Attrition: The Great War On PTSD

The Great War On PTSD

December 3,
2008: The U.S. Department of Defense and the Veterans Administration (VA) have
linked their medical databases to enhance treatment of soldiers who have
suffered injuries that might contribute to long-term PTSD (post-traumatic
stress disorder) conditions. There is a PTSD epidemic right now, created by the
unprecedented exposure of so many troops, to so much combat, in so short a
time.

In response
to this, the U.S. Army now mandates a
mental health evaluation for everyone in the army. Those who have not been in
combat will serve as a baseline for comparing to those who have. Moreover, the
army wants to find out to what extent non-combat operations (training can often
be quite intense) can add to the stress that could eventually lead to PTSD. The
basic idea here is to "mainstream" PTSD, trying to convince all the
troops that PTSD is just another occupational hazard, not something you should
try and hide, and hide from. You can't, and increasingly, the army won't let
you. The records sharing recognizes that PTSD symptoms many not show up until
years after the soldier has left the military.

In the last
year, the army developed a new program to detect, and treat, the many PTSD
sufferers it believes it has. This was accomplished by performing screening
during the delivery of routine medical care, including annual checkups. Doctors
are given a script that uses some simple and non-threatening questions to
discover if the soldier might have PTSD. If further questioning reveals there
may be some PTSD, the soldier is offered treatment as part of regular medical
care, not a special PTSD program. It was those programs that put off many
troops.

While most
troops now accept that PTSD is not a sign of mental weakness, but a very real
combat hazard, many still avoid special PTSD treatment programs. By making PTSD
treatment (which is usually just monitoring, and the use of some anti-stress
medication for a while), part of regular medical care, much of the stigma
disappears.

The army
has, over the years, developed a set of guidelines for how to recognize the
symptoms of combat fatigue (or PTSD). With all the attention PTSD has gotten in
the media of late, troops are more willing to seek treatment, or at least admit
there is a problem. While extreme cases of PTSD are pretty obvious, it's the
more subtle ones that army wants to catch now. These are easier to cure if
caught early.

But the army
find itself facing several sources of PTSD. First, there was the discovery that
many troops, because of exposure to roadside bombs, and battlefield explosions
in general, had developed minor concussions that, like sports injuries, could
turn into long term medical problems. Often these concussions were accompanied
by some PTSD. The VA is particularly interested in knowing about a soldiers
prior exposure to roadside bombs.

Another
problem was that, nearly a century of energetic effort to diagnose and treat
PTSD (including much recent attention civilian victims, via accidents or
criminal assault), had made it clear that most people eventually got PTSD if
they were in combat long enough. During World War II, it was found that, on
average, 200 days of combat would bring on a case of PTSD. After World War II,
methods were found to delay the onset of PTSD (more breaks from combat, better
living conditions in the combat zone, prompt treatment when PTSD was detected).
That's why combat troops in Iraq and Afghanistan often sleep in air conditioned
quarters, have Internet access, lots of amenities, and a two week vacation
(anywhere) in the middle of their combat tour. This has extended their useful
time in combat, before PTSD sets in. No one is yet sure what the new combat
says average is, and the new screening methods are an attempt to find out.

What the
army does know is that a large percentage of its combat troops have over 200
days of combat. Some have three or four times that. So far, treatments
(counseling and medications, for the most part) have worked. But these are not
cures. A major reason for army generals talking about the army "needing a
break" (from combat) is the looming loss of many combat experienced troops
and leaders (especially NCOs) to PTSD. The army won't give out exact figures,
partly because they don't have much in the way of exact figures. But over the
next decade, the army will get a clearer picture of how well they have coped
with PTSD, among troops who have, individually, seen far more combat than their
predecessors in Vietnam, Korea or World War II.

The army is
dealing with PTSD head on, believing that what happened in Iraq, will happen
again, and now is the time to get ready. Experience so far has shown that PTSD
can be delayed, perhaps for a long time. When a soldier does come down with it,
PTSD can often be treated, and its effects reversed. This has large
ramifications for non-military medicine, for many civilians suffer from PTSD.
That's because military recruits are screened for their ability to handle
stress and resist PTSD. In the civilian community, there are far more people
who can acquire PTSD after exposure to much less stress.

The military
and the VA expect that, by pooling their knowledge, and personnel medical
records, they can detect trends in PTSD, and that will help in developing
treatments, or ways to prevent the condition in the first place.