Causes and Repercussions of Post-Traumatic Stress Disorder (PTSD)

Abstract

This paper explores the causes and repercussions of Post-Traumatic Stress Disorder (PTSD) on the U.S. military that were deployed to Iraq and Afghanistan, and their families. It also looks at the repercussions of PTSD on the U.S. government and evaluates the level of governmental aid to veterans diagnosed with this mental health problem. The theoretical background of the paper consists of the overview of research findings on causes and repercussions of PTSD, and efforts to handle it on the part of the medical personnel and the U.S. government.

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The empirical part of the paper presents the findings from interviews with three research participants who have undergone (undergo) PTSD-related treatment, as well as their wives. The interviewees comment on what caused their illness, how they overcame (or overcome) it, and whether government aid was (is) helpful. Additionally, the views of the spouses are provided as to the repercussions of the PTSD on their family life. Next, the findings from the interviews with two government officials are analyzed as to the role of the U.S. government in taking care of veterans with PTSD.

The research concludes that despite the efforts that are made by the Veterans Affairs Administration, these are not enough. The accessibility and quality of PTSD-related medical care need to be enhanced along with improvement in veterans' funding. It is recommended that the U.S. government should stop sending people to hot spots to spare their lives, their mental and physical health.

Keywords: PTSD, VA, U.S. Marine Corps, veteran, deployment, Iraq, Afghanistan, combat, mental health, casualties, military, government aid, family, repercussions, causes, government officials.

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Defining PTSD

Posttraumatic Stress Disorder or PTSD is a type of anxiety disorder following an individual’s exposure to one or more life-threatening experiences: war, homicide, natural disasters, sexual assault, and vehicular crashes. It may be identified by certain symptoms in an individual (Sayer et al, 2009, p.238). The symptoms of PTSD include distress related to those memories that are linked to the individual’s trauma, thus unwanted, reduced level of responsiveness to the outside world, as well as various signs of psychological arousal including hyper-vigilance and disturbance of sleep (American Psychiatric Association, 1994).

Recent Statistics

PTSD is highly prevalent among certain segments of the U.S. population. These are people whose trauma rates are quite high. Namely, PTSD is widespread among combat veterans. To compare, PTSD prevalence for 1 year among Americans is found to be 4 % or less (Kessler et al, 1999, p.115). At the same time, PTSD prevalence reaches 15% among combat veterans in the United States (Hoge et al, 2004, p.14). Besides, it is predicted that as many as 10% out of the overall number of combat veterans will experience PTSD partially (Weiss et al, 1992, p. 365). Therefore, the problem affects a large segment of the U.S. population.

Rationale for Research and Statement of the Problem

Although causes and effects of PTSD have been discussed in the academic sources, this issue still remains unclear, especially in relation to veterans of Iraq and Afghanistan wars. Also, the extent of family life problems needs further research as well as ways to solve the problem. Besides, the balance between government efforts to combat the problem and veterans’ needs in relation to PTSD should be assessed.

Overview of Research Structure

This research will present findings from the qualitative study that examines the causes and repercussions of PTSD on ex-military, their families, and the government. It will comprise five parts. The first part will provide the background to the study and identify the study problem. The second part will provide a summary of previous findings on the topic that are most informative for the proposed research. The third part will discuss the methodology of the study. This will include the justification of the approach (quantitative, qualitative, or mixed), description of the selected method, description of the research sample, and discussion of the data analysis method. The fourth chapter will focus on the study’s findings. The paper will end with conclusions drawn from the conducted research and its theoretical background.

Literature Review

PTSD: Research and Treatment Highlights

The problem of PTSD impact on various segments of the U.S. population has received lots of attention from late. Particular attention has been paid to combat-related PTSD, namely to the gathering of statistical data to explore the scope of the problem and defining barriers that hamper effective treatment (Tuerk, Steenkamp & Rauch, 2010). Besides, the impact of PTSD on criminal behavior and criminal responsibility has been studied (Burgess, Stockey & Coen, 2010, p.1). Government initiatives to relieve PTSD have been the subject of recent research, as well (Shea-Porter, 2009).

