Post-traumatic stress disorder undoubtedly affects some Service personnel who have been deployed on operations but two medical experts who work with veterans are keen to explain some of the misunderstandings associated with the condition. Report by Cliff Caswell.
In a world where demands on soldiers are higher than they have been for decades and where combat on current operations is up close and personal, it is unsurprising that the topic of soldiers’ mental health has been hotly debated in the media.
Amid two campaigns in Iraq and Afghanistan, thousands of column inches have been devoted to the psychological problems troops face as a result of their experiences, and what is being done to help them.
But while the phrase post-traumatic stress disorder (PTSD) has become a buzzword to describe an anguish afflicted on personnel in the wake of battle, the reality is more complex and the condition is only one in a range of psychological issues that can occur after disturbing events.
Although some undoubtedly suffer as a result of what they have been through, the fact is that most of those who have faced combat come through without ill-effects and experts in the field are concerned that recent reports may have left soldiers and veterans confused about PTSD and whether it can be treated.
Dr Ian Palmer, a professor of military psychiatry who heads up the Medical Assessment Programme for ex-Service personnel in the Baird Medical Centre at London’s St Thomas’ Hospital, is among those worried about the lack of understanding.
As well as PTSD being far less common than many believe, the former lieutenant colonel, who served in the Balkans and Rwanda during his 25-year Army career, emphasised that sufferers could nearly always be returned to full health:
“The worse the traumatic event, the greater the possibility of troublesome symptoms but the overwhelming majority of PTSD cases respond well to treatment,” he said. “It is simply not the case that it is incurable.”
While health professionals continue to debate the exact nature and causes of the disorder, and whether there is more than one type, there is broad agreement that there are three symptom groups, or pillars, experienced by sufferers.
The main afflictions are the re-experiencing of a traumatic event through intrusive thoughts and disturbing images and sounds and smells triggering reminders of the problem situation. This is distressing and often causes the edginess and insomnia typical of the second pillar, known in medical circles as ‘arousal’.
Sufferers are also likely to avoid anything that reminds them of the event, becoming reluctant to talk about what is happening to them and withdrawing into themselves. Issues of guilt and shame are frequently seen and many often mask their distress by drowning their sorrows:
“Some of these symptoms are experienced by most people sometime in their lives,” said Dr Palmer. “After the break-up of a love affair, for example, most of us become distressed when reminded of our former partner and we may avoid certain events, places and people associated with our loss. We may even drink more too.
“For some individuals it can also be difficult to accept that they have changed as a result of their experiences and this is not helpful. Sometimes people are troubled by guilt and can even view their recovery as being shameful, but grief and loss are normal and commonly encountered. Mourning is an integral part of healing.”
Most patients do not need any medical help and recover of their own accord in a few weeks. Dr Palmer’s colleague, Dr Graham Fawcett, a clinical psychologist who works in a London clinic involved in the MOD-backed Veterans Mental Health Project, said seven in ten patients would heal themselves within the space of a month:
“If somebody is showing marked post-traumatic symptoms early on we call this an acute stress reaction,” he said. “We do not carry out any treatment because 70 per cent will get better with support from their colleagues, friends and family.
“Those who have not recovered after a month are classified as having Simple PTSD. The treatment involves the sufferer reliving experiences and going over their memories. This works for nearly three quarters of these patients. Most trauma reactions settle within three months, and only a small minority will need more intensive treatment.”
While cases of PTSD remain rare, Drs Palmer and Fawcett were both keen to stress that help and advice is available and that anyone concerned about their mental health could come forward in complete confidence:
“The psychological reactions to trauma are complex and different people react differently to situations,” said Dr Fawcett. “But whatever the symptoms may be, the best advice is don’t suffer in silence.
“Treatments are effective, particularly when started sooner rather than later. If you think you need help, or someone you trust suggests you need help, get it.”
Veterans with mental health concerns should contact the Medical Assessment Programme on 0800 169 5401 or email [email protected]
This article first appeared in the May 2009 edition of Soldier – magazine of the British Army.
