Treating Psychological Trauma in Iraq and Afghanistan War Veterans

Baltimore Sun

Psychologist explains problems combat veterans of Iraq and Afghanistan can face when they come home – and how they can get help

May 13, 2007 – Four years ago when President Bush declared major combat over in Iraq, the first troops began to come home to an insidiously invisible war: the psychological trauma caused by their combat experience.

In a study of soldiers returning home after that first year of war, one in eight was found to have post-traumatic stress disorder or some other mental disorder, according to a Walter Reed Army Institute of Research study reported last year in The Journal of the American Medical Association.

Now, one in three veterans of the war in Iraq, and one in nine of the military operation in Afghanistan, face mental health problems, including depression, anxiety or post-traumatic stress disorder, according to the Iraq and Afghanistan Veterans of America.

Among other things, veterans of Iraq and Afghanistan are experiencing family problems, drug and alcohol abuse, untreated post-traumatic stress disorder, depression, and suicide – all directly attributable to service in a war zone, according to Paul Rieckhoff, a former infantry officer who formed the powerful veterans’ group.

Long-term studies of Vietnam veterans show that almost one third have required psychological care. PTSD affects their families as well.

Back From the Front: Combat Trauma, Love and the Family, a new book by psychologist and therapist Aphrodite Matsakis, explains how the psychological trauma from combat can also hurt loved ones dealing with veterans’ emotional numbing, anger, guilt and sexual difficulties – and offers ways to get help.

Author of Vietnam Wives, Matsakis has spent more than 30 years counseling veterans and their families. Her latest book is published by Sidran Institute, a nonprofit organization in Baltimore that helps people understand and recover from traumatic stress, dissociative disorders and co-occuring problems such as addictions.

For many years, the Silver Spring resident worked for the Veterans Affairs medical center and readjustment counseling services. She continues to counsel veterans and their family members in her private practice.

What is the history of combat stress? How have we looked at it?

Sending people to war has always carried a price tag. Soldiers will have some kind of stress reaction that can change a person fundamentally. In World War I, soldiers who displayed symptoms of combat stress on the battlefield were often punished and some were executed as traitors. In World War II some were accused of being cowards and put on trial. There is a dialectic here. On the one hand, we see society saying they’re traitors and weaklings while the mental health profession says this is a normal consequence.

What did you find in your early work with the wives of Vietnam veterans?

Wives would speak of husbands who were not communicative. A vet might have a sudden eruption of fury that would lead to punching a hole in the wall, then leave home for hours or days because he did not want to hurt his family.

I heard about ambivalent intimacy: a veteran very much needing the wife or girlfriend and yet being afraid to be really close. …

[Post-traumatic stress] is all about being overstimulated and understimulated, about hyperarousal and numbing. No one wants to feel like a vegetable or to be so anxious you feel as if you’re going to lose your mind.

There may be some triggers that a particular veteran might never be able to handle, like a parade, because there are too many people. He or she can’t feel safe there because they can’t monitor the situation and be fully aware of what’s going on. That can happen in any place with a lot of uncontrolled movement that’s unpredictable.

How does the public treat the spouses of veterans suffering from PTSD?

I think that basically, they’re ignored. Women I’ve counseled have shared with me that, on the one hand, they’re treated like “heroic martyrs” for “standing by their man” through thick and thin, kind of like their patriotic duty. On the other hand, they may be blamed in part for their veteran’s problems: “If only you were loving enough, understanding enough, giving enough, he wouldn’t be having half the problems he’s having.”

Wives have been accused of being “codependent” or “loving too much” by family, friends and mental health professionals. Sometimes they are accused of as being “sick” themselves for staying with a troubled veteran. If a veteran came home missing his legs, it would be expected that the wife would loyally stay with him. Yet many combat reactions have a physiological or biological basis that’s just as much to do with the body as an amputation.

Why are some vets affected more by their experience than others?

Everyone’s experience in the military is different. The rates of mental distress have been found, thus far, to be related to the degree and severity of combat experience, the degree of physical deprivation and impairment (wounded vets have the highest rates), to age – younger vets are more affected than older ones. It may matter whether or not a person was traumatized before entering combat, whether or not he or she was exposed to atrocities or friendly fire, and the amount of emotional and financial support available upon return.

What are the most common difficulties that vets suffering from PTSD show?

Feeling separate and different from those who didn’t go to war. Bewilderment and shame at having PTSD symptoms, and hence, low self-esteem, especially when the expectation is that he or she will “adjust” in a ridiculously short period of time. Depression. Being on the lookout for danger. The “death taint:” fearing that those he or she loves may be harmed. Intrusive thoughts, flashbacks, nightmares which interrupt one’s sleep or ability to concentrate. Survivor guilt. Irritability, anxiety and sadness when confronted with reminders of war experiences.

Can vets recover from this trauma?

In most people’s minds, that means returning to who you were before going to war. That would also mean that he or she does not think about their experience or have feelings about it. If that were true, then for every one of us to be “normal” we’d have to forget our own history.

I think we have to look at other definitions. Freud said mental health consisted of the ability to love, work and play. You can suffer from anxiety attacks, nightmares and other symptoms of combat trauma, but if you can still love, work and play – i.e. function – then you are recovered.

What are some of the issues that a vet’s family must confront and deal with?

A veteran’s numbing, depression and reactions to triggers. There’s the veteran’s needs for down time. Perhaps they will have to deal with problems with anger, alcohol or drugs. If the veteran has missed out on significant family events, he or she may feel like an outsider for a while. The family has to get to know each other again. There may be shifts in power; the responsibilities and power need to be shared.

Children have to get to know their parent again. They may have misinformation about his or her role in the war or about the nature of war. They may wonder if their parent harmed children. They may be proud of their parent’s military role but resentful of the fact they were away.

Do veterans with PTSD suffer from media stereotypes?

Yes. They are portrayed as walking time bombs, or as having five-hour flashbacks where they don’t know where they are or what they are doing . These sensational images make the news and make movies interesting but are hardly representative. These images are also unfair, overly simplistic and a great disservice to vets and to their families. In your book, you make the point that combat can also develop character in a positive way.

What are some of its potential benefits?

A greater appreciation of life and a greater desire to have close relationships with family and friends. There can be spiritual development as well. It may increase their ability to work in a team as well as discipline and loyalty. There’s the ability to sacrifice for a cause greater than self. Ability to handle change and uncertainty and ambiguity. Ability to handle crises.

How can we treat our returning soldiers better?

People need to learn about the full range of combat reactions (not just PTSD) and see them as a normal continuation of survival mechanisms from war. Calling vets “crazy” or “weaklings” or seeing them as “super machos” who can handle anything are also perceptions that have to go.

Only a true anti-social personality or true psychopath or a truly crazy person out of touch with reality could go through a war and not be changed by it in some way, not suffer some loss of innocence, not be anxious, angry or depressed about some aspect of his or her experience.

People need to learn not to press vets to talk and to allow them the space they need to process what happened without calling them “loners” or “anti-social.” They must respect the veterans’ emotional pain, whatever form it takes.

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