SOLDIER'S HEART

It has been over 60 years since the end of WWII and many of the veterans who fought that war are now in their 80's. It won't be too much longer until this entire generation of Americans has passed away.

To date, WWII still stands as the most destructive event of human history in terms of the incredible amount of bloodshed and human suffering that we as a species have ever visited upon ourselves. And the suffering this war generated will continue to live on for generations even after all of the veterans who fought that war have passed away.

One aftermath of this war is the gradual recognition that the effects of war on an individual have long term life consequences both for the veteran and their families that, until recently, were not well known or understood.

Today, the term PTSD (post traumatic stress disorder) has entered the cultural lexicon and denotes the pernicious effects trauma has on those individuals that were exposed to repeated life threatening events over which they had little control; e.g., combat. PTSD is a descriptive term that denotes ongoing unpleasant and debilitating experiences during which a person frequently relives a horrific, life-threatening event via nightmares, repetitive thoughts and images, or even acting as if the event was happening all over again.

In their book, Combat Stress Injury Theory, Research, and Management, Charles Figley and William Nash detail the history of combat-related PTSD,

"Combat-related PTSD may be a condition that existed from the start of humankind. The written history of PTSD dates back to the account of Achilles in The Iliad by Homer (800 BCE). More recently in the US, symptoms of PTSD have been described as “soldier’s heart” during the Civil War, “shell shock” during WWI, “combat fatigue” or “war neurosis” during WWII, and PTSD after the Vietnam War. The third edition of the Diagnostic and Statistical Manual of Mental Disorders published in 1980 was the first to publish diagnostic criteria for PTSD."

They go on to further delineate the common symptoms experienced by those who suffer from combat-related PTSD,

"After experiencing a traumatic event, the three core PTSD symptom clusters include: re-experiencing, avoidance/numbing, and hyper arousal. The re-experiencing symptoms include: recurrent and intrusive distressing recollections of the event; recurrent distressing dreams of the event; flashbacks; intense psychological distress when reminded of the event; and physiological reactivity when reminded of the event. The avoidance/numbing symptoms include: efforts to avoid thoughts, feelings, or conversations associated with the event; efforts to avoid activities, places, or people that are reminders of the event; inability to recall important aspects of the event; decreased interest in significant activities; feeling detached from others; decreased range of affect; and sense of foreshortened future. The hyper arousal symptoms include: problems sleeping, increased irritability; difficulty concentrating; hyper vigilance; and exaggerated startle response."

Figley and Nash also outline how memories of combat related experiences continue to haunt combat veterans long after the battle is over:

"When a combat veteran returns from the most intense experience of his life, those intense experiences continue to “play” over and over in his mind. However, the more he attends to those thought intrusions, the more intrusive they become. Learning to shift attention away from those intrusive thoughts and into the moment at hand allows those intrusions to lessen, and daily functioning to increase."

Individuals who suffer these symptoms will often attempt to cope with them by learning ways of behaving that have the short term effect of avoiding and escaping from situations and events which invoke them. As a result, high incidences of drug/alcohol abuse and addiction, interpersonal conflict, domestic violence, divorce, depression and suicide are characteristic outcomes for those who suffer from PTSD.

One promising treatment for combat-related PTSD outlined by these authors is Zen meditation (zazen). These authors assert that, ... "when engaged in Zen meditation, patients significantly reduce their sympathetic arousal, even without controlling their breathing or otherwise consciously manipulating their physiology." This ability to reduce sympathetic arousal helps veterans to tolerate intrusive memories and thoughts and respond more favorably to treatment for PTSD.

In addition to the psychological distress outlined above, veterans who suffer from PTSD may also suffer a "spiritual crisis," as a result of their combat experiences according to Figley and Nash:

"The direct spiritual consequence of participation in war has only recently begun to be studied, as has the potential role spirituality may play as a healing resource for those recovering from the war zone trauma. Researchers and theorists about the effects of trauma have suggested that traumatic events frequently call into question existential and spiritual issues related to the meaning of life, self-worth, the safety of life (Janoff-Bulman, 1992)."

The authors go on to state that spiritual practices and activities that are "inward and outward focused," can be incorporated to heal the spiritual consequences associated with combat-related PTSD. Specific recommendations for healing the spiritual wounds of combat involve the following:

"A variety of inward experiential exercises involving meditation, breathing, guided imagery, and silent prayer are appropriate. ... From an outward perspective spiritual practice should include service and work on behalf of others. ... Service for others ... is a way of creating personal meaning and living a life that matters."

Mindfulness-based experiential psychotherapies such as Mindfulness Based Stress Reduction (MBSR), Dialectical Behavior Therapy (DBT), Mindfulness Based Cognitive Therapy (MBCT) and Acceptance and Committment Therapsy (ACT) are a new class of treatment approaches that rely heavily on Buddhist concepts and practices. It turns out that these therapies are deeply rooted in practices that promote prajna wisdom and compassion and have shown promise as evidence-based treatments for PTSD.

As more and more young men and women return from combat duty in Iraq and Afghanistan, socially engaged Buddhist practices and modern day therapies based on ancient wisdom traditions have much to offer those who have suffered severe trauma in war.