As we ended last week’s blog, I was suggesting that the solution in changing the behavior in our wounded warriors would be found in addressing the emotional states caused by combat. Unfortunately, this is not what we do. As most of you know, when our warriors become combat ineffective from the “unseen wounds” of war, their first-line choices for healing are medication and/or exposure therapy. In essence, we offer them mind-numbing medications to suppress the “emotional side of the equation” and we offer exposure therapy to address the “behavior side of the equation.” I know now there are better first steps to heal our warriors. I also believe using the above-mentioned first-line options are a huge disservice to the majority of our warriors. Bear with me as we take a look first at medical management of PTSD.
No Pill is Gonna Cure My Ill
I would invite every reader to spend some time with a wounded combat veteran and ask them how many medications they are taking? I’m not talking about vets from World War II, Korea, Viet Nam, or even the Gulf War, as most of these vets are advancing in their age and are presenting with other health problems like hypertension, diabetes, and cancer. I’m talking about Lance Corporal Jones, age 28, a veteran of Afghanistan or Staff Sergeant Smith, age 33, who led the charge into Baghdad. On average, you can expect to hear that 7-13 different medications have been prescribed to them over the course of their matriculation out of the service. With that much medication in play, you’d think we would be getting great results, right? We’re not and there is a glaring reason.
We don’t even know if the majority of these medications work in patients with PTSD!
If you were to do a bit of research, you would find that there is very little evidence that supports the use of over 95% of the medications used to treat PTSD in our warriors. That’s right! Only 2 medicines, Paxil and Zoloft have an approved indication for PTSD. But if we really wanted the best for our warriors, we would ensure that the scientific literature was based on combat-related PTSD, right? It’s not like a little research would bankrupt a major drug firm. Unfortunately, there is very little scientific data that is available for combat-related PTSD, and the data that does exist is insignificant, at best. To be completely honest, there is NO DRUG that has been approved by the FDA for this diagnosis caused by combat-related trauma!
Medications today are prescribed to address symptoms (i.e. hypervigilance, anxiety, insomnia) and do not address the cause of combat stress. I understand that PTSD is very complex. It has 3 components that must be present for diagnosis, namely:
- Intrusive thoughts
I get it!
What I don’t understand is why the medical community involved in the mental health care for our veterans doesn’t get it? Can anyone explain to me why we attack our bodies (take medication) as a means to solve the problem in our mind?
I’m not suggesting that medicine is totally ineffective. I’m saying the approach is flawed! I would also like to add, if you are reading this and are taking medication, do not stop taking your meds!
I say again, DO NOT STOP TAKING YOUR MEDS!!!
I would only discontinue prescribed medication under the supervision of a physician, as abrupt discontinuation will cause you more problems. Trust me on this one. The problems of abrupt withdrawal will make a bad flashback feel like a kindergarten birthday party. What I am getting at here is that medication is a poor first-line therapy for our warriors. On top of that, we increase our levels of disservice using the other first-line therapy given to our warriors: exposure therapy.
That’s What They Wanna Give Me
It has been my experience that much of the exposure therapy available to our warriors is designed to address behaviors that “do not work” by unearthing associated emotional states. I would even like to commend the psychology community for trying to address the emotional component of the trauma. Unfortunately, many (not all) therapists have a hard time connecting with our service men and women. It’s the age-old struggle of the irresistible force meeting the immovable object. Therapists want to know how warriors are emotionally feeling and warriors want to stop acting the way they behave. Believe me, most of the ugly things warriors step over when they are locked and loaded are gruesome and evil. It’s painful to discuss them. It’s also difficult, as repeatedly stepping over “dead things” has a tendency to desensitize us as a species. The challenge is connecting, but the reality is the warrior doesn’t buy it. That’s important when you try and relive the trauma of combat over and over again, in a safe environment, where ultimately past behaviors can be extinguished. Face it, if you’re supposed to be “leading this experience”, but our warriors know you haven’t been there…it’s not going to work! This will ultimately create a dangerous impasse between client and therapist.
It’s dangerous, because the therapist may begin looking for another means to help their client. I realize your intentions are good in helping someone, but when you start to help guide them through combat traumas, then open a new door…a door that leads to the warrior’s past life as a civilian, you have violated their trust. You have also abandoned the warrior…just like everybody else that he or she ever trusted when they were healthy. You have also reinforced everything the system is telling our warriors…”as a warrior, you are worthless!”
You don’t need to be a Ph.D. to know that when you promise one thing and yet do another, that’s dishonest.
I know if I dug long enough and deep enough into any person’s past, I could find some sorrow, shame, guilt, or fear. In my opinion, when the therapist starts with combat trauma but switches to the civilian past, they have forgotten the patient and begin chasing their own agendas. The therapeutic alliance, as it is referred to, is a strong predictor to the potential success of therapy. Simply put, if you click with your therapist, you will have a better chance of having a successful and trusting relationship. Without trust, therapy becomes just a means to a paycheck for a mental health worker. The patient just becomes a revenue stream. I’ve read the literature that suggests the effectiveness of exposure therapy and I believe there is a place for it, in certain cases. What I’m telling you, as a first-line solution to warriors…it is a flawed approach, too.
It appears I am painting a pretty bleak picture of the current situation and condemning the professionals currently involved. That is hardly the case. I cannot ignore how useful medication can be, especially when there is evidence to support its use. I also have seen great work between clients and therapists when the goals of therapy are clearly defined. What I take issue with is the approach. It is flawed because as a first line solution, both methods ignore the ability of the warrior to do the work for themselves. I didn’t say by themselves, I said for themselves.
How we would accomplish that end will be the subject of the next installment in this ever-growing dialogue.
I want to show you a better way.