Roman General Post Traumatic Stress Disorder: From A Combat Veteran's Perspective

 Foreword from Dean;

Thanks to a post at Miss Beth's Victory Dance I followed a link to PTSD, A Soldiers Perspective and read what I consider to be required reading for all military service member, their families, loved ones, and friends, or any one who cares about our young and not so young warriors.

Far too often veterans live with the trauma of combat or near combat, seldom if ever speaking about their experiences. Many suffer from Post Traumatic Stress Disorder without knowing it or why they seem to feel so much different after they get back home and away from the stresses and rigor of being in a war zone.
This is a very serious issue and I ask that you read this great article by Roman General.
If you know a veteran, his family, loved ones or friends please pass this on to them. There is help out there and we owe it to them for the sacrifices they made on our behalf.

Thank you.

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August 14th, 2008 by Roman General

The original paper that inspired the message and name of my blog:

12/2/2007

Returning Combat Veterans have a difficult time reintegrating back into society and family life. The scope of this paper explains these issues as they relate to the hindrance of Veterans from attaining a meaningful and productive life.

Returning Combat Veterans (RCV), have a difficult time reintegrating back into society and family life. They deal with a myriad of symptoms combining to hinder the RCV from coping in the civilian world, while having constructive relationships with their family and friends. The RCV struggles with these issues on a daily basis. The scope of this paper explains these concerns as they relate to the hindrance of the veteran from attaining a meaningful and productive life.

The symptoms of Post Traumatic Stress Disorder (PTSD) range from acute recurring of memories, nightmares and flashbacks, sleep problems, chronic fatigue, ego developmental disorder, defense mechanism dysfunction, dissociative states, memory repression and memory loss, identity diffusion, chronic depression and suicidal ideation. Substance abuse, addiction, survivor's guilt and somatoform disorders further encumber our soldiers in arms suffering from PTSD.

Combat trauma experiences can cause sleep disturbances in RCV who suffer from PTSD, for the purpose of this section we will concentrate on the psychological aspects of sleep deprivation and the side effects inherent with mental health problems (Caldwell et al, 2005). The avoidance response enables a deadening or numbing of feeling and aids in societal and expressive withdrawal, reducing participation with the external world. The intrusive responses include hyperarousal, irritability and an exaggerated startle reaction, acting out violently, nightmares, flashbacks, and hypersensitivity to stimuli in the environment (Silverstein 1994). “PTSD develops when traumatic events are unresolved and the person is unable to integrate the reality of the particular event and resulting repetitive replaying of the traumatic images, behaviors, feelings, physiological states, and interpersonal relationships” (Caldwell et al, p. 722).

The dreaming process of memory consolidation, when modified by the effects of PTSD and sleep disorders in patients affects Rapid Eye Movement (REM) sleep. An association lies between REM sleep and the processing of memory fragments and information into semantic memory. These processes aid in the contextual consolidation and formation of fluid memories, much like a computer arranges and stores information on its hard drive. A lack of sleep often disrupts this process and leads to memory fragmentation, memory loss or repression of memories. Studies showed that RCV had a higher rate of REM sleep than the control groups, indicating a higher dreaming scape for the RCV. The leading theory states that elevated levels of the neurotransmitter norepinephrine in PTSD patients while awake and asleep, creates a hyperarousal and hypervigiliant sleep state where traumatic dreams recur (Caldwell et al).

The fifth stage of Erikson's stages of psychological development deals with the identity verses role confusion crisis which normally happens in late adolescence and early adulthood. In this stage the person has formulated their constitution of personality, connecting the past with the present. Essential to the completion of this task is the successful formation of principles and moral judgment to make choices in areas such as profession and marriage. “[Erikson] observed a phenomenon which he described as an identity crises, suggesting that through the exigencies of war [the RCV] lost a sense of personal sameness and historical continuity. They were impaired in that central control over themselves for which in the psychoanalytic scheme, only the inner agency of the ego could be held responsible. Therefore, I spoke of a loss of ego identity.” (Silverstein, p. 71). Most of the young women and men inducted into the military have yet to crystallize their formation of a self-image; with the underdeveloped individual identity the effects have been tremendous on the undeveloped ego.

