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The battle within: Treating PTSD in military veterans

The battle within: Treating PTSD in military veterans
From Al Jazeera - November 12, 2017

More than 20 million US military veterans are currently living in the US. After years of serving their country and waging war overseas, many of them struggle with post-traumatic stress disorder (PTSD), homelessness and addiction.

Peter Collins has been a licensed independent clinical social worker since 1988. In the past 10 years, he hasworked with over 6,000 veterans and their families in a programme called Military and Veteran Services.

In the following account, he describes the symptoms of PTSD and provides an insight into how the US government deals with the veterans' battle within.

I know one veteran who walked into a shopping mall, and when he saw a woman wearing a burqa, he immediately grabbed his kid and ran out of the mall. He felt threatened based on his experiences in combat - not knowing who were his friends or enemies and expecting both, men and women, to do 'terroristic' things. That's an example of avoidance, which is one of the four major symptoms of PTSD.

The PTSD diagnosis did not exist until the Vietnam War.

PTSD has been called many things throughout history. In the Civil War, it was called, "soldier's heart", and in World War II and World War I it was called "shell shock" or "battle fatigue".

Once the Vietnam war started to get rolling, the PTSD diagnosis was formalised, which was a real benefit, because then treatment protocols were figured out and more people were getting an accurate diagnosis.

Flashbacks, hypervigilance and avoidance

The four symptoms of PTSD start with re-experiencing, which happens in many different forms, including having nightmares or flashbacks.

Flashbacks can take over to the point where you feel like you are in the middle of the trauma right at that moment. Intensive thoughts and feelings are also part of re-experiencing and can take you away from anything that you are doing or that you are trying to concentrate on.

The second symptom is what we call hypervigilance. This is the sense that one is constantly on guard for any potential threat. Usually, the threats around them are amplified, so things that would not cause a person without PTSD to be triggered feel much larger to the veteran with PTSD.

Avoidance, the third symptom, is the need to avoid things that remind them of the trauma. That can be sights and sounds; it can be smells, it can be crowds of people. They also avoid conflict and crowds. Avoidance is a big part of the picture.

Finally, there are negative emotions and cognition. Depressive feelings and guilt.

Sometimes there's a moral injury where battle buddies may have been killed by friendly fire, and so it is emotions that affect the way that they think. There are some cognitive distortions that they have, thinking that perhaps loved ones ca not be trusted, not trusting systems, particularly systems like the VA [Department of Veteran Affairs].

Hypervigilance... is the sense that one is constantly on guard for any potential threat. Usually, the threats around them are amplified, so things that would not cause a person without PTSD to be triggered feel much larger to the veteran with PTSD.

Peter Collins

In the last 10 years, I have worked specifically with service members and their families in a programme called Military and Veteran Services.

Service members and veterans are referred to us with a PTSD diagnosis in place. Others come in, and it's a fairly simple matter to take a look at the four major symptoms of PTSD and see if somebody endorses them, and for how long.

We provide some basic tools for them to better cope with their symptoms, while exploring the options for treatment.

We deal with a lot of post-9/11 veterans, many of whom have been deployed multiple times because that conflict required multiple deployments.

We have seen many veterans who were in the National Guard, who prior to 9/11 would drill once a month and go to an annual training for about a week. They would be on call for disasters in cities, like floods and those kinds of things.

But all of a sudden 9/11 happened and the same people that had never been to war and really did not get the full training to go to war went on multiple deployments into war, which they did not expect and neither did their families.

'They were not allowed to wear uniforms when they came home'

We also deal with a lot of Vietnam veterans, who are kind of a special group. Many of them never got treatment. They were not welcomed home from their service, because of the state of the country and their country's feelings about the war in Vietnam.

Many Vietnam veterans are living off the grid. They live in the woods, and they do not interact with society.

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