Bad News and Good News on MLK day.

"Let them join the Army because the Army makes men."
-Dalton Trumbo, Johnny Got His Gun

The bad news: New Generation of Homeless Vets Emerges
I wrote a paper about this exact same subject for English 200 last semester (I'm cutting and pasting here, so some of the graphs might not show up, not to mention a lot of the editing, but you'll get the idea):

Justin March
English 200
Essay V
14 Dec. 07

Coming Soon to a Classroom Near You: Post-Traumatic Stress Disorder

Because most of the public does not experience combat, many Americans cannot understand the effect that modern combat has on a person. It is safe to say that even individuals who experience combat can’t possibly understand the extent to which they may be changed. In order to address possible cases of Post-Traumatic Stress Disorder (PTSD) in troops returning from Iraq and Afghanistan, the Department of Veterans’ Affairs, universities, and local communities should establish resources and guidelines to help veterans cope with changes that may manifest in the months and years following a discharge from the military.
Associated Press writer, Brandon Stahl tells the story of man who did not receive adequate mental health attention after fulfilling his military duty. Kevan Boman, 52, of Duluth, MN has been homeless for three years following a mental breakdown that stems from his experiences as an Army reservist. Activated from reserve duty in 1991, Boman was sent to the first Persian Gulf War where he worked as a medic. After returning home, he experienced sleep deprivation, an inability to concentrate, and a constant state of agitation, which led to altercations with his wife. After September 11, 2001, he was again activated; he served in Afghanistan, survived, and returned to Duluth to a high-paying job with a health care staffing agency (Stahl).
After experiencing further mental trauma in Afghanistan, Boman walked out of his house and made the decision to be homeless. Citing guilt regarding his military experience, he said, “I lived. That’s my sin.” A downward spiral of increasing drug use after his divorce resulted in cocaine addiction, further compounding his mental anguish.
It may be difficult for some to understand the forces that could drive a man to throw away what could be conceived of as a good life. While Boman’s case is an extreme example, those who experience horrible and exceptionally stressful events often react in an extreme manner, either immediately or at a later period. This reaction is called Post-Traumatic Stress Disorder (PTSD) and it is not uncommon for anybody who has experienced terrible events (such as military combat, rape, witnessing extreme violence, etc.).
Dr. Peter Panzarino explains, “In general, post-traumatic stress disorder can be seen as an overwhelming of the body’s normal psychological defense against stress. Thus, after [a] trauma, there is abnormal function (dysfunction) of the normal defense systems, which results in certain symptoms.” Symptoms such as the re-experiencing of trauma, persistent avoidance, and increased arousal are universal to those experiencing PTSD (Panzarino).
The re-experiencing of trauma occurs when an individual has distressing recollections of dramatic events. Nightmares or daytime flashbacks can occur, as well as external cues from daily life that reactivates memories of trauma; this can manifest itself in physical reactions such as a rapid heart rate and sweating (Panzarino).
Persistent avoidance occurs when an individual actively avoids situations where trauma-related thoughts and feelings may trigger memories that he or she does not want to re-experience. This often leads to avoidance of social settings, and results in a restricted range of feelings (Panzarino).
Increased arousal can be seen as the manifestation of traumatic experiences through eruptions of anger, concentration difficulties, sleep interruptions, and a heightened level of watchfulness (Panzarino). A study performed by The Journal of Abnormal Psychology suggests that an increased level of arousal, called “hyperarousal,” plays a more predictive role in identifying PTSD due to the comorbid tendency of an individual experiencing hyperarousal to try to self-medicate with drugs and alcohol (Taft 499).
Comorbidity is the association of one disorder with another. All too often in the case of PTSD, another associated (and more often than not, more destructive) disorder may be diagnosed singularly while PTSD may be overlooked as the root cause of the ailment. Examples of comorbid disorders associated with Post-Traumatic Stress Disorder are depression, alcohol and substance abuse, specific phobias, panic disorder, and even schizophrenia and borderline personality disorder (Brunet 502).
PTSD among combat veterans has a relatively short history as a medically diagnosed disorder. During World War I, the symptoms addressed above were attributed to the earth-shaking cannons and bombs that had never been used at such a magnitude in wars past, a condition called “shellshock” (Panzarino). In World War II, a soldier’s internal trauma was termed “combat fatigue” (Panzarino). Soldiers and marines returning from the Vietnam Conflict who were experiencing difficulties adjusting to a civilian life were thought to have an undefined affliction called “Post-Vietnam Syndrome” (Panzarino). The Center for Disease Control eventually classified these afflictions as essentially the same with the release of the National Vietnam Veterans’ Readjustment Study (NRVVS) in 1988 (however, the methods used in the study are now considered faulty as the study seems to have overestimated the rate of PTSD by 40%). Regardless of its faults, the NRVVS was the study that gave credence to the idea that military personnel who experienced high levels of combat were at serious risk of PTSD (McNally 923).
In the 21st century, the current wars in Iraq and Afghanistan have lasted much longer than expected, resulting in extended deployments and re-deployments of American soldiers and marines, and an increasing number of veterans suffering from PTSD. However, instead of addressing this problem, the U.S. military has started to use some soldier’s medical records to root out other possible non-combat causes of PTSD – essentially using a soldier’s medical record against him or her. If anywhere in their medical record, personnel have a past history of personality problems or pre-existing mental health problems, they can be released from the military without any medical benefits; therefore, they are not eligible for any veteran support for PTSD-related problems (PTSD given mis-diagnosis). This practice of dumping problematic soldiers is a major cause of many veterans existing in civilian society with serious mental problems. If soldiers are healthy enough to enter the military, they should be healthy enough to receive the benefits of its veterans care upon discharge. Unfortunately, the military has not held up its end of the bargain.
A study from The New England Journal of Medicine by Charles Hoge, et al. examines the levels of PTSD in soldiers and marines who had been deployed to the wars in Iraq and Afghanistan. 811 marines and 881 soldiers who were deployed to Iraq and 1956 soldiers who had been deployed to Afghanistan took part in the study. Two definitions of PTSD were used, a broad definition (Figure 1), where current psychiatric diagnoses were followed, and a strict (conservative) definition (Figure 2) that required a
report of either functional impairment or several symptoms by the individual soldier or marine (15).
Figure 1: Percent of returning personnel - Figure 2: Percent of returning personnel Broad Definition PTSD diagnosis Strict Definition PTSD diagnosis

