To help vets, overhaul how we treat PTSD

One out of every three Americans returning home from Iraq or Afghanistan struggles with psychological wounds, such as post-traumatic stress disorder (PTSD). They are your neighbors, coworkers, and friends. After serving our country, they become cogs in a byzantine system, delivered outmoded treatments and profit-driven pharmacology that produce sub-par results. The current veteran suicide rate of 20 per day should shock the conscience. Equally alarming, however, is the fact that only half of those with PTSD seek treatment, and 20 percent of those who seek help, actually complete their treatments.

President Donald J. Trump, like his predecessors, has discussed overhauling the Department of Veterans Affairs. Under consideration is a plan to allow military veterans to opt out of medical care at VA hospitals and instead see private doctors.  But we also need to have a serious conversation about how we treat PTSD. Over the past fifteen years, the military has made great strides in medical innovation; especially in battlefield life-saving techniques and innovations in prosthetics. However, less progress has been made in significantly reducing the effects of the invisible injuries of war. Many of today's approaches to treating PTSD have barely budged since World War I. Worse, many of the therapists providing services to veterans  are not trained to deal with or understand the types of trauma that veterans experience.

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The current approved treatments for PTSD go something like this: 1) meet with a mental health professional and answer a series of questions. 2) Get prescribed medications --anti-depressants, anti-anxiety, sleep drugs 3) Rinse and repeat, with the drugs daily and with the talk therapy, weekly.   This approach simply teaches veterans how to live with a diminished version of themselves. Moreover, concern still remains about the stigma associated with seeking help.

An August 2015 study in the Journal of the American Medical Association found that trauma-focused psychotherapies, which are considered first-line therapies in most treatment guidelines for military-related PTSD, yielded outcomes only marginally superior to non-trauma-focused approaches. As we enter our 16th year of war, it's high time to ask ourselves: Is the current approach of talk-therapy and pharmaceuticals merely treating the symptoms or trying to address the root causes of the problem?

This is not to condemn organizations working hard to help veterans recover. But, the root causes often relate to why a veteran joined the military rather than what happened while they were deployed. Additionally, treatments are culturally inconsistent with military and veteran populations, for whom training and directness are more accepted.  For example, combat veterans often brag about the harshest place they ever slept - under a Humvee, in a shipping container, or next to a generator. Yet when they come home and struggle, they are given weighted blankets to mimic the feeling of being swaddled, as if they were an infant.

Interestingly, 30 percent of Vietnam veterans came home from war with symptoms of PTSD.  However, only 4 percent of Vietnam prisoners of war came home with these symptoms.  One of the key factors of these POWs' success is that many of them viewed their struggle in captivity as a means to a better life.

Researchers at the University of North Carolina, Charlotte have found that those who, like POWs, experience post-traumatic stress and demonstrate that they can not only recover, but learn and grow and become stronger from their traumatic experiences. Increased personal strength, improved relationships, a greater appreciation for life, deepened spirituality, a new outlook on life - these are all signs of what the researchers call posttraumatic growth.

Recent research and work to combine posttraumatic growth concepts with non-clinical activities is showing promising alternatives to longstanding PTSD protocol.  In an immersive curriculum, veterans are trained in posttraumatic growth while learning new skills such as meditation, yoga, goal setting, and other ancient warrior wellness practices so they can leverage their understanding of what was gained and lost in combat.  These approaches align with the mindset and culture of the veterans' military experience: that is, rather than treat them, train them to be stronger.

To be sure, alternative medicine and non-trauma approaches may meet some resistance among the rank and file as well as military providers. The VA, like any sprawling organization, may be resistant to change.  But non-trauma-focused providers and approaches have a proven track record.

The aftermath of World Wars I and II demonstrated that post-war eras present incredible opportunities for veterans to improve the societies and work forces they reenter with their can-do work ethic and entrepreneurial spirit.  To maximize their contribution to society, however, we must first heal the invisible wounds of war.

Ken Falke is a retired Navy Explosive Ordnance Disposal (EOD) Master Chief Petty Officer and the chairman and founder of the EOD Warrior Foundation and Boulder Crest Retreat for Military and Veteran Wellness. Army Major John Spencer is a scholar with the Modern War Institute at the US Military Academy in West Point.


The views expressed by authors are their own and not the views of The Hill.