Situations of war have often come with massive costs for those involved. Many people lose their lives, and others suffer physical injuries that change their lives in a way that they can never recover. The consequence of war that does not receive as much attention is the mental and emotional scars that those who are at the forefront have to live with for the rest of their lives. PTSD resulting from combat is an issue that requires so much care as well as support for the veterans of war because it affects the rest of their lives. This paper delves into the subject matter and explores the impact of the involvement of US troops in the twin wars in Afghanistan and Iraq occasioned by the September 2001 attacks and how that war has led to an increase in the cases of PTSD among veterans. The paper also delves into the role that multiple deployments play in increasing one’s risk of contracting PTSD as well as other mental ailments.
Throughout time, there have been many names given to the invisible wounds of combat. During the American Civil War, the Army physician J. M. Da Costa wrote of the “irritable heart,” with included symptoms that we now call panic (Backer & Picken,2007). There were other names such as war neurosis, battle fatigue, post-Vietnam syndrome, and what is now the correct medical term; PTSD. The Vietnam war according to the authors was one particular turning point as so many returning veterans soon developed complications that the medical fraternity then did not understand, but they were signs and symptoms of PTSD. Then in 1980, the American Psychiatric Association coined the current term, posttraumatic stress disorder. The medical doctors and behavioral theorists have known for some time that service members and veterans are at increased risk of anxiety disorders due to their exposure to combat (Harben, 2009; Backer & Picken,2007). Dealing with PTSD begins with understanding what it is and what it is all about.
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Post- traumatic stress disorder, a debilitating condition that associated with war
It is a mental disorder that could develop out of an individual undergoing or experiencing an event that is scary, dangerous, or shocking (nimh.nih.gov, 2016). The explanation given by bodies dealing with mental health issues is that the feeling of fear or being afraid is only a natural reaction that one gets as a result of undergoing a disturbing or a traumatic situation. The fear triggers a series of responses that are essentially the body way of adjusting to protect itself or avoid the danger. One could think of the responses in the context of “fight- or- flight” healthy reaction meant to protect a person from the adverse situation. Any normal human being experiences some reaction after a traumatic event, and that is just the body’s adjustment mechanism, and they should not take long to recover from the symptoms. If one still feels the need to respond as though they are facing danger long after it has subsided then, that may be a case of PTSD (helpguide.org, 2016).
Trying to figure out PTSD or its symptoms may not be an easy undertaking, but at the same time, it is nothing new that providers have yet to see. Medical practitioners have studied and documented PTSD for a long time, and they discovered that individuals that experienced a traumatic event were more likely to suffer from it as a consequence of undergoing something out of the normal or what is typical for a human being. In the context of war, the concern now for many people is the factors that may accelerate the chances of those in active combat contracting PTSD such as the multiple deployments and the intensity of the war (Jakupcak, Wagner, Paulson, Varra, & McFall, 2010). Cases abound of active members exposed to the reality of war that has suffered the effects of PTSD and related symptoms. For the military leadership, it is of utmost importance to understand PTSD and its implications as it can have a tremendous impact on a unit’s mission and its readiness for battle (Jakupcak et al., 2010).
The United States entered combat operations in the Middle East, as a response to the September 11, 2001, attacks. The George Bush administration first led an invasion of Afghanistan at the end of 2001 in pursuit of the Taliban militants as well as Al- Qaeda, the group headed by Osama Bin Laden and that claimed responsibility for the attacks. The US army dubbed the Afghanistan incursion Operation Enduring Freedom (OEF). In 2003; the United States made another attack, this time to Iraq in March 2003 after suspecting that the country, then under its despot leader Saddam Hussein was stockpiling weapons of mass destruction (Badger, 2014). This invasion is what became known then as the Operation Iraqi Freedom (OIF) (Badger, 2014). The two engagements saw the largest deployment of US troops in combat, with about 2.5 men and women having served during battle (Badger, 2014). Just as the needs of war required more boots on the ground, a sizeable number have returned with psychiatric issues and mental health problems such as PTSD (Fisher, 2014).
The growing understanding of the subject of PTSD among veterans has created and interest among different people who are interested in understanding the problem in depth and knowing how to combat and prevent it. Some psychologists and psychiatrists have undertaken research that has supported the notion that troops deployed to the battlefields of Afghanistan and Iraq were highly prone to developing psychiatric and psychological disorders to include PTSD (Fisher, 2014). One such report details the findings of a study conducted by RAND Corporation focused on the “invisible” wounds, a term that describes the impact of multiple deployments away from the physical and visible harm of death and injury. The increased operational tempos that were the hallmarks of the OIF and OEF have resulted in variable deployments lengths, multiple deployments and unpredictable time at home “dwell time” (Harben, 2009). As the need to put more boots on the battlefield grew the risk of the officers suffering lifelong mental injuries that may not heal like the physical ones.
