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Contemporary Issues in Public Health
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Introduction
Post-Traumatic Stress Disorder (PTSD) is a psychiatric disorder that is related to serious types of traumatic incidents in life. This disorder got special attention in 1980 and since then scientists are working on this problem. PTSD is one of those considerable public health issues that affect women more than men. It is also common in combat veterans and people who have experienced physical injuries. The U.S. population surveys show that lifetime PTSD prevalence rates range from 7% to 8%. Most important factors in the development of PTSD usually include genetic and environmental factors. People usually go through some chemical changes in this problem. Chronic form of PTSD is very much disturbing for patients and their families. It has been observed that people who have experienced any violence can begin committing crimes. That is why, it is important to give proper treatment to patients of PTSD.
Several treatment strategies are available for this disorder for improved and better public health. The veterans who have contributed a good part of their life to the welfare of the nation and security of other citizens are exposed to dramatically traumatizing events during a conflict. It could be things like shocking explosions in front of them, the soldier next to them being killed or worse dismembered right in front of them. The heat of the moment may not see them really getting emotional in that situation, but these create strong imprints in their minds. When they come back into peace zones or even return home, those horrible scenes tend to keep coming back and create deep traumas. This is an acknowledged and accepted PTSD syndrome seen in soldiers coming back from conflict zones and today is an area of serious concern in public health. This paper essentially focuses on the PTSD experienced by War Veterans, particularly the service personnel who took part in the Afghan conflict. Post-Traumatic Stress Disorder, usually deemed a psychiatric disturbance caused by disastrous emotional and psychological pain, demands better ways to solve its many associated problems, including policy changes.
Military Operations – The Human Cost Involved
Even though the term PTSD was not coined so early, doctors started identifying a psychological disorder among soldiers and war veterans as early as in the year 1919 at the time of the First World War. At that time, this psychological condition was termed by the doctors as “shell shock”. In military terms, PSTD is called “operational stress injury”.
As on the 7th February, 2011, almost after nine long years of service in the Afghan conflict, the military combat operations in Afghanistan were officially concluded by Canada. Irrespective of this, roughly about 1, 00o military personnel belonging to the Canadian Forces (CF) are still living in Afghanistan for offering training services to the security forces of Afghanistan .
Overall, roughly about 30, 000 Canadian military personnel were positioned in Afghanistan. This number, in terms of the strength, is much above than the Canadian men who took part in the 1950-1953 Korean War, and this makes the Canadian military forces deployed in Afghan to be the largest since the Second World War. The amount of human destruction in the Afghan conflict was massive amounting to the death of fifty-eight veterans, four civilians, and a total of 1, 859 military personnel being injured.
The human face of the Afghan conflict repeatedly resulted in traumatic experiences for quite a few of the military personnel, for who, more often than not, their service in the Afghan conflict cost their mental well-being. These post-traumatic effects are difficult to be anticipated as they are not visible, rarely and hesitantly disclosed by the victims, and also because the effects appear after many years of the actual shocking incident.
PTSD in Military Personnel and War Veterans – The Public and Social Issue
The ratio of the people serving in military who are also victims of PTSD initially tends to be as close as the general public; however, the same becomes considerably more with the increased exposure to atrocities of war. The ratio of veterans who are victims of PTSD is much higher when compared to the men who are currently service the military forces. The maximum ratio of PTSD is 42.5% among the war veterans obtaining services from the Veterans Affairs Canada (VAC), since its inception in the year 2006 with the introduction of the New Veterans Charter. With the Canadian government concluding the combat operations in Afghanistan, military personnel approximating between 25, 000 to 35, 000 would be discharged from the duties of the CF between the period 2011- 2016. Out of this, it is estimated that a minimum of 2, 750 would suffer from PTSD, and roughly about 5, 900 from some kind of a mental health issue.
About PTSD
As already mentioned above, PTSD is a psychological disorder experienced by few people who would have been through any kind of a dangerous or a shocking incident. Feeling scared while in a dangerous situation is very common. When such scariness insinuates numerous split-second changes within an individual’s body in order to prepare the body to handle the danger or even evade it. However, in individuals suffering from PTSD, this reaction is either damaged or altered to an extent. People suffering from PTDS fail to come out of that fear, even after they get over the dangerous circumstance. Essentially, their fear continues.
PTSD is not a health condition that has any relation with the age of the person. Anybody can be victims of PTSD at any age. A few people commonly suffering from PTSD are victims of sexual abuse, accident victims, soldiers and war veterans, or anybody who would have witnessed or experienced a catastrophic incident.
The diagnosis of PTSD is becoming highly established in the psychiatry community, and this eventually is giving way to a kind of standardization in the diagnosis of PTSD. For instance, if the case of North America is concerned, PTSD diagnosis is largely based on the criteria that are established by the American Psychiatric Association (APA) as delineated in its Diagnostic and Statistics Manual of Mental Disorders (DSM). According to the fifth edition of the DSM that was released in the year 2013, PTSD does not any longer be categorized as an anxiety related disorder, but it is regarded as one of the five ‘trauma-and-stressor-related-disorders.’
