Documente Academic
Documente Profesional
Documente Cultură
Lorissa McKay
Professor McGriff
ENC 1102
2 December 2019
According to the website for the National Center for PTSD, PTSD-like symptoms have
Consequently, combat PTSD is an aspect of military service that can be a major factor for any
service member serving in a time of war. In the United States, we currently have living Veterans
of World War II, the Korean War, the Vietnam War, the First Persian Gulf War, the Second
Persian Gulf War(commonly known as Operation Iraqi Freedom), and the War in Afghanistan.
These veterans range in age from the oldest, at 110 years old, to new enlistments as young as 18.
PTSD rates vary for each cohort, and it follows that the aftermath and struggles that these men
and women face with their diagnoses vary as well. For the last two decades post 9/11, American
service members have seemingly been involved in continuous combat on multiple fronts. The
experiences they have been immersed in have created ripple effects in their home lives that last
long after a deployment ends. Post traumatic stress disorder is affecting more and more families
and soldiers as the war on terror continues into the present day. The protracted nature of this war
on terrorism has created a problem that can seem invisible, even as it is vast. While the public
and Veteran’s Affairs Administration try to do what they can to treat American service members
McKay 2
at home, resources for and awareness of the evolving complexities of the issue still need to
Awareness of Combat-related PTSD and its prevalence and symptoms has spread
throughout the United States since the American Psychiatric Association first named it in 1980
Diagnostic and Statistical Manual of Mental Disorders(Friedman), yet our service members
continue to be at high risk of developing Post Traumatic Stress Disorder, and with that diagnosis
the possible complications of lifelong symptoms, suicide, depression, violence, poor coping
skills, and ruined relationships. Some Americans may feel that enough is being done, that the
systems already in place from the Veteran’s Administration are doing the job of healing our war
fighters. I believe we have a very long way to go before that is true. It is imperative that we
change and revitalize the treatment of Combat PTSD at every level for the evolving needs of our
generations of Veterans. To do that, we must first create and utilize mechanisms and screening to
prevent service members from being adversely affected by their trauma, continue to develop and
research effective treatments, and finally, we as a society must increase overall awareness of the
PREVENTION
country still has battles to fight. How could it be possible to stop a person from reacting
in extreme ways to what are indisputably extreme circumstances of trauma? In fact, the
dual approach of first screening service members for probability of developing PTSD,
and then preemptively treating them for it before it develops is actually not far from
reality. Perhaps the most intriguing and exciting idea for the future quality of life of all
McKay 3
policies.
others were able to identify certain demographic traits that increased the probability of
developing PTSD(Xue, et. al.). These traits could be used in conjunction with other
screening processes to focus efforts on those that are most likely to benefit. Essentially,
criteria. In another cutting edge process, the U.S Army has developed a new biological
screening method; a blood test that can tell medical providers and unit commanders just
how likely a person will return from a combat deployment with PTSD symptoms(“Army
Blood Test”). Again, this sounds so scientific as to almost be unbelievable, but with a lot
of potential for good. If soldiers can be screened before entering combat, perhaps those
with a greater chance of PTSD can be pre-treated in some way to prevent the trauma from
are exciting, but perhaps even more crucial to the ultimate goal of prevention is unit
preparedness. Combat commanders have not always balanced the need to encourage
exposed to trauma. A soldier should never go through what Army Medic Jonathan Nurell
did in his journey home from war with PTSD(“The US Military and Old vs. New”).
According to a CBS News report, the Army command delayed sending him home for his
PTS, and it resulted in months of suffering for him and his family(“The US Military and
Old vs. New”). My interpretation of the Armys’ slow treatment of Jonathan Nurell,
McKay 4
against his doctor’s orders, is that the military is not consistently taking PTSD as
seriously as it should be. Compounding the culture of the commands themselves, are the
service members who have their own cultural barriers to seeking mental health care. As
“Soldiers, sailors, airmen, and marines are encouraged to develop inner strength
and self-reliance. They take pride in their toughness and ability to “shake off” ailments or
injuries. One former battalion surgeon noted that his marines did not
want to seek help for any medical problems and took pride in their never having
This passage illustrates exactly how reluctant these men and women are to admit
to being anything less than fit. Many military men and women are looked at as heroes,
and with that comes an extra burden of toughness and stoicism. In my opinion, this
mindset increases the responsibility that the command leadership has to counteract the
culture of outer toughness and intervene, screen, and treat those that need it. Only once
all levels of the military leadership is proactive, prepared, and equipped with the most up-
TREATMENT
Unfortunately, it appears that far too few Veterans are being properly treated for PTSD.
