Issue 26 PTSD Defined, Part 2 Dr. Neal Olshan Healing the Invisible Wounds! PTSD manifests as a depression and stress disorder, but one that plays a movie of the traumatic event on a continuous loop in the brain. The person who suffers from this feels alone, as if being in a deep hole with no way out and with no energy to begin the climb. Others offer suggestions, but they are not in this hole with the one who suffers. Going deeper in that hole, and allowing more dirt to fall on the problem will not solve anything and will not allow the sufferer to emerge to live in the light again. The reality is that emotional suicide is committed long before the physical act takes place in many instances. A veteran friend who I saw the other night at a U.S. Marine Corps Forces Special Operations Command benefit function, and who carried the scars of combat, looked upset. When I asked why, he told me that he had just seen someone with whom he had served and asked how he was doing. The person said very curtly, “Fine. Why?” My friend was upset because he knew the man had been suffering from PTSD, but was acting as if everything was OK. Many who suffer from PTSD try to keep up a brave front to the world, but those who are close family and longtime friends know there is a serious problem and that the person has changed dramatically. In the last column on PTSD, we talked about the downward slope to alcohol, drugs, violence, and suicide, but it is important to know that the person who suffers is not alone and can reach out to form connections that will aid in their recovery. Before I talk about those connections, I want to emphasize that we associate PTSD primarily with veterans, but I have worked with many police officers who face daily instances of traumatic events. Many of these are facing the unknown when they knock on a door for a domestic violence call or walk up to a car on a dark road. Many are killed or injured each day, but until retirement, they face that danger. They have also seen the dead, children who died needlessly, women who were battered beyond recognition, those who were severely burned, and car accidents that mangle bodies in unthinkable distortions. These first responders need to have an outlet, a place to talk and know that their choices were the best they could make at the time. Unfortunately, Hollywood always shows them drinking at a bar at the end of the day. Perhaps that is true in some cases — and that may be the place to vent — but alcohol and depression are bad bedfellows, particularly when you take them home to your family. Josh Jackson, a police officer in Northern California and operations director of LMS Defense, stated that he felt that having channels of communication among police officers who can openly talk about the emotional impact of some of their experiences would aid in relieving the stress associated with the job. Robert Rouleau, a veteran, told me the following: “The big thing that people need to understand about PTSD is that we had a 24/7 support group we trusted that vanished the day we got out of the service. We lived and breathed every day with the same guys. We went to hell and back with them. We literally put our lives in their hands. Now it is all gone and you feel left out in the cold surrounded by people who did not go through it with you, who don’t understand what is going on in your head … That is why I think it hits a lot after we get out, why it doesn’t happen when the group is together. We need to be there for each other at that moment.” Vartenin Ashaq was born in Iraq and faced being the victim of oppression under Saddam Hussein. Her father owned a printing business, and one day, the minions of Hussein killed her brother, and her father’s business was taken from him. At the age of 18 she became a citizen of this country, the one that gave her family safety and freedom and she felt that she wanted to make a difference and give back. She became a linguist for the Department of Defense and delivered “intelligence products” translated into and from Arabic to facilitate operations of several combat and intelligence teams from 2009 to 2011 in Iraq and then from 2012 to 2013 in Kuwait. Every nine months she was moved to a new unit, and each time she had to build trust with that group. Although not specifically classified as a soldier, she was in combat theaters as mortars exploded close by, was under fire, and worked with interrogations as a linguist. She has been part of a double whammy — the victim of a cruel dictator and a participant in a war zone, and all as a very young woman. There are times when we can wonder how much the human body and mind can endure. With the love of her husband and family she has been able to work through many of the horrors that she remembers, but still cringes at loud noises, especially those produced by airplanes and motorcycles. Now let’s look at what we can do to help those who suffer. When should I get evaluated for PTSD? > If you continue to experience PTSD symptoms for more than three months. > If you experience repeated nightmares about the experience. > If you think about the traumatic experience even when you did not want to do so. > If you repeatedly avoid situations that remind you of the experience > If you are constantly on guard or easily startled. > If you feel numb or detached from others, activities, or your surroundings. Current research recommends that if you answered “yes” to any three items, you should seek more information from a mental health care provider. A positive screen does not mean PTSD and only a qualified mental health care provider can diagnose you with PTSD. Types Of Treatment That Are Effective For PTSD Treatments available for PTSD fall into two categories, psychotherapy, sometimes called counseling, and medication. In many cases, especially at the onset of treatment, talk therapy and medication may be combined. Psychotherapy Cognitive behavioral therapy (CBT) is the most effective treatment for PTSD. Typically, you meet with your therapist once a week for three to six months. There are different