Understanding PTSD

Veterans ask if they’re getting the benefits they deserve
05:13 PM EST on Friday, November 11, 2005
By TIFFANI HELBERG / 6NEWS
6NEWS
The Disabled American Veterans broke ground on a new service center that could help many who have risked their lives for freedom.
The Disabled American Veterans broke ground on a new service center Friday. It could help many local veterans who said they’ve risked their lives for our freedom. Yet some veterans said they’re not getting the benefits they deserve.
Vietnam veteran Sterling Grier said the government has turned its back on him. Medical experts said the war left him with a debilitating mental disorder that makes him incapable of working. Yet the government only pays back his service to his country with ten dollars a month.
“I wanted to be a soldier. I figured it was my job and my duty,” said Grier.
Grier has a sad story to tell. A story about a 19-year-old turned sharpshooter who was sent to the heart of combat in Vietnam.
“Everyday when we go out somebody wasn’t coming back,” he said. “And you wondered ‘was it your day?'”
Grier watched dozens of friends and enemies die. At the end of his service he returned home to a life of crying spells and isolation.
“I think about the guys that was hurt and wounded and I can hear the voices,” said Grier. “I still can hear them… at night I think about them.”
He was diagnosed with Post-Traumatic Stress Disorder of PSTD. It’s a psychological problem created by a traumatic event like war. Symptoms include flashbacks and nightmares. The federal government pays benefits to veterans who suffer from PSTD, but not Grier.
“They’re saying it’s non-service connected which is crazy… he wasn’t suffering from war trauma before he went,” said Sam Gordon a veteran and a claims officer. “They just keep denying his claims.”
He’s helped organize a book of Grier’s paperwork. It’s a record of the more than 30 years that Grier has been trying to get his military benefits.
“He has all the required evidence. It just doesn’t make sense. The short answer is he just fell through the cracks,” Said Gordon.
A letter from Grier’s psychologist said he is totally disabled and suffers from PTSD related to his service in Vietnam.
That’s proof Gordon said that Grier should be entitled to almost $2,400 a month today and at least $300,000 in back benefits. Gordon said Grier’s case is not unusual.
“A lot of them feel like they’ve been discarded like they’re second class citizens,” said Gordon.
“I hope that one day I’ll get what’s entitled to me,” said Grier.
Almost two out of every 10 combat soldiers returning from Iraq are expected to suffer from PSTD and other problems. That’s according to a New England Journal of Medicine Study.
Because of the holiday, we could not reach federal officials for comment.

ABSTRACT
Background The current combat operations in Iraq and Afghanistan have involved U.S. military personnel in major ground combat and hazardous security duty. Studies are needed to systematically assess the mental health of members of the armed services who have participated in these operations and to inform policy with regard to the optimal delivery of mental health care to returning veterans.
Methods We studied members of four U.S. combat infantry units (three Army units and one Marine Corps unit) using an anonymous survey that was administered to the subjects either before their deployment to Iraq (n=2530) or three to four months after their return from combat duty in Iraq or Afghanistan (n=3671). The outcomes included major depression, generalized anxiety, and post-traumatic stress disorder (PTSD), which were evaluated on the basis of standardized, self-administered screening instruments.
Results Exposure to combat was significantly greater among those who were deployed to Iraq than among those deployed to Afghanistan. The percentage of study subjects whose responses met the screening criteria for major depression, generalized anxiety, or PTSD was significantly higher after duty in Iraq (15.6 to 17.1 percent) than after duty in Afghanistan (11.2 percent) or before deployment to Iraq (9.3 percent); the largest difference was in the rate of PTSD. Of those whose responses were positive for a mental disorder, only 23 to 40 percent sought mental health care. Those whose responses were positive for a mental disorder were twice as likely as those whose responses were negative to report concern about possible stigmatization and other barriers to seeking mental health care.
Conclusions This study provides an initial look at the mental health of members of the Army and the Marine Corps who were involved in combat operations in Iraq and Afghanistan. Our findings indicate that among the study groups there was a significant risk of mental health problems and that the subjects reported important barriers to receiving mental health services, particularly the perception of stigma among those most in need of such care.

