Psychiatrist: Peacekeeping too passive for peace of mind

[The Bread Guy]

Shared in accordance with the "fair dealing" provisions, Section 29, of the Copyright Act - http://www.cb-cda.gc.ca/info/act-e.html#rid-33409

Soldiers better off fighting
Peacekeeping too passive for peace of mind, says psychiatrist
CHRIS LAMBIE, Halifax Chronicle-Herald, 5 Jul 06
http://thechronicleherald.ca/Front/514286.html


Fighting war might be easier on the head than peacekeeping, says a Halifax military psychiatrist who recently returned from Afghanistan.

Canadian troops are now involved in combat operations in the volatile southern province of Kandahar.

"In some ways, combat is psychologically better for people, for soldiers, because you’re not as helpless as you are as a peacekeeper," said Maj. Rakesh Jetly, the psychiatrist in charge of the Canadian Forces Trauma Centre in Halifax.

"As a peacekeeper, you have to sort of stand there as a passive witness to terrible things that are happening."

Maj. Jetly returned to Halifax recently after spending two months with a mental health team treating coalition soldiers and civilians in Kandahar.

In 1994, he served as a doctor with Canadian troops deployed to Rwanda. The central African country’s bloody genocide of more than 800,000 members of the Tutsi ethnic minority and politically moderate Hutus, orchestrated by Hutu extremists, is widely seen as one of the worst humanitarian disasters of recent times.

"When we were in Rwanda, you were trying to help people, but then there were so many rules in place and so many things that you can’t do, that you start to feel unhealthy," he said.

The same phenomenon was at play with Canadian troops in the former Yugoslavia, Maj. Jetly said.

"You may see something bad happening, but the rules of engagement say it’s not your job to intervene," he said.

"In Afghanistan, if you see something bad happening, you can intervene."

That means soldiers can react the way they’re trained to, Maj. Jetly said.

"Which I think could be psychologically healthy. But, by the same token, the intensity of the combat is incredible, so there is a very, very large number of threats that people are feeling. People are being hurt. We’ve had casualties; we’ve had deaths, so those will take their toll."

Since 2002, 16 Canadian soldiers and one diplomat have died in Afghanistan. Many others have been injured in rocket attacks, bombings and road accidents.

While the Halifax psychiatrist is quick to say "there really isn’t a lot of strong evidence" to support the theory, he said the concept of a "psychologically good war versus a psychologically bad war" is often the topic of conversation among conferences of his peers.

"For a soldier, being shot at or shooting at somebody is likely less harmful to them than watching a four-year-old get hurt."

Military mental health experts are on the lookout for soldiers suffering from post-traumatic stress disorder.

While the diagnosis has only been around for about a quarter of a century, people have long known that when soldiers return from war, they’re different, Maj. Jetly said. They can experience "massive changes in personality," become more aggressive and may use drugs, alcohol and gambling as coping mechanisms.

"They may have been the life of the party and now they’re quiet."

Returning soldiers bogged down with depression and apathy may need treatment.

"Basically an event occurs, or a series of events occur, that overwhelms a patient’s coping mechanisms," Maj. Jetly said. "As the event is occurring, the person will react with extreme horror, helplessness (and) fear."

It could be triggered by a roadside bombing "where you see friends blowing up in front of you," he said.

People tend to revisit such traumatic events, Maj. Jetly said.

"It can be re-experienced in many ways, including nightmares and flashbacks where you feel like you’re back there again. You might get physiological arousal; you might start to feel chest pain or headache or funny feelings in your gut when you’re reminded of the event. You might have psychological reaction when reminded of the event in the sense that you might feel irritable or angry . . . or sad."

People start experiencing "avoidance symptoms," he said, staying away from anything that reminds them of the traumatic event, such as crowded places.

"The last group of symptoms are called hyper-arousal, which is irritability, difficulty sleeping, and also just hyper-vigilance — just being on guard all the time. "

( clambie@herald.ca)

 

[Haggis]

As time progresses, it will be intersting to see the comparison of PTSD rates between "now" and "the good ol' days of peacekeeping".

 

[GAP]

Over the years, in talking to many, many Viet Nam vets, most did not suffer from what PTSD is being described as. They came back, got on with their lives, remembered the good, funny times, put the rest in a cubbyhole, to be dissected one small bit at a time, and in most cases simply ignored/forgotten until a key word/issue brings it out. (boy, with MJP in the sandbox, did it ever bring back lots of keywords!!) The main thing that I want to emphasize is the people got on with their lives, didn't dwell on issues that grew as the story grew, etc. In some cases, even while we in-country, we could tell some people would use the situation we had dealt with as an attention getter, just their personality, I guess. Others, well, they shouldn't have been there in the first place. It was a day and an age of telling people to "suck it up... puppy" attitude.

