Almost 40 percent of Iraq and Afghanistan veterans receiving health care from VA hospitals have one or more mental disorders.

A new study, published in the July 16 online edition of the American Journal of Public Health, reported this and other shocking news about the mental health of our veterans of the Middle East wars.

The study’s principal author, Dr. Karen H. Seal, an assistant professor of medicine and psychiatry at the University of California, San Francisco, had even more distressing news. She said:

When the definition is expanded to include diagnoses of mental health disorders or psychosocial behavioral problems such as homelessness, or both, 43 percent of these veterans received these diagnoses.

If previous history with Vietnam-era veterans is any guide, the burden of mental illness will follow these veterans for many years to come. The research reported on in this post seems to back this idea up.

The findings of the study and its implications are detailed under the following headings:

• How the study was conducted?
• What were the findings of the study?
• The incidence of mental illness among veterans is accelerating
• It can take years for Anxiety Disorders such as PTSD to develop
• What are the implications of the study?

How the study was conducted?

The health records of 289,328 Iraq and Afghanistan veterans entering Veterans Affairs (VA) health care from April 1, 2002 to April 1, 2008 were studied by researchers at the San Francisco Veterans Administration (VA) Medical Center and the University of California, San Francisco. This number accounts for about 40 percent of returning veterans.

Mark Kaplan, a professor of community health at the School of Community Health at Portland State University in Oregon, noted that the study only covers veterans who have received care at the VA, but there are many more with serious mental health problems that are either seeking care privately or not at all. He said,

This study adds to what we know about this population, however, that’s the veterans who seek care at the VA system. But if you look at the total population of veterans from all wars, there are one-third of all veterans who have these problems.

What were the findings of the study?

Well over a third of the returning veterans, 37 percent, received a diagnosis of having a mental disorder. Of these, the largest groups of diagnoses were:

• 22 percent: Post Traumatic Stress Disorder (PTSD)
• 17 percent: depression
• 7 percent: alcohol use disorder
• 3 percent: drug use disorder

Many veterans had several mental health problems. In fact, 29 percent of veterans with mental health issues were diagnosed with two different conditions, and 33 percent were diagnosed with three or more. Women were at higher risk for depression than were men, but men had over twice the risk for drug use disorders.

Active duty veterans younger than 25 years had higher rates of PTSD and alcohol and drug use disorder diagnoses compared with active duty veterans older than 40 years. Greater combat exposure was associated with higher risk for PTSD.

Veterans older than 40 with the National Guard or the Reserves were more likely to develop PTSD and substance abuse disorders than those under 25. Dr. Seal said a possible reason is that older reservists go to war from established civilian lives, with families and full-time jobs, making combat trauma potentially more difficult to absorb. She continued:

It’s the disparity between their lives at home, which they are settled in, and suddenly, without much training, being dropped into this situation.

The incidence of mental illness among veterans is accelerating

Dr. Seal states that, “What’s really striking is the dramatic acceleration in mental health diagnoses, particularly PTSD, after the beginning of the conflict in Iraq,”

The increase in mental illness diagnoses accelerated after the invasion of Iraq in 2003, the researchers found, increasing 4 to 7 times. Among the group of veterans who enrolled in veterans health services during the first three months of 2004, 15 percent received mental health diagnoses after one year. But after four years, the number had nearly doubled, to 27.5 percent.

Dr. Seal attributed the rising number of diagnoses to several factors: repeat deployments; the perilous and confusing nature of war in Iraq and Afghanistan, where there are no defined front lines; growing public awareness of PTSD; unsteady public support for the wars; and reduced troop morale. She said that “waning public support and lower morale among troops may predispose returning veterans to mental health problems, as occurred during the Vietnam era.”

It can take years for Anxiety Disorders such as PTSD to develop

Dr. Seal said often it takes more than a year for symptoms of PTSD to appear and diagnosis to be made. She said,

The longer we can work with a veteran in the system, the more likely there will be more diagnoses over time. It sometimes takes time, given the stigma associated with mental illness, before we are able to break through the barriers and have patients tell us what is happening.

This finding supports the recent move to extend VA benefits to five years of free health care, which allows VA doctors the time to detect and treat more mental illness in returning combat veterans, the researchers said.