Tuerk et al. (2010) provide an overview of the issues linked to the effective treatment of combat-related PTSD in the context of contemporary public health issues. The main point of the article is that due to the extent of mental health difficulties experienced by returning troops the scope of medical aid to the PTSD-diagnosed military has to be broadened. The authors provide a reliable overview of the secondary data including the latest reports in public health, pharmacotherapy, and government initiatives. PTSD is conceptualized on the basis of meta-analysis and synthesis of empirically-based research.

Along with the evaluation of the progress in the sphere of combat-related PTSD treatment, barriers have been identified which prevent people from effective treatment. Specifically, these are a lack of innovative approaches to psychotherapy, low levels of veterans’ access to empirically supported strategies in PTSD therapy, and poor access to public health facilities, etc.

Hoge et al. (2004) provide a consistent assessment of mental health in the U.S. troops deployed to Iraq and Afghanistan. On the basis of the anonymous survey, it has been estimated that the military that was deployed to Iraq had greater exposure to combat than those deployed to Afghanistan. Respectively, the percentage of research participants who provided responses that indicated PTSD, major depression, or generalized anxiety was significantly higher among those deployed to Iraq (Hoge, 2004, p.13). Apart from identifying the high level of risk of PTSD among these troops, the study revealed the insufficiency of mental health therapies provided to the military.

On the one hand, this is associated with the concern about stigma among those who needed mental health services; on the other hand, lack of screenings for PTSD and major depression prevent Soldiers and Marines from getting adequate medical assistance. The study provides implications for future research and policy: the quality of mental health care to the troops deployed to Iraq and Afghanistan should be enhanced in terms of reduction of stigma and overcoming of barriers (Hoge, 2004, p. 19). Importantly, this study uses reliable research tools and methods, as well as an adequate sample, which allows generalizing the overall situations in the Marine Corps and Infantry. The study helps to prioritize the focus of mental health services on Iraqi and Afghani troops and identifies barriers for effective treatment.

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Federal Aid for Veterans Diagnosed with PTSD

Shea-Porter (2009, p.236) argues that government initiatives in order to help veterans relieve their mental health problems have been quite successful and need to be extended. The value of the article is in its provision of expert opinion: Shea-Porter, a Congresswoman from New Hampshire, reports her experience as a member of the Armed Services Committee and the Personnel Subcommittee in relation to PTSD initiatives. She expresses confidence that the government will be able to deal with the problem of PTSD treatment effectively.

However, the article lacks a critical insight into the problem, and in some cases, Shea-Porter’s statements seem to lack empirical support. In particular, she talks about what has been done by her to improve the situation but fails to accurately identify serious gaps that need to be addressed in the future. Her claims are often general and unwarranted, although they may be helpful as a source of expert opinion.

Tuerk et al. (2010) provide an overview of recent successes of policies directed at combat-related PTSD treatment initiated by VA (Veterans Administration), DOD (Department of Defense), and CDP (The Center for Deployment Psychology). Importantly, the authors attempt to predict the way the problem is going to unfold in the future. Given the likely growth of PTSD-related cases, multiple additional outreach programs will be required to address the issue fully. This article is helpful since it informs the current research about the successes and gaps in modern handling of the problem of PTSD treatment among U.S. veterans and allows gaining insight into the future.

Causes and Repercussions of PTSD on Veterans and Their Families

Shea-Porter (2009, p.235) provides an overview of the causes, scope, and approaches that are dealing with PTSD at the government level. It cites secondary research data that allow us to clarify the causes of PTSD such as stressors of service, multiple deployments, insufficient time to recover, and specifics of war in Iraq and Afghanistan.

De Burgh et al. (2011) provide a qualitative assessment of a range of credible peer-reviewed secondary sources on the issue of the psychological effect of military deployment on spouses. Despite the fact that the research focuses only on spouses of the male personnel and only in quantitative studies of troops deployed to Afghanistan and Iraq, it managed to create an objective picture of psychological problems in the military’s families.

In particular, three major sets of problems have been identified: problems related to psychiatric disorders, stress, and marital health (De Burgh, 2011, p.194). It has been revealed that female spouses of the military personnel are at a higher risk of developing such mental health problems as sleep, anxiety and adjustment disorders, depression, and acute stress reaction. At the same time, it has been found that only a certain percentage of spouses seek mental health aid due to perceived stigma.