(Adapted from Hoge 19) (Adapted from Hoge 19)
From this study, one can infer the massive scope of PTSD in American veterans, especially as more veterans return in increasing numbers from Iraq and Afghanistan. However, Hoge’s study, which was performed within veterans’ first three months of return from combat zones, does not illustrate the fact that PTSD can manifest itself months and even years after discharge (Milliken 2141), as in the case of Kevan Boman from Duluth (Stahl).
Recently, The Army Times posted an article on its website claiming a 20,000 jump in the number of veterans seeking treatment for PTSD. This jump brings the number of cases documented by the Department of Veterans Affairs to 50,000, while the official military statistic of personnel with PTSD is 30,000. The Army Times article goes on, “The discrepancy underscores the view by the military and civilian health officials that troops tend to ignore, hide or fail to recognize their mental health wounds until after their military service” (Zoroya). The phenomenon of denying problems and not reporting mental health trauma immediately can be inferred from Figure 3 and is also discussed in Hoge’s study:
In the military, there are unique factors that contribute to resistance to seeking such help, particularly concern about how a soldier will be perceived by peers and by the leadership. Concern about stigma was disproportionately greatest among those most in need of help from mental health services (20).
In a political science class last semester, the subject of extended deployments came up; a student stated that military personnel are accountable for their decisions to join the military. This concept, that soldiers know what they are getting into and that their trauma, mental and otherwise, are products of their own decisions may be technically true, no matter how distasteful, but I think many such students don’t realize that they will be affected by these veterans’ afflictions sooner or later. A large percentage of this contingent of the military are also enrolled in college and will be returning to their studies as soon as they return home, in addition to new veteran students who will start college to take advantage of the Montgomery G.I. Bill upon their release from active duty which will help pay for their education. This student’s statement may seem ignorant, but if examined in the context that less than one percent of the U.S. population is fighting in Iraq or Afghanistan compared to the percentage of the general population fighting in other major wars (Figure 4), it is not hard to see where this lack of understanding comes from.
This disconnect between veterans and the public at large, particularly college students, is troubling to me. On one hand, there are soldiers experiencing mental disorders and associated ailments, and on the other hand is the civilian population with only a vague idea of the mental trauma that soldiers face and (most likely) a preconceived notion of who and what soldiers are. Mix into the equation the fact that the average combat veteran has been trained to perform violence, in fact, more than likely has committed an act of violence, and the situation can become frightening due to the possibility of PTSD-related problems.
Even more frightening are the massive numbers of patients in need of treatment for PTSD, with no complete cure known. The Washington Post recently ran a piece claiming that the psychedelic drug, Ecstasy, is currently undergoing clinical trials as a treatment for PTSD (Shroder).
The problem of veterans returning from war with PTSD and its comorbid disorders should be addressed head-on by colleges and universities across the United States as increasing numbers of veterans with PTSD integrate themselves into higher learning communities. A little time and money spent getting health service professionals and counselors ready for a population with PTSD would be well spent. There should also be support groups set up to provide counseling, as well as military-only group counseling sessions for veterans. With one of the largest barriers to care being the stigma of PTSD among the military (Hoge 20), I believe the best plan of action is to address this stigma face to face, and let veterans help themselves and each other. The alternative is to do nothing and hope for the best - a plan that, time and time again, has been proven not to work.
No one can say that there won’t be any problems with the readjustment of combat veterans to civilian life, but it seems the right thing to help veterans who have given service to the U.S. If you agree, you should talk to your college or university’s administration as well as your local politician to address this situation. If you do not agree, think of what you might say to the hardened war veteran, who may need a bit of help working some things out, sitting down next to you in your college classroom.

