Treatment Online

Delayed PTSD Symptoms Complicate Treatment
> 11/14/2007 2:20:44 PM

Many of the soldiers returning from current overseas operations are suffering from PTSD and will face its effects for months or years to come. They just don't know it yet. And this lack of awareness may prevent them from receiving treatment in the crucial first stages of the disorder. An analysis of nearly 90,000 Iraq veterans at the infamous Walter Reed Medical Center revealed that the issue is far deeper than any responsible parties wish to acknowledge, concluding that the military must continue to update its mental health services with each incoming wave of unfortunate research; the tide will not even out anytime soon.

PTSD does not strike every affected party in the same way; it is a multi-faceted disorder capable of assuming more than one form. Distinctions based on the period of time between the initail trauma and the disorder's onset were made early in its history, but the differences between the two are becoming clearer. It would appear that early-onset PTSD is usually a more transient disorder - half of the surveyed servicemembers who'd qualified for PTSD on initial diagnosis improved over the six-month period between the first and second checkups. This observation may also serve as a rare instance of testament to the effectiveness of the military's treatment plans. Unfortunately, the late-onset group proved much larger and more deeply affected: their symptoms were more severe and less likely to diminish with time. Reservists registered the highest rates of PTSD at approximately 36%; this trend may be explained by the fact that reserve soldiers face less intensive training and may prove ill-prepared for combat because of it. They also return directly to civilian life after deployment, and the dramatic contrasts of that transition could magnify subsequent symptoms of "shell shock."

While the military has taken the absolutely crucial first step by requiring mental health screenings for all returning soldiers, and updating that policy to include 6-month follow-ups certain to uncover even more cases, but these efforts will clearly not be enough. The military cannot be expected to conduct extensive tracking programs for years after the end of active duty, but simply acknowledging and testing for the problem will not suffice. Interestingly, the military's screening process failed to provide treatment for some of PTSD's major concurrent conditions: only 0.2% of the returning soldiers who reported alcohol abuse were referred for treatment, and a majority did not receive help until at least three months after the initial report. This alarming statistics implies an unfortunate tendency to overlook problems deemed too widespread to combat effectively.

Congressional commitees convened to assess degrees of progress on this very subject deemed the military's response insufficient, and while Congress declaring another organization ineffective seems like hypocrisy of the highest order, the military has obviously received the (political) message, and if more prodding is required it should happen as soon as possible. Of course, like all systematic reforms, this one will probably take far longer than it should. The military only began recognizing combat-related PTSD after the APA formally defined it in 1980, leading a stream of Vietnam veterans to seek treatment and compensation for the debilitating phobias and nightmares that haunted them years after the last shots were fired (an estimated 10% still suffer from chronic symptoms). Still, the suggestions of multiple bi-partisan commissions should give the military some very concrete ideas for institutional reform. Some bicker about limited funds and the issue of funding screenings at the expense of treatment. This should not be an issue to the wealthiest and most powerful nation in the world, and nothing will change the fact that thousands of troops who've served their country overseas are returning whole but profoundly unhealthy, rattled by internal demons that cannot be denied. If the military wishes to counteract increasing degrees of scrutiny from the government and a skeptical public, they should work in cooperation with every relevant committee. Bureaucracy sometimes works to serve a larger purpose, and this one is worthy of the full attention of our government and our military.

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