types of CBT that are effective for PTSD. Medication Medication can raise the level of serotonin in your brain, which can help to make you feel better and experience fewer symptoms of PTSD. The two serotonin uptake inhibitors that are currently approved by the FDA for the treatment of PTSD are Zoloft and Paxil. Caution: Some physicians will prescribe medicines called benzodiazepines for people with PTSD. These medicines are often prescribed to people who have problems with anxiety. While the medication may help at first, they do not treat the core PTSD symptoms. They may lead to addiction and are not recommended for long-term PTSD treatment. Finding A Therapist You need to interview a potential therapist and ensure that they are experienced in providing the latest PTSD treatments. The three interview questions that demand a positive response prior to engaging in any treatment plan are: How long have you been in practice and are you licensed? Have you treated PTSD previously? If you choose a psychologist or counselor, do they work with a doctor who can prescribe medication. Beyond these questions, you should get a feeling of trust with the therapist that would allow for full disclosure. Where Should I Go For Treatment Veterans Administration The Veterans Administration healthcare system is many times the only place available to the military veteran to establish that their condition is related to their service. This may involve both treatment and benefits. Although there has been a significant amount of controversy regarding multiple aspects of the Veterans Administration care of veterans, it is the only option available to veterans unless they have health insurance for treatment from a private source; however, the V.A. is the only pathway to benefits. Pros > Typically, the first and perhaps only alternative for the veteran. > Involved in cutting-edge research for the treatment of PTSD. > Typically located in most major cities. > Those in treatment are from the military. Cons > Long, and at times deadly, waits for evaluation and treatment. > An overwhelming bureaucracy to fight through for services. > Little or no ability to obtain second opinions outside of the Veterans Administration. Law Enforcement Police officers need to see if their department offers critical incident stress management or utilizes any employment assistance programs. Alternatively, most police officers will be covered by private insurance and can read below regarding steps to choose a therapist. Psychologist Men and women who were licensed by their particular state to practice psychology. Ask and verify that they are licensed. You may also check with the psychology board of your state to inquire about any complaints. Pros You have the opportunity to research and pick your own therapist. You can interview and evaluate the therapist and make a decision regarding proceeding with treatment. Your treatment is typically customized to your particular situation and circumstance. You can choose whether you want to be seen by a male or female therapist. Cons Your insurance company may not be accepted by the therapist you choose and therefore you would have to pay cash. Your insurance company may require a substantial co-pay for each visit. Therapists specializing and experienced in the treatment of PTSD may have longer wait times to get an appointment. Psychiatrist A psychiatrist is a physician who has the ability to prescribe medication. Pros The psychiatrist can prescribe medication for your PTSD. Some psychiatrists also provide talk therapy. Cons A high percentage of psychiatrists do not accept insurance and your first visit can be very expensive. It may be difficult to find a psychiatrist who prescribes medication and provides talk therapy. Counselors A counselor will typically have a master’s degree and will provide talk therapy. Pros It may be easier to obtain an appointment with a counselor than a psychologist or psychiatrist. If you have to pay for each session, typically the expense is less than a psychologist or psychiatrist; however, many are providers with insurance plans. Cons A counselor may be limited in their training regarding the treatment of PTSD. Resources I have taken the liberty to reduce the number of references since the Internet is flooded with resources. After putting the term PTSD in the search engine, 12,000,000 citations were listed in less than the blink of an eye. Experiencing PTSD is not a sign of weakness. Don’t allow the stigma of PTSD to be a barrier for you to receive help. Sometimes you need a buddy to help you over the wall. In a Crisis? Call 911, go to an emergency room, or call 1-800-273-TALK (1- 800-273-8255) PTSD Returning from the War Zone…A guide for families of military members www.ptsd.va.gov The National Center for PTSD www.ptsdinfo.org Depression National Institute of Mental Health depression fact sheet www.nimh.nih.gov/health/publications/depression-listing.shtml Alcohol and Drug Abuse Alcohol and Drug Abuse Facility Locator findtreatment.samhsa.gov Alcohol and Drug Abuse Information and Resources www.alcoholanddrugabuse.com Ask Dr. O Writing PTSD Part Two has proven to be a more complex task than first perceived. Each of us, in our own small way can make an impact. If a friend or fellow warrior is having problems, don’t ignore…get involved. There are a multitude of avenues to pursue from direct contact to helping financially. Due to the significant growth of veterans’ aid groups, always check and verify before sending your donations. Please send me your thoughts. Suggestions or questions and ideas for future columns are always welcome. Contact me at [email protected]. About the Author Dr. Neal H. Olshan is the developer of Evolution of Mindset and is a consulting psychologist for corporations and the sports industry for athletic improvement through the use of his Mindset program. He is also a pilot, an award-winning photographer, an author of both fiction and nonfiction books, and the chief combat psychologist for LMS Defense. 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