Beyond The Trauma:Invisible Injuries of War Andrea McSweeney Edith Love Rachel Powell
The military soldier may experience trauma in a variety ofcircumstances, during training as well as war. In some cases, severeinjury and sometimes loss of life, may occur. Studies have shown thatthe longest lasting effects seem to emerge from wartime experiences.Many soldiers have been affected directly and indirectly after beingexposed to death and destruction during combat. Often they arerequired to be on alert, ready at a moments notice, waiting for daysor weeks at a time, for a confrontation to happen (National Center forPTSD, 2010).
Soldiers are always on alert with the threat of losing their life when in combat. Many soldiers survive events in which they witnessed the killing of civilians and the death of fellow soldiers, even their adversary. Even individuals in supporting roles, such as medics, nurses, persons serving grave duty, transport pilots, and Military Police, among others, are at risk to develop problems. The internal thoughts of these events remain strong and continues to interfere with their functioning and enjoyment of life (Karmey, 2008)
Stress injuries are invisible, which means they are often overlooked by leaders and other professionals Stress injuries can provoke feelings of shame in soldiers, resulting in their reluctance to admit to having terrifying or horrible experiences The severity of any given traumatic stress injury is unpredictable, it requires patience and understanding during the treatment process Sometimes, the disabling effects of traumatic stress injuries may be delayed in their onset until weeks or months after returning from a deployment (Mettler, 2011)
Post-traumatic stress disorder (PTSD) is a mental health condition thats triggered by a terrifying event. Symptoms may include flashbacks, nightmares and severe anxiety, as well as uncontrollable thoughts about the event. After a traumatic event, many people have a difficult time adjusting and coping with their thoughts . But with time and taking care of yourself, such traumatic reactions usually get better. In some cases, though, the symptoms can get worse or last for months or even years. Sometimes it may prevent you from performing normal daily routines. In a case such as this, you may need to seek intervention from a professional.(National Center for PTSD, 2010)
There are many different ways that PTSD can impact youreveryday life.• Flashbacks- reliving the trauma over and over, including physical symptom like a racing heart or sweating.• Bad dreams.• Frightening thoughts.Re-experiencing symptoms may cause problems in a person’severyday routine. They can start from the person’s own thoughtsand feelings. Words, objects, or situations that are reminders ofthe event can also trigger re-experiencing (Tull, 2009).
• Staying away from places, events, or objects that are reminders of the experience.• Feeling emotionally numb or losing interest in things you use to care about• Having trouble remembering the dangerous event.• Feeling strong guilt, depression, or worry• Losing interest in activities that were enjoyable in the pastThings that remind a person of the traumatic event can trigger avoidancesymptoms. These symptoms may cause a person to change his or her personalroutine. For example, after a bad car accident, a person who usually drives mayavoid driving/riding in a car (Tull, 2009).
• Being easily startled• Feeling tense or “ on edge”• Having difficulty sleeping, and/ or having angry outbursts.Hyper arousal symptoms are usually constant, instead ofbeing triggered by things that remind one of thetraumatic events. They can make the person feelstressed and angry. These symptoms may make it hard todo daily tasks, such as sleeping, eating, or concentrating(Tull, 2009).
