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William Gonzalez
Instructor: Malcolm Campbell
English 1103
May 4, 2016
Combating the Ghosts of War
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 PTSD.
They bring home an invisible enemy that is sometimes even more dangerous.
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.
For soldiers 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 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
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. The goal of the class
is to strengthen soldiers natural resilience, and to help deal with depression and other chronic
diseases.
Back in Afghanistan, we laid on our cots, unaware of the passing of time. Could have
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.

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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?
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,
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. The latter, which is the feeling of never being safe
and always being on guard, often contributes greatly to insomnia. Use of these medication, 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 would 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.
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

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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
have chosen to stop taking them all together. Instead seeking a non-pharmaceutical approach to
PTSD.
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 cognitivebehavioral 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
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
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

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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
process. The goals here are to; normalize the symptoms, gather information, instill hope, and to
promote communication with self and with the therapist. (Moore)
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.
Majority of patients who go through the complete 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