This is Julia Hugo Rachel. Like millions around the world I was accused of having a mental illness, had my child taken away from me and spent years in mental and physical agony. Then I found I was not mentally ill but instead had a virus and was cured. There are many people like me and this book, Viral Assault, will show victims, families and friends that there is hope. This is my story.
We met Mike Zacchea earlier on in this book. He was the American advisor to an Iraqi battalion during eight months of exceptionally fierce fighting during Operation Phantom Fury, the 2004 effort to liberate Fallujah from Iraqi forces. It was a brutal battle of house to house fighting and Mike repeatedly led his unit from the front. He was eventually wounded by a rocket propelled grenade and stayed in the fight for a further six weeks until relieved. He eventually retired from the Marines on medical grounds.
As he recovered from the war, it was Mike who set fire to his house while his terrified wife locked herself in the bathroom to defend from his rage and the dangerous melding in his mind of Iraq and the US which was fueled by his flashbacks of his experience of close quarters combat. While the couple are now getting divorced, Mike has used his experiences both to learn for himself and to apply the lessons to help others recovering from their wounds, both mental and physical. Today, he is one of the nation’s leading experts on PTSD and other physical and psychological effects of combat.
Post Traumatic Stress Disorder (PTSD) and Traumatic Brain Injury (TBI) have become convenient buckets for the medical professionals to lump millions of veterans who suffer from a complex and often little understood range of illnesses. Most are treated as psychological disorders to be helped with drugs or therapy but there is growing evidence that these two illnesses are much more complicated than was at first thought.
“Everyone in the medical establishment has a specialty and they use their particular hammer to knock in the nail,” said Mike. “But there are many different species of PTSD where one type in the military is different for a child who has suffered abuse or a woman who has been raped.”
Based on his own experience and what he has heard from other veterans, Zacchea feels that the current “one size fits all” approach may not be any better than no approach at all; that drug treatments were just a “giveaway to Big Pharma” and that in his case medical marijuana was the most effective solution; that many feel betrayed by their country both when they interact with the military leadership and especially with the VA; and that many veterans need an entire personality reset which might be helped by getting a decent job to reinstate self-respect or by any other activity such as scuba diving or horseback riding that activates different neurological pathways to act as a counter weight to the nightmares and the darkness.
What is very clear is that there is no simple diagnosis and no easy answer. Instead, research seems still to be in its infancy with many unanswered questions around the brain chemistry of PTSD sufferers, their physical makeup and the interface between psychological and physiological symptoms.
For now, PTSD is characterized as a mental health condition triggered by extreme stress or a traumatic event. The American Academy of Family Physicians further describes the disorder as the “subsequent development of four general symptom domains: re-experiencing the event or intrusion symptoms; avoidance of people, places, or things that serve as a reminder of the trauma; negative changes in mood and thoughts associated with the event; and chronic hyperarousal symptoms... PTSD is diagnosed only if symptoms persist beyond one month after the event.”
Though PTSD was in modern times (in World War 1, it was known simply as Shell Shock and the ancient Greeks may even have had a diagnosis), the actual disorder didn’t gain formal recognition until 1980 when the American Psychiatric Association (APA) updated the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) to include the disorder. Before that point, PTSD faced major scrutiny, often being called a “weakness” or calling the sufferer “simply shocked” by their experiences from their time in battle. Before this point, civilian sufferers of PTSD were also largely ignored.
Today, PTSD is much more well known and recognized, and while the numbers are not certain, is estimated that 7.8 percent of all Americans will experience PTSD at some point in their lives. In the course of a year, about 5.2 million people between 18 and 54 years old will have PTSD. Within those numbers, it has been found that women are twice as likely to develop PTSD, but a connection as to why has not been determined. Among veterans the rates are even higher with 31 percent of Vietnam veterans, 10 percent of Gulf War veterans and 11 percent of veterans of Afghanistan having it. And though PTSD is most often only associated with veterans, it can also affect survivors of “terrorist attacks, natural disasters, serious accidents, assault or abuse, or even sudden and major emotional losses.”
The difficulty with PTSD does not stop at the symptoms though. Identifying the disorder can prove to be just as challenging. For some, especially veterans, diagnosis comes a little easier because of the sheer number of them who are affected. And oftentimes, especially for those who served in combat zones, PTSD is expected. But when it comes to civilians who have not seen the battlefield, PTSD is not necessarily the first diagnosis doctors predict.
