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The Future of Trauma

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Post-Traumatic Stress Disorder (PTSD) has been a mental health condition, classified in the Diagnostic Statistical Manual (DSM) of the American Psychiatric Association (APA), since 1980.

The Diagnostic Statistical Manual (DSM-III) in 1980 classified PTSD as an anxiety disorder, DSM IV (1994) and DSM-IV Textual Revision (TR) also reaffirmed PTSD as an anxiety disorder.

DSM-5 (2013) reclassified PTSD as a Trauma and Stress-Related Disorder.

PTSD in terms of its longevity, 35 years as a recognized diagnosis, can be seen as a young adult. However, the phenomena of intrusive thoughts, nightmares, startle response, psychic numbing, foreshortened sense of the future, avoidance and problems modulating mood due to the exposure of trauma go back to at least the Peloponnesian war.

I have been working with people with Post-Traumatic Stress Disorder since 1985. At that time, I started seeing military personnel suffering from addictions who were also presenting with a lot of anger, hyper-vigilance, problems with their mood that really referred to other challenges than their problems with alcohol or drugs.

Post-Traumatic Stress Disorder (PTSD) refers to the inability of a person to process trauma that may have resulted from exposure to war, physical or sexual violence, natural disasters like hurricanes or earthquakes, terrorism or events like motor vehicle accidents.

Since 1980, Post-Traumatic Stress Disorder has progressed from being seen initially as a disorder afflicting those who were engaged in direct military combat to now being inclusive of those who have experienced sexual assault, including those who are military service members and veterans who have suffered Military Sexual Trauma (MST).

PTSD affects the patient, the spouse or partner, children, other family members, friends, the greater community, even mental health providers.

Effective interventions for PTSD have included Pharmacotherapy, e.g., use of medications like Sertraline (Zoloft), Paroxetine (Paxil) and other medications. Effective psychotherapy treatments have included Cognitive Behavioral Therapy (CBT), Exposure Therapy, Prolonged Exposure Therapy, Cognitive Processing Therapy (CPT), Eye Movement Desensitization Reprocessing (EMDR), Acceptance And Commitment Therapy, Virtual Reality Therapy and Psychodynamic Therapy (Lambert 2008).

Dr. Bessel Van Der Kolk, M.D. of Boston University Boston has also published research on the efficacy of Tai Chi, Yoga, and involvement in theatre as a catharsis for the treatment of PTSD (Van Der Kolk 2015).

Interventions for PTSD are also addressing the moral and ethical and spiritual injuries that are incurred as a result of being exposed to trauma (Nash, Litz 2013). Moral Injury has been characterized as being what you have experienced in trauma and how it has violated your spiritual, moral or ethical understanding of what it means to be human and what it means to have a relationship with God or the divine however known.

Regarding the future, treating trauma will continue to be a challenge that will require great utilization of health care resources and expense. Military service members, veterans who have served in Afghanistan, Iraq, Operation Desert Storm Desert Shield, Vietnam, Korea and even World War Two will still receive care along with the ever increasing numbers of people suffering from Military Sexual Trauma (MST) as well as those who have suffered physical, sexual violence, those who have suffered due to natural disasters and motor vehicle accidents.

In the future, I would foresee that we will be treating those traumatized from their experience fighting ISIS, which could be at least a ten year campaign.

I also predict that we will also be treating those who are operating drone (Unmanned Aerial Vehicles) (UAVS) warfare aircraft that are targeting and killing enemy combatants thousands of miles away from computers and consoles located in portable buildings on United States military installations.

What makes the drone worker population unique in terms of their trauma experience is that instead of being deployed for twelve months overseas to a war zone, instead the drone worker is working a twelve hour shift operating a drone from a U.S. military installation that will fire missiles at enemy combatants and kill them several thousand miles away, but there will also be a high likelihood that large numbers of unintended civilian casualties will occur (e.g., collateral damage). When a drone worker finishes his or her shift, it will not be farfetched to imagine that this worker will stop off at the supermarket and pick up some milk to take home to their family, spend the evening at home as if nothing happened during the work day and then return to the silo the next day for the next shift. There is already concern about the rising number of suicides with the drone worker population. This will radically accelerate the number of new PTSD cases seen in a medical system that is already over-burdened and is experiencing great stress.

Increasingly also there will be the phenomena of military veterans with PTSD having great difficulty engaging their adult children who are also in the military and who are suffering from PTSD.

Bottom line, PTSD will not be resolved anytime soon. We need to acknowledge that war and other forms of traumatic assault are not good for the human brain.

It's going to take all of us: the clinicians, the researchers, medical centers, universities, churches, and community service and veteran organizations, including the whole society to be sensitive to the needs of those who are recovering from trauma.

The Congress again needs to remember, "War is the last option, not the first." For those members of Congress who are jingoistic and who want to pound their chest in great bravado in supporting a new war; their behavior can be described in Jackson Browne's words

"You can count on them to tell us who our enemies are, but they are never the ones who will fight or who will die."

If you want a healthy population and a thriving society, you don't hastily start a war, because if you do the repercussions will be felt for decades and for generations.

May we have the courage to do what needs to be done and allocate the appropriate resources to heal those suffering from trauma now and always.

If you -- or someone you know -- need help, please call 1-800-273-8255 for the National Suicide Prevention Lifeline. If you are outside of the U.S., please visit the International Association for Suicide Prevention for a database of international resources.