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One in three homeless
men in America is a veteran.
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Jeffrey
was a silent hero, touching many lives......
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"Hope For Our Heros"
Rummage Sale! |
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Every dollar generated
goes toward helping combat veterans to receive mental
health care and treatment for combat PTSD” See Details |
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"To thy hands we our souls,
Lord, commend" |
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Loved ones lost to
combat PTSD related suicide.
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The wars in Afghanistan
and Iraq will produce a new generation of veterans at
risk for the chronic mental health problems that result,
in part, from
exposure to the stress, adversity, and trauma of
war-zone experiences. These risks have been described
and discussed repeatedly in the media and have absorbed
the attention of policy makers and care providers in the
Departments of Defense and Veterans Affairs. Many of the
challenges soldiers face in these new wars reflect
well-researched universal psychological themes of combat
(e.g., life threat, killing). However, it is important
to appreciate the specific demands and contexts of these
new wars in order to raise the awareness of civilians
back home, to prepare loved ones for soldiers' return,
to estimate the need for clinical services, and to make
other policy recommendations. |
The wars in Afghanistan
and Iraq are the most sustained combat operations
since the Vietnam War. A wealth of research has shown
convincingly that the frequency and intensity of
exposure to combat experiences is strongly associated
with the risk of chronic post-traumatic stress disorder
(PTSD; APA, 1994) and related impairment (Kaylor, King,
& King, 1987). As a result, there is good reason to be
more concerned about the long-term mental health toll
associated with these new wars than with the toll of
other post-Vietnam War operations, such as the mission
to Somalia (Litz, Orsillo, Friedman, Ehlich, & Batres,
1997) and the 1991 Persian Gulf War (Wolfe, Erickson,
Sharkansky, King, & King, 1999). Only one comprehensive
study has examined the mental health impact of the wars
in Afghanistan and Iraq (Hoge et al., 2004). This study
evaluated active-duty soldiers' reports of various
war-zone experiences and the rates of mental health
problems; the estimated risk for PTSD from service in
the Iraq War was much higher than from service in the
Afghanistan mission (18% vs. 11%, respectively). In both
contexts, reports of combat exposure were highly
associated with the risk of PTSD. |
However, combat is not the
exclusive source of danger, conflict, and severe stress
in a war-zone; nor is it the necessary and sufficient
cause of
military-service-related PTSD (King, King, Foy, Keane, &
Fairbank, 1999). A variety of war-zone experiences
contribute to veterans' risk of chronic PTSD and
impaired functioning in relationships, work, and
self-care. The examination of the long-term risks for
veterans of any war also requires an evaluation of the
unique socio-economic-cultural contexts that dynamically
shape soldiers' recovery and adaptation across the life
span (Friedman, 2004; Weathers, Litz, & Keane, 1995). It
is too early to definitively describe the factors that
these soldiers will struggle with as they reemerge into
their families, their communities, and the culture at
large. The first step in the process of understanding
these new wars is to appreciate the demands that
soldiers face, which will affect recovery and
adaptation. |
Guerilla Warfare in
Urban Environments
Especially since the end of formal combat operations,
the Iraq War has
exposed soldiers to potentially traumatizing contexts
that affect coping capacities and adaptation. The
conflict in Iraq has been fraught with the dangers that
ensue from guerilla warfare and terrorist actions (e.g.,
roadside bombs) stemming from ambiguous civilian threats
(Hoge et al., 2004). In this context, there is no safe
place and no safe duty, although some duties are
particularly high-risk, such as patrolling dangerous
areas and driving trucks. In Iraq, soldiers are required
to maintain an unprecedented degree of vigilance and to
respond cautiously to threats. There is great concern
that soldiers will mistakenly think civilians who mean
them no harm are actually combatants. Soldiers also need
to be careful about possibly causing collateral damage
to civilians in urban environments. The latter can cause
chronic anxiety and strain (Litz et al., 1997). In Iraq,
62% of soldiers reported being in threatening situations
where they were unable to respond aggressively because
of the understandably constrained rules of engagement (Hoge
et al., 2004). Taken together, these unique features of
the war in Iraq create the conditions whereby stress
hormones are released excessively, with unknown, but
likely significant, consequences regarding health
maintenance, restoration, and coping capacity. It is of
note that although formal ground combat lasted only four
days in the first Persian Gulf War, rates of chronic
PTSD were surprisingly high because of the chronic
stress and strain of possible chemical or biological
attack (Wolfe et al., 1988). |
The Aftermath of
Violence
In Iraq, the ratio of wounded to killed-in-action is the
highest in United
States history (Ricks, 2004). This is in part because of
the type of life
threats incurred (e.g., 94% of soldiers in Iraq endorsed
receiving small-arms fire; Hoge et al., 2004) and the
advances in protective gear and acute medical care.
