Suicide is the fourth leading cause of death in American soldiers. Since the beginning of the “war on terror,” the Army has lost more than 580 soldiers to suicide, the equivalent of an entire infantry battalion. Military suicides in 2008 were 13% higher than in 2006. In addition, nearly 6,500 veterans take their own lives in a year (Human Events 6/16/08).
The record high number of suicides was the subject of a Senate hearing on March 18, 2009. Most of the victims seemed to have been suffering from post-traumatic stress disorder (PTSD) (Democracy Now 2/20/09).
It is estimated that about 20,000 troops in Iraq and Afghanistan were taking selective serotonin reuptake inhibitor (SSRI) antidepressants and/or sleeping pills such as Ambien—including 70% of those who attempted suicide. While the Army states that “failed relationships” are the primary cause of suicides, some think the drugs contribute, and criticize the “pharmacologic imperative” said to dominate in military psychiatry (Mark Thompson, “America’s Medicated Army,” Time 6/5/08).
A problem that is likely related is the traumatic brain injury (TBI) reportedly suffered by as many as 360,000 U.S. troops (AP 3/5/09). TBI can result from blast injuries, even in the absence of direct impact trauma (Bhattacharjee Y. Shell shock revisited: solving the puzzle of blast trauma. Science 2008;3198:406-408), for example, from improvised explosive devices (IEDs).
The prevalence of PTSD increased linearly with the number of firefights experienced during deployment: from 4.5% with no firefights, 9.3% with one or two, 12.7% with three to five, and 19.3% for more than five (P<.001) (Hoge CW et al. N Engl J Med 2004;351:13-22).
The rapid compression/decompression accompanying a blast wave can produce showers of air emboli in the carotid artery, detected by Doppler up to 30 minutes after the injury. On this basis, hyperbaric oxygenation has been recommended for treatment, and has had favorable results in 16 out of 16 cases, even long delayed. The military, however, is not yet using this treatment (Army Times 3/3/09).
A research protocol for hyperbaric oxygenation has been approved, and enrollment of veterans with TBI is slated to begin in about 3 weeks. (See testimony before House Armed Services Committee, May 14, 2009 by Walter Jones).
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Psychiatrists have largely abandoned their role as psycholtherapists and become primarily psychopharmacologists. This began in the 1950’s and escalated rapidly toward the end of the 20th century. Consequently brain chemistry has trumphed emotional contact as the main stay of treatment.
I recently attended a conference on addiction where some prominent psychiatrists and neurologists presented the latest research on dopamine modulators and brain chemistry. At the conclusion of his lecture one of the doctors stated that the research has convinced him that “emotion is just a chemical reaction in the brain”. This position is held by many, if not most of those in the psychiatric community.As far as psychiatry is concerned, much to the detriment of patients, the dreadful has already happened.
I agree that many of them feel this way. Fortunately, I believe the opposite is also just as true, emotion can cause a chemical reaction in the brain just as much as a pharmaceutical. If we reach out and help create the “correct” emotional response to a situation, then the improved chemical response will predominate. I believe this is what cognitive behavioral therapy is doing. I am not sure if anyone has gone so far as to prove it. It would then help further demonstrate why those of us in good relationships have healthier lives than those living independently.
I think there needs to be more emphasis on the contribution of Traumatic Brain Injury (TBI) to the development of Post Traumatic Stress Disorder (PTSD). It sounds like that would be the basis of “Shell Shock Revisited” (above). An organic (concussive) cause for PTSD would refocus diagnosis and treatment. American Indian Vets have a support group for PTSD because it is so out of their culture for their emotions to get the better of them. The understanding by the patient that this is primarily an organic, not psychic, disorder should promote acceptance and a more optimistic outlook. How hard must it be for a SEAL to accept that he has become a psychologic basket case?
If you have a close call, say in traffic, even if nothing happens, the thought, the realization, of what might have happened, changes your body-mind chemistry. The body and mind cannot be separated, as far as I can see. These men need more than pills, and maybe even something other than, pills. People are social animals. Dogs would help them, also.