In a VA study, Dr. Karen Seal revealed that only 9.5% of newly diagnosed Iraq and Afghanistan
War Veterans attended the recommended number of treatment visits to the VA in the first year
after diagnosis with PTSD(Seal et. al. 5). This number is only those that were identified as
actually having PTSD. One can imagine that there are also those that go undiagnosed and miss
attending any treatment at all. A possible reason for this disconnect between diagnosed Veterans
McKay 5
and seeking treatment is that most PTSD treatments were not developed specifically for combat
PTSD, and hence, do not address a signature feature of it that is unique to war- that of “moral
injury”(Litz, et. al. 696). “Survivor guilt” is another combat related stress that could contribute to
moral injuries may not feel their symptoms are addressed in standard treatment. The standard
treatments are developed from “the civilian world, chiefly with sexual assault
victims.”(Tramontin) It is understandable that while PTSD from sexual assault might be very
similar in some ways, there are fundamental differences between the traumas. In addition,
civilian mental health care providers are not all familiar with certain unique aspects of Combat
PTSD, and that is important, since not everyone has access to a VA facility. In a discouraging
survey, the majority of 132 practitioners responded that they did not feel equipped to effectively
treat the military population or their families for PTSD(Tramontin). Practitioner confidence
seems like a crucial factor in treatment success. One brand new example of a military combat
specific treatment from early 2019 is called 3MDR. It is a therapeutic treatment in the early
stages of development which brings many aspects of therapy together by combining virtual
reality with exposure therapy and treadmill walking(Jancin 1). The fact that 3MDR is being
tested on military veterans during its development is a positive indicator that it will be tailored to
On a positive note, at least many effective treatments for PTSD do exist, and more are
being studied every day. While I believe that Post Traumatic Stress can have lifelong effects, I
also believe that it is beatable. Experts in the field of psychiatry have identified accepted
evidence-based treatments that are standards of care for Post Traumatic Stress. According to the
National Center for PTSD, therapies, antidepressants, and emerging treatments are part of a large
McKay 6
group of treatment possibilities that can be optimized for each individual under the guidance of
pharmacological medicine are all well-known to the public as effective against PTSD, and
together with some of the new military-specific treatments in development, my hope is that
Veterans will finally have that vital combination of emotional, physical, moral, and familial
COMPLEXITY
Many Veterans with PTSD feel as though they have never left the battle. The symptoms
flashbacks seem completely out of place in a safe home with a family, but to a service member
with PTSD, it feels the same as their war zone. Vietnam Veteran Ed Cardenas described his life
with PTSD poignantly in a documentary by Kara Frame. “When was I in Vietnam? It was last
night, it was this morning. Five minutes ago before you asked me. And I will probably go back
tonight.”(qtd in “I Will Go Back Tonight.”) Treatment for PTSD should be just as encompassing
and complex as the disorder itself. As described by Mr. Cardenas, PTSD can infiltrate every area
of a person’s life. A treatment approach that meets the medical, emotional, familial and societal
needs of our Veterans in a thorough manner is the only possible way to honor the sacrifices and
commitments they have made that placed them in the position of needing help.
Combat PTSD has so many sides to it that the true complex nature of it can be missed
during screening, diagnosis and treatment. Some people believe that C- PTSD is simply a case of
jumpy nerves or shell-shock. Research shows that it is just the opposite of simple. “Simple”
never describes PTSD because it is a great many things, and doesn’t present in the same way in
each individual. Symptoms also vary in severity and frequency. PTSD symptoms affect
McKay 7
individuals, their relationships, jobs, and communities. Management of PTSD can also be a
lifelong consideration for Veterans and their families. In one case described on the NPR radio
show “All Things Considered”, a Vietnam Veterans’ PTSD was triggered after he was diagnosed
with a terminal illness; the anxiety, fear, and powerlessness he must have felt as a result of his
medical diagnosis and treatments triggered flashbacks of the war(Dembosky, 2017). This
exemplifies the tragic fact that some people may never be free of the potential for lifelong effects
Adding layers to the complexity of diagnosing and treating PTSD, the effects of the
disorder itself can also keep sufferers from seeking help. In a study done on Veterans of
Afghanistan and Iraq, soldiers who were screened as likely to have PTSD via questionnaire, were
twice as likely to have mental resistance against mental health treatment(Hoge et. al. 10). It is a
tragic irony when the illness itself serves to block the cure. The complexities of PTSD
presentation can allow it to remain silently waiting, only to pop out when people least expect it
or are prepared to handle it. Anything from soldiers on their deathbeds, strife with children,
spouses not getting along, violence, work-related stress and more could combine with post
traumatic stress and initiate a triggering of symptomatic PTSD. Unfortunately for them, most of
the world just isn’t prepared to make allowances for behaviors that arise from untreated PTSD.
Sufferers also risk further indignities of a military culture that seems intolerant to
perceived weakness. According to Hoge et. al, some of the common objections of Veterans to
getting help for their PTSD symptoms are “I will be seen as weak”, “It would harm my career”,
“Members of my unit would have less confidence in me”, and “My leaders would blame me for
the problem”(Hoge et. al. 10). What this indicates to me is that service members are willing to
neglect their own mental health to seem brave, or to avoid backlash from their peers or superiors.
McKay 8
Stigmatization is an important issue that is a barrier to effective care for these individuals.
