The Failure to Properly Diagnose

The history of man is replete with conflict. It seems that since recorded history man has fought wars within their own group or against outsiders. Historians can study these conflicts and provide information on battle tactics, war heroes, war booty and the impact on politics. But rarely can one find an extensive description of one major consequence of war – soldiers coming home with various mental illnesses and one of the most popular of which is known as the Posttraumatic Stress Disorder (“PTSD”).

The misdiagnosis and mistreatment of veterans with PTSD is due to the tendency of the military to downplay the impact of the illness and also because PTSD is often masked by its symptoms which are equally serious such as depression, substance abuse, and eating disorders etc. Health workers believe that the US Armed Forces should come out in the open and acknowledge the severity of the problem in the hopes of developing effective treatments for soldiers suffering from PTSD. Background

Since the beginning of recorded history, tribes, people groups, and nations are always at war whether in a state of readiness or actually in combat trying to eliminate the other army from the face of the earth. It maybe a civil war, a war for independence, an attempt to repeal colonizers, an international conflict or the more recent war against terrorism but it is all the same in terms of the human aspect of the conflict. Even with highly advanced weaponry and gadgets modern war cannot eliminate the need to send in troops and allowing them to fight man versus man.

Historians can collect artifacts, study documents, and gather data regarding war exploits – war booty collected, territories conquered, and the political ramifications of the war’s aftermath – and yet fail to give information regarding the mental state of the combatants. Everyone knows what happened in the American War for Independence. The inhabitants of the colonies successfully destroyed British hegemony. But little is known about the soldiers who lost their arms and legs in the bloody conflict. Little is known about the mental state of the enlisted men who saw their comrades obliterated by exploding canon balls.

And no one knew how they tried to cope after leaving the army and coming home to their respective families. There is evidence to show that PTSD is prevalent among soldiers in the Civil War, World War I, World War II, the Korean War and the Vietnam War. But these symptoms were misdiagnosed. One of the possible reasons why PTSD was clouded in mystery can be attributed to the relatively recent emergence of modern psychology – supported by a more scientific approach. According to Coon psychology began as part of philosophy but as a science it dates back only about 120 years.

“The science of psychology began in 1879 at Leipzig, Germany where Wilhelm Wundt had a laboratory studying conscious experience (Coon, 19). It is no wonder therefore that no one knew about PTSD before the advent of modern psychology. One wonders how the ancients cope with battle-scarred veterans suffering mental problems. Therefore, it is only in the 1980s when PTSD was recognised as a formal diagnosis (Dryden-Edwards, 1). Yet scientists agree that this condition may have existed since the time humans experienced traumatic events.

PTSD was called by different as early as the American Civil War. According to Dryden-Edwards, in the American Civil War: …combat veterans were referred to as suffering from “soldier’s heart. ” In World War I, symptoms that were generally consistent with PTSD were referred to as “combat fatigue. ” Soldiers who developed such symptoms in World War II were said to be suffering “gross stress reaction,” and many who fought in Vietnam … were assessed as having “post-Vietnam syndrome. ” PTSD has also been called “battle fatigue” and “shell shock. ” (Dryden-Edwards, 1).

What is PTSD? According to the National Center for Posttraumatic Stress Disorder under the auspices of the U. S. Department of Veteran Affairs, PTSD is an anxiety disorder that can occur after someone has been through a traumatic event. A traumatic event is further defined as, “…something horrible and scary that you see or that happens to you” and that during this type of event, “…you think that your life or other’s lives are in danger” (National Center for PTSD, 1). Thus, anyone who has gone through a life-threatening event is prone to develop this type of mental illness.

These events can include the following: • Combat or military exposure; • Child sexual or physical abuse; • Terrorist attacks; • Sexual or physical assault; • Serious accidents; and • Natural disasters such as hurricane and earthquake (National Center for PTSD, 1). It must be made clear though that there are many who went through horrible events such as those listed above but they do not develop PTSD. This led many to argue that those who have PTSD are prone to develop the illness not because of what happened to them but the problems is already inherent in them.

Others even go as far as saying that soldiers who develop PTSD are mentally weak to begin with and so when faced with a problem that they could not deal with they succumb to the pressure and begin showing symptoms of anxiety disorder. It is safe to say that no one really knows why some soldiers have PTSD while others who experienced the same life-threatening event can move on with their lives and can readjust to civilian life. Assessing Patients with PTSD According to some researchers the prevalence of PTSD among combat veterans can go as high as 30 percent (Dryden-Edwards, 1).

This is indeed a significant number but the problem is that no one seems to know that they have one or that a family member is suffering from this condition and has never received adequate treatment. A veteran who is suffering from depression or substance abuse may begin to wonder if there is much more to this behaviour. The war veteran can begin an initial assessment by looking at the following checklist provided by health workers who specializes with mental illness. This is because in most cases PTSD is dependent on the following conditions (National Center for PTSD, 1): • Intensity of the trauma and how long it lasted;

• The person lost someone close to him or her; • Proximity of the person to the traumatic event; • The degree of reaction to the traumatic event; • The degree of control felt by the person with regards to the event; and • The degree of help and support received after the traumatic event. Veteran soldiers can go back to the most harrowing events of their military career and using the above-mentioned list can make an initial assessment. With the help of friends and family members he or she can make the decision to seek help and stop pretending that there is nothing more to the addictions and the continuing struggle with depression.

