PTSD / OSI [Merged]

[Armymedic]

Just to disclaim before I start...This is a bit outside my lane as I an not a doctor, and have a broad general understanding of this.

Should PTSD be divided into 3 categories and renamed?
1. Operational Stress divided into two sub categories - Combat stress
                                                                           - Operational stress
2. Workplace Stress
3. Nervous breakdown

Post Traumatic stress (PTS) which is the true root cause of PTSD usually includes an incident with death or where people or the person themselves are injured or in percieved risk of being injured or killed themselves.

Critical incident stress (CIS)(which I am familiar with and have experienced due to my line of work) is where the exposure to similar stress stimulia as above that causes immediate responses. The body's and mind's ability to deal with that stress is what seperates those who do or do not develop PTSD from thier critical stress.

Combat and operational stresses may or may not, depending on personal circumstance and previous experience induce a situation which causes CIS or PTS.

So to divide it into the grouping you suggest minimalize PTSD to some of thier root causes. PTSD, regardless of the cause is still PTSD.

And as you may know, PTSD is not / does not limit itself to sex age or occupation. It is the experiences I meantioned above that cause it. Its just more common in the military.

Noting that; points 2 and 3 are psychological events, but should not be classed as PTSD. Confusion as such is one of the problems in the diagnosis and treatment.

 

[Edward Campbell]

I wonder: To what, if any extent training and discipline can help people cope with Traumatic Stress?

I know people, served with people, who shared experiences very like Romeo Dallaire's, for example, albeit on a smaller scale but equally or more 'up close and personal.'  Most of them seem to have come through the experiences with little visible problem.  The odd nightmare, I suppose; some have unreasoned distastes for certain people (groups of people) or places; a few simply avoid any associations which might require them to discuss their experiences.

What seems, to me, to unite them, besides age, is that they were all came up through a system in which priority was given to recruiting tough young men and then â “ through intensive training and socialization - toughening them further while, simultaneously, instilling very, very high standards of self-discipline.

If my observations are correct â “ and I'm quick to admit that's all they are: my, essentially random, observations of some people â “ then can we, should we stiffen our recruiting, training and performance standards to reemphasize which I will call, for lack of a better phrase off the top of my head, the soldierly virtues?

I see those virtues as being:

o Toughness;

o Superb Discipline;

o Good training; and

o Good leadership.

It takes more than that to make a good army but those things seem, to me, to be the core of a good soldier.

I'm not suggesting, not for a moment, that those who have experienced PTSD are not good soldiers.  Of course they are or were, but I ask if the army did all it could to prevent them from experiencing the disorder which results from the unavoidable stress.

 

[Kat Stevens]

Edward, your observations are pretty accurate.  In the socio-engineering petri dish that the CF became in the '80's and '90's,  training people to be tough and disciplined is no longer in.  Much better to teach with a hug than a harsh word, suits the PC "we don't want to hurt anyones feelings" agenda.  You're correct, maybe if we'd been trained harder, fewer of us would be walking around with a label today.  It however, has become much easier to pigeon-hole, label, and medicate than to prevent.  No such thing as a rotten kid anymore, he has ADHD, and so on.  Don't exactly know where I was going with this, fingers took on a mind of their own, sorry for the ramble...

Lest We Forget

CHIMO, Kat

 

[SHELLDRAKE!!]

I am a firm believer of CISD (critical incident stress debrief). As soon as possible after an incident, getting all parties together to talk about the incident that just happened in an informal environment can do wonders at preventing PTSD. That way everyone can cover what went right, what went wrong and what can be improved on. It also gives the people involved reassurance that theres others to talk to and prevents the feelings that your the only one who feels this way.

