Tell the SOB's who don't know anything, to go to a suicide hotline like the one I work for- and got training for. Ask a volunteer what it is like to talk to someone who is drunk off their ass, playing Russian Roulette with a gun, hearing the click of the chambers as they tell you they want to die, and they cannot live with what they saw over there. I volunteer 8 hours a month- and every shift I get at least one of those calls. You go outside afterwards, shaking, and if you don't puke, you cry uncontrollably, your hands shaking so bad you cannot even light a cigarette to calm down, or reach in your purse to grab a Kleenex to wipe away the snot rockets.

I am not an expert - other than having family members who served in WW II, Korea, and Vietnam. I have a family member right now serving in the Middle East. I fear for him, not only if he gets killed over there- but if he comes home, what condition his body and mind will be in. All I know is I pray to what ever, that I am not on shift the night he gets drunk and pulls out his rifle and decides to play Russian Roulette with it if and when he comes back home.

Thank you for writing this Philip.

There may also be something different about the baggage our troops are carrying into battle from their childhoods. Other wars were fought with draftees which means a broader sample of the civilian population. Our recruiters nowadays are literally staking out high school students in the worst socio-economic areas of the US, areas with the highest levels of stress. This is definitely going to skew the sample.

I wonder if there is any correlation between PTSD rates and the home country's ambivalence about or frank opposition to the war in question. After all, high PTSD rates were noted after Vietnam as well. Regardless of a soldier's personal views, I would think it would be hard to risk one's life in an effort deemed by the majority of the home population as a wasteful mistake.

Consider the (American) Civil War and World War II--both horrific conflicts by any measure. But I would guess that PTSD rates (for Union veterans especially in the Civil War) were somewhat lower because the civilian population overwhelmingly viewed the conflicts as necessary and justified.

Good issue to follow. I have no idea why ptsd might be higher in gulf war vets compared with korean war or vietnam war. there are some things that are done better now than vietnam, such as building and maintaining companies, instead of having them rotate in and out on a rolling schedule, interfering with solidarity - which has been noted as a big problem in vietnam war. I do believe that it is true that a great portion of returning vets now are Rx SSRIs, or atypical antipsychotics, and the suicide and aggression problems with SSRIs may have a big role in the current problems seen with suicides, and returning vets killings wives and girlfriends. Generally, the vets are given meds - with shakey if any support for actually treating PTSD, but little to no psychotherapy - which actually has effectiveness data for PTSD. Not easy to achieve in some cases, since the trauma experiences of war can be very profound, but clearly better than a pill. I believe in two totally separate articles in the past yr or yr and a half I believe, Newsweek has noted: high Rx for returning vets and noted high suicides. Yet failed (or editorially decided to not make) any connection. That is from memory so I could be wrong - one article could have been in Time, the other in Newsweek. On that subject of SSRIs and agression, I happened to bring this up while discussing realted topics with good friends - as soon as I mentioned, in polite terms, versus the polemic I might post here in comments, possible aggression from SSRIs, another in this group began nodding her head, and told her story. bottom line the SSRI made her aggressive like never before. This from a high functioning, responsible, mature adult. She dropped that med and went back to her reasonably normal level of functioning (we are all a little crazy, but most of us are not physically attacking spouses). One diff between this current era and the VN or Korea generation is our style of delaying adulthood, and instead allowing children to be children up through teen years. Many kids get to college or enlistment age with no experience in regular chores, money management, fulfilling obligations such as helping out other family members (babysitting, caregiving for elderly, cooking, shopping, etc) - all of which I surely did in my teens, and was common in previous generations. There may be a whole host of kids who go off to war at a chronologically adequate age, but with little maturity, relative to past generations. I have been able to work with vets going back to WWII (thank God what a bunch of guys) - with these very old vets, we would do "reminiscence therapy:" even if they can't remember a lot (some had alzheimer's), they often could describe their first job (one of our topics). These guys talked about significant jobs at ages 10, 11, or 12. Driving a tractor, bailing hay, etc. Now, we parents wipe our kid's noses til they are at least 21. So, it is possible that the maturity factor could be different. At the same time, the concept of PTSD, plus getting a monthly paycheck for having PTSD, was unknown for WWII guys, but has grown to be well recognized. Sad. Fort Lewis is a beautiful place, and stryker brigade guys are great. The VA has great research resources, and hopefully the will to attack this problem.

