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Thread: mTBI, PTSD and Stress (Catch All)

  1. #121
    Council Member Brian Hanley's Avatar
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    Default PTSD - From a different context

    My personal view on PTSD (which includes having symptoms for years) is that it is an adaptation. Consider what the result is:
    • Ehanced startle reflex and instant capacity for violence (i.e. rapid response capacity)
    • Hyper-alertness (i.e. situational awareness)
    • Light sleep and disrupted sleep patterns (i.e. less easy to creep up on while asleep.)
    • Tendency to be unpredictable and make sudden changes of plan. (i.e. less predictable.)

    All of those characteristics are survival adaptations when a person is hunted or at risk.

    Those adaptations can be problematic when one returns to "normal society", and they can be very problematic if the person thinks there is something seriously wrong with them. The adaptation comes out when needed, for some it is harder to put away than for others.

    My experience was that starting about 4 or 5 months after coming home for good, I began to have issues. My unconscious was in overdrive trying to find the threats so I could avoid them. But since I couldn't find any, that mechanism just kept amping up more. I suspect quite a few people start drinking or doing pot or whatever to calm down, but that just makes it worse.

    What I recommend to people I talk to is first, do a few things to keep cool. Instead of fighting the impulse to lock down, go ahead if you have to. Skip the firearms unless you are in a real bad area, but keep some minor thing like a heavy flashlight on hand if it helps you sleep. Most of all, focus on reality testing and staying social. Don't withdraw, get out and do something. Doesn't have to be a lot of talk-talk unless a guy wants it. I never found talk "about it" helpful myself. But getting out cycling, or hiking, or doing some project together is. It can be very surreal being out there with "regular folks" for a while though. I've had that feeling for days sometimes like I'm walking around in someone else's life, almost a dream I'm having. The unconscious is like a 2 year old toddler inside, not terribly smart, and has to be shown or told clearly what is going on, that things are ok. It will work to say or do it, but it can take time. It takes time and work to bring out the PTSD adaptations when they are needed. It takes time and work to mellow later.

    Aside from that, yeah, it's a change and you won't ever be the same again. That's just how it is. Things mellow out with time, and there are good things with the bad. For instance, I prevented a woman getting kidnapped around here because seeing that swift economy of motion of an experienced attacker set me off - bang.

    So yes, it's real. Someone finding themselves revving up when society around them says they should be relaxed and out of the storm is, I think, much of the problem. Relax and understand this too will pass.

  2. #122
    Council Member Ken White's Avatar
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    Default Good post. Well said in all aspects

    and I can identify with all of it.

  3. #123
    Council Member reed11b's Avatar
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    Default

    I have a lot to say on this, but currently lack the skills to say it well. Good points all, I don't agree 100% across the board, but I will say that the Vet Centers have a policy of not diagnosing for a reason(we assess only). Also keep in mind that what many here have described is either traumatic readjustment (Most of us go through this) or "simple" PTSD. There are also individuals that have had multiple exposures to trauma from an early age (complex PTSD) that may be compounded by military trauma or that show no readjustment symptoms, but show symptoms years later (delayed onset PTSD). Both complex and delayed on-set PTSD are far more difficult to treat and tend to have more severe consequences on the individuals ability to adapt. For those out there helping there brothers or working on readjustment themselves, my heart goes out to you.
    Reed
    Quote Originally Posted by sapperfitz82 View Post
    This truly is the bike helmet generation.

  4. #124
    Registered User AlifBaa's Avatar
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    Brian is on point with his recommendation that we teach guys to 'lean into' symptoms of PTSD. It is a mistake to treat it as a mental disorder, or to encourage disculpability for one's actions. Strength pulls people through this kind of thing. Taking ownership of one's thoughts and actions is appropriate. Painting warriors as victims is not.

    Or am I wide of the mark, and just describing what works for me?

  5. #125
    Council Member Red Rat's Avatar
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    Default The UK Experience

    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?
    Last edited by davidbfpo; 10-25-2009 at 09:50 PM. Reason: Replaced blue font with quote marks.

  6. #126
    Council Member Ken White's Avatar
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    Default Re: your question. We may and I'll see if I can find it.

    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...
    Last edited by Ken White; 10-25-2009 at 10:18 PM. Reason: Typos

  7. #127
    Council Member MikeF's Avatar
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    Default Quantitative Physiological differences...

