PTSD: Treatment of Soldiers Returning from The Middle East - Term Paper Example

Post-traumatic stress disorder, known as PTSD in the literature and among experts, is a problem that affects a wide range of people, including car accident victims, victims of violent crime, and soldiers returning home from conflicts in foreign countries. PTSD is a condition that arises when an individual finds adjustment back to a “normal” way of life difficult, given the psychological impact of the catalyzing event. For a soldier returning from war, this catalyzing event may be a traumatic injury or the death of a close one on the battlefield. The varying causes and symptomologies of PTSD make the condition difficult to predict and identify. Overall, the disorder is becoming more and more common in the general public of returning soldiers, either because the combat experience is changing or mental health specialists are becoming better equipped to identify and diagnose symptoms. Changes in the number of returning soldiers diagnosed with PTSD directly affect the ability of public organizations like the Veterans Administration to effectively deal with the problems of returning soldiers, which federal and state governments are legally obligated to do. Currently, a fundamental incapacity exists in the system established to address the mental and physical health of returning soldiers, which is overwhelmed by the number of veterans maimed or wounded by combat. As defined by the mental health community, post-traumatic stress disorder is a condition that occurs following a major traumatic event and includes re-experiencing phenomena, avoidance of distressing thoughts, detachment from other people, sleep disturbance, hyper-vigilance, and increased irritability (Bisson, 2009). Re-experiencing, emotional avoidance, and increased arousal symptoms are the mostly clearly identified hallmarks of the condition. PTSD is differentiated from a so-called “normal” response to an abnormal, or traumatic situation, insofar as the subject does not begin to feel better in time. In fact, symptoms of PTSD worsen through time if they are not effectively treated. Although the psychological (or “external”) symptoms of individuals returning from combat are well-known, how they are expressed differentially among those persons can vary. Neurologically, PTSD is likely rooted in the amygdala, which is the brain’s center of emotional processing (Shin, 2009). In studies of those affected by PTSD, the amygdala was hyper-responsive to trauma-related stimuli and amygdala activation was tightly correlated to PTSD symptom severity. From these facts, researchers conclude that PTSD is primarily an emotional disorder, which manifests itself with symptoms in other areas of the individual psychology. This conclusion is consistent with the other information mental health specialists have about how the condition is expressed and how the brain functions. Although this neurological basis is relatively well-understood in the literature, it is difficult to define exactly how events from an individual’s experience lead to a hyper-activation of the amygdala. As mentioned previously, PTSD is a mental condition that arises when an individual finds adjustment back to a “normal” way of life difficult. For soldiers, events that could be considered “traumatic” in one way or another are an everyday experience. Experiencing physical injury, being in a gunfight, or being assaulted recur repeatedly over the course of a soldier’s time in combat. Virtually any life-threatening event in wartime may be considered, by a mental health profession, a “trauma”. For a therapist, particularly difficult about a subject suffering from PTSD is the subject’s emotional avoidance of the situation, which makes understanding the traumatic situation notoriously difficult to understand and to address. Returning to the neurological basis of PTSD, it may be the case that prolonged amygdala hyper-activation leads to a protraction of that excess arousal even long after the combat environment has gone. The role of emotions in survival being well-known, there is sufficient evidence to support the theory that PTSD is caused primarily by prolonged, high levels of emotional sensitivity (Shin, 2009). In addition to neurological evidence, evidence regarding predispositions and environmental triggers also exists in the literature. For example, Koenen et al. (2007) examined birth cohorts to examine childhood factors that increase one’s risk for developing PTSD. They concluded developmental capacities from early childhood before age 11 increase risks of trauma exposure and adverse reactions to trauma. These adolescent risk factors fall into two groups: (a) maternal distress and the loss of a parent, and (b) low intelligence and chronic environmental adversity (Koenen, Moffitt, Poulton, Martin, & Caspi, 2007). The value of these results pertains to how mental health professionals treat and retrospectively diagnose the causes of PTSD symptoms in individuals coming back from combat. Also, the first category (a) lends further support to the view of PTSD as an emotional disorder, but may indicate that emotional hypersensitivity in soldiers that causes PTSD may extend beyond the beginning of combat. Post-traumatic stress disorder is difficult to diagnose insofar as identifying its symptoms and differentiating them from others disorders often requires an extended period of time. Diagnoses of PTSD must incorporate some justification in terms of how the disorder debilitates the subject and leaves him or her unable to complete normal daily tasks for more than a month. An established set of diagnostic criteria for the condition reflect re-experiencing events, emotional avoidance, and increased arousal as mentioned previously (Grinage, 2003, pp. 2402-3). Diagnostic validity of PTSD is demonstrated first by a screening questionnaire, which has a sensitivity of 80 percent. Once a subject is screened as possibly having the disorder, a physician takes a patient history, during which emotional trauma becomes especially relevant. Comorbidities with other conditions like major depression, manic depression, alcohol problems, social anxiety, and drug abuse are relatively common (Grinage, 2003). Such comorbidities make clear-cut diagnoses of PTSD difficult looking at symptomology alone. Treating PTSD, like other widespread psychological ailments, usually occurs in some combination of medication and live therapy to resolve the anxiety felt toward the traumatic events (or series of events). Psychotherapy is usually undertaken to some extent as a first response to ameliorating the symptoms of PTSD (Grinage, 2003). Between 20 and 40 percent of patients who undergo psychotherapy alone achieve 50 percent reductions in their symptoms over a six-week period. This reduction improves ten percent over a 16-week period. Therapies open to PTSD sufferers include cognitive therapy and stress inoculation training, which facilitate environments in which subjects can face their fears and manage anxiety. A significant number, approximately 14 percent, of PTSD patients drop out of psychotherapy, theoretically because of their emotional avoidance (Hembree & Foa, 2001). Because PTSD often has significant effects on the family of the individual affected (as is often the case with soldiers returning from combat), psychotherapy for family members is necessary in many instances. In terms of PTSD pharmacology, clinical trials focus on selective serotonin reuptake inhibitors (SSRI) medications, commonly used in the treatment of depression and anxiety. The comorbidity of these other psychological conditions with PTSD makes a joint pharmacological intervention sensible. Paxil and Zoloft, the only two FDA-approved drugs to treat PTSD, were shown effective in treating the disorder (62 and 54 percent effective, compared to 37 percent who received a placebo) (Marshall, Beebe, Oldham, & Zaninelli, 2001). Medicating PTSD sufferers is common in treatment given by mental health professionals, although this has been criticized as a way of not giving therapy to rapidly increasing numbers of combat veterans who need therapeutic treatment of their disorder. In more acute cases of PTSD, several SSRIs are helpful, which makes the prescription of only one SSRI in most cases ineffective. The Veterans Administration must focus on giving well-rounded treatment to ameliorate PTSD symptoms. However, the question of whether combat veterans actually receive well-rounded treatment (that is, treatment that includes medication and psychotherapy) does not have a clear answer. The epidemiology of PTSD is shocking. For veterans of conflicts in Iraq and Afghanistan, studies show one in ten veterans face serious mental health problems that include acute cases of PTSD (between 23 and 31 percent of returning soldiers) along with significant comorbidities that lead to suicide attempts, alcohol abuse, and violent behavior (Niiler, 2010). In response to these numbers, the Veterans Administration has detailed its problems to the public and to Congress about its failure to provide adequate care and treatment to mentally-wounded soldiers returning from Iraq and Afghanistan. According to some reports, the Veterans Administration faces a backlog stretching to upwards of 175,000 claims for disabilities, along with a 110 day wait time for veterans to have their claims processed (Niiler, 2010). These kinds of numbers indicate a “bureaucracy” for veterans trying to seek help for their