Combat and Rescue

Breeding grounds for PTSD

Atholl Malcolm, CD1, PhD, RPsych

Reprinted from "Trauma and Victimization" issue of Visions Journal, 2007, 3 (3), pp. 17-19

stock photoFrom 1964 to the early ’80s, I was an air navigator/tactical officer in the Canadian Forces. I was one of a large number of air crew trained and contracted to serve for five years. My goal was to finish this term, get my discharge gratuity and go to university.

In the middle of my stint, the rules changed and we were all offered a permanent commission. I accepted, but soon realized that a degree would help career advancement. Getting a degree in psychology seemed easiest to manage while being posted in different locations around the country—and I was interested in understanding human nature.

While taking this degree, I was flying with 442 Search and Rescue Squadron. In those days, emergency locator beacons were not very accurate. We would spend several weeks at a time looking for lost aircraft in British Columbia’s unforgiving terrain and mountain weather.

I was taking a course in abnormal psychology at this time, and was particularly struck by a textbook chapter on traumatic stress and its effects. It seemed to apply to our environment and, especially, to the Rescue Specialists, whose job included parachuting into what can only be described as human carnage.

I recall one tragedy when five lives were lost in the crash of a light plane. While we were circling above, our specialists on the ground were getting ready to sort out the mess, place body parts into body bags, and so on. Then word came to wait until the coroner arrived on the scene. They had a long wait, guarding the scene and keeping bears away. When the coroner arrived, he took one look, threw up and left, telling our team to get on with it. A coroner had difficulty dealing with a scene that was commonplace to the Rescue Specialists.

Old-Fashioned ‘Therapy’

After a long day of searching, we would relax with a few drinks. If the search ended successfully, with lives saved, we celebrated; if there were fatalities, we drowned our sorrows.

Over time, it became apparent that many of us were more comfortable around each other than at home with our families. Our crewmates understood why we stood around telling war stories, avoiding personal issues. We had a great sense of ‘gallows’ humour. Looking back, it is easy to see why there was high rate of family breakdown and other difficulties.

A Second Career

After completing my doctorate in Clinical Psychology and 20-plus years in the military, I began a new career as a psychologist in private practice.

Regarding my 442 Squadron days, the circle is completed, as the old textbook predicted. In the last two or three years, my practice has assessed several of my former squadron colleagues for post-traumatic stress disorder (PTSD). These people are now retired, but due to the traumatic sights they were exposed to, some are badly affected. Fortunately, they are entitled to, and are receiving, much-needed therapeutic assistance from Veterans Affairs Canada.

What is Trauma?

In my military day, Canada's involvement in peacekeeping was extensive, but active engagement in combat operations was rare. Now, a large number of Canadian troops are exposed to highly traumatic events. However, PTSD is not just a soldier’s disorder. It also applies to assault victims and relief workers and police officers, and to anyone who is involved with others who have been traumatized.

There are three major components to PTSD. The first is increased arousal, which involves, for example, a heightened startle response and sleep difficulties. The second component can include re-experiencing the initial event when a reminder triggers a traumatic reaction. I treated one soldier who was triggered by the sight of a local soccer pitch, because an area of vegetation around it was similar to vegetation around a mine field in Bosnia. Other forms of re-experiencing include nightmares.

The third component is a strong desire to avoid anything that is a reminder of the event. So the PTSD sufferer will avoid social interaction in case someone brings up a topic of conversation that may trigger a reaction. Avoidance may also include avoiding or pushing away family members, because the heightened arousal causes inappropriate emotional reactions. This causes guilt and shame. So the sufferer, in an attempt to avoid hurting the people he or she loves, will spend hours in isolation—in the basement on the computer, for example. Or, they will spend excessive time with the colleagues who understand them because they are in the same boat—and it is often over a drink.

PTSD is an anxiety disorder. Alcohol, other drugs, gambling, sex and pornography are common avoidance behaviours, because they represent means of distracting from the anxiety. Depression is also a common side effect of PTSD.

Treatment of the Traumatic Memory

Treatment can take several forms. All involve exposure to the original trauma and learning to cope with it.

When a person is exposed to a physical threat, it is the “fight-or-flight” centres of the brain that are activated. In this context, the event is not memorized in the true sense of the word. To explain: if we think of something that happened in the past, even an unpleasant event, we talk our way through the memory as we visualize the event, and we can choose at any time to distract ourselves. A traumatic memory lacks the cognitive or self-talk component, because there was a lack of cognitive processing in the first place. In the fight-or-flight response, our reaction is physical and more or less instantaneous: we either fight back or run away.

Brain scans have shown that when a person is subjected to something that triggers the original memory, the sites of the brain where verbal material is processed are relatively quiet compared to when someone thinks about a non-traumatic event. So, in therapy, by gently and gradually re-exposing a PTSD victim to the original trauma and helping the person stay with it while talking about it, we build the verbal component.

Once the verbal component is built, the person has an option to choose not to think about it. In this way, the instantaneous startle reaction is less likely to happen, and the person now has some control over it. A major fear in PTSD sufferers is lack of control, because that was inevitably a significant factor in the original trauma.

More than 50% of PTSD sufferers develop chemical or other dependencies. From a treatment point of view, it is absolutely necessary to treat these co-occurring problems together.

Optimism for the Future

The good news is that following treatment, my friends from air force days are coping and their family life is improving. There is now a much greater understanding of brain chemistry and this very real disorder. “Shell shock” and “lack of moral fibre” are terms that have been placed where they belong—in the trash can.

We can now provide therapies that work. It is my experience, however, that many PTSD sufferers are reluctant to seek help. So it often up to a family member to take the first step. I have seen many clients who came only because their marriage was on the line if they did not. Nevertheless, they entered the therapeutic door, and that is a major step.

PTSD is just as real a disorder as a broken leg. If you have any concern about whether you may be experiencing a post-traumatic disorder, seek help right away.

 
About the author

Atholl is a clinical and consulting psychologist in private practice. Formerly the department chair of Psychology and Applied Leadership at Royal Roads Military College, he is currently an Adjunct Associate Professor at the University of Victoria. Visit his website at www.drmalcolm.ca

 

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