Post Traumatic Stress Disorder in Veterans of Operation Iraqi Freedom

By Mathew J. Kleinhans
Woodland Community College

The war in Iraq is the most sustained combat operation since the Vietnam War, and initial signs show that this ongoing war is likely to produce a new generation of veterans with chronic mental health problems associated with participation in combat. Many of the challenges facing the soldiers in Iraq are stressors that have been identified and studied in veterans of previous wars (e.g., fear for own life, participation in killing). This war in Iraq is no different in that it also presents challenges that impact the mental health problems facing soldiers today and possibly throughout the remainder of their lifespan. In fact, I have a close friend who served three tours in Iraq who is dealing with a mental health issue called post traumatic stress disorder which he has suffered from since leaving the Marines.

Post-traumatic stress disorder (PTSD) is an anxiety disorder that may develop after an individual is exposed to one or more traumatic events. During war military service members are exposed to a number of potentially traumatic events — ones in which the individual’s life is in critical danger, he or she is seriously injured, and/or there is a threat to physical integrity, either to one’s self or to others (Maguen, S. 2008).

What are the mental health impacts of the war in Iraq? One of many comprehensive studies has examined the mental health impact of the wars in Afghanistan and Iraq. The New England journal of medicine ran a piece in 2004 regarding soldiers combat duty in Iraq and Afghanistan, and the mental health problems that can occur from such duty. This particular study evaluated soldiers’ reports of their experiences in war-zones and reports about symptoms of psychological distress. The results of this study indicated that the estimated risk for posttraumatic stress disorder (PTSD) in soldiers from service in the Iraq War was 18% (Hoge et al. 2004).

My friend, Corporal Richie Gunter enlisted in the United States Marine Corps in November 2002 at the unusually older age of 27 years old. In March of 2003, he along with his Company, Bravo Company, of the 1st Battalion 5th Regiment Infantry Marines, were deployed to Iraq and were the spear of the initial surge into Baghdad. Over the course of the next four years Ritchie completed his initial tour and was called back two more times, totaling three tours in Iraq within just four years of service. In a personal interview with Richie Gunter on November 10, 2008 he stated, “I witnessed numerous incidents of death, mayhem, and utter chaos…fucking chaos (R. L.Gunter, personal interview, November 10, 2008).” In November 2006, four years after enlisting, Richie got out of the Marines and one month later was diagnosed with PTSD.

Other studies indicate that more frequent and more intense involvement in combat operations increases the risk of developing chronic PTSD and associated mental health problems. Initial evidence indicates that combat operations in Iraq are very intense (Anderson, P. 2008). Soldiers in Iraq are at risk for being killed or wounded, are likely to have witnessed the suffering of others, and a majority of these soldiers have participated in killing or wounding enemies and/or civilians as part of combat operations. All of these activities have an association with the development of PTSD.

Symptoms of PTSD most often begin within three months of the event. In some cases, however, they do not begin until years later. The severity and duration of the illness vary. Some people recover within six month, while others suffer much longer (Chakraburtty, MD, Amal, comp. 2007). Symptoms of PTSD are normally grouped into three main categories: Re-living, avoiding, and increased arousal.

Chakraburtty (2007) describes that in a re-living scenario, people with PTSD repeatedly re-live the ordeal through thoughts and memories of the trauma. These may include flashbacks, hallucinations and nightmares. They also may feel great distress when certain things remind them of the trauma, such as the anniversary date of the event. From an avoiding aspect, the person may avoid people, places, thoughts or situations that may remind him or her of the trauma. This can lead to feelings of detachment and isolation from family and friends, as well as a loss of interest in activities that the person once enjoyed. In the case of increased arousal, these scenarios include excessive emotions; problems relating to others, including feeling or showing affection; difficulty falling or staying asleep; irritability; outbursts of anger; difficulty concentrating; and being “jumpy” or easily startled. The person may also suffer physical symptoms, such as increased blood pressure and heart rate, rapid breathing, muscle tension, nausea and diarrhea.

Two years later, after being diagnosed and treated, Richie still struggles with “Re-living” PTSD. He stated, “It’s not as bad now as it was in 06, but I still have extremely lucid nightmares that I can’t seem to suppress. The worst ones are the nightmares of the friends that I lost. My buddy Jeff Starr, Pfc Torres– I can name a bunch of names right now, you know, those are guys that I hung out with a lot… and they’re gone. I witnessed a lot of gnarly shit…Shit most people wouldn’t even be able to fathom” (R. L. Gunter, personal interview, November 10, 2008).

