PTSD... a Parent's Perspective

As anyone who has read this blog for more than 30 days knows, our combat-wounded son also carries the invisible wounds of post-traumatic stress disorder.

Back in 2006, I was honored to have something I wrote included in Operation Homecoming: Iraq, Afghanistan & the Home Front. I had been invited to attend the launch of the book with other contributors at The Library of Congress in Washington, DC. Excited as I was, I didn't attend. I made a journey instead to a different destination after I received a call from Fort Benning that my son had been hospitalized for his worsening PTSD crisis. As I had before -- when Noah graduated Basic, when he graduated Airborne, when he deployed to Iraq, to Germany when he was wounded and when he was returned stateside -- I flew to offer encouragement and to do what I could. It's what a parent does... when they can.

We had been in constant contact with Noah in the 18 months from deployment and that point in 2006... In Noah's case, it took a lot of guts and a lot of asking for the help he knew he needed. He overcame the resistance of his unit NCO.. he overcame the stigma. In real words, he said, "I'm fucked up and I need help."

We have been there every step of the way. His dad is a Vietnam veteran and he and I have friends who fought the invisible war after their return, so we strongly encouraged him to seek help. We have been there through his treatment and his diligent attempts to stay in the Army... and his eventual medical discharge. We're still here with him.. and for him. It's what a parent does... when they can.

Through all of this, we have tracked his PTSD... the steps forward and the steps back. I have ranted, raved, blogged and asked the obvious questions about diagnosis, treatment and the stigma of PTSD. I have blogged (here and many, many more times) about the changes in our son... I have tried hard to tell everyone that combat-induced post-traumatic stress is a normal response to war and that it doesn't always rise to the level of a disorder but that if it messes with you and your relationships and your daily life, IT IS OK TO SEEK TREATMENT. You are not victims... and PTSD is as real as is cancer, tuberculosis, diabetes.

As for Noah, he has reached a plateau in his recovery; it has not been nor is it easy for him on a daily basis. Or for us.

PTSD is like -- no, it IS -- the bogeyman... behind every door, hiding in every shadow... the invisible monster that has stolen the smiles and maybe even a part of these soldiers' souls... and they fight every day to keep from losing more and trying to get that piece back. It's incredibly TOUGH for those veterans and HARD for their families... the nightmares that we cannot send away; the fitful sleep that we cannot ease; the anger that we cannot avoid or abate but that is not really about us; the inattention; the forgetfulness; the moodiness. There are days when he's having one of "those" days or he's in one of "those" moods that we cannot have a cogent conversation unless we are willing to agree with everything that comes out of his mouth... so some days we just don't have conversations. I joke that I gave birth to just one child named Noah, but we live with two of them -- and we're never sure which one will walk into a room.

We accept that all that can be done is being done... we know the who, what, where, when & why, but no matter what we do we cannot ever fully understand because.. well, BECAUSE. The only comparison to the difference between "know" and "understand" that I can relate to is childbirth. Everyone knows what it is. We know it's painful. We know it's more painful for some than others. However, if you haven't given birth, you can't understand. I hope that makes sense. That is not to say that non-sufferers cannot be empathetic and supportive. We know many who are encouraging and supportive to both Noah and to us. We don't tolerate condescending, but we know that when we see it.

In addition to the day to day moving forward with this bogeyman is dealing with all things that are Life. Noah does a lot of balancing... parenting a 19-month old, trying to find a job (no, O, there are STILL no jobs), attend school, work as a Reserve (part-time) firefighter, attend medical and counseling appointments... that can be -- and often is -- exhausting mentally and physically. Sometimes for us as well. We still see flashes of temper... we know he has restless (and some mostly sleepless) nights and nightmares. He has flashbacks which occasionally are intense.

