Dealing with the Depression Following the War in Iraq

All across the country military men and women are coming home from the war in Iraq, otherwise known as Operation Iraqi Freedom. This "Operation" is costing many soldiers not only their physical lives but their mental lives as well. It's one thing to come home with part of your leg or arm amputated, but it is an entirely different matter when you come home and you have lost the ability to sleep well at night. Or you cannot stand the sound of fireworks, or you cannot drive over a bridge for fear something terrible will happen, or you wake up in the night screaming from the horrors that your mind will just not forget. This is the case with many military veterans returning home from the war in Iraq. One wife recalls of her husband, "He keeps waking up from nightmares and screams at night. When I wake him up there are always body parts that he's trying to attach - 'this head doesn't fit this hand and this leg doesn't match the other'. The whole time he is screaming, and then there are his depressions, and his desire to die and commit suicide . . ." (Dekel et al, 2005) It was determined that this woman's husband was diagnosed with combat related post traumatic stress disorder (Dekel et al, 2005).

According to Jennifer Fischer Wilson, post traumatic stress disorder (PTSD) is "manifested as intrusive and unexpected re-experience of the initial trauma; avoidance of people, places, activities, or thoughts that trigger traumatic memories; emotional numbing, feelings of being on guard or irritable; and difficulty concentrating" (Wilson 2007). The National Center of PTSD defines this disorder in a similar way by dividing it into three parts: re-experiencing, avoidance and numbing of emotion and arousal (Ruzek, 2005). During the re-experiencing part, veterans may have disturbing dreams, they may feel like they are back overseas at war again, or they may have a hard time concentrating and focusing their minds on every day tasks. During the second part, veterans go to great lengths to avoid even talking about any situations about their experiences during war time. Veterans may also start abusing alcohol, taking medications or drugs trying to "silence" the thoughts in their heads (Ruzek 2005). During the third stage called arousal, veterans may become jumpy and unable to fully relax; they are greatly worried about the safety of themselves and their loved ones (Ruzek 2005).

This author has read, on more than one occasion, that PTSD is the Iraqi war's signature disability. According to a study done at the department of defense, between 15 % and 29% of veterans from the wars in Iraq and Afghanistan will suffer from PTSD (Simon, 2007). "As of August 2006, 63,767 discharged soldiers from Iraq and Afghanistan were diagnosed by the Department of Veteran Affairs with a mental disorder, 34,380 of them with PTSD (Simon, 2007). This same study from the Journal of the American Medical Association states that "close to 90% of troops are involved in some kind of firefight, and more than half of the soldiers there have handled human remains" (Simon 2007). Also, contributing to PTSD is the fact that "65-75% of United States service members have seen allied persons wounded or killed" (Hoge & Castro, 2006). It is plain for to see that the weight of this wars tragedies lie heavily on the shoulders of United States soldiers.

This war is dangerously stressful on these soldiers and it has started to push some of them to the edge. To go through a "typical" day of a soldier in Iraq or Afghanistan is unlike any civilians have ever seen or dare to see. One veteran states "Dealing with exploded vehicles and body parts and roadways blanketed with shrapnel all day, every day, is incomprehensible" (Simon, 2007). Some civilians really push some veterans for answers to questions such as "What was it [the war] like?" According to veteran Garrett Reppemhagen, "You just try to give them a softball answer. Yeah it was horrible -whatever. You say it was hot. You don't tell them what its like to kill a man or to have one of your buddies blown up. You just don't go there" (Davenport, 2006). One veteran states, "Dealing with exploded vehicles and body parts and roadways blanketed with shrapnel all day, every day, is incomprehensible (Simon, 2007).

Many of these soldiers fear the stigma of mental illness or feel ashamed for the things that they have done and they maybe feel like they deserve to have nightmare and flashbacks. According to Bobby Muller who founded Vietnam Veterans of America, "War changes a person. You go down a path of darkness. You warp. Back from war, a person will experience predictable emotions: Guilt in part because you've come back - survivor guilt; shame because, trust me, shameful things happen all over the place in war; and trauma, because when you are dealing with killing and the degradation of human beings that happens when fighting a war, there's a lot of trauma. When you come back, you need society's absolution to help you heal; knowing that what you did had to be done" (psychotherapy). Since there is a strong correlation between PTSD and depression and problematic drinking (Erbes et al, 2007) many veterans are finding other ways to cope with the effects of war. According to the article in Military Medicine, Dr. Christopher Erbes concluded that problematic drinking rates were at 33% for veterans returning from the war in Iraq (p.359).

