mTBI, PTSD and Stress (Catch All)

[Steve Blair]

I think this kind of touches on one of the reasons why we have so much trouble dealing with PTSD: Americans have been conditioned to want ONE therapy or ONE pill to fix everything (sort of an extension of Tolkein's "one ring to rule them all" theory). And now we're dealing with something that is a very individual experience with very individual responses. There is no one magic way, and the sooner our various institutions and personalities involved come to grips with that, the better off we'll all be.

[Boondoggle]

I think this kind of touches on one of the reasons why we have so much trouble dealing with PTSD: Americans have been conditioned to want ONE therapy or ONE pill to fix everything (sort of an extension of Tolkein's "one ring to rule them all" theory). And now we're dealing with something that is a very individual experience with very individual responses. There is no one magic way, and the sooner our various institutions and personalities involved come to grips with that, the better off we'll all be.

http://www.nationaljournal.com/njmag..._20081122_7953

http://www.nationaljournal.com/njmag...81122_4027.php

http://www.camplejeuneglobe.com/arti...e/onbase03.txt

http://hosted.mediasite.com/hosted5/...d8d5e965e0cc06

[Op_Shrink]

Everyone,
I have enjoyed the discussion and insight from the group. I am an operational psychologist working at SWCS. I have worked extensively with combat veterans in areas of PTSD, mTBI, Substance Abuse, etc. I have utilized both individual and group therapy and agree that no one method is right for every single war fighter. In my experience troops seem to be more receptive to military jargon being incorporated into the therapy process. For example, instead of doing "homework" we do "missions" for the week. This may seem trivial but again the war fighters appear to like that mentality of going on a mission such as placing themselves in a crowded mall while wearing a uniform and coping with the physiological, emotional, and mental symptoms. They purposely shift their mindset to viewing it as an obstacle that they have the strength to overcome. Groups are used to process the missions, bounce ideas off one another, and hold each other accountable. Again, in my experience the war fighter appreciates a no B.S.-take-responsibility-for-your-actions kind of group. They also understand that they are not alone in what they are experiencing and can find a built in support group. I tell all my new war fighters up front that I will never say that I totally understand what they are experiencing because I am not a war fighter. I may deployed 3 times, but unless I have kicked down doors and engaged in personal combat I need to respect their experience. And I agree with marct: one needs to mix it up to find what works. I have had soldiers implement yoga, combatives, exercise, nutrition, etc. with conventional therapy. I could go on about resiliency, nature versus nurture, physiological and neurological changes, etc. but do not want to bore the group. Please let me know thoughts, especially if something needs clarification.
Thanks for what you do.
Doc

[davidbfpo]

Op_Shrink,

Welcome aboard and thanks for those insights. I am sure some others will be along shortly, to add or repeat their views.

[marct]

Hi Op Shrink,

Interesting comments, especially about the use of specific terms. I have similar experiences with "crafting" terminology to match the groups and individuals I've been counselling. I'd be interested to see if you are (or have) incorporated both active story telling and mythic story telling with some of your groups and, if so, do you find the active story telling coming to resmeble the myths.

Cheers,

Marc

[120mm]

I'm interested in the use of terminology as well.

I am having a hard time with the concept, as I can visualize this geeky dorky psychologist trying to use terminology they are unfamiliar with to "identify" with combat vets, and my first, gut reaction is anger. (Actually, with one exception, psychologists in the past I've encountered automatically engage my "anger" response.)

It would take a skilled individual indeed to avoid coming off as phoney in my mind's eye.

I've found in my own journey that one of my hot spots is posers, or folks acting as if they "understand". Because frankly, most have no frame of reference.

[AmericanPride]

FT Campbell had another safety stand-down last week because seven soldiers have been killed in accidents (don't know if any were suicides) since the start of the fiscal year. Earlier this year, the post shut down training for a week because of the high number of suicides.

Are these trends unique to Ft Campbell/101st? Or is it the tip of the spear for underlying Army-wide problems? Why are American soldiers dying by suicide and recklessness at rates at times higher than those killed in action? What can junior leaders do to mitigate these problems in their units?

[Schmedlap]

When Soldiers return from a deployment, they have lots of money. They have been getting paid tax-free, had far fewer living expenses, and now they've got 12 months of drinking to catch up on.

They will inevitably feel the need to buy cars, clothes, and bikes. They realize how far behind they are in their drinking and will attempt to catch up in order to bridge the 12-month lag. The women in the area know that 20,000 young men with fat wallets are back in town and looking to party.

I don't know any way to get around this without assigning a member of the clergy to shadow each individual Soldier for their first 6 months home. They're young, they're back from 12 months of combat, they've got more money than they're accustomed to, and the entire local area (the women, the car dealers, the club owners, the bars, etc) are all awaiting their return.

