2. Personal Considerations
‡ This presentation will contain images, and
topics about combat and Post Traumatic
Stress Disorder (PTSD). I intend to invoke an
emotional response.
‡ If you feel uncomfortable at any time you may
leave without comment or question.
5. ‡ Joes are divorcing
Soldiers Around Me͙
‡ Lots of beer drinking
‡ Risk taking (fights)
and not caring about
consequences
‡ Drug and Alcohol
Abuse
‡ Joblessness
‡ Nightmares and lack
of sleep
‡ Attrition of NCOs
6. ‡ Driving at night at 30 MPH a trigger
Myself
‡ Easily irritated
‡ Hyper vigilant- very wearisome
‡ Startle response
‡ Merging onto the freeway and driving
‡ Relationships ended
‡ Easy to get into a fight
‡ No memory/concentration
‡ Strange emotions unexpected
‡ 4th of July was no fun
9. 2000 to 2006, 1,066 male veterans
in Oregon took their lives.
Suicides among Oregon service members
and veterans over the past five years shows
that more Oregon veterans died at their
own hands than at the hands of their
enemies in war zones
Officials calculate the deaths at a rate
of roughly 20.2 per 100,000 soldiers --
which is higher than the adjusted
civilian rate for the first time since the
Yearly increases in suicides have Vietnam War
been recorded since 2004, when
there were 64 -- only about half
the number now. And they've
occurred despite increased
training, prevention programs and
psychiatric staff
10. The numbers kept by the service branches don't
show the whole picture of war-related suicides
because they don't include deaths after people
have left the military. The Department of Veterans
Affairs tracks those numbers and says there were
144 suicides among the nearly 500,000 service
members who left the military from 2002-2005
after fighting in at least one of the two ongoing
wars.
The true incidence of suicide among military
veterans is not known, according to a report
last year by the Congressional Research
6 years
Service. Based on numbers from the Centers
72 months for Disease Control and Prevention, the VA
estimates that 18 veterans a day -- or 6,500 a
288 weeks
year -- take their lives, but that number
1066 Oregon Suicides includes vets from all previous wars.
3.7 Suicides a Week
11. A 2003 New England Journal
of Medicine Study found that
15 percent to 17 percent of
Iraq and Afghanistan veterans
were suffering from PTSD,
and more than 60 percent of
those showing symptoms
were unlikely to seek help
because of fears of
stigmatization or loss of
career advancement
opportunities.
12. According to the PDRHL from
the Department of Defense
Behavioral Health Survey
43% of 2000 National
Guard Members had
readjustment issues after
returning from the war zone(s).
Nationally, the overall rate
of PTSD has been described
as being at least 30%.
13. I would be seen as weak by my unit members 65%
My unit leadership might treat me differently 63%
My unit would have less confidence in me 59%
My leaders would blame me for the problem 51%
It would harm my career 50%
Difficulty getting time off for the problem 55%
It is difficult to schedule an appointment 45%
I don͛t trust mental health professionals 38%
Mental health care doesn͛t work 25%
I don͛t know where to get help 22%
15. Red Badge of Stephen Crane͛s book about
the Civil War contained themes
Courage of masculinity symbolized by
war.
Where are the mental wounds?
Do we discount them because
they are
‡ invisible
‡ counter to our notions of
masculinity
‡ ͞secondary͟
16. PTSD from Ancient Greece to the
Present
‡ Nostalgia
‡ Hysteria
‡ Shellshock
‡ Buck fever
‡ Combat fatigue
‡ Battle reaction
‡ Disorderly action of the
heart
‡ Soldier͛s heart
‡ Homesickness
‡ Irritable heart
17. And what about when
your warrior͛s anger
goes home? What is
it like with his wife
and children? Is it
useful then, too?
Cicero
18. Back then, PTSD was called
combat fatigue, and it was a
serious problem. In the
European Theater, 25
WWII
percent of all casualties
were serious PTSD cases. In
the Pacific Theater, the rate
varied widely, depending on
the campaign. In some of
the most intense fighting,
like Okinawa in 1945, it
accounted for over a third of
all wounded.
19. Iraq and According to a more recent
Post-Deployment Health
Afghanistan Reassessment 38 percent of
regular soldiers, 31 percent of
Marines, and 49 percent of
National Guard report
psychological symptoms.
Those who had served
repeated deployments were at
extremely high risk of problems
and the toll on their family
members was great.