The article mentions one thing that I found myself and most others described, probably better than me. Hyperawareness. At night ( and day) sound is your friend. You identify each and every sound and categorize it as threat/non-threat, and move on. Even now, every sound I hear at night, from my sons coming home and immediately thinking "Ah,...they're safe now" to street noises, I still categorize everything. No, I am not a raving maniac or any of that nonesense, but it is such a habit, I felt more comfortable doing it, than losing it.

Just a thought

 

[Hot Lips]

As time progresses, it will be intersting to see the comparison of PTSD rates between "now" and "the good ol' days of peacekeeping".

Indeed Haggis

HL

 

[Scoobie Newbie]

I have often wondered how the WW1 and WW2 vets fared.

 

[paracowboy]

I have often wondered how the WW1 and WW2 vets fared.

Great-Granpa on Dad's side fought in both, and Grandpa on Dad's side fought in WW2. Grandpa on Mom's side fought in WW2, as well. All 3 scoffed at the concept of PTSD after the war. (Which makes me question their honesty a bit.) I know that Grandpa on Mom's side had a flashback on his deathbed to Normandy. My wife, being somewhat familiar with Infantry talk, spoke to him in terms that he understood, and he relaxed enough to pass away quietly a few hours later.

 

[medicineman]

I have often wondered how the WW1 and WW2 vets fared.

My Grandfather was one of the last dudes out of Dunkirk and then as a reward, got the dubious pleasure of fighting the Japanese in South-East Asia.  There were many things he'd gladly talk about, but some he steered away from, such as liberating POW camps the Japanese had set up, the number of people he was personally aware of he killed (he was an artilleryman, though they were used as infantry in the jungle frequently) he'd admit to 3 and quickly changed the subject. 

I think you'll find that they too have little private places nobody else is allowed into and if they become unlocked, problems arise.  I always find it interesting to watch the young guys on Remeberance Day talking to the vets - the kids think they are either a little callous about how they talk about their friends dying or they don't know how to handle it when they do the opposite and break down.

MM

 

[GAP]

the kids think they are either a little callous about how they talk about their friends dying or they don't know how to handle it when they do the opposite and break down.
MM

Friends dying or being injured, I have found, were always talked about shortly after the action. Lots of black humor, jokes, cliches, but for the most part it was dealt with right there and then, and we moved on.

 

[Kat Stevens]

I can see the value of this, and I think it's spot on.  It was once called combat stress, wasn't it?  Having never been in combat as my disclaimer, I would argue that combat RELIEVES stress, it's the anticipation of it that creates stress.  I'd much have preferred a somewhat clearly defined enemy and a clear goal, than be surrounded on all sides by people who didn't want me there in the first place.

 

[medicineman]

Friends dying or being injured, I have found, were always talked about shortly after the action. Lots of black humor, jokes, cliches, but for the most part it was dealt with right there and then, and we moved on.

I've noticed alot of stuff coming back out on Rememberance Day from people - hence the name of the day.  I think a few wobblies at the Legion loosens things up as well mind you...

Weird one from my own point of view, I was at the War Museum in Ottawa one dreary Remeberance Day looking through the newly opened UN exhibit there.  I was in uniform still, just looking around with the rest of the customers, chatting with vets and such.  I came across a picture of some engineers doing a minefield breach and I recognized a couple of them - I guess I must have gone a little pale because somebody asked me I knew anyone in  the photo - I replied "Yes, all of them, but the guy in the front was killed about 2 weeks after the photo was taken".  Dude and his wife went pretty quite, picked their chins up off the floor and that was the last I heard from them.

MM

 

[HItorMiss]

There is a picture in the War Museum that when I took my family and in-laws past made me nearly break into tears I hurried past without a word, while my Mother in law asked my wife what the problem was. My wife quietly informed her as to who it was (though how she didn't know in the first place is beyond me) and we moved on it wasn't spoken of again.

Your right it's all put into tiny little corners we don't go into much except on "special" occasions and even then no matter how many time we go there hurts just as much. I find that unless your talking to someone with similar experiences they just don't get it and never can.

 

[KevinB]

I am not surprised -- The US Army noticed a remarked increase in PTSD cases in its foray in the Balkans that it had in its war fighting endevours.

