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In order to better understand PTSD, we must first understand what society deems “normal”. Imagine the last time you and your family enjoyed a nice weekend dinner. You head to your favorite restaurant. It is a busy evening and the restaurant is full. Hours pass as you sit among the chatter of other patrons enjoying some quality family time. You sip wine and enjoy your meal as your kids excitedly discuss what they will have for dessert. Your focus is on enjoying the evening and little on those around you. After your children have enjoyed their ice cream dessert, you ask for to-go boxes. Your husband graciously tips the waitress before you head out as a family.
This is what the typical American family can relate to.
But what if that experience were of a family with a veteran who suffers from post-traumatic stress disorder? The scenario might be quite different like it is for Andrew.
Andrew is a 32-year-old Iraq veteran who was discharged from the Army with post-traumatic stress disorder. He was deemed 100% disabled yet tries to live a normal life for his family. Upon deciding to eat at his children’s favorite steakhouse, he feels his anxiety creeping up on him, yet he refuses to let this ruin the family outing. The restaurant is filled with patrons and no booths are available so Andrew and his family are given a table in the middle of the dining area. As they patiently await their waitress, Andrew breaks out in cold sweats.
The chatter of the other dining guests grows louder; everything slows down. He can feel his heart pounding as he counts the exits and scans the surrounding patrons looking for potential threats. After just a few minutes his alertness has broken out into a panic attack. He rushes out the back exit of the restaurant, leaving his family behind. He makes it just in time to vomit in the nearby bushes. The evening out is ruined and his family must ask for the meal to go and leave. He curses out loud and breaks down in apology knowing that he has done every therapy and medication that the Veteran’s Affairs Administration has offered, yet he finds himself unable to adjust to civilian life.
This scene is far too common among our veteran community when PTSD is present.
They search for relief and the ability to heal and are met with medications and psychotherapy which the VA deems as a proper treatment to bring back a quality life. Too often these treatments are inadequate and do not work. Despite this leaving veterans feeling hopeless about their life and wondering if there is more out there that can help them, the VA and supporters of conventional medicine contend that the most efficient way to reduce symptoms of PTSD in veterans is by use of psychotherapy and prescription medications.
However, over the last few years studies with complementary alternative medicine (CAM) practices have proven that utilizing integrative medicine as a form of treatment has produced improvements in the functions of the brain and nervous systems that trigger the “fight or flight” symptoms of PTSD. Integrative medicine modalities encourage veterans to take an active role in their mental health by offering a variety of treatment options that steer away from the typical VA treatments.
Post-Traumatic Stress Disorder goes beyond the surface of what most people see and understand.
PTSD is classified as an anxiety disorder that many veterans develop after their time in service. In fact, 11- 20% out of every 100 current war veterans experience symptoms of PTSD; while veterans of past wars are finally being acknowledged and examined for suffering from post-traumatic stress disorder (Dept. of VA, 2018).
These symptoms are extremely complex and form an intricate spider-like web which causes an impairment to the entire lifestyle and behavior of the individual. The symptoms of PTSD are a result of the extreme trauma that causes the disruption to the normal functioning of numerous “neuro-biological systems.” Some systems that become deregulated include the serotonergic system which regulates the release of serotonin, the noradrenic system which influences the adrenaline activity, and the dopaminergic system which regulates the release of dopamine. An increase in these systems cause a manifestation of problematic symptoms that involve hyperactivity, aggression, and avoidance (Bravo-Mehmedbasić, 2010). At the same time, the autonomic nervous system becomes highly unbalanced.
During high stress situations, the sympathetic nervous system is engaged for extended lengths of time. This causes an unbalanced state with the parasympathetic nervous system and results in the veteran becoming “stuck in hyper-arousal.” This extended state of hyper-arousal then triggers an overwhelming fear response and the brain cannot gain a sense of control (Justice, Brems, & Ehlers, 2016); often referred to as the “fight or flight.” These malfunctioning brain and nervous systems are what leave veterans to suffer through life with extremely uncontrollable symptoms.
Veterans with PTSD are met with a variety of common symptoms which are treated with Western Medicine by the Veteran’s Affairs Administration.
Research has shown that approximately one out of every four Iraq and Afghanistan era veterans who received care from the VA displayed symptoms of and were diagnosed with PTSD (Phillips, & Wilson, 2018). The VA defines post-traumatic stress disorder as “the experience of a traumatic event followed by the development of four clusters of symptoms including intrusive symptoms, avoidance symptoms, negative alterations in mood or cognition, and increased arousal or reactivity” (Justice, Brems, & Ehlers, 2016). Despite PTSD symptoms varying by the individual, there are many that are common among veterans. These symptoms often are displayed as mood disorders or aggression and do not only occurred during the day but also at night which is manifested in nightmares and insomnia.
Currently, the VA focuses on examining the symptoms displayed by veterans with PTSD and aims at treating only these.
This includes the use of numerous psychological therapies which focus on cognitive-behavior, cognitive processing, and prolonged exposure therapies. The VA considers these “first-line treatments” for post-traumatic stress disorder and oftentimes are accompanied by the prescription of various medications. Anti-depressants are the most commonly prescribed, along with sleeping medications. The VA has elected the use of Selective Serotonin Re-uptake Inhibitors (SSRI’s) as the basic prescription medication for veterans with PTSD. One doctor states that better pharmaceutical treatments are needed because SSRI’s only provide so much help while other forms of medication have displayed severe side effects in veterans (Reisman, 2016). The issue with this treatment is that the focus remains on relieving symptoms such as anxiety, depression, insomnia, tremors, and panic while the actual problem of the brain and neurological changes never get addressed.
In fact, when a veteran is prescribed an SSRI to alleviate anxiety, the VA providers rarely take into account the conditioning that has taken place within the veteran’s brain.
