Medicine in Wartime: Invisible Wounds Plague Iraq, Afghanistan Veterans

By: Diana Barnes-Brown for Body1

Over the past quarter century, popular entertainment and news media have offered countless images and accounts of war-shaken veterans, focusing primarily on depictions of “shell-shocked” Vietnam or World War II veterans – eccentric and sometimes even comic characters who ran from the room or hid under tables at the sound of a whistle, pop or bang.

Learn More

Recognize and Treat PTSD Symptoms and outcomes of PTSD may include flashbacks, nightmares, panic, anxiety, uncontrollable anger, violent outbursts, depression, spousal or child abuse or mistreatment and substance abuse. PTSD- and trauma-related symptoms and behaviors may have specific triggers, such as loud noises, chemical smells, crowds, or images or accounts of similar traumas to the one experienced by the victim. Unlike normal unpleasant memories, the flashbacks and nightmares associated with PTSD and trauma are often full-body experiences, which may cause anything from a racing heart rate, pallor and dizziness to uncontrollable terror or rage and attempts to escape a perceived threat or trigger. If you suspect that you or someone you know suffers from PTSD there is help. To seek help for non-veterans with post traumatic stress syndrome, take the first step; contact a trusted doctor or healthcare provider and set up an appointment. To seek help for military members, visit the VA Web site for resources.

These depictions are based on stereotypical behaviors associated with post-traumatic stress disorder (PTSD), a form of psychological illness now recognized as a very real consequence of having survived serious physical or psychological traumas, including war, natural or man-made disasters, or serious abuse or violence.

While many may believe that war-related incidences of PTSD and other mental illnesses are limited to times past, this assumption is far from the case. As a result of the invasions of Iraq and Afghanistan, men and women in the United States Armed Forces are coming home with both physical injuries and invisible, but no less present, psychological scars of war.

PTSD was defined in the early 1980s, in large part because medical and mental health experts recognized a frequently co-occurring set of symptoms in men and women who were soldiers or victims of war. Now it is known that these symptoms are seen in many cases where humans have been exposed to one or many traumatic events that provoked feelings of intense terror, horror and helplessness.

Usually, the traumatic events return by way of disruptive memories, flashbacks, nightmares or night terrors, and hallucinations, and may be triggered by anything that acts as a reminder of the initial trauma, such as a sight, sound or smell. Sufferers of PTSD often experience trouble sleeping, heightened irritability or explosive tempers and difficulty focusing on day-to-day tasks. Intense guilt, depression, anxiety, panic attacks, substance abuse, and violent or abusive outbursts (either emotional or physical) may also occur, compromising relationships and the safety of loved ones.

Veterans especially may experience feelings of estrangement, believing that the day-to-day concerns of spouses, friends and children are trivial or even meaningless compared to the horrors of war, and this can contribute to a cycle of erratic and negative behavior followed by further alienation.

A report in USA Today told the stories of soldiers and victims of war in similar situations. One man responsible for calling in an Apache helicopter strike on a house was horrified to realize that there were children trapped inside the building after the strike. The sound of their screaming haunts him as he tries to readjust to his life in Texas. “The army is a way to get away from poverty here… you go to the Army and expect to be better off,” he told the paper.

In the same report, another veteran noted he was court-martialed for being AWOL (absent without leave) because he checked into a civilian facility to receive treatment for PTSD so severe it was triggered by the scent of diesel fuel which is used to fuel military vehicles. Another said he was nauseated by the smell of a barbeque pit because it “smells like searing flesh,” a smell he knows from time spent in Mosul, Iraq.

After more than three years of war and undefined combat in the Middle East, the Defense Department is beginning to realize the gravity of the problem; a 2004 study of troops returning from Iraq showed that soldiers and marines who need psychological help the most are the least likely to get that help because of the extent to which mental healthcare is stigmatized in the military. One out of six of the participants in the study said they suffered from severe depression, PTSD, or other psychological complaints, while three out of five of the sufferers felt their commanders and peers would treat them differently if they admitted their need for help.

While there is still a long way to go before veterans are seeking – and getting – the sort of mental health support they need upon return from combat, veteran centers and the Department of Veteran Affairs (VA) service providers have long been sympathetic to the plight of soldiers with unrecognized or untreated psychological complaints and are working hard to make a difference.

Modalities for treating the new wave of psychologically-injured veterans include training healthy veterans to offer peer counseling, installing better psychological service options in VA clinics and military hospitals and educating doctors about the proper use of anti-anxiety and anti-depressant medications. Also, veteran center mental health staff is mostly made up of veterans who have been in combat and are capable of empathizing with those who seek their help. These offerings represent very important first steps in the treatment process because, as concerned caregivers often note, one of the biggest challenges in treating the psychological scarring of war is convincing victims they are not alone and need not be ashamed.

Last updated: 20-Mar-06