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Post-traumatic Stress Disorder and Traumatic brain

injuries in U.S. Soldiers

Psychology 103
Professor: Warnke
19 April 2009
Post-traumatic stress disorder (PTSD) is a disorder that can develop following a traumatic

event that threatens your safety or makes you feel helpless. Most people associate PTSD with

battle-scarred soldiers – and military combat is the most common cause in men – but any

overwhelming life experience can trigger PTSD, especially if the event is perceived as

unpredictable and uncontrollable. Post-traumatic stress disorder (PTSD) can affect those who

personally experience the catastrophe, those who witness it, and those who pick up the pieces

afterwards, including emergency workers and law enforcement officers. It can even occur in the

friends or family members of those who went through the actual trauma.

The Army’s first study of the mental health of troops who fought in Iraq found that about

one in eight reported symptoms of post-traumatic stress disorder. The survey also showed that

less than half of those with problems sought help, mostly out of fear of being stigmatized or

hurting their careers.

The survey of Army and Marine combat units was conducted a few months after their

return from Iraq or Afghanistan last year. Most studies of past wars’ effects on mental health

were done years later, making it difficult to compare the latest results with those from the

Vietnam or Persian Gulf wars, said Dr. Charles W. Hoge, one of the researchers at the Walter

Reed Army Institute of Research.

“The most important thing we can do for service members who have been in combat is to

help them understand that the earlier that they get help when they need it, the better off they’ll

be,” Hoge said.

PTSD in soldiers is known as “The combat wound that you can’t see, touch or feel

without asking.” In 2004 on my first deployment, my unit redeployed home to the United States.

When we arrived home we were released to our families for two hours. After the two hours of

family time we had to report back to our units and turn in all of our gear. Once the gear was
turned in, the commander spoke with all of us, family members included. His topic was Post

deployment re-integration (PDR). He advised everyone that the men of his unit will be busy the

next week getting shots and speaking with health care professionals from all different back

grounds. The idea behind it was to have all of the soldiers shots up-dated and screened for a

number of things to include depression and PTSD.

The big issue is, once the process was started most soldiers just wanted to get back home

to rest and relax with their families as soon as possible. This type of mind set in the soldiers to

include myself resulted in a disaster. For example, all of us said we “felt fine” or “I’m 100%

doc” when the doctors asked if there was anything wrong. The doctors knew and understood that

PTSD did not have time to set in. So the doctors just made a number code in our records and said

“welcome home,” as they handed us back our records. After several months had passed and

soldiers had time to reflect on their combat tours, many found that something was not right.

Some soldiers found it impossible to sleep at night; others found that their home life was not the

same as it used to be. For some of my closest friends it was the horror manifested itself deep

inside people in their normal daily activities, such as driving, shopping and work.

My symptom of PTSD was constant restlessness. I always had to be doing something and

I kept telling myself it was a direct reflection of my on the go mindset from Iraq; I really thought

that it was too; that’s until I started having terrifying nightmares. The nightmares were getting to

the point where I was hardly sleeping out all. I realized that if I slept in my living room with the

TV on the Military channel I could sleep almost five to six hours. After deciding to visit the

“head doctor” or psychologist, he told me that he wanted to give me a full physical followed by a

written and hands on PTSD test.

What I failed to point out to the doctors one month earlier during the PDR, was the fact

that I suffered two traumatic brain injuries or (TBI’s) while serving in Iraq. Traumatic brain
injury is a complex injury with a broad spectrum of symptoms and disabilities. The impact on a

person and his or her family can be devastating. A traumatic brain injury (TBI) is a blow or jolt

to the head or a penetrating head injury that disrupts the function of the brain. Not all blows or

jolts to the head result in a TBI.

The severity of such an injury may range from "mild" (a brief change in mental status or

consciousness) to "severe" (an extended period of unconsciousness or amnesia after the injury).

A TBI can result in short or long-term problems. My particular TBI experience occurred during

two mobile combat patrols. My vehicle was hit by an Improvised explosive device (IED); I was

thrown from the vehicle and landed me on my head. You would think I would have learned my

lesson after the first time this happened, but I thought that my brush with death was nothing

much to worry about considering that the worst of the war was coming to an end. Truthfully, I

thought I was superman. After I explained this to the doctor, the doctor told me he would also

like to do a CT scan of my brain to check for any permanent damage.