22. On September 13, 1848,
Phineas Gage Phineas Gage was foreman of
a work gang blasting rock
while clearing the roadbed for
a new rail line. After a hole
was drilled into a body of rock,
one of Gage's duties was to fill
the hole with gunpowder, add
a fuse and sand, and then
pack the charge down with a
large tamping iron.
24. In total, how
many times
has Mark
McGwire
swung a
Baseball Bat?
He labored through the 2000
season with a bad right knee,
missing virtually all of the second
half. He had surgery to correct
patella tendinitis.
One season with a bad knee
G AB R H 2B 3B HR RBI SB BA OBP SLG
changed his swing enough to
Career 1874 6187 1167 1626 252 6 583 1414 12 .263 .394 .588
cause him to retire.
25. Conditioning
‡ Pavlov in 1904
‡ Skinner developed
further into
Behavioral
Engineering
‡ Rewards and
Punishments develop
automatic behaviors
26. ͞Train Like You Fight͟
Methods used to train is
an application of
conditioning techniques to
develop ͚quick shoot͛
ability.
The modern soldier trains
in full gear, shooting
blanks at realistic targets
until reflexive fire is
obtained.
27. Train Realistically
This muscular, life sized
male upper torso body
form is intended
specifically for precise
marksmanship training.
The cavity in its back
holds red balloons to
resemble vital organs.
The body drops when a
red balloon is shot.
28. The Unnatural Act of Killing Another
‡ It is estimated that in
World War II, 75 to 80
percent of riflemen did not
fire their weapons at an
exposed enemy.
‡ In previous wars nonfiring
rates were similar.
‡ In Vietnam the nonfiring
rate was close to 5 percent
29. I yelled ͞kill, kill͟ ͚til I was hoarse. We yelled
it as we engaged in bayonet and hand-to-
hand combat drills. And then we sang about
it as we marched. I had stopped hunting
when I was sixteen. I had wounded a squirrel.
It looked up at me with its big, soft brown
eyes as I put it out of its misery. In 1969 I was
drafted and very uncertain about the war. I
had nothing against the Viet Cong. But by the
end of Basic Training, I was ready to kill them.
-Jack, Vietnam Veteran
On Killing
30. ͞To survive and be victorious on the battlefield, our
warriors must aggressively seek out the enemy and kill
them. This has far reaching spiritual and psychological
implications. In order to be ͞successful͟ the warrior must
not miss a beat in pursuing and eliminating adversaries one
after another. When they attack the enemy, they are
trained to go one step beyond personal moral boundaries
and take the life of another human being. This eventually
becomes their personal horror of war- this is one primary
aspect that damages the soul. The ͞killer instinct͟ that is
so energetically thrown around in locker rooms and
corporate sales meetings becomes a very real impulse to
soldiers in the heat of battle. Without this instinct the
warrior is very luckyʹ or very dead.͟
Down Range: To Iraq and Back
31. Almost all service members returning from
the war zone will experience some of these
behaviors and reactions. It͛s vital that you
remember that having these reactions does
NOT automatically mean you have PTSD. It
would be abnormal if you didn͛t experience
some of these feelings and behaviors following
what you have been through in the war zone.
32. Amygdala
‡ Connection with lots of
areas of the brain
‡ Emotional stamping of
events
‡ Increases reflexive
reactions
‡ Signals sent ͚upward͛
are checked by
prefrontal cortex.
33. Signs & Symptoms of PTSD
‡ Flashbacks, or reliving the ‡ Self-destructive behavior,
traumatic event for such as drinking too much
minutes or even days at a ‡ Hopelessness about the
time future
‡ Shame or guilt ‡ Trouble sleeping
‡ Upsetting dreams about ‡ Memory problems
the traumatic event ‡ Trouble concentrating
‡ Trying to avoid thinking or ‡ Being easily startled or
talking about the frightened
traumatic event
‡ Not enjoying activities
‡ Feeling emotionally numb you once enjoyed
‡ Irritability or anger ‡ Hearing or seeing things
‡ Poor relationships that aren't there
34. Anxiety
‡ The mind stays on ‡ Physical symptoms
vigilant, ever on alert.
‡ Emotional fatigue
‡ This keeps emotions and
the body aroused. ‡ Mental fatigue
‡ Chronic or severe arousal ‡ Spiritual fatigue
changes the nervous
system.
‡ Smaller threats than usual ‡ Exaggerated stress
sound the alarm. response
‡ Takes longer to return to ‡ Avoidance is hallmark
resting state.