Source Information&References are found at Site

Matthew J. Friedman, M.D., Ph.D.
The data presented by Hoge and associates in this issue of the Journal1 about members of the Army and the Marine Corps returning from Operation Iraqi Freedom or Operation Enduring Freedom in Afghanistan force us to acknowledge the psychiatric cost of sending young men and women to war. It is possible that these early findings underestimate the eventual magnitude of this clinical problem. The report is unprecedented in several respects. First, this is the first time there has been such an early assessment of the prevalence of war-related psychiatric disorders, reported while the fighting continues. Second, there are predeployment data, albeit cross-sectional, against which to evaluate the psychiatric problems that develop after deployment. Third, the authors report important data showing that the perception of stigmatization has the power to deter active-duty personnel from seeking mental health care even when they recognize the severity of their psychiatric problems. These findings raise a number of questions for policy and practice. I focus here on post-traumatic stress disorder (PTSD), because there is better information about this disorder than about others and because PTSD was the biggest problem noted in the responses to an anonymous survey among those returning from active duty in Iraq or Afghanistan.
The rigorous evaluation of war-related psychiatric disorders is relatively new, having begun with the National Vietnam Veterans Readjustment Study.2 This national epidemiologic survey of male and female veterans of Vietnam was conducted in the mid-1980s. The veterans were therefore assessed 10 to 20 years after their service in Vietnam. The prevalence of current PTSD was 15 percent among men and 8 percent among women. The lifetime prevalence of PTSD was higher — 30 percent among male veterans and 25 percent among female veterans.
A retrospective cohort study of veterans of the Gulf War that was conducted between 1995 and 19973 showed a prevalence rate of 10.1 percent for PTSD among those who had experienced combat duty, in contrast to a prevalence rate of 4.2 percent in a matched cohort of Gulf War-era veterans who had not seen combat. The adjusted odds ratio for PTSD for those who had been in combat was 3.1; this is similar to the odds ratios in the present study of 2.84 for soldiers and 2.66 for Marines after deployment to active duty, as compared with soldiers before deployment.
In a longitudinal study of New England veterans of the Gulf War, the prevalence of PTSD more than doubled between the initial assessment performed immediately after their return to Fort Devens, Massachusetts, and the follow-up assessment performed two years later. The rates increased from 3 percent to 8 percent among male veterans and from 7 percent to 16 percent among female veterans. Higher levels of symptoms have been reported among members of the National Guard and the Reserves than among active-duty personnel.4
Finally, a retrospective survey of American male and female soldiers deployed to Somalia between 1992 and 1994 showed an estimated prevalence of PTSD of approximately 8 percent, with no difference according to sex.5 When the focus of this mission shifted from a United Nations’ humanitarian peacekeeping operation to a more traditional military deployment to subdue the Somali warlords, there was greater exposure to traumatic situations and a higher prevalence of PTSD among the American troops.6
It is unclear at this time whether the prevalence of PTSD among those returning from Operation Iraqi Freedom or Operation Enduring Freedom will increase or decrease. On the one hand, it is encouraging that the Department of Defense has been active in providing mental health care in the war zone and psychiatric resources in the United States and has demonstrated a commitment to monitor psychiatric disorders, as reflected by the present report. Furthermore, the findings of the National Vietnam Veterans Readjustment Study suggest that considerable recovery from PTSD among veterans is possible, as shown by the difference between the lifetime and the current prevalence of this disorder.
On the other hand, the National Vietnam Veterans Readjustment Study cannot tell us whether the onset of PTSD occurred while Vietnam veterans were still in uniform or at some time later, during the 10 to 20 years between their exposure to war and the survey for the study. Indeed, there is reason for concern that the reported prevalence of PTSD of 15.6 to 17.1 percent among those returning from Operation Iraqi Freedom or Operation Enduring Freedom will increase in coming years, for two reasons. First, on the basis of the findings of the Fort Devens study,4 the prevalence of PTSD may increase considerably during the two years after veterans return from combat duty. Second, on the basis of studies of military personnel who served in Somalia, it is possible that psychiatric disorders will increase now that the conduct of war has shifted from a campaign for liberation to an ongoing armed conflict with dissident combatants. In short, the estimates of PTSD reported by Hoge and associates may be conservative not only because of the methods used in their study but also because it may simply be too early to assess the eventual magnitude of the mental health problems related to deployment to Operation Iraqi Freedom or Operation Enduring Freedom.
