STARLIGHT
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Capt T. Eliasson, CCFP, MD is a family physician with the Canadian Forces Medical Group Headquarters, Detachment Edmonton, who works at the Garrison Edmonton Clinic. She is a graduate of the University of Alberta and received her certification from the College of Family Physicians in 1995.
What is PTSD?
I remember hearing about post traumatic stress disorder (PTSD) briefly in medical school and did not think much about it until I started practising as a General Duty Medical Officer (GDMO) in 1995. It is a psychiatric condition that is defined by a patient having an unusual human experience that is distressing. The traumatic event is persistently experienced (i.e.flashbacks). The patient also avoids any stimuli associated with the trauma and has persistent symptoms of increased arousal, i.e. irritability or anger.
Who gets PTSD?
In my three years of family practice in the military, I have seen patients who have developed this condition after tours in Bosnia, Cambodia, Rwanda and Somalia. It affects non-commissioned members and officers, medical personnel and combat arms soldiers. The only other thing these people have in common, besides their cluster of symptoms, is the fact that they tend not to seek medical help until they are unable to function at home or work.
I think the reason for this late presentation is two fold; the first may be the stigma that surrounds a "mental illness" and the fear that their superiors will gain knowledge of their condition, the second is the fear of a medical category downgrade with the potential for release if they are considered unfit for deployment.
How do we screen for PTSD?
The current screening program at the Garrison Clinic Edmonton is called the
"post-UN medical." At this appointment, it is hoped that the member will
disclose any difficulties he or she may be having. I don't know for sure,
but I suspect a lot of cases are missed. Apparently, the Area Social Work
office has a new PTSD screening program for the reservists who come back
from UN tours, although it is still in is early stages.
What do we do when a patient presents?
For members who present to the Garrison Clinic Edmonton with symptoms of PTSD, a GDMO has a few options. There are two military psychiatrists on staff who are available for consultation. Dr. Passey, one of the psychiatrists, has an expertise with this condition and is a super resource. There is also a civilian psychologist who has been working with the military for several years and has practical experience with PTSD. Finally, the social work department and the Chaplains are always ready to lend a hand.
There are two groups of people who are probably lost to follow up. The first are the reservists who cope on their own with this condition for months, sometimes years. Because they do not receive medical care through the Forces, they may present to a civilian doctor with PTSD symptoms. Their physician probably does not understand the military culture, is probably not well versed on PTSD, and may not have the resources that are available to the CFMS. All these things together would leave the reservist with a hard road ahead. The second group of people who are lost to follow up are the regular force members who choose to leave DND because of PTSD symptoms. Instead of going through the pain of dealing with their illness, they leave the military, hoping that their symptoms will be left behind too.
What can we do?
In my practice, I am seeing more and more members "coming out of the wood
work" with this condition. At Garrison Edmonton, we do have resources to
help them. Yet, it seems that we are "closing the barn door after the
horses have escaped." I believe that this is an area that requires
Director of Medical Service attention. It would be most helpful if a more
effective screening program was developed and if a PTSD program/team was
available for consultation when needed. With education, we would be able
to destigmatize this common condition and encourage all military members to
present for treatment at an earlier stage.