PTSD is caused by a traumatic occurrence and can affect just about anyone that experiences such an event (helpguide.org, 2016). Previously diagnosed cases have shown that it can cause an enormous amount of stress and causes interference with family as well as social functions. It, therefore, affects one’s ability to function normally and interact with other people. For many researchers, identifying and pinpointing the possible risk factors that place Service Members and veterans as high-risk people to experience PTSD is of academic and clinical importance. There are several studies by different authors who have sought to decipher a host of issues regarding the same. Possible immediate triggers that may precede the onset of PTSD include, but not limited to; continuous combat experience, being a witness to fatalities, major trauma, discharging of a firearm, and related stress and trauma that may manifest as a result of the being deployed.
The twin battles in Iraq and Afghanistan have been known to be the longest military campaign in the history of America and also the most involving since the second world war (Badger, 2014). Regarding the numbers, the author notes that there were 2 million troops deployed as of late 2010. The war saw a high rate of disability, brain injuries related to the trauma in the warfront, and (PTSD), more than in any other engagement before that. For the veterans, and indeed, anyone else suffering from PTSD, it is imperative that they receive treatment as soon as possible. If not treated for PTSD or depression there can be a host of consequences to follow. According to Sabella, (2012), the issues include problems such as drug use, suicide, marital problems and unemployment that can stem from PTSD issues.
As part of understanding PTSD, some studies conducted showed that longer dwell time may reduce the post-deployment risk of PTSD and other mental disorders (nimh.nih.gov, 2016). An example of such reports is the one by the RAND Corporation that emphasized on the need for mental health services including proper diagnosis and treatment. According to Tanielian, (2008) some of the problems that the authorities should consider addressing include issues such as wait times and the availability of providers. The length of a tour can also be one of the determinants of the development of PTSD and depression (Tanielian, 2008). Other such as the number of deployments and the location of deployments also appear to have an impact on the risk of developing PTSD and other mental disorders.
A recent study by Chan, (2009), revealed the rate of comorbidity with veterans and clinical depression had a PTSD rate of 36%– 50%.Since the beginning of campaigns in Iraq and Afghanistan, many researchers have conducted studies that supported the theory that combat operations can lead to an increased probability of mental health disorders (Seal, 2009). In doing so, they have proven than being in the battlefield constitutes enough traumatic events for one to develop the disease. The analysis of continuous deployments has provided evidence of increased rates of depression and PTSD and thus impaired mental capacity. In their 2008 study, the RAND Corporation report titled Invisible Wounds of War provided an extensive and comprehensive review of the prevalence of PTSD and depression.
The study employed the methods of direct interviews with veterans as well as questionnaires to obtain information. They focused on members of the army and the marines that had served on more than one mission in the wars. In a self- test questionnaire, most respondents reported experiencing nightmares and inability to get proper sleep at night. Closely related to that were constant flashbacks of horrific events that took place on the battlefield. Other problems reported include avoiding anything or anyone that reminded them of the war, being on guard and a constant feeling of danger, muscle aches, and headache, diarrhea, and pressure to drink and use drugs. All these are symptoms of PTSD (nimh.nih.gov, 2016).
Contracting PTSD while on active duty has dire consequences for service men. The condition makes it impossible to discharge one’s duties as required. The clearest indication of this problem is 64% increase in the number of officers forced to leave active duty because on mental problems in 2009 from 2005. That is a disturbing statistic by any means and one that points to a bigger problem (Sabella, 2012). To make it even worse, one in every nine cases of soldiers discharged has something to do with a mental disorder. Best practice demands that after returning from war, most if not all US military members require health care services for PTSD and they should undergo observation for a while to check if they exhibit any symptoms of the condition. The care and interventions that these personnel receive will be critical for the federal health care system and most importantly, in ensuring they live as close to a normal life as possible. Several factors are prerequisites for the establishment of appropriate treatment for PTSD. The government and the military leadership have to provide enough practitioners to treat the patients, and mental health providers have to be well informed on the treatment protocols (Sabella, 2012).
The current evidence points to a situation where people are not doing enough to deal with PTSD among veterans. No less than former Defense Secretary Leon Panetta stated that he was unsatisfied with the Pentagon’s current approach to combating military mental illness problems. He also said the Department of Defense will review its procedures for handling mental health cases (Sabella, 2012). The policy that the top figures at the Department of Defense and other relevant bodies such as the Veterans Administration employ is based on factors of psychosocial rehabilitation, which stress the involvement of active participation by the veteran. It is a requirement that the providers have active relationships with veterans receiving their services. The VA started publication of its history and its development psychosocial rehabilitation program and the medical treatment for mental disorders (Baker & Pickren, 2007; Baker, 2007). That initiative offers hope for the veterans who undergo untold suffering because of PTSD and the chance for them to start the journey towards recovering their lives and getting to do what they would have wanted with their families and the rest of society.
