Veterans, Combat Stress and the Family: A Bipartisan Federal Issue Briefing” hosted by Witness Justice and supported by VVA. Panelists included VVA’s Dr. Tom Berger; Kathryn Power, CMHS Director; John Baker, Attorney; Todd Bowers, IAVA; and Gen. Xenakis, DoD

October 24, 2008

   
Good morning, distinguished guests and ladies and gentlemen. On behalf of Vietnam Veterans of America, I am proud to be here today, and I’d like to thank Witness Justice and the Veterans’ Initiative Center & Research Institute for providing me the opportunity to participate in today’s briefing on veterans, combat stress and the family.

“We’ll always have Paris,” said Humphrey Bogart as he parted from Ingrid Bergman in the film Casablanca. It’s a great movie line and it says a lot about the amazing human gift called memory. Like Bogey, you can keep your favorite places and people with you simply by pulling up your happy memories of them – even if they’re miles away or long-gone. Without flipping open a scrap book or putting in a CD, you can conjure up your newborn’s first smile or words, the ecstasy – or agony – of prom night, or even the aroma of Mom’s freshly baked cookies.

But memories have a dark side also. They can make you feel devastated, furious, or humiliated (many of you just thought about prom night again, didn’t you?), even decades after something bad happens. What’s more, bad memories seem to stick more than happy ones – and that’s especially true for the terrible memories like the ones our combat veterans have.

While many of us are aware of the prevalence of combat stress among our Vietnam vets and returning OIF/OEF veterans, it is my sincere hope that you will leave today’s briefing with a better understanding of the impact of combat stress in the reintegration for our returning troops, how this affects families, and how it potentially can lead to family violence.

First, however, a very brief history of combat stress, or what we know today as post-traumatic stress disorder, PTSD. It is a very old malady and as such, has been called a variety of names. In the 1670s, Swiss military doctors described the symptoms as “nostalgia”. During the Napoleonic wars of the early 19th century, battlefield surgeons began calling it “exhaustion”, and by the time of the American Civil War, it had become known as “soldier’s heart” and “the effort symptom”. “Shell shock” became the term commonly used

in World War I, and this was succeeded by “combat fatigue” and “battle fatigue” in World War II. By the time the war in Vietnam was winding down in the early 1970s, the term “Post-Vietnam Syndrome” was being used to describe veterans’ traumatic stress reactions during and after their military service in Southeast Asia. Finally, in 1980, the term “Post-traumatic Stress Disorder” appeared in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM III) and is still used today.

Now PTSD has a lot in common with a normal stress reaction; the big difference is that it’s a much more powerful response, and it doesn’t go away. PTSD also looks a lot like acute stress disorder – in fact, acute stress disorder becomes PTSD, diagnostically speaking, if symptoms last more than a month generally speaking.

Every medical disorder has its own signature, a pattern of symptoms that allows physicians to make a diagnosis and plan a treatment approach. In the case of PTSD, doctors look for three main types of symptoms: 1) re-experiencing the traumatic event or events, which includes intrusive, distressing recollections of the past event, flashbacks, nightmares, exaggerated emotional and sometimes physical reactions to triggers that remind the person of the event(s); 2) avoidance or emotional numbing, which includes avoidance of activities, places, thoughts, feelings, or conversations related to the trauma, and restricted emotions; and 3) increased arousal as indicated by difficulty sleeping, irritability or anger outbursts, difficulty concentrating, hyper vigilance, and an exaggerated startle response.

Normally you can easily brush aside an unpleasant thought. If you have PTSD, however, thoughts and emotions force their way into your mind, leaving you completely at their mercy.

The intrusive thoughts that occur in PTSD almost always cause a strong surge of emotion – anger, fear, humiliation, and helplessness – because the stress response is a total mobilization of the body’s physical resources. Powerful neurochemicals flood our brain and body, including epinephrine, Nora epinephrine, serotonin, dopamine, and endogenous opiates and benzodiazepines. Sugars are also

mobilized from liver and muscle, the respiratory rate is increased as is heart rate and blood pressure, and the immune system is activated.

When you’re asleep, these intrusive thoughts show up as nightmares. During the daytime, they pull you away from present time, sometimes making you behave in ways that don’t make sense to the people around you. The best-known type of these daytime intrusions – although not everyone with PTSD experiences it – is a flashback.

A flashback is a memory from your trauma that intrudes into the here-and-now, making you feel like you’re right back in the past. Flashbacks typically contain random bits and pieces of information – a sound, odor, the color of a bystander’s umbrella – rather than a full-fledged memory. That’s one reason it’s hard to make sense of these blasts from the past or gain control over them without help from a therapist.

Flashbacks usually involve sights and sounds as when a veteran sees and hears the sounds of a long-ago battle, but as I said, they can also include smells, tastes, or sensations of touch. Sometimes a flashback just won’t go away.

Not all intrusive thoughts, however, involve sensory flashbacks. Often, people with PTSD have other negative thoughts, such as “Other people are out to get me”, or Nothing goes right for me” that stems from their trauma.

If you have PTSD, other people around you may mistakenly believe that a flashback or other intrusive thought is “all in your head”. What they don’t understand is that in reality, your whole body, not just your mind, gets in the game. That’s because you’re not just thinking about the past, you’re actually reliving it.

