For everything we hear about it, Harry Croft writes, many of us still don’t know enough about PTSD.
Today, millions of Americans feel their lives have gone terribly wrong, but they don’t know why. Statistically, if they are veterans, it is likely that many of them have Posttraumatic Stress Disorder, or PTSD. And those statistics are quite daunting: there are 18 suicides everyday of veterans returning from the combat zone, and it is estimated that 1 in 5 soldiers will be impacted by PTSD in one way or another.
For many people affected by PTSD, the symptoms of the disorder are unrecognized, simply because they may have been present for so long that those who suffer with it—as well as their families, friends, and co-workers—have come to accept their posttraumatic behaviors as normal for them. Many Vietnam-era veterans became aware of their symptoms almost immediately after their return home from the war. But others, including many of the veterans of the Iraqi and Afghanistan wars, suffer a slow kindling of the disorder, in which the process starts slowly and worsens as time goes by, producing more and more severe symptoms. Known as late onset PTSD, it builds with time and chronic exposure to multiple traumatic stressors and multiple deployments.
Still others, it is now known, had PTSD before they even enlisted. During periods when recruitment requirements were pressing, waivers of the traditional standards for enlistment were conferred, in order that many might be permitted to volunteer. Today’s volunteer military became a Mecca for young men and women seeking to leave social environments and family lives marked by abuse, neglect, drugs, or domestic and gang violence. But this emotional baggage continued to burden them throughout their military careers and made it more likely they would develop combat-related PTSD.
Whatever their personal situation, many veterans and their families have learned over the years to shape their lives around the illness in ways that were usually intended to gloss over and deny the major impact it was having upon them. The illness has made them strangers to their families and—what is worse—strangers to themselves.
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Here are some of the common signs and situations where PTSD typically shows up:
- Marriage and family relationships. If there’s one symptom that impacts families and marriages more than any other, it’s irritability and sudden, unexplained anger. It’s the hair-trigger temper, the intolerance for even the smallest of problems and the determination to make major issues out of minor ones.
- Absent from major life events. A veteran suffering from PTSD will often have trouble with crowds and miss special occasions such as weddings, graduations, birthdays, reunions, funerals, etc.
- Trouble on the job. PTSD can cause a veteran to have trouble with memory, concentration or clear thinking. It may cause states of hyperarousal or hypervigilance which leads to workplace distractions. PTSD sufferers may also feel “over-controlled” by a boss which can render them more vulnerable to stress reactions on the job leading to increased absence or disappearance from their work station.
- Self-doubt. Warriors with PTSD will doubt their skills, the sufficiency of their actions in combat, and the correctness of the life-death decisions they have made. They doubt the value of what they themselves have sacrificed, whether it was right to go to war, if they acted properly by firing or not firing their weapons and they doubt their role in their own families, communities and their units. They also doubt their very acceptability before God.
- Re-experiencing the traumatic events. Flashbacks, recurrent nightmares and undesired recollections and thoughts; emotional and body reactions to smells, sounds, sights and internal physical feelings; intense distress at exposure to things or events that are in some way similar to the traumas that were actually experienced.
Returning to normal everyday life for a veteran impacted by PTSD is extremely difficult because anything can potentially trigger a violent and terrifying flashback. Give your spouse or partner as much support as needed, but also know when to back off and not force anything on them.
Look for local support groups in your area. Trying to cope alone makes it much more difficult. Also make sure you are working with a qualified psychiatrist and/or psychologist who specializes in combat related PTSD. It’s also especially important to restrict alcohol consumption because alcohol will intensify PTSD problems, not help it.
Whatever their personal situation, many veterans and their families have learned over the years to shape their lives around the illness in ways that were usually intended to gloss over and deny the major impact it was having upon them. The illness has made them strangers to their families and—what is worse—strangers to themselves.
As difficult as it often is for people to explain why they are different now, it is rarely difficult for them to remember what they were like before. Often, the memories of what life was like before PTSD developed provoke tears and recollections of a way of being and of living that have slipped like sand through the fingers of affected people and disappeared.
Just because PTSD has become a common term doesn’t mean that people are any better informed about it now than they were forty years ago. At best, most members of the public are familiar with one or two common symptoms of the illness. But that is certainly not an adequate base of knowledge to tell if a person has the condition.
The bottom line: if you are a veteran and start to see some changes in your life and even suspect it could be PTSD, seek help immediately.
—Photo familymwr/Flickr
About Harry Croft M.D.
My father was an Infantry platoon leader in the ETO. Some of his experiences stil bother him. We have an elderly neighbor who fought in the Phillipines. When he talks about what the Japanese did to civilians and prisoners, he can hardly speak.
Would this be considered PTSD?
Do we have an expansion of the definition? Or are we talking about something other than being bothered all your life?
Like to see the cite for the eighteen suicides a day.
I believe that the 18 Suicides per day figure comes from the Rand Corp Study “Invisible Wounds of War Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery” – 2008.
Most interesting for “future attention” and to be placed on “watch lists” is the content of the CDC report “National Intimate Partner and Sexual Violence Survey” 2010 – see page 100 of the Full Report
Which Future Publications?
Why the Bias in that subgroup to only “female active duty military and female spouses of active duty military.”?
Who decided on that “Odd” sample and the sex bias?
Are female Vets or Female active duty military immune from being the Perpetrators of “Intimate Partner and Sexual Violence” against their partners and spouses – what ever the partner or spouse’s sex?
