At a crowded bar on a busy Friday night in Hampton Roads, Virginia, you are bound to run into some military men and women. Home to the largest Navy base in the world, Hampton Roads is abundant with service members, former and current. Enter any conversation at the bar with a service member and you’re sure to discuss the various branches of the military, how many years someone has been in, how many tours they’ve done and the weapons they are familiar with. One thing that most likely won’t be discussed or brought up at any point during the conversation, however, is Post-traumatic stress disorder, better known as PTSD.

Although millions of Americans are suffering from PTSD, it isn’t a topic that many discuss. According to the National Institute of Mental Health, “PTSD is an anxiety disorder that some people develop after seeing or living through an event that caused or threatened serious harm or death. Symptoms include flashbacks or bad dreams, emotional numbness, intense guilt or worry, angry outbursts, feeling ‘on edge,’ or avoiding thoughts and situations that remind them of the trauma.” PTSD has been diagnosed in hundreds of thousands of soldiers returning from the wars in Afghanistan and Iraq and it is believed that thousands of other cases go undiagnosed each year.

It is important to add that while PTSD may seem like a relatively new diagnosis, PTSD symptoms have been experienced by people for decades. PTSD, as it specifically relates to warfare, can easily be dated back to World War I. During the First World War, the brutal nature of trench warfare and the mental problems that followed lead to the concept of “shell shock.” For the remainder of WWI and into WWII shell shock was not treated as a mental disorder but more as a character flaw (many WWI shell shock victims fled from the trauma of the trenches and were shot by their nations for cowardice) and studies on the disorder did not advance. Shell shock was rarely discussed or researched and almost forgotten about until the U.S. intervened in Korea and entered the Vietnam War, which was more intense and savage combat than America had ever experienced. The physiological effects the war was having on soldiers sparked conversation, research and the understanding that treatment was needed. The National Vietnam Veterans’ Readjustment Study concluded that nearly one-third of Vietnam veterans have had PTSD at some point in their lives. In 1980, the American Psychiatric Association first named PTSD and added it to the Manual of Mental Heath Disorders.

Despite advances in research and medicine concerning PTSD in the past decade, veterans suffering from the disorder are still struggling to overcome it, with many turning to drugs and alcohol which in many cases can then lead to homelessness, violence and crime in the months and years following their return home. The American Psychological Association states, “Two-thirds of homeless Iraq and Afghanistan veterans in one major sample had post-traumatic stress disorder (PTSD)—a much higher rate than in earlier cohorts of homeless veterans, who have PTSD rates between 8 percent and 13 percent, according to a study in press in the journal ‘Administration and Policy in Mental Health and Mental Health Services Research.’”

Another troubling route some veterans suffering from PTSD find themselves on is legal trouble or worse, in prison. In 2004, the Department of Justice’s Bureau of Justice Statistics found that nearly one in 10 inmates in U.S. jails had prior military service. The rise in crime among veterans could be linked to many service members being unable or unwilling to get treatment for mental health issues who instead decide to self-medicate via substance abuse. For those willing to get help with counseling, problems also arise. The U.S. Department of Veterans Affairs is overflowing with returning soldiers and often takes years to provide help to soldiers that need it, at which point it is sometimes too late.

Another factor to consider about those experiencing PTSD is that many start to suffer adjustment issues while still enlisted. If an enlisted soldier breaks the law, it is likely that he/she will be ordered an other-than-honorable discharge or a dishonorable discharge. Unfortunately, veterans who receive these discharges aren’t eligible for many, if any, VA benefits and are very limited as to the amount of mental health care available.

The tragedy of PTSD going undiagnosed and untreated has oftentimes left veterans feeling as though the only way out is by taking their own lives. The National Alliance on Mental Illness reported, “A report issued in the spring of 2010 estimated that 18 veterans die by suicide every day. The same report found that as many as 950 suicide attempts each month occur among veterans receiving services through the Veterans Administration (VA). The rate is lower, however, among veterans aged 19 through 29 who are receiving services when compared to those who are not currently receiving care through the VA.”

Evidence of this level of tragedy can be found in Superior, Wisconsin, on a warm August day in 2010 where Matthew Magdzas, suffering from PTSD since his return from Iraq in 2007, unloaded his pistol into the people that loved him most. Amid marriage troubles and mental health issues stemming from PTSD, Matthew Magdzas experienced a mental break. First killing April, his 26-year-old wife who was 9 months pregnant with a baby girl and had a c-section scheduled for the following day. Next was their 13-month old daughter Lila who was playing in her play pen quietly. Then Matthew aimed the gun at the family’s three dogs, ending their lives before lining the pistol up to his right temple and pulling the trigger, the 14th and final shot of the day. Time reports, “ Magdzas was one of 113 National Guard members who killed themselves in 2010. The Guard’s skyrocketing suicide rate, up 82% from 2009 and 450% from 2004, now exceeds that of active-duty soldiers. This fact underscores the plight of Guardsmen, who — unlike their full-time Army buddies — lack the jobs, support and camaraderie found on military bases after they return home from war.”

PTSD is alive in the hearts and minds of many of those who fought to protect our freedom, and the topic deserves to be discussed. It needs to be discussed as often as possible, and something has to change for the men and women needing treatment for mental health issues. The idea that a service member can survive tours overseas and return home only to be haunted by their experience and possibly lose the remainder of theirs lives in one way or another can only be described as the ultimate tragedy.

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