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Discussion: Post-traumatic Stress Disorder In Iraq War Veterans

posted on November 10, 2006

During the Civil War, it was called soldier's heart. During World War I the dazed and confused were seen as shell shocked. In World War II it was known as battle fatigue. Today these feelings of alienation, depression, anger, and sleeplessness are known as Posttraumatic Stress Disorder. And of the soldiers serving in and returning from Iraq, nearly one in six exhibits these PTSD symptoms.

Here to help us understand the condition is Major James Rachal, who is a psychiatrist counseling Army, Air Force, and Navy PTSD Patients at Offutt Air Force Base in Nebraska. Also joining in the discussion is Pat Wilson, a social worker with Mercy Medical Center of North Iowa in Mason City. And with us as well is Peter Bieber, an Iraq war veteran now working as a firefighter and paramedic in Mason City. The repercussions of wartime stress have caused him to seek counseling.

Major Rachal, six people -- six soldiers may experience injuries in battle. They may experience traumatic conditions. What are the factors that lead to that one soldier who goes home and has PTSD?

Rachal: Well, we really can't predict who is going to have PTSD and who doesn't. What we do know is certain things make people more susceptible to PTSD. A lot of times we look at the soldier's age. Younger soldiers tend to be more at risk than older soldiers. The kind of support they have when they get home. And the more support they have, the less likely they are to have PTSD. And probably the most important thing that happens is the actual trauma and how frequently it has occurred. The more severe the trauma and the more frequent that the person goes through a trauma, the more likely they are to have posttraumatic stress disorder. A lot of times -- the most frequent time we see posttraumatic stress disorder is when the soldier is physically wounded or injured or has somebody close to him that's wounded or injured and he observes the injury.

Mundt: And that younger soldier, it's because he hasn't been battle hardened?

Rachal: Not necessarily. It's -- basically the younger soldier tends to -- because younger soldiers' minds tend to be a little bit more malleable and not set in his world views a lot of times, they will incorporate the trauma into how they actually see the world. And that will lead to them having more severe symptoms.

Mundt: Could you say that someone who might be psychologically weaker and that's why they get PTSD, or does that not play a role in it?

Rachal: No, it doesn't. Really, the main risk factors are what the person actually experiences. You go through a severe enough trauma and frequently enough, you're going to have PTSD, period. I see very strong psychologically willed people, people of high ranking, people of almost any walk of life, and because of what they've experienced, they've have -- they now exhibit symptoms from posttraumatic stress disorder.

Mundt: Pat, I want to ask you a little bit about the kind of symptoms that you see that are markers to you of posttraumatic stress disorder.

Wilson: We see things that are like flashbacks or bad dreams, people reliving the incidents over and over again, waking up and actually thinking they're back in the war situation. We've had soldiers identify that their wives -- spouses are trying to wake them up from a bad dream, and they'll wake up trying to put their hands around that person's neck or reaching for a gun. A lot of flashbacks, startle reflex, always being hyper-vigilant, waiting for the next thing to happen. Those are some of the symptoms that we see.

Mundt: And, Major Rachal, did those symptoms show up quickly after the soldier returns from Iraq?

Rachal: It really varies. Sometimes you can see -- sometimes you can see symptoms almost immediately, but a lot of times those symptoms will stay hidden until maybe six, seven, eight -- I even look for posttraumatic stress symptoms as far as a year out from somebody returning from Iraq. So just because -- and actually when they come back from Iraq, a lot of times they won't have any symptoms. They're excited to be home. Their excited to see their loved ones, and they're really not focusing on what happened. But as time wears on, you start seeing more and more symptoms occur.

Mundt: Pat, you treated Vietnam veterans who had PTSD.

Miller: I did.

Mundt: Did you see different kinds of symptoms or different intensity of symptoms from Vietnam veterans as you've seen from soldiers who come back from Iraq?

Wilson: Actually I think the symptoms were very similar, different kinds of circumstances. At that point in time, that was a very unpopular war. And I think part of the difficulty with Vietnam soldiers were that they came back expecting to be heroes, expecting to be congratulated. They were spit on. They were hit. They were trying -- people even tried to injure them. Our folks -- I think our soldiers coming back now are a lot more sophisticated, not as naive, but also have gone through some really horrific situations where they've had to do things that are completely out of the realm of what they would expect. They've had to shoot at or perhaps even almost run over a two year old because they thought they might be carrying a device -- an IED, an explosive device. So it's totally out of the character or out of the content of what they're expecting.

