Invisible Wounds
BETHAN NODWELL
© 2013 FrontLine Defence (Vol 10, No 4)

Is PTSD really an “invisible wound”? Not really. Although it is not as easy to recognize as broken bones or a bloody wound, the signs are clear for a professional who stops to look closely enough. But, let’s be honest, it’s difficult for the rest of us to recognize and deal with someone with a brain injury, and we may not be as automatically empathetic with behavioural problems as when we see a glaring physical injury. The manifestations of PTSD are complicated, subtle, and frequently devastating.

According to Psychology Today, Post Traumatic Stress Disorder (PTSD) is defined as an “anxiety disorder that may develop after exposure to a terrifying event or ordeal in which severe physical harm occurred or was threatened. Traumatic events that may trigger PTSD include violent personal assaults, natural or unnatural disasters, accidents, or military combat.” It often involves upsetting memories or thoughts of the trauma, a numbing of emotions, increased arousal or hyper vigilance after hearing a loud noise or being in an uncomfortable place, and sometimes severe personality changes occur, potentially leading to violent behaviour toward themselves or others.

PTSD has been haunting the psyche of military culture ever since war began. The Spartans called it The Trembler. During the civil war, Americans called it Soldier’s Heart. In WW1, it was called Shell Shock, and in WW2 it was called Combat Fatigue. All of them were very dishonorable diagnoses. Soldiers returning from Vietnam mentally fragmented were labeled with Vietnam ­Syndrome which has led to upwards of 100,000 suicides in the past 30 years. In the 1980s, the American Psychiatric Association was finally able to give this condition a name and place in their extensive ­academic literature. Finally it had a real name, with real symptoms, a real diagnosis and a real opportunity to be understood and studied.

Somehow the concept of PTSD has become a household word with nods of acceptance from the general public. However those in the military who suffer from this condition still tend to isolate themselves, fearing career ruination and stigmatization if they come forward to seek the necessary help. As a result, for more often then not, they stay dangerously silent and dangerously ­vulnerable.

According to BGen Bernier, Director ­General of the CF Health Services Group, their own internal studies have found that approximately 7% of military personnel would think less of a colleague with a mental health condition. That starkly contrasts with the general population where 51% of Canadians indicated they would not socialize with someone they know has a serious mental health condition.

How is it that a culture that is so engaged in medical technological developments and diagnoses is having such trouble evolving past a 19th century mindset in regards to brain injuries?

The injury itself varies greatly from ­soldier to soldier and manifests itself on a very personal timeline. Some start showing signs immediately after a traumatic event. These are easier to recognize because your peers are on high alert for such signs. Others may have symptoms that lie dormant for months, years or even decades. These are the trickiest ones because few are watching for signs any longer, especially not the ­soldier.

Violence and Suicide
A frightening aspect of PTSD is the violence. Domestic and family violence escalate when an undiagnosed partner is roaming freely throughout the home, often creating fear and havoc for the family involved.

Suicide is the deadliest side effect of PTSD. Although hard to believe, Canada does not keep thorough statistics on the suicide rates of its soldiers. However, if one looks at statistics for the USA, its Department of Veterans Affairs calculates that one American soldier commits suicide every 65 minutes. We know we are not immune to those combat related realities.

The Brain
It is often called an “invisible wound”, but PTSD is not always so invisible once the brain is imaged through an MRI, CT or PET scan, or a MEG (magneto encephalogram). Using these technologies, neuroscientists can actually see damage to the grey matter.

There are changes in the electrical discharge of brain cells – “fear centers” in the brain are more active, and there is a reduction in the number of cells travelling the pathway between the cortex and the limbic system. The hippocampus, the amygdala, the anterior cingulate gyrus, all very sophisticated parts of the brain, show measurable differences in those suffering from PTSD and those who don’t.

Still, we are talking the brain! A real final frontier for the medical profession! What is known is limited – and PTSD research funding is more limited still!

Treatment Options
How to treat these barely-understood parts of the brain is where more research is required. Many experts believe that the brain is a retrainable organ, and though there is damage to the actual brain, the good news is, that this damage may not always be permanent.
What options are available for soldiers suffering today? Sadly, not enough. And what programming, research and staffing does exist, is grossly underfunded. That being said, the following conventional treatments have seen positive results on some individuals.

Behavioral and Cognitive Therapy
Sometimes talking through the incident can change the power and meaning that is associated with the traumatic event. It can be extremely difficult, in that it requires reliving, remembering and articulating the event that they often would rather forget.

Peer Counselling
This is popular among soldiers who prefer to talk with those who have “been there” and can understand. These days, online forums are another option for soldiers who want to keep their anonymity but need to talk. “Military Minds” seems to be the most popular and credible Facebook group ­available to suffering soldiers, although the Facebook market is quite saturated with support groups these days. Government sponsored support groups are also available.

