Wars are inarguably deadly, but what happens after can be even more so. John Aronno, writing for the Alaska Commons, states, “The epidemic of veteran suicide claims an estimated 22 military veterans every day. More veterans die from suicide every year than the total of American casualties from both the Afghanistan and Iraq wars.” This stunning statistic serves to display the severity of one of the most common, but least talked-about mental illnesses: Post-traumatic Stress Disorder, or PTSD. PTSD can be troublesome for some and debilitating for others. Many testimonies have been given by veterans who have suffered from PTSD. They tell of veterans’ struggles with the disease treating its symptoms. Our military veterans are perhaps the most vulnerable to PTSD, and, for all they have given for this country, they deserve medicine, therapy, and other treatment that is effective in fighting their symptoms. Unfortunately, there are often many obstacles that prevent veterans from getting the care they need.
Post-traumatic Stress Disorder is a mental illness that can be caused by a variety of experiences and presents itself with myriad symptoms. PTSD is a psychological condition officially added to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) in 1980. The condition was long thought to be caused by a “weak mind,” especially for soldiers on the battlefield (Gould, 506). The addition of PTSD to the DSM-VI marked a shift in paradigm in the psycho-medical field that stress-related mental illnesses are legitimate health problems. PTSD is found in patients who have experienced a near-death – or otherwise threatening – events themselves, witnessed the event second-hand, or even learned of such events. For veterans, those experiences are often tied to combat (IED explosions), but are also often tied to sexual abuse or assault, especially for women. It has been estimated that around 11-20% of veterans from operations Iraqi and Enduring Freedom have PTSD (“How Common Is…”). The way veterans’ brains react can cause a wide variety of symptoms. To be diagnosed with PTSD, the DSM-VI requires that a patient exhibit intrusive memories of the event (often in nightmares or flashbacks), avoidance of trauma-related thoughts or reminders, increased negative thinking (such as a loss in interest of hobbies the patient once found enjoyable, or being isolated), and trauma-related reactivity – such as aggression, heightened reflex response, or difficulty sleeping (“PTSD and DSM-5”). In addition, these symptoms must have persisted for a month or longer before the diagnosis is made and cause significant impairment of typical daily activities (“PTSD and DSM-5”). So, when people outside of the military, or those who have personal biases against issues pertaining to mental health, claim that PTSD is only veterans feeling sorry for themselves and they feign mental insecurity to get government money, they grossly misunderstand the gravity of the symptoms felt by victims of PTSD. PTSD is not an excuse to get government money or pity, it comprises a very serious set of symptoms that affect every facet of a veteran’s life. The wife of a veteran tells the story of her husband’s battle with PTSD after returning from the battlefield. Her husband had deteriorated overnight from a normal, functioning adult, to “someone whose hands tremor so badly he cannot tie his own shoes and has night terrors so vivid he is often hoarse the next morning” and braces himself for impact every time something as small as a pebble hits the bottom of their car (Nolan). The victims of PTSD live with a condition that forces them to relive the most horrible experiences imaginable, over and over again. It is important to note that, while PTSD is the most diagnosed mental illness in veterans (Ramsay et al. 332), not everyone exposed to trauma develops the disorder. Fewer than ten percent of trauma survivors actually develop PTSD in their life (Nevid, 379). Veterans may be particularly vulnerable because of the intensity of the trauma they experience, and because they are often repeatedly exposed to that intense trauma.
Even though members of the military experience some of the most devastating trauma imaginable, the community they are placed in is one of the least conducive to issues of mental health. Because of the tacit social norms within the Armed Forces, veterans often have a hard time admitting to their struggles with PTSD, or even realizing they have it in the first place. A study done by the RAND Corporation found that less than half of the veterans of operations Iraqi and Enduring Freedom who had PTSD had sought medical help (Tanielian et al., 435). This is simply reinforcement of what was already known: the mindset within the military that weakness is unacceptable can serve as an obstacle between veterans and treatment years after their deployment is over. This is corroborated by a study published in the Journal of Applied Social Psychology. The study found that, in the military, admitting to a psychological problem was more stigmatizing that admitting to another medical problem and that service members felt admitting to a mental issue would jeopardize their job (Britt, 1599). Veterans are intimidated by the public stigma about mental health. They fear being humiliated and isolated; they fear losing their honor.