A recent reanalysis of the data from the National Vietnam Veterans Readjustment Study2 and the Hawaii Vietnam Veterans Project7 suggests that after the development of PTSD, the risk factors for persistent PTSD are “primarily associated with variables relating to the current time frame: current emotional sustenance, current structural social support, and recent life events.”8 This information is clearly useful for mental health policy and planning, because it raises the hopeful possibility that PTSD may be reversible if patients can be helped to cope with stresses in their current life.
There are obviously important distinctions between the period after the Vietnam War and the present. Americans no longer confuse war with the warrior; those returning from Iraq or Afghanistan enjoy national support, despite sharp political disagreement about the war itself. In addition, the field of study of PTSD has matured to the point where effective evidence-based treatment and practice guidelines are available for use by the Departments of Defense and Veterans Affairs and by civilian mental health practitioners. Cognitive-behavioral therapies have been successful in the treatment of PTSD, and two selective serotonin-reuptake inhibitors have been approved by the Food and Drug Administration.9,10,11 Practitioners in the Departments of Defense and Veterans Affairs are sophisticated and strongly motivated to continue to improve their skills in treating PTSD. Collaboration between mental health professionals in the Department of Defense and those in the Department of Veterans Affairs is at an all-time high. For example, the Veterans Affairs National Center for PTSD and the Defense Department’s Walter Reed Army Medical Center collaborated to develop the Iraq War Clinician Guide (available at www.ncptsd.org/topics/war.html ) and to conduct a multisite, randomized trial of cognitive-behavioral therapy for PTSD among female veterans and female active-duty personnel.
In a best-case scenario, active-duty, Reserve, and National Guard personnel as well as veterans of Operation Iraqi Freedom or Operation Enduring Freedom with symptoms of PTSD will take advantage of the many mental health services available through the Departments of Defense and Veterans Affairs. Educational initiatives will be implemented to help veterans and active-duty personnel recognize that the loss of social support or the effect of recent adverse life events may precipitate a return of the symptoms of PTSD. Veterans and active-duty personnel will also be encouraged to monitor their psychological health and to seek treatment if and when it becomes necessary.
Alas, there is also a worst-case scenario that demands immediate attention. Hoge and associates report that concern about possible stigmatization was disproportionately greatest among the soldiers and Marines most in need of mental health care. Owing to such concern, those returning from Operation Iraqi Freedom or Operation Enduring Freedom who reported the greatest number or the most severe symptoms were the least likely to seek treatment for fear that it could harm their careers, cause difficulties with their peers and with unit leadership, and become an embarrassment in that they would be seen as weak.
These findings are consistent with those in an earlier report that showed low use of mental health services among Navy and Marine Corps personnel.12 In contrast to a rate of 28.5 percent among male civilians with a psychiatric disorder who sought treatment,13 only 19 percent of servicemen with a psychiatric disorder sought treatment. Furthermore, among military personnel with PTSD, the rate of seeking treatment was only 4.1 percent, which is substantially lower than that for other psychiatric disorders. This finding may indicate that within the military culture, “succumbing” to PTSD is seen as a failure, a weakness, and as evidence of an innate deficiency of the right stuff.
Hoge and associates suggest that the perception of stigmatization can be reduced only by means of concerted outreach — that is, by providing more mental health services in primary care clinics and confidential counseling through employee-assistance programs. The sticking point is skepticism among military personnel that the use of mental health services can remain confidential. Although the soldiers and Marines in the study by Hoge and colleagues were able to acknowledge PTSD-related problems in an anonymous survey, they apparently were afraid to seek assistance for fear that a scarlet P could doom their careers.
Our acknowledgment of the psychiatric costs of war has promoted the establishment of better methods of detecting and treating war-related psychiatric disorders. It is now time to take the next step and provide effective treatment to distressed men and women, along with credible safeguards of confidentiality.
Dr. Friedman reports having served as a paid speaker for GlaxoSmithKline, Ortho-McNeil, and AstraZeneca.
The opinions expressed in this article are those of the author and do not necessarily reflect the views of the Department of Veterans Affairs.

