IN SERVICE TO THEIR NATION
PTSD The War Within
By Lynn Feehan
Both history and mythology have told vivid stories of the psychological effects of war . Ancient Mesopotamian texts suggest such responses have been around since the beginning of recorded time . Even in the King James version of the Bible , Deuteronomy tells of soldiers being removed from frontlines due to breakdowns .
Fast forward to the 18th century when French revolutionary fighters were diagnosed with “ acute stuporous posttraumatic states ,” more crudely called “ idiotism .” While American Civil War Veterans plagued with issues were described , more kindly , as having “ Soldier ’ s heart ,” based on changes observed in their pulse rate , or “ Nostalgia ,” as in having an extreme longing for home .
During the Industrial Revolution , the psychological responses by survivors to man-made disasters confounded physicians . In 1884 , German physician Dr . Hermann Oppenheim described the result as “ traumatic neurosis .” Starting a debate that went well into the 20th century : Were the responses simply hysteria ? Or the result of a physical injury such as a concussion , and therefore a long-lasting result of combat ? SIMPLY PUT , WERE THE RESPONSES REAL ? NAMING THE UNSEEN
Generally , the medical community required observable evidence of an ailment in order to provide it with a name , grammatically speaking , these are nouns . A malignancy is found , it ’ s “ cancer .” An artery is clogged , it ’ s “ arterial sclerosis .”
But when thousands of soldiers survived heavy artillery battles clearly sick with no observable cause , the physicians of World War I diagnosed them by applying an adjective : “ shell-shocked .” German psychiatrist Dr . Robert Gaupp reported that many were seemingly unscathed but presented with mental disturbances and continued to fill hospitals well after combat . Psychiatrists began working to provide a diagnostical definition of this debilitating but invisible condition ,
20 AHERO MAGAZINE SUMMER 2021 ultimately laying the foundation for our understanding of it today .
In 1941 , psychoanalyst Dr . Abram Kardiner , whose research would ultimately define PTSD , theorized in “ Traumatic Neuroses of War ” that the lesson of the shell-shocked soldiers was to treat them immediately to prevent the effects from becoming permanent . With World War II raging , soldiers were described as suffering from “ exhaustion ,” or “ combat fatigue ” – euphemisms that seemed to minimize their condition . They accounted for about 40 percent of all discharges .
Few in the military accepted there was a “ real ” issue . The U . S . Army developed a medical training video to treat “ exhaustion ,” yet General George Patton infamously struck and berated two hospitalized soldiers who , as far as he could see , had no apparent injuries . However , America ’ s involvement in the Vietnam War from 1955 to 1973 , brought a fundamental change : Previously developed principles were being approved to assess and treat this gradually acknowledged condition . CONFLICT ’ S AFTERMATH : FROM PTSD TO RISING RATES OF SUBSTANCE-ABUSE AND SERVICE-RELATED SUICIDE
American Vietnam Veterans began a mental-health advocacy campaign in 1967 . PTSD became officially recognized in 1980 . What had been termed “ post-Vietnam syndrome ” was redefined not as a sign of weakness , but as a normal response to the violence and war . Today , years later , PTSD remains a chronic reality for many Vietnam Veterans .
There have been numerous conflicts and wars requiring American combat forces to deploy . The 21st century ushered in the “ War on Terror ” after the attacks by Islamic extremist group al Qaeda on September 11 , 2001 . What began in Afghanistan on October 7 , 2001 , is about to turn 20 years old . Still ongoing , it is the longest war in American history .
It is estimated that 35 percent of Afghanistan and Iraq War Veterans have been diagnosed with disorders such as PTSD or depression , which are strongly linked with substance-use disorder . Studies show that many substance users are attempting to relieve their symptoms .
Women , no longer barred from serving in combat-related positions , are exposed to the same stressors as their male counterparts . Many have also been subjected to military sexual trauma ( MTS ), and are reluctant to report it to their superiors . This group is not limited to females , but women are at a far higher risk for MTS , which also can lead to substance abuse ( SUDs ) and addiction . A MOVING TARGET : THE EVOLUTION TO PRESCRIPTION-OPIOID ADDICTION
Substance abuse that began during the Vietnam era dealt primarily with heroin , due to its easy availability . Today , service personnel are more likely to be dependent on opiates prescribed by physicians to ease posttraumatic stress or pain . In 2009 alone , there were 3.8 million opiate prescriptions – more than quadruple the number in 2001 . Fear of damaging their military career keeps many active-service members from seeking help with dependency .
Veterans that have been dually diagnosed with PTSD and SUDs are likely to have co-occurring psychiatric and medical conditions which can include seizures , liver disease , schizophrenia , and anxiety disorders . Previously disorders were treated one at a time , but treatment recently has been integrated to address multiple disorders at the same time with better results . Also encouraging is the development of non-pharmaceutical PTSD treatments such as cognitive behavioral therapy and equine therapy , which are proving effective for many who want to shed their dependency on prescription meds .