[Ken White]

Are these trends unique to Ft Campbell/101st? Or is it the tip of the spear for underlying Army-wide problems? Why are American soldiers dying by suicide and recklessness at rates at times higher than those killed in action? What can junior leaders do to mitigate these problems in their units?

both the Korean and Viet Nam wars. As Schmedlap says, sort of goes with the job. I doubt much can be done without a significant improvement in the US K-12 educational system and / or better parenting, both of which are unlikely. All you can do is try to educate without hectoring or being condescending -- that'll just make 'em push harder.

Part of the problem is that we treat them like children so they act that way. Instead of punishing miscreants, we punish all by restrictive and corrosive measures so they get their petty revenge by doing dumb stuff. I suspect the Legions had the same problem with they younger troops -- but a 25 year enlistment probably kept some of that down...

[MikeF]

Just one comment to add to Schmedlap and Ken's wisdom.

A good leader has a feel for his boys. If you notice someone is "off," then you should engage him in an appropriate way particularly if an outgoing soldier has withdrawn.

This does not mean you lecture. Often, you might just need to listen. He may simply need to get something off his chest- problems at home, nightmares from a bad time in combat, whatever.

Part of that is just knowing your people.

v/r

Mike

[Abu Suleyman]

I doubt much can be done without a significant improvement in the US K-12 educational system and / or better parenting, both of which are unlikely.

Wait, are you saying that our military is made up of people, just like the rest of society? And here all this time I thought the flaws in the military were a product of the fact that only the deranged and mentally incompetent got duped into joining.

[Schmedlap]

And here all this time I thought the flaws in the military were a product of the fact that only the deranged and mentally incompetent got duped into joining.

That's one way to put it, but the more accurate description is that they are downtrodden serfs who had no other options in life. Furthermore, they are mentally fragile and the inherent immorality of the war (made so by it being sold with lies in order to enrich oil men) caused these mentally fragile victims to do things like suffer PTSD and commit suicide in droves - almost at a rate as high as suicide rates in other developed countries. Had they not been born to poor families with low IQs, they would have gone to an Ivy League school and gotten a REAL job, selling mortgage backed securities.

[Ken White]

What is this 'real job' stuff -- not I, not I...

[Hacksaw]

both the Korean and Viet Nam wars. As Schmedlap says, Part of the problem is that we treat them like children so they act that way. Instead of punishing miscreants, we punish all by restrictive and corrosive measures so they get their petty revenge by doing dumb stuff. ...

Struck a chord Ken... Long ago in a battery far away... I used that approach...

Soldiers deserve to be treated (rewarded/disciplined) as men and women - Since we are all human, second chances are appropriate for offenses that don't warrant immediate dismissal... a third strike was not a given... of course we could administratively remove under-performing soldiers back then... point being... my Soldiers had the lowest DWI and serious incident rate in the Corps... when asked for our unit's "secret" and I explained why... The senior leaders were usually dissatisfied with the response.

Now I caveat.... I had to deal with long deployments with tax free dollars, but not the mental aftermath of close combat stress...

[OfTheTroops]

Are these trends unique to Ft Campbell/101st? Or is it the tip of the spear for underlying Army-wide problems?

Well the army has been walking down the High-risk behavior and suicide prevention. I have seen a lot of attention in that direction as it is a serious issue but I don't know how much we have improved at preventing these tragedies but God knows we try.

Number one rule is the guy that takes care of me is to my left and my right and i take care of them but sometimes it just ain't enough.

[Red Rat]

We now think that we will have an issue - how big it is we do not yet know.

We know that boys coming back from a demanding op tour with money in their pocket want to drive fast, drink lots and have a good time; it was ever thus. We have a major campaign on at the moment to remind soldiers that while they may have survived the tour, they are not invincible and that fast cars and alcohol kill, especially when combined.

In terms of PTSD we know it will be an issue but how big we do not know. We have seen a huge rise in referrals of WW2 and Korea veterans for Mental Health issues. Anecdotally I would say it is because warfare affects all people but that previously a stoic attitude of 'suck it up' applied for those who had real issues. Now there is a recogntion that not all injuries are physical but that all injuries are treatable and do not have to be suffered ad infinitum. Accordingly more veterans are coming forward for help.

What this means for the modern day service personnel is that we think that what we see now in termsof PTSD and psychological truama may be the tip of what we will see 10-20 years downline. Of great concern is the following which was reported extensively in the UK in August of this year:

A report by probation officers' trade union NAPO found that more than nine per cent of the country's prisoners were former armed forces personnel, often suffering from post-traumatic stress.

Initial data suggested as many as 8,500 members of the UK's 93,574-strong prison population were ex-servicemen, and it is thought the number could be even higher.

