By David DeRocco
Determining the true human cost of war is not as simple as totalling the number of military and civilian lives lost in the conflict. Returning soldiers – and in truth, all active military personnel fortunate enough to make it home – must ultimately be included in the aggregate amount, for each one is potentially susceptible to the lingering subconscious effects of any psychological trauma experienced during his or her tour of duty.
Recent events have reinforced that fact with often tragic results. On April 2nd, 2014 for example, a U.S. veteran of the Iraq War being treated for depression, anxiety and other illnesses walked into Fort Hood military base in Texas and opened fire, killing three people and wounding 16 more before committing suicide. In Canada, a spate of soldier suicides – including three in a span of three days in November, three in January and two less than a week apart in March – have left Canadian Armed Forces and Veterans Affairs Canada searching for answers and questioning the way they deal with and track military suicides.
If there is any good to come from these tragedies, however, it is the fact they have helped renew public debate on the issue of Post-Traumatic Stress Disorder (PTSD) – not just in military circles, but in all cases where individuals have experienced single event trauma or endured sustained periods of high-level “stressors.”
“For appropriate reasons, there is an increasing awareness of PTSD within military populations,” says Colonel Rakesh Jetly, Canadian Armed Forces psychiatrist and Senior Clinical Mental Health Advisor to the Surgeon General. “A decade of war has made this a reality for Canada and its allies. However, those of us in the field know that PTSD by no means is exclusive to soldiers. Other high risk occupations include police, paramedics, firefighters and most first responders.”
Historically speaking, lingering psychological issues suffered by battle-worn service personnel were most commonly diagnosed as “shell shock,“ “battle fatigue“ or in modern vernacular, “operational stress injuries (OSIs).“ However, better understanding of the effects of psychologically distressing events on both a person`s biology and psyche have helped refine the definition of PTSD into a more inclusive disorder that can affect almost anyone.
“We live in a world where bad things happen to people,” explained Colonel Jetly. “In addition to the above groups, every day Canadians are susceptible to PTSD as a result of events such as rape, motor vehicle accidents and childhood traumas. This is why as a society we need to increase awareness of mental health conditions, encourage people to seek care, invest in research and ensure that we have the capacity and the ability to deal with complex disorders such as PTSD.”
What exactly is PTSD? By definition, Post-Traumatic Stress Disorder is recognized as a “condition created by exposure to a psychologically distressing event outside the range of usual human experience, one which would be markedly distressing to almost anyone and which causes intense fear, terror and helplessness.” In medical circles PTSD is classified as a type of anxiety disorder, a category of common mental health problems affecting approximately 1 in 10 people. However, despite its name the debate continues on whether PTSD is better described as an injury or illness rather than a disorder.
“People have struggled with this classification,” suggests Dr. Charles Nelson,
Psychologist and Clinical Coordinator in the Operational Stress Injury Clinic at London’s Parkwood Hospital. “PTSD encompasses all of these dimensions. In operational terms, it is clearly an injury related to service. It is also an illness that can render an individual severely incapacitated and, like all disorders, there are known phenomena that contribute to the manifestation and exacerbation of symptoms.”
Despite increased awareness of PTSD Dr. Nelson acknowledges that clear diagnosis is not always easy to determine despite the presence of identifiable symptoms. “With careful review of the situation and response to trauma, a diagnosis can reliably be made. However, the symptom overlap with such conditions as Major Depressive Disorder and other anxiety disorders demand a careful and comprehensive assessment. Complicating this further are the many possible co-morbid problems including substance misuse and consequential relational problems.”
What, then, are the most common symptoms found in people suffering from PTSD according to Dr. Nelson?
“Most often hyper-vigilance, re-experiencing or reliving phenomena, experiential avoidance and emotional numbing,” he explained. “Less commonly dissociative symptoms may also be evident. Symptoms vary, but there is a collective impact on the individuals’ ability to function normally.”
Hyper-vigilance was just one of the symptoms affecting former military police officer Brian Lintner and his ability to function normally in civilian life once he retired. The long odyssey he endured on the way to securing his diagnosis of PTSD is one shared by many sufferers of the disorder. Lintner, now 52 and living in Burlington, knew he was heading into a military career at an early age. “Before I was 15 years old I knew I was going to join the military,” recalled Lintner. “I didn’t know what I was going to do, I just knew around that time I was going to join the military.”