Next, it has been found that spouses suffer from marital dissatisfaction during long deployments, which puts marital relationships at risk. At the same time, marital health has been found to suffer greatly from the inability of PTSD affected military personnel to reintegrate into family life, including parenting, communication, and bonding problems. Also, stress has been revealed to be twice as high in spouses of the deployed troops as in those of the non-deployed. The biggest stressor is pregnancy.

The study concludes that spouses of the deployed military are at a greater risk of mental health problems. The factors that contribute to their mental health or lack of it are: deployment lengths, the mental health of the returning military, and personal circumstances of spouses, including pregnancy. Besides, the researcher identified the interrelationship between spouses’ mental health (De Burgh, 2011, p.197). The research has been particularly helpful in creating the general picture of the PTSD impact on spouses’ health, its factors, and its major aspects.

Carter et al. (2011) focus on the role of spousal support and communication during the troops’ deployment to Iraq, particularly on their PTSD exposure. It has been found that frequent telephone conversations, e-mails, care packages, and letters were a means of enhancing marital satisfaction in the couples who were partially satisfied. Deployed male spouses were found to have had smaller exposure to PTSD during and after combat (Carter et al, 2011, p.355). At the same time, males who had low marital satisfaction did not benefit from spousal communication, which was typically delayed and scarce; thus, they were subject to a higher risk of PTSD. The study provides valuable primary data related to the topic of spousal interaction and PTSD. The conclusions are based on the data obtained as a result of a highly reliable method of a randomized controlled trial.

Research Design

 

Research Objectives

The aim of the research is to explore the causes and repercussions of PTSD on the American military, their families, and the state. In order to achieve the aim, the author has set the following objectives:

  1. To define PTSD and describe the situation with PTSD in the United States.
  2. To examine the causes and repercussions of PTSD from the perspective of the military who were deployed to Iraq/Afghanistan.
  3. To examine the repercussions of PTSD from the perspective of these veterans’ spouses and families.
  4. To explore the views of the military with PTSD on governmental aid.
  5. To explore the views of governmental officials on the issue of governmental assistance to veterans diagnosed with PTSD.

Research Questions

The following research questions were set on the basis of the stated research objectives:

  1. What is PTSD? What is its prevalence in the U.S.? What are recent research and treatment highlights in relation to PTSD?
  2. What are the causes and repercussions of PTSD on the military who were deployed to Iraq or Afghanistan?
  3. What are the repercussions of these veterans’ PTSD on their spouses and families?
  4. Was governmental aid accessible and sufficient? Do the veterans feel satisfied with it?
  5. What are the views of government officials on effectiveness of federal aid provided to the veterans diagnosed with PTSD?

Research Methodology

Qualitative Approach

To collect and analyze the data, the author has chosen to use the qualitative approach with descriptive orientation. The selection of qualitative approaches is justified by the importance of doing qualitative research in social subjects (Dey, 2005). Qualitative research is defined as a specific unfolding model that takes place in a natural setting and enables the researcher to develop a sufficient level of detail owing to extensive involvement in real experiences (Creswell, 1998).

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Research Methods

In this research, interviews were used to collect data along with observation. Interviews, which were videotaped and uploaded to the Youtube by the interviewers with the permission of the interviewees, were transcribed and then analyzed by the author. The observation was used to analyze the conduct of the participant in treatment.

Research Participants

Due to the specifics of this study, the author has used a stratified and purposive research sample. The key participant characteristics were the current state of mental health (in treatment/not in treatment), military service, gender, and occupation. Three military that have been deployed to Iraq or Afghanistan were chosen as research participants: two of them currently in the U.S. Army, the third one – an ex-military by an honorable discharge. Two of the participants had PTSD and recovered from it, the third one is currently in treatment. Two wives of the military participated in the interview. Also, two government officials related to Veterans Affairs and PTSD issues have participated in the interviews.

Data Analysis

To analyze the collected data, the qualitative thematic analysis was used. Themes and sub-themes were identified in the transcribed interviews. This allowed eliciting the necessary data to answer the research questions.

