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Combat PTSD (Post-Traumatic Stress Disorder)

Summary of Combat PTSD Hurricane Katrina ravages the Gulf Coast in 2005, as well as an earthquake savages Pakistan, India and Afghanistan. In 2004, a crushing tsunami rises out of your Indian Ocean. A terrorist attack paralyzes a nation with a mid-September morning in 2001. Every two minutes, as a famous is raped.1Over Six million are going to complete motor vehicle collisions annually.2One to 3 million are victims of domestic violence annually.3And some are sent to combat.

Trauma and disaster are section of the human experience. Statistically, 50 percent of us should be expecting to thrive a minumum of one traumatic event over the course of our way of life.4

As animals, you will find there’s built-in capacity to accommodate our changing environment and also to the stresses and circumstances of life. Our adaptability acts as protection. After having a traumatic event, it really is natural to experience stress and preoccupation with the event. Even though it might not exactly feel -normal- back then, replaying the episode is our brain’s means of processing, modifying and integrating the brutal incident before moving forward to.5

Unlike combat stress disorder, that is an instantaneous response to events taking place about the battlefield, post-traumatic stress disorder develops with time. Richard Pierce, a Vietnam veteran who may have been a tireless advocate for returning combat veterans, describes the build-up of PTSD: -In its early stages I do think the nightmares, withdrawal, and anxiety are natural defensive reactions to some very traumatic experience. Only at that early stage it’s like a toothache, painful and troubling. Left untreated, the infection festers and grows. This is when it is deemed an illness.-6

PTSD leaves an unpleasant impression around the mind, being a scratch on an old vinyl record, which could cause permanent damage after a while. Dr. Edward Tick, a clinical psychotherapist with extensive experience treating veterans and author of War and also the Soul: Healing Our Nation’s Veterans from Post-Traumatic Stress Disorder, is the term for combat PTSD as -frozen war consciousness.-7

Time appears to stand still because the trauma survivor skips back repeatedly for the event through intrusive thoughts, nightmares, along with other triggers. Each re-experience leaves the sufferer mentally and physically drained, along with their anxiety and frustration increases because they continually feel out of hand. Avoidance or rage may result along with any number of other symptoms and reactions.

Symptoms and Reactions
Following a stint in the battleground, veterans go back home changed.

Although are strengthened with the challenges of combat, others return using a changed take a look at themselves as well as the world around them. For a few, reactions with their experiences might be short-lived (perhaps lasting the initial few months of reintegration into civilian life). For others, healing might require long-term vigilance and care (lasting months, a few years even decades).

Typical signs of combat-related PTSD (in no particular order, with additional symptoms to follow):

Survivor guilt
Cynicism
Frustration
Fear
Negative self-image
Difficulties with intimacy
Distrust
Loneliness
Suicidal feelings
Preoccupation with thoughts of the enemy
Revenge fantasies
Addiction
Alcoholism
Believing that feelings are meaningless
Feeling powerless or hopeless

Resignation (-don’t care-)
These list includes only a small portion of the symptoms that may be found in a veteran managing PTSD. Additional symptoms or categories of problems are shown below.

In 2000, the American Psychiatric Association revised the PTSD diagnostic criteria in its fourth update of what’s considered the ‘Bible’ of psychiatry, the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR).

For a PTSD diagnosis, someone have to be -exposed to your traumatic event- and met with -actual or threatened death or serious injury, or even a threat on the physical integrity of self varieties.- Their response could have -involved intense fear, helplessness, or horror- at that time.

PTSD makes it necessary that monthly following your event they’re still experiencing flashbacks, having nightmares, emotionally and/or physically addressing certain triggers, actively avoiding thoughts and feelings or discussions or people or places where remind them of the trauma, feeling -pumped up’ or not capable to relax, getting angry easily, etc. These symptoms would combine inside the patient, affecting their ability to perform in social and employment situations. These reactions to trauma would fall under three symptom clusters as outlined below: intrusive recollections, avoidant/numbing symptoms, and hyper-arousal symptoms.8

Intrusive – Re-experiencing in the traumatic event(s)
Distressing recollections
Flashbacks (feeling as if you’re back combat while awake)
Nightmares (frequent recurrent combat images or another frightening themes while sleeping)
Becoming upset when reminded of the incident

Feeling anxious or fearful (as if you’re within the combat zone again)
Because trauma survivors have these upsetting feelings once they feel stress or are reminded of these trauma, they often times behave as should they be in danger again. Some may get overly interested in staying safe in situations that aren’t truly dangerous. For example, an individual residing in a safe and secure neighborhood may still believe that he needs to provide an security alarm, double locks around the door, a locked fence, along with a guard dog. Because traumatized people often feel like they’re at risk even though they’re not, they could be overly aggressive and lash out to protect themselves should there be no need. For example, an individual who was attacked could possibly be quick to yell at or hit somebody who seems to be threatening.

