Post-traumatic stress disorder is easy to understand but incredibly complex to treat, says a University of Victoria counselling psychologist.
Tim Black, UVic professor of counselling psychology, said manuals of mental illness define PTSD as a reaction to traumatic stress. And traumatic stress is defined as experiencing, witnessing or hearing about anything that threatens life, limb or integrity of the person.
But it gets tricky to treat, or sometimes even recognize, when you consider every person is a unique individual, each with their own past history, relationships and viewpoints, said Black, who also administers the Vancouver Island component of the Veteran's Transition Program.
"It's very complex but it's also very understandable when you dig into the 'why,' " he said.
For example, a military unit of 20 people can come under fire, but only one man [and they are mostly men] later suffers PTSD.
Perhaps he was the only person who saw a unit member killed. Or perhaps he saw the body afterward and it reignited a childhood trauma of stumbling across a body. Or perhaps he couldn't return fire for some reason and feels guilty. Maybe he was later chewed out by the sergeant major and shamed in front of his unit colleagues.
"It's not a simple dose-response thing where you get a dose of trauma and you get PTSD," Black said.
Similarly, he said individual symptoms of PTSD can vary widely, from trouble sleeping, to difficulty with concentration, to nightmares and night sweats. The movie stereotype of the trauma victim shivering, shaking or blacking out are rare, however.
Often, a returning service person can languish for years, never understanding what's happening. Perhaps they self-medicate with alcohol or drugs and never seem to reach their potential.
It's why Black likes to concentrate on transition to civilian life rather than overt treatment of PTSD when it comes to helping veterans. All veterans leaving the military community have some transition issues to overcome when leaving military life.
For example, at work a military person might take time to fix a machine perfectly because he has been taught lives are at stake. But the civilian has to get that machine up and running as quickly as possible, perfect or not, because money is lost when production stops or slows.
Or a job foreman with a military background might insist his civilian crew stay on the job until all work is done. But that attitude can earn trouble with workers who clock out when their shift is over, or with company managers who object to any surprise overtime expenses.
"PTSD is just part of the transition," Black said. "There is a whole host of other things around transition. And society has a responsibility to receive them back well and help them in this society."
Black noted society helped out in the past. Second World War veterans came home welcomed as heroes with parades. And they were presented with an entire continent committed to rebuilding, moving into a civilian economy, putting veterans to work and into affordable homes.
However, as successful as the national transition was after the Second World War, Black noted those elderly veterans even now deal with obvious signs of traumatic stress, often as they enter palliative care.
It's called delayed-onset PTSD. "They are on the palliative ward yelling in the middle of the night," Black said.
"They've lived their whole lives, had their families, had their kids and now they are dying and they can't keep the war at bay anymore."
Meanwhile, Canadian military people coming back from Afghanistan, the Gulf War, Rwanda or the former Yugoslavia are often met with community indifference and apathy. That can contribute to a painful readjustment, or add extra stress.
"We don't organize as a community to say, 'Welcome back, and we want you back now,' " Black said. "Veterans can start to think, 'Well, what did we really do over there?' "
Furthermore, about 30 per cent of the service people sent to Afghanistan have been reservists. Unlike regular force members, who return to barracks, regular parades and base routine, the reservist is put straight back on the civilian street and told to go back to his old job.
But Black emphasized overseas deployment can be an enormously positive experience for many. And given the way Canadians are handling duties overseas, nobody who deployed overseas with the Canadian Armed Forces should feel in any way ashamed.
"Canadian soldiers are respected around the world as some of the best trained, most competent soldiers anywhere," Black said. "I know that. I've been told that.
"But as a society, the prime minister says we are leaving and as far as I know there is no ticker-tape parade planned for Main Street to welcome back the heroes of Afghanistan." -