 

[visitor]

Toughness and discipline do not necessarily reduce PTSD. In the "good old days" when people were not identified and treated, they lived   lives of quiet desperation characterized by alcoholism, spousal abuse,, drug addiction and veiled suicide in the form of car "accidents'".   Things were not always good behind the closed doors and stiff upper lips   of the 40s and 50s. Ditto with ADHD. We now know that that the brains of those with ADHD are different than typical brains and we now provide help. While there are a few cases of overdiagnosed, gray area, the   situation for the vast majority of sufferers of emotional and cognitive disorders is much better   now than it was years ago. "Pigeon holing" is just a perjorative name for pattern recognition in order to be the most efficient at using treatment modalities. We don't "pigeon hole" people when we notice the cluster of symptoms they have   is TB or cancer. We diagnose so we can treat.

 

[pbi]

If I am not mistaken, there is a body of empirical evidence gathered in the last few decades that suggests very strongly that the psychological effects of combat can be mitigated. "Mitigated", I said...not "prevented". I do not think that there is anything out there to suggest that it can be "prevented" in a healthy, functioning, non-psycopathic human mind.

I believe that this mitigation is a product of several things:

-trust in peers and leaders;

-strong unit cohesion overall, and particularly at the sub-unit levels;

-clear understanding of the mission, the situation and the risks;

-expectation of success;

-belief that if you are injured you will be cared for quickly and effectively;

-ability to "fight back" effectively;

-confidence in equipment and own skills;

-personal religious faith;

-pro-social adjustment; and

-strong and healthy family of origin environment.

I do not believe that on their own, any one of these is sufficient, but in combination they seem to offer a great possibility to slow the rate at which people will become psychological casualties. Where they are absent, in my (layman) opinion the risk will go up as these mitigating factors decline.

This is why good units typically last longer in tough situations than bad ones. No unit will last any longer than its people do.

Cheers.

 

[buzgo]

I watched the show last night with my father, who came to Ottawa to go to the National War Memorial today. He served with the 8 CH and was deployed to Egypt in the 60s - he had some friends killed during the tour and had experiences that he still won't talk about. We spoke quite a bit about the people profiled in the documentary and I had some realizations that may or may not be relevant. I don't want to label any groups or point any fingers mind you... but it may come off that way:

When the guy who had been taken hostage by the Serbs near Visoko in '95 was talking, I started thinking: I was with the National Real Link (NRL) det in CANBAT2 from Feb - Sep '95. I was there when the Serbs shelled the camp, I was there when the hostage situation happened, and I was there for several other smaller incidents. I did my pre-deployment training in Valcartier with 12 RBC. During the time we were in Val, there were a couple of suicides (guys that were deploying to Bosnia). While the 5 Bde guys were in Bosnia, there were MANY incidents ( We sent the SIRs back to Canada) ranging from minor disciplinary problems to at least one suicide. Then apparently there were suicides AFTER the tour.  So what I am wondering is: Is there something in the way that 5 Brigade was training, or something in the makeup of soldier from Quebec that makes them MORE susceptible to PTSD effects? I don't recall there being these kinds of problems when I was with 2 CMBG.

I'm not discounting anyone's experiences. I myself had issues when I returned from that tour - as a reservist I was dumped back home with NO support and it took a while to feel better.

 

[paracowboy]

studies are being done now that are based on Grossman's findings. If you haven't read On Combat, or On Killing, and are a soldier, police officer, or simply care about the welfare of your soliders and your police officers, read them.

 

[pbi]

studies are being done now that are based on Grossman's findings. If you haven't read On Combat, or On Killing, and are a soldier, police officer, or simply care about the welfare of your soliders and your police officers, read them.

Agreed. I have heard Grossman speak. He is a bit of showman, but he has some very important things to say. IIRC, he claimed that the majority of US troops in combat do NOT develop PTSD, and that while recuiting into the US Army is difficult, retention in combat arms units that have been to OIF is quite good.

Cheers

 

[Gunner98]

Should PTSD be divided into 3 categories and renamed?

1. Operational Stress divided into two sub categories - Combat stress
                                                                          - Operational stress
2. Workplace Stress
3. Nervous breakdown

Stress categories - at best.  3. is a reaction, 2. Is a potential cause.  1.  Combat and operational stress do not necessarily result from a Traumatic Incident. 

