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Daniel Huynh

Professor Flores

ENG 1201

07/30/2020

How Does PTSD Affect Veteran’s Civilian Life and How Does It Get Treated?

Fathers, mothers, sons, and daughters have gone to serve and protect America’s freedom

to hopefully come home with a prideful smile on their faces as they reunite with loved ones.

However, some of these fathers, mothers, sons, and daughters return home with more than just a

smile. They return home with haunting images of their battle-buddy bleeding out in the middle of

a jungle or of a child soldier that fought to the death in the desert of Afghanistan. Although those

were only examples, it is what some veterans with post-traumatic stress disorder have to go

through in their nightmares. PTSD is a disorder that is not fully understood however it is known

to lead to antisocial behaviors, intrusive memories, and overwhelming negativity, these

symptoms and many more greatly affect an individual's life and can even affect loved ones. The

Department of Veterans Affairs, also known as VA, provides veterans ways to fight PTSD and

overcome their horrors so they can return to their friends and families with that smile. Therefore,

the budget increase that the VA will receive this year is greatly justifiable and is crucial in aiding

veterans and the ongoing research to understanding PTSD.

War is not only time consuming and costly, but war also changes the lives of people who

come back to civilian life. The Department of Veteran’s Affair, also known as VA, have been

dealing with Post-Traumatic Stress Disorder for a long time. They have gathered a lot of

information on how PTSD victims live their lives. VA is a government department that focuses

on caring for veterans and their families (VA.gov). The purpose of the department is to keep the

promise that was made my President Lincoln, “To care for him who shall have borne the battle,
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and for his widow, and his orphan.” This is especially important for veterans with PTSD because

the VA prepared to provide countless programs to treat them and if not, the VA provides

disability checks to veterans or their family (VA.gov)

PTSD is more detrimental than it may seem from the surface. According to the National

Center for Post-Traumatic Stress Disorder, which is a department within the Veterans Affair that

help with researching PTSD and other “stress-related” disorders, says that dating all the way

back to ancient times, PTSD has been recorded among warriors during the Assyrian Dynasty that

suffered from traumatic events during combat. Now in modern times, scientists and researchers

can precisely record information efficiently about PTSD and this has led to the understanding of

the basic symptoms of PTSD.

From the outside, he/she may seem like a normal veteran, but PTSD can affect people in

many ways and the one that many do not see is the mind and what he/she thinks. Veterans who

suffer mentally must face the constant guilt and anger. According to Siobhan Murphy, a

researcher who created models and studies about the relationships of things that relate to PTSD.

Murphy states in his paper called, “Anger, Guilt and Shame as Mediators in the Relationship

Between War Experiences and PTSD: Testing the Moderating Role of Child Soldier Status”, that

PTSD victims that fear their emotions and thoughts result in them becoming angry at

him/herself. Although, they might not outwardly display their anger sometimes it is the self-hate

anger which causes oneself to become more hostile to those around them, for example, a veteran

that was interviewed by the National Center for PTSD stated that before her deployment it was

hard for her to get angry and now after she returned home, she would rage and get angry at the

“smallest” and “stupidest” things. PTSD mentally can make a person change the way they used

to live their lives.

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Not only is there anger that individuals must deal with, but sometimes they also must deal

with a sense of guilt. Individuals may feel and tell themselves they are at fault for someone’s

demise or that they believe the world to be a danger to them, even if it was literally out of their

control. In another interview done by the National Center for PTSD, an interviewee reported that

everything he did during the Vietnam war was wrong, and he blames himself for everybody that

died there. For PTSD victims, developing a sense of guilt is possibly the worst thing that could

naturally happen because once an individual develops feelings of guilt it leads to “rumination

and avoidance of traumatic reminders” which causes a huge mental block on recovering from

PTSD (Murphy). Guilt seems like a big factor in why most individuals have trouble recovering

from their traumatic experience and it may take years of treatment to be able to overcome the

feelings of guilt.

PTSD controls a lot of an individual’s social behavior. Based on interviews from the

National Center for Post-Traumatic Stress Disorder, many of the interviewee could not enjoy

normal activities the same anymore. A veteran in the interview said he couldn’t handle a person

talking a different language because he had a traumatic experience which caused him to back

himself onto a wall and couldn’t move until the person left. Another example from the interview

is a veteran who could not leave her own house because she felt like her attacker was outside

waiting for her. On a deep psychological level, these veterans seem like they are suffering from

anti-social behaviors along with avoidance that is caused by their trauma. One could assume they

act this way in order to avoid another traumatic event from happening, even when it causes great

discomfort.