When it comes to civilian PTSD, there are also a few distinctions in extremity. For example, as one study headed by Ronald C. Kessler, PhD concluded, sexual assault victims acquire the disorder at significantly higher rates as compared to other causes.
Another interesting bit about civilian PTSD emerged from a study in Cook County Chicago, which is “one of the busiest trauma centers in the nation, treating about 2,000 patients a year for gunshots, stabbings and other violent injuries.” Upon the decision to screen patients for PTSD, the center found that 43 percent had signs of PTSD. A fair number of these patients were victims of gun-violence and other violent crimes, making the connection between PTSD and said violence more obvious.
“We knew these people were going to have PTSD symptoms,” said Kimberly Joseph, a trauma surgeon at the hospital. “We didn’t know it was going to be as extensive.”
Upon analyzing the findings, hospital employees pushed for additional funding to provide personnel to continue conducting the screening. Hospital administrators denied the request.
Though the high rates of civilian PTSD were unusual in this case, non combat related PTSD can be caused by a variety of factors.
Other causes of PTSD like car accidents, injuries or childhood trauma can be just as severe. They can also be triggered by memories, sights, sounds, smells, sensations and so on. These reactions may result in raised heart rate, sweating and muscle tension as well as a variety of other symptoms. While it is common to think that avoiding the triggers that cause this pain would be the best case scenario, it is actually important for the sufferer to find ways to cope with the triggers through therapy or other practices.
However, even if a person experiences a traumatic event, it does not imply that they will develop PTSD. Though, as we saw in the statistics above, veterans and those in combat zones get the disorder at much higher rates than civilians, the disorder and whether or not a person will get it varies.
“The nature of trauma and an individual's biology, environment, and life history combine to predispose an individual to PTSD,” say David Yusko, Psy.D. from Perelman School of Medicine and Natalie Gay, B.A.,Psychology from University of Pennsylvania.
Until recently, it wasn’t known just how many people, veterans and civilians, were suffering. But in that same study from Kessler, the author went on to conclude that PTSD is “more prevalent than previously believed and is often persistent.” Because the study was conducted just a short time after PTSD was officially recognized as a disorder, it can be identified as one of the factors that furthered the public knowledge and acceptance of PTSD in the United States.
But those affected by PTSD are not only the sufferers. Their families often see an extreme struggle in learning to live with their loved one and their illness. After almost five years of marriage, Lea Farrow described the difficulties that she, her husband and their children began to face as a result of her husband’s PTSD from his time as a paramedic.
“Anger had become a constant presence in our home,” she writes.
Farrow described the difficult process of finding treatment, including the various medications and therapy. Though some of the treatments were to be expected, not everything in the healing process went as planned for the family.
“No one could tell me how long therapy would take. No one could predict when things might get better, or that they may get worse. No one could guess what would become of his career. No one could foresee what it might do to our family.”
As Farrow’s family continued to learn to deal with PTSD, she described the havoc it wreaked on her and her husband’s lives as well as those of her children. And after five years, she was able to put into words exactly what it is to live in the same home as someone with PTSD and to try to help them with the disorder.
“It is to worry about where he is, what he’s doing, if he’ll come home, if he’s been drinking, if he’ll remember, if he’s okay. It is to hear the sharp words and venomous tongue, but not let yourself listen to them. It is to watch extreme anger erupt out of nowhere, but have no time to take cover and no way to extinguish the fire.”
The negative effect on families has actually been proven and was highlighted in one article from the VA which states “Vietnam Veterans have more marital problems and family violence. Their partners have more distress. Their children have more behavior problems than do those of Veterans without PTSD. Veterans with the most severe symptoms had families with the worst functioning.” Though the effects on the families of veterans from other wars are still being studied, the statistics from the Vietnam War alone are enough to show the correlation.
PTSD’s reach has also been studied far beyond just the United States. The struggle the disorder creates can be quite different depending on a given situation, but is usually just as difficult to live with.
For example, Louisa Rodriguez, whose partner Simon Buckden served in Bosnia, Northern Ireland and the First Gulf War begins her story with a terrifying account from Rodriguez of how PTSD crept into the couple's life until it had taken over.