Mundt: Peter Bieber, you were a medic in Iraq. You experienced some horrific and difficult situations. Can you tell me a little bit about the experiences you had once you came home?

Bieber: When I first came home from Iraq, for me personally having been injured and taken that route home, you kind of feel a wide range of emotions. Having lost a good friend of mine who was my truck partner in Iraq, you feel sadness over that event. You feel guilt over leaving your buddies behind. You also feel elation at being reunited with your family and your kids. So it's -- it's really a whirlwind of emotions that you experience in a very short amount of time. And so that for me was kind of hard to deal with, wanting to be able to express to people what happened over there but trying to be careful that you don't give away too much information because you don't want to feel like you're victimizing your family as well.

Mundt: Did you find then that over a period of time, five, six months, seven months afterward, that you began to sort of relive these experiences again?

Bieber: As the Major said and as Pat said, it was about, for me, about six, seven months after I got back that I really started to experience some -- really a sense of loss, a sense of guilt. I really kind of became a news junkie, and I would look for anything on TV that had to do with Iraq or Afghanistan. You feel guilty that there are still soldiers over there that are doing the job and they're having to face those situations, and then also survivors guilt at having survived an event that you really can't explain how you got out of that claimed the life of a friend of yours. So it was really a lot of feelings to deal with.

Mundt: And there's a particular incident that I've heard you tell, and I'd like to have you relay it. It involves surgery and an incident that occurred afterward that, although you were unaware of it at the time, was perhaps a warning signal to others.

Bieber: Yeah, I had to have some scheduled surgery. It was fairly routine but it did involve general anesthesia. And I was under a lot narcotics and pain relievers when I came out of the surgery. Those kind of things can make it more susceptible. But there were a lot of risk factors that kind of built up to that and led up to that. And when it finally occurred, it was more dramatic than just trying to deal with the depression and guilt and stress. So I really don't remember much about it, but it was an event that lasted for about three hours that was, I guess, what you would call a full-blown flashback.

Mundt: And tell me a little bit about the treatment that you've been going through and how it's helped you process what you've experienced.

Bieber: Well, being a wounded veteran, all soldiers who return from theater are entitled to two years of veterans benefits -- Veterans Administration health benefits, and then you can claim those benefits again when you retire. Having received a Purple Heart and being wounded, you're entitled to those benefits for life. So I took advantage of as many of those opportunities. I saw a doctor at the V.A. Got a physical. Did a mental health screening as well. I'm also fortunate that the fire department I work with, the Mason City fire department, has a -- the city of Mason City has a very solid employee assistance program and when my wife and I decided that I needed to go beyond and get professional counseling, that we had that available. And of course, Pat Wilson was the individual that I chose to see, having that been recommended to me by a very dear friend of me that knew her. So I took -- just simply took advantage of the program that was available.

Mundt: Pat, tell me a little bit about this program. This program is called Enduring Families. It serves members of the Guard.

Wilson: It serves members of the Guard and their families.

Mundt: What are the special needs for members of the Guard who come back from Iraq as opposed to members of the military, the Army?

Wilson: Well, one thing that happens with the Guard members is that when they come back, they do not go back to a military base. They come back, they go home, they go back to their jobs and to their normal lives. And they drill again, of course, on weekends, but that might be the only time that they would see people who had had the same life experience. The rest of the time, they're in the civilian population. So they don't necessarily always get the support that soldiers on a military base might get or have access to the same services. They have to work harder to get those services. So what we do with enduring families is meet with those folks as soon as they come back for their first drill weekend. We meet with the soldiers to say this is what you might expect, these are -- these are the things you might see. We also meet with their families, parents if they choose to come of adult soldiers and spouses, where we would be saying this is what to look for with your soldier and if you see these things start to happen, then here's how to get the help.

Mundt: Major Rachal, we just have a few seconds left, but I wondered if you could tell me about a way to get in touch with, you know, with the people who know how to help if someone who is watching knows a family member who's going through these kinds of experiences.

Rachal: Certainly. For both Iowa and Nebraska, we -- two different routes to go. If you're back -- if you return from deployment, within the first six months you're eligible for military benefits on a military base. So certainly at Offutt Air Force in Nebraska, we would see folks within the first six months. After that the Veterans Administration will see you for the next two years. And really, if you have mental health concerns, contact them because if they are a result of the deployment, regardless of what time frame, even two, three, four years out, they still will evaluate you and look into those concerns.

Tags: Iowa Iraq war PTSD stress veterans war