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Allan Schwartz, Ph.D.Allan Schwartz, Ph.D.
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Post Traumatic Stress Disorder and Iraqi Veterans

Allan N. Schwartz, LCSW, Ph.D. Updated: Feb 15th 2008

american flag Out of a deep sense of respect and honor I feel compelled to write about a wounded veteran of the Iraqi war. The respect I have for him developed from the things I learned about him this week. More than that I learned about Post Traumatic Stress Disorder in a way different than I really knew before. This man, who shall remain anonymous in order to protect him, is representative of countless other soldiers returning from Iraq and Afghanistan with concussions, brain injuries, loss of limbs and PTSD.

This is the story of a particular soldier who did everything he could to protect his men and do his job in ways that were courageous and necessary. Home, now, from the war, he is not angry or bitter about the army or about the Iraqi people for whom he has nothing bad to say. In fact, as he stated it, the army saved his life because he was on the road to deep trouble as a result of the dysfunctional and violent family in which he grew up. He credits the army with setting him on the right path so that he was able to go to college, get an advanced degree and an excellent job prior to his volunteering for a tour of duty when he was in his late thirties.

During the fateful second tour of duty he witnessed many suicide car bombings and was injured with shrapnel because he was so near the explosions. Shrapnel was the lesser injury compared to the concussions and, ultimately, the brain damage he suffered. That damage wiped out the memories of everything he studied in graduate school. He was told by army physicians that the information is stored in his brain but is unavailable to him because the neurological pathways to the stored information are destroyed.

As bad as the injury to his brain is he also suffers from PTSD that results in him having extreme stress reactions to things that, for the average person, would be fairly mild. For example, if an ambulance drives by with lights and sirens going, he feels transported back to the zone of combat in Iraq. Despite taking medications to help him sleep, reduce his depression and his anxieties he can still feel as though he is back at war when a stimulus like that of an ambulance happens by.

I met this man as a result of his having qualified for a psychiatric service dog to help him feel safe when he is away from home and traveling around the city in which he lives. Within two weeks of having been trained in how to use the dog to be of help to him, the dog was totally bonded and loyal to him. One of the many things this specially trained dog does for him is to help reduce anxiety and panic when he is in public and prone to feeling hyper alert to dangers. The dog positions itself to block anyone coming down the street from coming too close to him. The dog literally watches his back to block anyone coming up from behind. The dog does not threaten people but simply uses its body as a barricade to prevent any stranger from getting too close. The dog was trained first by the "Puppies Behind Bars" program (prisoners train the puppies) and by my wife who specializes in training psychiatric service dogs and the people who will utilize them.

What is striking about this veteran is the degree to which he can maintain his sense of humor despite all that has happened to him. To add "insult to injury" his first wife divorced him when he returned home because he was so different from the man she had known prior to the war. Undaunted, he remarried someone who is able to see the man underneath the injuries and who is willing to learn how to cope with the results of his injuries, i.e., his forgetting to do things she has asked him to do or that he promised to do earlier in the day. What his sense of humor makes clear about him is the degree to which he cannot help forgetting to do things he wants to get done.

Trauma can result from lesser events than experienced by this and other soldiers. In fact, trauma symptoms can be placed on a continuum from mild trauma reactions to an incident all the way to full PTSD. According to the DSM IV full PTSD results from having been in a situation so overwhelming as to be seriously life threatening.

We also know that stress and trauma accumulate over the life time of an individual so that if a disastrous situation occurs, the over all and accumulated effect leaves the person with PTSD.

It takes great passion to help someone who has experienced PTSD. This particular veteran has a wife who attends support groups of wives who have husbands and soldiers with PTSD. The wives in the group learn from one another how to cope with and help these men when they awake with night terrors, get angry too easily, experience flashbacks and forget to carry out common and everyday tasks.

Symptoms of PTSD:

1. Recurrent thoughts of the original trauma.

2. Hyper alertness in public.

3. Anxiety and Panic.

4. Irritability.

5. Extreme reactions to noises and other stimuli that are similar to the original trauma.

Further information about PTSD suffered by veterans is available at:

http://www1.va.gov/opa/fact/ptsd.asp

Your comments are welcome and encouraged.

Allan Schwartz, LCSW, Ph.D.

Readers who live in the Boulder, Colorado metro area, or in Southwest Florida may contact Dr. Schwartz for face-to-face consultation. He is also available for psychotherapy through Skype video for those who are not in Florida or Colorado. He can be reached via email at dransphd@aol.com for details.