Hoge et al. (2004) indicated that 94% of soldiers in Iraq reported receiving small-arms fire. In addition, 86% of soldiers in Iraq reported knowing someone who was seriously injured or killed, 68% reported seeing dead or seriously injured Americans, and 51% reported handling or uncovering human remains. The majority, 77% of soldiers who were deployed to Iraq, reported shooting or directing fire at the enemy, 48% reported being responsible for the death of an enemy combatant, and 28% reported being responsible for the death of a noncombatant.

A variety of environmental factors specific to each mission may also contribute to the risk of mental health problems in veterans. For example, factors like poor diet, severe weather, and deficient accommodations will shape soldiers’ responses to war-zone deployments. Extensive time away from family members, and the disruption of occupational goals, may serve as severe stressors. Although, many soldiers may find meaning and gratification in their “care taking” roles in Iraq, which can potentially buffer the impact of some war-zone stressors.

What is the long-term prognosis for soldiers exposed to stressors in Iraq and diagnosed with PTSD? Extensive research indicates that early distress and symptoms of PTSD are not very good predictors of a long-term prognosis. Thus, while Hoge et al. (2004) reported that 18% of soldiers newly redeployed from Iraq have PTSD, it is likely that this rate will decrease over time. Compared to the 10% of Gulf War veterans that suffer from PTSD (Hogan, PhD, Michael F., ed.), the difference is noticeable. The Hoge et al. (2004) study suggests that in the face of severe military service demands, including combat, most men and women do remarkably well across the lifespan. On the other hand, if the mission is experienced as a failure, if soldiers deploy more than once, if new veterans who need services do not get the support they need, or if post deployment demands and stressors mount, the lasting mental health toll of the wars in Iraq may increase over time. “I did the whole head shrink and Ambien treatment for about a year and it did help, but I just had a hard time talking to someone who I felt couldn’t even begin to grasp what I’d been through without actually going through it himself. After about a year of treatment, I decided to deal with it myself. I was back full time with the farm, my time was occupied and I guess I had a different type of therapy. Work. I’ve just learned to live with the nightmares (R. L. Gunter, personal interview, November 10, 2008).”

For those soldiers who don’t recover, the most troubling aspect of military-related PTSD is its chronic course. There is evidence that once veterans develop military-related PTSD their symptoms remain chronic across the lifespan and are resistant to treatments that have been shown to work with other forms of chronic PTSD (Dryden – Edwards, R. n.d.). With that being said, it is extremely important to provide early intervention to reduce the risk of chronic impairment in veterans. However, there are troubling signs that many soldiers from are reluctant to seek help or that help may not be readily available to them. For example, Hoge et al. (2004) found that although approximately 80% of Iraq soldiers who had a serious mental health disorder acknowledged that they had a problem; only approximately 40% stated that they were interested in receiving help and only 26% reported receiving formal mental health care. It appears that modern career soldiers are concerned about the stigma associated with mental health problems and the potential negative impact on their careers or social status.

There is much that is still unknown about how soldiers adjust to the enormous demands in today’s new war zones. It is important to appreciate the stressors and traumas of these new wars in order to raise the awareness of civilians back home, prepare loved ones for soldiers return, and meet the clinical needs of our newest veterans.

References

Anderson, Pauline. “Combat, Deployment, Increases Risk for Posttraumatic Stress Disorder.” Medscape Today. 15 Jan. 2008. Medscape Medical News. 27 Nov. 2008 <http://www.medscape.com/viewarticle/568951>.

Chakraburtty, MD, Amal, comp. “Mental Health: Post-Traumatic Stress Disorder.” WebMD. 1 Mar. 2007. 27 Nov. 2008 <http://www.webmd.com/anxiety-panic/guide/post-traumatic-stress disorder>.

Dryden – Edwards, Roxanne. “Posttraumatic stress disorder.”Medicinenet.com. Ed. Melissa Conrad Stoppler. 4 Nov. 2008 <http://www.medicinenet.com/posttraumatic_stress_disorder/article.htm>.

Hogan, PhD, Michael F., ed. “Post-Traumatic Stress Disorder.” Office of Mental Health. July 2008. 27 Nov. 2008 <http://www.omh.state.ny.us/omhweb/booklets/ptsd.htm>.

Hoge, Charles W., Carl A. Castro, Stephen C. Messer, Dennis McGurck, Dave I. Cotting, and Robert L. Koffman. “Combat Duty in Iraq and Afghanistan, Mental Health Problems, and Barriers to Care.” The New England journal of medicine 351 (2004): 13-22. NEJM. 4 Nov. 2008 <http://content.nejm.org/cgi/content/full/351/1/13>.

Maguen, Shira. “Posttraumatic stress disorder.” POV. 14 Oct. 2008. 4 Nov. 2008 <http://www.pbs.org/pov/pov2008/soldiersofconscience/special_ptsd.html>.