Post Traumatic Stress Disorder Associated With War Veterans and Victims

  Except maybe for those who sell military arms and equipmentsand, therefore, think that "war is good for business," most of us would agreethat war is destructive and has no benefit whatsoever to humanity. The loss ofmillions of lives; the destruction of almost everything that man has built overthe centuries; the millions of people who suffer from major and permanentbodily injuries and loss of limbs; and the traumatic and post-war psychologicalsufferings of both soldiers and civilians (who were in harms way), makes onewonder whether it is ever worth it "to fight for one's country." 

            After a war has ended, the suffering does not cease. The soldiers who returnhome--both those wounded physically and those who actually experienced theanguish and atrocities of war-and those civilians who were caught in thecrossfire, are all permanently scarred for life. For those soldiers and civilianswho survived, many of them will spend the rest of their lives suffering frompost-traumatic stress disorder caused by war.

            The experience of war is unlike any other experience. When you see your buddieswounded and dying in the fields of battle, and you find that there is literallynothing you could do to save them, but to run away so that you could saveyourself; when you are captured as a prisoner of war and you are torturedphysically and psychologically in order to break down your will, the traumaticand psychological scars that you suffer becomes so immense that they haunt youfor the rest of your life. This paper will discuss some of the aspects ofpost-traumatic stress disorder caused by war and other "armed conflicts."

            Post-traumatic stress disorder (PTSD) is an anxiety disorder. It is a mental illness thatdevelops after a person has been exposed to a terrifying or life-threateningevent. Those who have experienced rape or sexual abuse, or have personallywitnessed a family member murdered, or those soldiers and civilians who haveexperienced the horrors of war are usually the ones who suffer from such typeof mental disorder. Such horrible experience is forever ingrained in theirmind. Like a major painting that makes a very good lasting impression on theviewer, the atrocities of war and other life-threatening experience is foreveretched in one's psyche as probably the worst lasting impression. And becausethe bad memory can never be erased, it is like a horror movie that keeps on playingand keeps on frightening you, literally to death.  

            Those who suffer from PTSD experience flashbacks-vivid and horrific memories of whathappened. A sound, a click, a movement, or anything associated with the pastevent, would trigger a flashback. I have heard about a veteran of the Viet NamConflict who, whenever he experiences a flashback, would pick up a broom andhold it like a rifle, all alert and ready to fire. His wife and children lookon in horror at what is happening and would try to calm him down. Sometimesmedication helps; sometimes the flashback just happens. Because PTSD is soprevalent with war veterans and civilian victims, this type of mental illnessis sometimes referred to as "traumatic war neurosis." PTSD has only beenrecently recognized as a type of mental illness during the last three to fourdecades, after the end of the Vietnam War; but such type of mental illness hasbeen seen in many military veterans and civilians since the First and SecondWorld Wars [1]. The number of veterans-initially those from the Vietnam War--diagnosedwith PTSD has been steadily rising. The number increased since 1992 when theUnited States first invaded Iraq. This number of veterans with PTSD spiked up(and continues to climb) since America re-invaded and occupied Iraq severalyears ago [2].

            Not much is known about the bio-neurological bases or reasons for PTSD. Further,there has been much disagreement within the field of mental health as to thebio-neurological causes for PTSD. Many studies are now being conducted to tryto understand this debilitating mental disorder so that we could find atreatment to cure it. A number of studies relating to PTSD are now focusing onthe interaction between the ventromedial prefrontal cortex (vmPFC), the amygdala,and the hippocampus areas of the brain. This particular focus appears to makesense because the amygdala region of the brain plays a strong role in mattersinvolving fear and anxiety; and the hippocampus region plays an important rolein episodic memory. The third-region of the brain--the vmPFC-is also veryimportant for these studies because it directly projects to the amygdala and is believed to provideinhibitory signals to the amygdala that regulates emotion, such as fear. It hasbeen found, for example, that PTSD patients with a reduced hippocampus functionhave a reduced vmPFC function [3,4]. Whenever PTSD victims are exposed to reminders of traumatic events,they exhibit diminished responses in the vmPFC region, but exaggeratedresponses in the amygdala. It, therefore, appears that PTSD is somehowcorrelated with the "over-activation" of the amygdala as a result of thediminished inhibitory control by the vmPFC and a decrease in the brain's hippocampusfunction [3]. As a result, PTSD victims experience (and suffer) a lot of fearfrom their battlefield memories.

            One study in particular has been conducted on Vietnam War veterans with brainlesions and Vietnam veterans with only combat exposure who have either beendiagnosed with PTSD or have never experienced PTSD. It was found that thoseveterans with lesions in the amygdala region of the brain had reduced levels ofPTSD. The fact that the lesions in the amygdala appear to be directly relatedto a reduction in PTSD symptoms shows the very close interrelationship betweenthe amygdala and vmPFC regions in studying this particular mental disorder [3].

            There is something in the brain of those with PTSD that appear to be causing the lackof inhibition on the vmPFC so that the amygdala is not activated. What is itabout a life-threatening or highly traumatic experience that causes the brainto malfunction and cause PTSD?  Isthere an organic change or chemical imbalance to these parts of the brain thatcauses the disorder? Although we still do not know why this happens, we do knowthat what these men and women "see" or experience is very real to them. In manyinstances they will shout and begin fighting, even striking at thin air, if amemory itself becomes real to them.

