by Dr. (Maj.) Dennis P. Tansley
8th Medical Operation Squadron Mental Health Flight commander
11/30/2012 - KUNSAN AIR BASE, Republic of Korea -- -- "They
can't have Post-traumatic Stress Disorder, they haven't really
deployed!" a supervisor said in disbelief when discussing a member who
had deployed to a country far from any combat action.
A commander at another base once insisted, "no way, they haven't even
been downrange" when one of their members was diagnosed with PTSD.
Some believe that an individual must actually be near a combat zone in
order to develop PTSD symptoms. That's not necessarily true. I have
worked with members at multiple installations who were diagnosed with
combat-related PTSD, yet hadn't physically been to combat zones.
There's also a good amount of research showing that it's possible to
develop PTSD by watching videos, such as Predator reconnaissance and
combat feeds, seeing photos, hearing or reading stories of traumatic
events from downrange.
Bottom line: someone could be half way around the world when they're exposed to a combat situation and still develop PTSD symptoms. It's the exposure to the traumatic stressors, events, or situations and not necessarily actually
being there that's key to understanding the potential for personnel to
develop PTSD symptoms. Additionally, repeated or continuous exposure to
traumatic events could also heighten the chances of developing PTSD.
One of the most researched cases where people have developed PTSD
symptoms while being geographically removed from an actual traumatic
event occurred on Sept. 11, 2001. After 9/11, multiple research studies,
to include those by the Veterans Affairs' National Center for PTSD,
showed that the more people in the general population watched the
attacks on TV, no matter where they were in the U.S., the more they
experienced anxiety and PTSD symptoms.
It's important to understand some degree of PTSD symptoms, such as
avoidance, emotional numbing, and being on guard are normal and adaptive
survival reactions to extremely abnormal situations. Personally, I tend
to be a little hyper-vigilant when I'm downrange.
We may see some kind of stress reaction in returning members because war
is stressful business. It doesn't matter if they saw combat while in
Afghanistan, were deployed away from the action, or even at their home
station. We also expect them to recover over time and see their symptoms
fade away when removed from the stressful situation.
However, this doesn't always happen. There are times when the symptoms
remain or worsen over time. Some symptoms to look out for include:
disturbing memories, avoiding things that trigger painful memories,
nightmares, flashbacks, intense anxiety or anger, irritability, and
jumpiness. This can be thought of as members not being able to recover
from their extremely abnormal experiences.
Doctors Patricia Resick, Candice Monson, and Kathleen Chard described it
in their 2011 manual for treating PTSD, "Because we know that PTSD
symptoms are nearly universal immediately following very serious
traumatic stressors and that recovery takes a few months under normal
circumstances, it may be best to think about diagnosable PTSD as a
disruption or stalling out of a normal recovery process, rather than the
development of a unique psychopathology."
I have worked with members diagnosed with PTSD related to
Operation Iraqi Freedom and Operation Enduring Freedom - without even
being in the Middle East; they were exposed to live or recorded combat,
torture and beheadings by the enemy and other similar events from a
The most effective treatments shown time and again for helping personnel
recover from their traumatic experiences, embrace the concepts of
exposure therapy, or desensitization. With this kind of treatment,
people recover by first talking and or writing about the traumatic
events, and going through a guided process to help them learn ways to
recover from the PTSD.
Members cannot fully recover from their traumatic experiences unless
they deal with them. Avoiding or "suppressing" the memories does not
work - it's like putting a band-aid on an arterial wound...ineffective -
and will likely lead to other problems in a person's life.
Treatment helps them better understand what's going on in their lives
and why. Through therapy and support, our military members can learn
skills to recover from PTSD in order to live a fuller life.
A few of the more widely used research-based treatments in today's
military include Cognitive Processing Therapy and Prolonged Exposure
Therapy, both individual modes of treatment, and Conjoint Couples
Therapy, which treats both PTSD symptoms and relationship dysfunction in
couples. The U.S. military has also adopted using virtual reality
software to help simulate combat situations in psychotherapy sessions.
In conclusion, members don't have to actually go to war to experience
PTSD symptoms. It's the exposure to traumatic events that precipitates
or exacerbates these symptoms. If you or someone you know is suffering
from war-related experiences, please seek help.
Even if you've never set foot in a combat zone, but have been exposed to
war in some fashion - torture and beheadings by the enemy or other
similar events, you could still be suffering from PTSD. I suggest you
visit your local military and family life consultant, chaplain or mental
health provider and take the first step into a better future for you
and your family. If you are feeling overwhelmed or suicidal, call DSN: 118 to be connected to a crisis hotline.