Kaplan noted that it is not uncommon for problems such as PTSD to arise years, even decades, after service. “We don’t know the full emotional toll of the wars in Iraq and Afghanistan,” he said.

What are the implications of the study?

Dr. Seal believes that more resources are needed to deal with the problem of mental illness among returning veterans. She states that:

After the start of the Iraq War, there is a growing burden of mental illness, particularly post-traumatic stress disorder (PTSD), that will require increased allocation of resources for better detection and early intervention to prevent chronic mental illness, which threatens individual veterans, their families and communities.

Simon A. Rego, associate director of psychology training at Montefiore Medical Center in New York City, says,

An important and often overlooked finding here was that a lack of social support — being separated, divorced, widowed, etc.– may pose a serious risk for new post-deployment mental health problems.

Rego emphasizes that this underscores the need for social support services for returning veterans who are unmarried and/or without social support. He continues:

All too often we focus on treating the symptoms but fail to address the individual’s social context. Based on the data here, a failure to do so could lead to increased risk in developing new mental health problems.

What do you think?

I live in the city that is host to Fort Benning, one of the largest army installations in the world. There is a continual flow of new recruits coming in for training, combat-ready soldiers being deployed to Iraq and Afghanistan, and veterans returning from the wars. The health and well-being of these troops is a matter of no small concern to not only the Army, but to the entire community.

The results of the study reported on in this article are distressing to me for two reasons: I am shocked how many veterans are returning home, burdened by a load of mental woe and illness that will follow them the rest of their lives; and I cannot help but think of the millions of veterans of former wars whose mental disorders went undiagnosed, and whose lives were lived out in pain and frustration.

• Do you think that the dramatic rise in diagnoses of mental illness in veterans is due to better diagnostic techniques, or the increasing difficulties of the wars?
• Congress has increased the length of time a veteran can be treated by the VA to 5 years. Do you think it should be longer still given the long gestation of PTSD?

©2009 Michael L Nichols. All rights reserved.

Resources Used in This Post
Chong, Jia-Rui. (2009, July 16). Percentage of veterans with mental health problems jumps dramatically. Retrieved July 21, 2009 from Los Angeles Times web site: http://latimesblogs.latimes.com/booster_shots/2009/07/veterans-mental-health-veterans-affairs-study-.html
Dao, James. (2009, July 16). Vets’ Mental Health Diagnoses Rising. Retrieved July 21, 2009 from The New York Times web site: http://www.nytimes.com/2009/07/17/health/views/17vets.html?_r=1&ref=health
Grohol, John. (2009, July 18). Veterans’ Mental Health Concerns Rising. Retrieved July 21, 2009 from PsychCentral web site: http://psychcentral.com/news/2009/07/18/veterans-mental-health-concerns-rising/7199.html
Reinberg]]Reinberg, Steven. (2009, July 16). Many Veterans Need Mental Health Care. Retrieved July 21, 2009 from HealthScout web site: http://www.healthscout.com/news/1/629099/main.html
Seal, Karen; Metzler, Thomas; Gima, Kristian; Bertenthal, Daniel; Maguen, Shira; Marmar, Charles. (2009, July 16). Trends and Risk Factors for Mental Health Diagnoses Among Iraq and Afghanistan Veterans Using Department of Veterans Affairs Health Care, 2002-2008. Retrieved July 21, 2009 from American Journal of Public Health web site: http://www.ajph.org/cgi/content/abstract/AJPH.2008.150284v1

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What is daydreaming? What is escapism? And are these symptoms of Post Traumatic Stress Disorder (PTSD)?

These are questions set for me by Spark, one of the readers of this blog.

The words “escapism” and “daydreaming” have strong moral overtones, especially “escapism.” Our society, based on Puritanism, frowns on all things that can’t be termed “productive.” To waste time in escapism and daydreaming are looked down upon as “lazy” or “sinful,” whether the terms are used in a secular or religious sense.

What exactly is escapism? Is it always a bad thing? And similarly, daydreaming: Is it mere escapism? Does it provide something useful to humans? Is it laziness? What is the nature of the flashbacks experienced with PTSD? Are they a type of daydreaming, or just escapism?

These are the important issues explored in this post.