“I remember the first time I was woken by Simon crying out: this awful, blood-curdling scream. Suddenly he was back in the war zone with a gun in his hand and a woman in front of him, covered in blood. He squeezed my hand tightly and wouldn’t let go until morning. I recall thinking, ‘By day he’s my brave ex-soldier; but by night, who is this man?’”
Slowly the couple learned to cope with Buckden’s condition, doing little things to accommodate and make him feel more safe in everyday situations. Examples include having him sit with his back to the wall when they would go out so that he wouldn't feel as though someone could attack him from behind and so he could survey the rest of the room at all times. (This is a very common veterans’ response where they learn never to become vulnerable or unprotected).
Even with the accommodations, the two couldn’t suppress all of Buckden’s outbursts. And though sufferers describe the way the condition affects them in different ways, Buckden found it to be almost synthetic.
“When a PTSD hit [outburst] is coming on I can feel it like a chemical,” Buckden said. “I stop shaving and eating, and I withdraw from my friends. The most upsetting thing is taking the anger out on Louisa. I try to be a decent person. The last thing I want to do is upset someone I love.”
This withdrawal from loved ones is a common theme amongst sufferers of PTSD. Many also report turning to alcohol, insomnia and nightmares as well as anxiety. Familial reactions on the other hand can range from sympathy and avoidance to depression, anger and guilt.
And where symptoms vary for sufferers, there is just as much variation in treatment.
One of the most popular and varied options for sufferers of PTSD is therapy. But within therapy there are a few different options. One widely used treatment for PTSD is Cognitive Behavioral Therapy (CBT). Within the VA this therapy is applied in two different forms: Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE) therapy. Cognitive Processing Therapy is a manualized therapy, meaning there are specific guidelines for each step whereas in prolonged exposure therapy, sufferers practice reliving their traumatic experience as a way of learning to cope with it. Both of these therapies are forms of psychotherapy and were originally designed to help with depression, but as more was learned about PTSD, doctors began applying the practice to their PTSD patients.
“The goal of cognitive behavioral therapy is not to diagnose a person with a particular disease, but to look at the person as a whole and decide what needs to be fixed.”
Part of this process includes four steps as identified by Robert Kaplan and Dennis Saccuzzo in their study Psychological Testing: Principles Applications and Issues. Where the first steps are to identify critical behaviors and determine whether critical behaviors are excesses or deficits. Next, evaluate critical behaviors for frequency, duration, or intensity. The last step is to attempt to decrease frequency, duration, or intensity of behaviors and if there are deficits, attempt to increase behaviors.
But types of therapy for PTSD vary widely and have been studied on numerous levels for effectiveness and results.
Another form of recovery for PTSD sufferers is what is known as Eye Movement Desensitization and Reprocessing or EMDR. This is another form of psychotherapy where the therapist uses a multi-step process to assess, desensitize, and install a positive memory with the negative memory to make the event less traumatic. Bilateral eye movement during the process is another key to this therapy.
The science behind the therapy is best described by the experts at the EMDR Institute Inc.
“EMDR therapy shows that the mind can in fact heal from psychological trauma much as the body recovers from physical trauma. When you cut your hand, your body works to close the wound. If a foreign object or repeated injury irritates the wound, it festers and causes pain. Once the block is removed, healing resumes. EMDR therapy demonstrates that a similar sequence of events occurs with mental processes. The brain’s information processing system naturally moves toward mental health. If the system is blocked or imbalanced by the impact of a disturbing event, the emotional wound festers and can cause intense suffering. Once the block is removed, healing resumes.”
Besides the eye movement and desensitization, this therapy also involves a body scan where areas in the body that hold any remnant or recollection of the traumatic event are targeted. The goal of this section is to rid the body of any uncomfortable physical sensations that remind them of the event which gave them PTSD.
However, it should be noted that while this form of therapy has been in existence since 1989, it is not without its share of controversy.
Some argue that the movement of the eyes is totally insignificant for healing and that the only healing properties of EMDR are in its similarities to CBT. On the other hand, numerous sufferers of both combat and noncombat PTSD have reported the success of EMDR in coping with their disorder. In the meantime studies dissecting the success of EMDR are still in progress and no definitive answers have been concluded, leaving the justification of performance of the therapy up to those who use it.
