Veterans and Post-Traumatic Stress Disorder: A Conversation with Dr. Frank Ochberg
JS: Since we are looking at issues of alienation faced by returning veterans, perhaps we can discuss the specific challenges faced by some women veterans. Men who have served often feel a sense of alienation once they leave the military but, from what I’ve read, women veterans may feel an even stronger sense of alienation. Some have spoken of feeling almost invisible when, for example, they’re socializing with their male comrades, because there’s often an assumption that they’ll be a wife or a girlfriend rather than a former soldier.
While it’s certainly the case that most soldiers are male, and that, generally speaking, women don’t experience the same level of combat as most male veterans, women have made and are making a huge contribution to the military in places like Afghanistan and Iraq. Yet there’s a sense, perhaps, that they aren’t being recognized in the same way as the guys.
And can you also talk about the challenges faced by women veterans who have experienced harassment or sexual assault in their time in the military? That is something that must be very difficult to deal with because those women are potentially feeling alienated not only from the society they’re returning to but alienated from the band of brothers they have served with.
FO: Let’s take the second part of the question first; this is a very important issue. The rates of abuse of women in the military are very, very high. I’ve been talking with women in the military and non-military women who have written books about military women. Being harassed is close to 100%.
The Service Women’s Action Network cites some important research on this topic–you can see it here. It makes for grim reading. Here are some excerpts:
- While one in six civilian women experience sexual assault, for military women this number climbs to approximately one in three
- Almost 3,000 military sexual assaults were reported in 2008; 163 sexual assaults were reported in Iraq and Afghanistan
- 79% of women serving in the military since Vietnam reported experiences of sexual harassment
- In a study of a sample of veterans who were seeking VA disability benefits for PTSD, 71% of women and 4% of men reported an in-service sexual assault. For men, the assault was more likely to occur while out of service; for women, the opposite was true
- Sexual assaults that occur in the military are often not isolated incidents and may involve more than one perpetrator. Of those women reporting rape, 37% report being raped at least twice, and 14% report experiences of gang rape
- Some evidence suggests that black women in the military are more likely to experience more severe forms of harassment compared to their white women counterparts, including unwanted sexual attention and sexual coercion
Anne G. Sadler and colleagues have an excellent study, available here.
For therapists who are not as familiar with PTSD or working with the military as I am, I point out that if they’ve dealt with incest, they know that the problem is that there’s been a sexual interaction that is taboo. But, worse than that, there’s always a mother or a father figure involved—a non-offending parent. Incest is all about secrets, and these secrets mean that you don’t have the trusting relationship that you need to have with your parent.
Now, in the military, the parent is the officer in command who doesn’t know about this, or who refuses to take it seriously. And that creates a terrible disruption in the military family. It’s important to realize that a significant number of the women who are serving in the military have come from a circumstances where they’ve been the victim of incest or of battering, or of abuse or neglect. That is a motivating factor for them joining the service—to escape from a hell at home.
That’s not to say it’s always the case. My daughter served in the military; she’s now happily married and a mom and a successful professional, but she encountered many of these women who were abused. It’s common, and it affects women from all walks of life. So, we are talking now about something that is not a secret. It’s written about. But it’s a big problem, and we have a lot of work to do to help these women come back from military service, and from sexual abuse while in military service, to have the dignity and the physical and mental health that they deserve.
The same goes for your question about servicewomen sometimes feeling “invisible.” I’ve also seen news reports of women veterans who attend reunions and celebrations, and who are assumed to be spouses, not soldiers, sailors or marines. As you say, all veterans are susceptible to alienation, but not being recognized as “one of the guys,” so-to-speak, must be an added frustration for servicewomen. We owe these women veterans recognition and honor. Conversations like this one help spread the word.
JS: Let’s say there’s a veteran out there, whether male or female, who is having nightmares, having flashbacks, feeling seriously messed up, but, for whatever reason, he or she doesn’t want to see a counselor or psychologist. Are there simple, practical steps they can take to mitigate or resolve their problem? Can yoga, meditation, or physical exercise be as effective as therapy?
FO: Well, there’s a lot that you can do that can be very effective. Other colleagues and I have put as much as we can into the Gift From Within website, and you and I are talking to help that website extend its reach to those who may not have therapists, or have had unfortunate experiences with therapists and want to learn on their own.