Soldiers in Iraq are thus not only at risk for being
maimed but also for witnessing, or suffering from, the
aftermath of violence. For example, 86% of soldiers in
Iraq reported knowing someone who was seriously injured
or killed, 68% reported seeing dead or seriously injured
Americans, and 51% reported handling or uncovering human
remains (Hoge et al., 2004). Witnessing the aftermath of
violence and death has been shown to create risk for
anxiety, anger and aggressive behavior, somatic
complaints, and PTSD (McCarrol, Ursano, & Fullerton,
1997). |
Witnessing mass
destruction, especially the suffering of civilians, also
contributes to the risk of developing PTSD (Litz et al.,
1997). On the other hand, the lasting psychological
consequences of causing destruction and
perpetrating violence have been strikingly
under-researched. For some, the shame and guilt induced
by killing of any kind in combat can arguably be
uniquely scarring. Hoge et al. (2004) found that 77% of
soldiers deployed to Iraq reported shooting or directing
fire at the enemy, 48% reported being responsible for
the death of an enemy combatant, and 28% reported being
responsible for the death of a noncombatant. |
Erosion of Meaning,
Acceptance, and Support?
Several factors may erode morale and mission-related
beliefs and attitudes:
the significant human toll, the contentious nature of
the extensive and
extended sacrifice made by soldiers (especially
national-guard and reserve troops) and their families,
and concerns about whether veterans will be sufficiently
taken care of when they return to the states. Public
opinion and material and emotional support have been
shown to affect the impact of deployment sacrifices and
exposure to trauma (Bolton, Litz, Glenn, Orsillo, &
Roemer, 2002; Koenen, Stellman, Stellman, & Sommer,
2003). Many soldiers may find meaning and gratification
in their helper roles in Iraq and Afghanistan, however,
the positive impact of humanitarian duty and
nation-building can be trumped by potential threats and
global support for the mission (Litz et al., 1997).
Although the public support for a mission is no longer
conflated with support for soldiers, as was the case
with the Vietnam War, it is likely that morale and the
sense of purpose have degraded since the formal combat
operation ended in Iraq. However, there is no available
research on the topic. |
There are troubling
initial signs that soldiers from the all-volunteer
professional military are reluctant to seek help or help
may not be readily
available. For example, Hoge et al. (2004) found that
although approximately 80% of Iraq and Afghanistan
veterans who had a serious mental health disorder, such
as PTSD, acknowledged that they had a problem, only
approximately 40% stated that they were interested in
receiving help. In addition, only 26% reported receiving
formal mental health care. Modern career soldiers are
very concerned about stigma and may be ashamed of
opening themselves up to professionals. They are also
very concerned about taking on a 'sick' or 'weak'
persona and expect that it will negatively impact their
careers. |
Prior Trauma
Prior trauma and adversity is a robust predictor of
military-related PTSD.
This underscores that soldiers may have mental health
burdens that they bring with them to dangerous
deployments. Indeed, life-span traumas are extensive in
military personnel. For example, Bolton, Litz, Britt,
Adler, and Roemer (2001) found that 74% of soldiers
reported being exposed to at least one potentially
traumatic event-separate from their time in military
service-in their lifetimes, and 60% reported being
exposed to more than one across their life spans, with
the majority of these incidents occurring prior to
military service. King et al. (1999) found that the
extent of early trauma was associated with the
development of PTSD for both men and women. Bremner,
Southwick, Johnson, Yehuda, and Charney (1993) found
that after controlling for combat exposure, Vietnam
veterans who experienced a greater number of traumatic
events prior to joining the military were more likely to
have PTSD. Childhood physical abuse was particularly
predictive of combat-related PTSD. |
Deployment Variables
Traditional combat is not the only source of severe
stress in a war-zone; nor is it the necessary and
sufficient cause of military-service-related PTSD
(King et al., 1999). War-zone demands are multifaceted,
and contextual features such as poor diet, bad weather,
and poor accommodations shape how soldiers cope during
and after deployments. In addition, perceived
life-threat is an important determinant of long-term
adaptation (King et al., 1999). |
Post-Deployment Factors
The association between social support and the
development of PTSD is very robust in combat veterans
compared to civilians exposed to interpersonal violence
(Brewin, Andrews, & Valentine, 2000). Vietnam veterans
who report active engagement in the community are less
likely to have PTSD (Koenen et al., 2003). Sutker,
Davis, Uddo, and Ditta (1995) also found that a lack of
family cohesion predicted the development of PTSD in
Persian Gulf veterans. A tendency to use social supports
specifically to disclose personal problems and to talk
about events experienced during a deployment are also
associated with adjustment. For example, Vietnam
veterans who discussed their military experiences
demonstrated decreased rates of PTSD (Green, Grace,
Lindy, & Glesser, 1990). Koenen et al. (2003) found that
veterans who reported discomfort in disclosing their
Vietnam service experiences to friends or family
demonstrated an increased risk for developing PTSD. |
Generally, stressful
demands and adversity after a mission affect the degree
of posttraumatic impairment. For example, King et al.
(1999) found that male and female Vietnam veterans who
had postwar experiences that were more
stressful reported more severe PTSD. Wolfe et al. (1998)
found that the relationship between sexual harassment
and PTSD symptoms was affected by a number of
post-service stressful life events in Persian Gulf
veterans. |
Conclusion
If you suspect that you or your spouse is dealing with
Post Traumatic Stress Disorder and you are looking for
support... seek help. You can not fight PTSD alone nor
will it just go away. |
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Read More: |
Understanding The Biology
of PTSD
Diagnostic Criteria of PTSD
PTSD and the Family
PTSD and Children |
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