Article from: https://www.stress.org/military/ The American Society of Stress
Definition of Combat/Operational Stress (COS) and Combat Operational Stress Reactions (COSR)
The sum of the physical and emotional stressors experienced due to combat or extended operations and their manifestations.
Definition of Post Traumatic Stress Disorder (PTSD)
A mental health condition that’s triggered by a terrifying event such as war. If COS is not recognized and appropriate treatment isn’t implemented, often PTSD presents. Symptoms may include flashbacks, nightmares and severe anxiety, as well as uncontrollable thoughts about the event.
Relationship between PTSD and COS/COSR
1. PTSD and COS share common symptoms.
2. By definition COS cannot become PTSD until the trauma is over (past).
3. Evacuation of Service Members exhibiting COSR’s can result in chronic PTSD.
4. Most cases of acute, chronic, and delayed PTSD after a war did not exhibit symptoms of COS during the battle.
Soldiers are trained to fight. Basic training is a process designed to develop skills which will keep a combatant alive and fighting long after he or she might have given up under more normal circumstances. These patterns do not go away by themselves if they have been burned into the soul by a traumatic experience. There is no basic un-training.
Emotional numbing allows for the person to put aside feelings and do whatever it takes to survive or help others survive. This is appropriate and effective. Later such numbing may include a sense of not really being a person, feelings of not fitting in, that no one can understand, feeling or being told that one has no emotions, and not being able to feel emotions in situations calling for intimacy, tenderness, sexuality or grief. Efforts to avoid thoughts or feelings associated with the trauma may include isolating, substance abuse (drugs, alcohol, food, cigarettes), and other compulsive behaviors (watching T.V., exercising, workaholism, perfectionism, gambling, risk-taking, sexual adventures).
Hyper vigilance kept the veteran alive in dangerous situations. This includes constant scanning for danger, startle responses such as hitting the floor at loud noises, having trouble falling or staying asleep, going from fine to enraged in seconds, and changes in the biochemistry of the brain which bring the survivor to full alert much faster than the other people, especially in the face of a trigger that reminds the person of some aspect of the trauma.
Re-experiencing the trauma through obsessive thoughts, nightmares, flashbacks, sudden reemergence of survival behaviors, and emotional overloads, rages, or deep depressions when exposed to something that reminds them of the trauma are important messages from the veteran’s self: respect what you have been through and get help. Unfortunately most veterans believe that they didn’t have it as bad as someone else, so they shouldn’t be bothered by those experiences. Many veterans also experience a feeling of guilt at surviving when others did not. Survivor guilt may cause an inability to enjoy life, self-destructive behaviors, and depression.
Finally many veterans have a secondary traumatization based on experiences of outright rejection, disrespect, or thoughtlessly spoken words when they returned. The pain this caused is often covered up with anger.
Post traumatic reactions often become a cycle of despair, intrusive memory followed by efforts to numb it till it breaks out again, and again, and again. Each of the normal reactions to traumatic experiences can also have a profound and painful effect on the family. Some families believe that these symptoms are their fault, which the veteran may reinforce because it is easier for him to believe he goes into rages or gets numb because the house is messy or the kids are noisy than because of something that happened to him on the other side of the world ten, twenty, forty years ago. Pain also results if family members do not understand that these reactions are normal and believe the veteran “should be over it”.
Furthermore if these issues have caused family members time and again to put aside their own needs and concerns to try and help the veteran, they may have developed patterns for coping that are ineffective, which they may be unable to see, including focusing their lives on fixing the veteran, efforts to control everything and everyone around them, people pleasing, fear of asking for what they need, not knowing who they are anymore, hopelessness, and despair. The family often cycles through rescuing, failure, resentment, and despair over and over again. Many veterans do not understand why their families should or even could have problems. After all they have never been to war. Some families have been to war in their own homes in the flashbacks, nightmares, or violent actions of their veterans. They have PTSD from those events. They may also have PTSD from prior life experiences.
Beyond that there is the pain family and friends feel when they see someone they love suffer. They want to help. They would do anything to take away that pain, but nothing that they do today will change what happened to their veterans in the war. Nothing hurts more than to see someone you love suffer and be unable to help. Many veterans are able to identify with this pain when they remember how they felt about their wounded.
War affects us all. Veterans develop survival skills which keep they from participating fully in family life yet prefer to think war didn’t affect them. Families develop painful patterns of denial. At AIS, we believe it is okay to be bothered by trauma. We believe it is normal to be bothered by trauma. In the past people were blocked by the ignorance of how trauma affects the survivors and their families, but today we have a choice. When we let go of denial and work on acceptance of the normal consequences of war, we become able to learn from our experiences and to change and grow in healthy way that were not open to us before.
The 12 Steps for Veterans and Families
Here are the steps suggested as a program of recovery:
1. We admitted we were powerless over the effects of war on ourselves and our families—that our lives had become unmanageable.
2. Came to believe that a power greater than ourselves could restore our sanity.
3. Made a decision to turn our will and our lives over to the care of our Higher Power as we understood our Higher Power.
4. Made a searching and fearless moral inventory of ourselves.
5. Admitted to our Higher Power, ourselves, and to another human being the exact nature of our wrongs.
6. Were entirely ready to have our Higher Power remove all these defects of character (survival skills).
7. Humbly asked our Higher Power to remove our shortcomings (survival skills).
8. Made a list of all the people we had harmed, and became willing to make amends to them all.
9. Made direct amends to such people wherever possible, except when to do so would injure them or others.
10. Continued to take personal inventory and, when we were wrong, promptly admitted it.
11. Sought through prayer and meditation to improve our conscious contact with our Higher Power as we understood our Higher Power, praying only for knowledge of our Higher Power’s will for us and for the power to carry that out.
12. Having had a spiritual awakening as the result of these steps, we tried to carry this message to others, and to practice these principals in all our affairs.