Mind Matters — PTSD

“I had thirty-eight guys under my command. One shot himself in the leg to go home. Seven of them got divorces, one is in a mental institution, and one took his own life a few months after he got back … . Not everyone comes home with post-traumatic stress disorder (PTSD), but no one comes home unchanged.” So spoke Paul Rieckhoff, executive director of the Iraq and Afghanistan Veterans of America, to the Los Angeles Times in 2006.

Since his comments, the mental health of Iraqi and Afghanistan vets has become an even greater concern, with PTSD and suicide on the rise. The National Center for Post Traumatic Stress Disorder defines “PTSD as an anxiety disorder that can occur after you have been through a traumatic event. A traumatic event is something horrible and scary that you see or that happens to you. During this type of event, you think that your life or others’ lives are in danger. You may feel afraid or feel that you have no control over what is happening.”

Recently, Thomas Insel, M.D., Director of the National Institute of Mental Health, related that “suicides and psychiatric mortality of this [Iraq] war could trump the combat deaths.” The Rand Corporation has already done a study that has concluded that 300,000 Iraq/Afghanistan vets suffer from PTSD or major depression, and that half of these cases go untreated. In an article in The New Republic, Sarah Stillman notes from this same study that 320,000 of the returning troops suffer traumatic brain injuries. And again, only half seek treatment.

Traumatic Brain Injury (TBI) has been dubbed the “signature wound” of the Iraq war, given that approximately sixty per cent of troops entering Walter Reed Medical Center are diagnosed with brain trauma due to the impact of explosive devices, such as roadside bombs. When the blast occurs, the soldier’s brain hits the skull, leaving no outward signs of injury, but precipitating closed-head internal injuries difficult to diagnose. TBI can lead to cognitive difficulties and also to psychological problems. Stillman advances that it is not only PTSD, but also the increase in TBI’s, that are causing such a high rate of suicide among the veterans of this war.

And the veteran’s physical and emotional difficulties do not occur in a vacuum. The long arm of trauma stretches over generations, pointy fingers jabbing everywhere. Consider this: a young man comes home from the Iraq War, let us say with TBI, having been in the vicinity of several car bombings, and with PTSD, having seen an innocent Iraqi family blown to bits, as well as witnessing a best buddy’s death. He comes home with recurring, intrusive thoughts, awakens with night terrors. He is jumpy and hyper-vigilant with every unexpected sound. Yet he returns home to his family—his parents, his wife, his toddler, whom he left as a baby. His trauma creates a context of anxiety for his family. His child becomes an emotional barometer of his pain, picking up on Daddy’s hyper-vigilance and becoming aggressive and anxious herself. Hi wife feels he cannot connect with her anymore, she feels unloved and doesn’t know how to engage him. His parents don’t see a son anymore, but a stranger. Already, his trauma has extended beyond himself and into the lives of all those around him. His child can carry emotional suffering on to the next generations. The adult children of Holocaust survivors know well how the trauma of one generation continues its cascade of woundedness. So too, with returning soldiers and their traumas.

And if an individual’s trauma burden is felt by the family, so do the family’s emotional burdens carry on into the society. One way or another, we all eventually need to recognize a communal responsibility of care. We have a long road ahead of us with a lot of returning vets who will need support—otherwise, expect a whole lot more homelessness (yes, many of the homeless are vets), a whole lot more domestic violence, a whole lot more drug and alcohol abuse, and a whole lot more suicides in the coming decades.