By Dr. David Ferguson, Fox Army Health Center, Redstone Arsenal, ALJune 11, 2009
The memories I have of Soldiers with Post Traumatic Stress Disorder start in 1976. The first Soldier I remember with PTSD, we called Sgt. Ski. He was my platoon sergeant and neither he nor I knew what PTSD was but the symptoms were very obvious with him.
He would let no one walk behind him. He startled easily when an unexpected loud noise occurred. I remember when the jeep backfired in the motor pool and he "hit the dirt." Sgt. Ski could not stand crowds. He preferred to be alone and he had a table in the corner at the NCO club. He could be found in there from about 3 p.m. till closing most days. Sgt. Ski had been an infantryman in Vietnam, but he would never talk about it.
The next Soldier I remember with PTSD was Dan. He was a civilian when I met him and he and I were working on our psychology degrees in the same psychology program. Dan was a great guy but everyone said he was "moody and not much fun to be around." Dan had served in Vietnam also. He was brilliant but concentrating was very difficult for him. He often looked tired and would occasionally talk about not being able to sleep because "the nightmare came again." He stated that he knew that being in Vietnam had changed him in ways that he did not want to change. He said that he was studying psychology so that he could help other veterans.
Next, I met Ben while I was at Walter Reed in their psychology training program. He had served as a green beret in Vietnam. He had also been a sniper. He stated that it had not bothered him to shoot enemy soldiers when he was "in country." But, now, he was seeing their faces in his dreams. He talked about his current marriage, which was his fourth marriage. Ben said she could not understand and he could not explain it to her. He said that if she knew what he had done, while in combat, that she would immediately leave him. He talked with guilt and shame about his children. He said that he abandoned them because he just could not get close to them. He knew they hated him but he just did not care enough to try and mend those relationships.
Bob was the next veteran I met with PTSD. He cleaned our offices in Fort Leonard Wood, Mo. Bob was rather small which allowed him to be a "tunnel rat" in Vietnam. He talked about what it was like to crawl back in the Vietnamese tunnels, not knowing who or what would be around the next corner. He stated that he always carried a flashlight with him now. He always slept (when he could) with a light on. He said being in the dark or waking up in the dark was terrifying for him now. He reported that a dark room could almost instantly trigger a flashback and he would feel like he was back in a tunnel. He said that sometimes it would take two days before he felt like he was fully back to the present.
HUNDREDS OF STORIES
Since then, I have had the honor to hear hundreds of veterans tell their experiences of being in combat and combat environments. These honorable men and women have taught me a lot about PTSD. They have told these experiences through tears of debilitating grief, guilt and fear. They have been willing to open their Pandora's box to memories that they had refused to even acknowledge, much less tell. They have brought tears to my eyes as they talked about losing a best friend. I have listened as a Soldier tried not to vomit when he talked about his commander getting killed. Their shame has been almost unbearable as they talked about children and other civilians that were killed or maimed during combat operations. I am extremely grateful for what these Soldiers have taught me. One request from these combat wounded is that I use any part of their story or experience to help other veterans. So, honoring that request, I would like to pass on a few simple guidelines.
First, for the veteran with PTSD or symptoms of PTSD (see symptoms below):
Aca,!Ac PTSD is an anxiety disorder. Anxiety is the problem. It returned with you from your deployment. You were taught to "stay alert and stay alive" while in the combat zone. Your anxiety in the combat environment kept you alive. Anxiety is reinforced in a dangerous environment. However, if you have been back from deployment for at least six months, have not received any consistent mental health assistance, and your anxiety has not decreased significantly, it probably will not decrease significantly.
Aca,!Ac Avoidance keeps you from reducing your anxiety. Anxiety is maintained by avoidance. Avoiding talking about your experience, avoiding thinking about your deployment, and avoiding memories will not reduce anxiety. If avoidance was going to reduce anxiety, it would have worked within six months. Continuing to avoid will maintain the anxiety. The more a person avoids something that makes them anxious, the more anxious they will be when they are unexpectedly confronted by it.
Aca,!Ac Confront your anxiety. People overcome anxieties regularly in life by confronting or facing the thing that makes them anxious. For instance, children who are afraid of dogs are gradually introduced to a puppy. They learn to play with the puppy and then begin to play with a bigger dog, in a safe environment. Through this gradual approach, a child overcomes his or her fears. The combat veteran should have a systematic way of overcoming his/her anxiety.
A relatively simple system can be as follows:
Write out your memories. Although this seems frightening and overwhelming to most veterans, it is a good starting point for confronting anxiety. You are in control of what you write and, therefore, you can start and stop anytime you want. Writing out memories does not cause a person to get anxious or upset. However, it does release anxiety or grief that is already present in a person. So, write and do it privately. Save it for yourself.