    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

  8. #128
    Council Member MikeF's Avatar
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    Default Excellent post all..

    Particularly from Brian Hanley. Here's some additional quantitative data that better decribes it...

    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

  9. #129
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    Default Post-combat stress as a defense

    So far as I know, this is the first PTSD case decided by SCOTUS. Analysis by Lyle Denniston at SCOTUSblog:

    Post-combat stress as a defense
    Monday, November 30th, 2009 1:14 pm | Lyle Denniston

    The Supreme Court, in a sign of the times for a nation at war on two fronts, on Monday put defense lawyers on notice that they should be prepared to use evidence of “post-traumatic stress disorder” to try to save accused veterans from the death penalty. Ruling without full briefing or a hearing, and with no dissent noted, the Court apparently overturned the death sentence of a Florida veteran whose “combat service unfortunately left him a traumatized, changed man,” as the Court put it in Porter v. McCollum (08-10537), involving Korean war veteran George Porter, Jr.

    “Our Nation has a long tradition of according leniency to veterans in recognition of their service, especially for those who fought on the front lines as Porter did,” the opinion said. “The relevance of Porter’s extensive combat experience is not only that he served honorably under extreme hardship and gruesome conditions, but also that the jury might find mitigating the intense stress and mental and emotional toll that combat took on Porter.”
    Because the case turned mainly on the specific facts of the prosecution and defense of Porter for murdering his former girlfriend and her boyfriend, it is not clear that the ruling will have a direct impact on other criminal cases in which combat stress might be a key factor. However, parts of the Court’s opinion read as if the Justices did intend to speak more broadly.....
    Please note the 16 page opinion (here) is a Per Curium (all Justices agreeing). It raises no novel legal issues; and the guilty verdict stays in place. The trial will address solely the sentence (death or not), with the jury hearing the PTSD evidence.

    So, discuss freely, if you are so inclined.

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    I wonder if this will open the dam. I can foresee 2 issues at first glance.

    1. The military justice system. If this grows in favor, and finds application beyond just death sentences, military courts are going to be confronted not just with mental state of these troops, but in what for a good many, might have been excacerbated by poor treatment or even outright hostility from the command. There will be commands who will fight this and there will be some courts that might struggle with that issue.

    2. How are civilian courts going to handle these cases when some may not have a real connection to the military? As one example, it's probably not unlikely that at some point people will use this as a defense but their service won't justify it. Courts will need to have the ability to reach out and verify service details in order to justify its use in court, something that could be abused. Just relying on service records may not be enough.

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    Default Hi Boon,

    Good thoughts and points.

    The impact of this decision may be less than overwhelming. The key point is that the plea and evidence are allowed in mitigation of sentence, not mitigation of guilt. Since nearly everything is allowed in evidence when considering sentence (even in ordinary cases), I don't see the case as a huge change in the law.

    Now, if they had said that PTSD would excuse guilt, that would have been a dambuster.

    Regards

    Mike

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    I suspect that if this is ever used at the trial court level to score a GBMI or NGRI decision that the voir dire proceedings will be ten times longer than the rest of the trial as the prosecutor attempts to prevent the defense expert witness from using the term PTSD, prevent the defense from mentioning prior military service, and prevent the expert from disclosing what events brought about the onset of the mental condition that the defense is asserting. Most juries will probably be very sympathetic toward combat veterans asserting PTSD.

  13. #133
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    Default Schmedlap, maybe, maybe not

    This comment applies only to the guilt phase of the trial.

    By using the PTSD argument in this phase, you might have to say that the PTSD caused him to do the act (in effect, admitting the crime).

    So, you run the risk of doing to your client what Mike Tyson's lawyer did to him. Paraphrasing the argument as I recall it - His childhood and life were so traumatic it turned him into an animal, just an animal.

    A jury might well symphathize with a vet, but it is not likely to symphathize with an animalistic murderer, rapist or home invader.

    Now, PTSD might work in a case that has some other redeeming factors, such as Anatomy of a Murder where temporary loss of mental capacity was allowed as a defense (with PTSD claimed as a basis for that). Or, in the Astan HT case, where premeditated murder ended up as a manslaughter plea - and the judge gave a light sentence.