Another type of visual based recovery has also been introduced in this era of technology: virtual reality. In this treatment, patients relive their experience in a controlled environment made to replicate the original situation. Like the other therapies which deal with replicating the event, this therapy is done in a safe zone where veterans know they have control and security.
“Exposure-based therapies have been shown to be a promising form of treatment,” said Skip Rizzo, a psychologist at the University of Southern California's Institute for Creative Technologies in Los Angeles, who is leading the work. The [virtual reality] format may appeal to a generation of service members who have grown up with the digital world, and feel comfortable with it."
In these first-person games, the veterans are able to produce digital representations of the analog situations they have experienced, customizing details to fit their memories. In one study discussed in Livescience, 20 service members tested the new therapy type, testing areas of activity in their brains as they tested. Of the group, 16 reported improvement while the four others reported no change.
The final type of therapy which is performed in person rather than online or with software and is often used for PTSD sufferers is group therapy. Unlike the other one-on-one therapies, this type is executed in a crowd setting where sufferers are encouraged to share their stories and their struggles with one another in hopes of creating camaraderie and a place to share personal cures. This type of therapy is often favored by the VA because many veterans share similar experiences from their time in war and therefore have similar causes of their posttraumatic stress.
Though therapy can be extremely helpful for some patients, others prefer pharmaceutical treatments for relief of their symptoms. On the medication side of the disorder, popular medications for treating PTSD include antidepressants such as selective serotonin reuptake inhibitors (SSRIs). Forms of these medications include citalopram (Celexa), fluoxetine (such as Prozac), paroxetine (Paxil), and sertraline (Zoloft) which have been shown to reduce symptoms of depression and anxiety. Some veterans also report that medical marijuana is a much more effective treatment than any other prescription. Other medications which aid in sleep are also popular as insomnia is also often associated with PTSD.
And soon, one more medication will be available to more sufferers of PTSD and was approved recently. A county court judge in Illinois ruled that the state must add PTSD to the medical marijuana acceptance list. Illinois will now join 15 other states and Washington D.C. that “either specifically include PTSD or give doctors broad enough discretion to recommend marijuana for the condition, according to the Marijuana Policy Project, which seeks to end criminalization of the drug.”
This isn’t the first time PTSD has seen changes in the law which rule in favor of sufferers though.
According to the Associated Press, one psychologist testified in favor of a veteran with PTSD who, shot 24 rounds at law enforcement and fire fighters as they surrounded his house responding to a fire.
“Joshua Eisenhauer returned from Afghanistan with post-traumatic stress that made him a paranoid, hyper-vigilant insomniac, and so delusional that he drew his weapon whenever anyone came to his door in Fayetteville, North Carolina,” the story reads. “They say untreated PTSD could scramble his mind beyond repair if he spends the rest of his sentence, up to 18 years, in Raleigh Central Prison.”
As a result, psychologists and representatives are calling for lesser prison sentences for veterans with PTSD, saying they are not responsible for their actions when suffering from untreated Posttraumatic Stress Disorder. Though no one was harmed in the case of Eisenhauer, his untreated PTSD was causing major psychological damage.
The whole issue of veterans with PTSD is much broader than this case. Another illustration is that of Christopher Lee Boyd whose Marine convoy was ambushed in Iraq in November 2004. The Humvee Boyd was driving was hit by an RPG and four of the men in the vehicle were killed and another five injured with only Boyd himself escaping physical harm.
After Boyd returned to his home in Virginia, his family noticed a gradual change in his behavior which was fuelled by nightmares which were only held at bay by drinking until he passed out. This gentle, easygoing and good humored man became bad tempered, anxious and tough to be around. He began carrying a gun and everything came to a head after a night out drinking in a local bar. He blacked out and the next thing he remembers was being in a police car on the way to jail.
The cops told Boyd that he had pulled his gun on his friend in the bar and shot him in the chest. The bullet had passed clean through his friend’s body and he survived which is why he only received five years in prison.
There are lessons to be drawn for veterans of the wars in Iraq and Afghanistan from what happened after the Vietnam war. The number of Vietnam veterans in jail rose steadily until it peaked at one in five and in 1988 more than 50% of all Vietnam veterans said they had been arrested with a third arrested multiple times.
