More Good Questions

At a date later in this month and another in April, I have been asked to speak before two classes of social work students at Virginia Commonwealth University (Richmond, VA) about veteran issues, their readjustment to civilian life, and also what they, as soon-to-be social workers, can best do to assist them in these matters. While my qualification to answer such questions is dubious at best, I can confidently state that the challenges many of these vets have faced are things that I, too, have faced, and in time learned to either live with, overcome, or perhaps still struggle with today. At any rate, I am flattered with the invitation, and hopeful that something I may mention will help these students better help veterans.

In preparation for these presentations, I have been given a list of several questions that I should be prepared to answer in an intelligent manner. In looking at them, they are reasonable, important, and certainly worth addressing. In part because I wish to practice answering them (and you are the lucky readers), and in part because I think they should be viewed by a wider audience than just these two classes, I am going to respond to some here on the blog. I apologize if this seems to be exploiting an audience, but I have a hunch that these represent questions from a much wider audience. Some I have answered in part, but others I have not. So, without further rambling about it, I will simply begin.

Q: Have you or anyone you know experienced PTSD? If so, how has it affected your life?

The specific causes of PTSD are multitudinous, but basically encompass exposure to any traumatic event that threatened or caused grave physical harm. These needn’t be restricted to combat situations, and can include such events as rapes, assaults, riots, automobile accidents, fires, and so forth. I do not claim to be a psychologist, so I can neither list all the situations that may cause such a condition, nor outline the specific psychological processes that lead to symptoms of PTSD. Contextually, I was asked if my military experiences have brought about such symptoms, so that is the question I shall address.

How PTSD manifests in symptoms is even broader than what can cause it, making direct diagnosis undoubtedly difficult, since it is often hard to pinpoint what behavior is a direct cause of these exposures to trauma. In the case of veterans, however, it often appears as increased arousal (excessively alert, difficulty falling asleep and staying asleep, etc), but includes also such things as total avoidance of the issue, refusal (or inability) to talk about anything remotely similar to the traumatic event, general irritability, anger, and relationship problems. Personally, I would describe many of the symptoms to be increased exhibitions of behavior patterns already fairly common with veterans transitioning to civilian life.

For my part, given my understanding of PTSD, its causes and symptoms, I have at various times exhibited signs of having it. How much is directly tied to traumatic events and how much is simply the consequence of a military lifestyle is difficult to determine. Nevertheless, I will attempt to separate the two.

It is extremely common for newly-returned troops to be incredibly jumpy and sensitive to sudden loud noises, movements, etc. This is particularly true when coming from a combat zone where most of the casualties incurred where from indirect fire (mortar and rocket attacks on bases), and IEDs (which are frequently artillery rounds hidden on a roadside). I have observed many a Marine standing around outside on a stateside base when artillery training commenced in the distance. They lurch, look momentarily confused, and appear like they’re seeking a location to run for safety. Within a moment, they usually catch themselves and shake it off. Their heart rates, however, remain high, and the adrenalin is still in their system.

Upon return from my first tour (wherein we sustained the most mortar, rocket and IED attacks), I was initially extremely sensitive to loud noises, to include balloons popping, tires blowing (on the highway), pots and pans being dropped, and other sudden, staccato sounds. In fairly short order, however, overreaction to this diminished, though I am still sensitive to a few sounds (for example, a snow plow dropping it’s blade onto asphalt in preparation to plow – which sounds like a detonating mortar round). Others do not recover so quickly, for whatever reason, remain jumpy, and continue to overreact to these stimuli for years to come. Though I cannot prove it, I believe that one’s in-country exposure to this type of attack is directly related to the length of time one remains sensitive to these sounds.

How has this affected my life? Very little, though being startled does immediately cause an injection of adrenalin into the bloodstream, an increased pulse rate, and activation of “fight or flight” muscles. The urge to run or hide usually quickly subsides. If it changed anything, it diminished my ability to enjoy 4th of July fireworks and may have contributed to an increased desire for silence around me.

An increased interest in silence may also relate to dislike of chaotic situations, with several competing speakers, loud music, or even an excess of motion. While such things aren’t necessarily going to cause any sort of “episode,” they are certainly nice to avoid. Combat, above anything else, is the epitome of chaos and confusion, and none of us really enjoyed that aspect of it. While this may translate to an avoidance of large crowds and activity for some, I have not really found this to be the case personally.

What HAS changed, however, is my hearing. In doing some research, I have discovered that an inability to “pick a voice out of a crowd” is more psychological than it is aural. When in loud places, I have difficulty distinguishing background noise from a speaker’s voice, which certainly causes some social awkwardness. It is not an inability to hear, but difficulty listening. It is unclear to me if this is a consequence of military service, though I do know the problem did not develop until during/after my service. The embarrassment of having to lean in more than usual to hear, coupled with the frustration of asking others to repeat themselves has caused me to avoid situations when I will have difficulty participating in a conversation.

Perhaps the most common symptom of PTSD is general irritability, though it is also the most difficult to directly attribute to PTSD. During times of heightened alertness (specifically following a combat deployment), it contributes to impatience and leaves one quick to anger. Part of this, no doubt, is simply caused by military service, where many orders are conveyed with yelling, everything is conducted with a sense of urgency, and waiting is totally abhorred. However, a greater display of this irritability directly following a combat deployment suggests that it is, at least in part, related to PTSD.

