Gonzalez 1

William Gonzalez
Instructor: Malcolm Campbell
English 1103
April 26, 2016
Combating the Ghosts of War
One by one we return slowly to our cots, utterly exhausted, and without a thought we
pass out face first into our pillows, not even bothering to take off our clothes and gear that are
drenched from many hours in the Afghan heat. One by one we drag ourselves into the crowded
little room, without a sound except for boots shuffling and the creaking of our cots. We dont
waste our breath, because we know that we will be going back out soon enough. This time is
crucial. Firstly because we need our rest for follow-on missions that will inevitably come, and
second because our minds need to be turned off.

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paragraph to start with narration

Since 2001, America has been in a constant state of war against a faceless enemy without
a uniform. An enemy that is not a person, but an ideology that does not seem to have an end in
sight. Many brave men and women have volunteered to do their part to combat this new threat.
They have experienced the harsh realities of war that most people will never know, and in many
cases, have brought some of that reality home. The U.S. Department of Veterans Affairs
estimates that 11 percent of veterans coming home from the war in Afghanistan have posttraumatic stress disorder (PTSD). They bring home an invisible enemy that is sometimes even
more dangerous.

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As a soldier out on patrol, your mind is always racing. We train our bodies daily while
we are back home to make sure that we can physically do what needs to be done, training that

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includes walking six, eight, twelve, even twenty-five miles if we have to, with anywhere between
35 and 100 pounds on our backs. We do: hill sprints, jumping jacks, lunges, squats, presses,
burpees, tire flips, sleigh drags, step-ups, push-ups, sit-ups, pull-ups, V-ups, (lots of ups) all to
prepare our bodies for the great challenges that lay before us. It was a very clear goal, we knew
that we would be walking up mountains, we knew we would be carrying heavy things, so we
knew how to train for it. While it is true that you can never be completely prepared for combat,
our bodies were the closest.
The mind on the other hand is a very complicated thing to train. The Army knows this
and has put into practice a few different mandatory classes that soldiers must go through before,
and after deploying, like resiliency training. This training attempts to teach soldiers that when
they get knocked down, mentally or physically, to bounce back up, like a tennis ball. One of the
primary pieces of this training is the ATC model, which breaks down how situations can play
out, negatively or positively. ATC is an acronym that stands for, activating event, thoughts, and
consequences. It shows the soldiers how to identify situations, and see the different ways they
could play out. For example, an activating event or situation could be going to the mall. Once the
soldier is at the mall we evaluate some possible thoughts that he may have, such as, Something
bad is going to happen, This place is dangerous, or Something is wrong with me. These
thoughts are known as thinking traps, or thoughts that will lead to a negative outcome. Some
consequences of this thinking could be nervousness or anxiety, which could trigger a fight or
flight reaction, causing the soldier to either want to escape or causing hypervigilance and
aggression. After identifying these possible outcomes, we try to change the soldiers ways of

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thinking to more positive ones such as, Lots of people go through this, and Transitioning back
from a combat zone takes time, since the activating event cannot always be avoided. This new
way of thinking should also change the consequences to positive ones like being more confident
in the situation, and being more tolerant of ones own emotions. After understand is taught to the
soldiers, we teach them the next step which is to Hunt the good stuff, or to see the Silverlining in everything. This is done most easily by practicing good humor, which is the hallmark
of any resilient soldier. The overall goal of the class is to strengthen soldiers natural resilience,

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and to help deal with depression and other chronic diseases.

Back in Afghanistan, we lay on our cots, unaware of the passing of time. Could have

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been an hour or a day since weve been in our hazy sleep. But that was the point, to not worry, to
not think. The point was, to allow our minds to defragment, much like a computer. This crucial
time is a must if the mind if going to be ready for the next mission. It doesnt have to necessarily
be sleep, to even rest for a few minutes would at least get some space cleared in our heads. The
unfortunate few who suffered from insomnia, just laid there, staring at the ceiling. Many nights
and days like that are starting to take their toll; they are noticeably less cheerful. The depression
starts to affect everything else, the mission, their relationship with their team, and even the
relationships back home.
Despite the Armys efforts, according to the Department of Veterans Affairs 2012
Suicide Data Report, 22 veterans commit suicide every day. This raises some questions: what
can be done? What treatment or medication can we prescribe to these individuals to help lower
this number? There are myriad medications that have been used to help veterans deal with PTSD,
but do they actually help?

