Government Can Do More to Treat Veterans with PTSD

The murder of American Sniper author Chris Kyle at a Texas gun range by a fellow vet said to be suffering from Post-Traumatic Stress Disorder (PTSD) has restarted a national conversation about PTSD and raised questions about whether the government is doing enough to identify and treat those suffering from the condition.

Kyle's killer, Eddie Ray Routh, had only recently been diagnosed with PTSD, according to his brother in law, but had a history of mental illness over the last several years. While details remain sketchy, it is possible that Kyle, who had dedicated his life to helping returning warriors with PTSD and other problems in adjusting, made a tragic mistake in bringing Routh to the gun range. Kyle may have been trying his own version of "exposure therapy" -- a treatment option for PTSD sufferers where the clinician takes the patient back to the trauma and has him relive it repeatedly and, "ideally, with each retelling of what happened, the event would seem gradually less threatening." Psychiatrist Albert Rizzo told the CNN:

"What happened this weekend with the death of former Navy Seal sniper Chris Kyle at a gun range is exactly the opposite of the evidence-based approach to treating PTSD," termed 'prolonged exposure' or 'virtual reality exposure' therapy, he said. "Chris Kyle, while well trained in his field, had no clinical training in conducting therapeutic exposure."

It is never advisable to put someone with PTSD in an environment where there is likely to be uncontrolled exposure to provocative events -- such as gunfire and visuals of people shooting guns -- because this could stoke a flashback in the PTSD sufferer.

The use of virtual reality in therapy shows how the government and military are light years ahead of how PTSD was viewed after the Vietnam War, when the military determined that " if the problem lasted more than six months after the soldiers returned home, then it obviously was a pre-existing condition and had nothing to do with their wartime service." At that time, PTSD was known as "stress response syndrome," and the military's shameful determination that our veterans were suffering from a condition unrelated to their combat experience condemned tens of thousands of vets who desperately needed help to a nightmare existence that many still suffer from today.

The issue with the government's response to PTSD today is that, put simply, the problem is bigger than anyone imagined a few years ago and potentially as large as the number of PTSD cases for Vietnam vets. A study in 1993 found that more than 830,000 Vietnam veterans suffered from symptoms related to PTSD to one degree or another upon returning home.

Last year, the VA reported that through September 2011, more than 247,000 veterans of the Iraq and Afghanistan wars had been treated for PTSD. But according to the PTSD Foundation of America, that number represents less than 40% of our veterans who need help. A veteran's own personal code of conduct that refuses to allow him to acknowledge "weakness" and a military culture that stigmatizes PTSD sufferers have contributed to some startling -- and worrisome -- statistics.

There were a record 349 suicides of active duty personnel in 2012. Nearly two in three marriages of PTSD sufferers end in divorce. The inability of the PTSD patient to hold a job has contributed to an epidemic of homelessness among combat veterans. It is estimated that one in three returning vets will exhibit at least some of the symptoms of PTSD, with between 13-20% of vets needing psychiatric care.

A companion condition to PTSD -- Traumatic Brain Injury (TBI) -- is also a mental health problem, given the large number of soldiers wounded in IED attacks. The condition presents itself in similar ways to PTSD and it's estimated that between 4-9% of returning vets suffer from TBI.

Suicidal thoughts, alcoholism and drug abuse, waking nightmares, insomnia, losing contact with reality, and being transported back to the battlefield -- the physical symptoms of PTSD are so debilitating that in severe cases it is possible that the victim will lash out violently. Whether Eddie Ray Routh suffered a terrifying flashback on the gun range or, as he told his sister, he simply "traded his soul for a new truck," PTSD played a role in this tragedy, and advocates are worried that the media -- ever looking to oversimplify -- might stigmatize returning vets suffering from PTSD as crazed killers.

It's happened before with vets returning from Vietnam. Several high-profile murders by mentally ill Vietnam veterans spawned a seeming frenzy in the press, with lurid stories of violent vets driven to kill by their "unique" experiences in Vietnam. Popular culture contributed mightily to the portrait of the murderous Vietnam veteran, as both films and television shows painted a picture of the moody, brooding ex-soldier who might explode into violence at any moment, and for no reason.

The stigma that attached to the Vietnam vet as a result of this media campaign prevented thousands from seeking needed treatment. Could it happen again? The media hasn't changed much, but has society changed to the point that we can view PTSD with more understanding and perspective?

The U.S. government, after a slow start in the early part of the decade, has begun to gather and concentrate considerable resources to address the issue of PTSD-TBI in veterans returning from Iraq and Afghanistan. The latter part of the Bush administration and the entirety of the Obama administration has seen many changes in how the military identifies probable PTSD sufferers, and reforms in how benefits are dispensed have streamlined the process so that those diagnosed with PTSD can now get treatment more quickly.

In 2010, the president signed an executive order making it much easier for veterans from any war to get treatment for PTSD and claim disability benefits. Now, all the veteran needs is for a doctor to confirm a diagnosis of PTSD for the patient to receive benefits. Previously, the process was far more involved and could take years for a case to be resolved.