Post-traumatic Stress Disorder
“Exposure to an exceptionally threatening event of catastrophic nature” – PTSD! A condition which has been around since the human race began. Early humans would have endured attacks from predatory animals, witnessed atrocities from fighting between tribes or have been subjected to life changing circumstances. Today we contend with warfare, terrorism, traumatic accidents, serious illness and loss of loved ones in tragic circumstances. Then and now the severity of exposure can immediately, or over time lead to stresses on the brain, which present as PTSD.
In 1980, the American Psychiatric Association created the post-traumatic stress disorder diagnosis and since then, major research has been undertaken into the condition.
Symptoms of PTSD normally develop within the first month of exposure to a traumatic event, however in a minority of cases symptoms can appear months or even years later. Constant severe symptoms may be experienced by some, whilst others may have symptoms which for a while dissipate and then develop to become more severe.
Every conflict has its casualties both military and civilian, those wounded and sustaining life changing injuries and others who witness terrible incidents, or are involved in the aftermath. Soldiers, sailors, airmen of all ranks, including officers, may develop PTSD, following exposure to trauma. A study undertaken by King’s College London and published in the British Journal of Psychiatry in 2018, reported that “for the first time we have identified that the risk of PTSD for veterans deployed in conflicts was substantially higher than the risk for those still serving.” Approximately 1 in 3 service people during their military career would deploy on operations. Whilst veterans would previously have been slow to come forward for treatment, possibly due to the stigma associated with PTSD, this had improved. Veterans were now more likely to access treatment within 2 – 3 years following exposure, down from 10 – 13 years.
The transition to civilian life on leaving the military with mental health conditions and loss of social support were seen as potential triggers for PTSD.
According to helpguide.org, PTSD develops differently in each veteran and within four symptom clusters. The American Psychiatric Association also defines similar clusters. Symptoms reported by both organisations are grouped below:
- Recurrent, intrusive reminders of the traumatic event, including distressing thoughts, nightmares, and flashbacks where you feel like the event is happening again. You may experience extreme emotional and physical reactions to reminders of the trauma such as panic attacks, uncontrollable shaking, and heart palpitations.
- Extreme avoidance of things that remind you of the traumatic event, including people, places, thoughts, objects or situations you associate with the bad memories. This includes withdrawing from friends and family, losing interest in everyday activities and resisting talking about what happened or how you feel about it.
- Negative changes in your thoughts and mood, such as exaggerated negative beliefs about yourself, others or the world and persistent feelings of fear, guilt, or shame. You may notice a diminished ability to experience positive emotions and an inability to remember important aspects of the traumatic event. The negative thoughts may lead you to have distorted views about what caused the event or the consequences of it, leading you to blame self or others. You become much less interested in activities previously enjoyed. You may also become detached or estranged from others and unable to experience positive emotions.
- Being on guard all the time, jumpy, and emotionally reactive, as indicated by irritability, anger, reckless behaviour (including in a self-destructive way), difficulty sleeping, trouble concentrating, and increased alertness.
We hear about military operations, the number of deaths and casualties sustained and the suffering endured in civilian populations. But, to comprehend what it must have been like first hand, the stresses on those involved, their stories need to be heard. To celebrate its 100th anniversary, ‘Combat Stress’, a charitable organisation which supports service people suffering from PTSD and other major mental health conditions, made a video. It takes you on a journey from when a service person enlisted, through the life changing experiences they had and symptoms, to treatment received and the difference it was making to their lives. To give context and understanding to the events which led to PTSD and other complex mental health conditions, their stories are summarised;
Northern Ireland – The place lit up, flashbangs going off. The boss was shot and dragged to a safer place, leaving a trail of blood. We knew to apply field dressings, first one, was still bleeding so a second and third were applied. Still bleeding after three meant that a tourniquet was needed. We learnt that he had a severed femoral artery. Later at a field hospital a nurse asked if I was okay. I knew I had blood on my hands. I was asked to clean myself up and, in the mirror, I noticed for the first time that my face was covered in blood. I collapsed!
Falklands – I was on board the Sir Galahad, I knew we were an easy target! Within 4 minutes 55 were killed and 138 injured. Waterproofs melted into people. I was a young man and had to go and rescue some of those people.
Bosnia – Hit a landmine and saw a young kid starving, he had lost both of his parents. The look in his eyes was like he had seen some terrible stuff.
Northern Ireland – A car had exploded and been swept across the road. When I arrived the passenger door was open, a person I knew, a lovely person, a handyman. His family had been targeted for work he had done for us. His family were in the car, wife badly burnt cradling her daughter. He had been cut in half. I remember the daughter’s slippers blown out of the car and onto the road. The car he was driving, I had sold to him.
Afghanistan – Lots of kids of Afghan tours had burns on the ward. We had 10 intensive care beds, which was a lot. A typical shift handover when full included, 5-6 burns, I didn’t like burns! About 4-5 children would be in the beds, the remainder filled with soldiers. A lot of colleagues didn’t want to look after the children and I didn’t want the burns. Children would be covered in lots of horrible dirty wounds. I was a nurse of 34 years, I vomited!
A mix of medication and therapies are often used to treat people with PTSD. The goal when applying therapies is to;
- Have a positive impact on a person’s symptoms
- Provide the skills needed to enable self-help
- Restore self-esteem
- Cognitive Processing Therapy (CPT),
- Prolonged Exposure Therapy (PE)
- Eye Movement Desensitisation and Reprocessing (EMDR)
- Stress Inoculation Training (SIT)
- Arts Therapies
A ‘White Paper’ on music therapy and its positive impact on PTSD sufferers, was written by the US Department of Defence, to understand how music might be used to support its service people.
To find out more about Music Therapy services, contact MediMusic.
PTSD Resolution is a UK charitable organisation supporting veterans, reservists and families who are “struggling to reintegrate into a normal work and family life because of trauma suffered during service in the armed forces”. For further information and support contact PTSD Resolution on Tel: 0300 302 0551 or email: ptsdresolution.org.