mTBI, PTSD and Stress (Catch All)

[Op_Shrink]

120mm thanks for sharing your experience and sorry it has been such a negative one. So far my military career has granted me quite a bit of freedom in practicing psychology. I think some of the friction arises when Command doesn't advocate for us, which results in stigma for any soldier needing to seek help. I need Command and families to be my greatest advocates. There are always going to be psychologists, physicians, nurses, etc. who are great providers but do not have great military bearing. Also, just because someone hasn't deployed doesn't mean they don't have the skills to help. They just won't really understand, which is okay as long as they acknowledge that shortcoming to the soldier. For me it comes down to genuinely caring about the soldier and their family and taking the time to listen to their experiences and know them. Having a cup of coffee or a guy swinging by the office to talk off line is what I should be taking the time to do. I just want to encourage you that there are quite a few psychologists who have that mindset, especially in the BCT's and SOF community. Well time to work on some more ILE stuff. Have a good one.

[AdamG]

Reading music

Marijuana May Be Studied for Combat Disorder
By DAN FROSCH
Published: July 18, 2011

DENVER — For years now, some veterans groups and marijuana advocates have argued that the therapeutic benefits of the drug can help soothe the psychological wounds of battle. But with only anecdotal evidence as support, their claims have yet to gain widespread acceptance in medical circles.

http://www.nytimes.com/2011/07/19/us....html?src=recg

[ganulv]

but it’s not as if we don’t have a good idea of how to effectively treat PTSD. It’s just that the treatment is multi-modal, not quick, not cheap, and requires a good and adequately staffed infrastructure. Pero esos son otro viente pesos, as they say in Puerto Rico.

[AdamG]

(AP) TOPEKA, Kan. - An Army sergeant accused of killing four fellow soldiers and a Navy officer at a mental health clinic on a military base in Iraq two years ago should be tried for murder but should not face the possibility of execution because he suffers from serious mental illness, a military judge recommended.
Sgt. John Russell, who is accused of opening fire at the combat stress center at Camp Liberty near Baghdad in May 2009 in what would be the deadliest act of soldier-on-soldier violence in the Iraq war, should be held accountable for his actions and face a court martial on the five counts of premeditated murder he faces, Col. James Pohl wrote in his recommendations issued Friday.

http://www.cbsnews.com/stories/2011/...20108375.shtml

The enemy is anybody who's going to get you killed, no matter which side he's on - Yossarian, CATCH-22

[ganulv]

Suicide and the United States Army: perspectives from the former psychiatry consultant to the Army Surgeon General | Cerebrum

The two portions of this piece which most piqued my interest:

Perhaps counterintuitively, suicides among those who have major injuries are rare; more often a minor injury or backache contributes to depressive symptoms, a belief that one cannot “be the Soldier I used to be,” and irritability.

Therapy dogs are now with several of the Combat Stress Control teams in Afghanistan. Soldiers will stop by to pat the dog. Wounded soldiers find that the presence of their service animal decreases their PTSD symptoms and their feelings of anger and fear. Veterans who would not leave the house will bond with their dogs, walk them, and regain structure in their lives.

[davidbfpo]

Hat tip to Leah Farrell (via Twitter) for this pointer - to a vivid, hard to read personal account of PTSD by an Australian soldier, who joined as a private and became a general. From the sub-title:

Major General John Cantwell fought in Iraq in 1991 and again in 2006. In 2010 he commanded the Australian troops in Afghanistan. Upon his return, he was in the running to be the Chief of Army – instead, he found himself in a psychiatric ward.

Link:http://www.smh.com.au/lifestyle/casu...917-2612i.html

We've seen similar references and I do wonder what the impact upon each national society will be of ex-veterans who think this:

I seethe at the indifference of most Australians to the efforts of our troops overseas.

I know there are some biker SWC members, so:

Bizarrely, I can ride a motorcycle without having these foolish panic attacks. I have no idea why.

Finally:

I understand that I am on a long journey of recovery, but I know also that I will complete that journey, someday. I am determined to get better. I will beat this thing.

A book is due out next month:

Exit Wounds: One Australian's War on Terror by Major General John Cantwell (with Greg Bearup), published by MUP on October 1.

Link to publisher:https://estore.mup.com.au/items/9780522861785 and no trace on Amazon.

[davidbfpo]

Introductory remarks have been edited slightly:

Daniel Somers was a veteran of Operation Iraqi Freedom... Daniel suffered greatly from PTSD and had been diagnosed with traumatic brain injury and several other war-related conditions. On June 10, 2013, Daniel wrote the following letter to his family before taking his life. Daniel was 30 years old. His wife and family have given permission to publish it.

Link:http://gawker.com/i-am-sorry-that-it...ium=socialflow

He refers to twenty-two military suicides daily. I tried to identify a thread on PTSD and suicide, but my search failed, so dropped in here.

[ganulv]

[Somers] refers to twenty-two military suicides daily. I tried to identify a thread on PTSD and suicide, but my search failed, so dropped in here.

