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Go Back   Armchair General and HistoryNet >> The Best Forums in History > Historical Events & Eras > Modern Wars & Warfare > Military Medicine

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Military Medicine Discuss aspects of this specialist field not covered in other forums.

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  #1  
Old 28 Apr 14, 18:08
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PTSD in the modern US & British Armies.

(Moderators - If I have chosen the wrong section to put this in then please feel free to move it).

This is taken from an occasional blog I write on the Daily Telegraph website here in the UK. I think it speaks for itself, forgive me if I come over a bit preachy or high horseish but it is a subject I feel strongly about and was reminded of it yet again by hearing a program on a BBC radio channel this evening:


Dear All,

I have just listened to a very harrowing program on BBC Radio 4 presented by Michael Goldfarb entitled Suicide Watch. As harrowing a listen as it assuredly was I am glad I caught it and stuck with it to the end.

The program highlighted the growing numbers of returning U.S. service personnel who have committed suicide following deployments to Iraq and Afghanistan, indeed so many have now killed themselves that they outnumber their comrades killed by enemy action in those theaters. How can this be? PTSD is by no means a new phenomenon and yet it is still claiming victims well into the twenty first century. As far as I can judge (based on the program), there are two main reasons, namely the world the returning soldier returns to after their deployment and the number of deployments they serve (there are of course other factors).

The first one is a problematic issue to resolve. Personnel returning from deployments where they have been subjected to the most brutal of sights and situations rely on each other to get them through but when they return home they are confronted by people for whom the most pressing thing on their minds is whether their favored candidate on American Idol is going to get through to the next round or if the local burger joint will still be doing the two for one offer they had last time. As Americas Armed Forces are an entirely volunteer force they see their decision to serve as doing their country and fellow citizens a service, trouble is their fellow citizens largely pay little more than lip service and even those that are appreciative of their sacrifices have no idea of the stresses they have endured, how can they? The disconnect between warrior and civilian has grown so wide neither side can really understand the other, a situation that is exacerbated by the speed with which personnel are transferred from peace to war and back again giving body (and more importantly in many cases) mind little chance to make the transition.

The second (and to me at least) less surprising major factor is the number of deployments personnel undergo. As with most other major Western powers, the United States is scaling back troop numbers which has one blindingly obvious and entirely predictable knock on effect; increased tours for those personnel that remain. With budgets everywhere undergoing cuts force levels have dropped which means that the pool of suitable service men and women has shrunk which in turn leads to less rest between deployments for the units most suitable for the sort of situations faced in Iraq and Afghanistan. War is being fought on the cheap yet the tempo of war has actually increased. How can soldiers, marines, aircrew and sailors maintain any meaningful levels of mental health when they have little chance to process the things they have seen and done? Even outside of combat deployments service personnel must train hard for combat and the sort of situations they can expect to face in the military and that training often comes at a price in the occasional death and injury of personnel undergoing such strenuous exercises. Politicians know this and yet they continue to wield the axe while at the same time getting involved in military campaigns. The usual, threadbare excuse offered is that since the fall of the iron curtain the world has become a safer place and fewer troops are required. Even a cursory glance at todays newspapers and television news will expose that thinking for the nonsense that so obviously is. Syria, Ukraine, Russia, sabre rattling by the Chinese over Taiwan and Japanese lumps of rock no sane person would fight for are just the more obvious flash points that will in all likelihood need addressing (whether people in the west like it or not) at some point in the not so distant future. It cant be done with a skeleton staff and on a comparative shoe string.

Before we in the UK start to feel self satisfied, our service men and women face and will continue to face similar challenges as planned military cuts start to bite deeper. Suicide levels may be below Americas but our veterans struggle with similar mental health, alcohol, and violence problems, both whilst still serving and back in civvy street while many find themselves in prison. Increased deployments can, do and will have life threatening consequences for British soldiers just as they have on their American colleagues. To know this and do nothing is close to murder, to be ignorant of the practical effects these cuts are having on service personnel is even worse.