After a trauma, you desperately want your terrible feelings to go away – but when PTSD strikes, unpleasant emotions just don’t pack their bags and leave. In fact, they grow even stronger over time, causing you intense distress. In order to cope, your mind tries to block or avoid these bad feelings with the intention of protecting you from the

hurt. These mind games lead you to change your behavior in different ways. For example, you may avoid activities associated with
the trauma – if your trauma occurred in a moving convoy in Iraq, when you return home, you may drive faster without regard for other vehicles or directions. Or you may block out key parts of the trauma – this blocking is called psychogenic amnesia, or you may avoid movies or tv shows for fear of seeing scenes that remind you of your trauma; or you may find it hard to fall asleep because you worry that nightmares will dredge up the fears that you’re trying to suppress – and of course, when you’re awake, all you want to do is sleep as a means of escape from the daytime thoughts that plague you, a real Catch 22.

A related problem that occurs with PTSD is emotional anesthesia, a different trick your mind uses to help you avoid pain. It works to some degree, but it also makes feeling the emotions you want to feel more difficult. For example, people who viewed themselves as outgoing, fun, warm, and loving before a trauma often say that they now have trouble feeling an emotional attachment to others or reacting in a normal way to life events. It hurts relationships; you may find sexual relations and intimacy unpleasant or simply boring; and it steals the joy in your life – you may lose interest in hobbies and recreational activities that you formerly enjoyed. And emotional anesthesia can also make it harder for you to conjure up the emotions or enthusiasm you need to envision your future. The fancy term for this is called “foreshortening”, which means that you have difficulty planning ahead and picturing where you’ll be in the future, or you lose interest in your personal health – perhaps developing nutritional and substance abuse issues.

The last hallmark of PTSD that I want to mention today is hyper arousal, or when the nervous system stays on red alert all the time, and they can’t let their guard down. This situation causes a range of problems that affect their relationships with other people and their general overall well-being such as chronic irritability, difficulty sleeping, other physical reactions triggered by a fight-or-flight reaction whenever a PTSD trigger occurs, and quickness to anger – what I’ll call the ride on the adrenaline train…

Anger is one of the most common problems that troops encounter after deployment to the battlefield. This emotion, which stems from the high level of arousal and aggression needed for survival during
war, can make reestablishing connections with family and friends a difficult challenge because military training often teaches the use of feelings and emotions for the most rudimentary of purposes, namely differentiation between safe and dangerous situations. Skills required for distinguishing emotional nuances and exploring emotions within interpersonal relationships are NOT taught by the military. The military’s mission requires training our service members to go into dangerous situations, effectively assess the level of danger within the situation, and neutralize that danger using whatever force is necessary, regardless of how personnel feel about the mission.

Combat missions are inherently aggressive and that aggression is reinforced each time a service member is placed in harm’s way. Combat veterans have been taught to use aggressive tactics to maneuver safely through issues and problems, and when you add the component of learning how to disconnect from emotions, combat survival skills are nearly useless in creating an emotionally fulfilling relationship in civilian life.

So there are lots of reasons a combat veteran feels angry. First, anger is usually easy to tap into (and therefore accessible at a moments’ notice) and is often used to mask underlying feelings that are much more difficult to deal with such as sadness, depression, or guilt. Post-deployment anger can also stem from discouragement or frustration the veteran felt during deployment and even during reintegration.

“Following the rules” is critical while you’re in war, and you may become angry if those around you aren’t following the rules or doing what they’re supposed to be doing at home. This can even start during deployment because while in battle, problems become amplified. This means any fault you find in your comrades or superiors before or during deployment become more obvious during critical situations; just at the moments when you believe the person needs to perform better or at a higher level. Thus, you come to believe that others are not performing their jobs the way they should.

This same anger carries over upon transition manifesting itself with family and friends or others in the community. For example, you get angry over minor traffic situations or getting cut out of line at the movies…

And because you feel like others aren’t doing what they’re supposed to be doing, you may try to take over and wind up being over controlling, and that has serious consequences in personal relationships and with children in particular. Anger can also be easily displaced onto the wrong person or into the wrong situation.

Anger can also be related to issues of trust and betrayal. When service members return from war, they often realize that they’re exasperated with the way life works, with the government and military systems, furious about being dragged into a war when war was unexpected in their life, or angry with their Higher Power. And anger can be a response to being victimized and can also be directed toward a perpetrator of violence such as an enemy combatant or perpetrator of military sexual violence.

Lastly, anger and irritability can be associated with the fear or loss of control felt at times during deployment. In times of extreme stress, terror, or life threatening situations, such fear may be expressed as fight, flight or freeze responses. Anger can motivate you, protect your feelings of self-esteem, or make you feel in control. You may feel angry from discouragement, or frustration over leaving a job unfinished, such as leaving when the war is not finished, or even at the injustices of the world over which you have little or no control.

In conclusion, our complex brains and powerful memories distinguish us as one of the most intelligent of animals on the planet, and yet this very intelligence that leaves us vulnerable to the intrusive effects of trauma such as flashbacks, body memories, post-traumatic nightmares and behavioral re-enactments. Exposure to trauma alters people’s memories in a number of ways, producing extremes of remembering too much and recalling too little. In my opinion, barriers exist to recognizing the impact of trauma – the reality of traumatic amnesia in individual trauma survivors has repeatedly left our society with a cultural amnesia, especially when the trauma has occurred

within marginalized groups such as veterans In other words, there’s a reluctance of both the survivors to dredge up the memories of the trauma and reluctance on the part of the larger audience to listen to the stories. As a result, it’s been easy for both survivors and the public to lose the thread of the cause and effect relationships inherent in trauma. It is time to look seriously at how the impact of combat trauma can play in the role of responses, responses which can place the family in a situation that is not safe and one that is often seen as domestic violence.

Thank you, and afterwards I’ll be glad to answer any questions you might have.