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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Imagine, if you can, spending a year to 18 months in a place where death is a daily occurrence. As a matter of survival you’re forced to shut down a large portion of what makes you human. Emotions are something you just cannot afford. You see danger everywhere.
Now think about finally returning home, presumably safe, to the loving family and supportive friends that have been your anchor. You’re calm, happy and, most importantly, alive. But slowly the panic begins to set in. While your outward appearance may project normality, inside your entire life is falling apart.
Sleep is hard to come by as your dreams are filled with gruesome images. You cannot go shopping because crowds can mean an ambush, and the slightest bit of stress sends you into a rage. You argue constantly with the spouse you swore devotion to, the drive to work becomes an exercise in explosive avoidance, and your daughter is no longer allowed to ride the bus to school because of the fear of it being bombed en route. Finally, you turn to alcohol and drugs to dull the pain, and your career begins to suffer as unknowing superiors see not a victim in need of help, but an insubordinate servicemember who has had yet another run-in with the law.
For a large number of servicemen and women this is an all too real fact of life - that the very thing that kept them alive in combat is destroying the life to which they longed to return.
“A lot of the symptoms look like bad conduct,” says Dr. Ken Hirsch, program manager for outpatient and residential PTSD (post traumatic stress disorder) programs at Tripler Army Medical Center. “If you’re drinking to control symptoms, you’re likely to have alcohol-related problems. DUIs, showing up with alcohol on your breath, spouse and child abuse - that looks like you’ve become a bad apple, a bad soldier, or a bad Marine, when in fact it may be related and caused by PTSD symptoms.”
PTSD is a very serious but treatable affliction that has become a hot button issue as an ever-increasingly unpopular war rages on, and the number of casualties, both mental and physical, continue to grow. Fortunately for those suffering in Hawaii, the program at Tripler may be the best thing yet in helping these men and women reclaim their lives.
Hirsch and his staff are having success with a series of possibly ground-breaking methods that include group therapy and treatment - some include Vietnam-era veterans, a process Hirsch calls “desensitization en vivo,” where patients are purposely put in stressful situations to teach them how to react in such instances, physical education and Cognitive Processing Therapy. Patients in the resident program - made up of those afflicted with the most severe forms of PTSD - go through an intensive two-month program that begins at 8 a.m. and ends at 4:30 p.m. five days a week. After-dinner hours and weekends are spent on different forms of treatment.
“Some of the work is purely educational things,” says Hirsch. “They learn what PTSD is and learn about medication. Sexuality and PTSD are important because sexual dysfunction among PTSD patients is very common. We cover spirituality, biofeedback to teach them how to control their own physical and psychological responses. We teach relaxation techniques, parenthood skills, communication skills and anger management.”
And then there is learning to live with the guilt of actually making it out alive.
“That’s real hard to deal with. Feeling ‘Why did I live and why did my buddy die?’ That’s real hard to talk about. That’s a big one: survivor guilt.”
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While the reported number of servicemen and women who have sought counseling after their deployments in Iraq and Afghanistan seems frighteningly high, Hirsch is careful to point out that only a portion of those seeking treatment are actually diagnosed with PTSD, and that an even smaller number are severe enough to warrant hospitalization.
“Historically, among those formally diagnosed, 17-18 percent of those who come back from OIF (Operation Iraqi Freedom) and OEF (Operation Enduring Freedom) have had some level of emotional difficulty that would justify treatment. PTSD is about two-thirds of that.”
Though most who return from combat do not require counseling, it is incorrect to say that these men and woman have been unaffected.
“Everyone who goes to war is affected some way. How badly and in what way is a continuum,” says Hirsch. “One extreme is that I don’t like to think about it but it doesn’t affect my life. The other extreme is I can’t live my life anymore because I can’t go out of my house without thinking I’m under attack. I have to drink or use drugs in order to calm myself down to fall asleep. I can’t tolerate even the most moderate stimulus without going into a rage.”
Though PTSD often gets lumped with other anxiety disorders by laymen and the media, PTSD has very strict symptoms that must be met before the disorder can be diagnosed.
“The servicemember must have had one or more exposures to very traumatic events and then (suffer from) three major symptom clusters. There is re-experiencing the event, avoidance and hyper arousal - always on guard, a sharp noise could cause you to seek shelter under the kitchen table and look for your weapon, always sitting with your back to the wall, you don’t sleep very well, intrusive thoughts, images, nightmares or
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