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The Veterans’ Guide to PTSD

Post Traumatic Stress Disorder affects many servicemen and women returning from tours of duty. Unaware that they are suffering from the condition, upon returning to civilian life they may be left undiagnosed and untreated, with potentially devastating consequences.

Our Veterans’ Guide to PTSD has been written to help veterans and their families to understand the causes, symptoms and very real dangers of PTSD. Sharing the experiences of real soldiers who have been effected with the disorder, the Veterans’ Guide to PTSD is designed to increase awareness of combat-related PTSD, to help sufferers and their families identify the condition, and to encourage veterans to seek the treatment they need and deserve. The Veterans’ Guide to PTSD is not intended as medical advice or treatment. It is designed as a tool to indentify and understand the symptoms that might be experienced following combat-related trauma and to begin a process of recovery.

Post Traumatic Stress Disorder affects many servicemen and women returning from tours of duty. Unaware that they are suffering from the condition, upon returning to civilian life they may be left undiagnosed and untreated, with potentially devastating consequences.

Our Veterans’ Guide to PTSD has been written to help veterans and their families to understand the causes, symptoms and very real dangers of PTSD. Sharing the experiences of real soldiers who have been effected with the disorder, the Veterans’ Guide to PTSD is designed to increase awareness of combat-related PTSD, to help sufferers and their families identify the condition, and to encourage veterans to seek the treatment they need and deserve.

The Veterans’ Guide to PTSD is not intended as medical advice or treatment. It is designed as a tool to indentify and understand the symptoms that might be experienced following combat-reated trauma and to begin a process of recovery.

INTRODUCTION

Advances in medical science have revolutionised the way that physical battlefield injuries are treated but understanding and treating mental health injuries such as combat-related PTSD has lagged way behind. Even admitting that such injuries exist at all has only come about in the last century. Removing the stigma surround those who need help is still an on going issue, and for those suffering from PTSD, the problem is very real, urgent and all-consuming. Undiagnosed and untreated, otherwise healthy people can descend from an apparently unremarkable life to a living hell of broken relationships, financial ruin, addiction, violence, prison and tragically for some suicide. The PTSD Project believe we have found a better way.

Every human being is unique. Therefore every mental health issue is almost certain to have it’s own particular characteristics and no cure is going to work in exactly the same way for two people. However, the experiences of others can be enormously helpful and many can benefit by learning of what others have been through. As mental health professionals quite correctly say, one man’s cure maybe another man’s poison, but there is no denying the benefit of shared experiences. That is what The Veterans’ Guide to PTSD sets out to do.

The Ministry of Defence and the Armed Forces must become more accepting of the existence of mental health illness and continue to bear down on the stigma that still surround those who ask for help. GP’s within the NHS must become more aware that patients that are military veterans may have seen, heard and experienced things not encountered in civilian life. The Police and those administering the Criminal Justice System must be more watchful to pick out military veterans who come into their hands and try harder to understand their particular circumstances. The PTSD Project will continue to expand our assistance, not only to treat those with Post Traumatic Stress Disorder but also to offer early-intervention programmes for those with related conditions such as anxiety and depression.

We have compiled a Veterans’ Guide to PTSD which has been written to help veterans and their families to understand the causes, symptoms and very real dangers of PTSD. The Veterans’ Guide to PTSD is designed to increase awareness of combat-related PTSD, to help sufferers and their families to identify the condition, and to encourage veterans to seek the treatment they need and deserve.

Many veterans are paying a hidden price for being soldiers. Often they are unaware that they are carrying psychological injuries as a result of being exposed to life-threatening situations. upon their return home, some find it difficult to fit back into society.

No one knows exactly how many undiagnosed veterans there may be suffering combat-related PTSD. It is shameful that people that choose to serve their country are overlooked by its government. PTSD is costly for veterans, their families and society at large, needlessly destroying relationships with friends and family, making it difficult to hold down jobs, sometimes causing disruptive, depressive or violent behaviour that can result in drug and alcohol abuse, crime or suicide.

British governments have been slow to react to the problem of PTSD within the Army. The US government first recognised problems of combat-related PTSD at the end of the Vietnam War in the 1970’s. The American military openly admit that 1 in 5 of their troops returning from conflicts will suffer from mental health problems such as combat-related PTSD. The Pentagon also admits that the disorder has increased in the conflicts of Iraq and Afghanistan and believes that as many as 1 in 3 of their soldiers could suffer from combat-related PTSD. Although the British Army are more aware of the problems these days, there is still not enough being done to identify the veterans who are suffering from combat-related PTSD. The recent wars in Iraq and Afghanistan have compelled past and present governments to come up with Desensitisation and Trauma Risk Management(TRiM) programmes in order to deal with the effects of combat-related PTSD. Although these schemes have been in place for a while, the vast majority of veterans still slip through the net. The route cause of the problem is that veterans do not realise that they are suffering from combat-related PTSD.

