PTSD/ PTS Veterans as Students Students as veterans Gladys Smith Webster University

1. PTSD/ PTSVeterans as StudentsStudents as veteransGladys Smith Webster University

2. A 2003 New England Journal of Medicine Study found that more than 60 percent of those showing symptoms (PTSD) were unlikely to seek help because of fears of stigmatization or loss of career advancement opportunities.

3. Education • The number 1 reason for enlisting in the military (35%). • Estimated in 2009 316,000 veterans were under 25. • About 25% of new recruits buy into the GU Bill • There is an influx of veterans in colleges and universities.

4. Veteran Students are Different • Older • May have more responsibility (spouse, kids, military duties) • Different life experiences. • May be struggling with after affects of deployments (emotional, physical, social).

5. After Effects of Deployment (s) • Physical Conditions (head injuries, orthopedic, GI, Pulmonary, dermatologic). • Combat Stress Injuries-PTS, depression, anxiety and panic, anger, substance abuse. • Financial/Occupational • Reintegration (families, friends, Civilian life)

6. According to the Department of Defense Behavioral Health Survey 43% of National Guard Members had readjustment issues after returning from the war zone(s).

7. I would be seen as weak by my unit members 65% My unit leadership might treat me differently 63% My unit would have less confidence in me 59% My leaders would blame me for the problem 51% It would harm my career 50% Difficulty getting time off for the problem 55% It is difficult to schedule an appointment 45% I don’t trust mental health professionals 38% Mental health care doesn’t work 25% I don’t know where to get help 22%

8. Red Badge of Courage Stephen Crane’s book about the Civil War contained themes of masculinity symbolized by war. Where are the mental wounds? We discount them because they are • invisible • counter to our notions of masculinity • “secondary”

11. I don’t rate feeling this way

12. A Veteran

13. And what about when your warrior’s anger goes home? What is it like with his wife and children? Is it useful then, too? Cicero

14. PTSD from Ancient Greece to the Present • Sophocles, Homer • Nostalgia • Hysteria • Bible’s Job, Joseph, David • Shellshock • Buck fever • Combat fatigue • Battle reaction • Disorderly action of the heart • Soldier’s heart • Homesickness • Irritable heart

15. WWII Called combat fatigue and it was a serious problem. In the European Theater, 25 percent of all casualties were serious PTSD cases. In the Pacific Theater, like Okinawa in 1945, it accounted for over a third of all wounded.

16. Iraq and Afghanistan According to a more recent Post-Deployment Health Reassessment 38 percent of regular soldiers, 31 percent of Marines, and 49 percent of National Guard report psychological symptoms. Those who had served repeated deployments were at extremely high risk of problems and the toll on their family members was great.

17. The Brain

18. Conditioning • Pavlov in 1904 • Skinner developed further into Behavioral engineering • Rewards and Punishments develop automatic behaviors

19. “Train Like You Fight” Methods used to train is an application of conditioning techniques to develop ‘quick shoot’ ability. The modern soldier trains in full gear, shooting blanks at realistic targets until reflexive fire is obtained.

20. I yelled “kill, kill” ‘til I was hoarse. We yelled it as we engaged in bayonet and hand-to-hand combat drills. And then we sang about it as we marched. I had stopped hunting when I was sixteen. I had wounded a squirrel. It looked up at me with its big, soft brown eyes as I put it out of its misery. In 1969 I was drafted and very uncertain about the war. I had nothing against the Viet Cong. But by the end of Basic Training, I was ready to kill them. -Jack, Vietnam Veteran On Killing

21. “To survive and be victorious on the battlefield, our warriors must aggressively seek out the enemy and kill them. This has far reaching spiritual and psychological implications. In order to be “successful” the warrior must not miss a beat in pursuing and eliminating adversaries one after another. When they attack the enemy, they are trained to go one step beyond personal moral boundaries and take the life of another human being. This eventually becomes their personal horror of war- this is one primary aspect that damages the soul. The “killer instinct” that is so energetically thrown around in locker rooms and corporate sales meetings becomes a very real impulse to soldiers in the heat of battle. Without this instinct the warrior is very lucky– or very dead.” Down Range: To Iraq and Back

22. ? Amygdala Visual

24. Almost allservice members returning from the war zone will experience some of these behaviors and reactions. It’s vital that you remember that having these reactions does NOT automatically mean you have PTSD. It would be abnormal if you didn’t experience some of these feelings and behaviors following what you have been through in the war zone. It isn’t an Either/Or… it is a spectrum