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Gonzalez 4

For soldiers dealing with any kind of mental illness, whether that be anxiety, depression,
bipolar disorder, or PTSD, there are medications that can help deal with these. Currently, the
only FDA approved medications to treat PTSD are Selective Serotonin Reuptake Inhibitors
(SSRIs), specifically Zoloft and Paxil (Jeffreys). These drugs block the chemical serotonin,

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which is linked to mood, from getting absorbed by brain cells. The four main symptoms that
these medications are trying to treat are; intrusion, avoidance, negative or possibly harmful mood
swings, and changes in arousal and reactivity. Some examples of Intrusion are; nightmares,
invasive thoughts, and unwanted visions of past events that cause emotional distress. This is the
symptom that is typically thought of when thinking of PTSD. Avoidance is when the person
intentionally avoids certain places, names, or topics in an attempt to not be reminded of the
traumatic event. Negative alterations in mood and cognition is the symptom that I feel like I had
the most personal trouble with. It is the unreasonable blame of self or others, the feeling of being
alienated while with friends and family, and the inability to feel emotions, or a numbness. Lastly,
changes in arousal and reactivity can lead to feelings of never being safe and always being on
guard, trouble falling and staying asleep, and possibly the most dangerous symptom, selfdestructive behavior.

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Use of SSRIs, as well as some over the counter drugs, help soldiers in combat to
maximize their downtime by allowing them to get much needed sleep, and thus help with
overall mission readiness. However, I have personally seen very few cases where soldiers admit
to needing these medications, as it is seen as a career-ending statement. While it is not an official
policy of the Army to send a soldier home if he requests medication, often times the unit
commander will replace the soldier in the squad by moving him to a less kinetic job, such as a

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Gonzalez 5

radio operator or gate guard. This denies the soldier much needed experience in his job and will
put him behind his peers for promotion.
Its a bright, chilly night in Afghanistan, the moon is high in the night sky giving great
visibility. We dont even need a red flashlight or night vision to navigate the forward operating
base (FOB) tonight. Everything is as clear as dayand that is a dangerous thing. They usually
dont attack at night, we do, it is when we have the technological advantage, so Gilbert and I feel
safe walking around outside. Plus, if any rocket attacks were to happen, the radar would pick it
up and sound the alarm, giving us at least a few seconds to dive for cover. Man I wish I was at
this FOB with you Gonzo, shit is crazy here, Gilbert says with a smirk. Gilbert and his squad
are visiting my isolated little FOB from a much larger one about 50 clicks away, a large
operation was going on this week and our commander had requested reinforcements. Hed been
here for less than a week, and he had already seen some action. We walked into two near
ambushes that week, and had some recon missions go south when the enemy started dropping
bracketed mortar fire near us. Earlier that same day, his mine-resistant ambush protected
(MRAP) truck had hit a pressure plate triggered improvised explosion device (IED) that had
mangled the front half of it. Luckily the Army learned from Iraq and built the new trucks pretty
tough, he walked away with only mild symptoms of traumatic brain injury (TBI) and a fun story
to tell the boys back home. I figured you had your fun already this morning, I reply, shaking
my head. He laughs, No way man, this is it, this is what we trained for. I didnt go to ranger
school just to fuck around stateside my whole career. This is our job brother, were are living it!
A few moments later we hear an eerily familiar high pitch whistle. At first it was very faint, then
got much louder and lower in pitch as it flew meters over our head. BOOM! Shrapnel and rocks
zip past us as we both instinctively put our arms up to shield our faces. Before the dust settles,

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who request medication

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we are sprinting to the nearest bunker before any more hit. We meet Bridge, Chisholm, Bradley,
and a few others from our scout platoon who ran inside the same bunker. Everyone good?
Bridge says as he starts patting Chisholm down. What the fuck, where the fuck was the
alarm?! Chisholm grunts angrily. Gilbert looks up at us, and even in the night shadows, we can
clearly see the fear in his face as he holds his right arm. Bridge scoots past us to get a closer
look. Shrapnel, or a rock turned projectile, had made a deep, jagged laceration across the
underside of his wrist, severing tendons. Gilbert stares at Bridge with unflinching terror in his
eyes, Dont let them send me home.

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PTSD in soldiers

Medication can be used for a positive effect, but many soldiers see it as a Band-Aid on
the problem. For those who do seek medication for PTSD, they are often given many drugs that
are off label. These drugs include Prozac, Vicodin, Percocet, Motrin, Lidocaine, and Seroquel,
just to name a few. These off label drugs are easily abused, and dont target any specific
problem. It is a type of recon by fire, which is what the military does to try to locate or entice
an enemy into the open. They shoot without a specific target in a general direction to see if there
is anyone there. In the same way, the military shoots many different medications at a problem
in hopes that it will hit the mark or at least find the issue. While this method can be used to
positive effect in a tactical situation, it doesnt quite work with PTSD. With this unfocused tactic,
soldiers have reported feeling like a zombie, or a situation in which a soldier said, Id take all
my medication, and I'd sit down, and a whole entire day would pass, and I would just get up and
go to bed (Lawrence). In an attempt to break the addiction to some of these drugs, some soldiers

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have chosen to stop taking them all together, instead seeking a non-pharmaceutical approach to

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PTSD.