I continue to read and research on the topic... but the amount of information can be overwhelming. Here is just the most recent Clinical Trauma Update from ONE organization:

This issue of CTU-Online contains 6 summaries:

Treatment
1. Meta-analysis suggests drugs are more effective than psychotherapy for treating combat-related PTSD: PTSD treatment research has made important advances over the years. One of the key questions remaining concerns the relative efficacy of drugs and psychotherapy. There have been very few direct comparisons. The best evidence comes from meta-analyses, which have tended to show larger effects for psychotherapy. Investigators at the University of Michigan recently conducted a meta-analysis of 24 studies to specifically compare the effect of the two modalities on combat-related PTSD.
Read more… [snip]

2. Neurobiological stress response may predict PTSD treatment outcome: A new study conducted by researchers at Mount Sinai School of Medicine and the Bronx VAMC examined how treatment for PTSD affects cortisol and other measures of the function of the hypothalamic-pituitary-adrenocortical (HPA) system. Cortisol, which has been a particular focus of research, is produced to help regulate the stress response. Some researchers have even suggested that abnormalities in the HPA axis may increase vulnerability to the development of PTSD. But prior to the new study, there had little evidence about whether the HPA system predicts treatment response or is affected by treatment.
Read more… [snip]

3. Cognitive-behavioral therapy for PTSD improves patients’ sense of their physical health: Individuals with PTSD suffer more chronic health concerns and have a poorer perception of their physical health than individuals without PTSD. If PTSD is associated with poor health, it follows that treating PTSD could improve health, but in fact, there is little evidence that this is the case. Prior studies have found no effect of PTSD treatment on physical functioning, although the effect of treatment on symptoms has not been examined until now. Investigators in a new study assessed self-reported physical symptoms in 108 women with PTSD who were treated with one of two evidence-based treatments for PTSD, Cognitive-Processing Therapy and Prolonged Exposure.
Read more… [snip]

4. CBT [cognitive behavioral therapy] treatment for substance use and PTSD decreases PTSD, not substance use: An estimated 30-50% of individuals undergoing addiction treatment also have a lifetime diagnosis of PTSD. Several therapies developed to address co-occurring PTSD and substance abuse have been designed as stand-alone treatments. Now researchers at Dartmouth Medical School have developed a cognitive behavioral therapy intended to be integrated with ongoing addiction treatment.
Read more… [snip]

Comorbidity
5. New findings from the Millennium Cohort Study: Investigators recently took advantage of data available from a unique project underway in the Department of Defense, the Millennium Cohort Study. This is a longitudinal survey of a large sample of active-duty and Reserve/Guard personnel who were enrolled between 2001-2003 and will be followed for the next 21 years. One study examined how current and past PTSD relate to mental and physical functioning. The other examined whether how physical and mental functioning predicted PTSD several years later.
Read more… [snip]

6. Gender differences in potential mechanisms of PTSD and substance use comorbidity: Many individuals with PTSD also have a substance use disorder. The two problems are mutually reinforcing. Substance use for self-medication can actually exacerbate PTSD symptoms, creating a cycle that is difficult to break. Furthermore, substance abuse may complicate treatment. Thinking that emotion regulation might play a role in explaining the link between these two disorders, the authors of a new study examined difficulties controlling impulsive behavior when distressed and lack of emotional awareness and clarity in 132 men and 50 women admitted to an inpatient alcohol and drug treatment center in Washington, DC.
Read more… [snip]

If you're interested in this level of study, you can subscribe to this newsletter yourself:

http://www.ncptsd.va.gov/ncmain/publications/subscribe_ctu.html

And, of course, you can check out the "PTSD Resources" link on my right side bar...

And here's a few more..

Iraq War Clinician Guide, 2Ed.
Deployment Health Clinical Center/PTSD
Dept. of Veterans Affairs: National Center for PTSD
Iraq War Resources
PTSD Combat: Winning the War Within (Info Blog)

In our life -- in Noah's life -- it's harder some days than others... but we can see that Noah continues to move forward... and he deals with it (some days better than others heh.) I'm not sure that we always equate "moving forward" with "progress", but it's better than it's been but not as good as we hope it will be.

We once worried that we might not ever see our son smile again, but he does smile. There was a long spell when he couldn't laugh. Now he can laugh... maybe not as often as we'd like, but we know that his CAPACITY for life... and loving life have been restored. We have witnessed over these past few years a return of a measure of Noah's optimism... some days he doesn't see the glass as half-empty... and that's something.

IF you have PTS or PTSD, get help. It works. It can get better.