Findings and Discussion

Causes and Repercussions of PTSD on Veterans and Their Families

Qualitative thematic analysis of interviews with U.S. combat veterans deployed to Iraq or Afghanistan allowed us to obtain the following data in relation to suggested research questions:

  • What led to participants’ developing PTSD? Was it during deployment or did they start to feel it after returning home?

When asked about causes of PTSD, the veterans, Sergeant Josh Hopper (not in treatment), Major General David Blackledge (not in treatment), and U.S. Marine Veteran Hank Lee (currently in treatment) named

  • experiencing battle on a daily basis and seeing lots of casualties;
  • suffering from IED blasts;
  • traumatic brain injury;
  • being wounded in a suicide bombing;
  • being severely injured in an ambush;
  • being severely injured after the destruction of a platoon by a rocket-powered grenade.

As for the issue of whether the military started feeling the PTSD symptoms during deployment or after they returned home, both interviewees indicated that they felt the symptoms of PTSD during deployment, right after combat-related experiences, and continued to feel them after they returned home. Specifically, Sgt. Hopper pointed out at the fact he started to feel different during his second deployment, which was in Iraq.

He said he felt something was wrong about him and something was bothering him, which was something he could neither understand nor handle. He says, “every morning I would come and say everything was fine, but that was a mask, and I said to myself I had to do something about that.” As for General Belckledge, he started feeling the symptoms of PTSD right after his life-threatening experiences during deployment to Iraq. As for Hank Lee, he started feeling the way he does (he is currently in treatment) during the deployment.

Further, when asked about the effects of PTSD on their health/life, both participants admitted to having serious psychological troubles in the past. Here it needs to be mentioned that both interviewees, Sgt. Hopper and General Blackledge, underwent psychological treatment and talk about repercussions of PTSD in the past tense; whereas Hank Lee talks about his health condition in the present tense. The research question was

  • What were (are) the repercussions – the effects on interviewees’ life – of the PTSD?

The following repercussions have been mentioned:

  • having trouble sleeping;
  • getting angry without any reason at all;
  • having nightmares;
  • getting emotionally distant from family and friends;
  • losing interest in children;
  • drinking;
  • losing interest in usual life activities;
  • being unable to remember how to get around when driving;
  • mood swings;
  • suicidal thoughts.

Specifically, Sgt. Hopper admitted to becoming detached from his spouse, family, and friends. He says, “I used to call parents two or three times a week, but then I stopped doing that. They started calling because I didn’t call”. Upon his return home, he says he could not enjoy his children. Coming back from work, he says, “I just poured a drink and sat till I fell asleep to wake up next morning”. General Blackledge says that for a year after he was wounded during the suicide bombing he was not able to sleep normally, got angry unnecessarily, felt frustrated, experienced nightmares, and felt it was going to last till the end of his life.

Hank Lee says that he has trouble sleeping, but for medicine, he can remain sleepless for 3 or 4 nights; he has flashbacks once he encounters some information or sees some image that reminds him of his war experience; he is unable to drive since he does not remember how to get around. Also, with the help of observation, it has been found that Hank Lee, who is currently in treatment, demonstrates the effects of PTSD in his behavior during the interview: he evidently has some trouble concentrating, he feels tense, when recalling his experience in jail, he bites his lips and demonstrates excessive anxiety; he cannot sit still during the interview, instead he fidgets, moves his arms restlessly, turns his head. Besides, he sometimes produces inadequate reactions: when asked about something by a civilian interviewer he responds, “Yes, Sir” the way soldiers respond to the senior staff in the Marines Corps.

As for the third research question, it was about the quality and effectiveness of federal aid. Two participants, Sgt. Hopper and General Blackledge said they were satisfied with the quality of medical aid they received in relation to PTSD treatment. Both military currently serve in the U.S. Navy and have recovered from PTSD with the help of qualified medical help. In particular, Sgt. Hopper says his treatment was something like having classes. In three months, the interviewee recovered from the symptoms that he had, he says. Similarly, General Blackledge says he was examined and monitored by a senior psychiatrist who helped him regain his mental health. The officer compares PTSD recovery with recovery after a physical injury: a person with PTSD who receives qualified mental health help will regain strength and resiliency and will be even tougher after treatment.