Being aware of what may trigger an episode of PTSD is commonly the main focus of treatment because it is believed that these are what activate the “fight or flight” mode. The intricate web of PTSD symptoms is constantly activated and not only present during a triggering experience (Phillips, & Wilson, 2018). More often than not the physical symptoms, such as tremors or cold sweats, are a reaction caused from the disorder once a trigger has come and gone; thus becoming an unconscious lingering of symptoms of post-traumatic stress disorder that is incorrectly addressed, leaving the veteran more agitated, stressed, and less likely to seek VA treatment. These unsuccessful treatment plans leave many veterans displeased and skeptical of what the VA can do for them.
There is a strong stigma about receiving care at the Veteran’s Affairs Administration that leads many veterans to avoid treatment or not take their wellness seriously.
Despite most veterans considering their PTSD to be less of a stigma than other mental health disorders among society, having a mental illness is not something that is easy for the average veteran to admit or accept. The majority of veterans admit to finding it difficult to reintegrate with society once their service is over and the ability to create a new norm becomes nearly impossible. This exasperates their PTSD symptoms; leaving the veteran more incapable to adapt and hesitant to admit that they have a problem which needs addressing and correction (Mittal, 2013). One analysis revealed that of the returning Iraq veterans, 20% of them returned suffering with some form of post-traumatic stress disorder; yet out of these service members only 53% of them sought treatment during their first year upon returning (Justice, Brems, & Ehlers, 2016).
Another study conducted on 100 service members returning from deployment and received the usual treatments of psychotherapy, cognitive-behavior therapy, and prescription medication determined showed less than a 2% improvement in lifestyle and mental health status. This led researchers to state that there was “no statistically significant improvement” after receiving treatment (Bravo-Mehmedbasić, 2010).
In addition, current veterans with PTSD see the past generations of veterans who are still experiencing extreme psychological issues after 20 years post service and view this as the VA providing treatment that does not work.
They see that there has been no improvement in the way the VA handles treatment of PTSD and believe that all veterans will receive no help from what the VA offers them (Halimi, 2015). With almost half of veterans returning from deployment not seeking corrective treatment and veterans viewing the VA as a joke, many are forced to attempt their own coping mechanisms which, often times, lead to deeper issues.
Unfortunately, due to the lack of veterans seeking care at the VA we see a rise in suicide rates among younger veterans.
Data from the Department of Veterans Affairs shows that approximately 20 veterans a day take their lives (Shane III, 2018). Another study stated that there was a 31.8% suicide risk among veterans with PTSD (Halimi, 2015). From this data, it’s easy to see that current treatments aren’t providing the care that veterans need to cope with their PTSD.
“So what is the VA doing to help eliminate these statistics and provide proper care?” This question was asked to Rob Guevara, an Iraq veteran who was discharged from the Army with 100% disabled; 70% which is due to his PTSD alone. His response was astonishing:
Not enough. Every time I visit my mental health provider they conduct what they call a Suicide Risk Analysis. Basically they ask me if I am suicidal, have had suicidal thoughts recently, or if I am homicidal. That is it. It is easy to just answer no; they don’t question you further. They do the same about depression. It is easy to see that they don’t really care (Guevara, 2019).
It is apparent that there is quite a dissatisfaction among veterans with the treatment they receive for post-traumatic stress disorder. Due to the unsatisfactory results from VA care, many veterans are finding this to be a waste of time and the mental health of veterans is in a state of serious risk; leaving us to ask, “Is there anything more effective at aiding in the rehabilitation of our veterans with PTSD?” as we look towards the expansion of treatment.
Healing PTSD: Part 2
- Bravo-Mehmedbasić, A. (September, 2010). Impact of Chronic Posttraumatic. Stress Disorder on the Quality of Life of War Survivors. Psychiatr Danub. Vol. 22 No. 3. Pg 43430-443430-435. Retrieved from: https://www.ncbi.nlm.nih.gov/m/pubmed/20856187/?i=2&from=combat%20ptsd%20exclusion&filters=ffrft
- Department of Veteran’s Affairs. (September, 2018). How Common is PTSD in Veterans? U. S. Department of Veterans Affairs. Retrieved from: https://www.ptsd.va.gov/understand/common/common_veterans.asp
- Guevara, R. (2019, June 14). Personal Interview.
- Halimi, R. & Halimi, H. (September, 2015). Risk Among Combat Veterans with Post-traumatic Stress Disorder: The Impact of Psychosocial Factors on the Escalation of Suicidal Risk. Department of Psychiatry, Regional Hospital, Gjilan, Kosovo Vol. 52(3) Pg 263- 266. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5353059/
- Justice, L., Brems,C., & Ehlers, K. (October, 2016). Bridging Body and Mind: Considerations for Trauma-Informed Yoga. International Journal of Yoga Therapy. Vol. 28 Issue 1. Pg 39-50. 12p. doi: 10.1776T1/2018-00017R2
- Mittal, D., Blevins, D., Curran, G., & Sullivan, G. (June, 2013). Stigma Associated with PTSD: Perceptions of Treatment Seeking Combat Veterans. Psychiatr Rehabil. Vol. 36(2), Pg. 86-92. DOI : http://dx.doi.org/10.1037/h0094976
- Phillips, R. & Wilson, S. (November, 2018). Posttraumatic Stress Disorder Symptom Network Analysis in U.S. Military Veterans: Examining the Impact of Combat Exposure. Frontiers In Psychiatry. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6259007/#__ffn_sectitle
- Reisman, M. (October, 2016). PTSD Treatment for Veterans: What’s Working, What’s New, and What’s Next. MediMedia USA. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5047000/#__ffn_sectitle