Jacob N Francis 3rd Period 4/24/14

Post-Traumatic Stress Disorder in Military Veterans:

Causes and Solutions

Even in times of trauma, we try to maintain a sense of normality until we no longer can. That, my friends, is called surviving. Not healing. We never become whole again ... we are survivors. Lori Goodwin

Abstract Conflict is an inevitable phenomenon, it always has been, and therefore war is also. The nature of war is brutal, and has consequently resulted in tremendous mental health deterioration among the military personnel that participate in combat situations. Numerous veterans of war have long suffered from the psychological syndrome known as post-traumatic stress disorder, which has become a frequent byproduct of combat-exposure. With advancements in science and technology, our nation should be able to effectively, and efficiently, treat the sufferers of the disorder. Such a mental ailment cannot be overlooked, especially among those whom have served with great valor in the defense of our nation.

Introduction In all of history, hundreds of major wars have been recorded, with an estimated four billion deaths as a consequence. In the United States alone, over 1.3 million soldiers have been killed in all recorded U.S. wars, and over 1.5 million have been wounded throughout that same time period (Harden, 2013). War is a brutal phenomenon, which can be tremendously strenuous on the mental health of its combatants. This type of mental stress and intense exposure to warfare can often result in psychological deterioration, and disorders such as depression, anxiety, and most common in war veterans, post-traumatic stress disorder. Post-traumatic stress disorder is not necessarily only confined to war exposure itself, though its likelihood has been found to be much higher in such experiences. Post-traumatic stress disorder was not added to the Diagnostic and Statistical Manual of Mental Disorders by the

American Psychiatric Association until 1980, when the third edition of the DSM was written; the guidelines for PTSD has been revised multiple times since. As rendered by David Baldwin PhD., there is essentially no cure for post-traumatic stress disorder, and furthermore that, there can be no cure for PTSD (Baldwin, 2014). Baldwin determines that since PTSD is a mental ailment, there is no distinct identifiable causation for the origin of such traumatic responses. In other words, post-traumatic stress cannot be formally cured because it lacks a physical complexion; for an example, an illness such as polio can be cured with a simple vaccine, PTSD does not have such a cure (Baldwin, 2014). Due to this misfortunate dilemma, a general focus needs to be fixated on the available, viable services and treatments that can relieve the American veterans that are currently struggling with this dreadful condition; with such mental health conditions becoming more prominent with combat exposure, a resolution needs to be obtained. Newer and better options have been developed over centuries, as we have discovered more and more about the elements of war each time it has been experienced.

Brief History of Post-Traumatic Stress Disorder Although post-traumatic stress was not ultimately recognized until the 1980s by the American Psychiatric Association as an anxiety disorder, it was nonetheless still an existent phenomenon long before it was officially acknowledged. Countless traumatic experiences throughout the ages have plagued various men with the tribulation of PTSD. One of the oldest accounts of post-traumatic stress comes from approximately three thousand years ago, in documented writings of an Egyptian war veteran named Hori, who described his mental state

before engaging in combat. This took place well before the term or general idea of post-traumatic stress disorder was established. An excerpt from Horis writings reads as: You determine to go forwardshuddering seizes you, the hair on your head stands on end, your soul lies in your hand. (Bentley, 2005) The psychological spectacle appeared to be originally studied in 1968 by military physicians of the Swiss Armed Forces, whom reviewed militia combat reactions and the correspondence with individual behavior. The disorder was initially labeled by the Swiss as nostalgia, characterized by the symptoms of depression, anxiety, insomnia, and homesickness (Bentley, 2005). Progressively overtime, the sensation of post-traumatic stress became more prominently recognized; it became known as heimweh (translated as homesickness) by the Germans in the seventeenth century, estar roto(translated as to be broken) by the Spanish in the eighteenth century, and what was previously identified by the American military as shell shock during the early twentieth century. The term shell shock was proposed along with the theory that ammunition shells, upon impact, would produce a concussion-like force that would disturb the functioning of the human brain. The term battle fatigue was also associated along with this around the same time period, because of the noticed lack of willpower and increased depression symptoms that veterans displayed. After extensive research, the American Psychiatric Association finally labeled such a phenomenon as post-traumatic stress disorder, in the early 1980s.

Causes and Symptoms of Post-Traumatic Stress

Interestingly enough, electroencephalography (EEG) brain screenings for post-trauma have exhibited lower frequency levels within the frontal lobe; this has been specifically noticed on the left side of the frontal hemisphere of the brain. The frontal lobe has been particularly studied on the ground theory of it being in control of psychological reactions, especially during traumatic events, in which devastating perceptions are difficult to comprehend or fathom from PTSD veterans; this is often the source of veterans developing a disassociated mind state, and consequently this condition can cause subjects to lack the proper judgment required to take the first step needed in receiving treatment. Psychologist G. Frank Lawlis, who believes in a multistepped treatment program for PTSD has also observed the following in the brains of posttrauma sufferers: Making the picture more complicated is the agitation in the temporal lobes, containing the emotional and memory functions. These areas have been shown to have a mixture of complicated reactions, especially memory (Lawlis, 2009) *** Several PTSD veterans often resort to alcohol or marijuana in an attempt to remediate the anxiety that accompanies their various other symptoms. This approach usually only makes coherence worsen; the worsening judgment often can lead to poor choices and destructive emotional, and in same case physical, destruction. The symptoms of post-traumatic stress disorder are made up of three different categories: Reliving, Avoiding, and Increased arousal (Schlanger, 2005). Reliving is characterized as re-