I looked around the Web for a few minutes and came upon the following from a 2011 report:

[T]he VA estimates that a veteran dies by suicide every 80 minutes.*

That is eighteen veteran suicides daily, so a bit lower than Mr. Somers’s figure, but still, for perspective:

[A]lthough only 1% percent of Americans have served in the military, former service members represent 20% percent of suicides in the United States.†

-------
* Harrell, Margaret C., and Nancy Berglass. Losing the battle: the challenge of military suicide. Policy brief. Center for a New American Security, October 2011: p. 1.
† ibid.

[davidbfpo]

Ganulv,

I understand that the suicide rate amongst ex-UK servicemen is high too. Another SWC member I think referred to more committing suicide after the Falklands War (1982) than were killed in the conflict.

[jmm99]

Does the comparison of 20% of suicides being vets vs. 1% of the population being vets have any materiality (weight, significance) ? You judge.

The data in the CNAS study (see notes 2 & 3) come from Facts about Veteran Suicide (VHA, updated April 2011); also from whence:

30,000 - 32,000 US deaths from suicide per year among the population overall (Centers for Disease Control and Prevention)

Approximately:

20 percent are Veterans (National Violent Death Reporting System).

18 deaths from suicide per day are Veterans (National Violent Death Reporting System).

Taking 32,000 (all US suicides) x 20% (vets) = 6400 / 365 days = 17.5. Pretty simple - and also pretty simplistic.

Consider this one, A "Suicide Epidemic Among Veterans"? (2008); first for some background on the death stats:

Veteran status has been part of the standard death certificate since 1939. The National Vital Statistics System, however, is a terribly decentralized system in which the states voluntarily participate. The federal government is a subscriber to that data and pays for it on a per record basis through grant agreements with the states. That data element, veteran status, has never been collated at the federal level. So while the data exists on an existential level it might as well not exist in any practical sense.

Only a minority of states supply vet data. Obviously, this is an area where Big Data would be useful - Come on NSA !

In order to exert some control over the study, one might look beyond vet & non-vet to age and gender classes. The "Suicide Epidemic" article looks to those distinctions, based on 2004 data from two public use databases managed by the Centers for Disease Control and Prevention's National Center for Injury Prevention and Control (this and that).

First take the 2004 data for all US suicides by age (per 100,000):

15-19 years, 8.2; 20-24 years, 12.4; 25-34 years, 12.6; 35-44 years, 15.0; 45-54 years, 16.5; 55-64 years, 13.8; 65-74 years, 12.3; 75-84 years, 16.3; and 85+ years, 16.4.

The rates for vets vary all over the place - 17 to 32 per 100,000.

Second, take the data for males (per 100,000):

15-19 years,12.6; 20-24 years, 20.8; 25-34 years, 20.3; 35-44 years, 23.0; 45-54 years, 24.7; 55-64 years, 22.0; 65-74 years, 22.5; 75-84 years, 34.8; and 85+ years, 45.0.

and, third, the 2004 data for white males (per 100,000):

15-19 years, 13.5; 20-24 years, 22.0; 25-34 years, 21.7; 35-44 years, 25.6; 45-54 years, 27.5; 55-64 years, 23.9; 65-74 years, 24.1; 75-84 years, 37.0; and 85+ years, 48.3.

So, for the 20-24 years cohort, we see for 2004: 12.4 (all); 20.8 (males); and 22.0 (white males). Looking at all 20-24 years males, over a number of database years:

1979 -- 26.5
1980 -- 26.8
1981 -- 25.7
1982 -- 25.2
1983 -- 24.0
...
1993 -- 26.5
1994 -- 28.0
1995 -- 27.0
..
2002 -- 20.8
2003 -- 20.2
2004 -- 20.8

The salient point - compare apples with apples.

Next up, JAMA, Post-service Mortality Among Vietnam Veterans (1987):

The post-service mortality (through December 1983) of a cohort of 9324 US Army veterans who served in Vietnam was compared with that of 8989 Vietnam-era Army veterans who served in Korea, Germany, or the United States. Over the entire follow-up period, total mortality in Vietnam veterans was 17% higher than for other veterans. The excess mortality occurred mainly in the first five years after discharge from active duty (rate ratio, 1.45; 95% confidence interval, 1.08 to 1.96) and involved motor vehicle accidents, suicide, homicide, and accidental poisonings. Thereafter, mortality among Vietnam veterans was similar to that of other Vietnam-era veterans, except for drug-related deaths, which continued to be elevated. An unexpected finding was a deficit in deaths from diseases of the circulatory system among Vietnam veterans. The excess in post-service mortality due to external causes among Vietnam veterans is similar to that found among men returning from combat areas after World War II and the Korean War.

From this study, we can conclude that the critical period for in-theatre personnel (for motor vehicle accidents, suicide, homicide, and accidental poisonings) is the first five years post-theatre.

Similar findings for deaths among Australian vets and non-vets, in the later period starting 15 to 20 years post service, are found in Mortality of National Service Vietnam Veterans (1997), including:

Suicide, which has been of particular interest in Vietnam veterans, was not significantly elevated, with a relative risk of 1.13.

This is an area where one should make haste slowly.

Regards

Mike