35. Dissociation
‡ Perceived detachment of ‡ Traumatic memories are
the mind from emotional walled off
states or even the body. ‡ Dissociated material is
‡ Dreamlike state or unreal highly emotional and
place. relatively non verbal
‡ Poor memory of specific ‡ Triggers can be the sense,
event body movement, dates,
‡ DID, Fugue stressful events, strong
‡ Fragmented emotions, cognitive
patterns, behaviors, out
‡ State-dependent of the blue, and
memories combination.
36. B Buddies VS Withdrawal
A Accountability VS Controlling
T Targeted VS Inappropriate Aggression
T Tactical Awareness VS Hyper-vigilance
L Lethally Armed VS Locked and Loaded
E Emotional Control VS Detachment
M Mission Operational Security VS Secretiveness
I Individual Responsibility VS Guilt
N Non-defensive Driving (combat) VS Aggressive Driving
D Disclipine and Ordering VS Conflict
37. You are likely to feel okay
the first few months after
returning home from war
Many cases of PTSD do not
become dysfunctional until
years later
Ignoring it does not make it
go away
38. What is Dysfunctional?
‡ Impaired in function;
especially of a bodily
system or organ (of a trait
or condition) failing to
serve an adjustive
purpose.
‡ If a person is behaving in
ways counter-productive
to their own well-being
40. ‡ Medication
Many Treatment ‡ Psychotherapy
Options ‡ Exposure Therapy
‡ Cognitive Behavioral
Therapy (CBT)
‡ Eye Movement
Desensitization &
Reprocessing (EMDR)
‡ Memory Work
‡ Art Therapy
‡ Thought Field Therapy
‡ Healing Rituals
‡ Group Therapy
‡ And More͙
41. Call of Duty 4
U.S. Army medical researchers have noted that
soldiers that play violent video games, are better
able to handle the stress of combat. More
elaborate (virtual reality) combat simulations are
now being used to treat combat veterans who
are suffering from severe stress reactions from
combat (PTSD, post-traumatic stress disorder).
www.strategypage.com
44. Pathologizing
It is important that therapists who work with veterans
be educated in the warrior tradition and its rituals in
order to recognize and help veterans identify with [the
use of] warrior traits. Ignoring these traits is harmful
to the veteran, for then the inner warrior remains
invisible. Pathologizing the traits is also harmful, for
then the vet is further wounded by reductionist
interpretations that may minimize their importance
to him͙ or empty them of their spiritual potency.
-Edward Tick, Ph.D.
War and the Soul
45. I am an American Soldier.
I am a Warrior and a member of a team. I serve
the people of the United States, and live
the Army Values.
I will always place the mission first.
I will never accept defeat.
I will never quit.
I will never leave a fallen comrade.
I am disciplined, physically and mentally tough,
trained and proficient in my warrior tasks
and drills.
I always maintain my arms, my equipment and
myself.
I am an expert and I am a professional.
I stand ready to deploy, engage, and destroy,
the enemies of the United States of
America in close combat.
I am a guardian of freedom and the American
way of life.
I am an American Soldier.
46. Family Members
‡ Provide opportunities to ‡ Do not pressure to talk
talk ‡ Do not stop them from
‡ Don͛t be afraid to ask about talking
the war ‡ Try not to make judgmental
‡ Accept your limitations statements
‡ Offer attention, interest, ‡ Avoid telling what one
and care ͚should͛ do
‡ Educate yourself ‡ Watch for clichés or easy
‡ Find available resources answers (war is hell)
‡ Be supportive with ‡ Avoid giving advice without
expectation that fully listening
readjustment will occur ‡ Don͛t rush things
48. You might feel you can go it alone,
but͙.
Post Traumatic Stress
Disorder (PTSD) is not
only an individual
problem but also a
family and
community
problem.
49. Community
‡ Join the local VFW or
American Legion
‡ Make regular phone calls
to other ͚buddies͛
‡ Be a resource for fellow
vets
‡ Create a book club
‡ Mosaic.com
‡ Welcome home every vet
you see
‡ Join Vets for Vets
‡ Volunteer, even though
you don͛t feel like it
50. Quick Rundown
‡ Training has given you faster reflexes for combat actions
‡ Experiences give emotional shaping to memory
‡ It is normal to have mixed feelings about wartime
experience
‡ Having some symptoms does NOT automatically mean you
have PTSD
‡ Only a clinician can diagnose you with PTSD
‡ PTSD is not permanent and many treatments are available
‡ There are MANY resources available for treatment
‡ If left untreated it will negatively impact everyone around
you
‡ Healing is found via community