Army Begins Post Traumatic Stress Disorder, Traumatic Brain Injury Chain Teaching

By Jerry Harden, MEDCOMSeptember 20, 2007

Every Soldier should gain an understanding of Post Traumatic Stress Disorder (PTSD) and Traumatic Brain Injury (TBI) over the next three months, as a program of "chain teaching" will be carried out by unit leaders throughout the Army. Commanders will use a standardized script and supporting audio-visual products describing signs and symptoms of these conditions and reinforcing what Soldiers know about taking care of each other. There also will be a companion video oriented towards family members.

"Our Army is doing everything possible to come to grips with a very challenging and complex issue," said Army Chief of Staff Gen. George W. Casey Jr. "The goal is to educate all Soldiers and leaders on PTSD and TBI so they can recognize, prevent and help Soldiers receive treatment for these debilitative physical and mental health issues, and remove the stigma associated with seeking care. Look, this is not just a medical problem, it is an Army problem, and we are going to do all we can to help our Soldiers."

"We emphasize that every commander needs to be able to do an individual assessment of each Soldier. If a Soldier has an issue, that commander needs to be able to reach out and help that Soldier. Soldiers also need to be able to help each other" said Col. C. Elspeth Ritchie, psychiatry consultant to the Surgeon General of the Army.

All Soldiers in combat suffer stress, but most recover quickly. Those whose symptoms persist may have Post Traumatic Stress Disorder.

PTSD is a condition that often follows a terrifying physical or emotional event, causing the person who survived the event to have persistent, frightening thoughts and memories, or flashbacks, of the ordeal. People with PTSD often feel chronically, emotionally numb.

Soldiers with PTSD may have three kinds of symptoms for weeks or months after the event is over and the individual is in a safe environment. These symptoms are re-experiencing the event over and over again; avoiding people, places or feelings that remind them of the event; and feeling keyed up or on-edge all the time. These symptoms may interfere with the ability to live their normal lives or do their jobs.

PTSD is treatable, especially if treatment begins early. Treatment options include medication and talking therapy. Most Soldiers diagnosed with PTSD are treated successfully and remain on active duty.

Mild Traumatic Brain Injuries (mTBI) may be commonly referred to as concussions or "getting your bell rung." Unlike severe TBI in which there may be a penetrating head injury with an obvious wound, a mild TBI or concussion may have no physical signs. It may result from a hard blow or jolt to the head, or a blast exposure that causes the brain to be shaken within the skull. TBI may involve confusion, disorientation, or impaired consciousness, dysfunction of memory (amnesia), or loss of consciousness.

Most people with mild TBI recover fully, but recovery can take time. One purpose of the chain-teaching program is to equip Soldiers to recognize symptoms of these conditions in themselves or others so they can obtain treatment.

"It is important to remember, although you may not be struggling, your battle buddy may be. We know that combat and operational experiences will impact every Soldier differently," says the chain-teaching script.

Soldiers and leaders must understand that seeking mental-health assistance is not a sign of weakness, and that a Soldier's career is endangered not by treatment, but by allowing a mental-health condition to worsen without proper care.

The Mental Health Assessment Team IV (which evaluated mental health among Soldiers in Iraq in 2006) demonstrated that stigma continues to be a problem despite all the interventions we have put in place over the last four years. This will be another intervention to promote taking care of ourselves and our buddies," said Ritchie.

"This is an attempt to shift the culture. We know it will take time, but we need to act now," Ritchie added.

The Army provides many resources to help Soldiers suffering from PTSD, TBI or other behavioral-health problems. These include chaplains, deployable stress-control teams, medical and behavioral-health clinics and the Military One-Source hotline (1-800-342-9647), through which up to six free, confidential counseling sessions per issue can be scheduled.

Information about PTSD is available at www.behavioralhealth.army.mil and information about TBI is at www.DVBIC.org.