Denial and the fear of being branded as weak will drive them further into hiding and if they are afraid to reveal what they truly feel then there will be no hope for them. After the initial assessment and the war veteran decided to seek help from a professional, the mental health expert will examine the patient using the three groups of symptoms that are required to aid in diagnosis, these are listed as follows (Dryden-Edwards, 3): • Recurrent re-experiencing of the trauma such as troublesome memories, flashbacks, recurring nightmares about the trauma and/or dissociative reliving of the trauma

• Avoidance of places, people, and experiences – to the point of having phobia – that reminds the sufferer of the trauma • Chronic physical signs of hyperarousal, including sleep problems, trouble concentrating, irritability, anger, blackouts and increased tendency to be startled and hypervigilance to threat. When a war veteran begins to exhibit these symptoms it is imperative to seek help. The question remains, will they be able to break out of their shell and openly admit they have problems when society and the government are mum about the issue?

They will have a hard time doing that especially when mental problems will begin to kick in. It is at this point when family members will have to be involved in seeking medical help. Misdiagnosis and Mistreatment One of the main reasons for misdiagnosis is ignorance about the nature of PTSD, that it can be masked with symptoms that are not related to anxiety such as substance abuse and hyper-arousal, irritability and anger. But it can also be argued that the root cause of this ignorance is linked to the government’s denial to openly acknowledge that a high number of veteran soldiers are suffering from PTSD.

There is a good reason though why PTSD is shrouded in silence and this was explained by Scurfield who wrote: Our country has had a long history of a collusion of silence about the full human impact of war … This collusion of denial has been characterized by a convergence of military, medical and political forces that are responsible to maintain a fighting force: ready and able to engage in war, to continue and finish the war successfully, and then afterwards to marshal sufficient human and fiscal resources to respond to the next threat to our country (42). Since World War II Americans are very familiar with war.

It considered normal to be always on the alert for the next major conflict that will arise in a moments notice. With the advent of the Age of Terror America is brought back a time when nations are always in conflict with other nations. Thus, a sense of patriotism will always encourage volunteers and for young men to enlist in the U. S. Armed Forces. But if the government continues to downplay the full impact of the war then no one will know that a significant number of veterans may have come home alive but they left their mind somewhere in Iraq or Afghanistan. These war veterans did not come home whole but fragmented.

One of the major blocks to reaching out to soldiers with PTSD is the myth about war veterans perpetuated in military circles and inadvertently by society as a whole. Veterans are almost always portrayed as conquering heroes and patriots who served their country with courage and honor. Thus, American society as a whole tend to believe that, “Heroes don’t or should not have problems” (Scurfield, 43). The soldiers experience is romanticized in both film and literature giving the false idea that as long as the veteran survived the war unscathed then he will be able to move on with his life.

But Scurfield pointed out that the myths about war heroes send an extremely negative message especially to those with PTSD: “You must be weak of character or psychiatrically troubled if you have any war-related problems … The war is over; you should just forget about it and move on with your life” (Scurfield, 44). As a result veterans are likely to keep their problems to themselves, they will keep their distance from others and they will feel alienated, marginalized and unaccepted.

In the battlefield a highly decorated war hero may have been resourceful, courageous and extremely intelligent, able to solve problems swiftly and decisively. But if he has developed PTSD due to prolonged exposure with life-threatening conditions, he could not apply his wits and his military skills to make himself whole again. He simply needs professional help therefore the U. S. Armed Forces or his family must intervene in his behalf. Upon noticing post-traumatic reactions family members can begin linking behaviour with the war.

A spouse confided to Figley who wrote of her experience: When John started having problem related to the war he became depressed and withdrawn. My first instincts were to let him find his own space, but what finally worked was telling him how me and the kids were becoming scared of him. That got his attention (85). The above-mentioned example of confronting a loved one is an effective tool that is best used within the family. This means that even with a well designed program the family members are still in the best position to help.

Policymakers must keep in mind that in order to reduce misdiagnosis family members must be involved in the healing process. What the Armed Forces Can Do It is time for US Armed Forces to acknowledge the prevalence of PTSD. It is therefore imperative that the government will take extra steps to ensure proper diagnosis and to remove the stigma associated with PTSD. This will draw them out from their shell and the families will be more than willing to risk exposure, coming forward and seeking help. This will also reveal the true extent of the problem.

The government can then respond accordingly providing appropriate medical care and developing efficacious treatments that will speed up recovery. The government must also realize that an effective treatment program involves the family. Abraham Lincoln considered as one of the greatest American leaders of all time was heard to have said that America owe a debt of care for the brave soul who went to battle, “The warrior and family deserve attention today as much as in 1865, when these words were first spoken” (Figley, 81).