Re-experiencing symptoms really are a sign the body and mind are actively struggling to manage the traumatic experience. These symptoms are automatic, learned responses to trauma reminders. The trauma has become associated with many things so that when the person experiences these items, they’re reminded with the trauma and feels that she or he is in danger again. It’s also entirely possible that re-experiencing symptoms are actually a part of the mind’s attempt to sound right of the has happened.

Avoidant – Drawing inward or becoming emotionally numb
Extensive and active avoidance of activities, places, thoughts, feelings, memories, people, or conversations associated with or that call to mind your combat experiences
Depression and/or loss of interest
Feeling detached from others (discovering it challenging to have loving feelings or experiencing any strong emotions)
Feeling alienated, disconnected from the world around you and things that take place
Feeling betrayed by God and/or society (cast off)
Restricting your emotions
Trouble remembering important areas of what actually transpired throughout the trauma
Closing (feeling emotionally and/or physically numb)
Things around you seem strange or unreal
Feeling strange and/or experiencing weird physical sensations
Not feeling pain or another sensations
Because with the trauma and feeling as you have been in danger is upsetting, those who have experienced traumas often try to avoid reminders in the trauma.

Sometimes survivors are aware that these are avoiding reminders, but in other cases survivors don’t understand their behavior is motivated from the should avoid reminders of the trauma. Looking to avoid for the trauma and avoiding strategy for trauma-related problems may have a person from feeling upset for the short term, but avoiding treatment means that in the long term, trauma symptoms will persist.

Hyperarousal – Increased physical or emotional arousal
Difficulty sleeping
Irritability or outbursts of anger
Difficulty concentrating or thinking clearly

An exaggerated startle response (triggers bring you time for some combat zone event)
Hypervigilence, being overly angry or aggressive (feeling just like you have to defend yourself from danger, i.e. unrelenting survival mode stance)
Panic attacks
Triggers normally include any of the following:

Specific scenes – crowded streets, sunsets, sunrises, familiar clothing
Movement – someone rushing on the individual
TV – even if the story is unreal, the niche or even the environment might cause thoughts which become a trigger
Sound – helicopters, songs, unexpected loud noises
Smell – jungle or bush, rain, smoke, blood, cordite or explosives
Reading – or discussion about subjects of trauma
Touch – gun metal, webbing, blood
Situational – being crowded, walking across open spaces, feeling vulnerable or otherwise in charge
With every trigger and re-experience, depressive emotional and biological patterns or habits are set down. Modern psychology calls these patterns neural grooves. Eventually, people handling PTSD begin -organizing their lives around the trauma.- Their work, themselves relationships, as well as their long-term health usually suffer consequently.

You will need to be aware that being afflicted by combat trauma doesn’t automatically mean you’ll have problems with PTSD. Early intervention is vital. Setting constructive and positive responses to triggers noisy . stages raises the likelihood how the trauma reaction could be defused. Yet even with vigilance and many types of the best supports set up, the invisible scars of war can haunt a warrior for a lifetime.

One Vietnam Veteran’s Experience On February 4, 2005, Alan McLean, a Purple Heart and Bronze Star Vietnam veteran and popular rector at St. Luke’s Episcopal Church in Wenatchee, Washington, composed a letter to his wife and kids on his laptop. Inside the message, he apologized for many years because of not being stronger, explaining how the war in Iraq had made his nightmares about Vietnam more robust or painful. The former Marine second lieutenant added,- 35 Marines died today in Iraq, [a loss] only better noticed than my legs,- referring to the strong limbs a landmine had taken from him thirty-eight years before.9

