Putting Them Back Together Again
Dr. Ken Hirsch is using cutting-edge methods at Tripler to treat soldiers who return from the horrors of war with post-traumatic stress disorder.
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flashbacks. Even if (the patients) don’t have all three, (they) still have serious symptoms that warrant treatment.”
PTSD was recognized as a syndrome shortly after the Vietnam War, and therapists like Hirsch are still learning how best to treat the disorder that may be as old as war itself. In the last 50 years it’s been known as shell shock and battle fatigue. During the Civil War it was called “soldier’s heart.” In fact, Hirsch says, the behavioral problems associated with post-conflict anxiety disorders can be found in the writings on the ancient Greeks.
So, with such a long history, why is help finally becoming available?
Hirsch says that a large part is due to the developing science of understanding the disorder - the American Psychiatric Association’s Diagnostic and Statistical Manual that deals with PTSD came out in 1980 - and to the masculine attitude surrounding military units that prevents vets from seeking help. Warriors are supposed to be tough and the only injuries that matter are the ones that produce blood. A lack of public support for servicemembers can also prevent veterans from seeking help.
“A lack of support from the community when you come home is a significant factor,” says Hirsch. “So that made it far worse for those coming home from Vietnam, and not anywhere near as bad for those coming back from Iraq and Afghanistan.”
Looks like science isn’t the only thing to evolve.
For most of us, the closest we’ve come to understanding the disorder is through the comics and commentary by Doonesbury creator Garry Trudeau, which have followed his character B.D. as he takes part in therapy at a Veterans Affairs center.
“The way he portrays those patients is pretty accurate. He’s done a very good job,” says the former soldier and sailor who retired a year ago. Hirsch even says the cartoons can help veterans who may be unsure if they need help.
“They can see themselves in that, and that may encourage him or her to get treatment, and how they are being depicted getting treatment at the vet center is also pretty accurate. So I think it’s very good.”
But with such a serious topic, is the humor with which Trudeau finishes each strip appropriate? Yes, says the doctor.
“You have to have a break from stuff that is so blasted serious. You have to have some relief from it. We will intentionally do things to inject humor into our group. We will intentionally bring our patients to situations where they will laugh and have a good time.”
Some of these outings have included box car racing in Kapolei and putting them in a ring with ridiculously large boxing gloves and allowing them to have at it.
Hirsch says the patients at first thought the boxing idea as ridiculous only to end up on their backs not from punishment but from laughter.
“These are people who have not smiled or laughed since they got back. They have forgotten how to enjoy themselves,” he says.
With the large number of military among Hawaii’s small population, it is only a matter of time before any one of us has contact with a combat veteran. The question for the concerned and unknowing is how to react. We’ve seen the reports on TV, read stories in the papers, and it’s only natural to be curious about events that we can only imagine. But how does one broach a subject that could be potentially threatening? Hirsch says that even simple questions like “What was it like over there?” can arouse emotions.
“It’s part of the avoidance, and asking those innocent questions is enough to cause the person to think about those things they are avoiding and make them angry,” says Hirsch.
So how does someone show support without prying?
“Welcome home. Welcome home and what can we do to make you feel comfortable now that you’re back with us?” offers Hirsch.
“Make allowances for them. Recognize that these people have a lot to adjust to and that the same thing that gets them in trouble here when they come back cannot be turned off, that it kept them alive when they were in combat. Don’t ask questions about the experiences they’ve had. Instead, find out what we can do to help you get back in the job that you were in or want to get. It’s a matter of making a person welcome without probing.”
For further information about PTSD, Hirsch recommends www.battlemind.org and www.ncptsd.org. Both, he says, offer a wealth of information about the disorder that can be helpful to families and concerned friends.
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