Behaviors like these seem like actions to avoid events that can lead to their past traumatic

experience. These symptoms can control how someone acts and most of the time people do not

even realize they are purposely doing it, avoidance is the most common yet most ignored
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symptom of PTSD according to the VA. Trying to live a life normally would seem to be difficult

for veterans that developed these anti-social and avoidance behaviors, Imagine them trying to go

on a nice walk on the beach and a stranger suddenly starts speaking a different language and

suddenly they freeze and cannot do anything but stare at them until they leave. It disables so

many aspects of an individual life especially veterans who cannot enjoy the things they liked

anymore before their deployment.

Along with these symptoms, it brings along something most combat veterans with PTSD

experience. They are usually hypervigilant because mainly due to feelings of anger and guilt.

PTSD veterans, with high levels of combat stress, return to civilian life with low threshold for

threat perception which activates a biologically natural survival mode (Murphy). This statement

is backed up by the National Center for Post-Traumatic Stress Disorder, they discuss about

certain incidents of PTSD victims that kick into a state of angry survival mode when they hear,

smell, or see similar things that is closely related to their personal traumatic event and they react

with anti-social behaviors to try and prevent another traumatic experience. Hypervigilance has

prevented many PTSD victims from relaxing and they always feel like they are “on edge” and

this has caused them to lose trust in their personal relationships, such as marriage, kids, and

longtime friendships (National Center for Post-Traumatic Stress Disorder). This just goes to

show why many veterans have difficulty reappropriating to a normal civilian life because of their

constant hypervigilance.

Not being the person with PTSD can and will be very difficult to adapt to for most

normal people. Moments that were told by the veterans in the interview most of their friends and

families would not understand why they acted the way they did. Most of the time this has led to

high tension in relationships and even relationships where there was no trust. These PTSD

symptoms are no joke, it will and can break apart things that veterans once enjoyed and relished
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in before their deployment. The VA is there to help the family and not just the veteran, they

provide counseling and other means of aid in order to support them in their process of adjusting

to their loved ones with PTSD.

The PTSD symptoms that have been discussed so far are the most common ones that

have occurred to veterans. PTSD affects individuals based on how traumatic and how resilient

they are. Just discussing the symptoms, many would be able to see how it would affect the

relationships these individuals had before their deployment. It has been sadly recorded by

Christopher Erbes, a researcher that looked into regular relationships of veterans with PTSD, that

the findings in his paper, “An Examination of PTSD Symptoms and Relationship Functioning in

U.S. Soldiers of the Iraq War over Time” continued to"underscore” the major negative impact

that PTSD has on relationships. This means that veterans must try and fight their own issues in

their head and they must try and adjust appropriately to their relationships back at home.

Diving deeper on the topic of relationships, a study done by Lisa Teague Caselli, she

studied PTSD and how it affects marital adjustment and child behavior. Caselli states in her

study called, “The Effect of PTSD and Combat Level on Vietnam Veterans’ Perceptions of Child

Behavior”, veterans with PTSD report more difficulties with their interpersonal adjustments.

Interpersonal relationships are just connections with another person such as a friend or an

acquaintance. The difficulties in the relationship stem from PTSD symptoms such as the anti-

social behavior that was discussed earlier. Most of the time it is the other person without PTSD

that causes the relationship to be difficult because it is hard for them to acknowledge that he/she

has a disability and there are now things that they cannot do or talk about anymore.

Marital relationships seem to be the most difficult adjustment because PTSD affects

every facet of marriage. Marriage is the most intimate relationship one could have with someone

and it requires sacrificing a lot of time and energy. Veterans with PTSD report having trouble
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with satisfying their spouses compared to other veterans without PTSD. For example, according

to Caselli’s findings, PTSD has caused an above average amount of disagreement in marriage,

high tensions in the relationship, unsatisfied sex life and affection, and low common interest and

activities being shared. This is the sad truth that has torn marriages apart. Not being able to have

an intimate relationship because of PTSD would probably be another obstacle for PTSD

recovery.

Other than marital relationships, a father or mother with PTSD does perceive their own

children differently compared to normal returning veterans, Caselli conducted a study and she

found and discussed that PTSD subjects were consistently perceiving that their children’s

behavior were very problematic when compared to non-PTSD subjects. Even worse, PTSD

subjects that have children, can pass down the trauma symptoms but on a lesser scale onto the

child and this is called “secondary traumatization” (Caselli). According to the VA, secondary

traumatization can affect a child in many ways such as, a child “behaving like their parents'' in

order to understand them, or a child will form anti-social and emotional problems just like their

mother or father’s. These findings are so important because the VA has been able to help

veterans with PTSD to be able to show how to treat and prevent their kids from secondary

traumatization. PTSD will continue to impact many families of people if veterans are able to get

the right treatment in time.

