Post Traumatic Stress Disorder: What is it?

I've seen bodies ripped to pieces by bullets, blown into millions of scraps by bombs, and pierced by body traps. I've smelled the stench of bodies burned. I’ve heard the air sound like it was boiling from rounds flying back and forth. I’ve lived an insanity others should never live..."
Dennis Tenety, "Fire in the Hole"

Post Traumatic Stress Disorder (PTSD) has been around for a very long time. Military medicine had recognized this condition with a variety of labels. During the Civil War, the condition was called " Soldiers Heart." By WW I, it was re-named "Shell Shock", and during WW II, " Battle Fatigue.” Korean War veterans were diagnosed with " War Neurosis,” and "Vietnam Syndrome" for that generation of veterans. The VA was service connecting former combatants with a " nervous condition" or some other type of disorder prior to the advent of PTSD.
Post Traumatic Stress Disorder is a condition recognized by the American Psychiatric Association (APA). Criteria for diagnosing PTSD are published in the Diagnostic and Statistical Manual of Mental Disorders (commonly referred to as the DSM-IV. PTSD first appeared in this manual, published by the APA, in 1980 after significant research studies with Vietnam combat veterans.
PTSD may occur after a person has been exposed to a traumatic event in which the person experienced or witnessed an event that involved death, serious injury, or mass destruction. This could include events that occur in war, natural disasters, acts of terrorism, crime or abuse. For veterans, in particular, stressful traumatic events include combat zones, peacekeeping missions, training accidents, disasters, medical emergencies, and assaults. These events cause the survivor to react with intense fear, helplessness, hopelessness and horror.

Symptoms of PTSD include, but are not limited to:

·Recurrent, intrusive, and distressing thoughts about the event
·Recurrent dreams, nightmares (sometimes called "night-terrors") about the event
·Flashbacks (a sense of reliving the event)
·Distress caused by reminders of the event (sights, sounds, smells)
·Alienation, isolation, and avoidance of people and places
·Emotional numbing
·No sense of future
·Survivor guilt (for having survived when others did not, or for behavior required for survival)
·Difficulty falling or staying asleep
·Anger and rage
·Difficulty concentrating or remembering
·Hyper-vigilant or survivalist behavior
·Exaggerated startled response (usually to loud noises)
·These symptoms may lead to substance abuse or other self-destructive addictive behavior.

Who gets it?

Anyone can experience PTSD symptoms after being exposed to a traumatic event. PTSD is not a sign of weakness or malingering, but rather is a normal reaction to a horrific situation. There is no way to predict who will and who will not develop PTSD symptoms because it depends on how people perceive a situation, and other experiences they have had in the past. Some people may be more affected than others based on their perceptions and learned views of the world. Current research shows that there may also be genetic or biological factors that influence how a person will react to extreme stress.
In the military there are many dangers that service members are trained to deal with, and usually they are able to function during a traumatic episode. However, when the war is over or the crisis resolved and troops have deployed home, then psychiatric problems can begin to appear. It is not unusual for problems to appear months or years after the initial trauma. Sometimes, symptoms are brought on by experiencing another stressful situation like job or marital problems, or even military retirement. Often during deployments, the service members' families have had to get along without them, so when they come home they often feel out of place and not needed. Military reunions are glamorized in the media, and although joyous, they can be very stressful.

Families are also affected by PTSD. Living with someone who has PTSD symptoms can be stressful. Many spouses of Vietnam veterans have reported feeling as if PTSD is contagious. Children will mimic the behavior and attitudes of their parents. If PTSD symptoms have led to violence in the home, than another generation of PTSD sufferers have been created.  Family counseling is always recommended when a family member has been diagnosed with PTSD. If you are still on active duty, and experiencing domestic violence or child abuse, you should contact the Family Advocacy Program (FAP) or the Mental Health Clinic for assistance.

For many military women sexual harassment, assault, and rape are the cause of their PTSD. Unfortunately, the number of female veterans reporting these crimes is very high. However, these incidents often go unreported because the women are usually of lower rank than their assailants or are in their chain of command. If they report, they are at risk of being shunned or losing their jobs. There are many other complicating factors that effect military women who have been raped that are different from the civilian community. Military women are faced with issues of betrayal, role identification (soldier/victim) and loyalty to their service after being assaulted. This can be even more difficult if the rape occurred in a combat zone. In response to the needs of victimized sailors, the Navy operates the Sexual Assault Victim Intervention (SAVI) program. Perpetrators may also experience PTSD symptoms after an incident because of their own behavior.

What can be done?

There is help available. Whether you were in the military many years ago or if you are still in uniform, there are trained professionals who understand military trauma and PTSD treatment. The VA has over 170 Vet Centers and Sexual Assault Treatment Programs nationwide. The Vet Centers were started for Vietnam veterans, but now offer services to veterans from WWII, Korea, Panama, Lebanon, Grenada, Persian Gulf, Haiti and Somalia. You can contact your local VA Hospital to find out what services are available closest to you, and if you are eligible. The Vet Centers offer group therapy, individual counseling, marriage and family counseling. The VA also has inpatient PTSD programs, residential treatment, and day hospital programs. In addition, the VA has specialized programs for substance abuse, homeless veterans, and women's coordinators for female veterans.