Repercussions of PTSD on Veterans Families

From the available data, the following findings have been obtained. Andrea Hopper, the wife of Sgt. Hopper said she and her children suffered greatly from PTSD-related misbehavior of her husband. First of all, Andrea says, Josh Hopper became very distant. If before his first deployment her husband was “very sociable, affectionate, and friendly, and always showed that he loves you”, after his first deployment (to Africa), “he did not have much to do” with Andrea. The woman describes Hopper’s mode of life in the following way: “He would come home after the sun went down; would eat, drink, and go to bed”.

Things became worse after Hopper’s second deployment (to Iraq). Andrea says Hopper was getting more and more detached from his family and close friends so that “you could be in the same room, look at his face, and see he’s not here anymore; he was in another country”. Apart from constant mood swings, he was drinking a lot. Moreover, Andrea says, “we constantly fought”.

As for U.S. Marine Corps veteran Hank Lee, his wife does not report any violent behavior towards her. She confirms having a loving relationship with her husband and the fact that “every hour every day we spend together; we love each other”.

Veterans’ Views on Federal Aid

One of the research questions was about interviewees’ views on Federal Aid, it's quality and accessibility.

  • What are the participants’ views on Federal Aid? Is it accessible?

The responses of the three participants differed greatly. While both Sgt. Hopper and General Blackledge admitted to being satisfied with the kind of medical treatment they got, U.S. Marine veteran Hank Lee said that he is completely dissatisfied. Sgt. Hopper and General Blackledge say that they received adequate psychological treatment that helped them overcome PTSD and return to military service. That was the only help from the state that they mention.

Unlike these two participants, Hank Lee is dissatisfied with state aid. He says he was appointed three doctors in nine months who have been quite irresponsible in some cases. In one case, Lee was prescribed medicine in the wrong way. He now has to take fifteen medicines per day to support oneself. Besides, he says the VA will not pay his $30,000 debt for treatment. Apart from numerous surgeries that he has had since coming back home from his last deployment, he has received PTSD treatment. His disability money from the VA is 1,500 per month, which he thinks is little. Besides, he has no privileges for loans as a veteran though he needs such.

At the same time, money is not the biggest concern that Lee expresses about his position as a Marine Corps veteran. He says he has encountered numerous cases of neglect on the part of government officials not in the VA, but in other government organizations. For example, during one of his flashbacks, he started to behave noisily and he was taken to the police. There he was denied the right to take medicine which his wife brought. He was said they ran out of the medicine. That resulted in Lee’s inability to sleep for 4 days in jail.

Moreover, when Lee’s wife brought all the documents that proved that he was a veteran in treatment hoping to get him out of the jail and deliver him to the hospital; therefore her efforts to release Lee were ignored. When the officials saw Lee’s tattoo on his back that indicated he is from the Marine Corps they started making fun of him. When he said he was a veteran and needed treatment, they called him a liar. Next, Lee has suffered from the false charge of disorderly conduct, and had to hire a lawyer to prove his innocence.

The biggest disregard appears to be the unwillingness of state officials to help Hank Lee stop the process of deportation of his wife and his sole caregiver Jamie Lee. The U.S. Immigration and Naturalization Service are going to deport Jamie to Canada. There was a charge of a minor misdemeanor (swearing in the middle of the street) that was later dropped. It became the ground for starting the deportation process. Hank Lee has to prove his marriage is real in court to help his wife stay in the United States.

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He says he has faced a wall of disbelief and lack of cooperation in his efforts to keep Jamie in the U.S. despite the fact that she pays his bills, drives him around, reminds to take medicine, helps to look after his daughter and pets, and does other things. Jamie has already been deported for 22 days before, which left Hank helpless and in need of support. Yet, he does not have any assistance or feel any compassion in this case. Overall, Hank Lee feels utterly disappointed by the government aid and his social conditions. He says, “I am not happy with this country at all, I am disappointed; I have been forgotten.”

In summary, Blackledge and Hogger believe that federal aid in their cases of dealing with PTSD was effective and advise that all veterans who feel the same symptoms use the opportunity to get PTSD treatment. In their opinion, the biggest barrier is not the ineffectiveness of medical treatment, but the unwillingness of many soldiers and ex-soldiers to undergo PTSD treatment. Hogger says that to start his 3-month treatment he had to swallow his pride and overcome the psychological barrier of admitting his, as he thought weakness.

