Understanding and Overcoming the Stigma of PTSD
As United States involvement with conflicts in the Middle East comes to a close troops are returning to the civilian workforce. In a June 2010 poll, the Society for Human Resource Management (SHRM) found that 46 percent of the HR professionals responding said post-traumatic stress and other mental health issues pose hiring challenges. Just 22 percent said the same about combat-related physical disabilities. (http://www.shrm.org/Publications/hrmagazine/EditorialContent/2011/0711/Pages/0711meinert.aspx)
The media often stereotype these individuals incorrectly, portraying all troops as suffering from Post-Traumatic Stress Disorder (PTSD) and on the verge of violence. Not so says Harry Croft, MD, former Army doctor and psychiatrist and author of the book, I Always Sit with My Back to the Wall. Croft has evaluated more than 7,000 veterans for PTSD and says while one-fifth of soldiers returning from Afghanistan and Iraq may suffer from PTSD, veterans can make for some of the best employees in an organization if the employer and the Veteran take the time to understand the other and their experiences.
Croft offers this advice to employers hiring Veterans with PTSD:
- Understand the veteran, his or her skill sets and the differences in military and civilian culture. Hire veterans in pairs or groups because they’re used to working that way.
- Learn about PTSD so if you hire a veteran dealing with it, you know what the symptoms really are. This will help you understand that the vet is not trying to be disrespectful or obstinate and will help you understand the reasons they sometimes behave the way they do.
- Don’t give into the myths, mystique, and stigma about veterans with PTSD. Never will someone with PTSD behave like the soldier accused of killing 16 Afghanistan civilians. He was suffering from much more than just PTSD alone.
- Offer veterans you hire someone to talk to in confidence or a situation or way that might enable them to deal with their symptoms more effectively.
- Ask yourself why do you want to hire a veteran? It shouldn’t be because it’s a tax break, the patriotic thing to do, good for business, or because you feel sorry for them. Veterans just want to be given opportunities because they are the right person for the job.
PTSD is widely discussed. Unfortunately, information about this disorder is often misinterpreted or misleading. Misperceptions have emerged that negatively impact Veterans’ employment opportunities; opportunities which research shows are a major component of successful reintegration into civilian life.
While service members may experience stress reactions resulting from a combat deployment, those reactions may not necessarily be an indication of PTSD. Common symptoms, such as nightmares, increased anxiety, and reliving the event, are associated with both combat stress and PTSD. With PTSD, however, there is no noticeable improvement, the symptoms do not decrease, and the individual remains in psychological shock. Help is necessary to process the traumatic event and connect what happened with the individual’s emotions and memories about the event. (http://www.helpguide.org/mental/post_traumatic_stress_disorder_symptoms_treatment.htm)
Research has found several types of therapy effective in treating PTSD. Treatment is more likely to be effective if it is begun shortly after the traumatic experience. The Defense Center of Excellence describes various effective treatment options used by health professionals and clinicians; for example, cognitive therapy and eye movement desensitization and reprocessing. To increase the likelihood that therapy will be beneficial the center stresses the importance of understanding the individual’s specific needs and issues prior to beginning treatment. (http://www.dcoe.health.mil/ForHealthPros/PTSDTreatmentOptions.aspx).
However, many service members who experience PTSD may avoid beneficial treatment and support fearing they may be considered weak or that peers might lose confidence in their abilities. Thus, to make a real difference in the lives of those who need support it is important to share the truth about PTSD to dispel its myths. Research findings suggest that treating PTSD, even if some symptoms remain, could result in better employment outcomes for veterans. (Employment Outcomes and PTSD Symptom Severity)
Five Myths and Facts about PTSD
- Myth: I cannot get or maintain my security clearance if I am diagnosed with PTSD.
Fact: Getting treatment for PTSD is not necessarily a threat to an individual’s security clearance. In fact, mental health counseling can be a positive factor in the clearance process.1 Army records show that 99.98 percent of cases with psychological concerns obtained/retained their security clearance.2 Additionally, service members are not required to report some treatments, including those for PTSD, they received due to service in the military when they apply for a security clearance.3 Factors that could result in clearance refusal include not meeting financial obligations, criminal actions, or engaging in activities benefiting a foreign nation.1
- Myth: My military career will end if I am diagnosed with PTSD.
