Soldiers and Post-Traumatic Stress Disorder

Traumas are defined as injuries to the human mind/body which create physiological, psycho-neurological, socio-emotional, biological and/or spiritual wounds (Paulson and Krippner 1). Individuals who suffer some sort of trauma are often times left with psychological injury in the form of “post-traumatic stress disorder” (commonly referred to as PTSD) (Paulson and Krippner 1). Arguably the greatest trauma a person can endure is to be deployed to war and away from their homes and families. While at war, soldiers often experience (or perhaps only witness) atrocities that extend beyond the abilities of any coping mechanism that they either already had in place, or have at their disposal (Paulson and Krippner 1). As such, these soldiers are left with the after-effects of war, and subsequently diagnosed with PTSD. As of November 2004, more than 8,700 United States soldiers serving in Iraq and Afghanistan were treated through the Department of Veterans Affairs (Cantrell and Dean 85). As discussed below, PTSD manifests itself in many different ways and attacks multiple systems within the body. Various treatment options are being explored to treat combat veterans suffering from this disorder, and research continues as to how best make these soldiers whole again. Unfortunately, United States soldiers returning from the traumas of wartime experience are not receiving sufficient and/or proper treatment of the devastating effects from PTSD.

Arguably the most outwardly visible and prevalent symptoms in PTSD patients are the crippling psychological symptoms that plague these veterans. PTSD patients frequently suffer from symptoms such as dissociation, anxiety, depression and severe memory loss (Bremmer 222). Many veterans experience “intrusion symptoms,” marked by recurring memories of the traumatic wartime events (either in actual memories or disturbing dreams) and flashbacks (Nathan and Gorman 153). These intrusion systems often impede the veteran’s ability to function in everyday life (Nathan and Gorman 153). In fact, they can be so painful that patients work to avoid them at all cost (Nathan and Gorman 153). Part of the avoidance process involves the aversion to maintaining close emotional ties with family or friends for fear of again losing someone else close to them, or simply because the relationships alone serve reminders of the traumatic event (Nathan and Gorman 153; Cantrell and Dean 102). PTSD patients also have difficulty overall in managing their emotions, or even formulating correct emotional responses in social situations (Nathan and Gorman 153; Bremmer 222). Sufferers are often emotionally “numb” and appear to be absent of all emotions (Nathan and Gorman 153). However, the real issue is that these veterans cannot work through the grief and anger raging below their emotional surface (Nathan and Gorman 153). The converse is also true, and other veterans sometimes experience symptoms of “hyper arousal,” where they are irritable, emotionally explosive and suffer from unexplained anger (Nathan and Gorman 153; Cantrell and Dean 85). Regardless of on which side of the emotional spectrum the veteran falls, these emotions are unhealthy and are symptoms of PTSD.

Until recently, PTSD was thought to be merely a psychological disease (Pitman 1). However, new research points to many veterans suffering from biological complications as well (Pitman 1). Certain patients suffering from PTSD experience physiological problems, including accelerated aging causing stroke, heart attack and diabetes (Bremmer 222). Further, the introduction of physical stimuli can reproduce psychological symptomatology in patients, such as the onset of flashbacks (Pitman 2). PTSD patients also experience a myriad of other biological abnormalities, such as increased sleep movements, reduced hippocampal volume and EEG shifts (Pitman 3). This new evidence should change the way that veterans are treated for PTSD.

Historically, medical personnel have not fully understood PTSD and its effect on combat troops (Cantrell and Dean 84). Vietnam veterans returned from war and were left largely untreated, turning to various destructive behaviors in order to cope with their symptoms (Cantrell and Dean 83). Following the Vietnam war, however, came the advent of new treatment options. Currently there are multiple methods currently being utilized to treat veterans experiencing symptoms of PTSD. According to Nathan and Gorman, exposure therapy is the “current psychosocial treatment of choice” for PTSD patients experiencing high levels of anxiety (154). In this type of therapy, patients are taught to disassociate negative aspects of a traumatic experience, and respond to the triggering event in a new way through re-association of it with a pleasant (or even neutral) event (Nathan and Gorman 154). Patients treated with exposure therapy have shown reduction in PTSD symptoms (Nathan and Gorman 154).

Other treatment modalities are not as effective, if effective at all. For example, eye-movement desensitization utilizes, “psychotherapeutic approaches along with eye movements to stimulate the brain’s information processing system (Nathan and Gorman 156). The studies following these patients have yielded mixed results and are generally inconclusive (Nathan and Gorman 156).

