Defence

Work–Life

Post-traumatic stress disorder and the Australian Defence Force

Following on from last month’s Defence magazine Work–Life topic of resilience under stress, Group Captain Len Lambeth discusses the other side of the coin—what happens when an Australian Defence Force member experiences the results of trauma and what can be done about it?

It is often said that stress is the epidemic of the late 20th and early 21st centuries. One particular type, post-traumatic stress disorder (PTSD) has been seen by many to have reached epidemic proportions.

Members of the Australian Defence Force (ADF) are all subjected to stress—be it during combat, on operations, familial, financial or any of the other stress-filled areas of modern life. We don’t have any inbuilt mechanism for dealing with stress appropriately; we are often placed in highly stressful situations, and occasionally we respond by developing a stress-related disorder.

Myth or reality?

So what is it all about? Are those who develop disorders weak, are they faking it, or has their ability to deal with stress simply been overwhelmed?

Looking specifically at PTSD, we can see that in one form or another it has been recognised from at least early Shakespearian times. It has been given a variety of names: soldier’s heart, fright neurosis, war neurosis, shell shock, and post-Vietnam syndrome, to name but a few.

Many, doctors among them, doubt the existence of PTSD. There is a view that it is just a way to obtain compensation. Opposing these views is the fact that PTSD is one of the most thoroughly researched of all mental disorders. It has been recognised for centuries. Studies have demonstrated changes in areas of the brain associated with it and specific treatments have been developed which significantly alleviate it. This evidence suggests that PTSD is very much real.

What causes PTSD?

Exposure to a significant traumatic event is the problem. Combat, rape, serious accidents, domestic violence, or exposure to horrific events are some of the many incidents that may lead to the development of PTSD; the fact is, however, that they do not inevitably do so. Having an argument, being told off by your boss, or hearing of a traumatic event without being witness will not cause PTSD, although other types of stress disorders may follow.

Anyone exposed to significant trauma may get PTSD. The person may or may not have obvious vulnerabilities. In understanding that one person’s trauma is another’s thrill, we can’t predict who will develop PTSD, but we can say it is not a choice; rather, it is a genuine illness. It is most definitely not a sign of weakness.

How do you know you have PTSD?

Firstly, you have to have been exposed to a significant traumatic event. Then, you may notice that you keep going back there—in your recollections, your dreams, and you may have ‘flashbacks’ to the event. You may, when reminded of the event, experience many uncomfortable symptoms such as nausea, sweating and intense fear. This, of course, is extremely unpleasant and your reaction may be to avoid dealing with your PTSD. You may find that you won’t want to talk about what happened and keep right away from anything that reminds you of it. Even forgetting important parts of the event is common. You may find it difficult to relate to others, even to those close to you, and you may lose interest in many of your activities. A generally bleak outlook is often the result. Unfortunately, that is not the end of the story, for you may also experience problems with sleep, you may become irritable or find it difficult to concentrate and become nervous or ‘jumpy’.

How is PTSD treated?

The first thing to remember is not to panic. Discuss the problem with your local psychologist or medical officer. If they are of the opinion that you are likely to have PTSD, they will arrange for you to be assessed by someone who specialises in diagnosing and treating PTSD. You may, by now, have noted that you are quite depressed or ‘down’ and you may have automatically begun self-treatment by drinking to excess or by engaging in some other kind of ‘mind numbing’ behaviour. Although quite common, such behaviour is not preferable or healthy, particularly in the long term, and you should immediately seek professional help.

Initially, the task will be to reduce or eliminate the very unpleasant symptoms and signs of PTSD and any other related conditions. Next, your psychologist will try to improve your functioning and give you a sense of safety and trust. Finally, your psychologist will help you limit generalising or dismissing the trauma and protect you against relapse.

The fact of the matter is that many people with PTSD will require the use of an antidepressant. This is not something to be alarmed about. Most people will respond to one of the newer antidepressants, which are not addictive, are safe and easy to use, and have few serious side effects. Some individuals will require the use of other types of medication, but in such cases, the symptoms are so severe that the medication becomes necessary if relief is to be obtained.

Recovery and the long term

Most people with PTSD improve or recover completely. Some do unfortunately go on to follow a chronic course of illness. The point is that your best chance of recovery comes with early and appropriate treatment.

The other important point to bear in mind is that the ADF does not abandon you. Why would they? You have an illness from which, with appropriate treatment, you are likely to recover. You have valuable skills. It is not the ADF’s policy to seek to discharge you if there is any chance of recovery. Unfortunately, recovery is not always achieved. In this instance, like anyone with any other chronic illness that is not compatible with ADF service, you may be discharged. Seeking help early on will vastly decrease the chances of this happening.

For more information on PTSD from a Defence perspective, access the ADF Mental Health Strategy page, online at http://www.defence.gov.au/dpe/dhs/mentalhealth/index.htm.

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