problems. Although the Congress and federal government have doubled the budget of the Veterans Administration since the beginning of the Iraq war, the agency still cannot satisfactorily process this new influx of patients. Earlier this year, the federal government announced positive changes to the process veterans must go through in order to get their treatment (Martin, 2010). These changes include modifications to the agency’s qualification criteria; thus, veterans simply have to prove they served in a war zone (instead of proving their PTSD was caused by a war-specific event) in order to qualify for treatment. While these measures may make receiving the promise of treatment by the Veterans Administration easier to acquire, it does not necessarily mean actually receiving the treatment. By accepting more claims, the VA is taking on more financial responsibility, which could make everyone wait longer (Martin, 2010). In other words, the agency is throwing money at the psychological problems of the nearly 294,000 Iraq and Afghanistan veterans with PTSD. The well-publicized problems of the Veterans Administration’s attempts to deal with veterans suffering from PTSD are not borne of a lack of support, funding, or righteousness. Rather, they seem to be a structural incapacity to deal with large numbers of affected soldiers. This may be due to the increased role of the United States military in combat zones, which yields a provocative political conclusion that the best way to prevent post-traumatic stress disorder in soldiers is to not place them in traumatic combat experiences in the first place, and to alleviate the role of the military significantly. The red tape and bureaucracy in the Veterans Administration, even in light of recent changes to make the process of receiving benefits easier, is still clear enough for the public to see the inherent weaknesses in how the federal government treats returning soldiers. Similar to Vietnam veterans returning from a likewise unpopular war, veterans do not actively seek help for their mental problems. In fact, less than half of the 1-in-8 Iraq war veterans sought help for classic symptoms of PTSD (AP, 2010). This fact reveals one more weakness of the VA system: namely, the VA cannot help veterans that do not first seek them out for help. Post-traumatic stress disorder is a recognized mental health problem faced disproportionately in the American public by returning veterans. Recently, the wars in Iraq and Afghanistan have overwhelmed the Veterans Administration with soldiers who exhibit PTSD symptoms along with other mental illnesses. Although causes and treatments of PTSD are well-known from the literature, the VA is structurally incapable of processing patients and supplying them with necessary treatments to prevent long-term damage to their lives, their families, and society. Even in the wake of budget increases for helping returning veterans, problems still persist, and individuals still go untreated and unaware. Fundamental changes in how the public perceives war and its veterans are necessary for fundamental changes in how those veterans are dealt with. Works Cited A.P. (2010, June 30). 1 in 8 returning soldiers suffers from PTSD. Retrieved November 6, 2010, from Associated Press: http://www.msnbc.msn.com/id/5334479/ Bisson, A. (2009). Psychological treatment of post-traumatic stress disorder (PTSD) (Review). New York: The Cochrane Collaboration. Grinage, B. (2003). Diagnosis and management of post-traumatic stress disorder. American Family Physician, 68, 2401-2409. Hembree, E., & Foa, E. (2001). Posttraumatic stress disorder: psychological factors and psychosocial interventions. Journal of Clinical Psychiatry, 61, 33–39. Koenen, K., Moffitt, T., Poulton, R., Martin, J., & Caspi, A. (2007). Early childhood factors associated with the development of post-traumatic stress disorder: results from a longitudinal birth cohort. Psychological Medicine, 37, 181-192. Marshall, R., Beebe, K., Oldham, M., & Zaninelli, R. (2001). Efficacy and safety of paroxetine treatment for chronic PTSD: a fixed-dose, placebo-controlled study. American Journal of Psychiatry, 158, 1982-1988. Martin, D. (2010, July 12). PTSD treatment access to get easier for veterans. Retrieved November 6, 2010, from CBS Evening News: http://www.cbsnews.com/stories/2010/07/12/eveningnews/main6671863.shtml Niiler, E. (2010, June 7). One in 10 Iraq war vets face mental health problems. Retrieved November 6, 2010, from Discovery News: http://news.discovery.com/human/iraq-war-veterans-mental-health.html Shin, L. (2009). The amygdala in post-traumatic stress disorder. In P. Shiromani, Post-Traumatic Stress Disorder: Basic Science and Clinical Practice (pp. 319-334). New York: Humana Press. Read More