One in six returning veterans from Iraq and Afghanistan suffers from a substance abuse disorder; since 2004, the number of veterans treated for mental illness and substance abuse has increased 38 percent, and 81 percent of arrested veterans had a substance abuse problem.
But those statistics can be misleading and the Bureau of Justice Statistics report that veterans are less likely to be behind bars than nonveterans. The latest study tracked an estimated 181,500 incarcerated veterans in 2011-2012, 99 percent of whom were male. During that period, veterans made up 8 percent of inmates in local jails and in state and federal prisons, excluding military facilities.
In fact, the percentage of veterans in jail has been declining steadily since its post-Vietnam War peak, partly due to the ending of the draft and the switch to an all-volunteer force. The Bureau of Justice Statistics began tracking the number of incarcerated veterans after the Vietnam War. In 1978, about 24 percent of prisoners were veterans. That number has fallen steadily since then, as the military switched from the draft to an all-volunteer force.
Less than a third of veterans behind bars actually saw combat, but those who did also reported higher rates of mental health issues, according to the report. The decline in the veterans prison population tracks national demographics. Across the country, the number of veterans is shrinking fast as the millions of vets from World War II and Korea reach their 80s and 90s, and Vietnam vets reach their 70s.
Part of the decline in the numbers of veterans in prison has been the rise of a special type of court that is specifically available to deal with veterans’ cases. The first such court was set up in Buffalo, N.Y.in 2008 with the goal of diverting veterans charged with felony or misdemeanor nonviolent criminal offenses to a specialized criminal court that emphasizes treatment and rehabilitation guided by veteran health care professionals, veteran peer mentors and mental health professionals. Since then, the number of veteran courts has grown to 130.
Just three states currently allow PTSD to serve as a mollifying circumstance in court cases against veterans. But North Carolina state Representative Billy Richardson hopes to change that with his bill which recently passed the House Judiciary Committee.
“I would hope the public policy of our state would be that we care about our veterans enough to do this for them,” said Rep. Richardson said in an interview with the Associated Press.
Though different sentencing for sufferers is a starting point, correct diagnosis and treatment is another important step in the process of treating PTSD, and surprisingly, it’s not one that is always taken care of, even by the VA.
Over the past years, numerous cases of veterans and their health issues have gone ignored by the VA. This not only includes PTSD being overlooked and ignored, but other war-related injuries as well. Not only does the organization routinely purposely misdiagnose veterans for the sake of a smaller bill, they also attempt to get out of paying anything at all. The VA requires all veterans to prove that their disabilities are combat related which places the onus of proof on the veteran. This apparently simple request places the combat veteran in the middle of a massive and extraordinarily inefficient bureaucracy. On the one hand is the VA asking for all their relevant paperwork and on the other is the Pentagon which is opaque and difficult to navigate. In the middle is the traumatized veteran for whom such details may seem impossible to fathom.
Multiple publications have highlighted the struggle of veterans to have their disorders and combat-related injuries recognized by the VA. Yet the stories from veterans about the indolence and indifference of the organized specifically designed to serve veterans continues to mount.
But the discrimination extends beyond ignoring and giving incorrect diagnoses. In some cases, it turns in the other direction, faulting veterans and checking to see if their PTSD, obtained while defending their country, will affect job performance.
“Veterans applying for Department of Veterans Affairs jobs are routinely grilled about whether their combat experience makes them mentally unstable, despite a long-standing federal personnel policy that bars such inquiries,” reported the Daily Caller in a story about veterans being harassed about their PTSD.
This line of questioning came as part of a background check required for applying for a job with the VA. Though the department was required to change the form to exclude therapy related to time in the service, it subverts the ruling by using by using a “20-year-old form for its background checks.”
The movement to expose the VA has been gaining steam, not only in the fight to get equal and correct treatment for veterans, but by former employees citing discrepancies. In 2015, USA Today uncovered the mistreatment and disregard for veterans’ health.
WASHINGTON – The chief watchdog at the Department of Veterans Affairs investigates less than 10 percent of the nearly 40,000 complaints it receives annually about problems at the agency, even when they concern potential harm to veteran health, Deputy Inspector General Linda Halliday said Tuesday.