experiencing a traumatic memory, often through flashbacks, nightmares, and even hallucinations. There is sometimes a trigger for the remembrance of such a traumatizing incident. The second, avoiding, is the averting from a specific thing that could remind a person of a traumatic experience, such as a person or a place. The third symptom, increased arousal, is characterized as excessive emotions. This category can be defined through sub-symptoms such as sleeping trouble, relationship problems, anxiety issues, etc. Together as a whole, these symptoms cause extreme mental discomfort of its subjects, and produce the diagnosis of post-traumatic stress disorder.

Screening for Post-Traumatic Stress in Military Personnel Screening for PTSD is a seemingly complex process, with precision that may vary. The main screening technique is usually using a simply using an in depth, personal questionnaire, in order to better understand the mental state of the patient and observe their emotional behaviors. According to the PTSD Alliance (2001), clinicians begin the procedure with basic questions, such as, How are things at home? or How are your relationships? Screening questions are also asked, that help identify actual symptoms of post-traumatic stress. Screening questions can vary from Have you experienced distressing dreams? or Are you bothered by things from your past? An official diagnosis of post-trauma is under the discretion of the screening doctor. Pulitzer Prize-Winner Mark Thompson stated in an article written in Time Magazine in 2010, that the United States Army has seen an increase in suicide rates over the past six years, with the leading cause believed to be rooted from post-traumatic stress; 22 of the 32 suicides studied had been deployed military personnel, and 10 of which had been deployed two or more

times. The U.S. Army has also taken the initiative to implement a behavioral-health campus building at Fort Campbell, Kentucky, in which they can diagnose post-traumatic stress and traumatic brain injuries more efficiently (Thompson, 2010). Immediate Solutions for PTSD Treatment A couple different programs have emerged with the vast, growing demand of patients that are diagnosed victims of post-traumatic stress disorder. Different solutions have been explored in the field of treating post-traumatic stress. Post-traumatic stress is claimed to be best treated when it is detected early, rather than wait for symptoms to onset fully; this being theorized, it is best to receive treatment as soon as possible when diagnosed with PTSD. Post-trauma doesnt necessarily have an official solution at this moment in time, though there are a few treatment options available, particularly for those that have been exposed to combat-situations. One of the main remediation options is the therapeutic approach; there are two primary therapy plans for PTSD sufferers to receive: Cognitive behavior therapy and Stress management therapy. Cognitive behavior therapy involves teaching victims of PTSD different skills that can help them manage their emotions and thoughts, typically when theyre put in situations that cause them alarm. Another therapy route is the use of exposure therapies. This would be the process of directly, or indirectly, exposing PTSD subjects to their traumatic memories; this is hypothesized to reduce the patients fear of their respective, traumatic events by facing them full-on. The most practiced treatment however is the use of medication to ease the symptoms of post-traumatic stress. This is usually done by having patients take antidepressants for their depression and

benzodiazepines for their anxiety. Most doctors discourage the long-term use of such drugs however, as they can become highly addictive when patients become over-reliant upon them.

The Multi-Step Program Approach for PTSD Treatment

According to renowned psychologist G. Frank Lawlis, the treatment phase can be conceived as a multi-step program. Merely attempting to resolve post-traumatic stress (or any anxiety disorder for that matter) with the simple approach of "one-step" therapies can in actuality lead to further problems, while solely trying to use anxiety treatments can aggravate the activity of the frontal lobe. Lawlis proposes a seven-step procedure, which involves the following: The first step as described by Lawlis is having patients understand that they are in control. Many combatants and veterans whom suffer from post-traumatic stress affirm the constant fear of the inability to control their disturbed thoughts, also aiding in their distress. Victims of such trauma are unable to cease the memories of traumatic experiences, such as traumatic nightmares and emotional distress. Frank Lawlis refers to this as a stress storm, because due to the patients tending to feel imprisoned in their own misery, and sometimes even reporting the sensation of having, demon-like forces entering and controlling their minds, (Lawlis, 2009). In order to combat this, the first step is solely focused on having patients realize their self-charge. The second recommended phase is for the patient to release destructive thought habits from their mind. Casualties of PTSD often experience guilt, depression, anger and other emotions, which create a trap that can only reduce mood and self-confidence. A major practice in