            It is indeed very interesting that the brain could be adversely affected by thetraumatic experience of war that veterans with PTSD still see themselves asfighting a war that has already ended. The sad fact is that such is theirreality; they go to "the other side" every now and then. To those of us who donot suffer from PTSD, we want to bring them to the reality that is normal foreveryone.  This is not aphilosophical issue involving the "real world" that Plato mentions in his "mythof the cave." This matter is simply a bio-neurological disorder caused by atraumatic event that has adversely affected our perception of reality. With thecontinuing war in Iraq, we see more and more veterans returning home, whosooner or later begin to suffer from this affliction. It is a very real publichealth concern, which the U.S. Government must address immediately withfinancial aid for research and assistance to find a cure for this debilitatingillness.

            The ongoing studies to find the causes of this illness and to figure out a cure forthis illness are a step in the right direction. One of the most promisingstudies is the correlation between the vmPFC, hippocampus and amygdala regionsof the brain with respect to PTSD. But the effort by the Government must be aserious and concerted one, so that the veterans affected would not be disabledfor the rest of their lives.  

            Some treatments that have been used to lessen the effects of PTSD includeantidepressants and various forms of therapy. One type of therapy I find quiteinteresting is to make the patient "let go" of their repressed feeling of thetraumatic events they encountered in war and to "force" the patient to expresstheir feelings about what happened and to accept what has happened. This typeof therapy sort of brings "closure" to their traumatic experience, maybe notimmediately but gradually. Like every wound or suffering, it takes time for itto heal. 

            In many cases, veterans and victims of war try to put "in the back of their mind"and to forget their painful memories. We all do this. We want to forget the badthings that we experience in life; and we are usually successful at the minorones. But for our major bad experiences, they are very hard to forget, becausethey sort of cling to you. For the really bad experiences we have, like the experienceof war, the victims not only cannot forget them, but instead they remember themvividly and, worse, they act it out as if the war is still going on. To many ofus, this uncontrollable "playing out" of our nightmare is unnatural andfrightening.  

            Unlike most forms of therapy that advise PTSD patients to banish the thoughts of warand keep themselves busy so that they do not think about their experiences,W.H. Rivers, a wartime psychologist, suggests that we should try to make thesepainful memories more tolerable. For example, Dr. Rivers helped a young officerwho was buried alive during WWI. The veteran was advised by most everyone totry and forget the bad memories. He tried to do so during the day, but when hewent to bed at night, he would have vivid dreams and could only think of theterrible memories he had of the war. Because he was restraining his badmemories during the day, they would flood his mind when he goes to bed atnight. According to Dr. Rivers, talking about one's war experiences andanxieties helps to release the stress of the bad memories. With Dr. Rivers'help the veteran was able to sleep better at night after his therapy talkingopenly about his experiences and thinking about his memories throughout theday. By openly expressing his bad experiences and discussing it with Dr.Rivers, his war experience are no longer "bottled-up," so that at night hecould sleep better. Dr. Rivers' therapy may not work for everyone, but it hashelped many cope with their post-traumatic stress disorder [5].

            Thinking of horrifying and life-threatening experiences is not a natural thing to do.Those who do it need help because they cannot, on their own, stop such vividand horrifying memory from taking place. The therapy began by Dr. Riversencourages the victim to talk about his most unpleasant experiences, so thathe/she could come to terms with them. What is most important to note about Dr. Rivers' therapy ofopen-discussion and non-repression of bad memory is that this therapy has beenvery effective in helping those who suffer from PTSD. It has helped many of thereturning war veterans cope with their illness, maybe not entirely for some,but for the most part many veterans learn how to cope with their problem. Ibelieve that the reason for this is because the talk-therapy helps the victim"put to a closure" what the veteran could not do on the battlefield. In asociety where men view themselves as being "macho," veterans also seethemselves as being fully capable of taking their care of their (mental)problems. But until such time that a bio-neurological cure is found for PTSD,talk therapy remains one of the more promising approaches to treating thismental disorder.

            PTSD is a very unusual disorder because it appears to be the only mental disorderthat comes out of the causation from a prior event. It is indeed amazing that alife threatening or traumatic experience could bio-chemically affect how thebrain normally functions, and makes a normal person do abnormal things.  

Bibliography

1. Dryden-Edwards, Roxanne. "PosttraumaticStress Disorder (PTSD)". Medicine Net. Stöppler, MelissaConrad. 7 December 2007. 18 April 2008. <http://www.medicinenet.com/posttraumatic_stress_disorder/article.htm>

2.  Lewis,Libby. "Iraq War Stirs Memories for Vietnam Vets". National PublicRadio. 18 April 2008. 18 April 2008. <www.npr.org/templates/story/story.php?storyId=14529768>

3. Koenigs, Michael; Huey, Edward D; Raymont,Vanessa. "Focal brain damage protects against post-traumatic stressdisorder in combat veterans." Natural Neuroscience. Jan 2008:Vol. 11, no. 2, pp. 232-237.

4. Brennan,T; Dybdahl, R; Kapidzic, A. "Trauma-related and neutral falsememories in war-induced Posttraumatic Stress Disorder". Consciousnessand Cognition. Dec 2007: Vol. 16, no. 4, and pp.877-885.

5. Rivers,W.H. "The Repression of War Experience." First World War.Com.9 February 2003.  18 April2008. <http://www.firstworldwar.com/features/rivers2.htm>

6. Sparr,Landy F and Bremner, Douglas J. "Post-traumatic Stress Disorder andMemory: Prescient Medicolegal Testimony at the International War CrimeTribunal?". Journal of the American Academy of Psychiatry and theLaw. 2005: Vol. 33, no. 1, pp. 77-78.