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Many non-pharmaceutical solutions have been tried, but prolonged exposure (PE)
therapy has one of the highest evidence-based success rates dealing with PTSD (Jeffreys). An
alternate approach for soldiers coming home, prolonged exposure therapy is a type of cognitive-

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behavioral therapy. It helps by forcing soldiers to confront the traumatic events that they
experienced overseas by talking about the situation and recreating it in their minds. Overtime,
this exposure can alter the way they perceive that situation.
There are four parts to prolonged exposure therapy: repeated revisiting of the traumatic

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memories, repeated exposure to avoided situations, education about common reactions to trauma,
and breathing retraining (Moore). The first step of the PE process is to repeatedly tell the story of

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the traumatic event. For example, if a soldier witnessed an EID blow up the truck in front of him,
he would need to explain the whole story leading up to the event. He would then need to explain
exactly what he saw and what happened afterward. By doing this, he is normalizing the
situation, allowing the repetition of the story telling process to make it less painful to talk about.
The next step would be repeated exposure to the avoided situations, also called in vivo
exposure. During this step in the process, the soldier would be exposed to feared situations. For
example, if the soldier experienced a suicide bomber in a crowded bazaar while deployed, then
he might have developed a fear of being in crowded areas such as malls or fairs. In vivo exposure
would repeatedly put the soldier in those places, to show the benign nature of them.
Perhaps the most important step in the prolonged exposure process is the education of
how PE works. This is the gathering of information, and gaining an understanding of the entire
process. So when you are exposing yourself to things that you would have otherwise avoided,
you understand that it is not masochism, but that it is a very important part of the healing

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Gonzalez 8

process. The goals here are to normalize the symptoms, gather information, instill hope, and to

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promote communication with self and with the therapist (Moore).

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The final part of PE, is breathing retraining. This is similar to the deep breathing
exercises that are taught to most people as a way of dealing with anxiety. When a soldier, or
anyone, is dealing with a difficult situation, arousal control can be a quick and effective way of
lowering stress levels. However, retraining your breathing is not enough to deal with PTSD
alone, and is intended to be used along with the other steps of prolonged exposure therapy.
Gilbert has been home for 4 months. After the rocket attack (that could have been much
worse) he spent less than a month in Germany recuperating before being sent back to Fort Drum.
He was the only soldier from his platoon at work, every day, Monday through Friday. The only
requirement was to check in every morning at formation, then he had the rest of the day to think
about his brothers still in harms way, to regret not being there. Gilbert, like many other soldiers,
experience traumatic events and then get sent away to recover in isolation from their home unit.
He is forced to go to a few sessions of counseling, but that sense of alienation makes it hard to
communicate with anyone. His only counsel are the pain meds that he eats like skittles, and his
new friends Jack, Jim, and Jameson. According to the National Center for PTSD, about 1
in 10 soldiers returning home from war have these same problems with drug and alcohol abuse,
but in an infantry line company I would bet it is a much higher rate. Eventually, when Gilbert
hits rock bottom he seeks help through medication. They give him Prozac, an SSRI, to help deal
with his crushing depression from isolation.
A few months later, the rest of the platoon returns home. Even though they experienced
many more hardships in those last few months, their mental health is much better than that of
Gilberts. This is because when the platoon is all together, they unintentionally practice the first

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two steps of the prolonged exposure therapy, repeated revisiting and repeated exposure. Those
events, like seeing a comrades truck get blown up in front of you, or witnessing a brother get hit
by shrapnel, are discussed over and over. They each take turns telling the story from their
perspective, recreating it in their minds many times, normalizing it. Every day they patrol past
those same spots where these events took place, repeated exposure being forced upon them. Over
time this helps to heal the mental wounds that they received. When Gilbert is finally able to be
reunited with his platoon, and talk about the many things that they went through together, he too
starts the path towards recover, and begins to get better. The Selective Serotonin Reuptake
Inhibitors may have bought him the time he needed, when dealing with depression, to start the
more long term healing process of talk therapy.
The Majority of patients who go through the complete 12 week prolonged exposure
therapy, achieve remission or have a significant reduction in symptoms (Moore). So while
medications and prolonged exposure therapy both can help soldiers to overcome their PTSD,
they are best used in concert with each other. Medication for the short term fixes, to complete the
mission, and cognitive behavioral therapy when time permits, for long term health.

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Works Cited
Jeffreys, Matt. Clinicians Guide to Medications for PTSD. U.S. Department of Veterans
Affairs. Web. 15 Mar. 2016.
Kulkarni, Madhur, Katherine E. Porter, Sheila A.M. Rauch. Anger, dissociation, and PTSD
among male veterans entering into PTSD treatment Journal of Anxiety Disorders
(2011): 271-278. ScienceDirect. Web. 15 Mar. 2016.
Lawrence, Quil. Veterans kick the prescription pill habit, against doctors orders. National
Public Radio, 11 July 2014. NRP.org. Web. 15 Mar 2016.
Moore, Bret A., Walter E. Penk. Treating PTSD in Military Personnel: A Clinical Handbook.
The Guilford Press, 2011. Print