It is way past time for an honest debate within the Free World about what its citizens want and expect of their respective militaries (remember too that in time of natural or man made disaster military personnel are often at the forefront of relief efforts both home and abroad) and also what parts our politicians (I wont dignify them with the title of 'leaders') expect to play on the world stage that might require a military element, be it anything from providing UN Peace Keepers, enforcing no fly zones, providing humanitarian aid to full scale military deployments overseas. Once it is known what is truly expected of the military then there will be no excuse not to provide them with adequate resources AND look after their mental and physical health both during and after their service. Our service men and women put themselves on the line in peace and war alike, it is high time they were payed more than lip service.

http://my.telegraph.co.uk/drowningno...ning-veterans/
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  #2  
Old 28 Apr 14, 20:10
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Is it PTSD or something else? Could it be the nature of the society these warriors are returning to?
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  #3  
Old 28 Apr 14, 20:26
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I don't know the actual rate - but around here (E. TX) women vets have a much greater rate than their male counterparts, despite not being in Combat Arms.
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  #4  
Old 28 Apr 14, 20:30
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Past three years I've been working with a veterans service 'center'. One of things that has emerged in this are the number of men in the VA support system or entering it who seem to have been spuriously diagnosed as having PSTD. That is they are under treatment for heat disease, spinal or skeletal injuries, diabetes, cancer, & other non combat related problems. Along with all that the doctors also mark down "PSTD". Ok, maybe they know a lot more than lesser minds, but when the veteran is confused & skeptical of the diagnosis, "I sold steaks in the Commissary. How would I have PSTD?" you have to wonder if there are other reasons for including the diagnosis than clear observation of symptoms.

This leads me to wonder if a problem that probablly is serious for a large number of individuals is not being subject to data inflation/distortion making appear to apply to a much larger population.

A second question is if there is a false assumption that PSTD is significantly higher among the veteran population than in the general population. I have a very close friend who worked for nearly a decade in public safety in the Kansas City area. First as a EMT & then firefighter in the inner city, then as a suburban police officer. It does not take a lot of reflection to understand that one can have only so many people die in your ambulance or in a fire you are working before the stress has long term effects. I'd also note this individual in two years as a EMT was shot at far more often that I was in twenty years in the Marine Corps.

When you consider the broad range of psychological trauma the average person might be exposed to, molested or beaten as a child, automobile accidents, other accidents or disasters, as well as the violence & stress public safety workers are exposed to the question of PSTD starts looking far more complex than what we might gather from a news story or two.
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Old 28 Apr 14, 20:47
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Quote:
Originally Posted by T. A. Gardner View Post
Is it PTSD or something else? Could it be the nature of the society these warriors are returning to?
Last year I realized that the traumatic events underlying PSTD usually occur in veterans at about the same age span that male schizophrenia emerges, ages 16 through 25. many years ago it was pointed out to me we are all autistic, the difference is in degree. We have to wonder if some individuals are more vulnerable from deep rooted mental development patterns.

...and yes enviroment/education/upbringing matter. I was raised on a farm & blood, entrails, violent death were a routine part producing food. It was also common in the 1950s for farm workers to be missing fingers & limbs. I wont claim any of this made me somehow immune to PSTD but there may be a difference between seeing a mans arm ripped open before your 8th birthday or after your 18th

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Originally Posted by mimike View Post
I don't know the actual rate - but around here (E. TX) women vets have a much greater rate than their male counterparts, despite not being in Combat Arms.
Rape is one factor there.
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Old 28 Apr 14, 21:23
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Quote:
Originally Posted by mimike View Post
I don't know the actual rate - but around here (E. TX) women vets have a much greater rate than their male counterparts, despite not being in Combat Arms.
Transportation, Military Police.... Medical? That might explain it.
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Old 28 Apr 14, 21:29
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Quote:
Originally Posted by mimike View Post
I don't know the actual rate - but around here (E. TX) women vets have a much greater rate than their male counterparts, despite not being in Combat Arms.
We had a woman vet who had just been released from a VA PTSD inpatient center (we didn't know it at the time) who came to our range and committed suicide.
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Old 28 Apr 14, 22:37
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Quote:
Originally Posted by Dogsbody67 View Post
(Moderators - If I have chosen the wrong section to put this in then please feel free to move it).

