PTSD - The Individual Reality

I was asked to speak about PTSD at a MoveOn action to turn in a signed petition demanding the end of funding for the escalation in Iraq. Being a psychiatric RN it would have been simple to just review signs and symptoms, treatments and medications used. I could have brought my DSM-IV to read the criteria of the diagnosis.

This time I just couldn't do the usual. This time I wanted anybody listening to hear how it feels to be a combat veteran or family member struggling with Post Traumatic Stress Disorder. I wanted them to understand the pain.

Sometimes speaking clinically obscures the true reality of things. Hopefully the words I spoke today in some way helped toward the understanding of PTSD.

There’s much being said about Post Traumatic Stress Disorder these days but I keep wondering if most Americans truly understand what it is, what it isn’t and what the cost to the troops and the American society is.


PTSD is waking up screaming a best friend’s name. The nightmare of the IED killing him returned. Professionals call them nightmares but my experience has been they’re more like a video running in the mind repeatedly when attempting to sleep.


PTSD is waking to your wife’s screams, finding your hands on her throat and seeing her terrified look. She made the mistake of trying to cuddle while you were asleep.


PTSD is being a stranger to your own family. Your body returns but your core spirit has been changed and emotional responses are limited or absent.


PTSD is the constant vigilance for something bad to happen. It’s diving to the ground at the first loud sound nearby. It’s moving to defend yourself when someone approaches you from the rear.


PTSD is the nagging question why you survived but many of your friends didn’t. It’s cursing God for allowing you to survive.


PTSD is anger and red hot rage that burns in your soul and boils over with the slightest provocation. Boils over in violence, abuse and despair.


PTSD is using substances to medicate despair and depression. It’s blackouts and binges. It’s dependency and addiction. It’s a 40 oz., a track mark, a crack pipe, a line. Anything to take the pain away if only for a short time.


PTSD is drinking a bottle of tequila in a cheap motel in another state while loading your .357. It’s unlocking the safety, putting your mouth around the barrel and squeezing the gun metal trigger that will send a round through your palate into your brain. It seems the only way to bring peace.


PTSD is the inability to sleep for fear of dreams, because of need to be on guard and because your brain won’t shut down the memories.


PTSD is hearing a phone ring in the middle of night and immediately thinking someone died.


PTSD is sitting with your back to the wall in order to keep sight of anybody nearby.


PTSD is losing job after job because you can’t endure taking orders and the work seems meaningless.


PTSD is thinking suicidal thoughts frequently but never telling a therapist because you want to keep that option open.


PTSD is a prison cell following the murder of a man who insulted your wife.


PTSD is a prison cell following a bar fight and assault.


PTSD is the homicide of your wife after she tells you she’s leaving you.


PTSD is divorce and failed relationships.


PTSD is a homeless shelter on a freezing night


PTSD is sleeping under a bridge


PTSD is going through a restaurant dumpster to eat.


PTSD is never fitting in


PTSD is a parent seeing a government car pull up and two uniformed men getting out in front of the house.


PTSD is not hearing from a daughter in Baghdad after a roadside bomb is reported on the nightly news


PTSD is taking powerful medications that result in loss of sexual function


PTSD is waking to the cries of your infant daughter and thinking of that baby in Ramadi…the one accidentally killed by your gunfire.


PTSD is seeing Arab men and women approach on the streets of America and feeling anger and fear.


PTSD is being afraid of a child’s wave because that was the last image you had just before your best friend was hit by a sniper’s deadly bullet.


PTSD is a wife afraid of a husband’s changing mood.


PTSD is a parent hearing the news Marines were killed in Falluja and thinking of her son patrolling there.


PTSD is migraine headaches, ulcers and joint pain.


PTSD is panic attacks in large crowds.


PTSD is failing to enjoy holidays and family get-togethers.


PTSD is spending the first hour of a hike in the mountains thinking of combat patrols in Afghanistan.


PTSD is avoiding the desert area of Moab which once brought so much joy.


PTSD is being promoted at work only to be fired weeks later for insubordination and angry outbursts.


PTSD is isolating in a room soon after family arrives to visit.


PTSD is hearing helicopters flying over and remembering deadly firefights


PTSD is frequent memory lapses and poor concentration except the memory of violence


PTSD is no desire to play catch with your own son


PTSD is working too much and avoiding home


PTSD is attending the funeral of a close family member and lacking emotions


PTSD is road rage


PTSD is a single car accident in a remote area


PTSD is creating a situation for police to be called, stepping on the porch, aiming a weapon toward the police and being killed by gunshots.


PTSD is having an argument with a girlfriend and responding by hanging yourself hours later


PTSD is a stigma in American culture


PTSD affects families, friends and the entire community one way or the other if left untreated


PTSD is being a RN at a mental health center with a flare up of depressive symptoms but failing to get the understanding a co-worker got when undergoing surgery. It’s working as a RN with a psychiatrist who tells you she’d rather be dead than have chronic PTSD. I was that RN. I have chronic PTSD.



PTSD isn’t a personality disorder and the military needs to have heavy scrutiny for the abuse of the personality disorder diagnosis.


A review needs to be done of possible over use of diagnoses to separate troops from the military which leaves them unable to access mental health services because the diagnosis is considered a pre-existing condition.


Far too often the symptoms of personality disorder can also be symptoms of PTSD. Inadequate screening or evaluation to determine accurate diagnosis clearly violates the standard of care that should be in place.


Using less than honorable discharges to separate veterans of combat because of behavioral problems on return from combat is a reprehensible violation of ethics and standards of psychiatric care.


Using excuses that the standards for admitting a recruit into the military have been lowered is also a violation of ethics.