This is the first post of a series in which I answer readers’ questions. If you would like to ask a question, please feel free to leave your question in a comment or use the Contact tab to email me. I answer all questions, whether or not you agree to have it be the subject of a post. If you do agree, you will not be identified by name.

Spark’s questions

Spark asked the following questions:

I’ve lived with daydreaming/escapism ever since I was four. My escape mechanisms work in daydreams. It’s mostly fantasy, or the life I want to live. I believed my life wasn’t exciting, so my daydreams would reflect what’s lacking. They showed the opposite of my life. If I felt unsuccessful, I was über-successful in my fantasies.

I do see a recurring theme of my sadness there. I always dreamed of becoming a dancer, and my daydreams show my dance success, but the sadness of my reality somehow seeps into those daydreams. 

I am a creative person, and quite a few people told me my daydreaming/escapism is a gift  of many writers and storytellers. 

I’ve had traumatic events happen in my life that intensified this behavior. I’d like to know if daydreaming/escapism has any relation to  Post Traumatic  Stress Disorder. In addition to traumatic events, I didn’t have much of a social life and many friends.  Could this contribute to that condition?

Actually, Spark has asked are several questions:

• Is my daydreaming escapism or merely daydreaming?
• Is my daydreaming a bad thing?
• Is my daydreaming/escapism related to Post Traumatic Stress Disorder (PTSD)?
• Can my social life contribute to PTSD?

What is escapism and is it bad?

The Oxford dictionary defines escapism as “the tendency to seek distraction and relief from unpleasant realities, especially by seeking entertainment or engaging in fantasy.” 

Almost all leisure activities are escapism

Broadly speaking, then, almost all forms of leisure activities could be termed escapism. They take our minds off the problems and stresses of the workaday world. In previous times, this could have been dancing, singing and storytelling. In modern times, escapism can take the form of vacations, sports, tv, video games, books, hobbies, and playing with the kids.

So escapism is not a bad thing in itself. Despite the pejorative tone cast put upon it in recent times, it is a necessary recreation that restores us so that we can once again go out into the big, bad world.

But like anything, escapism taken past moderation can become a problem. It can become addictive, excessive and injurious. For example, playing video games for days on end, or getting so immersed in the internet that you have no time for your family.

So the morally wrong sense of the  term “escapism” should be reserved for those who take excessive time away from real life to the point at which they seem to be trying to escape from it. 

Answer to Spark’s question: Your daydreaming is the bad form of escapism only if it interferes with the other activities of your life. If moderate escapism is one of your “recreations,” like watching tv, then I see nothing wrong with it.

What is daydreaming and is it bad?

Another definition from the Oxford dictionary: Daydreaming is ” a series of pleasant thoughts that distract one’s attention from the present.” 

Daydreaming was long held in disrepute in society and was associated with laziness. Sigmund Freud felt that only unfulfilled individuals created fantasies, and that daydreaming and fantasy were early signs of mental illness. In the 1950′s some educational psychologists warned parents not to let their children daydream, for fear that the children may be sucked into “neurosis and even psychosis.” In the 1960′s, textbooks used for training teachers provided strategies for combating daydreaming, using language similar to that used in describing drug use. 

Everybody daydreams

Everybody daydreams, whether they admit it or not — or are even aware of it. Psychologists estimate that one-third to one-half of a person’s thoughts while awake are daydreams. Most psychologists consider daydreams a natural component of the mental process for most individuals.

A recent study, set up by Malia Mason of the Harvard Medical School and Massachusetts General Hospital, found that when people are busy on a task, one part of their brain lights up in brain scans. As soon as the task is completed, another part of the brain lights up: the daydreaming part. Mason said, 

There is a network of regions [of the brain] that always seems to be active when you don’t give people something to do. … It’s daydreaming. … In the absence of a task that requires deliberative processing, the mind generally tends to wander, flitting from one thought to the next with fluidity and ease.

[This] kind of spontaneous mental time travel lends a sense of coherence to ones’ past, present and future experiences. Although the thoughts the mind produces when wandering are at times useful, such instances do not prove that the mind wanders because these thoughts are adaptive; on the contrary the mind may wander simply because it can.

So, daydreaming is a natural, normal thing that happens to all of us all the time.

