Treating veterans' PTSD: interview with a caregiver

  The remains of a U.S. soldier who died in Afghanistan

Many new veterans returning from the Middle East are suffering from Post Traumatic Stress Disorder, or PTSD. PTSD sufferers may not display symptoms until weeks or months after their return. PTSD is rooted in the soldier experiencing a traumatic situation in which he felt extreme helplessness and witnessed/was a part of gross acts of violence. Soldiers need not be direct combatants. Medical soldiers, for example, can get PTSD from the recovery of casualties or experiences within a trauma unit. These symptoms can include hallucinations, violence, or fear of certain objects or locations that remind them of the traumatic event. Too often, PTSD sufferers self-medicate to deal with these problems because the flashbacks and recollection of the events can feel as real as if they were happening again.

I interviewed via e-mail a caregiver who sometimes works with PTSD sufferers. Kathyrn Mustard is a Licensed Clinical Social Worker with the VA Medical Center in Salem, Virginia. She works in the Inpatient Psychiatric Unit where she helps treat several mental illness forms to include PTSD. Approximately 75 percent of admitted patients have PTSD or PTSD-related symptoms.

In what capacity do you work with PTSD sufferers?

When veterans are admitted I meet with them and gather information to do a psychosocial assessment. If they are recently out of the military this is often the first time they are on an inpatient unit, and it is a relief for them to be validated that their symptoms are real, this is not something they can "work out for themselves" and the treatment team (which consists of myself, psychiatrist, psychiatric resident, medical students and a psychologist) reassures them that coming into the hospital was the right thing to do. At this point my role is to provide supportive counseling and education regarding PTSD and treatment, and work with the families on PTSD education and how best to help their loved one. Often it's the families who get the brunt of the vet's symptoms, and this can be very scary and confusing for families who don't recognize their loved one after returning from combat or some form of traumatic experience.

Where do they need the most help?

They need help in all areas-a lot of times they come in because the family is reporting increases in anger and irritability at home-in addition to nightmares, hypervigilance, etc. We have a "Center for Traumatic Stress" which is where we refer a lot of the vets for individual and group therapies… I would say the family unit as a whole needs the most work-the family usually needs a lot of education and support in addition to individual work with the veteran for him to feel validated and be able to have an outlet to talk with others about their symptoms. Unfortunately there can be substance abuse issues which have to be addressed as well-all of the above impact vet's families in a huge way-and there are sometimes physical abuse issues which come up due to poorly treated anger management issues.

How much about the root of their condition, i.e. what caused the PTSD, do they willingly talk about?

Generally most vets have freely spoken of their experiences in combat, or what they consider to be the most difficult thing is for them to deal with from combat. Some do dissociate and say they are "unable to remember" some of their experience-but for the most part they will tell their story. Military sexual trauma issues are much different-we often do not get into those as much on an acute unit due to the difference in those experiences.

What type of treatment is provided?

For treatment, we often begin with treatment with medications-sometimes antidepressants-some antipsychotics are also helpful with nightmares, sleep issues and flashbacks. Seroquel is used frequently where I work. After leaving the unit (usually within a week) we refer to other programs-Center for Traumatic Stress, Military Sexual Trauma groups, and the VA also has an inpatient PTSD program which directly deals with the trauma using psychodrama and then ends with a trip to the Vietnam War Memorial in DC. It is a very intense program that lasts 6 weeks, and the vets have to have had some form of individual counseling to address their PTSD prior to entering the program. They should also be drug and alcohol free.

How do you know when the treatment is successful?

It's hard to gauge the level of "success" because I see the most acute patients-however I think the long term counseling tends to deal the best with symptoms from what I've seen. Some vets feel individual sessions are more useful than groups; some vets report the group setting is difficult b/c they are hearing about other people's trauma. Other vets feel better when they hear others have had similar experiences.

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