SPECIAL SERIES : The War Issue
Experts Say Combat Soldiers Prone to Mental Trauma
More options for soldiers with Post Traumatic Stress Disorder
March 12, 2006 4:25 PM
Don Lau is what some might call a renaissance man. The alumnus of SF State and Golden Gate University, where he received his law degree, currently works as a free-lance computer consultant and tech writer.
But Lau has more than just this on his plate.
Day in and day out since returning from the Vietnam War in 1969, he has dealt with a gnawing mental disturbance, a condition called Post Traumatic Stress Disorder, which resulted from the trauma of living in a combat environment.
“I had it, but I didn’t understand what it was, there wasn’t a term until some decades later,” he said.
Formerly referred to as “shell shock” when seen in soldiers, the disorder encompasses a number of different mental disturbances as a result of experiencing trauma. The diagnosis of PTSD was first introduced in the Diagnostic Statistical Manual or DSM, a diagnostic reference for doctors, in 1980. This paved the way for a more appropriate approach to treatment.
In order to receive a diagnosis of PTSD, the individual must have experienced a traumatic and life-threatening event, said David Gard, an assistant psychology professor.
This event can be an accident, disaster, or violent crime involving injury or death. Any life-threatening situation, or witnessing a situation involving injury or death, can result in symptoms of PTSD.
It has been more than 30 years since the United State’s official pullout from Vietnam in 1973, and even those who escaped seemingly unscathed, bore the scars of PTSD, which affected about 15 percent of all male Vietnam veterans according to the National Center for Post Traumatic Stress Disorder. These soldiers returned at a time when treatment was insufficient and a stigma of weakness was associated with seeking help.
Today, veterans returning from Iraq and Afghanistan are seeking mental help early and at unprecedented levels, which bodes well for recovery, but will also have a tremendous fiscal impact on the Veteran’s Affairs Administration, or VA.
“To see 31 percent of soldiers seek mental help is unprecedented,” said Keith Armstrong, a clinical professor of psychiatry at UCSF, and social worker at the San Francisco Veteran’s Affairs Medical Center.
This figure was demonstrated in a 2003-04 Journal of the American Medical Association study, which followed more than 200,000 returning soldiers from Iraq and Afghanistan.
There are 1.2 million troops who are rotating in and out of Iraq and Afghanistan, meaning that a couple of hundred thousand will require mental health help if the figure of 31 percent proves to be representative, according to Armstrong.
“(This figure) looks like a fairly big problem, although it’s hard to know the exact impact," he said.
There is less of a stigma attached to seeking help today than there was 30 years ago, said Gard.
According to the VA, 20 percent of all returning Iraq soldiers seeking care do so for mental health reasons. Between 2002 and 2005, 19,000 veterans were seen at VA’s nationwide, and 17 percent of those were diagnosed with PTSD.
Returning soldiers may not immediately realize that there is anything wrong, according to SF State broadcasting professor and Vietnam veteran, Rick Houlberg. PTSD can be an underlying problem that suddenly surfaces after the individual has already re-assimilated into his or her life.
Like most PTSD sufferers, Lau's personal relationships immediately began to suffer after his return. While attending SF State, his relationship with his girlfriend became a struggle.
“I had nightmares,” he said. "She would say, ‘What’s the matter? You're home, the war’s over.’”
This disconnect led to their eventual break-up.
Lau describes his return as a homecoming in which he was not accepted in any sense of the word. Although he now receives medical care through the VA, he was deemed not eligible at the time of his return, and so he relied on the free Haight Ashbury Clinic and Kaiser while he was employed.
According to Armstrong, the VA has made tremendous strides in providing mental health care in the last 20 years.
“It used to be that they did a bad job of providing care,” said Armstrong. “There were very few mental health interventions,” he said, adding that diagnoses often were for schizophrenia and anti-social behavior disorder.
According to Houlberg, PTSD is usually resistant to only one form of treatment, and responds better to multiple approaches including medication and talk therapy.
According to the National Center for Post Traumatic Stress Disorder, up to 8 percent of all people will have PTSD at some point in their lives.
Although, treating combat-related PTSD is more difficult than other forms because it does not stem from a single event, rather a prolonged series of traumas, Armstrong said
The symptoms of PTSD are often seen in conjunction with other mental disorders, as well as addictions.
According to Armstrong, sufferers deal with arousal, avoidance and intrusive symptoms.
Arousal involves inability to fall or stay asleep, nightmares, irritability, anger control problems, and constant scanning for threats.
Intrusive symptoms include powerful disturbing thoughts and flashbacks, although Armstrong said, this usually does not mean the person believes he is actually in a different time or place, as some people commonly perceive flashbacks.
Avoidance can manifest itself in emotional numbness, as well as agoraphobic and evasive tendencies, which are used to protect the sufferer from a perceived threat, or emotional trigger.
"I hated ‘Nam, I hated being there, but I'm proud of my service, and I have all of my extremities, which is nice."
Armstrong believes that veterans of the current war may be particularly vulnerable to mental disturbances.
“There are a lot of unprofessional soldiers from the National Guard and reserves, and they weren’t expecting to go to war," he said.
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