Tuesday, March 08, 2005

When Johnny Comes Marching Home

Part 1 De-Mystifying Post Traumatic Stress

I wanted to take up an interesting topic today, one that, by its name, by its very implication, evokes fear and uneasiness in a large part of the population. Let’s be frank: it scares the hell out of people.

Post Traumatic Stress (PTS)

Why does it provoke such unease and fear? First, because PTS (Post Traumatic Stress) involves the human psyche and, if there is one thing that’s bound to make people squirm a bit, its discussions about the things that can go wrong with the human mind. Secondly, because we’ve all been indoctrinated with films about the psychotic soldier that returns home to reek havoc on the society that sent him to do something that is against our usual human nature: to kill. Don’t forget the number of documentaries, news articles and snapshots offered by video journalists that have shown any number of episodes where once stable men (these are the usual sufferers in the pieces), snap and do themselves harm.

Of course, what you have seen are the extreme cases.

What we should keep in mind is that movies are just that, movies, and they often exaggerate a point in order to draw their viewers in, make the situation tenser, get you to relate. As for the news pieces and documentaries, they do serve their purposes because, at the very least, they get the word out that this condition exists and people should be aware of it for their own health as well as their loved ones.

I want to be clear though, as I begin to write on this subject that will make so many uncomfortable: I neither seek to inflate the situation nor to minimize it. Rather, I would like to, as the title of the piece suggests, de-mystify it a bit. Information is power. Acceptance makes it easier to recognize and be treated as well as let the potential sufferers know that they are not alone, they aren’t going crazy, there’s nothing to be embarrassed or ashamed about.

It is, in all actuality, very common and very normal.

I decided to write this piece because, as a frequent reader of webblogs written by soldiers and civilians either in the war zone, returning or returned, I noticed some beginning to discuss the “decompression” or “debriefing” sessions they were being put through by the military or through their own auspices as they try to adjust to a return to “civilization”.

Some have mentioned it in that slightly derisive tone that I’ve noted in my relationship with police officers and medical personnel. The tone that says, “Great, what do they think I’m going to get out of this? What’s it doing but eating up my time that I’d rather be spending getting back to my family or hanging out with my friends or just going some place quiet where I can hear myself think?”

Or, thinking, “I don’t need this. I’m fine. I mean, really, do they really think I’m just going to snap and start beating my wife/girlfriend, kids, dog and drinking myself into oblivion every night?”

Well, of course not. The whole purpose is to make sure that everyone gets a chance to wind down, to slowly turn down the volume and adjust. Even if half of these soldiers are just sitting there, listening with half an ear what the chaplain or seminar leader has to say and never take advantage of the counseling offered, they are actually still getting the benefit of the wind down.

And, the truth is, when you come out of a stressful and traumatic situation, whoever you are or whatever walk of life you are in, everyone needs some time to collect themselves, put things into perspective and relax without the added strain of trying to pick up their civilian life, their emotional attachments, or just every day things like paying the bills or mowing the grass or making sure the car is running.

In everyday life, there are a lot of people that don’t get that chance because they have to go on. The military, as imperfect as their programs may or may not be, at least has come to recognize it and give their men and women something that they may never get again in civilian life: time. Not just for the returning soldier, sailor, airman or marine, but, for the families as well since they have had to deal with the stress of not knowing where or how their loved one is, if they are hurt, if they will return. Wars, in and of themselves, create a lot more sufferers of traumatic stress than just those that went.

While I note many family support groups have been started and are active, there are many families whose son, daughter, husband or wife, mother or father, have been called up to from the reserves or national guard. Active military has been pretty good at working with the families of active military groups, but, it seems to me that we have pulled a large swath of society from everywhere around the country and some of them might not live in areas that have these support groups.

So, aside from the soldiers who may or may not feel they could use a little “decompression”, we ought to be aware that their families need a little of that, too.

Now, you may wonder why, aside from reading these blogs, I feel in any way capable of writing something effective about PTS. There are two reasons. First, I work in the health field. As a matter of fact, I work in a field that deals with a large segment of our elderly population, the traumatically injured, the chronically sick and the terminally ill. Most of the health professionals I work with are nurses and pharmacists. Our nurses spend a lot of time assigned to specific patients, they become involved with the families, working with them to care for their ailing loved one, they become, as much as they are warned not to, involved with the patients. It’s hard not to when you spend an hour or two (or more in some cases) every day or every few days with someone, maybe more than you spend with your own family.

Of course, “terminally ill” means that the patients will die and that’s tough when you have to see it over and over again. Eventually, our nurses end up leaving and returning to certain private practice sectors where they are more likely to just take a blood pressure and a temperature instead of seeing the dying and the dead all the time. In our business we call it “burn out”. It’s funny how the medical business, the front-runners of developing diagnosis and treatment, still tend to shun the actual name: Post Traumatic Stress. Law enforcement, firemen and health professionals use this term frequently. The old military slang was once “shell shock” and “battle fatigue” just to name a few.

Before PTS was widely understood, there was a lot of bad press associated with it and it still carries that baggage today. People tend to think of it in the most extreme versions and the people who suffer from it tend to think of it as some kind of weakness in themselves

Here is a reality check: millions of people suffer from PTS (post traumatic stress) every year.

It is that common and, as you can tell by the numbers, it’s very obvious that, in most cases, it doesn’t degenerate into that extreme we all think about when it’s mentioned. Contrary to popular belief, there are not millions of people walking around ready to "snap" at the slightest provocation.