Let's move forward and discuss additional information on the causation of PTSD and one

of the main debates is combat. Does the degree of combat/fighting affect the chances of forming

PTSD? In the study done by Alan Fontana, a researcher that conducted studies about war stress,

he stated in his paper, “A Model of War Zone Stressors and Posttraumatic Stress Disorder”, that

combat did not have significant direct effects on PTSD but rather it is the environment and the

omnipresent feeling of dying any minute. On the other hand, the study done by Lisa Teague
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Caselli, she discusses how there is a strong correlation to combat and PTSD symptomatology.

Although these studies are both credible and reliable sources, Caselli’s statement is used more in

describing the cause of PTSD to patients in this case because her research has been proven true

by the VA, they use her findings to help support their research on PTSD and that concludes the

major debate in the past, that combat exposure does affect the chances of PTSD.

Before even going into combat, Fontana stated that the environment and the feeling of

inadequate safety is a factor in PTSD. Fontana wanted to say that he believed that the lack of

“ammunition, supplies, equipment, food and water would lead to the greater chance of fighting”

and that when fighting there is an unconscious feeling of being killed or injured. Having this

sense of feeling hanging over you while fighting lowers your mental resilience thus leading to

being more vulnerable to getting PTSD. Another factor to being vulnerable to PTSD is when a

close friend or someone that is loved dies and that causes “grief which transforms in

uncontrollable rage during combat” which leads to the trying to vengeance for that person that

died (Fontana). Fontana stated in war that witnessing the death of others indirectly leads to

killing others which leads to more probability of getting PTSD. Sadly, it is what most veterans

during the Vietnam war had to go through during war and when returning to civilian life they

have to deal with the emotions of their friend dying as well as the feeling of killing someone.

This is the possibly the reason why the Vietnam war has the highest counts of veterans with

PTSD. Luckily, when the VA was established in 1989 they were able to get these Vietnam

veterans the help they needed.

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Fig. 1. Line graph showing the increase in suicide from veterans with PTSD

Fig. 1. Line graph displays the number of suicides from veterans with PTSD (Veterans

suicides increasing). If a veteran does not seek outside help when they have PTSD, one could

assume that it is the worst thing veterans can do. The graph above shows suicide rates increasing

in veterans with PTSD. This graph was made by the VA and this only shows years from 2005 to

2017 where most likely are veterans from the Operation Iraqi Freedom and Operation Enduring

Freedom. This does not mention the Vietnam veterans who were not able to get help from the

VA until 1989. Veterans with PTSD that have trouble identifying their anger and guilt will lead

to depression. Depression alone already affects millions around the world and at the end of the

tunnel is suicide if nobody helps those with depression. The VA will always be there for veterans

when they need it the most.

Getting treatment is important for PTSD victims. Leaving PTSD symptoms alone without

help will not go away but will only get worse. In a study done by Andrew Hale, a researcher that

explores the effects of Cognitive Processing Therapy, also known as CPT, stated in his paper

called, “Predictors of Change in Cognitive Processing Therapy for Veterans in a Residential

PTSD Treatment Program”, that CPT has been proven to benefit individuals a considerable

amount of times. Individuals who struggle with mental issues such as anger and guilt which
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sometimes lead to insomnia and depression, have “demonstrated greater than average symptom

reduction” for PTSD. The VA offers CPT to help treat these emotional and feelings of PTSD.

And the most useful treatment that VA offers is the Cognitive Processing Therapy. Dr. Alauna

Curry, a psychiatrist for the VA, says that CPT focuses on the things that PTSD has changed

such as personalities, power, self-esteem, and many others. CPT guides the patient to change the

way they think about the world and how it may not be as “black and white” as it may seem. Not

only that, CPT would help provide the needed repairs to relationships that PTSD may have

caused in a friendship or a marriage.

CPT has helped veterans to get back on their feet, let's look into how it works. According

to the American Psychological Association, also known as the APA has given brief insights on

what happens between the therapist and the patient. How CPT works is that it is over a 12

session course in which it starts with “psychoeducation” in which it allows for the patient to be

aware and identify their unconscious feelings and emotions. Next the patient then tries to make

an effort in describing everything that he/she believes about the traumatic event. Finally, the

therapist with this gathered information will begin to use “Socratic” questioning. Socratic

questioning is where the therapist makes the patient think their feelings and thoughts more

openly and to unravel the unconscious truth (APA). Further along the course, the therapist

becomes less of the leading figure but they will try to have the patient become more independent

so when they finish the 12 sessions the patient will be able to work through their feelings and

emotions effectively on their own (APA). This brief overview of the treatment seems to be very

hands off and it relies a lot on the individual and the therapist is just there to guide. This

approach may actually be really efficient for individuals who say that they “do not need help”.