Initially, McLean was supportive in the Iraq War, while he was from the war in Afghanistan, delivering a sermon on the have to have faith inside the government’s mission. Half a year later, because war reports extracted their heavy toll around the conflict-ravaged minister, he delivered an opposing sermon on the small farming community that he ministered over. As flashbacks and panic disorder progressively destroyed what little peace he were able to create for himself following Vietnam, he turned a pistol towards his chest as part of his church office last month 11, 2005 and escaped the war-torn earth. His daughter would later say, -I underestimated the potency of the war to adopt his life. I experience that, though my dad’s held it’s place in Wenatchee, the war in Iraq killed him.- 10

Good reputation for Combat PTSD
Though it’s been described by a few different names, post-traumatic stress disorder continues to be with us provided wars have been fought. The Greek historian Herodotus, writing from the battle of Marathon in 490 BC, mentions an Athenian warrior who went blind when the soldier standing close to him was killed, even though blinded soldier -was wounded in no section of his body.- Herodotus also wrote from the Spartan commander Leonidas, who, on the battle of Thermopylae Pass in 480 BC, dismissed his men from combat because he recognized these were mentally exhausted from previous battles.11

However, post-traumatic reactions were not exclusively available to those that fought in battle. Having survived the Great Fire based in london in 1666, Samuel Pepys recorded in his diary the frightened, angry, and disturbed moods that haunted him for the following almost a year, although he’d been uninjured within the fire and his house undamaged.12

It had not been until 1678 which a name was handed for the symptoms that made up post-traumatic stress, when Swiss physician Johannes Hofer coined the word -nostalgia.- Initially called the -Swiss disease- due to its prevalence among Swiss men who fought in mercenary armies, nostalgia was seen as a -melancholy, incessant thinking about home, disturbed sleep or insomnia, weakness, loss of appetite, anxiety, cardiac palpitations, stupor, and fever.-13 Throughout the same time as Hofer’s diagnosis, German, French and Spanish doctors noted similar symptoms in their combat troops.

In the Napoleonic era, French physicians developed [pdf] an extremely advanced and modern comprehension of the factors which lead to nostalgia, citing conditions ranging from the social towards the environmental. Dominique Jean Larrey, Napoleon’s chief surgeon, prescribed a program of treatment that although biologically-based, took social factors heavily into account and was in different ways a precursor to contemporary knowledge of the psychiatric results of warfare upon soldiers.14

The Civil War The American Civil War saw a tremendous surge in the quantity of soldiers who suffered from battle-related psychological trauma. In the war years, the Union Army recognized [pdf] over 2,600 cases of insanity and 5,200 cases of nostalgia.15 In addition to the official cases, many -insane- Union soldiers were simply discharged and left to locate their own way home. The population outcry that resulted over this led [pdf] to a 1864 War Department order requiring that such soldiers be transferred to the federal government Hospital until their own families could retrieve them.16

Desertion by psychologically traumatized soldiers has also been a difficulty. Those can not fight were labeled -malingerers- or -cowards,- and several soldiers deserted rather than risking being tagged with your labels. However, whichever options a combat-stressed soldier chose, the penalty was brutal: malingerers, cowards and deserters were executed by firing squad while their fellow soldiers were expected to watch. Everyone got the content of the items happened to the people who were don’t ready to fight.17

In 1871, an internist named Jacob Mendez Da Costa wrote [pdf] of the chest-thumping anxiety and breathlessness he had seen in many soldiers around the front throughout his time as being a Union doctor. The primary the signs of -the irritable heart with the soldier,- or DaCosta’s Syndrome as it became to get called, were a persistent tachycardia, or -hyper-arousal,- which generated anxiety and hyperventilation.18

While Americans waged civil war, The united kingdom was mired in a internal conflict of some other kind. Several deadly and highly publicized train accidents had rocked the united states, making a trauma condition called -railway (or railroad) spine.- First noted by an English surgeon in 1867, railway spine was -characterized from the manifestation of many different physical disorders in otherwise healthy and apparently uninjured railway accident victims.- Care about this new industrial age disorder spurred many in the profession of medicine to look at the role of psychological factors in -provoking- physical disorders.19

World War I The first organized military system for psychological treating combat fatigue occurred [pdf] throughout the Russo-Japanese War (1904-1906), when physicians were put as close on the front as is possible to allow them to perform evaluations of traumatized soldiers.20 This -forward treatment- recognized the need for caring for psychological casualties as quickly so that as close to the action as you can. The idea ended up being keep your traumatized GI near his unit, as it was observed that this farther away from the purpose of battle a soldier traveled, the less successful doctors were in enabling him during the fight.