    In most jurisdictions in non-death cases, the jury decides guilt and the judge sets sentence. So, the PTSD evidence would most likely be heard by the judge if not introduced in the guilt phase.

    Situational awareness needed on the part of the lawyer - plus good luck of the draw as to judge and jury.

  14. #134
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    JMM pointed out a mistake I made, I should not have used the word "defense", but rather mitigation, a major distinction that JMM pointed out. However, there are already defenses available under mental health to defendants and if I recall, most states focus on the ability to distinguish right from wrong (I'm reaching here it's been awhile) but if these mitigating factors find favor in the courts, no doubt the next step will to see if they can winnow their way under mental health defenses and which JMM alludes to in his post above this.

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    Quote Originally Posted by jmm99 View Post
    This comment applies only to the guilt phase of the trial...

    By using the PTSD argument in this phase...
    I was getting at the argument phase. I realize this specific case only applies to sentencing, but it seems like it could be a bellweather for the PTSD issue in general to be more prevalent in all phases of trials. I think prosecutors, fearing that juries will be sympathetic to PTSD, will be trying like hell to prevent the defense expert testimony from uttering any phrase that would clue the jury in to the fact that the defendant is a veteran and served in combat. I suspect they will argue that the mere mention of "PTSD" will make the jury overly sympathetic and argue instead that the expert can only refer to a mental condition brought about by a prior (unnamed) traumatic experience.

    Quote Originally Posted by jmm99 View Post
    ... you might have to say that the PTSD caused him to do the act (in effect, admitting the crime).
    I'm a little rusty on my criminal law, but isn't this the GBMI defense? It may be the ideal plea.

    Quote Originally Posted by jmm99 View Post
    A jury might well symphathize with a vet, but it is not likely to symphathize with an animalistic murderer, rapist or home invader.
    I don't know. I'm thinking of the trial for the Haditha Marines. One of the jurors was quoted as saying that he didn't think he had the right to question their actions in combat. That, to me, suggests that jurors are willing to ignore or reject facts if they simply have an aversion to seeing a veteran punished, possibly because they view him/her as a victim. Unforunately, many, many people do view our veterans as victims.

    Quote Originally Posted by jmm99 View Post
    Now, PTSD might work in a case that has some other redeeming factors, such as Anatomy of a Murder where temporary loss of mental capacity was allowed as a defense (with PTSD claimed as a basis for that). Or, in the Astan HT case, where premeditated murder ended up as a manslaughter plea - and the judge gave a light sentence.
    Again, rusty on my criminal law, but isn't that the NGBI defense? That might be an ideal plea.

  16. #136
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    Default Rusty on criminal law, Schmedlap ?

    Hell, you just took it - relative to this oldster.

    GBMI Defense = Guilty but mentally ill

    NGBI defense = Not Guilty by reason of insanity.

    Huge difference to the client between these defenses.

    1. GBMI Defense. There are two aspects to the sentence: (1) court ordered mental treatment; and (2) the punitive sentence. Logically, the mental treartment comes first; and that fits in with the usual intake system for felons given prison terms, a pre-incarceration psychologocal examination. BTW: if you have a client or are faced with a witness who has done prison time, obtain copies of his psychologiocal examinations. After the mental treatment ends, the prisoner is then sent off to prison to complete the punitive sentence.

    2. NGBI defense. No sentence; but only court ordered mental treatment. Once that ends, the client is as free as a bird. And, if the mental capacity problem is transitory (occured only at the time of the alleged offense), the client walks free from the courtroom.

    So, the default rule is not to plead to a GBMI; unless it's a dodge out of a death penalty case. In fact, if the defendant pleads a NGBI defense, I would be well advised as a prosecutor to request a GBMI instruction to give the jury an option to send the guy to prison (eventually).

    The NGBI defense, in its pure form, has some hurdles - ability to distinguish right from wrong. Of course, if the vet actually suffers from delusions and thought he was being attacked by Viet Cong, NGBI would apply in full measure.

    PTSD could also come up indirectly in other circumstances.

    1. Where a temporary loss of mental capacity is allowed as a NGBI defense - as in Michigan (Anatomy of a Murder), where the LT was acquitted. However, based on jury interviews, the jury found that his wife had been raped and beaten by the deceased; and that the LT was justified to take his retribution and defend her honor. So, there the proofs of PTSD (which were introduced) were a hook on which the jury could hang its hat.