this phase is having subjects learn to forgive themselves, and understand that theyve done nothing wrong. The third step, dubbed by Lawlis as the warrior brain phase, requires an assessment of the patients frontal lobe activity. Clinicians look at the stimulation of the frontal lobe during extensive concentration of the patient through EEG brain scans, which follow their thinking patterns. Along with this, the fourth step is for the patient to balance the brain so that it can begin to manage within itself. In simpler terms, the patient is ordered to slowly regain confidence in him or herself, in everyday life and arising challenges. Likewise, the fifth stage involves helping patients to overcome their symptoms of depression. Subjects, especially war veterans, are overcome with feelings of guilt and/or shame, causing them to become emotionally withdrawn; they use this as a defensive mechanism in order to repress their feelings. Patients must regain a sense of joy, and practically relearn how to take pleasure in things. The sixth phase demands sleep, and thus renewal, from the patient. Lack of rest can also be a relation to post-trauma, especially with recurrent nightmares of upsetting images; insomnia is the main concern of veteran depression and their overall feeling of lethargy. A key component of this phase is to have the body and the mind alleviated of destructive emotional habits; patients need restorative rest for healing to occur. The seventh and final step in the rehabilitation process is to begin reconnecting with other people. Traumatization is a difficult affair, and can leave persons in a state of betrayal that has to be overcome, even though the traumatization usually is not the particular fault of anyone. Patients often feel as though they cannot connect with others, because they lack the insight to

their situation and emotions. Lawlis believes this step to be, the reentry back into the community. (Lawlis, 2009) A Plausible Resolution for Post-Traumatic Stress Disorder Although David Baldwins proposal suggests that post-traumatic stress disorder can never be entirely cured, eminent psychiatric professor and radiology expert Dr. Alexander Neumeister, along with other researchers at the New York University Langone Medical Center, have recently been investigating a new potential pharmaceutical designed to specifically treat the symptoms associated with post-traumatic stress disorder. The nameless medical compound is described by Neumeister as marijuana-like, as its main function is to stimulate cannabinoid receptors (CB1 receptors), which in due course aid in the impairment of memory and the reduction of anxiety (Grush, 2013). Its been observed that every human brain contains endocannabinoids. These lipids are the regulatory factor of various processes, such as pain-sensation, mood, and even memory. The endocannabinoids naturally secrete glucocorticoids, a hormone that is responsible for equanimity when in the presence of a stressful, traumatizing stimuli. Neumeister and his researchers also observed that those who suffer from PTSD tend to have a greater number of CB1 receptors; this was because of the lower levels of arachidonoylethanolamine, also known as AEA (a cannabinoid neurotransmitter), in these subjects. Cannabinoid receptors are created to offset the lack of AEA, producing an imbalance in the endocannabinoid structure. The pharmaceutical currently in development by Neumeisters team may have the ultimate solution for PTSD treatment. This compound, described as being marijuana-like is aimed to intensify the concentration of and restore a healthy amount of endocannabinoids in the brain.

Neumeister has assured that this medication safe, and lacks the health problems associated with actual cannabis. Conclusion Evidently, in reality, there are plenty of treatment tactics available for veterans that are suffering with the strain of post-traumatic stress, so there must be an underlying cause as to why so many veterans still cannot be relieved of such a pandemic. In fact, currently, nearly 20% of the 1.7 million American military personnel who serve or have served in Iraq and/or Afghanistan suffer from post-traumatic stress. Why is it that so many veterans are having trouble with seeking treatment? Why is it so difficult for most to complete treatment? According to the American Psychiatric Association between 20-50% of military patients never fully complete their PTSD treatment (Robson, 2012). Could this be due to most not wanting to relive the past, or their inability to face their own anxiety? The main supposed reasons for this happening are understood to be a variety of different causes. Its believed that this could stem from a lack of trust towards psychologists, or the foolish belief that mental issues will eventually go away on their own, without the need for mental health treatment services (Kristina, 2012). Research psychiatrist from the Military Psychiatry and Neuroscience, Maj. Gary H. Wynn, advocates for advanced screening in order to incorporate patient preferences, to make them feel more comfortable and decrease the risk of them dropping out of treatment, or never attending treatment for that matter. Therapy services need to be appealing towards those veterans suffering with PTSD, who are already in a frail mental state.

The tragedy is that post-traumatic stress disorder will continue to be prominent issue amongst military personnel. Victims of PTSD cannot be forced to attend therapy or seek treatment, though help should be readily available to them. Hopefully with the development of Neuimesters revolutionary PTSD medication, more veterans can be treated more adeptly, and perhaps in the near future, other advances can allow those with post-traumatic stress to finally surmount their mental bearings and end their pain.

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Bentley, S. (2005, April) A short history of PTSD retrieved from: http://www.vva.org/archive/TheVeteran/2005_03/ feature_HistoryPTSD.htm

Harden, S. (2013, November 23). U.S. war death statistics retrieved from: http://www.statisticbrain.com/u-s-war-death-statistics/

Nordqvist, J. (2013, June 6) Possible prevention of ptsd discovered retrieved from: http://www.medicalnewstoday.com/articles/261598.php

Schlanger, D. (2005) WebMD: Posttraumatic stress disorder retrieved from: http://www.webmd.com/anxiety-panic/guide/post-traumaticstress-disorder

Thompson, M. (2010, August 16). An rx for the armys wounded minds retrieved from: http://thesteptoegroup.com/?p=530