Traumatic Stress Disorder Related to Prisoners of War
The objective of
this paper is to show how post traumatic stress disorder relates to
prisoners of war. There will be several questions presented and
answered in detail through out the paper.
In addition to my conclusion of the facts that I have
gathered, I hope to expand our understanding on prisoners of war and
how they are affected by captivity. Also included is a special
dedication to all veterans and prisoners of war.
were many soldiers that were captured during WWII, Korean War,
Vietnam War and the Gulf War. Whether
due to being shot down or captured during front line engagement or
by any other means, POW’s have been subject to ghastly forms of
torture and unthinkable psychological warfare such as starvation,
brain washing, physical mutilation, humiliation, sexual degradation,
electrocution, and severe sickness. Because of these acts that
occurred during captivity many soldiers suffer from post traumatic
stress disorder. PTSD is evident in soldiers who have experienced a
traumatic event. PTSD can disrupt and impair daily life if symptoms
are severe and lasts long enough. Questions to be addressed are: 1)
How does PTSD affect POWs? 2) Are treatment options available for
those that have PTSD? 3) Is treatment successful in helping POWs
cope with all they have endured? Primary focus on the questions
above will broaden our understanding of PTSD, what POWs go through
and how they live with it.
Does PTSD Affect POWs?
soldiers are given a medical exam and evaluated psychologically to
determine if they have any disorders and other problems.
PTSD can occur in anyone following traumatic events.
PTSD does not emerge in all POWs; it depends on how
long their captivity was, what they experienced and if they were
alone or not. Department of Defense psychiatrist Dr. (Lt. Col.)
Elspeth Cameron Ritchie says that “if you have colleagues with
you, you do a lot better than if you are isolated” (Agency Group
09, 2003). Ritchie also described that PTSD begins when the prisoner
feels helpless at the time of the event. The phenomenon of learned
helplessness is evident to the prisoners early on. PTSD can also
emerge many years after the former prisoners of war have been
liberated and readjusted to life. Sometimes this happens when other
events take place in his/her life such as death of a spouse, aging,
and physical limitations.
There are common
symptoms associated with PTSD that include: a constant reliving of
the experience, dissociation and hyper vigilance according to Dr.
Ritchie. Dissociation is when connections are broken.
Hyper vigilance is a feeling of being anxious or on edge all
the time. Other symptoms could include difficulty concentrating,
insomnia, unable to express one’s self, occupational
incapacitation, paranoid reactions and aggression. When these
symptoms become chronic that is when it is considered PTSD.
Unfortunately many sufferers of PTSD turn to alcohol and
drugs to help them cope with the symptoms. “We did see a lot of
alcohol and drug abuse in veterans with PTSD following the Vietnam
War,” Dr. Ritchie said (Agency Group 09, 2003).
The families of the
former POWs are also affected by this disorder in a great way.
They watch their loved one trying to cope with this disorder
and feel helpless and are unsure of what to do. It is very important
that the families become involved in the treatment plan to provide
support and encouragement. Some
things that can be done to help the survivor are listen and
empathize, spend time with them, if they permit, and most of all be
patient and love them.
One test that is
used to assess PTSD is called CAPS (The Clinician Administered
PTSD). This test was the first diagnostic technique used for
interview purposes and was developed by Veteran Administration
experts. This test is
used to diagnose PTSD in veteran military survivors and also
civilians who experienced traumatic events. The test has worked
quite well and was considered a year ago the gold standard for this
type of assessment (Kohn, Carol, et al, 2002, p7).
degrees of PTSD can also occur among different types of soldiers. A
follow up study was completed by Patricia B. Sutker of the New
Orleans Veterans Administration Medical center that revealed
“intense, prolonged stress may cause long-lasting psychiatric
disorders in almost anyone” (Bower, 1991, p68). In her study she
evaluated the current mental status of 22 POWs and 22 combat
veterans of the Korean War to see which group was more susceptible
to PTSD. The POWs spent an average of 28 months in captivity while
combat veterans spent an average of 14 months on the front lines.
The results revealed that prisoners of war are at a much greater
risk of developing PTSD than combat veterans. It is unsure why some
POWs avoid psychiatric disorders and others do not (Bower, 1991,
p.68). According to the National Center for Post Traumatic Stress
Disorder, “about 30 percent of the men and women who have spent
time in war zones experience PTSD.”
Treatment Options Available for Those That Have PTSD?
There are several
different ways to treat PTSD and each treatment will vary among
individuals. Not all treatments are successful and there is no cure
for PTSD. Some treatments that are used include cognitive behavior
therapy, group therapy, exposure therapy and drug treatments.
therapy and exposure therapy work together. Under controlled
conditions the former prisoner of war undergoes “repeated and
prolonged confrontation with anxiety-evoking objects or situations,
until anxiety is gradually reduced through the process of
extinction/habituation,” notes Maria Livanou, Department of
Psychological Medicine, Institute of Psychiatry (Livanou, 2001,
p181). This technique can work with a live therapist or the patient
can do it alone using his or her own images or audio tapes. Imaginal
exposure is when the therapist constantly repeats the experience in
detail to the survivor in present tense while the survivor focuses
on the most disturbing aspects of the trauma until habituation
eventually occurs and anxiety is reduced (Livanou, 2002, p.181). CBT
is considered to be an effective treatment option.