Yes, there’s a lot you can do. You can learn how to manage anxiety better—and yoga helps, exercise helps, avoiding stimulants when you’re getting ready to sleep helps. A lot of people don’t realize that caffeine isn’t limited to coffee; it’s in a lot of soft drinks. They’re losing sleep because they don’t realize that they’re medicating themselves with stimulants prior to trying to get to sleep, and sleep is never that good when you’re suffering from PTSD in the first place.
You can choose your friends carefully. A lot of people have friends and relatives who ask the wrong questions, or who simply aren’t there when you do choose to have your social rest and recreation. I find with a lot of my patients, military and non-military, that we go through who you can trust as a friend. You and I are talking now prior to the American holidays, we have Thanksgiving, then we have Christmas, and these are times when extended families get together. And for a lot of people who will benefit from self-help from PTSD, holidays are hard times.
Sometimes in these situations a lot is expected of them: they’re expected to drink, they’re expected to be friendly when sometimes they may not want to be. They have to be careful about limiting their dose of obnoxious relatives! That may sound so simple and so easy, but it’s not easy for my patients. I find that counseling and commiserating is important, but maybe it’s also about giving them license, to tell them, no, you don’t have to go home again. That sometimes they can take care of themselves. This can end up being important advice.
JS: Your comment about monitoring the intake of caffeine and limiting the dose of obnoxious relatives leads me to ask about the role of medication in the treatment of trauma or PTSD. There’s a section in Sebastian Junger’s book, War, where he refers to a company of US soldiers in Afghanistan, half of whom are supposedly on psychiatric medication. What are the advantages and dangers of this approach to treatment?
FO: I’ve got a lot to say on this, and I’ve talked with several of our colleagues in journalism about how heavily medicated our military are. It surprised me when I first learned about it, and it discouraged me that we are deploying into combat zones soldiers and marines who are being treated for depression. You wouldn’t do that—you wouldn’t allow that—for an airline pilot. And it’s not because the medication is bad. It’s because having depression and being treated for it presents a risk to everybody who’s on that airplane. There’s a lot of risk to fellow combatants, to civilians who can suffer collateral damage, when we deploy an army that requires psychiatric medication. That’s one thing.
But let me talk about the advantages of medication for veterans, who are in a different situation from those on active service. Veterans are people who are back at home and now in civilian life. If you’re a veteran and you need help falling asleep or staying asleep, it’s good for you to know how the anti-insomnia medication works, and there are often times when medication for insomnia is useful.
The drugs that help you fall asleep are habit-forming. But there’s a drug that helps you stay asleep called Trazodone that’s not habit-forming, that’s not harmful, and it’s very, very useful if you’re the kind of person who wakes up at two in the morning and can’t get back to sleep. There are a couple of drugs in its class, but the longest one on the market, which is safe and easy to use, is Trazodone, and I think that it’s useful to know about it.
You can read up on it. You need a prescription for it. But it can change your life if you’re living with two, three, four hours of sleep. It helps you get six or eight hours, because it restores the pattern that is interrupted by something called early morning wakening.
That’s just one example. Then there are anti-depressants, the drugs that are called selective serotonin uptake inhibitors, like Lexapro, Prozac, Zoloft—and these drugs have different names in different countries, but they’re generally related one to another. They help with depression and they help with a form of anxiety that comes all at once as a panic attack. They help with obsessive compulsive problems, and, in a way, you can think of PTSD as an obsessive compulsive problem. Your brain is causing you to go back over and over again to something that you don’t want to go back to; that you want to forget about. Well, it’s not as though these pills cure PTSD, but they help with the symptoms.
There are also a lot of veterans who have pain from nerve damage. They’ve withstood explosions, they’ve had broken bones. And there are some anti-depressants that are also good at relieving the perception of pain when the pain is due to nerve damage or nerve impingement – pressure on nerves. The medication’s name in America that I find most useful for the combination of emotional symptoms and this type of pain is Cymbalta.
I’m not here to recommend or advertise any particular medication, but I do think there are medications that make a big difference, that help relieve symptoms and help you get on with all these other things you have to do to transform yourself from a military person to a civilian. And that’s where the psychiatrists have an advantage. They understand the medications and they can prescribe the medications. But there aren’t enough psychiatrists to go around.
Jon Stephenson. (2013). Veterans and Post-Traumatic Stress Disorder: A Conversation with Dr. Frank Ochberg. Psych Central. Retrieved on July 3, 2015, from http://psychcentral.com/lib/veterans-and-post-traumatic-stress-disorder-a-conversation-with-dr-frank-ochberg/