This is taken from an occasional blog I write on the Daily Telegraph website here in the UK. I think it speaks for itself, forgive me if I come over a bit preachy or high horseish but it is a subject I feel strongly about and was reminded of it yet again by hearing a program on a BBC radio channel this evening:


Dear All,

I have just listened to a very harrowing program on BBC Radio 4 presented by Michael Goldfarb entitled Suicide Watch. As harrowing a listen as it assuredly was I am glad I caught it and stuck with it to the end.

The program highlighted the growing numbers of returning U.S. service personnel who have committed suicide following deployments to Iraq and Afghanistan, indeed so many have now killed themselves that they outnumber their comrades killed by enemy action in those theaters. How can this be? PTSD is by no means a new phenomenon and yet it is still claiming victims well into the twenty first century. As far as I can judge (based on the program), there are two main reasons, namely the world the returning soldier returns to after their deployment and the number of deployments they serve (there are of course other factors).

The first one is a problematic issue to resolve. Personnel returning from deployments where they have been subjected to the most brutal of sights and situations rely on each other to get them through but when they return home they are confronted by people for whom the most pressing thing on their minds is whether their favored candidate on American Idol is going to get through to the next round or if the local burger joint will still be doing the two for one offer they had last time. As Americas Armed Forces are an entirely volunteer force they see their decision to serve as doing their country and fellow citizens a service, trouble is their fellow citizens largely pay little more than lip service and even those that are appreciative of their sacrifices have no idea of the stresses they have endured, how can they? The disconnect between warrior and civilian has grown so wide neither side can really understand the other, a situation that is exacerbated by the speed with which personnel are transferred from peace to war and back again giving body (and more importantly in many cases) mind little chance to make the transition.

The second (and to me at least) less surprising major factor is the number of deployments personnel undergo. As with most other major Western powers, the United States is scaling back troop numbers which has one blindingly obvious and entirely predictable knock on effect; increased tours for those personnel that remain. With budgets everywhere undergoing cuts force levels have dropped which means that the pool of suitable service men and women has shrunk which in turn leads to less rest between deployments for the units most suitable for the sort of situations faced in Iraq and Afghanistan. War is being fought on the cheap yet the tempo of war has actually increased. How can soldiers, marines, aircrew and sailors maintain any meaningful levels of mental health when they have little chance to process the things they have seen and done? Even outside of combat deployments service personnel must train hard for combat and the sort of situations they can expect to face in the military and that training often comes at a price in the occasional death and injury of personnel undergoing such strenuous exercises. Politicians know this and yet they continue to wield the axe while at the same time getting involved in military campaigns. The usual, threadbare excuse offered is that since the fall of the iron curtain the world has become a safer place and fewer troops are required. Even a cursory glance at todays newspapers and television news will expose that thinking for the nonsense that so obviously is. Syria, Ukraine, Russia, sabre rattling by the Chinese over Taiwan and Japanese lumps of rock no sane person would fight for are just the more obvious flash points that will in all likelihood need addressing (whether people in the west like it or not) at some point in the not so distant future. It cant be done with a skeleton staff and on a comparative shoe string.

Before we in the UK start to feel self satisfied, our service men and women face and will continue to face similar challenges as planned military cuts start to bite deeper. Suicide levels may be below Americas but our veterans struggle with similar mental health, alcohol, and violence problems, both whilst still serving and back in civvy street while many find themselves in prison. Increased deployments can, do and will have life threatening consequences for British soldiers just as they have on their American colleagues. To know this and do nothing is close to murder, to be ignorant of the practical effects these cuts are having on service personnel is even worse.