Fact: Being diagnosed with PTSD in and of itself does not end your military career. There are plenty of examples where service members have sought treatment for various psychological health concerns, including PTSD, and it did not put their careers in jeopardy. In fact, a failure to seek treatment can lead to a more serious psychological condition, and could eventually prevent someone from carrying out some sensitive tasks.2 Seeking support to address psychological health concerns shows inner strength and is commonly looked on favorably.
- Myth: Service members only experience PTSD symptoms immediately following combat or a traumatic event.
Fact: Symptoms associated with PTSD usually occur within three months after the traumatic event4, but symptoms may not appear until six months, or even years later.5 The types of symptoms can be broken down into four categories: hyperarousal (feeling “keyed up”), avoidance (avoiding reminders of the event), intrusion (reliving the event), and feeling numb or detached.6 Nightmares, one of the most common symptoms, are experienced by 71-96 percent of those with PTSD.7 Reaching out for care is an important step since symptoms, such as nightmares, may lessen or disappear and then re-appear later in life. Early intervention can provide the right coping tools to deal with these symptoms, and sometimes even prevent development of chronic PTSD. Visit the National Center for PTSD to learn more about the types of symptoms associated with PTSD.
- Myth: Service members can never fully recover from PTSD.
Fact: Successful treatment and positive outcome are greatly enhanced by early intervention. With therapy, and in some cases medication, the symptoms of PTSD can be greatly reduced, even eliminated.4 Treatment can help you feel more in control and teach effective coping mechanisms to deal with stressful situations when they arise. There are many types of treatment; your medical provider can help you determine which one is best. You can also contact the DCoE Outreach Center 24/7 at 866-966-1020 where highly trained professionals can answer questions and connect you with local resources for support.
- Myth: PTSD is a sign of weakness in character.
Fact: PTSD is a common human reaction to very traumatic situations. PTSD seems to be due to complex chemical changes in the brain when an individual witnesses or experiences a traumatic event. The symptoms of PTSD appear to be frequently experienced in situations where someone perceives they have been exposed to a life-threatening event, although symptoms and reactions vary from person to person.8 As a service member dealing with PTSD symptoms, seeking help demonstrates strength and will provide benefits to yourself, your family, your unit, and your service. Do not hesitate to seek care – PTSD is treatable and reaching out early often leads to the best outcomes.7
Effective treatment for PTSD is not limited to the service member alone. In a research study published in Military Medicine (2012), the authors found interventions for military family members beneficial as a way of identifying signs of distress in service members and assisting in the prevention of stress-induced impairment. In this study, researchers introduced an educational website to assess and improve knowledge about PTSD. As well, they used the site to engage family members in positive actions to assist service members struggling with this disability.
After using the website, military family members reported a significant increase in PTSD knowledge. As a result of gaining that knowledge most family members reported taking actions shortly after using the website to help family service. The overwhelming majority who did so thought their actions were beneficial. Thus, educating family members about PTSD can have a positive impact on Veteran mental health outcomes and web-based content can be a valuable tool in support of that goal. (Web-Based Post-Traumatic Stress Disorder Education for Military Family Members)
Many websites addressing PTSD mention the importance of nutrition and a healthy lifestyle as means of relieving some of the symptoms of depression associated with this disability. In one how-to manual, Military Veterans PTSD Reference Manual (http://ptsdmanual.com/), Bub Parrish, a veteran who suffers from PTSD, provides the following suggestions to help manage PTSD symptoms. These suggestions support wellness across all members of the workforce:
- Maintain proper sleep habits as advised by your health care professional.
- Eat a well-balanced diet
- Manage anxiety as advised by your health care professional
- Participate in a structured and supervised exercise program as advised by your health care professional
- Set realistic goals for yourself
- Create small and manageable tasks
- Let others you can trust such as family and friends help you
The Job Accommodation Network provides further information on the causes of PTSD, its symptoms, and recommended accommodations. Refer to the HR Processes/Accommodations and Support Section [how do we want to make these links internally to the Get Skills Toolkit Website?] or visit http://askjan.org/media/ptsd.html .
