PTSD - a reminder

Tim Russert was on Imus this morning, and they briefly discussed PTSD as it relates to our returning veterans from Iraq and Afghanistan. I'm glad the subject got a little notice, but as usual, the MSM guys got it wrong. Their concern was that huge numbers of guys (and gals) would be returning with PTSD, and the military was trying to sweep it under the rug.

Sorta partly true maybe. A large percentage of our returning forces will have temporary adjustment symptoms of varying severity. It only stands to reason. Being away from friends and family is an adjustment, as is the return. Moving to a different country is an adjustment, as is the return. Even without the stressors peculiar to wartime, there are difficulties.

Mortal danger, whether intermittent or constant, creates body changes, starting with cortisol levels. The more danger, the greater chance of symptoms. Witnessing horrible events creates conflicts and dissociations. The more horrible, the greater chance of symptoms.

But most symptoms are temporary. A returning vet has been in a situation where mistakes mean death, so he can be very impatient with family members and coworkers who take what he considers to be a lackadaisical attitude to errors. Those who have had to be alert to subtle signs in the environment tend to be hypervigilant at first when they return from a war zone. They scan the horizon, they notice sudden movements in crowds, they find it hard to get to sleep because there is no one on guard. Their startle reflex can be on a hair-trigger.

Most symptoms recede in the first few months. Nightmares are usually the most persistent symptom, and can go on for years intermittently. C.S Lewis, who was in the trenches in France in WWI, said on the eve of WWII that he still had nightmares of the war, and didn't know if he could go through it all again. Lewis was a successful, clear-thinking individual with fewer than average neuroses - the chronic symptom of what we now know as PTSD did not stop him from having a normal life. But the pain was real.

It is important for those who have symptoms, and those around them to be aware of this reality. Most veterans, even those who have seen combat, will return to normal productive lives, with no more than their share of the difficulties that are the lot of mankind. But disturbed sleep, nightmares, and idiosyncratic irritability and triggers may persist. For some few - less than 10% - the chronic symptoms will be enough to seriously interfere with later life. As with any trauma, why some weather it and some are overwhelmed remains somewhat puzzling. We do, however, know a bit more about risk factors and protective factors than we did. Substance abuse makes things worse. Having a supportive network helps. Seeing more death is a higher risk factor. Having a religious community is a protective factor. None of these should be the least surprizing.

The people I speak to on the mental health side of the military don't seem to be sweeping anything under the rug. They very much want to be proactive, letting the returnees know what to expect and what the normal course of symptoms are. They also seem to be quite concerned about how spouses and children are taking all this. Whether any of this good intention is making its way to those who need it I can't say. Some will resist help, perhaps; some who are supposed to bring intelligent support will bring their pet theories instead and create harm. It's one more sacrifice the military offers on our behalf.

One of the local VA psychiatrists who is deeply involved in managing the return told us: "The country in general, and the military in specific, got it wrong thirty-five years ago. We want to get it right this time." He pointed out that Vietnam veterans groups were among the most dedicated and passionate volunteers for the current returning vets. I asked (from the audience) what he would most like to see change. Some folks aren't going to like the answer. I paraphrase:

"Most of the guys I see who have returned were in the guard. The thing they mention most often in the first few weeks is the inaccurate reporting of the war. They feel doubly separated from the people at home. Not only do we not know much, but what we do know is wrong. One of the things that ticks them off is people who think the only good thing that happened is that they came back alive and unwounded. That they did anything history-making, or even useful, is beyond the grasp of some people. I think it's a way of robbing them of their worth as human beings. People's politics make them blind to real human beings, and to the real good that has been accomplished."

This from a man who quite openly said he didn't think we should have gone to Iraq. But he has kept his sanity and plain sense, and has not refused to see the balancing factors. Would that others who opposed the war could be so human.