Military Personnel + Intimate Partner and Sexual Violence Survey + Female Bias + PTSD?
Call Me Cynical….. – but it’s been seen before – so I do fear that in the near future there will be yet more Hyperbole around rape and PTSD – and the agenda, politics and focus will get shifted away from Male Vets and Male active duty military where the higher costs are – both personal and financial.
The CDC report was famously delayed Twice for publication due to Political Fighting – so I do expect that any awaited reports from unpublished data will be subjected to the same Political Fighting which is all too often linked to the Money and where it goes!
Back in WW II it was called shell shock.
Then around the Vietnam era it came to be called combat stress disorder.
Now we call it PTSD.
My point being that the original terms were more honest about the cause
and thus hence the effect.
It seems that changing the language does indeed change perception.
Incidentally,for those that apply for PTSD disability,roughly %80 of those applicants are denied.
For the small minority that doe get a disability for that reason along, it is a partial disability (%10) and pays a huge $100 US per month.
(note that being disabled means not being able to work in a full functioning or paying manner)
Indicating loss of income and the resultant loss of wife and children in addition to avocation.
Yes, there is a lot to hide
*Combat fatigue disorder
I found this piece very well defined – and I do welcome the correct use of the term “Re-experience” rather than the misleading “Flashback”.
That Flashback term always implies the Hollywood and Media myth of it all being visual, when the “Re-experience” can be Auditory, Olfactory, Tactile and Emotional – with the Emotional being the most common and troubling. Imagine what it’s like to be sitting in the most beautiful and tranquil tropical location and suddenly all you feel is fear and dread – and you just can’t figure out why!
It’s hard to make sense of inexplicable fear and panic that just will not go away – and comes for apparently no reason and you can never be sure when it will leave. For so many it is not an instant reaction and there is a slow slide into “Re-experience” which makes identifying triggers and being able to avoid them near impossible. People learn to recognise the slide down, but fight to be able to avoid it starting. Physical and emotional isolation helps, but means that whole parts of life are also lost.
… and that is so true. The ability to recall your life prior to PTSD and see how it has changed so much is so very painful and troubling. I remember one guy saying that PTSD is not a disease, it is a thief – a burglar. Just when you think that the life you have is secure and a place to feel safe, that Burglar will arrive again and rip it all to pieces for the smallest of reasons. No matter what you do and how you secure your life that Burglar can always get in and just causes so much damage. Planning for the future always has that clause – if I’m able to. You can plan all you like, but when the day or event comes if your heart, mind and soul have just been Burgled again it’s hard to do anything – and another section of life passes you by.
People with Multiple Trauma find it hardest of all. That “Re-experiencing” can be terrible – you have emotions from one trauma linked to experiences from other traumas. As one person explained it to me – it’s like having many jigsaw puzzles all mixed up together. You look at one jigsaw piece and have to fight to figure out which puzzle it comes from – which picture it is part of – and how on earth does it link to the piece in the other hand.
The Emotional and psychological confusion that results all too often leaves people fighting with fractured reality – and the real and deep pain of being able to remember exactly what it was all like before the Thief took up residence in their lives and stole so much.
We should keep in mind that some of these veterans, not only suffer from PTSD, have physical disabilities…loss of a limb or disfigured; and may not be compensated properly or getting the medical care needed. I think veterans and the elderly are some of the most disenfranchised and forgotten people in society. They’ve worked and helped build the communities we live in and sacrifice their lives and future / livelihood for a nation they believe in.
I have to say that I find it fascinating – here is a post about men, medical and social need and hardly a comment. By comparison, a post goes up about Violence Prevention against Women – and there is an avalanche of responses.
In the USA the VA place a figure of 16% of returning service personnel have PTSD – that is over 200000 from Iraq and Afghanistan alone. The figures of Vets since World War II with PTSD is shocking – and higher than the incidence of rape or sexual assault related PTSD.
Odd is not the word!
I agree very much with this article, but the stats seem suspiciously high.
18 suicides per day means 6750 suicides per year. Just spitballing here, but if you multiply that by the 9 years of active operations in Afghanistan and Iraq, you get 59,000. So, there are as many vets committing suicide in the past nine years as there were KIA in the Viet Nam War. That seems like an overly large etimate.
Every one is one too many, and it shouldn’t matter whether it’s 18 per day or 5 per day, but exaggerated statistics threaten to undermine the cause.
Well you’re assuming the rate has been constant which seems very unlikely. The current rate might be 18 suicides per day (I’m not saying it is as I don’t really know) but it might have been one every 6 months for the first 6 years of the war.
Regardless the original information didn’t state it clearly enough and so I can see why you’d make the assumption. I just don’t think it is necessarily the right assumption.
If it is true that 80% of those applying for PTSD are denied then I am outraged as I’ve seen so many people scam the VA for disability using relatively minor problems, many of which were not caused in the line of duty. I served 12 years and never even talked to the VA because I did not want to be tempted to take some of the easy money that can be scammed from the VA. So now I find out that the people who really need help aren’t getting it? Outrageous!
The bottom line is that we need to take care of our returning veterans, especially those that have actually served in the war zones and have seen combat.
I am a veteran of the iraq afgan wars, i was diagnosed with ptsd in 2010 and have applied for every disibility and compensation i can for me and my family, and still have not seen anything the VA and the U.S dont care about us anymore as veterans what we did for this country means nothing to the politics at all.