A traumatic brain injury also known as TBI is caused by sudden blow or jolt to the head or a penetrating head injury that disrupts the function of the brain. Depression is frequently noted in individuals with chronic post-concussion syndrome (mild TBI). Individuals with TBI who experience depression post- injury report more symptoms and more severe symptoms than those TBI patients without depression. This can extend to the perception of other problems, including cognitive problems in individuals with TBI, with individuals with depression, anxiety and PTSD reporting more problems with cognitive function than other groups. Depression after TBI is linked to abnormal imaging results, older age at time of injury, and higher levels of depressive symptoms in the week following injury (Tanielian T, 2008)
Risking another brain injury (skiing, contact sports, motorcycles, etc.) Alcohol and illicit drugs Caffeine or “energy enhancers” Cough, cold, allergy meds containing pseudoephedrine Over the counter sleeping aids Returning too soon to a high risk area in a combat zone Returning to combat too soon… May result in susceptibility to repeat concussion May put the Soldier and fellow Soldiers at risk(Defense and Veterans Brain Injury Center, n.d)
A Major Depressive Episode is when an individual experiences a discrete episode ofpersistent and pervasive emotional depression. There must be at least 5 symptomsfrom the list below that persist for at least 2 weeks. One of the symptoms must be adepressed mood or loss of interest. These are two-questions generally asked duringthe screening process:1. Depressed Mood2. Markedly diminished interest or pleasure in all or almost all activities.3. Significant weight loss or gain, or increase/decrease in appetite.4. Insomnia or hypersomnia.5. Psychomotor agitation or retardation.6. Fatigue or loss of energy.7. Feelings of worthlessness inappropriate guilt.8. Diminished concentration or indecisiveness.9. Recurrent thoughts of death or suicide.(American Medical Network, n.d.)
The most common form of treatment is medication; various prescription medications exist for the purpose of treating depression Ex: Prozac and ZoloftCognitive therapy-This type of talk therapy helps you recognize the ways of thinking (cognitive patterns) that are keeping you stuck — for example, negative or inaccurate ways of perceiving normal situations. (American Psychiatric Association, 2000)
Major depression is a mood state that goes well beyond temporarily feeling sad or blue. It is a serious medical illness that affects one’s thoughts, feelings, behavior, mood and physical health. Depression is a life-long condition in which periods of wellness alternate with recurrences of illness (American Psychiatric Association, 2000). Major Depressive Disorder is more commonly known as depression Women are two times more likely to be affected by Major Depressive Disorder than men Causes may vary from biological to psychological Most episodes of depression usually end over a period of time but Major Depression can last for years Successful treatment of depression does not guarantee that it will not reoccur
Rates of PTSD, depression and TBI•About 300,000 currently suffer from PTSD or major depression•About 320,000 reported experiencing TBI during deployment(Rand, 2008)
The Department of Defense is responsible for providing the military forces needed to deter war and protect the security of our country. The major elements of these forces are the Army, Navy, Marine Corps, and Air Force, consisting of about 1.4 million men and women on active duty. They are backed, in case of emergency, by the 1.2 million members of the Reserve and National Guard. In addition, there are about 670,000 civilian employees in the Defense Department. Under the President, who is also Commander in Chief, the Secretary of Defense exercises authority, direction, and control over the Department, which includes the separately organized military departments of Army, Navy, and Air Force, the Joint Chiefs of Staff providing military advice, the combatant commands, and defense agencies and field activities established for specific purposes (U.S. Department of Defense, 2012).
The VA offers many benefits other than health care to dependents andsurvivors according to the Federal Benefits for Veterans, Dependents andSurvivors VA Pamphlet. Education/Training Home loan guaranty Life insurance Burial and memorial servicesWhen working with military connected families it is important to discuss theVA and its benefits with your clients. It is also important to encourage theveteran to enroll for VA healthcare benefits immediately after separationfrom the military. Sometimes family members are also eligible for benefits soit is important for social workers to know that the VA can be a great resourcefor military families (Department of Veterans Affairs, 2010).