Other resources include:
The Vet Centers Program was established by Congress, as part of the VA. The goal of the Vet Centers Program is to provide a broad range of counseling, outreach, and referral services to veterans, in order to help them make a satisfying post-service readjustment to civilian life. Since 2003, the VA has authorized Vet Centers to also furnish bereavement counseling services to surviving parents, spouses, children, and siblings of service members who die of any cause while on active duty, to include federally activated Reserve and National Guard personnel. http://www.vetcenter.va.gov/index.asp
America’s Heroes at Work:
America’s Heroes at Work, a DOL project, addresses the employment challenges of returning service members and veterans living with TBI and/or PTSD. Designed for employers and the workforce development system, this website provides information and tools to help returning service members and veterans living with TBI and/or PTSD succeed in the workplace. http://www.americasheroesatwork.com/
National Center for PTSD:
PTSD 101, a VA National Center for PTSD, is a web-based curriculum that offers courses related to PTSD and trauma. The goal is to develop or enhance practitioner knowledge of trauma and its treatment. Continuing education (CE) credits are available for most courses. http://www.ptsd.va.gov/professional/ptsd101/ptsd-101.asp
Where to Get Help for PTSD:
The VA National Center for PTSD provides a comprehensive list of resources that are available to veterans and the public on the issue of PTSD.
Swords to Plowshares:
Swords to Plowshares is a community-based veteran service organization that provides wrap-around services to more than 2,000 veterans in the San Francisco Bay Area each year, to assist veterans in breaking through the cultural, educational, psychological, and economic barriers they often face in their transition to the civilian world. Swords to Plowshares is a national model for veteran services and advocacy with more than 35 years experience, and a respected and comprehensive model of care for veterans in the country.
Post-traumatic stress disorder in occupational settings: anticipating and managing the risk
Paper describing employer’s responsibility regarding individuals with PTSD.
Post-Traumatic Stress Disorder (PTSD): Symptoms, Treatment, and self-help
Information describing PTSD, importance of appropriate therapy, positive ways of coping with PTSD
PTSD: A Soldier’s Perspective
Research suggests that the first step to supporting individuals with PTSD is to understand this disability. This blog provides some interesting insights into how one soldier with PTSD manages his disability. His suggestions on how to approach him and how to begin a conversation may provide ideas about how PTSD is impacting employees and their families.
SHRM Military Employment Resource Page
Real Warriors Real Battles Real Strength
The Real Warriors Campaign is a multimedia public awareness campaign designed to encourage help-seeking behavior among service members, veterans and military families coping with invisible wounds. Launched by the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE) in 2009, the campaign is an integral part of the Defense Department’s overall effort to encourage warriors and families to seek appropriate care and support for psychological health concerns.
1 Implementation of Adjudicative Guidelines for Determining Eligibility for Access to Classified Information [PDF 1.1 MB], Department of Defense. Published August 30, 2006.
2 Haire, Tamara. “Financial Problems or PTSD Need Not Affect Security Clearance,” Army News Service. Published July 8, 2009.
3 Miles, Donna. “Gates Works to Reduce Mental Health Stigma,” American Forces Press Service. Published May 1, 2008.
4 “TBI and PTSD Quick Facts [PDF 28.7 KB],” Deployment Health Clinical Center, Department of Defense. Last accessed Sep. 10, 2012.
5 Pueschel, Matt. “Combat Exposure Raises PTSD, Smoking, Alcohol Abuse Risks,” Force Health Protection & Readiness, Department of Defense. Published May 22, 2009.
6 “What is PTSD?,” National Center for PTSD, Department of Veterans Affairs. Last accessed Sep. 10, 2012.
7 “Nightmares & PTSD,” National Center for PTSD, Department of Veterans Affairs. Last accessed Sep. 10, 2012.
8 Stress & Trauma, Fact Sheets: A Normal Reaction to an Abnormal Situation, Deployment Health Clinical Center, Department of Defense. Last accessed Sep. 10, 2012.