Post-traumatic stress disorder

Even in the age of the cruise missile and the M1A2 Abrams tank, no matter how destructive military equipment might become, little can be achieved without the contribution of individual soldiers on the ground. Whether holding key terrain or resupplying combat units, today's soldiers are at risk from the same threats American soldiers faced two hundred years ago.

Technology has improved our weapons systems and their destructive capabilities, but it has done little to improve the human body's ability to take a bullet or to absorb the energy of an explosion. Similarly, technology has done little to improve the human mind's ability to assimilate and deal with trauma, and the trauma of war has certainly not changed over the years. Just as in the wars of America's past, the loss of a fellow soldier, the terror of combat, or the emotional pain of killing another human being is an experience faced by many soldiers in today's Army. The emotional trauma of combat that soldiers experience often results in post traumatic stress disorder (PTSD).

Barely a year after the first troops returned from Operation Iraqi Freedom, signs of PTSD became apparent everywhere and are quickly becoming a problem for leaders throughout the Army. With soldiers preparing to depart from or deploy to Iraq, a basic knowledge of PTSD will become increasingly valuable and necessary. Much like the body armor that protects a soldier's body from the impact of battle, knowledge of PTSD will help soldiers cope with the emotional and psychological impact of battle.

Although a relatively new term, PTSD has been around for many years. During the civil war, it was called "nostalgia," and it was believed that the soldier's strange behavior was caused by an intense desire to return home. During World War I, it was called "shell shock," and considered a disorder of the central nervous system brought on by the constant shelling and explosions of trench warfare. In World War II, it was thought that soldiers experienced "battle fatigue," a short-term response to the conditions of the battlefield. The typical treatment for a soldier was seven days away from the front line followed by return to duty. It was never considered to be a long-term problem, although in World War II, American fighting forces lost 504,000 men to psychiatric collapse, or "battle fatigue."

In the years following World War II, even those who had no symptoms during the war and had been discharged from the Army in good health, began showing up at veteran's hospitals with the same symptoms as soldiers discharged with battle fatigue. Vietnam veterans seemed to be affected by this syndrome to an even greater extent. It was estimated that one-third of Vietnam veterans suffered from what we now call PTSD. (2) Little was understood of this problem, and treatments seemed ineffective. It was not until researchers noticed that survivors of plane crashes, natural disasters, and terrorist acts displayed the same symptoms that progress began to be made. In 1980, the American Psychiatric Association included PTSD in its Diagnostic and Statistical Manual Hl, the standard book used to diagnose emotional disorders.

The National Center for Post Traumatic Stress Disorders defines PTSD as "a complex of distressing emotional reactions that can follow the experiencing of any kind of traumatic event, such as an accident, severe illness, natural disaster, rape, or combat." (3) It can occur both during the traumatic event, in the form of a breakdown, or after the event, by which it is revealed through a number of possible different symptoms. The National Center for Post Traumatic Stress Disorder further explains that, "People who suffer from PTSD often relive the experience through nightmares and flashbacks, have difficulty sleeping, and feel detached or estranged, and these symptoms can be severe enough and last long enough to significantly impair the person's daily life. (4) These symptoms can vary from person to person and in levels of severity. The symptoms range from depression, to uncontrollable anger, substance abuse, and even problems of memory retention and cognition. For example, one soldier might feel estranged from his family upon returning from war, and another may feel the desperate need for security from his family; one soldier may beat his wile or children, and the other will distance or isolate himself from peers and family members. Often the secondary, long-term effects of the symptoms of PTSD can become the more significant problem. For example, simple symptoms, such as chronic lack of sleep, can result in poor work performance. Problems, such as substance abuse can surface and eventually dominate a soldier's life. Family problems will worsen and possibly end in injuries to the spouse or children. Seldom will these symptoms simply disappear; they must be identified, confronted, acknowledged, and treated. To aid soldiers and families who suffer from PTSD, leaders must be aware of the wide diversity of symptoms and treatments."

The National Center for PTSD explains the neurological processes of PTSD: "PTSD is associated with a number of distinctive neurobiological and physiological changes. PTSD may be associated with stable neurobiological alterations in both the central and autonomic nervous systems, such as altered brainwave activity, decreased volume of the hippocampus, and abnormal activation of the amygdala. Both the hippocampus and the amygdala are involved in the processing and integration of memory. The amygdala has also been found to be involved in coordinating the body's fear response. Psycho physiological alterations associated with PTSD include hyper-arousal of the sympathetic nervous system, increased sensitivity of the startle reflex, and sleep abnormalities." (5)

This definition may be difficult to understand, but more simply put, in a time of extreme crisis, such as combat, the human brain pushes the human body into overdrive. Anyone who has been in combat or any situation involving a heightened state of fear or stress has experienced the adrenaline rush. This adrenaline rush is an effect caused by the adrenal glands in the body manufacturing epinephrine, cortisol, and norepinephrine. (6) These chemicals are responsible for giving the human body the energy it needs for fight or flight. The human body relies on this hyper-arousal to survive. Additionally, in times of pure terror or crisis, the body might release endorphins, "natural chemicals made by the brain that resemble painkilling drugs or opiates." (7) These chemicals cause soldiers to ignore pain and give the "out-of-body" feeling that is described by many during traumatic events. This survival technique is called emotional numbing. (8) These natural reactions appear to be temporary, so why would they cause long-term emotional disorders? Some scientists believe that the combination of the norepinephrine and endorphins help us to learn quickly and permanently. (9) This "super learning" is helpful because it teaches the human body to stay alive in similar situations. Therefore, some researchers believe that this permanent lesson during traumatic situations results in the development of PTSD. Many soldiers who return from Iraq complain about jumping at loud bangs. This is an example of a permanent lesson learned in combat. The mind has connected the loud bang to a reflex, which scientists refer to as "triggers." The trigger to a loud noise is simple to understand and PTSD symptoms can be triggered by a movie or conversation that a soldier has had during the day. It is identifying these triggers during treatment that helps soldiers cope with and manage PTSD.