It is way past time for an honest debate within the Free World about what its citizens want and expect of their respective militaries (remember too that in time of natural or man made disaster military personnel are often at the forefront of relief efforts both home and abroad) and also what parts our politicians (I wont dignify them with the title of 'leaders') expect to play on the world stage that might require a military element, be it anything from providing UN Peace Keepers, enforcing no fly zones, providing humanitarian aid to full scale military deployments overseas. Once it is known what is truly expected of the military then there will be no excuse not to provide them with adequate resources AND look after their mental and physical health both during and after their service. Our service men and women put themselves on the line in peace and war alike, it is high time they were payed more than lip service.

http://my.telegraph.co.uk/drowningno...ning-veterans/
Hi Db,have no answers to this quandary but what always amazes me about it is,publicly to the general world it is a new problem! Yet what about the absolute thousands that came home from the two World Wars? Horrific sights are not a new thing, yet little or nothing has been done in the past about it,Viet Nam,Iraq and Afghanistan did not invent these things,anyone with problems in that way was 'Bomb Happy' or suffering from 'Shell Shock' and more or less dismissed on those grounds. The British Government in the past has always turned a blind eye to things like that,that they do not fully understand or will cost them a 'Buck' or two!! Fortunately the World has backed them into a corner now on the subject and they have got to do something about it! Before 'Topping oneself' becomes an epidemic. lcm1
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Old 29 Apr 14, 01:20
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I truly believe that part of the problem here is simply the system. If you have more police you get more arrests. If you have more psychologists you get more crazy people.

It has as much to do with someone wanting to have self-worth as it does anything else. Add in an incentive like money and the problem only grows exponentially.

What's called PTSD today was looked at very carefully in WW 2 particularly by John Appel and Gilbert Beebe.

Get a copy of this sometime:

http://books.google.es/books/about/V...d=O0YrAAAAYAAJ

They followed 100 infantry companies in the MTO and ETO from entry in combat to the end of the war.
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Old 29 Apr 14, 02:43
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Quote:
Originally Posted by T. A. Gardner View Post
I truly believe that part of the problem here is simply the system. If you have more police you get more arrests. If you have more psychologists you get more crazy people.

It has as much to do with someone wanting to have self-worth as it does anything else. Add in an incentive like money and the problem only grows exponentially.

What's called PTSD today was looked at very carefully in WW 2 particularly by John Appel and Gilbert Beebe.

Get a copy of this sometime:

http://books.google.es/books/about/V...d=O0YrAAAAYAAJ

They followed 100 infantry companies in the MTO and ETO from entry in combat to the end of the war.
You could have part of the problem there. lcm1
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Old 29 Apr 14, 03:52
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Quote:
Originally Posted by lcm1 View Post
Hi Db,have no answers to this quandary but what always amazes me about it is,publicly to the general world it is a new problem! Yet what about the absolute thousands that came home from the two World Wars? Horrific sights are not a new thing, yet little or nothing has been done in the past about it,Viet Nam,Iraq and Afghanistan did not invent these things,anyone with problems in that way was 'Bomb Happy' or suffering from 'Shell Shock' and more or less dismissed on those grounds. The British Government in the past has always turned a blind eye to things like that,that they do not fully understand or will cost them a 'Buck' or two!! Fortunately the World has backed them into a corner now on the subject and they have got to do something about it! Before 'Topping oneself' becomes an epidemic. lcm1
You're quite right of course, PTSD is just the latest name for the problem and for sure, that problem has been ignored or misunderstood or poorly treated. Hopefully that situation is improving.