How about a definition such as:
Posttraumatic Stress Disorder, or PTSD, is a psychiatric disorder that can occur following the experience or witnessing of life-threatening events such as military combat, natural disasters, terrorist incidents, serious accidents, or violent personal assaults like rape. People who suffer from PTSD often relive the experience through nightmares and flashbacks, have difficulty sleeping, and feel detached or estranged, and these symptoms can be severe enough and last long enough to significantly impair the person's daily life.

PTSD is marked by clear biological changes as well as psychological symptoms. PTSD is complicated by the fact that it frequently occurs in conjunction with related disorders such as depression, substance abuse, problems of memory and cognition, and other problems of physical and mental health. The disorder is also associated with impairment of the person's ability to function in social or family life, including occupational instability, marital problems and divorces, family discord, and difficulties in parenting.

Source: http://www.ncptsd.va.gov/facts/general/fs_what_is_ptsd.html

 

[3rd Horseman]

Gunner98,

    Good points could you post the psy ref quote right from the med manual for PTSD. I cant remember it exactly but I do know it changed between 97 and 2000 and then I heard it changed back to the 97 diagnosis criteria. Can you elaborate a little.

  Reason being,  the definition changed and now encompasses more people such as we saw on the movie. With a move back to the old version if I'm correct will that cut out some current claims.

 

[Zarathustra]

How about a definition such as:
Posttraumatic Stress Disorder, or PTSD, is a psychiatric disorder that can occur following the experience or witnessing of life-threatening events such as military combat, natural disasters, terrorist incidents, serious accidents, or violent personal assaults like rape.

I think an important point is missing in this definition. This one is from the DSM-IV.

"A.  The person has been exposed to a traumatic event in which both of the following were present:
(1)  the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others.

(2)  the person's response involved intense fear, helplessness, or horror."
http://omi.unm.edu/PTSD-DSM-IV.html

The point is, the intense fear and helplessness must be present. You must lose control of the situation. If the stress is extremely high but you have been trained and you know what to do, you should still feel, to some degree, in control. And according to the DSM, you should not get PTSD. You will probably have symptoms like nightmares and hypervigilance, but they should go after a while, not persist forever.

 

[Edward Campbell]

...

The point is, the intense fear and helplessness must be present. You must lose control of the situation. If the stress is extremely high but you have been trained and you know what to do, you should still feel, to some degree, in control. And according to the DSM, you should not get PTSD. You will probably have symptoms like nightmares and hypervigilance, but they should go after a while, not persist forever.

I do not see how you can draw that conclusion from the definition presented.  It says:

(1) the person experienced, witnessed, or was confronted with an event or events that involved [one of]

"¢ actual or threatened death or serious injury, or

"¢ a threat to the physical integrity of self or others

(2) the person's response involved [one of]

"¢ intense fear,

"¢ helplessness, or

"¢ horror.

In other words a person who witnessed "a threat to the physical integrity of others" and whose "response involved horror" might suffer PTSD.  Plenty of people who spent time in Central Africa during the past 40+ years fit that definition - they witnessed, with horror, threats (and much, much more) to the "physical integrity of others" - even if few appear, to me, to suffer PTSD.

I think your deduction, that discipline and training allow most people to experience stressful, traumatic events without suffering disorders, is correct.  I just don't think your interpretation of the definition is sound.

 

[Zarathustra]

Where do you disagree with me ? That it's not automatic ? I agree... What I'm saying is the previous definition (from ncptsd) didn't involve the helplessness and horror part. I think it's important because not all threatening events can cause PTSD, only those where the response involves fear, helplessness or horror. And I suggest that training can reduce the fear and helplessness, therefore reducing the risk of PTSD even when the events are very threatening.