    Reader Comments
    Discuss this issue below or in our forums.

    dogs to help with tbi and ptsd? - courtenay stark - Nov 13th 2008

    i'm wondering if folk with tbi and ptsd (of whom i am one) can benefit from "just being around" dogs as visitors to their homes/work/etc.  this would be different from "obtaining a service dog", which i highly recommend.  i'm not sure if this is already being done at VA hospitals/within therapy contexts outside of VA places..  pls advise.

    Learning you may have a problem. Not Ready - Eddie Davis - Sep 28th 2008

    I went to the vet center for analysis for PTSD. I was not sure why I have been through 10 jobs in 9 years. I would suddenly stop breathing and start sweating. I was under the impression it was the affects of the 14 surgeries I have had, service connected. Unfortunately, when I went to the vet center, I starting talking about my life in a nut shell. She stopped me and requested that I take a test. She told me that scoring 28 identified me as being depressed. I scored a 40. She stated that she was supposed to end the session and call the ambulance to admit me to a syc ward. Fortunately, she beleived I was no threat and told me that I must go to the VA center and request a cronic pain evaluation and tell them the truth for the analysis of a syc. No veteran wants to think that he had problems, but when she was telling me about myself without me saying a thing, she told me that I was suffering from various items due to my 13 1/2 years of service that would make me unemployeble. I started crying. I was not prepared to hear this. I have been putting on a front, dressing professionally, seeming to be good spirited, and numb. My father died and I was not sad. My mother is in nursing home, and I do not care. I am irritated at work constantly. I stop breathing when I am just watching TV, and I get into cleaning moods and clean the entire house, wash cars. I am really scared of going to the syc. I am affraid of what I may find out.

    PTSD and service dogs - Andrea - Aug 22nd 2008

    I have complex PTSD.  I've had to come to terms with the fact that it is a life long affliction.  I have read about prisoners training "service dogs" but I did not know that some of these dogs were being used for PTSD and TBI.  Although, I have never fought in a war I have experienced bombings.  My husband is from Lebanon and I have been there at times when fighting has broken out (summer of 2006).  However, my PTSD is mostly the result of severe childhood physical, sexual, and emotional abuse.  At the age of fifty I still have severer peiods of flashbacks, dissociation, DID, etc.  Sometimes in public I get a sensation of people following me.  It is quite frightening.  Sometimes I hear one of my family members call my name even though I have moved far away from them.  Anyway, I've probably shared more than I needed or should have (sorry).  I want to ask you if you know if these specialized service dogs have ever been used for people with complex PTSD resulting from severe childhood trauma.  Although my PTSD is not a result of fighting in a war, I do feel somewhat of a "kinship" with Iraqi Veterans who suffer from this debilitating disease.

     Thank you so very much.

    Psychiatric Service Dog - Jennifer - Feb 22nd 2008

    I am trying to figure out what psychiatric service animal means. I have heard that businesses and other members have given people a bad time because they were not blind of deaf. People wanted proof, and it sounds to me, just from looking around a little, that you need to have an animal who is "trained" in order to be a service animal. So what does that mean for someone who has PTSD and wants to bring their dog around town with them.

    Thanks. 

    Clarification - Allan N. Schwartz, PhD - Feb 17th 2008

    What I want very much to clarify is that the veteran I am writing about is an aquaintance and NOT a patient. I can understand the assumption that he would be a patient but he is being treated by a therapist and by psychiatrists and neurologists at the Veterans Administration. I do feel privileged to have met him and hope to follow his progress: as a friend and not as a therapist.

    Thank you

    PTSD,TBI and the Contractor - Marcie Hascall Clark - Feb 16th 2008

    Thank you for this very informative post.  The compassion you feel for your patient is heartwarming.

    There is finally much attention being brought to our soldiers with PTSD and TBI.   There are as many contractors in the war zone as soldiers who receive little or no screening or follow up for both these problems when  they leave.

    Contractors must first litigate to prove they have PTSD before the Defense Base Act insurance they had been covered under will pay for diagnoses, counseling and/or other treatment.   Lititgation is a lengthy process and most of these cases are denied.  The insurance companies have access to lawyers, doctors who "specialize" in going to court for them, and all the time in the world to dally. They are reimbursed by our government under the War Hazards Act for all of this plus 15% administrative fees.

    We have no way of knowing how many contactors and their families lives are being ruined by TBI and PTSD that cannot get help.

    We do know of many suicides and talk with many we fear are close.

     Marcie Hascall Clark  www.dbacomp.com

     

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