Lincoln may probably have no idea of PTSD, but he was wise to consider the families and not just the soldiers who went to war. The wisdom of involving the family is seen in the fact that they can help the soldier recover from his psychological problems and at the same time it is recognizing the obvious that family members are the first to experience the negative effects of PTSD. This was expounded in the following statements: Just as the nation owes a debt to its warriors, it also has an obligation to the families of the warriors.

A warrior’s family is capable of doing much more for the veteran than any institution, no matter how committed. However, there is another equally important reason for attending to veteran’s families: the war effects are felt strongly by family members in their daily lives (Figley, 81). It is not fair to say that the government is not doing anything to combat PTSD. On the contrary one government agency the U. S. Department of Veteran Affairs is trailblazing the way to learn more about the condition.

According to Dombeck the said agency is responsible for securing an official diagnosis for PTSD in the 1980s. But in the same breath it must be said that the government has still a long way to go to prove that PTSD is top priority (Dombeck, 1). It must begin by being more open and honest about the true nature of war. The U. S. Armed Forces must realize that instead of being defensive about veterans developing PTSD, transparency may even lessen the criticism and result in more recruits. It is hard to join an organization knowing fully well the unacceptable way they treat their veterans.

Conclusion More often than not war is romanticized in both film and literature. Boys are made to like the idea of fighting the bad guys. Thus, going to war in defense of country is seen as a noble pursuit. As a result many are attracted to join the army or enlist in the various branches of the military. There is nothing wrong with the idea of fighting for the sake of freedom and democracy but the U. S. Armed Forces in conjunction with the government must do everything in its power to reveal the full impact of war. There is no need to sugar-coat the brutality of conflict.

In the 21st century the government must be more forthcoming with the idea that in a war there are casualties and that a human being can be hurt not only with shrapnel and bullets but also with the traumatic events that are witnessed by the soldier in the battlefield. Denying this fact will only create more problems down the road. If the government becomes defensive and continually downplaying the negative impact of war, there will come a time when this mentality will backfire. It can be argued that as more Americans get hold of the idea of PTSD, they will be more reluctant to join the army or the Armed Forces.

Aside from worrying about their recruitment quotas there is another major reason why the government should acknowledge the prevalence of PTSD and it is to draw out victims of traumatic events and make them feel that it is all right to come out and seek help. The acknowledgment of the prevalence of PTSD will help shatter the myth of surrounding war veterans. They are not invincible; they do not possess super human qualities. It is normal for them to feel that way because no normal person can survive a harrowing experience without somehow being affected by it.

It is true that there are members of the armed forces who went through similar traumatic events and yet able to move on with their lives. But because of the nature of PTSD and the tendency to deny problems, no one is really sure if they are mentally healthy or not. If the government will stop pretending that there is nothing wrong with war then resources can be diverted to take care of soldiers suffering from PTSD. It will encourage families to confront their loved ones knowing fully well that the government is fully supportive of their actions to seek treatment and medical care.

When the government will fully acknowledge the impact of war and the high probability of developing PTSD, mental health workers can begin developing programs that are geared to helping not only the victim but also the families of those suffering with PTSD. As mentioned earlier this is a step in the right direction because the family is in the best position to spot problems. Moreover, if denial and other stress related issues will begin to cloud the judgment of the war veteran the family can intervene in his behalf.

Works Cited

Coon, Dennis. Psychology: A Modular Approach to Mind and Behavior.CA: Thomson Wadsworth, 2005. Dombeck, Mark. “PTSD Treatment Readiness and the Looming Iraq War PTSD Bubble. ” MetnalHelp. net. (22 October 2007). 28 July 2008 <http://www. mentalhelp. net/poc/view_doc. php? type=doc&id=13700>. Dryden-Edwards. “Posttraumatic Stress Disorder. ” MedicineNet. (27 July 2008). 28 July 2008 <http://www. medicinenet. com/posttraumatic_stress_disorder/article. htm>. Figley, Charles. “For Those Who Bore the Battle: Family-Centered Veteran’s Services. ” The Legacy of Vietnam Veterans and Their Families. Ed. Dennis Rhoades & Michael Leaveck. Washington, D.

C. : Diane Publishing, 1996. 80-92. National Center for Posttraumatic Stress Disorder. 01 December 2007. What is Posttraumatic Stress Disorder (PTSD)? 28 July 2008 <http://www. ncptsd. va. gov/ ncmain/ncdocs/fact_shts/fs_what_is_ptsd. html>. Scurfield, Raymond. Healing Journeys: Study Abroad with Vietnam Veterans: Vol. 2 of a Trilogy. New York: Algora Publishing, 2006. Vedantam, Shankar. “Most PTSD Treatments Not Proven Effective. ” (19 October 2007). 28 July 2008. <http://www. washingtonpost. com/wp-dyn/content/article/2007 /10/18/AR2007101802186. html? hpid=topnews>.

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