Friday, June 29, 2007

Post-Traumatic Stress Disorder in the Foreign Service

Whenever someone mentions “post-traumatic stress disorder,” or PTSD, most people probably think of combat veterans returning from war zones. You might think of soldiers during and after the Vietnam War, and you might even think of some of the popular Hollywood movies that have highlighted the phenomenon, such as “Born on the Fourth of July” or “The Deer Hunter.”

However, we tend to neglect PTSD's effects on Foreign Service members who are placed in dangerous countries where violence is common. Such positions are termed “unaccompanied danger posts,” locations where family is not permitted to live with the Foreign Service member stationed there.

In Iraq there are provincial reconstruction teams, or PRTs, consisting of contractors who work in a particular province to meet and coordinate with Iraqis. To do this, PRT members require a heavily armed presence with them at all times. Kirk Johnson (whose interview with EPIC you can read here), a former USAID employee in Baghdad and a PRT member in Fallujah for four months, describes the heightened security risk involved with traveling outside a PRT enclave.

Foreign Service members often return from Iraq demonstrating a number of PTSD-related symptoms, including insomnia for up to several months, the most common symptom, an “easy to startle” response for several months and irritability and anger outbursts.

Sources vary regarding the prevalence of PTSD among Foreign Service Officers and the military. Some suggest that PTSD affects 40% or more Foreign Service and military members. The treatment available for returning Foreign Service members is voluntary and inadequate, prompting the Concerned Foreign Service Officers to issue a warning to members of the Foreign Service.

On June 19th, in the face of PTSD in foreign service members, the House Foreign Affairs Subcommittee on the Middle East and South Asia urged the State Department to make debriefings mandatory for civilian employees returning from Iraq and Afghanistan. A July 5 New York Times top story also cited the lack of health care availability for contractors working in Iraq. Tending to their health is the first step in the process of addressing PTSD in non-military persons and we encourage this move by the subcommittee. That said, we still require more data on the extent of PTSD in the Foreign Service and we must provide these individuals with the mental health care they require.

I recognize that you can't talk about the effects of the Iraq war without at least mentioning the enormous psychological toll the conflict has on Iraq's men, women and children, an issue we have written on in the past. It is an issue that will take an enormous amount of effort to address and one that cannot be ignored
or forgotten in this conflict.


Anonymous said...

I usually agree with the blogs on EPIC. But this is pure crap. You cannot compare combat military PTSB with diplomatic or do-good stress. Have you been in combat? Pretty soon we will have PTSB for rush hour traffic in DC!

Anonymous said...

You can't compare different cases of PTSD at all. Human psychology, while symptoms will be similar between individuals (i.e., nightmares, hyperviligance, etc.) the degree, severity, and effect it has on someone is really not something that can be generalized.

People do experience symptoms of PTSD for things like traffic accidents, and while (again) obviously not a good comparison to combat veterans - the effects of the trauma are the same - you're stuck in it, reliving it, and it interferes with your life.

Civilian service members, members of the Foreign Service - many of whom are in Iraq - can end up in situations that cause a stress reaction. Whether the experience is "bad" or "worse" - I doubt rating the tragedy of each moment is helpful. Having a tragic or painful moment seared into your mind is an individual experience, and cases should be treated as such.

What is hopeful, and helpful, for all who suffer from PTSD is the fact that the stigma associated with the disorder has decreased, there are more treatments available, and more people are able to seek treatment.

Chris Breuer said...

To the first anonymous posting: Beltway traffic has been known to cause PTSD.

Not really. I've never been in combat, thankfully. Nor have I been exposed to an event that induced PTSD symptoms. But I don't think that I must have been in combat or must have PTSD in order to write intelligently on the topic.

Note my wording: "Foreign Service members often return from Iraq demonstrating a number of PTSD-related symptoms." These symptoms can be present without full-blown PTSD, which more often appears in combat veterans. This is corroborated by the documents I cited in my entry.

The second anonymous posting said, "I doubt rating the tragedy of each moment is helpful." I would expand on that and argue that even though one person has full-blown PTSD and another person only shows symptoms of PTSD, both equally deserve the treatment he or she deserves.

jt said...

Just look at the headlines for the kid who jumped off a boat. Couldn't take living anymore after what had happened to him. Sounds a lot like this. Very sad.

Chris Breuer said...

JT, I just caught that headline myself. It's a terribly sad story. Survivors of sexual assault and rape frequently suffer from PTSD. According to this article (
Party.Attack.ap/index.html), the young man refused counseling due in part to the stigma of his attack, which weighed heavily on his conscience. It's important that, as happened after the Vietnam War, the stigma associated with PTSD be reduced so that victims feel comfortable about receiving the care they need.

Anonymous said...

Actually, Foreign Service Officers and others who work in PRTs and EPRTs embedded in US military units in Iraq share the daily risks of IEDs, suicide bombers, and snipers; when a member of their unit is hit, they share the feelings of loss; when bad things happen, they too have to suck it up and pray that they and their teammates make it back from their next time outside the wire.

Anonymous said...

For those of you willing to exhibit your ignorance by joking about a very serious disease (PTSD) incurred by very brave soldiers seeking to preserve your American freedoms; please continue to do so. This lack of empathy is why military recruitment is at an all-time low and moral among our troops has also declined. Over half our our troop are fighting under the influence of anti-depressants. The ER staff is still operating - only don't foreget that most of the medial staffs are coping with Prozoc...
Oh well, you just keep right on laughing. I bet you're one of those Bushites with the infamous bumper sticker; on a 1995 chevy barely getting along. I thought Republicans were prosperous; I'm sorry to rain on your parade but if you're not making at least 300k a year - your'e not really a Repubican. Nonetheless, if (and I do empasis IF), perhaps Mr. Mccain will assist you with purchasing a new car similar to one of his. After all, if you are republican, why not reap all the benefits and stop being USED on election day. Hello...

Anonymous said...

I returned from Afganistan and was diagnosed with PTSD after peeling every last one of my toenails off of my toes. I didn't feel a thing. After that, I developed an obssession with razor blades. I'm currently in treatment and receving help but as a daily sufferer of PTSD I was hoping to shed some light on the subject. Not all of us PTSD sufferers leap from windows; we suffer silently. There's no one to talk to because every has predetermined that you are "crazy". They simply cannot imagine the conditions that we soldiers and contractors endure while deployed. The isolation and lack of creative ways to vent are causing us to lose our best soldiers to PTSD. We may not have lost a leg or an arm; but something else just as important is missing - our lives, sanity, careers and future as we once knew it. Yep, our lives as we once knew it...before the nightmares carved it's place into our subconciousness. Thanks for listening.

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