If CPT does not work with patients and in some cases, it has not, the VA has other

treatment plans to help individuals and the next major treatment used is medication, although it
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can help with relieving the pain and anger issues. Another treatment program that is fairly new

but shown to be fairly effective, is called Treatment by Repeating Phrases of Positive Thoughts,

also known as TRPPT, Amani Kubitary, a PhD student in Mental Health that wrote a paper

called “War Experiences, Posttraumatic Stress Disorder, Sleep Disorders: Clinical Effectiveness

of Treatment by Repeating Phrases of Positive Thoughts (TRPPT) of Mental-War Disorders in

Syrian Refugees Children and Adolescents War Victims - A New Therapeutic Trial about his

experiment” in which an experiment was conducted to test the effectiveness of TRPPT back in

2018 where they took 41 Syrian children with PTSD, Sleep Disorders, and Negative War

Experiences and treated them with TRPPT. The results were phenomenal, Kubitary was able to

significantly decrease and reduce PTSD symptoms, SD, and negative war experiences. TRPPT

works by automatically transforming negative thoughts into positive thoughts (Kubitary). The

process trains the patient in “automatic thought to the impact of positive thought” (Kubitary).

This is fairly new, but if the VA is able to pick up this treatment then the VA will be able to

provide more effective psychological treatment than just the CPT. Veterans will be able to not

only deal with their PTSD symptoms but also with their negative war experiences.

It is understandable why people do not trust the VA. It seems like they have had multiple

accounts of surgeries and malpractice within the department which has led to the death of 21

veterans according to Jamie Reno, a reporter for a news blog called, The Reno Dispatch, reported

that she wrote about how the VA has lost multiple cases against people who lost a loved one due

to malpractice and yet even after the case was lost the VA did not hold the people responsible for

those deaths accountable. This is awfully true with bureaucracy and most national departments.

The people that caused those veterans to die should be held responsible no matter if it was an

accident, Reno wants transparency within the Department.

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Although what happened to those 21 veterans were terrible, in the general scheme of

things, The VA have seem to have caused more good than harm. When it was first established it

was able to help thousands of veterans and continue to help veterans and families in the Gulf

War and the Operation Iraqi Freedom/Operation Enduring Freedom. The VA may not be the best

in terms of doing surgeries but it does have one of the best mental health hospitals that are

suitable for treating PTSD veterans.

In conclusion, PTSD symptoms greatly affect individuals and their families and friends.

The treatment from VA will prove to be the best aid that veterans with PTSD can get at the

moment but all that the VA requires is manpower and money to provide the necessary resources

for these veterans. The pay bump this fiscal year will allow veterans to be able to afford

treatment through their disability benefit plan. Getting veterans the right treatment will allow

them to return home with more than just haunting images or experiences. They will be able to

work together on fighting PTSD and not be held back by past traumatic experiences. Veterans

with PTSD will be able to enjoy the things they once left behind to serve the country and form

strong bonds with their kids and not worry about passing down the trauma. The VA is necessary

and logically the best place for veterans with PTSD or any other military issues to be resolved

and treated, just like what President Lincoln promised.

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Work Cited

Caselli, Lisa Teague, and Robert W. Motta. “The Effect of PTSD and Combat Level on Vietnam

Veterans’ Perceptions of Child Behavior and.” Journal of Clinical Psychology, vol. 51,

no. 1, Jan. 1995, pp. 4–12. EBSCOhost, doi:10.1002/1097-4679(199501)51:1<4::AID-

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“Cognitive Processing Therapy (CPT).” American Psychological Association, May 2017,

www.apa.org/ptsd-guideline/treatments/cognitive-processing-therapy.

Donoho, Carrie J., et al. “A Decade of War: Prospective Trajectories of Posttraumatic Stress

Disorder Symptoms Among Deployed US Military Personnel and the Influence of

Combat Exposure.” American Journal of Epidemiology, vol. 186, no. 12, Dec. 2017, pp.

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in U.S. Soldiers of the Iraq War over Time.” Journal of Traumatic Stress, vol. 25, no. 2,

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Hale, Andrew C., et al. “Predictors of Change in Cognitive Processing Therapy for Veterans in a

Residential PTSD Treatment Program.” Journal of Clinical Psychology, vol. 75, no. 3,

Mar. 2019, pp. 364–379. EBSCOhost, doi:10.1002/jclp.22711.

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Disorder, Sleep Disorders: Clinical Effectiveness of Treatment by Repeating Phrases of

Positive Thoughts (TRPPT) of Mental-War Disorders in Syrian Refugees Children and

Adolescents War Victims - A New Therapeutic Trial.” Sleep & Hypnosis, vol. 20, no. 3,

Sept. 2018, pp. 210–226. EBSCOhost, doi:10.5350/Sleep.Hypn.2017.19.0153.

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Experiences and PTSD: Testing the Moderating Role of Child Soldier Status.” Journal of

Child & Adolescent Trauma, vol. 10, no. 4, Dec. 2017, pp. 323–331. EBSCOhost,

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