Prioritizing Veterans

“We exist in a context. We are more than our genes.” 

Robert H Pietrzak, Yale associate professor of psychiatry and public health and director of the  Translational Psychiatric Epidemiology Laboratory of the U.S. Department of Veterans Affairs National Center for PTSD

 

I was born in Washington, D.C. My father, mother, stepfather and uncle were all in government service for most of their careers, in senior positions from the Air Force to the Departments of State and Commerce. Extreme back issues kept me from military service. My best friend is a veteran of the Vietnam War, his life recently saved by a kidney transplant at a VA hospital. One of my closest friends in college went on to get killed in Vietnam as a young ensign helming a river patrol boat (a “PBR”) down the Mekong. I am honored by my family’s government service, my friends’ commitment to their country and the sacrifices they made. 

Yet because I support so many Americans protesting for equal justice – in the streets or “taking a knee” during the national anthem at professional sporting events – I am labeled as unpatriotic and anti-veteran and anti-military. I do not support violence, arson or theft. I do support “uncomfortable” expressions of dissent, knowing that nothing ever changes unless there is inconvenience, disruption and powerful demands for a new and better direction. Think civil rights and Selma, Alabama. The flag is a symbol. It is not “veterans.” It is not “soldiers who sacrificed for their country.” I have always felt proud chills down my back as I stared at the Iwo Jima Memorial on the many times I visited that monument. I am fiercely proud of our military, and I always have been. I resent anyone who says otherwise.

Those soldiers did not sacrifice for a piece of cloth, however magnificent and powerful that symbol might be.  They sacrificed for the freedoms and Constitutional guarantees that are symbolized by that flag. Patriotism should be more focused on the freedoms that flag stands for… not the symbol but the substance behind the symbol… and not for “law and order” autocrats who parrot slogans reminiscent of the very autocrats our soldiers fought so bravely to defeat. … “and to the republic for which it stands.” Regardless of the justification for the conflict, no one should question those brave souls who stepped into harm’s way to fight for their country. Each and every American owes those soldiers a debt of gratitude that they were willing and often did sacrifice their lives, their bodies and even their minds to that higher purpose.

To that end, today’s blog drills down on what was once dismissed as “battle fatigue” or even cowardice (as in Patton’s slapping a WWII soldier in hospital for breaking down from the violence and stress around him). It has always been that way with combat soldiers, but only in recent years has it been identified as a serious psychological disorder with even more serious and often deadly consequences. Posttraumatic Stress Disorder (PTSD). Hard to treat and often completely destructive to those suffering from PTSD in their ability to make and sustain relationships, contain depression and anger, function normally in daily life and sometimes and even to keep on living. Suicide rates among those who served in combat are staggering, double the rate in the general population. For example, in 2012, over 5000 vets suffering from PTSD took their own lives.

Here are some more nasty numbers (from US News & World Report), evidencing the prevalence of PTSD in our active military in recent times: 

• About 11 to 20 out of every 100 veterans (or between 11 and 20%) who served in operations Iraqi Freedom and Enduring Freedom have PTSD in a given year.

• About 12 out of every 100 Gulf War Veterans (or 12%) have PTSD in a given year.

• About 15 out of every 100 Vietnam veterans (15%) were currently diagnosed with PTSD when the most recent study of them (the National Vietnam Veteran Readjustment Study) was conducted in the late 1980s. It’s believed that 30% of Vietnam veterans have had PTSD in their lifetime.

The psychiatric/psychological community has long wondered whether some people are genetically predisposed to react to traumatic violence with symptoms of PTSD. A group of Yale University researchers addressed the issue in the September 30 issue of Biological Psychiatry: “Attachment Style Moderates Polygenic Risk for Posttraumatic Stress in United States Military Veterans: Results from the National Health and Resilience in Veterans Study.” As the above opening quote from the senior author of that study suggests, whatever the genetic predisposition for PTSD might be, appropriate nurturing treatment can overcome that proclivity and provide an effective solution.

Amanda Tamman, formerly of Yale and now a Ph.D. student in clinical psychology at St. John’s, writing for the Yale News (October 1st) provides a summary of that research: “Like many genetic studies on mental disorders such as depression, anxiety, and schizophrenia, PTSD studies have revealed numerous genetic risk factors that contribute to the severity of the disorder. For instance, a previous study of more than 165,000 U.S. military veterans led by Yale’s Joel Gelernter, the Foundations Fund Professor of Psychiatry and professor of genetics and of neuroscience, found variants in eight separate regions of the genome that help predict who is most likely to experience the repeated disturbing memories and flashbacks that are hallmark symptoms of PTSD.

“In the new study, Pietrzak, Gelernter, and colleagues looked at psychological as well as genetic data collected from the National Health and Resilience in Veterans Study, a national sample of U.S. military veterans supported by the National Center for PTSD. The researchers specifically focused on a measure of attachment style — the ability or inability to form meaningful relations with others — as a potential moderator of genetic risk for PTSD symptoms.

“Individuals with a secure attachment style perceive relationships as stable, feel that they are worthy of love and trust, and are able to solicit help from others. Those with an insecure attachment style report an aversion to or anxiety about intimacy with others, and have difficulty asking for help from others… They found that the ability to form secure attachments essentially neutralized the collective effects of genetic risk for PTSD symptoms. The impact was particularly pronounced in a variant of the IGSF11 gene, which has been linked to synaptic plasticity or the ability of the brain to form new connections between brain cells.  

“Pietrzak noted that deficits in synaptic plasticity have also been linked to PTSD, depression, and anxiety, among other mental disorders. The findings illustrate the importance of integrating environmental and social as well as genetic factors in the study of PTSD and other mental disorders, the authors said… ‘Social environmental factors are critical to informing risk for PTSD and should be considered as potential moderators of genetic effects,’ he said. ‘The ability to form secure attachments is one of the strongest protective factors for PTSD and related disorders.’

“The findings, which will help predict who is at greater risk of experiencing severe symptoms of PTSD, also suggest that psychological treatments targeting interpersonal relationships may help mitigate PTSD symptoms in veterans with elevated genetic risk for this disorder, he said.” In the end, we have to care, everyone needs to understand, and we need to increase our funding for the VA to provide the best caring treatment we can for those veterans suffering from PTSD and any other disability they may have. 

I’m Peter Dekom, and unless and until all Americans really care about all Americans and the freedoms that define our nation, what exactly is the point to the United States of America?