Rightly so, considering there has been evidence that the military and Department of Defense
have likely been summarily dismissing service members whose service-connected PTSD or other
injuries caused them to act out behaviorally. This is another tragic aspect of the military cultural
discharged from the military after exhibiting anti-social, addictive, violent, or other behaviors as
a direct result of PTSD is adding insult to injury for many, because with those designations
attached to a discharge, the Veteran is ineligible for treatment coverage through the VA.
According to a Government Accountability Office report, “More than 13,000 service members
separated from the military for misconduct in recent years suffered from post-traumatic stress
disorder, traumatic brain injury or another disorder and were prevented from receiving treatment
from the Department of Veterans Affairs because of their discharge status.”(Wentling) The irony
of the military dropping service men and women after combat injuries and trauma rendered them
unable to effectively reintegrate into their jobs and society is not only obvious, but ultimately
unfairly punishes some of the most selfless citizens of the United States. We can, and should do
better to ensure that all factors of Combat PTSD are considered at every level, so that each
soldier, sailor, airman and marine is treated with the care and respect they deserve.
CONCLUSION
Although outreach, awareness, and treatment of service members with combat-related PTSD has
come a long way since it was first identified, too many continue to suffer the constant symptoms
of untreated or inadequately treated PTSD. Veterans are also at high risk of comorbidities like
depression, alcohol and drug abuse. Their families suffer right along with them, in many cases.
The fact that the military itself, which deployed these brave people into a war zone in the first
McKay 9
place has also continued to injure them by inadequate treatment and inappropriate discharge is
the most tragic of all. As a proud and thankful country, we can do better for those who serve and
their families. My position is that each of us needs to pay attention to funding, awareness, and
treatment options for our Veterans. Anyone that cares about the brave people of our country that
place themselves in harms way with selfless dedication, should care about this topic. PTSD is
one of the two signature wounds of the modern wars in the United States, and it won’t be going
anywhere until we make it go away. This matters because there is a lot we are capable of
changing as everyday citizens and voters, and more attention on this subject will create more
Works Cited
"Army blood test could help identify troops suffering from PTSD." Adverse Event Reporting
https://link.gale.com/apps/doc/A600665981/GPS?u=navyship&sid=GPS&xid=54aa1f21.
Burnam, M. Audrey, et al. "Systems of Care: Challenges and Opportunities to Improve Access to
Their Consequences, and Services to Assist Recovery, edited by Terri Tanielian and Lisa
https://link.gale.com/apps/doc/CX1769900022/GVRL?u=navyship&sid=GVRL&xid=a7
www.npr.org/sections/health-shots/2017/12/16/569961321/reverberations-of-war-
complicate-vietnam-veterans-end-of-life-care
Friedman, Matthew J. History of PTSD in Veterans: Civil War to DSM-5. National Center for
PTSD. “PTSD: National Center for PTSD.” VA.gov: Veteran Affairs. 15 Aug. 2013,
Healy, Jack. Apology, but No Explanation, for Massacre of Afghans. The New York Times 23
but-no-explanation-from-soldier-who-massacred-civilians.html
Jancin, Bruce. "WALK AND TALK THERAPY: 3MDR intervention explored for refractory
PTSD." Clinical Psychiatry News, Apr. 2019, p. 1+. Gale Academic OneFile,
https://link.gale.com/apps/doc/A586014886/GPS?u=navyship&sid=GPS&xid=fc33a759.
Litz, Brett T., et al. "Moral Injury and Moral Repair in War Veterans: A Preliminary Model and
Intervention Strategy." Clinical Psychology Review, vol. 29, no. 8, 2009, pp. 695-706.
McKay 11
ProQuest, https://search.proquest.com/docview/42439114?accountid=28179,
doi:http://dx.doi.org/10.1016/j.cpr.2009.07.003.
Bonnie Strickland, 2nd ed., Gale, 2001, pp. 505-507. Gale eBooks,
https://link.gale.com/apps/doc/CX3406000506/GVRL?u=navyship&sid=GVRL&xid=c0
Seal KH, Maguen S, Cohen B, et al. VA mental health services utilization in Iraq and
Afghanistan veterans in the first year of receiving new mental health diagnoses. J Trauma
"The US Military and Old vs. New Ways of Thinking about Soldiers with PTSD." BBC Studios
https://link.gale.com/apps/doc/UUFDKW707952201/HWRC?u=navyship&sid=HWRC&xi
Tramontin, Mary. "Exit wounds: current issues pertaining to combat-related PTSD of relevance
to the legal system." Developments in Mental Health Law, Jan. 2010, p. 23+. Gale Academic
OneFile,
McKay 12
https://link.gale.com/apps/doc/A269921239/GPS?u=navyship&sid=GPS&xid=59f2e6e8.
Wentling, Nikki. Pentagon Issued 'Bad Paper' Discharges to Troops with Mental Illnesses. Stars
Xue, Chen, et al. "A Meta-Analysis of Risk Factors for Combat-Related PTSD among Military
Personnel and Veterans." PLoS ONE, vol. 10, no. 3, 2015. Gale Academic OneFile,
https://link.gale.com/apps/doc/A423859357/GPS?u=navyship&sid=GPS&xid=9f7c1678.