Ww1 ushered inside a whole new form of warfare, as modern weaponry inflicted a brutal toll about the flesh and mind. Captain F. C. Hitchcock, a British officer, reflected about this vicious new and violent way of warfare:

The noise . . . split our ears, and now we all felt quite dazed with the brain-racking concussions. . . . Battery power of French .75′s . . . were so rapid that they can sounded just as if they originated some supernatural machine-gun. . . . The men from the Company were very bitter to think that they been shelled for hours on end by a hidden foe.21

The -bitterness- that Captain Hitchcock recorded reflected situations from the new modernized form of combat, since the idea of fairness or control of one’s destiny was blasted into oblivion by the magazine rifle, the machinegun and also the quick firing artillery piece. Because of this, a brand new term was implemented to spell it out psychologically traumatized soldiers: -shell shock.-

Soldiers who endured this problem literally acted as if that they had sustained a surprise on their nervous system, often struggling with -staring eyes, violent tremors . . . and blue, cold extremities.- Additionally, many shell-shocked soldiers became [pdf] deaf, blind, or paralyzed, but they were physically uninjured.22

To treat shell shock, British and French psychiatrists expanded about the work of the Russian counterparts from the Russo-Japanese War, making forward treatment a fundamental portion of the treatment process. In 1917, Thomas Salmon from the U.S. Army Surgeon General’s office built upon the project in the British and French to generate the initial comprehensive treatment program for shell shock, or -war neuroses- because it was renamed. Salmon’s system, which involved placing psychiatrists in combat units with forward hospitals to compliment them, focused on four key treatment principles, that happen to be still the premise for the treatment of combat stress:

Proximity (treating the soldier as near for the battle as is possible)
Immediacy (treating the soldier at the earliest opportunity)
Simplicity (providing simple treatment like rest, a warm shower and food)
Expectancy (the expectation that this solider will resume fight after he’s been treated)23
Inspite of the progress produced in the psychological management of traumatized soldiers during World War I, lots of the conclusions the medical profession reached developed into flawed. For example, they still clung for the notion that just the -weak- fell for wartime strain, as well as holding fast to the proven fact that rigorous pre-enlistment screening can help you to split up those prone to experience shell shock and battle fatigue from people who could withstand the rigors of combat.

The second world war
[Larger version] “Three Lives Brightened by Deadly Nightshade”
Wyeth Pharmaceuticals placed this ad in daily life Magazine on September 17, 1945, touting the benefits of their product in curing “battle reaction/mental trauma” a result of WWII…and colic. While it didn’t come to be the cure-all they’d claimed, the marketing strategy is interesting because 1) it presents shell shock as being a normal, if trying, after effect of war; 2) the technique of psychiatry is addressed with respect and admiration; and three) an interdisciplinary treatment means for combat stress, with medication and counseling cooperating to come back the soldier to full health, is utilized. Could we imagine this kind of ad running today?

During the interwar years, the idea [pdf] that pre-enlistment screening could minimize combat trauma cases became so prevalent that, when Wwii began, psychiatrists were no longer assigned to combat divisions, with out provisions were designed for psychiatric treatment inside field.24 As a result, most of the successful -forward treatment- lessons of World War I were forgotten.

Unfortunately, the screening process ended up being an entire failure. Though twelve percent of the fifteen million armed forces recruits during Wwii were rejected as a result of psychiatric disorders (when compared with 2 % during Ww 1), psychological casualties during The second world war wound up being 2.4 times in excess of in Ww 1.25 Not merely was the screening process ineffective, it also finished up hurting the war effort; midway over the war, more soldiers were being eliminated [pdf] from the army than were being able to join.26

In spite of the failure in the screening process, there was still important lessons learned about combat stress during World war 2. One was that inexperienced troops were more prone to suffer breakdowns than seasoned soldiers. Another was that the threat of combat stress increased using the concentration of combat. Finally, and maybe most of all, it turned out learned [pdf] that group morale would have been a contributing element in preventing war trauma, as units with strong cohesion and leadership had fewer combat stress casualties.27

