Trying to tame unseen demons of war

  • Article by: Maura Lerner
  • Star Tribune
  • September 2, 2007 - 10:14 PM

Before they left for war in March 2006, more than 500 Minnesota National Guard troops volunteered for an experiment.

They agreed to answer a battery of questions about their mental health before setting foot in Iraq. Now they're back home, and the experiment is in full swing again.

Last week, a team of psychologists from the Minneapolis Veterans Medical Center began contacting the volunteers for their first postwar follow-up, part of a two-year plan to monitor them for signs of post-traumatic stress.

The project, Readiness and Resilience in National Guard Soldiers, is one of the first in the nation to study the emotional lives of National Guard troops before and after combat, lead researcher Melissa Polusny said.

The research was well underway before the suicide of Minnesota Marine Cpl. Jonathan Schulze in January focused sharp attention on how well the U.S. Department of Veterans Affairs provides mental health care for those fighting the war.

For Polusny, the mystery isn't why some soldiers become haunted or incapacitated by their memories of war, but rather why so many others are able to bounce back, without lasting hardship.

"While it's common to have some initial disruption in their life when they come home, most soldiers will be resilient -- they won't develop mental health problems," said Polusny, a psychologist with the Post-Traumatic Stress Recovery Program at Minneapolis' VA hospital.

She designed the study to examine the secrets of their success.

It comes at a time when there's been so much attention to post-traumatic stress, some veterans say, that many people think it's practically inevitable.

"It's kind of become like the catch-all phrase," said Dan Gazelka, 24, of Bemidji, Minn., a sergeant in the National Guard who returned from Iraq in July. "People automatically throw that out as soon as they hear that you went to Iraq. If something bothers you ... [they] automatically assume, 'Oh, you have PTSD.'"

It's estimated that 12 to 20 percent of Iraq war veterans are affected by post-traumatic stress, according to the VA's National Center for PTSD.

Three signs of PTSD

There are three telltale signs of the disorder: Flashbacks of the traumatic experience, feeling detached and shut-down emotionally, and being hyper-alert for danger.

But with returning veterans, it's really a matter of degree, experts say.

After combat, many report some temporary symptoms -- trouble sleeping, headaches, nightmares, edginess, or feeling sad, guilty or distracted, according to the PTSD center. It's a "normal reaction to combat experiences," says the center's 2006 Guide for Military Families, and most people "will recover naturally over time."

It only becomes a diagnosable mental illness, Polusny said, when the symptoms "get in the way of living your life," at times leading to tragic results: suicide, car accidents, alcohol and drug abuse, family violence and broken marriages.

Yet experts say that it's far from universal. "Most everybody who starts to study the issue is amazed at how resilient human beings can be in the face of trauma," said Dr. Irving Gottesman, a University of Minnesota psychologist who has studied PTSD.

Psychologists already know why some soldiers are more likely to get through combat emotionally intact. A big factor, Polusny said, is strong support from family and friends.

But she wanted to learn more about their coping strategies and personality traits. She persuaded the Department of Defense to fund the research, saying that it could lead to "new ways to increase soldiers' resilience and recovery from combat-related distress, and thus increase military retention."

Nearly two years ago, she and three other VA psychologists went to Camp Shelby, Miss., where 2,500 Minnesota Guard troops were preparing to deploy to Iraq. Of those, 531 agreed to fill out 22-page questionnaires covering everything from their childhood and family life to how they handle setbacks.

Col. Michael Rath, a National Guard physician who collaborated on the research, said that the study could help the military develop an early-warning system of sorts. Rath, a family physician in Mankato, said there's no good way to predict who will fare well in combat, psychologically speaking. The project may develop some indicators, and also offer better ways to prepare troops, he said.

At the start, Polusny expected the soldiers to be in good mental health. The most important insights will come later, as the researchers follow them for two more years.

A little worried

Gazelka admits that he was a little worried when his National Guard unit left for Iraq. He had heard so much about PTSD, he said, that he wondered, "Will I be able to deal with it?"

In Iraq, he saw plenty of horror as he cleared roadside bombs. His own vehicle was hit by one. Miraculously, he said, "We came out unscathed." He also shared his combat experiences in a blog, which he called a stress-release valve.

In July, Gazelka returned home to his wife, April, and son Landon, 2. "I've had a lot of close calls. And I'm very thankful to God and everyone else that I made it out," he said.

He and his guard buddies are watching for signs of stress. But he doesn't worry if they jump at loud noises or feel restless. "That's not necessarily a symptom -- we just came from a war zone," he said. "As far as I've seen, everyone is adapting pretty well. So far, so good."

Vietnam legacy

PTSD has gone by many names over the years -- shell shock, combat stress, the walking wounded. But most of what scientists know about it has emerged since the Vietnam War, Polusny said. By some accounts, it affected as many as 30 percent of Vietnam veterans.

Since then, the military has launched programs to train troops to recognize symptoms and to find help if they need it.

Don Elverd, a psychologist and a Vietnam veteran, said the military is doing a much better job with this generation than with his own. "The pendulum has really swung," said Elverd, who counsels veterans with PTSD at Hazelden, near Center City.

Not everyone has it

But he also worries that there may be too much talk about post-traumatic stress. Some veterans walk in with PTSD checklists, believing they have the disorder, even if their problems are less severe.

"They've got memories, they feel sad, they have some stuff that bothers them. But they do not meet full criteria for PTSD," said Elverd, who suffered from PTSD.

He says that he doesn't minimize the problem, but that "you have to be careful [that it does] not become a self-fulfilling prophecy."

Polusny sees no danger of that. The more that people know about PTSD, she said, the sooner they recognize symptoms and seek help.

And ultimately, that's her goal.

"For those people that are struggling," she said, "early intervention is the most effective thing."

Maura Lerner • 612-673-7384

Maura Lerner •

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