PTSD healing process must have balance
April 25, 2008
By Matt Smith
FORT LEWIS, Wash. (April 25, 2008) - During the Civil War it was referred to as "soldier's heart."
In WWI it was called "shell shock," in WWII it was called "battle fatigue." Korean War veterans were said to have "war neurosis" and Vietnam veterans were diagnosed with "post-Vietnam syndrome."
Post Traumatic Stress Disorder, as it has become known in recent years, has affected war combatants for centuries, if not millennia, with side effects ranging from mild - problems sleeping; certain sights, sounds or smells causing nervousness or jumpiness - to severe - nightmares, night sweats, being afraid to go to sleep for fear of being attacked, total lack of ability to interact with society.
For years there has been a stigma about PTSD in the military; that those with it should just suck it up, and that those who seek professional help are weak. It is that mindset retired Lt. Col. Dave Grossman has spent the past decade trying to eliminate.
"PTSD is not like being pregnant," said Grossman who spoke to the 98th Combat Stress Control detachment last Friday. "Pregnancy is a yes/no binary equation; either you are or you aren't. PTSD is like being overweight. Most of us have a couple pounds we can do without, but some people are 500 pounds overweight and it's going to kill them any day now.
"Once upon a time, we could only identify the guy 500 pounds PTSD ... Now we're dang good at spotting the guy who is 30, 40, 50 pounds PTSD and dealing with it before it becomes an issue ... a vast majority of them are people who are 20, 30, 40 pounds PTSD who, in previous wars, we would have never spotted."
According to his Web site - www.killology.com, Grossman is a psychology and military science professor at West Point as well as a former Ranger who has combined his experiences to become the founder of a new field of scientific endeavor termed "killology." The site also says his contributions to the field have helped to better understand "killing in war, the psychological costs of war, the root causes of the current "virus" of violent crime that is raging around the world, and the process of healing the victims of violence, in war and peace."
It is that mental healing process for those returning from war Grossman says is truly important both for the war veteran and those around him or her.
"PTSD is what we call the gift that keeps on giving," he said. "It impacts not just you, but your spouse and kids in the years to come. If you die, it's not contagious. If you lose a leg, your kids can't catch it. You come home with a load of mental baggage; it can pass on across the generations."
Left unchecked, PTSD can worsen over time, but the vast majority of veterans begin losing the PTSD "poundage" after the first three months or so of returning home. Most veterans eventually return to normal and through a concept called Post Traumatic Growth, Grossman says, can actually become stronger individuals.
"A doctor at Walter Reid sent me an e-mail and he said 'Ya know, almost everybody coming through here are stronger human beings from their experience. Their spiritual life, their social life, their family life, the vast, vast majority are better human beings from their experience.'"
Though it can be a touchy subject, Grossman said he teaches Soldiers that there needs to be a mental balance when evaluating for PTSD.
"I call it the pity party, everybody in society wants to play the victim. Everybody wants to wave the victim card, that's how you get power in society," he said. "So I teach a balance; no pity party, no macho man. Do not create an expectation that's going to be a problem, where it'll be a self-fulfilling prophecy. But if you do have a problem, deal with it, no macho man. John Wayne was an actor, (for) real human beings it can be harder. Create an environment where it's OK to go get help."
Preparing these battle-hardened warriors for the possibility of PTSD side effects is also of the utmost importance according to Grossman.
"Forewarned is forearmed," he said. "I talk about the puppy coming for a visit. We've got the human brain and we've got the dog brain. . In combat, under extreme stress the forebrain shuts down and the midbrain takes over. When you were a kid, how many times did you have to touch a hot stove' Once, right' When you do that, the forebrain shuts down and the midbrain takes over; the little puppy inside grabs you by the throat, pees in your lap and says don't ever do that again.
"The same thing happens with combat, you get powerful neuro-networks established. So you're home and a car backfires and you find yourself in gutter under a car and you think something's wrong with you; there's nothing wrong with you. It's just combat reflexes that will slowly decay."
Reverting to those combat reflexes while at home does not constitute PTSD, it's the inability to eventually "de-link the emotions from the memories."
"PTSD is when the puppy comes from a visit and you try to flee from the memory," Grossman said. "You try not to think about the event. You cannot not think about the event. You have got to make peace with the memory."
Still, one of the biggest obstacles mental health professionals have to overcome in dealing with PTSD is getting Soldiers and other war veterans to feel comfortable talking to someone about their problems.
Because of that, the Army has developed what are called Combat Stress Control units, which do exactly that - help Soldiers control their stress while in theater. These CSCs come in companies and detachment sizes, but serve the same purpose.
"They're there and hopefully get to know the combat units, the Soldiers. They kind of integrate themselves so there's less of a stigma," said Chief Department of Psychiatry at Madigan Army Medical Center Lt. Col. Kris Peterson. "CSC detachments and companies are the main module of mental health care that goes over. The units that do the best are the ones who get the Soldiers to understand that we're in this together."
Peterson said PTSD prevention is one of the most important missions for a CSC while in theater. Not only do they sit down and talk with individual Soldiers after a day in battle, they also help commanders and platoon leaders about what types of signs to watch out for. They teach them what types of coping mechanisms are healthy and what types aren't. They try to help Soldiers from having to "suck it up" all the time and provide some sort of outlet from the strains of killing on the battlefield.
"You look at the Vietnam guys and many of them went down that road (of just dealing with their problems)," said Puget Sound Veterans Affairs Director of Mental Health Murray Raskind. "We want to prevent as many of the OIF and OEF guys from going down that same road. We're not going to be able to do that for everybody, but if we can make a big dent in that, that would be huge for them as individuals and huge for the mission."
As for Grossman, bringing awareness to PTSD and PTSD prevention is a lifelong goal, one he feels passionately about and one he will continue to bring to the forefront of a nation deeply affected by war.
"It's just a mission to me," Grossman said. "I feel a great sense of urgency to get the word out."