25. Signs & Symptoms of PTSD • Flashbacks, or reliving the traumatic event for minutes or even days at a time • Shame or guilt • Upsetting dreams about the traumatic event • Trying to avoid thinking or talking about the traumatic event • Feeling emotionally numb • Irritability or anger • Poor relationships • Self-destructive behavior, such as drinking too much • Hopelessness about the future • Trouble sleeping • Memory problems • Trouble concentrating • Being easily startled or frightened • Not enjoying activities you once enjoyed • Hearing or seeing things that aren't there

26. Anxiety • The mind stays on vigilant, ever on alert. • This keeps emotions and the body aroused. • Chronic or severe arousal changes the nervous system. • Smaller threats than usual sound the alarm. • Takes longer to return to resting state. • Physical symptoms • Emotional fatigue • Mental fatigue • Spiritual fatigue • Exaggerated stress response • Avoidance is hallmark

27. Dissociation • Perceived detachment of the mind from emotional states or even the body. • Dreamlike state or unreal place. • Poor memory of specific event • DID, Fugue • Fragmented • State-dependent memories • Traumatic memories are walled off • Dissociated material is highly emotional and relatively non verbal • Triggers can be the sense, body movement, dates, stressful events, strong emotions, cognitive patterns, behaviors, out of the blue, and combination.

28. What is Dysfunctional? • Impaired in function; especially of a bodily system or organ (of a trait or condition) failing to serve an adjustive purpose. • If a person is behaving in ways counter-productive to their own well-being

30. Many Treatment Options • Medication • Psychotherapy • Exposure Therapy • Cognitive Behavioral Therapy (CBT) • Eye Movement Desensitization & Reprocessing (EMDR) • Memory Work • Art Therapy • Thought Field Therapy • Healing Rituals • Group Therapy • And More…

31. Call of Duty 4 U.S. Army medical researchers have noted that soldiers that play violent video games, are better able to handle the stress of combat. More elaborate (virtual reality) combat simulations are now being used to treat combat veterans who are suffering from severe stress reactions from combat (PTSD, post-traumatic stress disorder). www.strategypage.com

32. Pathologizing It is important that therapists who work with veterans be educated in the warrior tradition and its rituals in order to recognize and help veterans identify with [the use of] warrior traits. Ignoring these traits is harmful to the veteran, for then the inner warrior remains invisible. Pathologizing the traits is also harmful, for then the vet is further wounded by reductionist interpretations that may minimize their importance to him… or empty them of their spiritual potency. -Edward Tick, Ph.D. War and the Soul

33. Strengths of our warrior tradition

34. What is a HERO ?

35. I am an American Soldier. • I am a Warrior and a member of a team. I serve the people of the United States, and live the Army Values. • I will always place the mission first. • I will never accept defeat. • I will never quit. • I will never leave a fallen comrade. • I am disciplined, physically and mentally tough, trained and proficient in my warrior tasks and drills. • I always maintain my arms, my equipment and myself. • I am an expert and I am a professional. • I stand ready to deploy, engage, and destroy, the enemies of the United States of America in close combat. • I am a guardian of freedom and the American way of life. • I am an American Soldier.

36. Family Members • Provide opportunities to talk • Don’t be afraid to ask about the war • Accept your limitations • Offer attention, interest, and care • Educate yourself • Find available resources • Be supportive with expectation that readjustment will occur • Do not pressure to talk • Do not stop them from talking • Try not to make judgmental statements • Avoid telling what one ‘should’ do • Watch for clichés or easy answers (war is hell) • Avoid giving advice without fully listening • Don’t rush things

37. MyHeroesAtHome.com

38. Community • Join the local VFW or American Legion • Battle Buddy • Create a book club • Mosaic.com • Welcome home every vet you see • Join Vets4Vets.com • Volunteer, even though you don’t feel like it

39. Quick Rundown • Training has given you faster reflexes for combat actions • Experiences give emotional shaping to memory • It is normal to have mixed feelings about wartime experience • Having some symptoms does NOT automatically mean you have PTSD • Only a clinician can diagnose you with PTSD • PTSD is not permanent and many treatments are available • There are MANY resources available for treatment • If left untreated it will negatively impact everyone • Healing is found via community

40. Resources for students, staff & faculty • www.vets4warriors.com • www.ptsd.va.gov • www.militaryonesource.com • 1800-342-9647- Military One Source phone • Veterans Crisis Line 1-800-273-8255 • www.myhealth.va.gov • www.ulifeline.com • www.halfofus.com

41. Webster Counseling & Life Development • Patrick Stack- Director Counseling • Gladys Smith- Assistant Director Counseling • 540 Garden Ave • St. Louis Mo 63119 • 314-246-7030 • www.webster.edu • gmsmith@webster.edu • stackpa@webster.edu