The number of British troops who report combat-related mental health problems such as PTSD to the Army Medical Services is just 4%. These statistics suggest that in the UK we have only scratched the surface of this problem. British troops have gone through a similar experience to American soldiers in the same conflict zones, so where are our missing PTSD casualties, who have not come forward for treatment, who remain undiagnosed and trying to cope with it by themselves?

We will describe in depth the problems of veterans suffering from combat-related PTSD, showing why they are overlooked and how the disorder easily ‘masks’ itself. We explain how to spot the early signs and the effects the disorder can have on veterans’ behaviour, sometimes altering it completely, preventing them from living normal lives or fitting back into society.

We want this Guide to the first port of call in recognising and preparing all veterans and their families for the possibility of unknowingly suffering from combat-related PTSD, whether now or in the future. We aim to help put lives back on track and to demonstrate the steps involved in that recovery. In due course the Guide will be available as an e-book and in printed form as a source of identification of a problem and in the event that combat-related PTSD begins to show itself, to be used for advice whenever needed. The sooner the veteran understands the nature of his or her problem and accesses the appropriate treatment, the lesser the negative impact on his or her life and that of others, the better for all.

CHAPTER ONE – INVISIBLE WOUNDS

UNDERSTANDING COMBAT-RELATED PTSD

Are you suffering from combat-related PTSD after your army service?

You don’t know, do you? You haven’t got a clue, have you? You feel perfectly normal, but somehow things are different at home. You still love your family very much, but for some reason you often want to be alone.

In order to prevent promising futures deteriorating into a living nightmare, it is important to realise that the onset of combat-related PTSD can begin immediately after the trauma. However, it easily hides or ‘masks’ itself and sufferers can be totally unaware of their disorder for a lifetime if undiagnosed. Even if they or their families seek the help that they need, which is often too late to prevent relationship breakdowns and other serious consequences.

Soldiers find themselves in life threatening situations on a sometimes daily basis, where they are expected to kill or be killed. Part of their job can involve shootings, bombings, close quarter combat or other violent acts. These circumstances are like being psychologically ‘hit’ and potentially injured emotionally, over and over again. If a soldier is not physically injured in these events they ‘soldier on’, but tragically many bring home this carnage and terror in their minds. Unfortunately, this madness can be instantly brought back into play by the normal stresses of civilian life, when the slightest everyday thing can act as a trigger for the disorder, without their knowledge.

Combat-related PTSD can be understood as an invisible psychological wound, and like all soldiers who survive conflicts and wars, some are wounded and some are not. In the same way, some wounds heal and some do not. These invisible wounds need to be identified and treated, or just like any other wound they can fester and become worse. With full-blown or severe PTSD there is a higher chance that the person also experience other symptoms, which includes fits of intense rage and anger, anxiety, depression, and even thoughts of suicide. If these psychological wounds are left undiagnosed and untreated they continue to bleed. Overtime, a veteran’s entire psychological universe can be altered and their behaviour at home become more erratic, whilst seeming perfectly normal to themselves. It seems normal to them because it is the same behaviour that saved their life while living in conflict.

The veteran who is unknowingly suffering from combat-related PTSD in ‘Civvy Street’ is not living and thinking like a regular civilian, rather more like a machine. Each day, they exercise their coping skills by plotting and planning everything in the mind. They will stick to these plans rigorously, as if when following a drill. Problems can often occur when tasks and obstacles that are not part of their programme are encountered. If a machine breaks down it can cause confusing, bewilderment and pressure. Other circumstances that can be perfectly normal in civilian life can resemble experiences in conflict to the veteran. For example if a car back fires, it can bring back memories of ‘contacts’ or if curtains move their subconscious thinks of snipers. If something has even the slightest resemblance to experiences in conflict it can easily bring the symptoms of PTSD to the surface.

If a veteran’s mind is processing different information to everybody around him, there is little chance of him carrying on normal relationships. Ultimately, he may lose his family, friends, colleagues and his job. All because nobody realises he needs help to get over the trauma of the memories of conflict and war.

It is absolutely essential to catch combat-related PTSD at the earliest possible opportunity so that this disorder can be more easily treated and the veteran can return to duties or resume a normal, productive life.

HOW THE MIND WORKS

This guide explains in simple, layman’s terms, how veterans’ behaviour is so deeply affected by involvement in traumatic events and why they unknowingly bring the horrors home with them.