As for how it as impacted me personally, I have frequently found myself making a conscious effort to remain calm, not yell, and resist the urge to speak sharply to not only friends and family, but also total strangers. I have not permitted it to alter my social habits, but it has meant that I’ve had to issue a number of sincere and humble apologies for unbecoming behavior towards others.

A clear symptom of PTSD is the revisiting of the traumatic experience itself. This may come in the form of a waking “flashback,” but is more common during sleep – resulting in nightmares and perhaps a reluctance to sleep at all, since it will only cause one to relive the experience repeatedly.

I do not know anybody personally that relives his or her traumatic experience in nightmares, but many of us have encountered vaguely similar situations in dreams – wherein one sees killing, is being shot at (or even killed), observes others suffering a similar fate, and in some cases we are the ones doing the killing. They are clearly dreams, and nobody that I know awakens and wishes to continue thinking about such topics. It is quickly dismissed as a dream. For some, however, they may be so graphic or disturbing that they don’t wish to sleep again. I suspect that some veterans drink heavily to induce a sleep so deep that no dreams are ever remembered.

While I have certainly experienced my fair share of nightmares involving violent situations, they are neither sufficiently graphic or frequent enough to legitimately bother me. I dismiss them and continue with sleeping (or waking). Nor are they so disturbing that I awaken suddenly in any sort of panic. Others are not so fortunate.

Curiously, there are specific stimuli that may “encourage” dreams of this nature, such as watching a movie with a violent gun battle, a news clip, or even a written account of a similar situation. For this reason, many veterans may avoid movies, books, or video games that cause them to dwell on their own similar experiences. I have found myself overly-alarmed or “caught up” in various scenes of movies, such as the D-Day landing in “Saving Private Ryan,” the firefights in Mogadishu during “Blackhawk Down,” and other similar movies. For somebody that has never experienced combat, a depiction of it is so unfathomable that the viewer does not “enter it.” Yet for me (and other veterans) they are believable, and it is difficult to enjoy it as part of a movie. Instead I find myself in the scene itself and wishing I could somehow help. I have, thus far, not overtly avoided films as a consequence of this. Many do, especially World War II veterans. There are numerous accounts of them simply walking out of theaters during showings of “Saving Private Ryan.” Given what they experienced, I do not blame them in the least. It is not necessarily a nightmare to be relived, but a real event that the viewer enters yet feels totally powerless to help. Servicemembers, as a whole, do not like feeling helpless.

As I understand PTSD, it may also be delayed in its exhibition of symptoms. Thus, a seemingly well-adjusted veteran may inexplicably begin showing signs of PTSD. It should not come as a shock to friends or loved ones. The nature of the condition is that it may remain latent for quite some time. It depends on the individual, their traumatic experiences, and a host of other variables. It remains, important, however, to not ignore the symptoms should they arise.

What is most poisonous is when a number of PTSD symptoms all act simultaneously on a veteran. Jumpiness dissuades him from being in situations he cannot control (crowds, large social gatherings, noisy situations), irritability causes him to avoid others, and severely disrupted circadian rhythms (from nightmares and flashbacks) leave him routinely exhausted and even more irritable. These combine to create a belief that he is fundamentally different, that he does not fit in, and the symptoms are sufficiently overwhelming that he feels unable to overcome them. What results is a tendency towards isolation, which quickly serves to solidify that conviction. In short, the veteran is left alone with his thoughts, will never discuss experiences they are best not buried, and may begin to consider his difference from “normal” people so severe that fitting in is totally impossible. This line of thinking can become quickly self-destructive, difficult to reverse, and potentially fatal.

What can be done to help a veteran that suffers with PTSD? Depending on its severity and how much it influences their lives and behavior, they may wish to pursue treatment with a professional. The VA offers extensive programs for this, specifically tailored to veterans suffering with combat-related PTSD. While other mental health professionals may be qualified on paper, many lack the experience or specific training with veterans. I would personally recommend a VA professional before any other. They may be able to assist a veteran in talking through the problems, or perhaps even prescribe medications that calm the nerves until such things occur naturally.

Another hurdle is getting a veteran to admit that he or she may, in fact, have a problem. There is a general tendency to ignore the issue or deny a problem with it. More specifically, many may be willing to admit to themselves that they need help, but are uninterested in seeking it. There remains a common belief that a mental health issue is a clear sign of weakness. Rather than admit this, many will simply ignore the problem. I, too, have struggled with this thinking. Truly believing that an issue with PTSD is not a show of weakness is difficult. Until veterans feel “safe” and accepted with an admission that they need help, few will seek it. This requires a concerted effort on the part of friends and loved ones to accept the veteran non-judgmentally, and think no less of them if they choose to see a mental health professional.

The greatest help that anybody can offer a veteran is therefore this: patiently love and accept them in spite of them their struggles, and openly (and sincerely) indicate that a need for help in no way suggests weakness, but instead a boldness that tragically few possess. It is also imperative to not allow a veteran struggling with PTST to isolate him or herself. Friends and loved ones must keep up with them, even if they are poorly received. But in truth, they will probably not be poorly received if everything they do is firmly rooted in a sincere love and concern for their friend or loved one. Above all else, veterans nedd people to truly love them.

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