As mentioned earlier, though not termed as PTSD, this health condition was identified by the doctors during the First World War referring to it as ‘Shell Shock.’ This health condition in military personnel was associated with an injury of the brain that was caused due to the exposure of the person to artillery barrages. When doctors and psychologists came to know the same kind of symptoms were found in military personnel, who were not exposed to artillery barrages, functional details related to the diagnosis of ‘war neurosis’ were slowly abandoned. The first edition of DSM that was published in the year 1952, the condition of referred to ‘war neuroses as ‘gross stress action.’
At the time of the Second Worlds War, the American government had instructed all the recruiting offices to identify all the men who were at risk psychologically, and eliminate them from being recruited in to the US Armed forces. This resulted in approximately one million men being identified as unfit to join the army. Despite that amount of stringent screening, roughly about “10% of the American troops in Europe were declared to be “psychiatric casualties.”
In the year 1944, the U.S. government re-initiated a program for treating psychiatric casualties on-site, which was used for a short stint immediately after the First World War. This intervention resulted in the psychiatric casualties’ rate decreasing to 3% . This intervention was referred as the Salmon Program. The Salmon Program was so successful, that the same was even introduced prior to the beginning of the Vietnam War. The eventual result of this intervention during the Vietnam War was a 5% reduction in the rate of psychiatric casualties between the years 1965-1967.
Additionally, the success of the Salmon Program during the Vietnam War resulted in the DSM dropping the diagnosis of ‘gross stress reaction’ from its second edition that was published in the year 1968. However, the major issue with this was psychiatrists did not any longer have access to an official diagnosis of this health issue. Irrespective of this, psychiatrists were found to be treating numerous Vietnam War veterans suffering from a deferred start of ‘war neurosis..
A story of a Vietnam War hero being shot dead at gunpoint, shortly after receiving the Medal of Honour, prompted Dr. C.F. Shatan to coin the term “post-Vietnam Syndrome. ” Research about ‘gross stress reaction’ continued with a hope that the DSM would include its diagnosis in its proposed third edition that was to be shortly published. In the 1977 annual APA meeting that was held in Toronto, Canada, a team of experts researched and suggested a diagnosis for ‘Catastrophic stress disorder,’ which would even encompass diagnosis for a sub-category of ‘post-combat stress disorder.’ This, in 1978, was changed to post-traumatic stress disorder, by a working group of experts of the DSM – III.
Reasons for regarding PTSD in War Veterans to be a public health issue
PTSD, especially in the war veterans has different implications. The soldiers are trained to be ruthless in their approach and exterminate professionally as the situation demands. When a war veteran suffers from PTSD, he begins to hallucinate and vacillate between reality and illusions. These take different forms and intensities. Hallucinations could be triggered by sight, smell, words, sounds, or any other trigger, and this is rather difficult to predict even for the individual himself. When this happens in public, or even in private, the responses to such stimulus could be ranging between total withdrawal at one end of the spectrum to total aggression and offensiveness at the other end of the spectrum. Any action in this entire range would mean that any individual could get injured or veterans could inflict injury on themselves. Similar episodes that get constantly repeated start stressing the veteran as well as the immediate social structure, further deteriorate the physical and emotional well-being of this individual, so much so that social relationships get impacted and finally even lead to social disengagement.
This only serves further to deteriorate the veterans’ well-being and impact them negatively. This becomes a kind of vicious cycle, which has its origination in PTSD and eventually resulting in several other sever consequences. The well-being of war veterans is definitely a social responsibility and their ill-health is again a social malady.
On one side, there is a serious impact on the well-being of the war veterans as they are not able to slip into the civil society, and finally the society is not in a position to recognize and respond to them appropriately and take care of them. These could have severe repercussions on individuals, communities, and society as a whole. What starts-off with mere PTSD could end-up in disasters.
On the other hand, if a war veteran is trained and treated to be enabled to handle PTSD well, they can actually become assets even to the civil society, with the kind of skills that they possess. Some of the senior veterans like Commissioned and Non-commissioned officers also bring in extensive administrative, tactical, management and leadership skills that could be an asset to any public and private organization, if only PTSD is handled and managed well.
Conclusion
PTSD before becoming a social issue also has intense impact on their private lives. The veterans, if suffering from PTSD that is not acknowledged, treated and managed well, would lead to stressed relationships at all levels in the family. The relationship stresses will have negative impact on all the members of the immediate family, and this could lead to stress, anxiety, and even depression in the other family members.
Thus, PTSD among veterans is no longer an issue that an individual has to deal with, but rather has transformed into a public health concern at large. Therefore, the community or the society has direct or indirect responsibilities in handling this.
Recommendations
Recommendations towards framing of public policy towards PTSD is that the personnel in the armed forces, those in armed duty be screened for PTSD also as part of their regular health checks. This will allow for identification of PTSD inflict personnel and help in counselling, reassignment and/or discharge from the service. The families of the identified personnel must also be brought into the purview of managing PTSD so that there are no broader social issues that arise because of PTSD. A special wing in the armed forces must be created to monitor and manage identified PTSD instances and also extend support that may be required.
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