Animal Assisted Therapy
The positive results of service dogs and equine therapy just keep growing. Anecdotal evidence is overwhelming that ­animals benefit anyone who is suffering. Canine- and equine-facilitated psycho­therapy is a promising approach to address depression and other emotional or psychological problems. It is most important to choose a reputable kennel or horse farm.

Yoga
Fantastic for connecting mind, body and spirit – but not exactly “embraced” by grunt culture. Nonetheless, it has shown it’s capacity in enhancing immune function, reducing stress and increasing levels of oxytocin, a hormone that increases our sense of trust, empathy and optimism.

Nutrition and Regular Exercise
Simple but effective ways to help sufferers- in the long term very difficult to do when suffering alone.
 
Non-traditional Options
Some of the more radical treatments currently in clinical trials include:

Ibogaine
This hallucinogenic alkaloid, derived from the Tabernanthe Iboga plant which is unique to the rainforests of West Africa, has a long history of traditional use as a potent medicinal, ceremonial and spiritual tool. Currently being used for detoxification from hard drugs such as heroin, the Ibogaine “voyage” is powerful and should not be taken unsupervised or with unqualified individuals. Testimonials from former soldiers attest to improvements and ­permanent changes they have personally experienced. This is not a recreational drug. If taken improperly it could be fatal, however, if taken properly with expert supervision, could have very positive effects.

Ayahuasca
Similar but different to Ibogaine. Current research indicates that ayahuasca mimics mechanisms of currently accepted treatments to PTSD, and its use as an alternative treatment for other types of disorders are also being considered. However, more research is needed into how PTSD develops and memory formation to coherently understand the implications of ayahuasca in the treatment of PTSD.

Ecstacy / MDMA
Currently involved in clinical trials, MDMA removes shame and guilt, thus helping people articulate what were previously impossible to speak of. For those who dissociate, it aids in reconnecting with their surroundings and loved ones. Under the right conditions and supervision, could be potentially helpful for couples who are ­suffering through this condition together.

Marijuana
Some doctors now consider that if managed properly, marijuana can be a safe, efficient alternative to other medications that may cause troubling side effects. Like other narcotics, it does not treat PTSD but can provide symptomological relief and does not contraindicate with most prescription medications.

Virtual Reality Therapy
Video game therapy does not involve medication. Soldiers re-live incidents through a VR system which is intended to dull the traumatic memories. American soldiers have reported encouraging results. At $15,000 for the licensed software, this alternative may be worth more interest and investment here in Canada.
 
The Frontlines of Suffering
Self-described “rebel-founder” of Military Minds (the online forum for ­soldiers suffering with PTSD), MCpl Chris Dupee’s message is crystal clear, it’s the stigma and the consequences from being labeled with a mental heath diagnosis that keeps people in the dark, both literally and figuratively. “In combat arms, forget about it. If you say anything, you’re done,” is the common perception, he says.

Dupee believes the Military Minds slogan, “you are not alone”, sends a message that the road back has to be a peer-led initiative – ideally with the support and cooperation from the hierarchy in DND. “Master Corporals, Sergeants, Section commanders, Section 2ICs... they all need to take their sections aside and have a good [frank] talk. Should be a quarterly SOP. Guys aren’t going to trust anyone better than their 2IC’s – from the bottom up not the top down.”

If someone is suicidal or mentally fractured, the section commanders could be (and many are) the lifesavers, suggests Dupee – “if they are trained well enough in identifying the signs, symptoms and characteristics of PTSD and they know what to do about it.”

Finding professional resources that aren’t charlatans or profiteers is a sincere concern for Dupee. He is committed to protecting the vulnerability of those who engage on the MM page and reach out for help. He says he is living proof that peer support is the “best therapy you can get”.

Plan of Action Necessary
PTSD has always been here. It has been a fact of life for soldiers throughout history. Like the devil, it has had a variety of names, misnomers and superstitions associated with it. It’s real, the way epilepsy is real and no longer considered demonic possession. We now know it is a health issue. It is a brain injury. If left untreated, it doesn’t go away – it often gets worse.

More will be diagnosed in the years to come and we are confronted with a medical system that is overburdened, understaffed and under resourced. What is the plan of action for dealing with this?

Civilians who suffer traumatic stresses triggered by events such as serious car accidents or other life-changing crises can also develop PTSD, proving how far-reaching this can be throughout our society. Finding better treatments through research of the mental processes that come into play when an individual is confronted with traumatic situations will not only benefit those who serve in dangerous environments such as the military, police, firefighters and other crisis responders, but society as a whole. That being said, society has a particular obligation to protect those who serve and protect us.

Meeting the demand for appropriate mental health services, is the price of going to war and conducting military business. We must be injecting enough money into research, therapy and treatment for soldiers so they can actually get better and not end up homeless, depressed, drug addicted or suicidal. This gap in the health system affects the reputation and value of the Canadian Forces by insiders and outsiders, we can and must do better.

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Bethan Nodwell is a military spouse with a passion for politics, international relations and the defense industry.
© FrontLine Defence 2013 issue 4

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