Health

I didn't know about this until the other day when a neighbor mentioned it, but apparently there is an extensive literature and ongoing research about fish oil being good for lessening the impact of PTSD, or even of deterring it, if taken earlier.

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The New York Times discloses today that earlier this year, Gen. Petraeus was treated for prostate cancer. No wonder he looked a little peaked lately. This may also partly explain his relatively low profile on Afghanistan.

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Speaking of invading Iraq: The American Enterprise Institute may have been wrong about that launching that war, which I believe has been the biggest mistake in the history of American foreign policy. But, hey, everyone makes mistakes. They are holding what looks to be a good conference Friday about irregular warfare and psychological resiliency.  

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I have a lot of sympathy for people carrying around PTSD. It sucks.

But now I see where a former spokesman for the British ministry of defense says he has post-traumatic stress disorder from telling so many lies about the Iraq war. Really? If that were really the case, I'd expect to see the sidewalks of Washington crowded with former Bushies gone barking mad.

Hey, look out the window ...  

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Now the Pope breaks his wrist. Hillary Clinton, Sotomayor and so on-everybody is busting bones. A cast of thousands, if you will.

I had thought that what was going on was that aging boomers don't know when to stop. (The other day I jammed a finger just trying to stop a grounder in left-center field.) But I don't think the Pope really fits in that category.

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One reader of this blog, David McCracken, in response to an earlier posting suggested reading this article on PTSD that ran in Scientific American earlier this year.

It's worth reading. Essentially it argues that the diagnosis of PTSD is being "wildly, even dangerously, overextended." I think that may be true in some ways. But it seems to assume that having PTSD means being disabled. (And he shows how the U.S. government's benefit system seems to push veterans in that direction.) Yet, he says, he can point to a veteran he knows who supposedly is at risk, yet functions just fine, at home, at work and in society.

But I found a lot to disagree with here. First, I know plenty of people who I think have PTSD, yet function extremely well. That doesn't mean they don't have it. That just means they have learned to handle it, or even have moved on.  

I got the sense that the article's author, David Dobbs, and the researchers he interviewed know a lot more about psychiatry than they do about war. For example, I find it entirely possible that PTSD rates are higher for Iraq than they were in Vietnam. First, there is no safe, rear area in Iraq -- even the Green Zone has taken plenty of rockets. Second, and more significantly, the proportion of soldiers and Marines doing multiple combat tours is much higher in Iraq than it was in Vietnam, where there were lots of draftees who did one tour and then got out. 

I find Dobbs more persuasive when he argues that there is a "cultural obsession" with PTSD. "It may be our own postwar neurosis."

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I am posting this interesting note from a Marine veteran with his permission. I think there is something to consider here about his report of going through PTSD and coming out smarter, calmer and happier:

Regarding your new post on PTSD I'm glad that you posted the great link and, on a purely confidential basis, I believe the fairly common idea (certainly on the shrink side) that "PTSD...cannot be cured, only managed", may turn out to be a pile of horse manure in the long run.

How society defines its illnesses has a huge impact on their treatment.

Society is telling PTSD patients that they are marked for life and can never hope to cure themselves. That leaves no room for hope. And on what basis? We've barely got a handle on PTSD - have barely scratched the surface in terms of its effects on brain structure and avenues for treatment - and we're already calling quits on a cure? Why?

Recovery is possible. But as long as soldiers and Marines - often young, insufficiently skeptical, utterly reliant on authority - are told by everyone around them that the mind is like a bottle, and that once it breaks, you can piece it together again, but it'll never be as strong - as long as that's the social message, there's little hope for full recovery. But the mind isn't a bottle. It's a bone. Once it heals, it grows stronger, more resilient. We need to change the message to reflect the possibility of being strengthened by PTSD in the long run.

The timing of your blog post is very fortuitous. Last night, I received a call from one of the Marines who handled my medical discharge - for PTSD - and who's kept in touch with me since I left the Marines in '07.