Korean War The American military had still not corrected its too little treating combat stress if the Korean War began in 1950. Because of this, initial trauma casualty rates were two and 3 times above during Wwii. In lieu of while using the forward treatment techniques that have proved to be successful in earlier war efforts, psychological casualties were being evacuated in the combat zone, greatly harming their chances at recovery. As Peter J. Murphy wrote in Military Stress and gratifaction: The Australian Defence Force Experience, -lessons within the treatments for both psychological casualties of combat and returning veterans have experienced to be repeatedly relearned, at great personal cost to service personnel affected by the strain of war.-28

Fortunately, due mostly towards the efforts of Colonel Albert J. Glass, the principles of forward treatment were quickly reinstated, lowering the variety of psychiatric causalities. Other procedures were also implemented [pdf] in order to reduce combat trauma, together with a rotation system for troops, and greater tries to rest soldiers (rest and recreation or -R and R-).29

Regardless of the overall success of combat psychiatry throughout the Korean War (approximately 90 % of psychiatric casualties returned to address), a new problem developed: the psychiatric problems of rear-area or rear-echelon troops. Because war progressed and support troops, who rarely found themselves in dangerous situations, found outnumber those engaged in actual combat, psychological conditions just like what had been affecting soldiers who had once endured nostalgia, including desiring home and friends and boredom, became prominent. To look for respite from these symptoms, many rear-echelon troops looked to alcohol and drugs, and sexual stimulation. Unfortunately, the problems of rear-echelon troops were in most cases ignored [pdf]; they would embark on being the dominant psychiatric casualties of the next major U.S. conflict, the Vietnam War.30

Vietnam War -We don’t promise a rose garden.–1971 Marine Corps recruitment poster

Because of the Vietnam War’s slow build-up, the psychological casualties didn’t show up as soon as they’d in the past wars, when they did, they appeared with a reduced level in comparison to past conflicts. Period of time degrees of combat fatigue were attributed [pdf] to several factors, such as twelve-month rotation policy, the lack of sustained artillery fire as well as the deficiency of prolonged battles.31

However, it turned out a direct consequence with the war how the situation worsened, as veterans streamed in to the Va seeking help for trauma these folks were experiencing months and even years after their initial experiences for the battlefield. Dr. Matthew J. Friedman, who began a long career inside the VA in 1973, recalled how, -People were flooding the clinics, demanding we do something for their distress. We had no clinical terminology for which we were seeing. Their suffering was raw.-32

One of the primary barriers to treating veterans’ psychological symptoms would have been a insufficient consistent terminology because of their ailments, concerning was a minimum of eighty different names employed for the fact that was was essentially psychological trauma or combat stress considering that the syndrome had first been recorded.

Included in this are, but are faraway from limited to, the list below of terms (in no particular order):

post-traumatic stress disorder (PTSD), soldier’s heart, exhausted heart, irritable heart, Da Costa’s syndrome, Swiss disease, railway (or railroad) spine, railway shock, railway brain, fear neurosis, Erichsen’s disease, hysteria, exhaustion, disorderly action of the heart, heimweh (German, -homesickness’), war hysteria, traumatic hysteria, traumatic neurasthenia, shell shock, battleshock, battle reaction, battle fatigue, battle neurosis, battle exhaustion, combat fatigue, combat stress reaction, combat-operational stress reaction, war neurosis, war syndrome, traumatic neurosis (of war), nostalgia, mind sickness, combat trauma, combat exhaustion, nerves, maladie du pays (French, -disease in the country’ ), not diagnosed nervous, psychoneurosis, post-war disorder, acute stress disorder, acute stress reaction, gross stress reaction, post-Vietnam syndrome (PVS), post-combat disorder, catastrophic stress disorder, mental collapse, in-country effect, psychological injury, mental trauma, Old Sergeant Syndrome, acute combat reaction, acute combat stress reaction, neurocirculatory asthenia, effort syndrome, insufficient moral fibre, estar roto (Spanish, -to be broken’), delayed stress syndrome, psycho-neurosis, psychiatric collapse, Vietnam disease, nervous disease, nervous shock, physical shock, neurasthenia following shock and accident, accident neurosis, post-traumatic shock, veteran’s chronic stress syndrome, explosion blow, cerebro-medullary shock, emotional disturbance, simple continued fever, cardiac muscular exhaustion, cerebro-spinal shock, wind contusions, posttraumatic illness, chronic multisymptom illness, disordered action with the heart, post-combat stress reaction, Vietnam veteran syndrome, buck fever, re-entry syndrome, and post-Viet Nam psychiatric syndrome (PVNPS)
Much-needed reduced the cacophony of labels came when Dr. Robert Jay Lifton, a well-known research psychologist, used the phrase -post-Vietnam syndrome- on the Congressional Conference on War and National Responsibility in 1970. Dr. Lifton’s use of the term in the testimony was literally a defining moment inside treatment of combat stress.34