After you write out your memories, practice reading them aloud. As you read and reread these memories, you will reduce the emotion related to the memory. You will always have the memory, but you can reduce its sting.
After you have read a memory to yourself repeatedly (at least 25 times), you are ready to read it to someone else. Usually this is a spouse or partner. Tell them that you really do not want them to respond. You certainly don't want them to ask you a lot of questions. You just want to educate them some on what you have been holding inside. Tell them that you want to read it to them maybe once every two or three weeks just to help you get over it. You know that they cannot completely understand what it was like for you, but you want to help them understand some of it.
Confront your social anxiety. Most combat veterans come back with a higher level of anxiety in social settings. If they go out to eat at a restaurant, they like to sit with their back to the wall and be able to watch entrances/exits. They do not like being in crowded places. They will go very early in the morning or to places that are unlikely to have many people present. They are often on a 'snatch and grab' mission when it comes to shopping.
Start this confrontation process by going to a place that has a relatively small crowd. Place yourself in that setting and immediately your anxiety will increase. However, do not leave. If you stay in that setting for (usually) 60-90 minutes, your anxiety will go down on its own. At that point, you will know you have the ability to endure your anxiety and see it change. The mistake many people make is thinking their anxiety will never decrease. It will, if you stay in the setting long enough. This is a process called habituation. But the only way you get to know that it works is if you endure until you see the anxiety drop significantly from its peak.
Be systematic about this. Start with places that are lower on your anxiety scale and gradually work up to more anxiety inducing environments (the Commissary on a pay day weekend).
Confront your nightmares. I have heard more than one combat veteran say that he wished he did not have to sleep, because "sleep is when the nightmares come." Traumatic memories can surface as nightmares during sleep. Soldiers will often use distracters to reduce the likelihood of nightmares, like leaving the television on at night or using alcohol and other sedatives to sleep more heavily. These are avoidance techniques and do not reduce the anxiety or emotion related to the traumatic memory. The dream/nightmare is our sleeping mind's attempt to work out a problem that we have not solved. The more emotions attached to the problem, the more likely we will dream about it.
So, if your nightmare is one that frequently reoccurs, write it out. List as many details as you can remember. Then, read it aloud, over and over.
If the nightmare is unique, tell someone. This is usually enough to resolve a one-time nightmare. If that does not work, then write it out.
Additionally, mental health is improved by following the basic guidelines for health:
Aca,!Ac Eat a balanced diet.
Aca,!Ac Do not rely on caffeine to get through the day. Caffeine can mimic anxiety.
Aca,!Ac Engage in exercise. Exercise burns up energy and therefore lowers anxiety.
Aca,!Ac Engage in recreation. Find pleasurable activities and pursue them.
Aca,!Ac Have a good social support system and use it.
Behavioral Medicine Division's goal is to help Soldiers, retirees and their family members to improve their mental health. Many Soldiers who desperately need mental health assistance will never come to BMD because of the stigma still associated with receiving mental health services. Even if you never seek our services, you can apply some of the ideas listed above. Be methodical and consistent in your application. Look for gradual change and you will see it. Good luck and we thank you for your sacrifice.
Post Traumatic Stress Disorder symptoms include the following:
Aca,!Ac Re-experiencing the traumatic event.
Aca,!Ac Intrusive, upsetting memories of the event.
Aca,!Ac Flashbacks (acting or feeling like the event is happening again).
Aca,!Ac Nightmares (either of the event or of other frightening things).
Aca,!Ac Feelings of intense distress when reminded of the trauma.
Aca,!Ac Intense physical reactions to reminders of the event (e.g. pounding heart, rapid breathing,
nausea, muscle tension, sweating).
Aca,!Ac Avoidance and emotional numbing.
Aca,!Ac Avoiding activities, places, thoughts or feelings that remind you of the trauma.
Aca,!Ac Inability to remember important aspects of the trauma.
Aca,!Ac Loss of interest in activities and life in general.
Aca,!Ac Feeling detached from others and emotionally numb.
Aca,!Ac Sense of a limited future (you don't expect to live a normal life span, get married, have a career).
Aca,!Ac Increased arousal.
Aca,!Ac Difficulty falling or staying asleep.
Aca,!Ac Irritability or outbursts of anger.
Aca,!Ac Difficulty concentrating.
Aca,!Ac Hypervigilance (on constant "red alert").
Aca,!Ac Feeling jumpy and easily startled.