of PTSD and a 33% rate of alcohol abuse; 56% of these veterans had tried to access mental health services. In May, Military Medicine found that a small sample of deployed health care providers, somewhat removed from physical risk, have a 9% PTSD rate and another 5% diagnosable depression.  The sample of 102 questionaires had a return rate of 36%.  In all of these studies, given the military’s ambivalent attitude toward mental health, incidence may well be higher. 

We can expect increased incidence
Many studies suggest that longer deployments for servicemen in combat situations or others in high-stress conditions tend to raise both the incidence and severity of PTSD.  Given that our military is being deployed in Iraq and Afghanistan for longer tours, with less rest periods inbetween, we can expect a greater number and percentage of these dedicated people to suffer from PTSD. 

A course of action?
So it seems to me that we need to be ready for this wave of suffering and rise to meet it.  This will require more attention by voters to the disposition of resources to the Veterans Administration; a greater attention to military health policy, including research, treatment, outreach, and settlement; increased substance-abuse programs, for alcohol and other substances or media; and a more active interest overall in the social components of the wars (as opposed to the political machinations) in Iraq and Afghanistan.

We can do this for the most selfless and compassionate of reasons, but frequently that isn’t enough to affect comprehensive changes.  So here are others:  the number of combat-related PTSD sufferers are intelligent, trained, and disciplined individuals who could be engaged and constructive members of society.  A failure to treat this illness means that we cannot access their full talents, and often means we must approach the consequences of their loss: alcoholism, violence, drug abuse, homelessness, and other social ills.  As long as these veterans are unable to participate in the political, social, and economic aspects of our society to the fullest, our society fails to reap their contribution. 

With Vietnam, many veterans met outright hostility in their road to post-war adjustment.  With Iraq and Afghanistan, the good-natured indifference has been sufficiently blatant to reach almost that level of barrier to re-entry.  We have intentions: we do not have concrete actions.  Our veterans will be able to tell the difference; ultimately, we will too.

In short, society at large needs to make an attitude adjustment at least as great as that of the PTSD sufferer in order to bridge that divide.  Part of that bridge could be activism: in order to affect military culture through insisting to our elected leaders that this public health shortfall be addressed immediately, compassionately, and without ambivalence.

Related reading:
PTSD Combat Blog helps inform Veterans with PTSD
See Military Matters page for PTSD references cited in this post.
2003: Iraq deployments to last at least one year
2006: Iraq deployments and tour lengths extended
2007: Gates vows to fix mental health system
2007: Gates says extending 15-month deployments further a worst-case scenario

Disclaimer:
I am not a medical professional.  I have not formally studied psychiatry.  No one should rely on this post for medical advice, therapy, or prescription: if you have PTSD, please keep looking, as long as it takes, to find an appropriate medical professional.  If that’s not within the VA system, it’s still worth doing for the sake of your future. 

And if anyone wants to know more about PTSD, there’s a lot more on the internet.  I will also be posting more on this issue. . . . I’ve been interested in it for a long time.

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