 

[3rd Horseman]

The DSM has changed from when I was diagnosed. The old DSM which I believe may be being switched back is the true determination of a diagnosis from my prospective. It read (from memory) similar to the above but was only that the person had to have a real or reasonable perceivable threat of great body harm or death. Under that DSM the people who attended Swiss Air on the recover could not claim PTSD but only a survivor of the flight. Since all died no one from Swiss Air recovery could claim PTSD. I was on the Swiss Air recovery as a PTSD diagnosed victim from another Acton and I can tell ya that Swiss Air did not effect me other than as a bit of a trigger at times.

The girl in the Navy in the movie and all who were on Gulf War operations could not claim PTSD since they were 3,000km from the war and under no reasonable threat. Same goes for Remfs in Bosnia who were on the adriatic sea while the fighting was some 20 hours inland, yet they still claim........!

Edit: typo

 

[Edward Campbell]

Where do you disagree with me ? That it's not automatic ? I agree... What I'm saying is the previous definition (from ncptsd) didn't involve the helplessness and horror part. I think it's important because not all threatening events can cause PTSD, only those where the response involves fear, helplessness or horror. And I suggest that training can reduce the fear and helplessness, therefore reducing the risk of PTSD even when the events are very threatening.

I disagree with: "... the intense fear and helplessness must be present. You must lose control of the situation."

I don't think the definiton says that.  It appears to me that the authors of the definition intended that a person who observed, horrified, threats (or worse) to the physical integrity of others might become an offical candidate for PTSD.

 

[visitor]

The criteria says the person's RESPONSE is one of fear, helplessness, etc. That does not imply  that there is real loss of control, only  perceived  fearfullness and loss of control.

As well. there are individual differences present that make one predisposed to PTSD or more resiliant, under the same circumstances. For example, adults who have been abused as children  usually have a lower anxiety threshold than people not abused. There are  many other  variables that are not neccesarily  eliminated by training.  BTW,  Does the CF screen people for abusive backgrounds  during recruitment?  And one does not necessarily want to disclose that anyway.

 

[3rd Horseman]

Recruits screened for abusive back grounds ummmm... I doubt it. I guess thats why the second question I was asked by a social worker at the PTSD clinic in Ottawa was "have you ever been abused". I would suggest the opposite is true, the more you are abused as a child the more psycho you would be as an adult thus showing no signs of PTSD if put through a war.
Remember the only people who don't get PTSD are psychos.

 

[visitor]

I don't have the time or space to reply completely to your post, but I would just make an analogy: Some people are  fatally allergic when exposed to peanuts, some are not.  Some  get allergic by having frequent exposure, some are born allergic. Some learn  how to avoid peanuts and give themselves their shot when exposed, others have no such opportunity.  There are no value judgements made  of individuals who have peanut allergies or PTSD. The professionals who treat them, however, should be judged as to their competency.

Children who are  abused do not all end up with life long bad effects. In recent years, in fact there has been more research studying kids who have been abused and nevertheless turn out well, in order to find out what environmental or intrinsic factors protect them. One is intelligence. Another is having one person in their life that believes in them. Only one, imagine that.  There are more.

 

[George Wallace]

Children who are   abused do not all end up with life long bad effects. In recent years, in fact there has been more research studying kids who have been abused and nevertheless turn out well, in order to find out what environmental or intrinsic factors protect them. One is intelligence. Another is having one person in their life that believes in them. Only one, imagine that.   There are more.

Are we defining "Abuse" by todays standards or by 1950's standards?   In the 1950's a parent was allowed to perform the common practice of "spanking" and use of the "Strap" to discipline their child.   Teachers also conducted disciplinary acts in the same manner.   In todays Canada, that is assault.   It is considered Child Abuse.  

If, by this, you mean that some of the Baby Boomers have grown up to be model citizens, after years of abuse, I think we have a problem of perspective.   What is considered abnormal behavior in todays society, was once considered normal behavior.   How can we truly compare the two?  We are making criminals of people who abided by the laws of society.  People, who are now considered monsters by the liberal minds who have fashioned the new society.