PTSD Can Emerge in POWs, Combat Veterans and Civilians
By Rudi Williams
American Forces Press Service
WASHINGTON, May 12, 2003 - Post Traumatic Stress Disorder, or PTSD, is common in
former prisoners of war. But the disorder might not exist in the seven recently
returned American soldiers from Iraq, based on their experience.
"This was a relatively short period of captivity," DoD psychiatrist Army Dr.
(Lt. Col.) Elspeth Cameron Ritchie said, "and the seven were held together.
Historically, if you have colleagues with you, you do a lot better than if you
are isolated." She emphasized that she can't discuss more about POWs recently
held in Iraq.
"We've learned a lot from POWs from other wars," said Ritchie, program director
for DoD on mental health policy and women's issues. "Classically, the first
hours or days of capture are scary. You don't know whether you're going to be
killed. You're often moved from place to place, and maybe passed from one person
to another."
POWs held for a long time are eventually taken to a prison camp, she noted.
Prisoners in Korea and Vietnam were held for years in a situation of perhaps
chronic malnutrition, torture, maltreatment, or isolation or sensory
deprivation, Ritchie noted.
"So when you're looking at what a POW is going to face later on, you want to
look at what the captivity experience was," the psychiatrist said. "When POWs
are released, there's often a period of elation. Then it can be overwhelming,
particularly if the transition is too rapid, from being in a windowless cell to
having a thousand microphones stuck in your face."
Consequently, mental health experts take former POWs through what's called a
"decompression" stage. During that time, they're given a medical exam and a
psychological evaluation to see if they have signs or symptoms of the stress
disorder.
"Then we try to prepare them for the media and for all the reunions and
homecomings and everything they're going to face," Ritchie noted.
One thing most POWs experience is helplessness and lack of control, the doctor
said. She explained that's a bit different from combat veterans, who most of the
time had their weapon and their bulletproof jacket and knew what to do.
"As POWs come out of this phase during decompression, they often initially do
everything they're told to do," Ritchie said. "Then they begin to assert more
independence and start saying, 'No, I'm not going to wear hospital pajamas. I
want to eat what I want to eat. I want to go outside and have a cigarette. Get
your clipboard out of my face.'"
After the former POWs are evaluated for the acute stress disorder, they'll be
followed for at least a year to make sure the PTSD symptoms don't emerge. "If
they do, we treat them," Ritchie said.
Some PTSD suffers turn to alcohol and drugs, trying to drown out horrific
memories of their traumatic experiences, Ritchie said. "We did see a lot of
alcohol and drug abuse in veterans with PTSD following the Vietnam War," she
said.
"However, there was also a lot of alcohol and drug abuse while they were in
Vietnam. A lot of people were introduced to drugs - heroin and marijuana --
there who had never used them before."
"We haven't had the same pattern from other conflicts," the doctor noted. "In
the Gulf War I, there has been a much lower amount of PTSD. And we haven't seen
the same amount of drug and alcohol abuse. It can certainly happen in some
folks, but it hasn't been in the same prevalence as with Vietnam veterans."
Nowadays, post-battle debriefings and other interventions are used to allow
combatants to vent and share their emotional reactions before returning to
society and their families.
Ritchie said PTSD begins from a feeling of helplessness at the time of a
severely traumatic event. She also noted that the disease has three clusters of
symptoms -- intrusive re-experiencing of the event, numbness or disassociation
and hypervigilance. Hypervigilance is described as a feeling like, but not,
being on edge all the time.
"The adrenaline just won't turn off," she said.
"We like to break it down into the common immediate effects of trauma, and then
the longer-term effects," Ritchie noted. "The longer-term effects we call PTSD.
In the immediate effects of trauma from either combat or something like the 9-11
attack, you could have intrusive memories, where the scene plays over and over
in your head. You can have feelings of helplessness, fear or hypervigilance."
Ritchie said that she worked with some Pentagon workers after the 9-11 attacks.
If some people heard a loud noise from construction equipment, they would jump,
thinking that another plane was coming into the Pentagon.
PTSD also might cause changes in family relationships, she noted. "Some people
may feel like they're not able to express themselves to their families," Ritchie
explained. "They could also have a feeling of disassociation and numbness. If
the same effects carry on for a long time, and if they're chronic, that's part
of the PTSD picture."
The disorder is either treated with talking therapy or medication, the doctor
noted. "One of the talking therapies we use is called cognitive behavioral
therapy," said Ritchie.
"It often happens that these people develop distorted thoughts," the doctor
continued. For example, she said they might feel guilty because they think that
they should have done something to save their colleagues. Or they shouldn't have
been taken prisoner of war.
"Distorted thoughts and feelings of guilt can lead to further depression and
anxiety," Ritchie emphasized. "So as part of the therapy, we'll try to reframe
the distortion: 'You did the best you could. It wasn't your fault that your
buddy got killed.'
"We try to help that person realize that, although guilt is fairly common, they
shouldn't feel like they failed," she said.
On the other hand, former POWs are often treated as heroes, Ritchie said. But
"they may not feel like heroes. This may be a disconnect for them. They're
feeling guilty, yet the American public thinks of them as heroic. And we have to
help them explain that that's the American public's perception of them and help
reconcile those images of themselves."
Whether PTSD suffers have recurring episodes of their traumatic experience
throughout their lives depends on the person and the severity of the disorder,
Ritchie noted. She added that nightmares and insomnia may also be treated with
some very effective medications.
"We know that most people we treat get significantly better," she said. "Some
may keep some symptoms for a while. ... The goal would be to get them where the
symptoms don't interfere with their functioning."
![](/peth04/20041101200522im_/http://www.dod.mil/news/May2003/200305121a.gif) | "We know that most people we treat get significantly better,"
said psychiatrist Army Dr. (Lt. Col.) Elspeth Cameron Ritchie, program director
for DoD on mental health policy and women's issues. Photo by Rudi Williams
| ![](/peth04/20041101200522im_/http://www.dod.mil/news/May2003/200305121a_hr.gif) | High resolution photograph
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