I was talking to the CWO(3) who ran the SOTIC program in Ft Lewis for 1SFG - he said on his WO course they covered the issue that people with a clear focused mission did not have the same issued that the peacekeepers did.  Peacekeeping (at least under the UN) had been a terrible experience - underarmed or impotent sometimes being forced to stand aside while people are masacred in close proximity, or seeing the aftermath of "ethnic cleansing" (damn can't say genocide can we anymore the UN would be forced to act...)

The other issue was that the SF guys who had been a lot more active in peacetime than the big army had WAY lower rates of PTSD -- with the corelation that the better trained and prepared one is the greater the chnace for sucessfully dealing with the issues that arrise.

 

[Michael Dorosh]

I think you'll find that they too have little private places nobody else is allowed into and if they become unlocked, problems arise.  I always find it interesting to watch the young guys on Remeberance Day talking to the vets - the kids think they are either a little callous about how they talk about their friends dying or they don't know how to handle it when they do the opposite and break down.

Talking to vets is an art form to itself - just knowing the right language to use is tricky, and a little research goes a long way. It's all common sense stuff, really - if you know the name of the guy's company commander or battalion commander, and know what he means when he says they had a TEWT or practiced TOETs or left the "Start Line" or any number of expressions that may or may not be the same anymore, they are far more likely to open up. Most families, no shame to them, just wouldn't be able to speak the same language or know what to talk about. It's often the little questions that lead to the big stuff - starting out with "how old were you when you joined" and "what did your mom think about that" often gets you to the military stuff.  If you can throw in a "oh, you were in D Company? Wasn't Bruce Mackenzie your company commander there? What was he like?", it helps out a lot.

Though I find a lot of vets, being of that generation, would rather talk about how they fixed their house up last year or what kind of car they drive rather than their war experiences. Not all of them enjoyed the Army lifestyle in any event and just wanted to get the hell out and go back to farming. Those kinds retained few good memories, and nothing wrong with that either, was their choice.

Re: the flashback to Normandy on the deathbed. That's not a military thing specifically; I had an uncle who died in about 1999 - he spent the last couple of days in a small town in Saskatchewan in about 1964; just happened to be where the mind took him. Though I've read of a lot of deathbed apologies by veterans - to men they had killed in action. Paul Gross is basing his next movie on such a recollection.

 

[IN HOC SIGNO]

I was Chaplain at the OTSSC in Victoria for a while in the early part of this millennium. The WW2 Vets are coming forward now that there seems to be a recognition that they may have suffered. You have to remember the era they came from. It was unmanly to admit that you had a problem with anything that went on over there. They came home and, as others have stated, they filed it in the back of their heads. They had their nightmares and their times of depression and a lot of wives and girlfriends looked after them....God bless them all.
In an agreement with Veteran's Affairs we are treating these folks at our OTSSCs. PTSD is real and it's not new. They have moved on but in some cases they have never exorcised the demons.
The long ocean voyages back home in the old days helped cause they were with their buddies and their comrades and they got to process some of it and defuse each other. Today when you are in theatre one minute and back in Canada within half a day there is no time to normalize and get perspective. Many suffer from an inability to rationalize their experience in theatre to the daily triviality of life back home (incongruity).
We have a long way to go in understanding fully about all of this but at least we've started the process.
I know a lot of guys were really upset in the days when we had no power within the ROE to stop atrocities, It'll be interesting to see how the more robust missions effect our folks.

 

[3rd Horseman]

Shared in accordance with the "fair dealing" provisions, Section 29, of the Copyright Act - http://www.cb-cda.gc.ca/info/act-e.html#rid-33409

Soldiers better off fighting
Peacekeeping too passive for peace of mind, says psychiatrist
CHRIS LAMBIE, Halifax Chronicle-Herald, 5 Jul 06
http://thechronicleherald.ca/Front/514286.html


"In some ways, combat is psychologically better for people, for soldiers, because you’re not as helpless as you are as a peacekeeper," said Maj. Rakesh Jetly, the psychiatrist in charge of the Canadian Forces Trauma Centre in Halifax.

( clambie@herald.ca)

That is a load of crap, Jetley should not confuse unarmed observer with a fighting soldier on a UN auth mission, their is no such thing as a peacekeeper with a loaded rifle just a soldier doing his best. Why do we keep using the word that the media gave us. Soldiers who fought at Medak and all the other nameless places in the bulkans during the war had no issues with the so called peacekeeper word, it sure didn't slow down the full rate of fire from a 50 or section of rifles when it was called upon. Never figured the fire for effect from a Regt of 155 guns firing under a UN flag was a helpless act. {Peacekeepers} killed alot of bad guys in the good old days.