Similarly, Blackledge admits to psychological barriers. To specify, he says his wife did not support him once he said he would undergo PTSD treatment. She thought it would have a negative impact on his military career. Unlike Blackledge and Hoggart, both of whom are still in the military, Lee, who has an honorable discharge after serving 2 tours in Afghanistan and 1 in Iraq, is completely dissatisfied with his federal aid.

As for veterans’ wishes about federal aid, Hank Lee, a U.S. Marine veteran, says he feels his country does not need him and he gets insufficient help in all aspects. Financially, he receives 1,500 on a monthly basis, which is not enough to cover his expenses related to “legal hassle” and his hospital bills ($30,000). He has faced indifference and lack of responsiveness from government officials and feels what he has done for his country has not been appreciated. Hank would also wish to get some privileges in relation to loans.

Government Officials’ Views on Effectiveness/ineffectiveness of Federal Aid

From the available data, it has been found that government officials believe that the role of the state is critical in taking care of veterans of service in Iraq and Afghanistan. Jeff Miller, U.S. Congressman, and Chief of Veterans Affairs Committee says “we are supposed to take care of those who had been in the battle”. Further, Mr. Miller admits that U.S. veterans “need to be provided with better health care, especially those who reach out for help”. He confirms the fact that many veterans do not get a timely appointment for healthcare needs because of long waiting times. Hence, “PTSD goes untreated for far too long”.

Tim Walz, U.S. Congressman and a ranking member of the Veterans Affairs Committee, agrees that veterans with PTSD do not receive enough medical help in the United States. Despite the official figures that say that 473, 000 veterans have received treatment for PTSD across the United States, “their (veterans) biggest complaint is they want to get in”. Walz says that treating PTSD is just as important as treating a heart attack. People with suicidal attempts need to be treated immediately since PTSD “is not just a headache or a sprained ankle.”

While both officials agree on the need for changes as to treatment opportunities for PTSD-diagnosed veterans, they cannot name any particular legislation that would facilitate the process. So they advise veterans to “look outside the current system”. Long waiting lists and mental health issues prevent many veterans from getting adequate help, which often leads to suicide. Both officials agree that in the situation when more U.S. veterans die of suicide than from physical combat-related injuries, government aid “may have been not enough”.

Conclusions and Recommendations

The results of this study align with the recent findings on the causes and effects of PTSD among the U.S. military that have been deployed to Iraq or Afghanistan. It has been found that the causes of PTSD in the military are related to exposure to direct combat and life-threatening experiences, seeing lots of casualties, and having a brain injury. It has been found that the second or third deployment was associated with higher exposure to PTSD, similarly to Shea-Porter’s findings (2009). The repercussions on the military found in this study coincide with generally recognized outcomes of PTSD: excessive anxiety, sleeping troubles, depression, and loss of interest to habitual life activities, nightmares, frustration, feeling angry for no reason at all, and drinking alcohol.

Besides, the study confirmed the findings of De Burgh et al. (2011) about the negative impact of deployments on marital relationships. It has been found that PTSD-diagnosed military may get emotionally detached from their families, do not have an interest in children, do not communicate with wives, get addicted to drinking, and use physical force.

In terms of governmental aid, it has been established that currently not enough federal aid is provided to veterans in terms of medical, financial, and social support. Despite the fact that two of the interviewees said they were satisfied with medical aid, their opinions should be taken with care since they are currently in the military and are subject to a different funding scheme in their treatment.

Both sides, veterans and governmental officials, agree that more should be done to veterans in terms of accessibility of PTSD-related treatment. Importantly, government officials agree that the state is responsible for the veteran’s treatment. The results of this study partially confirm the findings of Tuerk et al. (2010) about the deficiencies of modern psychiatric treatment of PTSD which is rarely grounded on evidence-based, innovative models.

Overall, the major conclusion of the study is that federal aid to veterans with PTSD should be enhanced. Based on the research analysis and observations, it is recommended that the U.S. government should not send its military to hot spots to spare their lives, as well as their physical and mental health.

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