    2. Where intent, deliberation, premeditation is an issue - as in the Astan HT case where the gal was torched by the bad guy who was then executed by her bodyguard. PTSD could be a valid argument vs formation of intent, deliberation, premeditation. In fact, a fair argument could be made under the right facts that the killing was involuntary manslaughter.

    3. Where the defendant's perception is an issue - as in self-defense situations. E.g., the defendant viewed the deceased as a hostile threat (even if objectively he might be viewed otherwise) and reactions kicked in, etc.

    ---------------------------------
    Haditha is a timely citation, but involved a combat situation (not PTSD from events decades ago). LtCol Jeffrey Chessani's Board of Inquiry convenes today, December 2, at Camp Pendleton.

    Polarbear1605 knows more about Haditha in his little claw than I know. Of course, you know the story about him. It began "in the snows of far off Northern lands ...", where the Marines found him behind a log as an abandoned cub. They took him back to Quantico, raised him and then made him an officer and gentleman. Truly, an inspiring saga.

    Cheers

    Mike

  17. #137
    Council Member Polarbear1605's Avatar
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    Default A Can of Worms always makes for a great Case Study

    Ah Yes, Haditha! A bit surprised that it popped up in this discussion but probably a good example of how bad the government can goof up a high profile war crime/court martial. The case spun out of control when Rep Jack Murtha, spent two weeks hitting the news shows stating that the Haditha Marines “cracked’ and committed “cold blooded murder” while the investigation was still ongoing. The Marine Corps has since been trying to get all the worms back into the can (4 plus years). As a quick update: Eight Marines were referred to Court Martial in the Haditha incident where 26 Iraqis (16 civilians and the remained combatants but those numbers vary) were killed when a Marine rifle squad reacted to an ambush sprung on them in the recently occupied city of Haditha, in Nov 2005. Five of the cases were dismissed based on the Article 32 investigation. The sixth case, one of the battalion’s intelligence officers (Lt), went to court martial and was found not guilty. I should note that the Lieutenant was never charged with any of the deaths. He was charged with making false official statements and discharging himself illegally from the Marine Corps. He was found not guilty of all charges. The Battalion commander was next. At the beginning of the Court Martial the military judge found that undue command influence had tainted the case…case dismissed. The undue command influence was upheld by the Navy Appeals Board. Not to be denied, the Commandant referred the Bn CO to a Naval Board of Inquiry. The BOI started on Wednesday, Dec 2, at Camp Pendleton. The last case is against the squad leader (then Sgt now) SSgt Frank Wuterich. The SSgt did an interview with 60 Minutes and the prosecutor subpoenaed CBS for the out takes in hope of getting evidence. CBS, surprisingly, rolled over and provided the out-takes once it got to a federal court. Since the undue command influence goes back to the Marine Col (lawyer type) that did the Commander of Multi-National Corps – Iraq investigation and then was assigned to the Marine Command Convening Authorities staff, it also taints the squad leader’s case. I believe that the squad leader will eventually also receive a BOI after his court martial is dismissed for undue command influence.
    Collateral Damage: A number of other officers were relieved and censored including a Capt, two Cols and a Marine general, again before the investigation was complete. The Capt was a company commander located in one of Haditha’s adjacent cities (never figured that one out); the Cols were the regimental commander and the chief of staff for the Marines Forces Hq Iraq; and of course the commanding general of the Marine Forces Hq Iraq.
    This baby has worms and flaming ducks crawling all over the place. The best place to get additional information is at the DefendOurMarines web site:
    http://warchronicle.com/TheyAreNotKi...OurMarines.htm
    Last edited by Polarbear1605; 12-03-2009 at 04:44 PM.

  18. #138
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    Default Ptsd

    This is a disturbing development.

    Distressed soldiers treated at combat site

    Increasingly, the Army is trying to treat traumatized soldiers “in theater” — where they’re stationed. The idea is that soldiers will heal best if kept with those who understand what they’ve been through, rather than being dumped into a treatment center back in the States where they’ll be surrounded by unfamiliar people and untethered from their work and routine.
    ...and maybe this is because they are not sure of the diagnosis and don't want to provide soldiers with an easy out and a reason to stay at home?

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    Default Ptsd

    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

  20. #140
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    Default Welcome

    Op_Shrink,

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

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