Partnering with Dr. Chaim F. Shatan, Lifton helped to provide new focus and terminology towards the combat psychology revolution. In 1980, their work, together with that relating to veterans, psychologists, and anti-war activists, succeeded in convincing the American Psychiatric Association to include a definition for -Post-Traumatic Stress Disorder- to the third edition of the Diagnostic and Statistical Manual of Mental Health Disorders (DSM).

The DSM-I, published in 1950, had relied heavily on the input of World War II-era military psychiatrists for defining combat stress. Covering four pages, the words stated that -gross stress reactions- stemmed from either catastrophes or combat. Furthermore, its preface spoke of the -value of the stress definitions to military psychiatrists [and] psychiatrists utilizing veterans.- But ironically, all reference to such stress reactions was wiped directly from the DSM-II, posted at the peak in the Vietnam War in 1968.35

While using publication of DSM-III, the oversight was remedied. The state run name and definition once again in position, scientists and researchers were able to devote their energies to review the why’s of PTSD last but not least leave the if behind.

Afghanistan and Iraq Wars

“I am so fucking scared of everything.”
PostSecret is definitely an online journal sharing postcards mailed in from around the world containing secret regrets, hopes, experiences, fantasies, beliefs, and fears (to name but a few topics covered). On June 3, 2006, an anonymous Iraq veteran submitted these, written on the back of your graduation invitation envelope: “At my best friend’s graduation today, I heard a fireplace engine and could only make a bomb going off, the F.D. responding. Firecrackers stopped and I heard machinegun fire. When I drive within my car, as I search for oncoming traffic, Furthermore, i check local buildings and houses for snipers. I have been previously from the military for 2 years, and was just in Iraq for four months. We are so fucking scared, of the things.”

The relative quiet of U.S. combat inside the decades following the Vietnam War resulted in the situation of post-traumatic stress disorder largely faded from public view. However, things changed quickly in 2002 and 2003, since the nation became involved with Afghanistan and Iraq. And, just as they had done in The second world war, military planners disregarded the teachings of forward treatment, to fatal consequences.

The first sign that something was wrong happened 2002, when there were a rash of murder-suicides at Fort Bragg, New york concerning the killings of four military wives by their husbands, all recently returned Special Forces troops from Afghanistan. A year later, a wave of combat zone suicides in Iraq caused the Army must a team of doctors to ascertain whether the stress of combat and long deployments were contributing factors on their deaths.
On account of this, in 2004, the Army and Marines launched Operational Stress Control programs, embedding mental health personnel within deployed combat divisions. Greg Gordon, a spokesman for that Marine’s Personal and Family Readiness Division, told a Washington Post reporter at the time that, -Before, we’d to ship them out from the war theater. Now [the mental health professionals] can provide help immediately.-36

At the time of April 2006, over 230 mental health practitioners were treating frontline troops for that emotional (sadness, worry, fear), cognitive (disorientation, confusion, memory loss, inattention), and behavioral (aggression, suicidal) pieces of Combat Stress Disorder.37 Mirroring the goals established in WWI, the overarching aim is to rapidly return troops to duty and reduce the manpower drain. The hope is that early treatment will even decrease the combat veteran’s long-term mental medical problems and it is associated costs.38

This knol includes selections in the author’s book, Moving a Nation to Care: Post-Traumatic Stress Disorder and America’s Returning Troops (Ig Publishing, 2007). Ilona Meagher.

No area of the items in this site can be utilized or reproduced in any manner without written permission in the publisher. For additional on combat PTSD from this writer, kindly visit her online journal, PTSD Combat: Winning the War Within.

