Friday, November 12, 2010

“GOING HOME TO THE SOUND OF THE GUNS.”

“GOING HOME TO THE SOUND OF THE GUNS.”
Some Thoughts Regarding PTSD:  A Behavioral Approach to Post-Traumatic Stress Disorder -- An Alternative Course of Treatment for Soldiers of the United States Military.
Alvin Streeter
The National Institute of Mental Health defines Post-Traumatic Stress Disorder, PTSD, as an anxiety disorder that can develop after exposure to a terrifying event or ordeal in which grave physical harm occurred or was threatened. Traumatic events that may trigger PTSD include violent personal assaults, natural or human-caused disasters, accidents, or military combat.  My personal experience, however, suggests an alternative explanation and therapy.  Thinking back on my own return from service with the Marines in Vietnam many years ago, it occurred to me that if the returning soldiers today are like those of my generation, the real issue with PTSD is behavioral rather than medical.  Putting aside the truly psychiatric cases of mental illness, it may be that PTSD is actually a state of mind expressed in the behavior of soldiers returning from combat operations who are separated Too Suddenly  -- a kind of separation anxiety; a perverse form of home sickness. 
From this viewpoint, PTSD is a state of mind in which the returning military personnel is unable to “mentally and behaviorally leave” the combat theater of operations, continues to behave as if he or she is still in the combat theater while suffering from being separated from comrades and the excitement (and tension) of the war environment.  Discharged soldiers still want to be close to those left behind in their combat theater of operations and find it difficult to relate to those they knew before becoming soldiers.  It is this longing for a return to combat and the order and rules of the society of soldiers and arms that lies at the heart of PTSD.
We should remember that the Military socializes civilians into solders to function and survive in combat.  The trouble is that many soldiers can’t just depart their combat theater of operation or the state of combat.  Some soldiers can’t just pick-up and go “home” to civilian life.  They require a period of adjustment prior to returning to civilian society.  There has to be a real end to each soldier’s war for the solider to re-socialize back into a civilian once again.  Historically, as a country, we have not done this, but simply discharged returning soldiers to civilian life.  The result has been a large number of soldiers unable to leave their war experiences behind and stop behaving like soldiers.
This view suggests that PTSD is not an expression of a soldier’s guilt or trauma; but, rather, is an expression of the soldier’s longing for a return to the combat situation – the “high” all soldiers experience with the excitement and terror of life in the combat theater of operations.  Soldiers with PTSD, at root, unconsciously, miss their comrades, the war environment, and the military society.
 
How Does the Soldier Leave the War Behind?
 
Accordingly, there are several therapies one can offer as a “cure” for PTSD.  One has to approach a response to PTSD by asking the question -- how did the soldier go to war? in order to answer the question -- how does the soldier leave the war behind and go home?
One answer of how best to bring our soldiers home is to have our soldiers “Return to the sound of the guns” or to remain in some fashion in the military prior to their discharge.  Soldiers following this course of therapy would join a non-deployable reserve unit for an abbreviated period of time (say, one year or 6 months ,) drill once-a-month and complete their military service back in the United States. 
Another approach would be to assign returning soldiers to a stateside End of Military Service Unit (EOMS) where soldiers returning from combat theaters and scheduled for separation would be assigned to the EOMS where they would conduct military exercises in a simulated war environment for six months prior to their separation from the Military back to civilian life.
Treatment of PTSD may benefit from a focus on the soldiers’ behavior rather than their symptoms. Alternately, in this view, most PTSD cases are a reaction to the stress of separation, not the stress of combat.   Under this perspective, treatment would consist of involving the returning military member in a “returning home scenario”  analogous to the “going to war scenario,” i.e., from boot camp, advanced training, in-country deployment to something like, home-coming, pre-separation deployment, transfer to non-deployable reserve or discharge.
To date, PTDS is being treated as a medical condition, when it may be primarily a behavioral disorder. It is the opinion of this author that the majority of PTSD cases occur outside the theater of operations upon the service member’s return stateside and is essentially a behavioral expression of separation anxiety; a form of home sickness that may be treated best by behavioral interventions.  It may be that many soldiers with so-called PTSD are committing suicide out of an unconscious longing for their war experience, not guilt.  With this in mind, soldiers identified with PTSD may be helped from an approach that treats PTSD less as a medical issue and more as a behavioral adjustment facilitated by the soldier’s gradual separation from a society of warriors and war to peace and the responsibilities of civilian life.