I researched TBI’s during the days that I waited for my test results. The information I

found explains that TBI can cause a wide range of functional changes affecting thinking,

sensation, movement, language, and/or emotions. Some symptoms may appear immediately after

the injury and other symptoms may not appear for days or weeks. Because of the nature of the

injury and the symptoms, sometimes people may not recognize or admit that they have a

problem. Not admitting it could result in death. In post-concussion/mild TBI patients, recovery

time is within weeks/months, but a small percentage may have persistent symptoms. Patients

with moderate to severe TBI may never fully recover their pre-injury function. The rate of

combat-related brain injuries in service members returning from the current conflicts in Iraq and

Afghanistan appears to be higher than in previous conflicts. Nearly 30% of all patients with

combat-related injuries seen at Walter Reed Army Medical Center from 2003 to 2005 sustained a
TBI. Blast injuries are a frequent cause of TBIs. TBI is often associated with severe multiple

trauma, post traumatic stress disorder (PTSD) or undiagnosed concussions. Screening patients

who are at risk for a TBI is important in order to ensure that TBIs are identified and

appropriately treated.

This information shocked me. I went to work the next morning with a different frame of

mind, a different perspective on work. After being at work for awhile, I started to feel as if

possibly everyone was hiding their issues. Some soldiers dealt with their problems head on by

seeing doctors or talking about them. While others acted like nothing was happening. They went

about their lives as if the horrible things that they were exposed to in Iraq did not affect them. I

on the other hand found myself surrounded by lower enlisted soldiers in the platoon asking for

my help and advice. These soldiers had seen and done many of the same things I had so I was

able to relate better to them then some doctor could. Later on that same day, I took all of the

soldiers in need of help to the mental health clinic. I spoke with the RN at the front desk and

explained to her the delicate situation of my soldiers. As I was talking with her she cut me off

mid sentence and said,

“Sergeant Sullivan, we are completely booked for the next few months and to be honest

this clinic is not equipped to handle these types of cases.”

My mouth dropped to the floor. I could not believe what I was hearing. I replied,

“You mean to tell me that, there are soldiers in need of help and there is no help to be

given? Are the doctors that work here even trained on how to diagnose personnel for PTSD?”

There was no reply from the RN, just a red face. The soldiers just made appointments

anyway and hoped for the best. Meanwhile, I waited to speak with the officer in charge to find

out if there was another location that could help with their anxiety problems sooner. I was told he
was unavailable, so we decided to help each other out. We started learning as much as humanly

possible in a short amount of time we had left together before vacation. I made a power point

slide show with all of the information to sum up PTSD and TBI’s. Below is some information we

put together.

Sigmund Freud recognized anxiety as a "signal of danger" and a cause of "defensive

behavior". He believed we acquire anxious feelings through classical conditioning and traumatic

experiences. This belief by Sigmund Freud could not be more accurate in the case of PTSD.

Some of the other issues that haunt soldiers are:

Acting or feeling as if the traumatic event were recurring (includes a sense of reliving the

experience, illusions, hallucinations, and dissociative flashback episodes, including those that

occur on awakening or when intoxicated).

Intense psychological/ physiological reactivity/distress at exposure to internal or external

cues that symbolize or resemble an aspect of the traumatic events.

Persistent symptoms of increased arousal (not present before the trauma), as indicated by

two (or more) of the following: Difficulty falling or staying asleep, irritability or outbursts of

anger, difficulty concentrating, hyper vigilance and exaggerated startle response.

Some of the Stages of Grief:

• Denial: The initial stage: "It can't be happening."

• Anger/Guilt: "Why me? It's not fair." “He should be alive instead of me!”

• Bargaining: "Just let me live to see my children graduate."

• Depression: "I'm so sad, why bother with anything?"

• Acceptance: "It's going to be OK."

Ways to win against PTSD:

• Acknowledge there is a problem.