From the time he was recruited in 1980 until his retirement in 2003, Lintner spent his military policing career in typical fashion, hopping around continents and postings from Winnipeg to Germany, policing, securing, conducting investigations and often acting as bodyguard to high ranking allied officials. The work required Sgt. Lintner to be on his game at all times. “It was absolutely amazing work. You’re so amped up. You can see the electricity just jumping from your fingers you’re so amped up.”
The things that made him successful in his career, however, would later surface as roots causes of his psychological injury. “I was exacting. I was obsessive compulsive. Everything I did was done with a purpose and it was done seven times over to perfection. That tempo was difficult to maintain. But I maintained it, probably for 15 or 20 years: a high level of perfection and, at the same time, being hyper-vigilant. That’s something that doesn’t come easy.”
What was clearly not easy for Lintner the civilian was dialing down the amperage powering his hyper-awareness, especially in situations where his military instincts were engaged but restrained by the fact he had no authority to act. One such situation – in which a man wearing a long trench coat Lintner believed to be concealing a weapon entered and cased out the pub where Lintner and friends were sitting – exemplified the ongoing problems he was having adjusting to his post-military career.
“The guys I was with had absolutely no idea what I had seen, of the risk of what that guy was doing, and what I was thinking,” explains Lintner. “I don’t use the word risk flippantly – more as a way to assess the situation. I had no back up. Nobody had my back. I’ve got nothing to take this guy down. But wait – all that thought process, all those memories of what I should do mean nothing, because I don’t do that job anymore. I don’t have the authority. And then you’re just sitting there, and you’ve got this adrenaline rush, and the hair is standing up on the back of your neck. What do you do now? You just sit there and do nothing. Now I’m a civilian – let’s just turn the page on that book and forget what we’ve read in the first 20 chapters?”
By 2005 Lintner was becoming increasingly aware something was wrong; he just didn’t know what it was. He describes the feeling this way: “Say you’re trying to dial into a radio station, not digital but analog. And you’re getting that static in the background, until you hit the station right on the button, and it’s all nice and clear. Well, I could never find that clear station.” His wife and two children were also noticing his behavioural shift. “The changes my dad experienced were gradual,” remembers his 25 year old daughter, Robin Lintner. “They kind of snuck up on us. I realized one day that my dad wasn’t the same happy guy he was a few years before. He had made it a habit to withdraw from conversations and anything with strong emotions attached to it. He used to say he was just going with the flow, but he was actually avoiding it altogether.”
Determined to find help, Lintner approached Veterans Affairs. Thus began a five year journey that tested his will and determination as much as anything he had encountered while enlisted. His efforts also revealed the problems inherent in a system that encourages military personnel to submit claims, only to suffer the stigma and potential career ostracization related to the PTSD diagnosis. Lintner bounced around from doctor to doctor, psychiatrist to psychologist, recapping his problems while trying to cope with the residual psychological effects of his military policing experiences. When he was finally given a diagnosis of severe depression, Lintner felt he had found a starting point on his road to recovery. By 2010, however, a frustrated and still struggling Lintner made an appeal to Veterans Affairs, who sent him to another new doctor. This time, there was a different diagnosis: Lintner was suffering from PTSD.
Did the accurate diagnosis finally help speed up his recovery? Lintner says it’s never that simple for those suffering from PTSD. “You never get over it. You just learn to deal with it. There is no magical pill. You do learn how to manage it. And there is a lot of professional help available.”
Civilian police forces across the province are starting to recognize the need to implement measures that deal with PTSD. Cathy Ross, an Occupational Health Nurse with Niagara Regional Police Service (NRPS), says the NRPS is currently reviewing and revising its Critical Incident Stress Management (CISM) program to ensure appropriate assistance is available to members when needed. Four Workplace Safety and Insurance Board (WSIB) claims related to PTSD were submitted by the NRPS in 2013. As a result, Ross says more new initiatives are being scheduled.
“As part of the CISM program, we are exploring the possibility of implementing a Peer Support Team for ongoing support after the immediate traumatic incident. We have also recently implemented mental health training for all members in a Supervisory position in order to assist with recognizing possible signs and symptoms with their employees. Our EAP provider is also available to all members on a 24/7 basis for support and/or counseling.”
Thankfully, social awareness of PTSD is finally helping both individuals and high-risk professionals reduce the personal trauma involved in seeking help.