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Post Traumatic Stress Disorder can be caused by many life threatening situations, which are: Domestic Violence, Rape, Adult Survivors of Childhood Abuse, Public Trauma, Terrorism, Public Servants, Families of PTSD Survivors, Combat and many more.

We are here to help, not as professionals, but as peers.

Messages From Founder
No one knows what PTSD really is, until they walk in our shoes. We are hidden from the society because of our own fear. If it comes from war, the government want to keep us a less then honorable discharge so we are not a liability. We are wounded… but they do not give purple hearts for pain that lasts a life time. Society is interested in the rapist. The victim, male or female, is lost. No one cares about them. Wives are beaten daily and are subject to emotional trauma without hope. Children grow up in homes where they are physically or emotionally damaged for life. Whatever the cause, and there are many more, we are real people. Our pain is real. We do not want pity. Just the help we need to lead a better quality of life. Is that asking too much? God be with us All.

— Gregory A. Helle —
Chaplain and Founder

I founded the PTSD Alliance for veterans

I am a veteran of Vietnam

I am 100% disabled with PTSD

I honor all those who have given their lives for freedom

I honor all those who have given of their bodies for freedom

And I honor those who have given their minds for freedom

Our country does not understand that freedom is not free

That so many of us have been willing to die for the freedoms we enjoy

While those at home enjoy the freedom without thoughts of us who served

We served proudly and we do not feel anger for our physical and mental ailments

We are proud Americans

We just do not want to be forgotten

Dying for freedom is not the worst thing that can happen

Being forgotten is

To live in poverty because we cannot adjust to society

Or cannot find jobs

This is a shame for America

To allow those who serve be denied the freedom they served for

To be denied the basic human dignities

This is wrong America

Veterans gave you the right to have what you have

You owe it to veterans to give them the ability to enjoy the freedom

They were willing to give their lives for

Chaplain Gregory A. Helle
Founder, PTSD Alliance International

Disclaimer: This web site is not maintained by professionals, i.e., psychologists, psychiatrists, or other professionals in the psychiatric field. The advice given is from personal experiences and is not professional counseling. This not a VA site. The site is maintained by a Vietnam veteran disabled with PTSD with support from veterans, wives, children, etc. who are affected by PTSD.
Neither this site nor this organization is political. Although some articles will have political overtones out of necessity, this organization does not support any political party. This organization will not accept any manner of discrimination.
Please Note: The Alliance does not endorse or recommend the use of any specific treatment or medication for people with PTSD. Information on this web site is not meant to take the place of advice from qualified professionals. While visiting this site can help you gain a greater understanding of PTSD, it cannot provide a diagnosis or treatment. As you determine the best course of action for yourself, you are encouraged to share this information with your doctor(s), mental health care provider(s), family, and friends.

Veterans

Generations of Valor
Pearl Harbor Survivor Houston James of Dallas embraced Marin Staff Sgt. Mark Graunke Jr. during a Veterans Day commemoration in Dallas yesterday. Graunke lost a hand, a leg and an eye when he defused a bomb in Iraq last year. This week’s Images of U.S. troops in combat in Falujah deepened the day’s significance for many who attended tributes held in San Diego and across the nation. — Associated Press