Works Cited
Brunet, Alain, et al. “Don’t Throw Out the Baby with the Bathwater (PTSD Is Not Overdiagnosed).” The Canadian Journal of Psychiatry 52.8 (2007): 501-502. 17 Nov. 2007 .
Hoge, Charles, et al. “Combat Duty in Iraq and Afghanistan, Mental Health Problems, and Barriers to Care.” The New England Journal of Medicine 351.1 (2004). 18 Nov. 2007 .
McNally, Richard. “Psychiatric Casualties of War.” Science 313 (2006): 923-924. FindIt. PubMed. U of Minnesota Bio-Medical Lib., Minneapolis, MN. 18 Nov. 2007.
Meagher, Ilona. The War List: OEF/OIF Statistics. 2007. 1 Dec. 2007 .
Milliken, Charles, et al. “Longitudinal Assessment of Mental Health Problems Among Active and Reserve Component Soldiers Returning From the Iraq War.” The Journal of the American Medical Association 298.18 (2007): 2141-2148. FindIt. PubMed. U of Minnesota Bio-Medical Lib., Minneapolis, MN. 26 Nov. 2007.
Panzarino, Peter. “Post Traumatic Stress Disorder.” MedicineNet.com. Ed. Leslie Schoenfield. 24 June 2005. 17 Nov. 2007. .
“PTSD given mis-diagnosis by military.” PTSD Support Services. 4 May 2007. 18 Nov. 2007. .
Shroder, Tom. “The Peace Drug.” The Washington Post 25 Nov. 2007. 27 Nov. 2007 .
Stahl, Brandon. “PTSD vet ‘chooses’ homeless.” The Army Times 16Oct. 2007. 27 Oct. 2007 .
Taft, Casey, et al. “Posttraumatic Stress Disorder Symptoms, Physiological Reactivity, Alcohol Problems, and Aggression Among Military Veterans.” The Journal of Abnormal Psychology 116.3 (2007): 498-507. FindIt. PubMed. U of Minnesota Bio-Medical Lib., Minneapolis, MN. 18 Nov. 2007.
Zoroya, Gregg. “PTSD reports up 20,000 in a year.” The Army Times 19 Oct. 2007. 27 Oct. 2007 .

Now, the good news:

Sitting here in a small-town cafe in Wisconsin looking forward to my trip to Europe, and I overhear a conversation between a gentleman and an eight year old kid who has the day off from school because of Martin Luther King Jr. Day. The gentleman spent about a half hour trying to explain the significance of Dr. King to the young boy, who, while paying attention and being receptive, did not quite grasp why King was so important. The fact that an eight year old doesn't quite get it is quite alright given the fact that he has people who will enforce and repeat why today is important. People like this not only serve our children, but ourselves as well, and I can't stress how impressed and happy I am to see this kind of thing in this small little Wisconsin town. Despite all the bad news of the world, there still is good news, sometimes one just has to keep their ears open.