 

[DBA]

That is a load of crap, Jetley should not confuse unarmed observer with a fighting soldier on a UN auth mission, their is no such thing as a peacekeeper with a loaded rifle just a soldier doing his best. Why do we keep using the word that the media gave us. Soldiers who fought at Medak and all the other nameless places in the bulkans during the war had no issues with the so called peacekeeper word, it sure didn't slow down the full rate of fire from a 50 or section of rifles when it was called upon. Never figured the fire for effect from a Regt of 155 guns firing under a UN flag was a helpless act. {Peacekeepers} killed alot of bad guys in the good old days.

You need to reread the article. Summed up it says: Situations where soldiers are blocked from intervening may produce more stress and problems than those in which they can act. It uses the general characteristics of several recent missions to illustrate this. That none of the missions are monolithic in soldier's experiences in being able to act or not act has nothing to do with the main premise of the article.

 

[Gronk]

Just because Canadians saw combat in FRY, does not make that mission a combat one. There is a huge difference in ROE's between a UN mission and the current one in Afghanistan. I think Jetley is bang on. I know what it feels like to be unable to stop atrocities from happening.To be able to take the offensive in Afg was a relief to my mind.      As an aside,  I've spoken to a psychologist who attended a PTSD/OSI conference and he told me that it was accepted by everyone there that "peacekeeping" caused more problems with with PTSD than combat.

 

[3rd Horseman]

Gronk,
       
       ROEs do not make the difference as to a combat mission or not, we are playing with words here, combat is combat, FRY was combat, A stan is combat. They shoot at you, you shoot at them rather sums up combat in my mind. The ROE in the FRY never stopped soldiers from getting involved, they were complicated but very robust if you wanted to get into the action. The proof is the amount of ammo that went down range at the bad guys....lots. Some may not have gotten involved due to weak command using ROE as a limitation, others got right into the thick of it, its all about leadership and doing the right thing.
     I completely agree with your comments about taking the offensive, taking to trigger makes the day all that much easier on the soldier at the end of it all. Many took the offensive in the FRY some did not, that had nil to do with ROE from my perspective.
     I agree on your point of {Peacekeeping} combat ops taking a greater toll but for other reasons than illustrated. The issue with {Peacekeeping} UN combat is that you face two or as in the FRY three foes not just one like in A stan. The issue of fighting three EN and being surrounded is the stress-or not the inability to react (less unarmed mission).

Edit typo

 

[Gronk]

3rd Horseman,
                        I would have to disagree with you. The ROE's from FRY DID stop, or delay soldiers from getting involved in many cases. For example, belligerent roadblocks
would stop Canadian UN troops from moving into an area where fighting/cleansing was going on. Our ROE's dictated we could not pass by using force. Then the negotiations would begin, ( Often it was only a few guys with AK's and AP mines). By the time we got there, the damage was done. I've personally reported atrocities to higher (I was a no hook private at the time) and was told, "Roger, keep observing". I don't accept that my commanders were not aggressive enough or didn't want to get involved. Our hands were
tied by ROE's. We were ALL there to do the right thing.
  I don't think the amount of warring factions has anything to do with it. Our enemy in Afg is taliban/al queda, but they are not an organized army. They are an enemy of unlimited factions.
                                            Cheers,
                                                            Gronk

 

[3rd Horseman]

Gronk,

    I can agree with your first line that it did cause some problems but road blocks never stopped myself nor those I commanded from crossing them with violence. It is all about the perception, ROE in the FRY allowed for you to cross check points, if they would not yield to you then the ROE gave you the right to cross with force if need be. Most of the time it was always a bluff on the EN part and they never fought on crossing a road block. But I can tell you that on several occasions they did fight and at that point we used ROE to fire on them and cross. I can give many examples of road blocks that were breached with violence. But again as many more stopped soldiers from crossing because they did not want to get into the fight either by own choice or by commanders who chose to use ROE as an excuse not to fight. I could send you a nice video of the assault on Serb 1 check point, nice combat footage. Those that know of that check point know it was a tough one to cross, we crossed in 20 mins with full destruction to the check point and customs house and barracks. The Coy deffending also was decimated. The combat team attack on the bridge check point in Sarajevo by the french is just another example.

  On the issue of PTSD on the size and configuration of forces I think you are wrong on that issue. I would suggest that PTSD is more acute in soldiers that have several enemy such as FRY, less in the typical UN op were you have two and last but not least the A Stan which has a insurgent force. Finally the easiest for PTSD is the standard en with defined uniform and location.

  So on that I guess we agree to disagree.

Cheers