The Office of Inspector General, which is responsible under federal law for rooting out mismanagement and abuse at the agency, simply doesn't have the resources, Halliday said at a hearing of the Senate Homeland Security and Governmental Affairs Committee.
"There is a serious discrepancy between the size of our workforce and the size of our workload," Halliday said. She said her office has roughly 650 professional staff members while the agency they investigate has more than 350,000 employees and a budget greater than $160 billion. "The OIG is not right-sized to respond to all the complaints that we currently receive."
But that explanation was not good enough for VA whistleblowers at the hearing, who said that even the investigations her office does conduct are cursory and often target the VA employees who report problems - rather than the problems they are reporting.
"VA OIG investigations have been half-assed and shoddy," said Shea Wilkes, a social worker at the Shreveport, La., VA who was criminally investigated by the inspector general after he reported hidden wait lists for care at the facility. "The VA OIG has not been independent, but is working with the VA to do damage control, whitewash and intimidate truth-tellers and potential whistleblowers."
Wilkes co-founded VA Truth Tellers, a group of more than 40 whistleblowers from VA medical facilities in more than a dozen states -- including Arizona, Alabama, Delaware, and Wisconsin-- that provide care to more than 650,000 veterans annually. He said many have had similar experiences with the inspector general's office.
"The overwhelming majority would answer the VA IG is a joke," he said.
Halliday took over the inspector general's office in July after the previous leader, Deputy Inspector General Richard Griffin, abruptly retired amid criticism from the whistleblowers' group.
Halliday said she is trying to change the culture in the inspector general's office and attempting to reposition resources so her office can investigate more complaints, particularly those concerning veteran medical treatment. She said she also has ordered mandatory whistleblower-protection training for her staff.
"I made it a high priority and my first priority to reinforce that the OIG values whistleblowers and that we are hearing and learning from the more recent complaints," Halliday said.
She did not have any answers, though, for the family of whistleblower Christopher Kirkpatrick, a clinical psychologist at the Tomah, Wis., VA who committed suicide when he was fired in 2009 after reporting his concerns about the over-prescribing of medication to veterans treated at the facility.
The Office of Inspector General, in an effort to defend an earlier finding that there was no retaliation against Tomah employees who reported problems, including Kirkpatrick, issued a report in June suggesting Kirkpatrick was a drug dealer and another whistleblower, a pharmacist, was a bad employee.
"For my parents to have to read this document after everything they've been through is outrageous and unconscionable," his brother, Sean Kirkpatrick, testified at Tuesday's hearing.
Halliday, when asked by Committee Chairman Sen. Ron Johnson, R-Wis., what she planned to do to make amends with the Kirkpatrick family, said only, "I did not prepare that document."
A spokeswoman for Halliday, Catherine Gromek, declined to answer questions afterward about the report, saying she first had to provide the information to the committee.
Johnson called the report's insinuations about Kirkpatrick "reprehensible."
"That sounds like reprisal to me, to a dead person," he said. "I want that sinking in."
Johnson said he appreciated Halliday saying she values whistleblowers, but he said her office's actions don't reflect that.
"That's not the record," he said.
Kirkpatrick said after the hearing he is eager to hear what Halliday's office plans to do in his brother's case.
"One thing we want is Chris to have a clear name and people to understand that he was a whistleblower," Sean Kirkpatrick said. "He was retaliated against and he paid with his life."
Some veterans have voiced their concerns by staging group meetings and protests, others simply try for awareness to let others know of the goings on, but one veteran went so far as to kill when his PTSD claim was denied.
In El Paso, Texas last year, Jerry Serrato, a veteran seeking treatment for his PTSD, was denied that treatment by the VA when his claim was not found to be credible. Serrato took his anger at the VA out on one of the doctors at the El Paso clinic, shooting and killing VA psychologist Timothy Fjordbak. Serrato reportedly believed that Fjorbak was responsible for this denial.
Serrato had served in the U.S. army as an infantryman from March to July of 2007, but was medically discharged in February 2009. Though it cannot be determined if his claims of PTSD were false, the outburst and anger fit the description of the disorder. And because of the VA’s decision to make the process for veterans to get care for their PTSD laborious, a VA employee died.
