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PTSD, The On Going Story

26-02-2009

Australia’s latest deployment of operational forces is to Iraq and Afghanistan. There are some similarities with the Vietnam situation. They are both essentially “guerrilla” style conflicts, where Australians are operating in a foreign country against forces based in the environment (physical and social) of that particular theatre. They are situated in cultures very different from ours, with different languages.

Over the last 2 years or so of the Vietnam conflict, mines became a major problem as the VC and North Vietnamese forces learnt to improvise explosive devices, often by pilfering Australian minefields.

IED’s (improvised explosive devices) have become a major problem again, especially in the Afghanistan theatre. However, more powerful explosives and sophisticated remote detonation techniques have added to the danger.

The terrain of both theatres is very different from the jungles of Vietnam, demanding different tactics. The climate is markedly different, wet and dry seasons are now hot and cold ones.

Modern communication systems have made direct communication with families and loved ones much easier for operational members. Technology has also dramatically altered weapons systems and observational systems in the Middle East.

In both situations the Australians are part of a large multinational force, driven largely by an American political agenda. However, the polarization of views about the wars in the Middle East seems not as dramatic as it was regarding the Vietnam War. There was a tendency during the Vietnam War to “blame the warrior”. The young conscript, fresh from a year of intense jungle warfare was often treated appallingly, probably because it was a chance for many to vent their disapproval of the politics of the situation. The unsuspecting young man was suddenly the brunt of anger which was difficult for him to comprehend.

All troops deployed to Iraq and Afghanistan are regular or reserve members. Conscription is not an issue here.

PTSD (Post Traumatic Stress Disorder) is a term first coined in 1980. It was a result of huge demands being made on the American psychiatric system by soldiers returning from Vietnam. Psychiatrists have been seeing this disorder for more that 100 years. It follows exposure to life threatening situations. It can occur after natural disasters, fires, accidents of various kinds, physical assault and sexual abuse. Warfare exposes huge numbers of young people to personal threat and the human carnage associated with warfare. There was therefore a dramatic increase in numbers of persons with PTSD after the Vietnam War.

The American Psychiatric Association set up an expert group to define this disorder so there could be some agreement about its diagnosis and to facilitate research.

Deployments of Australians to Vietnam were usually 12 months. Although deployments to the Middle East are of shorter duration, redeployments are also common.

Before I retired from clinical practice in 2008, I had already seen several Defence personnel who had been deployed to the Middle Eastern theatres.

I was also aware that some people were reluctant to seek help for PTSD, because this meant that they were medically downgraded until treatment was finished (usually 1-2 years minimum). This was a problem because many were attracted to the financial benefits of redeployment and also because promotion was often delayed whilst they were medically downgraded.

Most of the Vietnam Veterans I have treated did not present until decades after their deployment. They had experienced the symptoms for that whole period, and the picture was usually complicated by alcohol problems (an attempt at self treatment), depression and family disruption.

It is my opinion that earlier treatment will be of enormous value to military populations with PTSD and to their families.

Not everyone exposed to warfare will develop PTSD. Of any group in this situation, probably over 50% will have symptoms for weeks after a particular incident. It is also well documented that exposure to a constant potential for harm can be as toxic as direct fire fights (e.g. support personnel).

If people are followed for a year after a deployment, about 50% will have had symptoms of PTSD which resolved by the end of the year. This leaves the other half who will have problems for many years if not treated appropriately.

So, what for Defence personnel deployed recently to the Middle East?

Luckily, thanks to the Vietnam experience, there is increased awareness of psychological issues associated with warfare. Specific programs for the treatment of PTSD and support of veterans’ families have been developed over the past 20 years or so e.g. VVCS; St John of God.

Whilst there are career implications associated with seeking treatment for PTSD, there may well be some delay in peoples seeking help. This is a difficult problem as persons with PTSD should not be deployed whilst under treatment. Even if their symptoms resolve they are at increased risk of developing PTSD again if they are in a threat situation.

One approach might be to at least educate the families of Defence personnel, with a view to supporting them and informing them of treatment options for their spouses. Either way, I expect a delay of several years until these people eventually come to treatment.

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