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Physician expert offers guidelines for dealing with post-traumatic stress disorder

Robin Wulffson MD's picture
PTSD, Veteran's Day, suicide, depression, unemplyment

Today, November 11, 2012, is set aside to honor our nation’s veterans. Many of these veterans not only need to be honored they also need help because they suffer from post-traumatic stress disorder (PTSD). Help is available in a book, released last year that deals with PTSD: “I Always Sit with My Back to The Wall.” It is co-authored by Harry Croft, MD and Rev. Dr. Chrys Parker, JD Dr. Harry Croft who served three years in the Army during the Vietnam era and for the past 15 years has evaluated veterans for post-traumatic stress disorder (PTSD). He has focused on the education of veterans, their families, healthcare professionals, and the general public on the ramifications of post-traumatic stress disorder. To date, he has evaluated more than 7,000 veterans for PTSD.

During an interview, Dr. Croft pointed out that that military suicide is out of control, with roughly one soldier committing suicide every day. From January through July of this year, a total of 116 active-duty soldiers and 71 reservists are believed to have killed themselves, compared with 165 and 118, respectively, in all of 2011. Dr. Croft notes that there are multiple reasons for the alarming increase in suicides among veterans including exposure to extreme stress and violence, long deployments in hostile environments, injuries sustained in combat or watching a fellow soldier become severely injured or killed. His book offers advice regarding the management of PTSD through the R-E-C-O-V-E-R approach: (1) Recognizing when PTSD is in your life; (2) Educating yourself about PTSD; (3) Connecting biology to your psychology’; (4) Organizing a comprehensive care plan for PTSD; (5) Viewing your issues in a new light; (6) Empowering yourself through strong systems of support; and (7) Redefining the meaning of your life.

Dr. Croft notes that when he and I were on active duty in the Army during the Vietnam era, PTSD had not been defined; however, the disorder existed. One element contributing to the increase in PTSD and suicide at present is redeployment. During the Vietnam War, the majority of service members served a tour of duty in Vietnam for about a year. Many, including myself, maintained a “short-timers calendar,” and marked off the days when one could return to “the world” and never have to return to the war. Many current service members undergo multiple deployments. Dr. Croft notes he has evaluated a number of veterans who were deployed four to six times. Although dwell time, the time spent away from combat, is supposed to be twice that of combat duty, due to current demands, service members often have only six months of dwell time before returning to combat.

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Many veterans have difficulty in obtaining employment upon return to civilian life. This is partially due to our flagging economy and high unemployment rate; however, other factors are involved. Dr. Croft notes that many employers are reluctant to hire veterans for fear that they might suffer from PTSD—even though most of them don’t. Employers may also be reluctant to hire reservists because of the likelihood that they will be redeployed. Veterans with PTSD often sleep poorly and some suffer from substance abuse problems. As a result, their work performance may be substandard and they are terminated.

Veterans with PTSD have trouble with relationships and become withdrawn. Their spouse may note that a different person that they do not know returned from deployment. Some lose their spirituality after witnessing the horrors of war. A common problem with today’s crop of new veterans is that they suffer from blast injuries, which result in chronic pain. These veterans are prone to develop dependence on pain killers such as Vicodin. Another problem is that they will see a healthcare professional with complaints such as depression, insomnia, or substance abuse and not mention that they are a veteran. The busy clinician will not recognize PTSD or suicide risk and simply write a prescription for an antidepressant or sleeping pill.

Although the reasons are important, Dr. Croft notes that the major point he wants to get across is that healthcare professionals, family members, as well as other individuals the veteran comes in contact with need to recognize the following warning signs:

  • Sleeping much more or less than usual and having a general lack of energy/interest when it comes to activities that are generally pleasurable, from sports and sex to time with family and friends.
  • Displaying a wide range of emotions from becoming overly excited to down in the dumps, impulsive, easily startled, secretive, easily angered, or starts engaging in high-risk behaviors such as alcohol and drugs.
  • A new interest or obsession with death, making changes to a will or tying up loose ends, has a negative outlook on everything and makes comments that things would be better without him.
  • Roughly one out of five troops who served in Iraq and Afghanistan suffer from PTSD, and if left untreated, might eventually lead to a more depressive state and eventually suicide. Signs of PTSD usually fall into three categories: re-experiencing, avoidance and arousal issues.

Dr. Croft says caregivers, spouses and partners of veterans should become actively involved, and specifically ask the veteran if he (or she) has thoughts of hurting himself or taking his life, and ask them to seek immediate professional help.

Reference: Harry Croft, MD