• Let the chain of command know right away.

• Someone always knows what is going on. Not telling is not helping!

• Get into a screening process ASAP.

• If afraid of “Chain of Command,” seek counseling on the outside. One source gives eight

free sessions to Soldiers and/or their families.

• Share with someone and don’t withdraw. Find a safe place to do this. Commander’s

office, Chaplin's office, VFW, somewhere you feel comfortable.

• The more you become unattached the more you will lose feeling of everything around

you. Stop the detachment.

• Get help so you can continue to be an effective soldier in the force, and an effective

family member as well.

According to the August 2006 Analysis of VA Health Care Utilization among US Southwest

Asian War Veterans: Operation Iraqi Freedom/Operation Enduring Freedom, 184,524 veterans

have sought care from a VA Medical Center since the start of OEF in October 2001 through May

2006. During this time, 1,304 OIF/OEF veterans were identified as having been evaluated or

treated for a condition possibly related to TBI. There is no medical code specific to TBI, and a

patient may carry more than one diagnostic code, but the most prominent injuries included

fracture of facial bones, concussions, and/or brain injury of an unspecified nature. August 2006
analysis reports 29,041 of the enrolled OIF/OEF veterans who visited VA Medical Centers or

Clinics had a probable diagnosis of either PTSD/TBI.

As you can see, there are now a number of ways you could find help and information. I only

wished that back in 2004 I could have found some of this information to help soldiers. Doctors

and their staff members are now better equipped with the correct tools to fight the war on PTSD

and TBI’s. Soldiers are more receptive to people, such as a well trained medical staff, who

understand what is happening to them, both mentally and physically.

Since 2004, I have been on two more deployments. One in 2005 and a second in 2007 for a

total of three; during both deployments I have seen medical staffs acting in a more caring manor

toward soldiers with both PTSD and TBI’s. Once we have returned home to the US, the medical

personnel meet with you (one on one) to screen you for any issues before releasing you into back

into main stream America. There are now a number of medical personnel on military

instillations solely dedicated to help soldiers with the “Combat wounds you cannot see.” This is a

huge improvement since my first deployment. For instance the Army established a New

prototype for rapid triage and diagnostic tool for combat casualty care (CCC) (titled Biomarker

Assessment for Neurotrauma Diagnosis and Improved Triage System; BANDITS) (Walter Reed

Army Institute of Research).

My fight with PTSD is over for the most part. These days I hardly have any flash backs and

loss of sleep. I have read and have been told that “PTSD will never leave your side until you deal

with the issues at hand” (Tokutomi, T. 2008). I believe that I overcome my PTSD by doing just

that, dealing with the problems head on. A fact that I found staggering was, one out of every five

active-duty Army soldiers and 42 percent of Army Reservists who have served in Iraq cite

mental health concerns months after they return home, according to a new Army medical study,
(Luis Martinez, ABC news). My doctor told me that the Army still finds the 42 percent to be

current till this day.

The truth is all soldiers have a form of PTSD or suffered a TBI while in the service. It’s just

those who admit that they do receive help. That equals better health care, and the health care is

for life.

Work Citation Page

(Dr. Charles W. Hoge, 2009) (Wed., June 30, 2004). 1 in 8 returning soldiers suffers from PTSD.
Retrieved April 21, 2009, from MSNBC Web site:

• LUIS MARTINEZ ABC News: Veterans Cite Mental Health Issues

• (Tokutomi, T., et al. 2008) brain injury .com | traumatic brain injury -- Latest Medical

• Walter Reed Army Institute of Research Department of Military Psychiatry

Some of the other programs that the Army has in place now are:

Mental Health America: Post-Traumatic Stress Disorder (PTSD)

• Military Veterans (Post Traumatic Stress Disorder) PTSD Reference Manual

• Post Traumatic Stress Disorder (PTSD)

• The Army's Post Traumatic Stress Disorder and Mild Traumatic Brain Injury
(PTSD/MTBI) Chain Teaching Program

• US Army Wounded Warrior Program

• Virtually Possible: Treating and Preventing Psychiatric Wounds of War

• Walter Reed Army Institute of Research WRAIR