References
-Statistics,- Rape Abuse & Incest National Network

-Car Accident Statistics,- CarAccidents.com

-Domestic Violence is really a Serious, Widespread Social Overuse injury in America: The reality,- Family Violence Prevention Fund

Matthew J. Friedman, MD, PhD. Post Traumatic Stress Disorder: The most recent Assessment and Treatment Strategies, (Overland park, Missouri: Compact Clinicals, 2003), 1.
Bessel A. Van der Kolk, Alexander C. McFarlane, and Lars Weisaeth, eds. Traumatic Stress: The results of Overwhelming Experience on Mind, Body, and Society, (Nyc: The Guilford Press, 1996), 3-5
Richard Pierce, -Re: Update,- Email message for the author, March 30, 2006.
Edward Tick, War along with the Soul: Healing Our Nation’s Veterans from Post-Traumatic Stress Disorder, (Wheaton, Illinois: Quest Books), 99
Van der Kolk, McFarlane, and Weisaeth, Traumatic Stress, 6.
The ‘Symptoms and Reactions’ section is an author-compiled composite of PTSD symptom descriptions culled in the Journal of Clinical Psychology Expert Clinical Guidelines Series; the always informative National Center for PTSD website; as well as the Vietnam Veterans Association of Australia.
Mike Lewis, -Vietnam, Iraq wars cited for minister’s suicide,- Seattle Post-Intelligencer, February 22, 2005.
Ibid.
Steven Bentley, -A Short Good reputation for PTSD: From Thermopylae to Hue, Soldiers Have Always Stood a Disturbing Reply to War,- The VVA Veteran, March/April 2005.
Ibid.
Major Stephane Grenier, -Operational Stress Injuries (OSI): A New Way to consider a vintage Problem,- Canadian Forces Support Personal Agency: Director of Military Family Services, June 12, 2005

Franklin D. Jones, M.D., F.A.P.A, -Psychiatric Lessons of War [pdf],- in War Psychiatry, The Textbooks of Military Medicine, ed. Brigadier General Russ Zajtchuk, M.C., (Washington, DC: Office with the Surgeon General, Department from the Army, 1995), 6.
Ibid, 8.
Nicolas L. Rock., M.D., F.A.P.A., James W. Stokes., M.D., Ronald J.Koshes, M.D., Joe Fagan M.D., William R.Cline, M.D., and Franklin D. Jones, M.D., F.A.P.A., -U.S. Army Combat Psychiatry [pdf],- in War Psychiatry, The Textbooks of Military Medicine, ed…
Penny Coleman, Flashback: Posttraumatic Stress Disorder, Suicide, and the Lessons of War. (Boston: Beacon Press, 2006), 23-24.
18. -U.S. Army Combat Psychiatry [pdf],- War Psychiatry, 153.
Ralph Harrington, -The Railway Accident: Trains, Trauma and Technological Crisis In Nineteenth Century Britain,- in Traumatic Pasts: Background and Trauma these days, ed. Mark S. Micale and Paul Lerner, (Cambridge: Cambridge University Press, …)
-U.S. Army Combat Psychiatry [pdf],- War Psychiatry, 154.
F. C. Hitchcock. Are in position to: A Diary with the Trenches, 1915-1918. (London: Hurst & Blackett, 1937; repr., Heathfield, England: The Naval & Military Press, Ltd., 2001).
-Psychiatric Lessons of War [pdf], – War Psychiatry, 9.
Ibid.
Ibid, 11.
Paul Wanke, -American Military Psychiatry and Its Role Among Ground Forces, – The Journal of Military History 63, no. 1 (January 1999): 127.
-Psychiatric Lessons of War [pdf], – War Psychiatry, 11-12.
Ibid.
Peter J. Murphy, -The Stress of Deployment,- Military Stress and gratifaction: The Australian Defence Force Experience, (Melbourne: Melbourne University Press, 2003), 7.
-Psychiatric Lessons of War [pdf], – War Psychiatry, 16-17.
Ibid.
Ibid.
Kate Mulligan, -For PTSD Care, It’s actually a Lot less than Vietnam to Iraq,- Psychiatric News 39, no.9 (May 7, 2004): 1

Gerald Nicosia, You will find War: Previous the Vietnam Veterans’ Movement (Nyc: Carroll & Graf Publishers, 2001), 158-159
Ibid., 179
Ann Scott Tyson, -Suicides in Marine Corps Rise by 29%,- Washington Post, February, 25, 2005.

-Army Suicides Hit Highest Level Since 1993,- Associated Press, April 21, 2006.
Bret A Moore and Greg M. Reger, -Combating Stress in Iraq,- Scientific American, February/March 2006, 35.

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