As for the idea that more psychiatrists will lead to more questionable diagnoses, unfortunately that is almost certainly bound to happen but it's no use throwing the baby out with the bath water, misdiagnosed or false claims will make up a small minority of such cases and pretending otherwise will not make the problem go away.
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Old 29 Apr 14, 06:49
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Quote:
he world the returning soldier returns to after their deployment and the number of deployments they serve
.

In other wars we knew when we could go home, even if it meant at the end of the war. Korea and Nam we had 13 months to do an unless your MOS was in short supply you were done with Nam. Now what do the people have. Deploy for 13 months and "readjust" for 13 and then back to do it all over again. Seems a lot for a person to do and stay healthy. Some troops have had 3, 5 or more deployments and that with a combat unit. Why do so many look for a way out?

Can it be that we over medicate? Is there a relationship between medicine and violent crime? May of our mass murderer's have been on one drug or another?
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Old 29 Apr 14, 08:03
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Quote:
Originally Posted by Half Pint John View Post
t.

In other wars we knew when we could go home, even if it meant at the end of the war. Korea and Nam we had 13 months to do an unless your MOS was in short supply you were done with Nam. Now what do the people have. Deploy for 13 months and "readjust" for 13 and then back to do it all over again. Seems a lot for a person to do and stay healthy. Some troops have had 3, 5 or more deployments and that with a combat unit. Why do so many look for a way out?

Can it be that we over medicate? Is there a relationship between medicine and violent crime? May of our mass murderer's have been on one drug or another?
One of the reasons people succumb to suicidal thoughts (according to an army specialist who contributed to the program I quoted) is due to disrupted sleep patterns that are left untreated. Eventuality the sufferers are not only seriously fatigued but when they hit the tipping point the lack of sleep effects the frontal lobe of the brain which deadens the sense of reasoning and makes a person more likely pull the trigger, especially as by that stage they are unable to empathize with how the ones they leave behind will feel.

Repeated deployments make the seesaw effect of the transition from combat to home worse which is why some soldiers seem able to cope with an initial deployment but then suffer after serving subsequent ones. It has been said (I forget by who) that a persons capacity to withstand combat (and by default any stressful job like police officer or paramedic) is like a sum of money in a bank that accumulates no interest - everybody has differing amounts upon which to draw but eventually it will run out. Repeat deployments merely ensures the acceleration of that process.
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Old 29 Apr 14, 11:47
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I left the army 20 years ago, a couple of years ago I was suffering from depression which I assumed was from the numerous heart attacks I had over a three year period, not so I went to a clinical psychiatrist who being an ex officer spotted something, he sent me got counselling where I was told I had PTSD from three tours of Northern Ireland in the 80's.
We didn't have help as such then and just put things out of our mind. Having a sense of humour kept me going but I'm worried of the backlash from Afghanistan and Iraq in years to come. NI was stressful because in some cases it was like patrolling any other town in the UK, it was a very long and bitter conflict which left its mark on a lot of people and still divides communities with sectarian hatred.
Iraq and Afghanistan were and are bloody, the initial invasion was destructive beyond measure and the destruction and death caused by US and British troops would certainly cause issues with some of the serving soldiers, add to that the insurgency after the invasion and you will have a time bomb of mental health issues for many years to come.
From friends I have that are serving and my son from my first marriage, I have found that constant redeployment is stressful but mostly on the families. The soldiers are too busy doing there jobs to let it effect them, it's when they get home and try to live a normal life when it hits them.
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Old 29 Apr 14, 12:36
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Quote:
Originally Posted by Dogsbody67 View Post
It has been said (I forget by who) that a persons capacity to withstand combat (and by default any stressful job like police officer or paramedic) is like a sum of money in a bank that accumulates no interest - everybody has differing amounts upon which to draw but eventually it will run out. Repeat deployments merely ensures the acceleration of that process.
I read Col. David Hackworth's "About Face" and he described it as a bottle that filled up. Everyone has a different size, but once filled, that was it and all the individual could take.
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