Sometimes military veterans will vent out their mental anguish on members of their own family. Rina is the wife of an Israeli veteran who was diagnosed with PTSD. She says "Today we don't go to celebrations together because he can't stand the noise . . . I don't go out anywhere because he doesn't let me" (Dekel et al, 2005). Mina is in the same situation as Rina and she says "It's as if I live alone. I have to prepare everything; I have to do everything alone. If I want to go out [he says], 'go by yourself', what am I - am I a widow?" (Dekel et al, 2005). Although these particular were veterans from a war in Israel the disorder is still the same and PTSD still affects family members and loved ones in the same war. The best way to help families adjust to a loved one coming home from a war is proper preparation.
Many families and significant others are willing to go to family readiness programs in order to prepare themselves for the deployment of their loved ones. According to the national center of PTSD families need to be prepared for the challenges that are certain to be evident when their soldier comes back home (Ruzek, 2005). For many the battle begins when the soldiers come home and families need to be prepared for difficult situations.

When many of these veterans return home will they seek the professional help that they need? More than likely, they will not. Of the 40% of soldiers diagnosed with PTSD who actually wanted to receive help, no more than half of them actually received professional help (Simon, 2007). So what are the options for veterans returning home who are experiencing some of the classic symptoms of PSTD, depression or hazardous drinking behaviors? Medications such as selective serotonin reuptake inhibitors and beta blockers have been used in the past. Other medications are being used for anxiety, depression and insomnia. But like any mental illness, there is no "magic pill" that is going to cure the disorder completely. More and more professionals agree that there must be a collaborative effort between the military, the civilian psychiatrist and the civilian psychologists to create the best treatment plan for each individual diagnosed with PTSD or any other related symptoms.

According to the national center of PTSD treatment will usually focus on setting goals, learning more about PTSD, learning coping skills, connecting with other veterans, participating in support groups and looking at yourself (Ruzek, 2005). The national center for PTSD also believes that cognitive behavioral therapy is the most effective treatment for PTSD (Ruzek, 2005).

Many people view the military as a world inside our world. They see it as a separate entity within the United States that has no need for civilian resources. They are completely self reliant and in many ways they are. This mentality can create conflict in an already delicate situation such as mental illness. Mental illness exists in the military as much as it does in the civilian world and both worlds need to connect on certain issues for the good of those who are suffering.

Most studies done on PTSD are done by civilian researches that have very small control groups to work with (Wilson, 2007). There are not many war veterans who will jump at the chance to share their thoughts and feelings about war especially if they are suffering from PTSD. According to Simon in her article Bringing the War Home, of the soldiers diagnosed with PTSD only 40 percent said they wanted help and about half of them actually received professional help (2005). This creates a dilemma for both military and civilian mental health professionals. How can proper research be done when so few veterans will agree to participate in PTSD studies? Furthermore, how can proper psychotherapy methods be studied and implemented when so few are willing to attend therapy sessions?

As health care workers we must educate ourselves on the signs and symptoms of PTSD, whether it is combat related or not. We must get in contact with mental health professionals and approach them with any health concerns we have for our patients. We must remember to utilize all our resources for the benefit of our patients, and most importantly we need to remember to see the person behind the disorder. Most veterans who are suffering from PTSD are trying so hard to be strong for themselves and for the people that they love. As health care workers we must be professional at all times and show compassion and true empathy for our military veterans.

References

Davenport, C (2006,May 14). Back from Iraq. Retrieved June 19, 2007, from Back from Iraq Web site: http://www.washingtonpost.com/wp-dyn/content/article/2006/05/13

Dekel, R, Goldblatt, H, Keider, M, Solomon, Z, & Polliack, M (2005). Being a wife of a veteran with post-traumatic stress disorder. Family Relations. 54, 24-35.

Erbes, C, Westermeyer, J, Engdahl, B, & Johnsen, E (2007). Post-traumatic stress disorder and service utilization in a sample of service memmbers from Iraq and Afghanistan. Military Medicine, 172, 359-363.

Hoge, AuthorC, & Castro, C (2006). Post-traumatic stress disorder in UK and US forces deployed to Iraq. The Lancet. 368, 837.

Ruzek, J (2005,November). National Center for PTSD. Retrieved June 22, 2007, from Returning from the War Zone Web site: http://ncptsd.va.gov/ncmain/ncdocs/manuals/GuideforMilitary.pdf

Simon, C (2007, January). Bringing the war home. Psychotherapy Networker, 30-37.

Wilson, J (2007).Post-traumatic stress disorder needs to be recognized in primary care. Annals of Internal Medicine. 146, 617-620.