A good way to understand this is to try to image the mind as a computer system that stores all kinds of different knowledge and information on to its ‘hard drive’, also known as the sub conscious. The mind needs the information that is stored in this ‘hard drive’ to go about daily life. If the brain wants or needs any information or knowledge it immediately askes the sub conscious for it just like a computer asks a hard drive for data. This process is as automatic and important as breathing.

The sub conscious steers and guides people through their daily lives, it is what makes an individual who and what they are and it forms a person’s character and patterns their behaviour. However, when people become involved in horrific or life-threatening situations, the sub conscious becomes overwhelmed and cannot continue to register and store away the memories in the usual way because the facts are unacceptable and devastating. When the mind cannot process this terrifying data  it becomes stuck. If left untreated, these traumatic events remain trapped in the veteran’s mind. These volatile memories can make veterans suffering from combat-related PTSD very vulnerable to ‘flashbacks’ when under pressure back on Civvy Street often entirely without their knowledge.

Tragically, the longer veterans process in combat-related PTSD are left to cope with the unexpected pressures of every day life in normal surroundings, the more the wounds of their sub conscious bleed, feeding them false information of their past experiences and bringing their conflicts alive in everyday situations, with potentially serious consequences for themselves and those around them.

Consider the following scenario. A veteran and his wife are leaving the house one morning, when a curtain moves in the house next door. The veteran’s wife notices that the neighbours are up and about and thinks nothing of it. The veteran, under stress and unknowingly suffering from combat-related PTSD sees the curtains moving as a sign of danger and threat, his sub conscious feeds him another mode of behaviour, one which is more appropriate to his role as a soldier than his character as a civilian and husband. He starts to check all the windows and roof tops looking for snipers and gunmen, putting him on high alert and creating tense and strange behaviour beyond his knowledge and control.

FLASHBACKS

A flashback is a complete mental duplication of a traumatic incident in every single detail including sights, sounds, smells, physical sensations and even tastes. Emotions such as rage and anger are also replicated. There can be a great many of these memories locked away inside a veteran’s mind depending on how many traumatic incidents affected him in this way.

Not everybody with combat-related PTSD, will suffer from this symptom, but it is very important to realise that for those who do, flashback can flip the veteran’s mind into a state of trauma whenever he comes under pressure, cutting him off from the real world and tricking his mind into a sequence of events that require very different responses to his immediate problems. There is no such thing a ‘standard’ flashback, some flashbacks may only last a few moments and others may last for days at a time. Only when a flashback has run its course will the veteran return to the present reality, entirely unaware of the experience.

These flashbacks do not happen at random or by chance. They are triggered by pressure, for example when the veteran cannot make the everyday decisions to do with his family, finances or work or when he is trying to cope with anxiety, depression, anger or even the deaths of his comrades. These pressures trigger the sub-conscious to provide a solution. Unfortunately when the sub-conscious is damaged with trauma, the only solutions available are those to traumatic incidents.

The main problem is the veteran cannot recognise a flashback even when he is experiencing one. We know that pressure is one of the triggers and therefore the best and only defence against these flashbacks is to eradicate or deal with these pressures before being affected by them. This is obviously much easier said than done. This greatly depends on the veteran and those around him becoming aware that they are suffering combat-related PTSD, recognising the dangers of pressure, when they are most vulnerable and at risk from flashbacks. A lot can be achieved by using common sense to predict and manage situations that will cause pressure; simply by expecting a flashback to happen, can often ensure it will not occur.

A pre-emptive technique works perfectly because it is like being pre-armed. This becomes a turning point that blocks the flashbacks before the veteran can be unknowingly pulled in by them.

DELAYED COMBAT-RELATED PTSD

We have learned that combat-related PTSD is a hidden injury that can be easily missed. Unfortunately most psychological injuries are masked and cannot be seen, so they are not treated immediately and troops on tours of duty carry on as normal with their front line duties straight after their involvement in traumatic incidents. Many soldiers go on to face multiple further traumas without ever being treated for this disorder during their service.

A patrol of 12 men could experience an ambush, bombing, shooting or other life and death trauma at the very start at their tour of duty. The incident may only traumatically affect one of the men at that time, but if no one requires treatment for physical injuries, then everyone will carry on with their duties. Without knowing, they could all have been affected by trauma that damaged their minds, yet the same men maybe immediately ‘hit’ again in another incident and this cycle can continue till the tour of duty is complete. So who knows how many of the original 12 man patrol could have been seriously traumatised by the end of their service, left undiagnosed, untreated and then returned home to their families.

All those men could now be at risk of developing PTSD, with an array of traumatic experiences locked in there sub-conscious, perilously ready to trick them when under pressure. It is essential to distinguish each veteran’s traumas and to treat them, because each ordeal will have its own agenda that can affect a veteran’s mind in unpredictable circumstances, even many years after the event.

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