Despite PTSD being a legitimate health issue, it often goes undiagnosed in primary care. Patients will often come to their primary care physician with complaints of a pain or other somatic (specifically relating to the body) symptoms. Because of PTSD’s propensity to cause strong avoidance of trauma-related discussion, patients may omit information about a traumatic event, or even deny that any event took place at all. Physicians do not consider PTSD as a cause for obvious reasons: they have no idea any trauma took place. A case study was done by Dr. Adrienne Williams at the University of Illinois at Chicago of a patient referred to as DeSean for his privacy. DeSean reported a burning sensation in his chest to his physician. He had already tried over-the-counter remedies, but nothing was working. The patient was also worried, despite the assurance of the clinic, that he had contracted an STD, but denied any extra-marital sexual activity. DeSean actually had PTSD, caused by a sexual assault at a bar months before. The study states that because of the avoidance PTSD causes, patient may deny to themselves that their symptoms are related to their trauma (Williams, 620). The study also points out, “overlooking PTSD as a possible source of symptoms can result in misattributing them to other causes” (Williams, 620). This should come as no surprise. PTSD has massive psychological implications, and those implications manifest themselves in many ways, but, if the correct source of a symptom is not established, clinicians’ attempts to alleviate them will be of no use. Veterans have the added difficulty of the social conditioning discussed above: weakness is not an option.
For many veterans, the only affordable primary care provider is Veterans Affairs. The VA – an organization which has the core purpose to help veterans with their military-related issues – can often be another obstacle between veterans and speedy, healthy, effective treatment. One of the most shocking stories is one briefly mentioned earlier in this paper. When a veteran – who is called DJ for privacy’s sake – was brought to the VA office, he was in bad shape. The doctor recommended residential treatment, and DJ was flown to a different facility. The psychiatrist there diagnoses DJ with PTSD and bipolar disorder (the latter of which DJ does not present symptoms of). The medications DJ is taking are not improving his condition, and when DJ and his wife mention that to his psychiatrist, DJ’s dosage is doubled. After a few days, it becomes apparent that every one of the psychiatrist’s patients has the same diagnosis and the same medication. DJ’s wife asks that DJ is reevaluated by a different doctor. While DJ is under evaluation, DJ’s wife overhears DJ’s last psychiatrist ranting about how she is a “yappy cur” who should stay quiet (Nolan). In the end, DJ’s wife reports that it took nine years in the VA for DJ to really get help. Another veteran explains how he was denied disability status for his PTSD because Veterans Affairs found his ailment was not tied to his time in service (Nolan). Of course, these story in no way represents the entirety of Veterans Affairs, but it reveals an important truth about the VA. There are lots of veterans from this past decade’s wars, and the VA has to try to keep up. That may mean rushing to hire doctors, or stretching their existing doctors extremely thin to treat most of their patients. It mirrors the problems of many other government agencies: regulation and scale often stifle productivity.
When veterans are finally able to overcome these obstacles and get access to a reliable clinician, they can find effective treatment. There are drugs known to be effective in reducing the symptoms of PTSD, but some should be more strongly considered for veterans than others. Antidepressants are often prescribed for PTSD. Prozac, Paxil, and Celexa are common forms of SSRIs. They can relieve insomnia, depressive moods, panic attacks, and other symptoms related to PTSD (Beckner et al., 132-133). Selective serotonin reuptake inhibitors (SSRIs) are one of the most recent and effective combatants against the most debilitating symptoms (Beckner, 133). Although they sometimes have side-effects such as nausea, dry mouth, and sexual dysfunction, SSRIs generally have fewer, and less dramatic side-effects than other popular antidepressants, like tricyclics and MAO inhibitors (Beckner, 134). Side-effects of antidepressants are usually more intense in the beginning of the patient’s use of the drugs, but will fade in time. Thus, it is important for veterans to be warned of this by their physician, to maintain consistent usage (Beckner, 134). At the end of the day, it is imperative to remember that each drug is unique, as are the patients they serve. Finding the most effective drug for each patient is the best way to treat some of the symptoms of PTSD.