Many ex-servicemen in jail show evidence of untreated post traumatic stress disorder (PTSD)
A Home Office survey found in 2004 that only about five per cent of prisoners being released from jails were ex-servicemen. Many were jailed for violent offences.

NAPO cited excess alcohol or drug taking as a common factor leading to former soldiers committing a violent offence and being sent to prison.

In the vast majority of the 70-plus case studies it collected, the ex-serviceman had served in either the Gulf or Afghanistan and was showing evidence of untreated post traumatic stress disorder (PTSD). One 23-year-old soldier referred to in the report described the difficulty of readjusting to civilian life after witnessing the horrors of the frontline. The soldier, who previously served with the Parachute Regiment on two tours in active war zones, has received five custodial sentences since leaving the military in late 2005.

He said he found it hard to 'reconcile the devastation, horror and distress of the war zone, with the comfortable life' he found himself and others taking for granted.

He self-medicated over a number of years using alcohol, became aggressive towards partners and others, and is currently serving four months for assault.

NAPO suggested there may be a lack of relevant stress counselling either on site or the point of discharge.

Does any country collate statistics on whether veterans are more or less likely to end up in gaol?

[Ken White]

Someone may know and beat me to it. In the interim, I'd posit a thought.

The kind of person, male or female that enlists in the combat arms or for a potential combat assignment in any service is almost certainly into accepting more risk than are most people. Those who indulge in risky behavior tend to err more frequently than do the Turtles of the world (who rarely get anywhere because they're afraid to stick their necks out... ).

I would be surprised if veterans were not over represented in prisons or homeless shelters among other places. I know PTSD exists and I also know people handle it in different ways -- I also know that some will uh, enhance, their 'symptoms' for various reasons and I know that prisoners will look for any angle that gives them a break, no matter how slight.

And no, Slap, I will not tell you how I know that last...

Concern for the welfare of the troops is necessary and good but I hope we don't go too far in trying to stifle risky behavior -- Armies would get bogged down without that. Oh, wait...

[MikeF]

I'm going to double-post this image b/c it's important. SPECT scans are allowing us to understand the impact a bit more...

Here's the latest research. I've seen better images, but this is the best that I could find on google.

http://www.clementsclinic.com/anxiet...in-spect-scans

v/r

Mike

[MikeF]

MG (ret) Bob Scales gave a Vietnam Veteran appreciation speech at the Truman Library. Some wise words that I wanted to pass along. H/T to Craig Mullaney.

Let me give you the bottom line up front: I’m proud I served in Vietnam. Like you I didn’t kill innocents, I killed the enemy; I didn’t fight for big oil or for some lame conspiracy I fought for a country I believed in and for the buddies who kept me alive. Like you I was troubled that, unlike my father, I didn’t come back to a grateful nation. It took a generation and another war, Desert Storm, for the nation to come back to me.

Also like you I remember the war being 99 percent boredom and one percent pure abject terror. But not all my memories of Vietnam are terrible. There were times when I enjoyed my service in combat. Such sentiment must seem strange to a society today that has, thanks to our superb volunteer military, been completely insulated from war. If they thought about Vietnam at all our fellow citizens would imagine that fifty years would have been sufficient to erase this unpleasant war from our conscientiousness. Looking over this assembly it’s obvious that the memory lingers, and those of us who fought in that war remember.

The question is why? If this war was so terrible why are we here? It’s my privilege today to try to answer that question not only for you, brother veterans, but maybe for a wider audience for whom, fifty years on, Vietnam is as strangely distant as World War One was to our generation.

Vietnam is seared in our memory for the same reason that wars have lingered in the minds of soldiers for as long as wars have been fought. From Marathon to Mosul young men and now women have marched off to war to learn that the cold fear of violent death and the prospects of killing another human being heighten the senses and sear these experiences deeply and irrevocably into our souls and linger in the back recesses of our minds.

As I've had the opportunity to talk with many wounded veterans from different wars over the past year, I'm constantly struck that those that suffered through PTSD, TBI, or a physical injury are not victims. Most found ways to prosper and go on to achieve great things after their war. MG Scales is much more eloquent about this phenomena calling it Post Traumatic Growth.

v/r

Mike

[82redleg]

Mike,

Have you read "Stolen Valor" by Burkett (sp?)?

He posits that anti-war people have co-opted PTSD to paint vets as victims and created a cottage industry of resourcing the VA, to the extent that the VA has paid benefits for "Vietnam PTSD" to thousands of frauds- from true veterans who never served in Vietnam to people who never even served in the military at all.

I believe that PTSD exists, but I think it is exagerated (by the "professional caregivers" with an agenda) and that with the proper support group (which must be composed of veterans) MOST people will overcome their trauma, as you appear to be working through.

ATW, ABN!!!!