Combat's Historic Legacy: Post-Traumatic Stress Disorder

Few days pass now without a news headline about Post-Traumatic Stress Disorder (PTSD) and its ongoing impact for veterans of America’s two most recent wars. It would be easy, especially for a younger audience, to assume that the disorder is fairly new.

But as Carlos Berry, MD, told members of the Jefferson County Medical Society at a recent presentation, the PTSD phenomenon--though not its current name--is as old as war and history, and was written about in ancient times long before the 20th century’s world wars made it more familiar to a modern public.

The classic 1970 movie Patton highlights one breakthrough in public awareness of PTSD—referred to during World War II as “shell-shock”—with a scene in which U.S. General George S. Patton slaps a recuperating soldier and threatens to have him shot for cowardice. The widely reported incident was a factor in Patton subsequently being relieved of his command.

“There was somewhat of an increase in awareness of PTSD after Vietnam,” Berry says, “of how it affected soldiers coming back from combat zones. The military knew about it, but knowing about it and being in regular contact with veterans who have it are two different things.

“The difference in our current awareness, going back to the post-9/11 years and the military’s experience in Afghanistan and from 2003 in Iraq, is that we know it’s important for care to be provided both in the combat zone, with combat stress units, and here at home with the Veterans Administration System which also engages non-VA stakeholders in the process, from private practitioners, medical centers, university centers, to the community as a whole."

Statistics show that being in a combat area significantly increases a veteran's likelihood of suffering from PTSD. A study released by the VA in the fall of 2012 reported that almost 30 percent of Iraq and Afghanistan war veterans, roughly a quarter-million people, are diagnosed with the disorder. And a veteran with multiple deployments to one of the zones more than triples his/her chance of screening positive for PTSD and major depression.

PTSD has been described as the invisible injury, one that can dramatically change the lives of veterans and their families, though initially showing few outward signs. Among the most common symptoms, however, are mood swings, and behavior that's an inappropriate response to a given situation. Those signs can also be expressed as nightmares and flashbacks, difficulty sleeping, anger and aggression, and hypervigilance--an exaggerated intensity of one's surroundings, and constantly scanning the environment for a threat, all of which creates added strains in social situations.

"Often, an individual's family members are the first to notice changes in a loved one," says Berry. "It might be avoidance and isolation, not wanting to go out and socialize like before, sometimes staying up till three or four o'clock in the morning. And the person might be overly irritable, angry, and more easily upset.

"PTSD can also cause a re-experiencing of the trauma, flashbacks and intrusive thoughts - maybe caused by seeing something on TV or hearing a sound that reminds them of what they've been through."

With severe PTSD, Berry says, sufferers might have trouble distinguishing traumatic past events from their current surroundings. "Most times, though, the individual patient understands that there's something unusual happening, but assumes that the problems are something they just need to just overcome with time, or to somehow deal with themselves; which of course is not the case.

"The main thing that the community needs to be aware of is that PTSD is a very prevalent and insidious condition. It also happens in circumstances of civilian trauma, but if someone is a veteran who has served in a combat zone, you need to keep in the back of your mind the possibility that they may be suffering from PTSD.

"Everybody needs to be reminded of the importance of seeking help, and that there are resources available. In addition to the Veterans Administration, there are veterans' centers that were established after the Vietnam war, as well as partners in communities, medical centers, and in private practice.

"Any resource is better than doing nothing, than trying to deal with PTSD on your own. There are a number of places that can be a first step in getting the help that you need."



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