Like most armor officers, I am not a psychologist, nor can I even begin to understand the innermost workings of the brain and body. However, I can confirm that it does not take a psychologist to identify PTSD, and identification is the first step in helping soldiers cope with PTSD. To identify PTSD, a leader must know his soldiers and note personality or behavior changes. Obvious symptoms include frequently being late to formation or documented family problems. More insidious symptoms caused by PTSD could include internal friction in a platoon or noticeable decreases in performance.

Most soldiers will attempt to hide emotions and problems from their supervisors, especially in an all-male environment such as the armor branch. It is essential that leaders watch for and acknowledge symptoms and promptly seek help for soldiers. Chaplains are a good resource because they have extensive training in PTSD. There are also resources at all Army installations for commanders and leaders to use, particularly in Iraq. A commander can employ the use of installation psychiatrists, and most units in Iraq have access to combat stress teams. Simple classes on FFSD for soldiers and first-line leaders will assist in helping soldiers cope with PTSD. It is a leader's responsibility to seek all available resources and get treatment for affected soldiers.

There are a variety of different techniques available for treating PTSD. Once identified, the treatment will typically begin with an evaluation of the soldier. Developing a treatment plan that meets the needs of the individual soldier will follow the evaluation. There are numerous ways to treat the disorder, depending on the symptoms. One of the first phases of treatment is simply educating the soldier and his family on the effects of PTSD. This can also be done at the company level with a short class from a combat stress team. Additionally, most treatments will attempt to resolve any sort of guilt or anger remaining from the traumatic event. It is also important that specific triggers for each person dealing with PTSD are realized. Identifying these triggers will help soldiers cope with and manage their symptoms. As stated earlier, PTSD treatments vary, but it is essential that soldiers receive treatment to prevent symptoms from getting worse.

As a scout platoon leader at the beginning of Operation Iraqi Freedom I, my peers and commanders would probably have described me as someone with strong character and normal emotions, and not one to easily fall prey to any sort of "mental disorder." However, on 27 May 2003, my life dramatically changed when my platoon was attacked at a checkpoint. On that night, two of my soldiers were killed and another nine, including myself, were wounded. One would assume that my recovery was most difficult at the beginning when I was being treated in hospitals, but it was not. As my physical wounds began to close, my emotional wounds were beginning to open. Two months after returning from Iraq, I began to feel horribly depressed. What seemed like "survivor's guilt" sapped my motivation and seemed to dominate my life. I suffered insomnia, with short bursts of sleep that were interrupted by fearsome nightmares.

As my condition continued to deteriorate, I sought help from installation psychologists and slowly began to regain control over my life. Strangely, my return to combat in Iraq seemed to help my nightmares and depression. A year later, I realize the symptoms of PTSD will probably always be with me to some extent, but I have learned, with the help of trained professionals, to recognize and control my symptoms. Ignoring these symptoms will not make them go away, it only leads to more serious issues that might effect your loved ones and your career. Armor leaders should be aware that many soldiers will suffer in silence, which could have a negative impact on many things, including unit readiness. Every leader, from team leader to company commander, should know how to recognize and treat symptoms of PTSD.

PTSD it is not a new problem, it was prevalent in the wars of the past. The characteristics and indications of PTSD can have destructive effects on soldiers and their families. Even though soldiers with PTSD appear physically unharmed, they truly are battlefield casualties and must be treated as such. Leaders can help soldiers deal with PTSD--learn more about the disorder and educate your soldiers. It is our job as leaders to take care of our men, both on and off the battlefield.

Notes

(1)Richard Gabriel, No More Heroes: Madness and Psychiatry in War, Toronto, Canada, Collins Publishers, 1987. p. 4.

(2)Zahava Solomon, Combat Stress Reaction: Enduring the Toll of War, New York, Plenum Press, 1993, p. 58.

(3)Ibid., p. 55.

(4)National Center for Post Traumatic Stress Disorder, accessed online at http://www.ncptsd.org, 15 February 2005.

(5)Ibid.

(6)Kay Marie Porterfield, Straight Talk About Post Traumatic Stress Disorder, New York, Facts on File, Inc. 1996, p. 26.

(7)Ibid.. p. 28.

(8)Ibid.

(9)Ibid., p. 34.

Captain K.C. Hughes is currently an assistant operations officer, 1st Armored Training Brigade, Fort Knox, KY. He received a B.S. from the U.S. Military Academy. His military education includes Armor Officer Basic Course and the Armor Captains Career Course. He served in various command and staff positions, including tank platoon leader, C Company, 2d Battalion, 72d Armor, Camp Casey, Korea; scout platoon leader, E Troop, 2d Squadron, 3d (2/3) Armored Cavalry Regiment (ACR), Fort Carson, CO; rear detachment XO, Z Troop, 2/3 ACR, Fort Carson; S1, 2/3 ACR, Fort Carson, and tank company XO, H Company, 2/3 ACR, Fort Carson.

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