Though the pain sufferers of PTSD can cause to those around them is great, the pain they cause themselves can be worse. The suicide rate among male veterans registered with the VA was 38.3 per 100,000, more than double the national average. The rate among women is 12.8 per 100,000.
One of the most thoroughly studied groups of veterans in terms of health effects is Vietnam veterans. Among those examinations are thorough looks at PTSD and suicide correlation. The study Suicide and Guilt as Manifestations of PTSD by Herbert Hendin, M.D., and Ann Pollinger Haas, Ph.D, explored that very question for truly startling revelations as discussed in the abstract and conclusions section of the study.
“Nineteen of the 100 veterans had made a post service suicide attempt, and 1 5 more had been preoccupied with suicide since the war. Five factors were significantly related to suicide attempts: guilt about combat actions, survivor guilt, depression, anxiety, and severe PTSD. Logistic regression analysis showed that combat guilt was the most significant predictor of both suicide attempts and preoccupation with suicide. For a significant percentage of the suicidal veterans, such disturbing combat behavior as the killing of women and children took place while they were feeling emotionally out of control because of fear or rage.”
“In this study, PTSD among Vietnam combat veterans emerged as a psychiatric disorder with considerable risk for suicide, and intensive combat-related guilt was found to be the most significant explanatory factor. These findings point to the need for greater clinical attention to the role of guilt in the evaluation and treatment of suicidal veterans with PTSD.”
Data from the National Vital Statistics System, a collaboration between the National Center for Health Statistics of the U.S. Department of Health and Human Services and each US state, provides the best estimate of suicides. Overall, men have significantly higher rates of suicide than women. This is true whether or not they are Veterans. For comparison:
From 1999-2010, the suicide rate in the US population among males was 19.4 per 100,000, compared to 4.9 per 100,000 in females.
Based on the most recent data available, in fiscal year 2009, the suicide rate among male Veteran VA users was 38.3 per 100,000, compared to 12.8 per 100,000 in females.
The reality is much more complicated than those simple statistics seem to suggest. According to the website veterans and PTSD (http://www.veteransandptsd.com/PTSD-statistics.html ) PTSD statistics are a moving target that is fuzzy: do you look only at PTSD diagnosed within one year of return from battle? Do you only count PTSD that limits a soldier's ability to go back into battle or remain employed, but that may have destroyed a marriage or wrecked a family? Do you look at the PTSD statistics for PTSD that comes up at any time in a person's life: it is possible to have undiagnosed PTSD for 30 years and not realize it--possibly never or until you find a way to get better and then you realize there is another way to live. When you count the PTSD statistic of "what percentage of a population gets PTSD," is your overall starting group combat veterans, veterans who served in the target country, or all military personnel for the duration of a war?
And veterans PTSD statistics get revised over time. The findings from the NVVR Study (National Vietnam Veterans' Readjustment Study, in Four Volumes) commissioned by the government in the 1980s initially found that for "Vietnam theater veterans" 15% of men had PTSD at the time of the study and 30% of men had PTSD at some point in their life. But a 2003 re-analysis found that "contrary to the initial analysis of the NVVRS data, a large majority of Vietnam Veterans struggled with chronic PTSD symptoms, with four out of five reporting recent symptoms when interviewed 20-25 years after Vietnam." (see also NVVR review)
There is a similar problem with suicide statistics. The DoD and their researchers tend to lose track of military personnel once they retire, and do not track veteran suicides for all branches of the military. And, not all suicides will be counted as a military suicide (plus, is a person who drinks themselves to death committing suicide?). A recent study found U.S. veteran suicide rates to be as high as 8,000 a year.