I agree with you that a lot of elements are coming together to create a "perfect storm" situation around this war. There is no doubt it's one nasty war and people are being stationed there longer and more repeatedly than in earlier wars. That's why it makes it even more imperative that we don't throw "cures" at these guys (and gals) that make them worse not better. How awful to fight the war without and come back and be made to fight a hidden war within against psych drugs that are being given to you in the name of restoring well being when they end up doing just the opposite. It's so insidious and tragic. Which one of these battles is really the worst one? I've been sounding the alarm about this for over five years, believe it or not, in letters and responses to articles, but it's only getting worse, a whole hell of a lot worse.

Ironically there is an article today in the NYT about an innocent Arab American imprisoned for 6 years, including at Guantanamo, and he was tortured. Guess what part of the regime was? Antidepressants. He's now working with a psychiatrist trying to get off. That tells you something doesn't it? A torture instrument -- that sounds about right to me.

Apologies -- he was not American, but no charges were ever made against him and 7 years of his life have been stolen to say nothing of the long term harm of his torture regime.

I heard someone mention earlier tonight that during World War II, one reason veterans fared better was that they were sent home on ships and thus given time to decompress that current troops who are flown home don't have. I'm not sure if it's true, but it's an interesting thought.

I would like to add that on www.ssristories.com there are over 53 stories involving soldiers. You can find them by going to the index, clicking on the additional column so it sorts alphabetically and scrolling down to "s" where the summary heading starts with "soldier." I know I sound like a broken record but quite honestly reading all of these together in conjunction with each other does make you think something is seriously wrong with treatment paradigms and that's it's doing these soldiers a whole lot of harm. We need to measure outcomes in a systematic fashion as we throw these powerful meds at these vulnerable and traumatized individuals with little to no warnings or monitoring. And certainly no education about tapering and withdrawal.

[In the search for "smart research"...]

A recent piece was published in an anthropology magazine entitled, "Becoming Monsters in Iraq," based on research with return vets who are now ardent war opponents. The authors argue that PTSD, as a clinical disorder, cannot be abstracted from the actual acts of witnesses and participating in dehumanizing crimes against people in Iraq/Afghanistan. For many soldiers, the lived experience of PTSD (both among those who avoid treatment and those who seek it) becomes part of a larger political statement against the impact of the war in these contexts.

There is a place for a discussion about the role of meds in ptsd treatment (In my own experience living under this label, it took me a few months after my dx to agree to my therapist's suggestion to try an ssri. After a month or two, I'm not sure what else the meds did or did not do, but I could talk for an hour with a therapist without crying. It helped.). The "therapeutic response" resulting from participation in social organizations devoted to anti-war activism with other returned vets, I imagine, far surpasses that which medications can achieve alone.

The article can be accessed in .pdf format at the magazine's website: http://www.anthronow.com

One big difference between Iraq and Vietnam: during Vietnam, many protesters were against both the war and the soldiers. Even with the low level of support for the Iraq war, civilians are far more supportive of the troops now than during Vietnam.

Some relevant trivia I learned only recently: last year when I was listening to Minnesota (or National) Public Radio, I heard from a speaker that many people who spat upon returning veterans were, in reality, pro-war civilians, who were angry that America lost the war. I mentioned that to a veteran a few months ago. To my recollection, he neither agreed or disagreed with that, but he replied, "we didn't lose the war, we retreated."

Not necessarily supporting my comments, but something recent, December 28 2008, Washington Times: VA grapples with veterans' mental traumas