Not all drugs are as safe and effective as the antidepressants listed above. Benzodiazepine drugs (e.g. Xanax and Ativan) are mild tranquilizers often prescribed to reduce stress related to disorders like PTSD (Beckner, 135). The drugs are popular because, unlike antidepressants, they provide immediate relief to symptoms. Unfortunately, usage over time reduces the effectiveness of the drugs, and a higher dose is often required to produce the same results. In addition, these drugs can be highly addictive (Beckner, 135), which makes them a poor option for veterans who already struggle with substance abuse as well as PTSD (Williams, 620).
Drugs can provide some relief from the symptoms of PTSD, but they will never achieve remission for veterans. As Doctor Williams states, “medications have helped relieve some symptoms of PTSD. However, medications are not recommended as first-line treatments” (622). Even though a veteran might feel better after beginning a comprehensive medication regiment, drugs should always play an “auxiliary role” to therapy by a psychologist (Williams, 622). Psychodynamic therapy is not too dissimilar from what may immediately come to mind when thinking about psychological therapy. It usually involves a psychologist asking the patient about their trauma experience, and the symptoms they face as a result (Nevid, 529). This type of therapy is widely available, and combats the avoidance that PTSD can create surrounding the trauma, but avoidance is not the only symptom of PTSD. To more effectively neutralize anxiety felt when veterans are exposed to reminders of trauma, systematic desensitization is often an efficacious option. This method of therapy would gradually expose each veteran to the triggers that most often set off their symptoms, working from triggers causing the least stress up to the most stress-inducing triggers (Nevid, 532). This method gradually disassociates the triggers from the trauma in the veteran’s mind. Other methods, such as group therapy or even such novel methods as Eye Movement Desensitization and Reprocessing, are also used to fight the source of stress-related disorders, like PTSD. Therapy methods like these are vitally important to the remission of veterans. Research shows that when mental illnesses are treated, patients show greater improvement than eighty percent of those who did not receive treatment (Nevid, 539). Therapy, with a supporting role from medication, can help veterans achieve remission.
Therapy to treat PTSD is vital, but one or two sessions a week of fighting the mental illness is often not enough if veterans return to the same deleterious lifestyle the other five or six days of the week. Lifestyle changes can greatly improve veterans’ mental condition. Doctors Victoria Beckner and John Arden in their book, Conquering Post-Traumatic Stress Disorder, explain, “even though it can be difficult to reach out to others, we cannot emphasize enough how much social support, friendship, and love are essential to your well-being” (157). The times when veterans are most prone to pull away from their loved ones are often when they need social support the most. Social interaction combats the withdrawal from family and friends many veterans experience existentially. When veterans feel down on themselves, their family and friends can be there to lift them up. When veterans get stressed out, their loved ones can be there to calm them down. Veterans can also yearn for the purpose that the military gave them during their time of service. The best option is find something that will give them fulfillment, and satisfy that appetite. Veteran Diego Camargo found fulfillment in photography, after struggling with PTSD and hungering for a sense of purpose after his service was over (Amias). Programs have also been set up for veterans to get involved in activities like rodeo and shooting sports. The most important aspect of all these lifestyle changes is that they take the negative thoughts produced by PTSD, and replace them with productive, positive ones.
Many veterans will deal with PTSD at some point in their lives, but it does not have to control them. PTSD is a debilitating disorder often caused by the rigors of war. Sometimes veterans with PTSD may not even realize they have the disorder, or outright deny to themselves or others that anything is wrong with them. Once veterans do decide to seek help, however, they have a variety of solutions at their disposal. Medication can relieve veterans of the sometimes-crushing symptoms of PTSD, and begin to live normal lives again. Therapy can systematically reshape thought-processes that contribute to PTSD, and begin veterans on their road to remission. Most people know perhaps one person who has served in the armed forces, perhaps many. If those people watching from the outside know the signs of PTSD, and the struggles veterans face, they can be equipped to help those veterans find the help they need to live productive, fulfilling lives. Regardless of that benefit, spreading awareness of the disorder, and its impact on veterans, can reduce the public stigma around PTSD, and encourage veterans to seek help. The first step in fixing an issue is admitting you have one, as it is often said.