As of September 2014, there are about 2.7 million American veterans of the Iraq and Afghanistan wars (compared to 2.6 million Vietnam veterans who fought in Vietnam; there are 8.2 million "Vietnam Era Veterans" (personnel who served anywhere during any time of the Vietnam War)
According to RAND, at least 20% of Iraq and Afghanistan veterans have PTSD and/or Depression. Other accepted studies have found a PTSD prevalence of 14%
A comprehensive analysis, published in 2014, found that for PTSD: “Among male and female soldiers aged 18 years or older returning from Iraq and Afghanistan, rates range from 9% shortly after returning from deployment to 31% a year after deployment. A review of 29 studies that evaluated rates of PTSD in those who served in Iraq and Afghanistan found prevalence rates of adult men and women previously deployed ranging from 5% to 20% for those who do not seek treatment, and around 50% for those who do seek treatment. Vietnam veterans also report high lifetime rates of PTSD ranging from 10% to 31%. PTSD is the third most prevalent psychiatric diagnosis among veterans using the VA hospitals
50% of those with PTSD do not seek treatment
out of the half that seek treatment, only half of them get "minimally adequate" treatment (RAND study)
19% of veterans may have traumatic brain injury (TBI)
Over 260,000 veterans from OIF and OEF so far have been diagnosed with TBI. Traumatic brain injury is much more common in the general population than previously thought: according to the CDC, over 1,700,000 Americans have a traumatic brain injury each year; in Canada 20% of teens had TBI resulting in hospital admission or that involved over 5 minutes of unconsciousness (VA surgeon reporting in BBC News)
7% of veterans have both post-traumatic stress disorder and traumatic brain injury
rates of post-traumatic stress are greater for these wars than prior conflicts
in times of peace, in any given year, about 4% (actually 3.6%) of the general population have PTSD (caused by natural disasters, car accidents, abuse, etc.)
recent statistical studies show that rates of veteran suicide are much higher than previously thought, as much as five to eight thousand a year (22 a day, up from a low of 18-a-year in 2007, based on a 2012 VA Suicide Data Report).
PTSD distribution between services for OND, OIF, and OEF: Army 67% of cases, Air Force 9%, Navy 11%, and Marines 13%. (Congressional Research Service, Sept. 2010)
recent sample of 600 veterans from Iraq and Afghanistan found: 14% post-traumatic stress disorder; 39% alcohol abuse; 3% drug abuse. Major depression also a problem.
Oddly, statistics for veteran tobacco use are never reported alongside PTSD statistics, even though increases in rates of smoking are strongly correlated with the stress of deployment and combat, and smoking statistics show that tobacco use is tremendously damaging and costly for soldiers.
More active duty personnel die by own hand than combat in 2012
some branches of the military do not keep fine-grained data, or any data at all on the suicide rates (and this must mean on the mental health as a whole) of their veterans. There are "battalion epidemics" of suicide in the military, which much higher rates of suicide and mental health problems.
What is clear from this barrage of statistics is the actual level of knowledge about the range of combat related illnesses is only skin deep. The diagnosis of PTSD or TBI is a convenience rather than a deeply understood illness such as cancer or AIDS. Studies are ongoing but the numbers of those diagnosed as ill, the high rates of suicide and alcoholism continue to rise with each study. At the same time, the range of treatments seem more like a Band Aid than a deeply understood and measured clinical solution.
Many PTSD patients I know that are given an ever larger doses of psychological medications tell me they only feel worse not better. Many Multiple Chemical Sensitive (MCS) and CFIDS patients and patients with HHV-6A high viral titers have adverse reactions to psychological medications as well. This alone should be a red flag to start looking for genetic and biological triggers for PTSD.
Studies are ongoing and there is no doubt PTSD will benefit from further refinement which will allow for more targeted treatments. PTSD is only studied as a Psychosomatic illness. But what if PTSD has a viral component or even a biological component- a genetic predisposition – that makes some victims more likely to become sick than others. Don’t we owe it to our veterans to thoroughly investigate and to find what the common elements are (aside from combat) between those who are crippled with PTSD and those who apparently emerge from combat relatively unscathed?
Clearly, much more work needs to be done. Veterans like Mike Zacchea are pointing the way but it is up to the medical establishment to carry the rock up the hill. We should all be looking to the VA to investigate until causes are better understood so that treatments can become more effective. For far too long, we have paid mere lip service to the veterans when we salute the Flag every Independence Day.
It is time for veterans and their families – those who have truly sacrificed so that the rest of us may remain safe at home – to receive the care and treatment they deserve.
This is Julia Hugo Rachel. Next week, I’ll be telling you about my journey through medical hell along with my son and what lessons I learned
One woman’s journey into medical hell and the lessons that will help cure millions.
Julia Hugo Rachel
PTSD and the Betrayal of Our Veterans