There are so many private clinicians or not-for-profit agencies that offer specialized treatment for PTSD similar to care provided by the VA. There are clinicians - psychiatrists, psychologists, social workers – (Certified Trauma Specialists or CTS) who are very qualified to treat PTSD. Interview potential therapists to be sure you feel they can help you. Get recommendations from other people, and do not be afraid to "shop around."

If symptoms are particularly severe and persistent, medication might be necessary. A psychiatrist should be consulted. You should have a complete exam to be sure there are no other conditions that are contributing to the problem.

Twelve-step programs, like Alcoholics Anonymous, can be helpful.  These self-help groups offer emotional support.  There are meetings held all over, and at various times of day.  Many groups are specifically for active duty service-members and veterans.  These groups are confidential.  Check your local phone book for chapters near you.

There are a variety of military and veteran groups and chat rooms on the Internet.  You can access the VA at for medical and benefits information.

"...the voice I learned to hear in the (Vet) Center whispers.  It tells me that I am wrong.  It tells me that the cruel equations of weight and temperature and humidity were more powerful than a 19-year-old's image of self and Corps.  It tells me with logic cool and clear that the memory that will never go away is underserved punishment, and that in that hour of that day I did the best a man could do and should be proud."
Ron Zaczek, "Farewell Darkness"
               Naval Institute Press

How to file a VA Claim

If your PTSD is related to your time in the service, then you might be eligible for a service-connected disability from the VA.  You should contact the American Legion to find out more about your military benefits, regardless if you got out of the service years ago or are currently in the process of transition.  You will need your DD214, military records, personnel (201) file, and any proof of combat awards or other reports that document your trauma (reports of a plane crash, ship sinking, explosion, rape or assault, duty on a burn ward or in graves registration, or POW status).  If available, your own diary or a witness statement from a friend, roommate or the clergy can be very effective as evidence.  You may need to have a VA exam if you have not seen a doctor.  This exam is free.

If you are a combat veteran, and received any of the following individual decorations, you can submit that as evidence of a stressful event:
·Air Force Cross
·Air medal with " V " Device
·Army Commendation Medal with " V " Device
·Purple Heart
·Combat Action Ribbon (CAR)
·Combat Infantryman Badge (CIB)
·Distinguished Flying Service Cross
·Distinguished Service Cross
·Joint Service Commendation Medal with "V" Device
·Marine Corps Expeditionary Medal
·Medal of Honor
·Navy Commendation Medal with "V" Device
·Navy Cross
·Navy Expeditionary Medal
·Parachutist Badge with Bronze Service Star
·Silver Star

If you are a victim of an assault, rape, domestic violence, mugging, stalking, or hate crime, and never reported the crime, the following is alternative evidence you can use to support your claim:
·Private civilian records
·Treatment records for a physical injury for the assault, but not reported as such
·Civilian police reports
·Reports from crisis centers
·Testimonial statements from friends (civilian and military), family, co-workers, clergy
·Personal diary or journal
·Request for changes in military assignment
·Increase in sick call or leave slips
·Change in military prescription and over-the-counter medications
·Substance abuse and/or other compulsive behavior
·Request for pregnancy test
·Request for HIV test or counseling for sexually transmitted diseases
·Counseling statements in personnel file
·Breakup of marriage or relationship
·Reports to Child Protective Services (in case of domestic violence)
·Hate mail/threatening letters

James Bliss VA Assistance
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                                                        ~ Not Whole ~
When I was tiny I wondered why you looked away when I talked to you or sometimes stopped reading in the middle of a story you got angry so quickly and I did not know why,  I thought I had made you mad.   I knew you were angry at somebody, everybody. Something. Someone had hurt  you.  Something had hurt you. You were always looking for someone. Something was missing. You were lost. No one could find you even when you were in the room.  I thought I was in the way sometimes.  There was nothing I Could do to help and sometimes I think I made it worse. I could not get close to you.  I started to punish myself in ways you punished yourself. Our family was not whole. Night time was alive with footsteps and tears. love was in our home. Battlefields were in your head.  The flag flew in our hearts, above our door ,  And reminded you of love lost. What we did not know how to give What we could not understand. What we could not know.  Now I look away as I read to my little one.  I sometimes cannot sleep at night.  Anger threatens to overwhelm me.   I am not alone.  I cannot feel as I am told I should. Your battlefields have made their way into my head.

Stephanie Laite Lanham, 2004 Written after counseling and knowing personally adults who grew up with veterans with PTSD.

No Thanks is Enough

Purple Hearts for the wounds we can see
Anguish for ones that are hidden.
Invisible scars of PTSD
Memories of combat unbidden.

A burden of war with no mercy, no ending,
Tattooed on the soul of a vet.
No medal, no ribbon, no manner of mending
This unpayable national debt.

Semper Fi,
Jean Bradley