Research conducted by Sabella, (2012) estimated that catering for PTSD treatment in the first two years after veterans return from a deployment costs more than $6.2 billion. The study thus concluded that there is a need for national effort needed in order to improve and expand the health care for veterans. The effort also requires a lot of cooperation between all people and experts. It requires not only the involvement of the military but also that of veteran associations and even civilian health care services. The effort should focus on encouraging service members to seek the help they need to assist with treatment (helpguide.org, 2016).
The studies also showed that PTSD and depression were highest among the Marines and the Army. The study also incorporated veterans who were no longer serving in the military. The results indicated that prevalence of PTSD was higher among several groups more than others. These included women, Hispanics, as well as enlisted personnel (Sabella, 2012). There were also treatment gaps discovered for individuals diagnosed with PTSD and depression. One of the most striking findings from the undertaking was the unanimous revelation by the respondents who attributed any mental health issues they may have had to the trauma they experienced while serving in the battlefield.
Leading scientists have reported that the readiness to handle a sudden increase in the cases of PTSD of both the Pentagon and the Veterans Affairs is wanting. Some of the teething problems include delays in treatment for those who needed treatment right away and less than adequate level of care for those did receive it. There were critical gaps in the times leading up to treatment. Eventually, issues such as these caused the resignation of VA Secretary Eric Shinseki (Badger, 2014). According to the author, the Defense Department have since taken a serious look at PTSD, but studies revealed that there are still some poor practices going on.
The number of deployments, as well as the country of deployments, may be the direct variables that appear present themselves as risk factors for developing PTSD (Tanielian, 2008). When it comes to the OEF and OIF, approximately 20% officers returning from Iraq and Afghanistan exhibited symptoms of PTSD or other conditions associated with depression (Badger, 2014). Sadly, though, only about just half of them according to Badger, (2014), got treatment. That is the damning indictment on the entire military setup and the VA for failure to adequately protect the gallant soldiers who give their all when they go to the war zone.
Stigma
While there are problems such as lack of enough resources and personnel that inhibit the provision of proper care for returning veterans, there is also the silent question of the associated stigma and fear of the unknown (Yehuda, Vermetten, McFarlane, & Lehrner, 2014). Several members do not seek help for their psychological illness because of fear of stigma. According to Vanecek et al., (2011), they do so because many believe that if they do it will be the end of their careers. While the situation has improved for the better in recent years, it was almost as though there was an unwritten rule within the military ranks that prohibited anyone from opening up about having PTSD (Sabella, 2012). As such, the reward that the brave individuals who had dedicated the best years of their lives fighting for their country ever received was years of untold suffering that they could never talk about with anyone else.
The other aspect of stigma, and perhaps the worst is the discrimination from society. Cases abound of war heroes who return home as entirely different people from the ones that left (Sabella, 2012). Some of the veterans become withdrawn, and some may tend to exhibit violent tendencies, often hurting the ones that they love. In other instances, veterans turn to drugs and alcohol as a means of escaping their reality, and whenever they get to such a point the consequence is that most of the society turn against them (Fisher, 2014). The lack of support does not make it any better and may push them even further into the bad habits and make it all the harder to redeem themselves. In cases where the people close to the officers turn away from them, it is usually a case of inadequate information and a sense of desperation as they do not know who or where to turn to for answers (Fisher, 2014).
In perhaps one case that is an exception rather than the norm, A judge in Cumberland County, North Carolina accompanied a veteran for his 24- hour sentence in a county jail (Wang, 2016). The Judge handed the sentence down to the decorated war veteran for lying in a mandatory drug test, having previously enrolled in the veterans’ treatment court program. The judge himself had served in US Army combat missions and thus fully understood what the veteran went through as a result of his PTSD diagnosis (Wang, 2016). According to Wang, (2016), it was the judge himself who drove the veteran to the jail and accompanied him through the night as they shared their experiences from their respective times spent serving. Such an occurrence demonstrates that there are people that understand the predicament of veterans diagnosed with PTSD, and if the rest of society adopted such an attitude, then the situation would be much better for everyone.
Conclusion
The prevalence of depression and PTSD in the military after completion of deployment is a grave concern that the society has not paid as much attention as it should probably have. PTSD will continue to be the aftermath of combat as long as there are wars. The top military authorities and other organizations such as the Veterans Administration must step up their efforts to cater for diagnosis and proper treatment of those returning veterans that may show signs of PTSD. Even more important is the need for the military to adopt strategies that will make it easier for members to report whenever they suspect they could be suffering from PTSD. The Society also needs to be more understanding and accommodating of the war heroes who show signs of mental disturbance upon their return home and help them in seeking help.
References
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Wang, Y. (2016). A compassionate judge sentences a veteran to 24 hours in jail, then joins him behind bars. The Washington Post. Retrieved from https://www.washingtonpost.com/news/morning-mix/wp/2016/04/22/a-judge-sentences-a-veteran-to-24-hours-in-jail-then-joins-him-behind-bars/
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