Daydreaming in childhood

Daydreaming first occurs for most people during childhood, sometime before age three. These early daydreams set the pattern for adult daydreaming. 

Daydreaming starts in childhood

Children who have positive, happy daydreams of success and achievement generally continue these types of mental images into adulthood. These daydreamers are most likely to benefit from the positive aspects of mental imagery. Daydreams become the impetus for problem-solving, creativity, or accomplishment. 

On the other hand, children whose daydreams are negative, scary, or visualize disasters are likely to experience anxiety, and this pattern will carry over into adulthood as well. A child’s daydreams may take a visible or public form: the daydreaming child talks about his mental images while he is experiencing them, and may even act out the scenario he is imagining. After age ten, however, the process of internalizing daydreaming, rather than acting them out, begins.

Daydreaming as a creative activity

Daydreaming can be a creative activityIt is not unusual for a daydream, or series of daydreams, to precede an episode of creative writing or invention. Athletes, musicians, and other performers use a form of daydreaming known as visualization. As the individual prepares for a competition or performance, she forms a mental picture of herself executing and completing the task with the desired successful outcome.

There are numerous examples of people in creative or artistic careers, such as composers, novelists, and filmmakers, developing new ideas through daydreaming. Similarly, research scientists, mathematicians, and physicists have developed new ideas by daydreaming about their subject areas.

The bottom line is the same as it is for escapism: Do the daydreams take over your life, do they go beyond the bounds of moderation? Do the daydreams interfere with your normal functioning to the point where you are impaired?

Answer to Spark’s question: Daydreaming is not bad in itself, if done in moderation. It can lead to creative ideas and actions. They can become the impetus for problem-solving and accomplishment. They are not mere escapism or laziness; they are a positive, entirely normal human activity that can be “productive.”

Daydreaming, escapism and PTSD

Flashbacks are not daydreams

Post Traumatic Stress Disorder (PTSD) is unique among psychiatric disorders in that it is identified not only by symptoms, but also by the precursor of the illness — the traumatic event. The person has been exposed to a traumatic event in which they were threatened with death or serious physical injury, and the person’s response involved intense fear, helplessness or horror.

Some of the diagnostic criteria for PTSD go far beyond daydreaming. The traumatic event is re-experienced over and over by:

• Recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions.
• Recurrent distressing dreams of the event.
• Acting or feeling as if the traumatic event were recurring

The social life of a person with PTSD can be severely hampered by other symptoms caused by the trauma:

• Efforts to avoid conversations associated with the trauma 
• Efforts to avoid people that arouse recollections of the trauma 
• Markedly diminished interest or participation in significant activities
• Feeling of detachment or estrangement from others 
• Restricted range of affect (e.g., unable to have loving feelings)
• Sense of a foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span)

Answer to Spark’s question: Daydreaming cannot be a symptom of PTSD, nor can escapism. The flashbacks of PTSD are always of a traumatic event, and never daydreams of simple fantasies. A restricted social life may be a symptom of some other Anxiety Disorder, but as a symptom of PTSD, it must be related to the traumatic event. Remember that PTSD always has a precursor to its development: the traumatic event. Remember also that restrictions to a person with PTSD’s social life are always a result of that traumatic event.

What do you think?

Despite the facts, society still frowns upon daydreaming and escapism. I consider it a product of denial and non-thinking! 

It is important to note that this post constitutes my opinion and should not be considered as a qualified medical diagnosis.  Please read my disclaimer!

• What do you think of daydreaming and escapism? Can they be positive, or are they always negative?
• What is the role of daydreaming in your life?
• Have you ever experienced going beyond moderation in daydreaming or escapism?

As always, your comments are welcome!

If you have enjoyed this article, please consider subscribing to this blog, either via RSS or email at the top of your screen. I would also appreciate your sharing it using your favorite social media, such as StumbleUpon or Digg. Just click the little green “ShareThis” button at the bottom of this post.