He asked me to call another Marine who's been dealing with PTSD for years and is trying to move forward, because he wanted me to relate how I've not just come to terms with PTSD, but haven't had any symptoms since roughly three months after my discharge. I'm calmer, smarter, happier than I've ever been in my life -- and I've tested myself under very stressful circumstances. Next month I'm heading to [deleted] because I can still contribute as a civilian. And by next year I hope to be waived back into the military, as an officer; and I wouldn't do so unless I was 100% confident that I will not jeopardize the men under my future command by re-enlisting with persistent symptoms or delusions that I'm fully healthy.

I cannot be the only one, because there's nothing special about me. And I'm not going to dedicate my life to this issue because I just want to move on. But more prominent veterans can make a difference. Iris Adler made a documentary featuring your own Nate Fick talking about how he overcame PTSD, in so many words. I was about to email Nate to ask him whether he thinks he's overcome it. Please ask him. If he's symptom-free, it should mean he's cured, not that it's always just around the corner; because "you never know about tomorrow" isn't a scientific benchmark. It's a recipe for anxiety and fear.

Veterans and serving Marines need to finally hear success stories. They need hope, not life sentences. We just need to find and publicize these stories.

So, maybe one question worth looking into -- and I've never heard of a journalist doing so -- is whether veterans with PTSD ever re-enlist.

Surely, out of the tens of thousands with PTSD, there must be some who came back -- in every sense of the words -- to continue doing what they love, and inspire those around them to stare their demons in the face and walk away much stronger for it.

If you like, I can write more about what factors helped me overcome PTSD, why treating PTSD like alcoholism encourages us to give into our symptoms, and other factors, like distinguishing between regular strong emotions and PTSD-induced emotions, which seem to be overlooked at large. But I think I've written enough for now -- I'm more interested in your thoughts in response.

Tom here: I think a better way of expressing the notion that PTSD cannot be cured but managed is to recognize that combat is often a life-changing experience. You can't undo the past, but you can understand and adjust to it, and move on, somewhat. 

On the issue of resiliency, CNAS also has a project looking at "post-traumatic growth," led by Army Capt. D.J. Skelton, a veteran of Second Fallujah. Here is a summary:

Post-traumatic stress disorder has hit the force particularly hard; however, some individuals also experience positive changes, a phenomenon referred to a post-traumatic growth. Indeed, service members may experience PTG along with PTSD or other mental of physical injury, and DOD and VA are increasing their efforts to understand PTG and resiliency. How might post-traumatic growth be incorporated into military mental health management?

You actually can listen to a presentation on this.

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The new issue of Army contains a thoughtful set of exchanges from the CompanyCommand website between a mother wanting to help her son as leaves active duty and others who have been through similar experiences.

The mother, whose name is just given as Judy, said that after her son's tour in Iraq, she found him "cold," and "filled with hate for the Iraqis." He shook when other cars on the road were came close. She asked, "Can we help him?"

There were several moving responses. Ryan Neely, an officer just back from 15 months in Iraq, advised:

Treat him like a man... My mother wanted to keep me in the box she felt comfortable with -- her innocent boy, clean cut and no rough edges -- but that wasn't me anymore. I felt belittled and misunderstood and underappreciated for the sacrifices I had made."

Molly Kranc, wife of an Army captain, added that in her own experience, "PTSD is a chronic condition that cannot be cured, only managed." I liked this insight, which is consistent with what I have seen. I was surprised that I hadn't seen this observation before.

Most strikingly, Ray Kimball called on his own experience to recount that after his combat tour, he was teaching at West Point and found himself irritable and short-tempered. But he didn't seek counseling, he recalled, was "when I nearly hit my now-3-year-old child because he wasn't getting dressed quickly enough. The shock of that was enough to force me to come to terms with that fact that what I was doing was not normal."

By the way, I think CompanyCommand and its sister site, PlatoonLeader, are two of the most effective and thoughtful military innovations of recent years. They are worth far more than whatever it costs the Army to operate them. (Fyi, you need a .mil address to get access to these, I think.)   

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