Being deprived of an identity ego formation the soldier has expectations to assimilate back into civilian life and form relationships, provide for their families, and generally assume a civilian personality while shedding their military persona; that which gives them a feeling of safety. Some RCV stay stuck in this military mode of identification, in which they have been taught to conform and repress distinctiveness, autonomy and experimentation; all common experiences in defining oneself and developing a healthy perspective. Silverstein (1994) goes on to quote Erikson, “To be able to truly surrender oneself in an intimate relationship, a certain level of self definition has had to have taken place during the stage of identity formulation. The fluidity of boundaries that occurs when relating intimately or sexually is threatening. The threat is the further loss of identity, which is tenuous to begin with. It is therefore an experience which is avoided by the individual who does not have a firm sense of identity.” A psychic numbing occurs that interrupts and interferes with connections with family, friends, community and a profession.

Silverstein (1994) emphasizes Erikson's diffusion of industry as a lack of organizing cognitive tasks, such as concentration, that would be necessary in maintaining an occupation. A fixation with simple activity or a 'spacing out' would hinder a veteran's ability to sustain gainful employment. “His preoccupation with traumatic experiences may have channeled his psychic energy in a way which precluded that which was necessary for career development” (Sliverstein, p. 74). Many RCV have had many sporadic jobs not lasting long in duration, repeating the pattern many years after their war experiences, and thus further reinforcing the undefined character.

Troubles devising a strong sense of identity often result in a development of a negative identity. Culture has an influence on the developing persona as societies norms are modeled after our parents and peers. At a time when adolescents have not completely formulated an ethical belief system conducive to successes within society, they have been subjected to the armed forces value structure. “In combat, strength and force can be the arbiter of justice and morality. The laws of guerrilla warfare pre-empt compliance with the social and legal niceties of the civilian world” (Silverstein, p. 75). Taken from the jungles or the desert to normal life, a survival response such as these endangers the RCV and exposes them to the legal system. Many times traumatized veterans become seditious and wind up on the wrong side of the law. RCV who have failed to effectively assimilate their wartime incidents become encumbered with guilt. RCV exist with the weight of survivor guilt and of their horrific conduct long after the events, hindering their pre-war values.

Impulse control becomes exaggerated from the demand that soldiers respond automatically, without hesitation which could cost them their lives otherwise. “This tendency to act impulsively is not solely a function of the condition of the combat experience. It is also arguably related, to lower levels of ego development, of which reduced impulse control is a concomitant” (Silverstein, p. 76). By using the lack of impulse control, the RVC may use this mechanism as an endeavor of atonement to ally their remorse. These imbalances leave the veteran unable to forgive themselves of their wartime activities with a crippling continuous cycle of insanity and self-torture.

Detachment and estrangement have been experienced by many RCV; many avoid others for fear of rejection. “The veterans have been trained to sense danger even before it occurs. In the face of danger, they have learned to sense and see danger even before it occurs. In the face of danger, they have learned to react quickly and to attack the danger in a way that shifts many of them into a paranoid-schizoid position of functioning” (Bradshaw et al, p. 472). A struggle arises in healing as the veterans move to a depressive position, as stated by Bradshaw et al, p. 472,“…they sense danger related to feelings of loss, guilt, vulnerability, sadness, remorse, compassion, empathy, and loneliness.” To regain control, Bradshaw further says, “…they shift to the less morally ambiguous paranoid-schizoid position. When they make this shift, they justify their feelings [and actions through this defense mechanism, giving them an]…adrenaline rush and [feelings of] no grief or depression.” When this high wears off, they feel even more depressed. This fragmented personality leads to a life of chasing oneself without knowing their relational boundaries between normal society and themselves.

 

References

Bradshaw, Samuel L., et al. (1993). Combat and personality change. Bulletin of the Menninger Clinic. 57 (4), 466-478.

Caldwell, Barbara A., & Redecker, N. (2005). Sleep and trauma: an overview. Mental Health and Nursing, 26, 721-738.

Silverstein, Rebecca. (1994). Chronic identity diffusion in traumatized combat veterans. Social Behavior and Personality, 22 (1), 69-80.

Posted in PTSD Perspectives.