In conjunction with other therapy options, PTSD patients are also treated with prescription medicines from three classes of pharmaceuticals – monoamine oxidase inhibitors, trycyclic antidepressants, selective serotonin reuptake inhibitors and benzodiazepines. A group of veterans tested the monoamine oxidase inhibitors, and the drugs were found to effectively treat PTSD symptoms (although not particularly helpful for intrusion symptoms) (Nathan and Gorman 156). The tricyclic antidepressants have had moderate success in treating intrusion and hyper arousal symptoms, and good results were obtained in a trial in Vietnam veterans suffering from PTSD (Nathan and Gorman 157; Pitman 359). However, most recently these drugs have been most widely used on “non-combat” patients – a group that excludes the veteran population and leaves them under-served (Nathan and Gorman 157). The most successful medicine used in treating PTSD is selective serotonin reuptake inhibitors, and this drug has proven successful in treating the gamut of symptoms (Nathan and Gorman 157). In contrast, while benzodiazepines are also moderately successful in PTSD patients, use of these drugs is contraindicated in veterans because there is a high risk for developing chemical dependencies in an already high-risk group (Nathan and Gorman 157).

Despite these mixed results, and absent one clear medication proven effective in treating all of the symptoms of PTSD, only eight clinical trials have been conducted since 1988 for drug treatment for PTSD (Pitman 359). Further, according to Pitman only two drugs have been tested more than once since that time (359). This is especially disconcerting given the fact that new discoveries have been made regarding a number of aspects of PTSD, and drug research has not kept up to adequately treat these patients (Pitman 340).

Given all of combinations available for treatment options, the single biggest failure in treating our soldiers from the devastating effects of PTSD appears to be in the prevention of the disease itself. The majority of treatment for PTSD is retrospective, and in reaction to veterans suffering from the lasting effects of combat (Pitman 377). However, Pitman explored “front-line” treatment performed by the Israel Defense Force during the Lebanon War (377). According to the article, front-line treatment involved “proximity to the site of combat, immediacy of the response, and explicit expectations of recovery” (Pitman 377). While researchers initially found that soldiers receiving this front-line treatment experienced lower levels of PTSD symptoms and lower incidences of actual PTSD, this finding was subsequently disproved (Pitman 377). Unfortunately, post-combat debriefing of soldiers in Operation Desert Shield did not yield the same results (Pitman 377). The debriefing activity failed to reduce the symptoms or incidences of PTSD in British soldiers (Pitman 377). Early intervention treatment options currently do not provide relief to veterans, but research suggests that this may be because of poor treatment strategies, as well as the timing of the treatment (Pittman 377, 381). Additional research is needed, especially as it relates to veterans, to improve the effectiveness of this treatment option.

Post-traumatic stress disorder is caused in veterans because of experiences they suffer (or witness) while at war. The disorder leaves lasting physiological, psycho-neurological, socio-emotional, biological and/or spiritual marks on these soldiers and, to date, the treatment options for PTSD are only moderately successful. As a country, we owe these men and women a better course of treatment to free them from the burdens of war. Unfortunately, United States soldiers returning from the traumas of wartime experience are not receiving sufficient and/or proper treatment of the devastating effects from PTSD. However, with the advent of new research and continuing developments in the field, this will change once and for all.

Works Cited

Bremner, J. Douglas. Does Stress Damage the Brain: Understanding Trauma-related Disorders from a Mind-body Perspective. New York: W.W. Norton, 2002. Print.

Cantrell, Bridget C., and Chuck Dean. Down Range: To Iraq and Back. Seattle, WA: WordSmith, 2005. Print.

Nathan, Peter E., Jack M. Gorman, and Neil J. Salkind. Treating Mental Disorders: A Guide to What Works. New York: Oxford UP, 1999. Print.

Paulson, Daryl S., and Stanley Krippner. Haunted by Combat: Understanding PTSD in War Veterans including Women, Reservists, and Those Coming Back from Iraq. Westport, CT: Praeger Security International, 2007. Print.

Shalev, Arieh Y. "Treatment Failure in Acute PTSD: Lessons Learned about the Complexity of the Disorder." Annals of the New York Academy of Sciences, vol. 821, 1997, pp. 372-87. ProQuest. Web. 20 Sep. 2013