PTSD: On Coming Home, Road Maps, Navigators and Bridge Builders (Updated)

(In response to comments to the cross-posting of this at Milblogs, at the bottom of this entry I have updated to include links to information on the connection between Traumatic Brain Injury (including mild TBI/post-concussion disorder) and PTSD.)

There is some interesting conversation happening around blogs regarding Post Traumatic Stress Disorder … especially by Grim at Blackfive, Kat at Argghhh and then Uncle Jimbo at Blackfive. Kat started out the discussion by cautioning against throwing out the baby with the bathwater by those who might be too quick to disprove or diminish the statistics and conclusions being spun and wrung on suicide and PTSD… and Grim and Jim brought their own personal perspectives to the discussion about PTSD.

I am more familiar with the effects of combat-induced PTSD on young men than I could ever have imagined I would be and far more than I ever wanted to be. I believe as Grim believes that every soldier (and I use that term to include all branches of service who have served in combat… just ‘cause it’s simpler) has post traumatic stress and will exhibit symptoms of PTS whether they are willing to admit it or not. I also agree with Kat that not all those who suffer PTS will develop the chronic form of this condition rising to the “disorder” part of PTSD. I will, however, quibble with Grim that this is not an illness and that it is part of the “normal” human condition. It may be an anticipated response to severe trauma but I have a hard time believing any part of it is “normal”… at least as we are talking about severe and/or chronic PTSD.

I know that those who serve and who have served in combat like Grim and Uncle J have a personal, distinct and first person view of PTS/D. I know that they experienced one or more of the symptoms that make up this maddeningly imprecise condition. There is no one out there who can tell us why some absorb their experiences and seem so unaffected by them while others seem to be punished and pummeled by them… no more than we can explain why some people get cancer and others do not. I cannot speak to the medical aspects or the personal experiences of soldiers.

However, as I have for the past 3 years, I can only contribute to the discussion based on my experiences as a parent… and, in this case, as the parent of a child with severe and chronic PTSD. Like most guys he thought he could handle his reactions himself and that time would heal all wounds… and the constant admonition of those he trusted to “suck it up and drive on” shamed him into believing that his condition was “normal”. The son who resisted the label… who refused to admit he could not come home without a navigator and helping hand until he was almost lost forever to all of those who love him. We knew before he left that war would change him, but this was not change -- it was a slow and desperate destruction.

We watched his determination -- and his deterioration -- for more than a year and all we could do was keep suggesting that he see someone… that he talk to someone. We worried; we researched and read; we found every online article; found the DoD’s PTSD Treatment guidelines; we talked to VA counselors for information. We have a 5-inch file full of information on what works, what doesn’t, what was promising and what was quackery. I repeat what my good friend has said about her son even two years after his return from Iraq, “If he didn’t have the same face and the same name, I would swear that this is not my son.” It was that way with our son for a while, but with treatment -- that navigator and a good road map -- we now see much more of the son we knew… but there were a number of occasions that I wondered if the conversation I had just had with my son would be the last. He was one of those who left the battlefield but brought the battle home.

Now I know from personal experience that some aspects of PTS make their way into a person’s personality as they adapt to life outside a war zone. For example, I know a 60+ year old Vietnam combat veteran who still prefers not to sit with his back to the door of a commercial establishment -- the result of having done so just once in a Vietnamese bar and it almost cost him his life. He deals. Same with a number of Iraq war veterans: they scan; they drive faster than they should; they are uncomfortable with roadside debris. Understandable. My son is especially sensitive to yellow dump trucks on the road. These I find to be the “normal” assimilation of personal experiences into a soldier or veteran’s psyche.

What is not normal is when the experiences cannot be assimilated or accommodated in every day life after returning: anxiety, aggressiveness, anger, nightmares, depression. Any or all of these -- as a result of combat experiences -- can fester and corrupt the “normal” thought process. It results in a chemical imbalance in a person’s brain. There is no “talking yourself out of it”… it’s not just feeling “blue”… it’s not just bad dreams but horrors you relive anew every time you close your eyes. The more they seek to control the symptoms, the less control they actually have. Nor is self-medicating, excessive drinking and “cutting” (self-mutilation) normal.

I know what Grim is saying -- letting everyone who has served or is serving in combat know that there is nothing wrong with you if you are experiencing the effects of war -- it is normal to be affected… to be changed by those experiences. I just fear that these young men and women will think, “Well, if it’s all normal, what’s the big deal then?” I know that Grim is not suggesting at all that the responses I list in the preceding paragraph are what he considers normal and I agree with Grim that every single person who has served can “come home”… I just think that not all of them will make it home without some assistance.

What is the best part of all this? I’m not the only one talking about PTSD. And GUYS WHO KNOW are joining the discourse. So this is for Grim, Uncle J, B5, John, Chuck… those who have crossed the chasm but stay to build the bridge:

The Bridge Builder
An old man, going a lone highway,

Came, at the evening, cold and gray,

To a chasm, vast, and deep, and wide,

Through which was flowing a sullen tide.

The old man crossed in the twilight dim;

The sullen stream had no fears for him;

But he turned, when safe on the other side,

And built a bridge to span the tide.

"Old man," said a follow pilgrim, near,

"You are wasting strength with building here;

Your journey will end with the ending day;

You never again must pass this way;

You have crossed the chasm, deep and wide,

Why build you the bridge at the eventide?"

The builder lifted his old gray head:

"Good friend, in the path I have come," he said,

"There followeth after me today

A youth, whose feet must pass this way."

"This chasm, that has been naught to me,

To that fair-haired youth may a pitfall be.

He, too, must cross in the twilight dim;

Good friend, I am building the bridge for him."
-- Will Allen Dromgoole

Updated: mild TBI (MTBI) can result in a condition called post-concussive (post concussion) disorder. I should have mentioned it in my piece... Here's some articles on that

MTBI v. PTSD

Post-Concussive Disorder

Post Concussion Disorder

Findings of Mild Traumatic Brain Injury in Combat Veterans With PTSD and a History of Blast Concussion

Post-concussion syndrome: clarity amid the controversy?

here's a number on the link between TBI and PTSD... (I should note that the VA routinely does TBI screening (regardless of the Army diagnosis) if a veteran was exposed to concussive injury.)

Illinois TBI/PTSD Program

PTSD After Severe TBI

my discussions with the fine folks at the VA indicate that in the past the Army strongly resisted (i.e., refused) testing for TBI absent serious [visible] head trauma; currently, when the Army agrees to testing, it involves CT and/or MRIs but not all evidence of TBI can be found on these scans (not to mention that it can take up to 6 months for closed head TBI to appear in scans if at all); EEG (brain wave testing) can be a diagnostic tool but is most useful on a comparative basis (one before, one after). HOPING the new Army TBI/PTSD Education Program helps to educate and remove the stigma...

Army to Launch Traumatic Brain Injury, PTSD Education Program