Brandy PorterfieldShaping Sheet10th Honors World Literature/CompositionLester11 April, 2012Part I: Research Question 1Q: Is PTSD a legitimate illness?CD: Before the 1986 change of direction, The VA (Department of Veterans Affairs) and militarydoctors commonly diagnosed veterans demonstrating symptoms of PTSD as having apersonality disorder, obsessive-compulsive disorder, paranoia, or schizophrenia, but never withPTSD (“The Veteran’s PTSD Handbook).Commentary:“What happens if this person served in WW1, WW2, the Korean War, Vietnam, orduring the 60’s, 70’s, or early 80’s and has PTSD? Because the VA did not recognize PTSD as anillness prior to 1986, this individual would be separated from the military without medicalretirement benefits or assistance from the Department of Veterans Affairs” (The Veterans PTSDHandbook).Commentary: The general public has always been intolerant of mental illnesses and often looksdown on those displaying such an illness.Commentary:A soldier devotes his lifeto his country and withstands extreme trauma on a dayto day basis when in physical battle. Persons who have experienced a trauma in which theyexperienced, witnessed or were confronted with an event involving actual or threatened death,
serious physical injury, or a threat to one’s physical integrity typically develop a psychologicalillness.Commentary: This illness, referred to as PTSD in today’s time, deserved proper recognition anddiagnosis long before the 80’s.Insert photo’s and QUOTE: “Victims are the members of society whose problems represent thememory of suffering, rage and pain in a world that longs to forget.” –Bessel van der KolkCD: Clinician and researcher, Bessel van der Kolk, first discovered the reality of PTSD when hedecided to go work for the Veterans Administration (VA) in 1978. “At that time, tens ofthousands of men who’d served in Vietnam suddenly seemed to come out of the woodwork,suffering from flashbacks, beating their wives, drinking and drugging to suppress their feelings,closing down emotionally,” recalls van der Kolk (Wylie, The Limits of Talk).Insert Photos of Vietnam warCommentary: “It was a phenomenon that spawned a whole generation of researchers andclinicians fascinated by what had happened to these guys.” –van der KolkCommentary: In the years since this phenomenon researchers have set off an explosion ofknowledge about psychobiology and the interaction of the body and mind.Commentary: The trauma field has gone from oblivion to become one of the most advancedand scientifically supported specialties in mental health.Insert photos of researchers/ scientistsCD: The National Center for Post-traumatic Stress Disorder was created within the Departmentof Veterans Affairs in 1989 in response to a congressional mandate to address the needs ofveterans with military-related PTSD (The Veterans PTSD Handbook).
Commentary: Its mission was, and remains: “to advance the clinical care and social welfare ofAmerica’s veterans through research, education, and training in the science, diagnosis, andtreatment of PTSD and stress-related disorders.”Commentary: PTSD is not a new disorder. Written accounts of similar symptoms can date backto the Civil War when a PTSD-like disorder was known as “Da Costa’s Syndrome.”Commentary: Although PTSD may have not always been considered a legitimate mental illnessthrough-out history, the disorder is now highly recognized and accounted for.Part II: Research Question 2Q: What treatments are most effective in treating PTSD?The science of PTSD: PTSD has a biological basis. It is associated with a host of chemical changesin the body’s hormonal system, immune system, and autonomic nervous system. Medicalresearch suggests that the intense bursts of brain activity during traumatic experiences may laydown new neural pathways in the brain. (Invisible Wounds).CD: In 2004 the VA and DoD jointly released a set of clinical guidelines for treating PTSD. Theguidelines included individual psychotherapy, group therapy, and pharmacotherapy.Commentary: Individual psychotherapy consists of Exposure therapy, Cognitive restructuring,Stress Inoculation Training, EDMR (Eye Movement Desensitization and Reprocessing)
Commentary: Group therapy consists of four to twelve clients, led by a mental healthprofessional, sharing thoughts and finding comfort in knowing they are not alone and gainingconfidence by helping others resolve their issue. Little research has been done to validate itseffectiveness or to delineate those characteristics of group therapy that lead to improvedclinical outcomes (Invisible Wounds).Commentary: In terms of pharmacotherapy, evidence indicates that certain medications,especially selective serotonin reuptake inhibitors (SSRI’s) such as Prozac and Zoloft, areeffective at relieving core symptoms of PTSD.CD: Exposure therapy, also referred to as flooding, imaginal, in vivo, prolonged, or directedexposure, is a type of treatment that requires the client to focus on and describe the details ofa traumatic experience in a therapeutic manner (Garske, Military Related PTSD).Commentary: Prolonged Exposure has proven effective in the treatment of PTSD symptomsassociated with a variety of traumas, including combat. This type of exposure significantlyreduces symptoms such as general anxiety, depression, guilt and anger.Commentary: Virtual Reality, a specific form of exposure therapy, can create environmentscontaining a wide range of trauma cues in a customized fashion, providing the clinician with apotentially powerful tool to facilitate activation of the fear memory and modulate emotionalengagement. ‘A case illustration on an Army infantryman named Michael in his mid 30’s withapproximately 9 years of active duty service displayed the effectiveness of Virtual RealityExposure. Michael’s pretreatment score of 58 was above the frequently used cutoff of 50 forscreening positive for PTSD. After six sessions of VRE, the patient’s pretreatment PCL score of58 was halved to 29, well below the frequently used cutoff for PTSD’(Reger, Gahm).Commentary: EDMR instructs clients to imagine a painful traumatic memory and associatednegative perceptions (such as shame or guilt) while visually focusing on the rapid eyemovement of the therapist’s finger. Several randomized controlled trials have been publishedover the last few years that suggest the EDMR is effective in reducing PTSD symptoms.
Insert therapy photosPart III: Research question 3Q: How do veterans with PTSD affect the community?CD: For people with PTSD, memories may be triggered by sights, sounds, smells, or feelingsthat remind them of the traumatic event. (Invisible Wounds).Commentary: Many veterans suffering from PTSD struggle from the symptoms of reoccurrence.Commentary: For example, the sound of a car engine may trigger the memory of shots fired onthe battle field therefor the veteran may become frightened or startled into reliving a traumaticscene.Commentary: Many of these reactions may cause one to become isolated.CD: Veterans with PTSD perpetrate domestic violence at greater rates than comparableveterans without PTSD (Invisible Wounds).Commentary: Getting anxious and angry over little things, the veteran makes everyday life forthe family extremely stressful.Commentary: Stressful event may lead the veteran to feel emotionally numb and “put up awall.”Commentary: In other situations, the veteran with PTSD may have a sharp temper or violentstreak that scares or angers a spouse.
CD:Troubled veterans are spilling into the criminal justice system. A small fraction wind up inprison for homicides or other major crimes but far more, though, are involved in drunken barfights, and alcohol fueled domestic violence. Their stories often spool out in raptured families,lost jobs and crushing debt (Alvarez).Commentary:Substance abuse is rising among veterans of combat in Afghanistan, Iraq. Studiesfind that drinking is more prevalent in the military than in the civilian population; the behavioralsurvey reported that heavy drinking among 18-25 year old men in the Army and the Marineswas almost twice as common among their civilian counterparts.Commentary:Another major aspect concerns veterans trying to maintain jobs or even get backinto the work force after war. Dealing with the symptoms of PTSD, a veteran struggles to workto their potential.