I should explain the second reason why I feel capable of writing on this subject. My father is a 21 year veteran of law enforcement. He retired almost ten years ago on disability. His diagnosis? Post Traumatic Stress Disorder. I have a little experience dealing with it personally, dealing with therapy, medications and, since the diagnosis was made, I’ve done a lot of reading from many different sources. My family did not end up joining any support groups. Maybe, had we been aware of the options, we would have, but, fortunately, our family was close enough that we acted as our own support group.

Believe me, if you have to deal with it the way we did, you quickly learn that PTSD doesn’t just affect the person with the diagnosis, it affects the whole family in little and sometimes, substantial ways.

Well, now that I’ve said the words a couple of times, maybe we’re all comfortable enough with it that it’s time to explain what it is and why it is.

Post Traumatic Stress is exactly what it sounds like. It is the after effects of a traumatic and stressful event, intermittent events, or a long period of continuing stress or exposure to trauma. This is often related to people who are injured in a single traumatic event, have an extreme fear of being injured or must make life or death decisions singularly, intermittently or continuously.

The word “post” in the diagnostic language is a bit misleading because it can actually begin to occur during the event(s).

In reality, it is a natural response to the natural inclinations of the body and mind and related to those age-old instincts of “fight or flight”. When people are exposed to an extreme event or numerous extreme events, this instinct and the neuro/biochemistry (like adrenaline, serotonin, melatonin, etc) that controls it, kicks in. Adrenaline is the “fight or flight” mechanism. In layman’s terms, it might also be referred to as “angst”, “agitation”, etc.

Serotonin tells your mind it’s time to relax. Melatonin tells you it’s time to sleep. In some situations, when there is an overlong period of adrenaline, the body cannot produce enough serotonin to counteract the adrenaline. Then, in response to the overwhelming adrenaline, when the serotonin finally kicks in, the body may produce an overabundance of this chemical. This generally leads to feelings of depression or sadness. Even more so, when the stressful events interfere with our normal habits of sleeping, the ability to control or produce the proper amount of melatonin can be affected as well and have short or long term effects on sleeping patterns. When confronted with stressful situations over a prolonged period of time the body’s natural ability to control these substances can be affected.

In people who are experiencing Post Traumatic Stress, this is manifested in, what we laymen and women call, “mood swings” and sleeplessness. These can be minor or major. The person can be happy and laughing one minute and moody, crying or even angry the next in extreme situations or, they may be relaxed and chatting one minute and withdrawn and tense the next.

Of course, this can happen to anyone so one should never jump to conclusions that they or their loved ones are suffering from Post Traumatic Stress. Diagnosis is best left up to a professional, though professional help should be sought if these conditions persist over an extended amount of time.

Other symptoms, from the minimal to the extreme can include restlessness, inability to sleep (insomnia), recurring dreams or nightmares (these can either be about the actual episode or some replication of an event), night sweats, mood swings (as we’ve already discussed), over reaction to events (like people who react with extreme fear or revulsion of water, fire, strong smells, the site of blood, loud sounds, etc) and other manifestations.

Again, don’t self diagnose or jump to conclusions about your loved one, just be cognizant that these things can occur.

Post Traumatic Stress comes in many degrees. Diagnostically, they are separated into two basic forms:

1) Post Traumatic Stress (or Acute Stress Disorder). This shares the same manifestations as Post Traumatic Stress Disorder (which is different), but often to a lesser degree or over a shorter period of time. PTS or Acute Stress can last from a few hours to a few months. Generally, if it lasts more than a month or two, it may be signs of a more significant issue.

2) Post Traumatic Stress Disorder. This is the chronic and extreme and is generally classified as lasting more than six months. In some cases, it is a life long problem.

What’s important to know is that people that may suffer from Post Traumatic Stress are not naturally nor always inclined to become sufferers of PTSD. We’re all different. We all handle stress and trauma differently. The person that may seem the strongest and most capable among us can sometimes be the person most likely to advance to PTSD. Others who we might feel are weak or “soft” may handle the stress perfectly fine and go on with their lives as if nothing really happened. There is no cookie-cutter response, diagnosis or treatment.

Well, now, if you’ve survived the dry dissertation about what it is and how it is, I hope you’ll read the subsequent sections about the commonality of simple Post Traumatic Stress, my personal experiences with this disorder, the effect on families, what to look for and things that we can do together to make people more aware of this problem, how to mitigate it and things you can do if it happens to you or your family.

Links:

Copshock: Surviving Post Truamatic Stress Disorder
About Trauma
National Centers for Post Traumatic Stress Disorder
NCPTSD: General Facts on Treatment
NCPTSD: For Veterans - FAQs, PTSD Treatment Programs, & Managing Stress

1 comment:

Kender said...

I had a great friend that suffered from PTSD. One year, fourth of july, hollywood park, the fireworks started going off, and here comes Bill, (very decorated 'Nam vet), running through the barn yelling about "charley at the perimeter" and disappearing into the dark.

I went searching for him and found him in a large pepper tree. How he got up there is still a mystery. We had to get one of the big horse vans (a semitrailer basically for hauling horses) so he could jump onto the roof of the trailer to get him down.

Another time at the Pomona (CA)Fair where they set off fireworks every night he ran by and dove into a dumpster and wouldn't come out until an hour after the fireworks stopped. I stood by the dumpster talking to him for that hour.

I think I will post the eulogy I did for him.