If a recruit has a pre-existing psychiatric condition on admission into the military why isn’t it diagnosed at some point before sending that person to a combat zone? Why is it predominately following combat such a harmful diagnosis occurs?


PTSD isn’t an excuse to commit acts of violence or other crimes


PTSD isn’t weakness, an attempt to get something for nothing or a flaw in character.


PTSD isn’t a condition which you tell someone to “suck it up”.


PTSD isn’t any less destructive than a heart attack or a broken leg


PTSD isn’t something you just get over


PTSD isn’t a condition that CANNOT be treated BUT there isn’t one treatment that fits for all


PTSD isn’t hypochondria


PTSD isn’t “all in your head”


PTSD isn’t something to be treated on the cheap


Post Traumatic Stress Disorder isn’t a disorder. It is an emotional and physical wound inflicted by either acute or long term trauma being witnessed or experienced. It has a physical component. It has a social component. It has an emotional component and it has a spiritual component.


The American people can choose to either properly treat the returning troops as soon as symptoms emerge or allow the symptoms to become long term. They will either pay a small cost up front or a huge cost later.


Today young men face homicide charges for murdering a family in Iraq following the gang rape of their daughter. These troops had faced heavy combat prior to this incident.


The young man who was said to be the leader of the group had a psychiatric evaluation many days before this happened. He was said to be homicidal, which is one of three standards requiring involuntary hospitalization. The other two are danger to self and being so gravely disabled one is unable to do the routine things to survive.


This young man was not hospitalized. He was given medications and told to get some rest and then returned to his unit. As a result a young woman was raped and she and her immediate family killed.


The military stance on mental health is clear. Col. Elspeth Ritchie of the Army surgeon general’s office says service members diagnosed with PTSD have been sent back into combat, partly driven by troop shortages.


“The challenge for us….is the Army has a mission to fight….so we have to weigh the needs of the Army, the needs of the mission, with the soldiers’ personal needs.”


The military has taken up the practice of sending troops back into combat zones under the influence of powerful psychotropic drugs…antidepressants, antipsychotics and anti-anxiolytics…which have potentially dangerous side effects and which need medical monitoring until it is clear what efficacy the medication has.


This practice is dangerous, irresponsible and outside the standard of care for psychiatric patients. Inserts on all these medications warn about driving and the use of heavy equipment until it is clear how the medication is reacting with the patient. Carrying weapons and possibly having the lives of other soldiers dependent on your actions surely falls under this warning.


Recent events have shown the military fails often in providing appropriate treatment for returning troops. In fact, there is new evidence some returning troops are being harassed and punished if they seek psychiatric care. There’s been a recent investigation of such allegations at Ft. Carson, Colorado following complaints by returning troops.


Such behavior only further blocks returning troops from seeking help because it clearly demonstrates a stigmatization of anyone utilizing mental health treatment.


Anyone who knows about the funding of the VA understands the funds remain discretionary. This continues to leave treatment facilities needed for proper care of veterans short of the monies required.


A large and diverse coalition of veteran advocacy groups has called for a fixed and rational way of funding the VA to meet the needs of all veterans. At this time the needed changes have not been made and returning troops are the ones who will pay for the shortfall.


Recent escalation of the number of troops sent to the combat zones will only cause a larger surge in the needs of returning troops. As much as one third of the returning troops will require mental health treatment at some point.


Already the VA has cut the time of psychiatric evaluations from 90 minutes to 60 minutes and the length of therapy visits from 45 to 30 minutes. They’ve also cut the frequency of visits for therapy from once every two weeks to one time each month.

Any professional working with patients diagnosed with PTSD knows this is substandard care.


PTSD is a serious condition that requires frequent monitoring when treatment begins. The re-living of the trauma through therapy makes the likelihood of self harm or self defeating behaviors much greater at the beginning of treatment.


If the patient is put on medications monitoring for side effects is essential. Doing assessment by phone and patient self report leaves the patient at a much greater risk.

Possible movement disorders need to be seen in person by a professional.


In the case of antidepressants it’s long been known since their first use a patient is most likely to be lethal at the onset of increased energy caused by the mediations. This requires more frequent assessments until its clear the patient is stabilized on the medication. The VA’s shortage of professionals and decreased face to face time with patients create a dangerous and substandard course of treatment.


I’ve used the term PTSD repeatedly to hammer home this is a condition that many returning troops face. It can insidiously kill some of those troops. It can cost the lives of family and friend. It can cause terrible tragedies to occur that could be prevented.

PTSD isn’t just the problem of the individual returning troops; it’s a problem for all Americans to take serious and demand our government do the right thing in treating.


The worst is still to come and the VA and military mental health services are lacking enough resources, trained staff and budget to treat the returning troops in appropriate and medically indicated ways.


In fact there are reports 90% of the mental health professionals in the military lack formal training in treating PTSD. The report also notes there is extreme burn out and lack of morale by the mental health providers in the combat zones.


It is not my intention to bash or denigrate the professionals treating the troops in the field or upon return. It is my intention to bring public awareness that supporting the troops needs to include provision of care that meets basic standards and is individualized. Supporting the troops needs to allow the returning troops the opportunity to return to the highest level of health possible.


I have 276 records of mainstream press reports related to returning troops having difficulty in readjustment to returning from Iraq or Afghanistan. The reports date back to the beginning of the war and run until 2006.


Here's a link to 147 of those reports:

http://timelines.epluribusmedia.org/timelines/index.php?&mjre=PTSD&table_name...
William Terry Leichner, RN

USMC combat infantryman - Vietnam (12/31/1968 -02/12/1969)

VVAW - Denver chapter

Co-founder of chapter in 1971 (please note there is a claim another chapter existed but since a national organizer was one of those helping to start the 1971 version, I assume the first chapter failed.)