Group therapy is
another treatment technique and involves a group of POWs that meet
in a certain place and time each week from an hour to an hour and a
half to openly discuss their problems. Often sessions are held in
Veteran Administration Hospitals or private meeting areas outside
hospital settings. Group
therapy allows the former POWs to start sharing their experiences
with each other therefore working on social skills and internal
psychological thoughts. The participants are given the opportunity
to interact with peers who have experienced similar situations as
there own, thereby creating social support. As the sessions continue
it is noticed that the POWs break similar patterns such as guilt,
shame and abandonment. A therapist is present to instruct, support
and encourage involvement. “Group therapy is especially helpful in
the cases of chronic war trauma as it permits therapeutical work on
the most painful wounds and residues” notes Salvatore Makler. (Makler,
et al, 1990, Vol 44, Issue 3).
Another form of
therapy is drug therapy known as pharmacological treatment.
There are several reasons as to why one would choose drug
therapy. Access to this type of treatment may be easier for the
patient and perhaps they do not want to relive the experience as in
cognitive behavior therapy. Also some people do not respond to psychological treatment,
therefore they choose drug treatments (Turner, 1999, Vol 354,Issue 9188).
are several different categories to choose from when it comes to
drug therapy. The most widely used drug treatment includes
antidepressants such as Zoloft and Prozac, although other
medications are used such as Serzone, Effexor and Elavil. (Aetna:InteliHealth)
This is considered the first line treatment when drug
treatment is indicated initiating serotonin reuptake inhibitors (SSRIs)
such as mentioned above (National Center for PTSD). To rapidly
relieve any feelings of anxiety triggered by PTSD some doctors might
prescribe anti anxiety medications such as Valium and Xanax to list
a few. Although the symptoms are reduced some of the drugs mentioned
above carry the risk of dependency. As with a lot of medications
being prescribed questions arise as to whether medications really
work or only mask the problem?
Treatment Successful in Helping POWs?
studies have shown that the treatments mentioned above are
successful in helping prisoners of war control the symptoms of PTSD
and be able to live a happy and productive life.
Some treatments are used in conjunction with others or some
by themselves. A sense of power (and other obstacles) can be
re-established if treatment occurs relatively quickly.
More often than not a survivor is more likely to have a
better outcome if treatment begins soon after the experience. “At
present, cognitive behavioral therapy appears to be somewhat more
effective than drug treatment. However, it would be premature to
conclude that drug therapy is less effective overall since drug
trials for PTSD are at a very early stage” (National Center for
PTSD). Many case
reports and studies have been published regarding the effectiveness
of treatments. The outcome of these studies vary among individuals
and which treatment is most effective. In general, behavioral
therapy and medication therapy specific to SSRIs have both been
shown to be effective (Foa, E., 2000, Vol 13).
It is evident that
prisoners of war and others who experience traumatic events are
greatly affected by PTSD and other disorders or symptoms if they
last long enough. It is
important to first identify the symptoms and then get help.
PTSD may not be curable but it can be controlled. Not all
people who have traumatic events need psychological treatment but
can improve their symptoms or condition through the help of family
and friends (depending on the severity of the event).
to All Veterans and POWs
and love are three emotions that occur to me when any veteran
honorable serves his country but when I hear a prisoner of war story
special emotions that I can’t even describe surface. Tears come to
my eyes when I think that someone I don’t even know is protecting
me but going through “hell” to do it. That person or persons
might die (as many have) for me to be able to sleep peacefully at
night. I thank God for their extreme dedication, bravery, courage
and existence. Peace,
liberty and the American way of life would not exist if brave men
and women did not step forward to defend us. Thank you all.
Group 09, (2003, May 12). PTSD Can Emerge in POWs, Combat Veterans
and Civilians. FDCH Regulatory Intelligence Database.
Bruce. (1991, February). Emotional Trauma Haunts Korean POWs. Science
News, Vol 139, Issue 5, p68, 2/3p.
Edna B.; Keane, Terence M.; Friedman, Matthew J. (2000) Guidelines
for Treatment of PTSD. Journal
of Traumatic Stress, Vol 13, No. 4, 2000, (National Center for
Carol; Hasty, Susan; Henderson, C.W. (2002, August). Clinical
Strategies Available for Assessing PTSD. BioTerrorism Week, 8/19/02, p7, 1/2p.
Maria. (2001) Psychological Treatments for PTSD: an overview. International Review of Psychiatry, 2001, 13, 181-188.
Salvatore; Sigal, Mircea. Combat Related, Chronic PTSD: Implications
for Group Therapy Intervention. American
Journal of Psychotherapy, 00029564, July 1990, Vol. 44, Issue 3.
Center for Post Traumatic Stress Disorder. http://www.ncptsd.org/facts/general/fs_what_is_ptsd.html
Stuart. (1999, October). Place of Pharmacotherapy in PTSD. Lancet,
00995355, 10/23/99, Vol. 354, Issue 9188.