VA provides readjustment counseling at 207 community-based Vet Centers located inall 50 states, the District of Columbia, Guam, Puerto Rico, and the U.S. Virgin Islands tohelp combat veterans readjust to civilian life.Eligibility: Veterans are eligible if they served on active duty in a combat theaterduring World War II, the Korean War, the Vietnam War, the Gulf War, or the campaignsin Lebanon, Grenada, Panama, Somalia, Bosnia, Kosovo, Afghanistan, Iraq and theGlobal War on Terror. Veterans, who served in the active military during the VietnamEra, but not in the Republic of Vietnam, must have requested services at a Vet Centerbefore Jan. 1, 2004.Services: Vet Center staff provides individual, group, family, military sexual trauma,and bereavement counseling. Services include treatment for PTSD or help with anyother military related issue that affects functioning within the family, work, school orother areas of everyday life.Bereavement Counseling: Bereavement Counseling is available to all family membersincluding spouses, children, parents and siblings of service members who die while onactive duty. This includes federally activated members of the National Guard andreserve components.(Vet Centers, 2012)
Provide readjustment counseling in a caring manner to eligible veterans and their families. Provide a broad range of counseling, outreach and referral services, to help veterans make a satisfying post-war readjustment to civilian life. Individual Counseling Group Counseling Sexual Trauma Counseling Marital/Family Counseling Bereavement Counseling Drug and Alcohol Referral Employment Guidance Benefits Assistance/Referral Liaison with VA & Community Resources (Vet Centers, 2012)
The symptoms associated with PTSD and Major Depression are often delayed in onset When a soldier discloses a history of TBI, this is not confirmation that one actually occurred…however The failure to report an event or seek medical help does not mean that a TBI did not occur When symptom onset is delayed by days to weeks after a TBI, the symptoms are most likely due to other causes than the TBI As the soldier begins to return to a functional or routine lifestyle, a physical or emotional stressor may cause re- occurrence of the symptoms (Flynn, n.d.)
It is important to remember that soldiers are not defined by their TBI, PTSD, or mental illness. Often it is necessary to involve the spouse, significant others, and in some cases the children, in the educational and healing process of the soldier It is important for providers to be competent when implementing services; improper interventions can present a delay in an individual’s progress. Sometimes providers do more harm by the treatment they prescribe Soldiers need time to tell their story and receive the comprehensive evaluation that they deserve – this can not be accomplished in a understaffed setting or a clinic with inadequately trained staff (Flynn, n.d.)
http://www.aw2.army.mil/ Army Wounded Warrior Program Christopher & Dana Reeve Foundation www.ChristopherReeve.org/Military Dept of Veterans Affairs --My HealtheVet http://www.myhealth.va.gov/ Dept of Veterans Affairs: Polytrauma System www.polytrauma.va.gov of Care http://www.dav.org Disabled American Veterans http://www.militaryonesource.com Military One Source www.vetcenter.va.gov/ Vet Center
Affairs, Department of Veterans. (2012, April 05). History-VA History. Retrieved January 24, 2013, from US Department of Veterans Affairs: www.va.gov/ about_va/vahistory.aspAmerican Medical Network. (n.d.). Major Depressive Episode. Retrieved January 24, 2013, from American Medical Network: www.health.amAmerican Psychiatric Association. (2000). Diagnostic and Statistical manual of mental disorders: DSM-IV-IV (4th ed.). Arlington, VA, USA.Defense and Veterans Brain Injury Center (n.d.) Traumatic Brain Injury. Retrieved January 15, 2013, from Defense and Veterans Brain Injury Center: www.DVBIC.orgDepartment of Veterans Affairs. (n.d.). Understanding Post Traumatic Stress Disorder Retrieved January 20, 2013 from: http://www.ptsd.vagov/public/ understanding_ptsd/booklet.pdfFlynn, F. (n.d) Lessons Learned in the Care of Our Wounded Warriors.Madigan Army Medical Center, TBI Program.
Karmey, B. R.-O. (2008). Invisible Wounds Predicting the Immediate and Long Term Consequences of Mental Health Problems in Veterans of Operation Enduring Freedom and Opearation Iraq Freedom. Rand Corporation.Mettler, M. a. (2011). Healthwise for Life. Boise, Idaho, USA: Healthwise for Life.National Center for PTSD (2010) .Returning from War: A Guide for Families of Military Members. Department of Veterans Affairs. Retrieved January 22, 2013, from http://www.ptsd.va.gov/pdf/familyguide.pdf.Tanielian T, a. J. (2008). Invisible Wounds of War:Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery. 292.Tull, M. (2009, July 08). An Overview of PTSD Symptoms. Retrieved January 22, 2013, from about.com: www.ptsd.about.comU.S. Department of Defense. (n.d.). Department of Defense. Retrieved January 22, 2013, from US Department of Defense: www.defense.gov
This work was supported by Fayetteville State University: Department of Social Work Mrs. Molly Williams, MSW, Professor- Research Mentor