Resources used in this post:

BNet: Health Care Industry. (2008). Daydreaming. Retrieved August 1, 2008 from BNet Web site: http://findarticles.com/p/articles/mi_g2699/is_0000/ai_2699000083

The Neurocritic, (2007, January 23). Daydreaming and Thought-Sampling. Retrieved x from The Neurocritic Web site: http://neurocritic.blogspot.com/2007/01/daydreaming-and-thought-sampling.html

Mason, Malia; Norton, Michael L.; Van Horn, John D.; Wegner, Daniel M.; Grafton, Scott T.; Macrae, C. Neil. (2007, January 19). Wandering Minds: The Default Network and Stimulus-Independent Thought. Retrieved August 1, 2008 from Science Magazine Web site: http://www.sciencemag.org/cgi/content/abstract/315/5810/393

MSNBC. (2007, January 19). Caught Daydreaming? Blame Brain’s Settings. Retrieved August 1, 2008 from MSNBC Web site: http://www.msnbc.msn.com/id/16709755/

wiseGEEK. (2008). What is Escapism?. Retrieved August 1, 2008 from wiseGEEK Web site: http://www.wisegeek.com/what-is-escapism.htm

Further reading:

A Head in the Clouds: Daydreaming could bring benefits – LSU Daily Reveille  

Daydreaming improves thinking -  Cosmos  

Escape from the Insipid: Our Brains May Be Wired for Daydreaming – Scientific American  

Why Does Daydreaming Get Such a Bad Rap? – WebMd  

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It has been estimated that 21 percent of adults in the United States (about 45 million people) currently smoke. It has also been found that individuals who have Anxiety Disorder may be particularly likely to smoke. Out of all Anxiety Disorders, individuals with Panic Disorder and Post-Traumatic Stress Disorder show the highest rate of smoking.

Smokers are twice as likely to suffer Post-Traumatic Stress Disorder as non-smokers, according to a recent study of male twin soldiers. The researchers also found that people exposed to trauma, whether or not they developed PTSD, were more likely to take up smoking.

About one-third of people go on to suffer Post-Traumatic Stress Disorder after experiencing severe trauma, according to estimates. PTSD is a mental illness characterized by Anxiety, flashbacks and panic attacks.

Karestan Koenen, the lead researcher in the study, believes there is a genetic link between smoking and PTSD. She said, 

Some of the same genes that influence risk for PTSD may influence risk for nicotine dependence, and vice versa.

 

Nicotine dependence has been associated with PTSD before, but the exact nature of the link has never been clear. The new study establishes smoking as a key risk factor in pre-disposing people to PTSD.

Koenen and colleagues at the Harvard School of Public Health in Cambridge, Massachusetts, looked at the health records of 6744 pairs of male twins who had served in the US military during the Vietnam era, about half of whom were identical twins.

The researchers found that shared genetic factors explained 63% of the overlap between PTSD and nicotine dependence in the twins. 

But Koenen discovered that those who had a history of smoking and who were then exposed to trauma had twice the risk of developing PTSD, compared to non-smokers who experienced trauma.

Koenen speculates that smoking may make one more likely to get PTSD. She said, 

Nicotine stimulates some of the same neurobiological pathways – the dopaminergic pathway associated with reward and fear – implicated in stress and addiction. Smoking may sensitize these pathways, so a subsequent severe stressor is more likely to give someone PTSD.

 

Koenen does not know “whether giving up smoking makes the increased risk go away.” She suggests the military conduct smoking cessation and anti-smoking programs. In addition, she thinks that they should pay extra attention to caring for soldiers with a history of smoking who are deployed in combat situations.

Do you know someone with PTSD? Are they a smoker? I’d like to hear your story!

If you have enjoyed this article, please consider subscribing to this blog, either via RSS or email on the top of the left sidebar. I would also appreciate it if you shared this article with your favorite social media, such as StumbleUpon or Digg. Just click the little green “ShareThis” button at the bottom of the post.

Reference:

A Twin Registry Study of the Relationship Between Posttraumatic Stress Disorder and Nicotine Dependence in Men. Archives of General Psychiatry (vol 62, p 1258), Koenen et al 

Smoking doubles risk of post-traumatic stress. NewScientist November 8, 2005  

Further reading:

Trauma, PTSD, and Smoking, Matthew Tull, PhD at About.com  

Nicotine Dependence, PTSD Symptoms, and Depression Proneness Among Male and Female Smokers, David A. F. Haaga, NIH Public Access

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