How to prevent turning trauma into a disaster?

This is also seen in military personnel who are deployed in overseas peace-keeping operations. The vast majority of soldiers return home safe and healthy. They are often self-contented. They were able to do the duties they were trained for, they were given an opportu-nity to contribute to a safer world and they often have experienced bonding with colleagues. The reverse of the medal consists of a small, but significant part of military personnel who are faced with a great diversity of health prob-lems. About one out of every five sol-diers develops post-deployment symp-toms (1).

Military deployment and trauma are often bracketed together. Problematic health status in military personnel is often attributed to PTSD, not only by laymen. This is not surprising, because the concept of PTSD originates from the problematic aftermath of the Vietnam War. In 1980, PTSD was introduced as a diagnostic entity in the DSM. However, equalling PTSD and military health problems would be simplistic. About a quarter of post-deployment symptoms can be explained by PTSD, but other main concerns are medically unex-plained physical symptoms, anxiety, depression and substance misuse.

In the 1990s, the need for a broader view was demonstrated in studies in Gulf War veterans. The American and British army were confronted with large groups of military servicemen, returning from the first Persian Gulf War, report-ing ill health. They were dog-tired and suffered from a wide range of symp-toms. In fact, these military experienced health complaints which are common in the general population. They suffered the same health problems although much more frequent as compared to civilians and military who were not sent to the Persian Gulf (2).

There was a lot of speculation on and rumour about the causes of Gulf War related illness. An unequivocal causal factor, e.g. exposure to harmful substances, has never been found. At that time, Dutch United Nations (UN) soldiers returned from deployment in Cambodia. Their health was also trou-blesome. Research showed that 17% of the ex-servicemen suffered from severe fatigue. PTSD was observed in less than 2% (3).

Post-deployment symptoms may be severe, persistent and chronic. They actually show striking similarities with the whether: the state of today is the strongest predictor for tomorrow’s situ-ation. A part of Gulf War and Cambo-dia veterans has significant complaints and is not able to get rid of them. War also leaves tracks in the long-term. Twenty-five years after deployment in Lebanon, about 15% of Dutch UN veterans still reported impaired psycholog-ical well-being (4).

Murthy and Lakshminarayana emphasize that research on the long-term course of stress-related symptoms and syndromes is needed. They are right in the sense that large scale epidemiological research on post-trauma psychopatholo-gy is relatively scarce. But the studies that have been performed yield rather unam-biguous results: war impacts on humans in varying degrees.

Here we enter the field of psychoso-cial care, a promising area which is expe-riencing a growth. Evidence and best practices have been showing the value of and need for psychosocial care, although knowledge gaps exist. For example, evidence based treatment of medically unexplained physical symp-toms is still lacking. Concerning early psychological interventions following trauma, we know what does not work, but we do not know what is effective.

Conflict and war may be a fact of life. There will always be trauma, distress and horror, but we can prevent turning trauma into a disaster. That is why we need to conduct research on these issues and that is why we need to invest in psychosocial care.

References

1.    De Vries M, Soetekouw PM, Van der Meer JW et al. Fatigue in Cambodia veterans. QJM 2000;93:283-9.

2.    Wessely S. Ten years on: what do we know about the Gulf War syndrome? Clin Med 2001;1:28-37.

3.    De Vries M, Soetekouw PM, Van der Meer JW et al. The role of post-traumatic stress disorder symptoms in fatigued Cambodia veterans. Mil Med 2002;167:790-4.

4.    Mouthaan J, Dirkzwager A, De Vries M et al. Libanon laat ons nooit helemaal los. Resultaten van onderzoek naar de gezondheid en het welzijn van UNIFIL’ers die in de periode 1979-1985 naar Libanon zijn uitgezonden. Doorn: Veteransinstitute, 2005.

Maaike de Vries

Impact Foundation, Dutch Knowledge and Advice Centre for Post-Disaster Psychosocial Care, Tafelbergweg 25, 1105 BC Amsterdam,

The Netherlands