PTSD sufferers aren't alone

Dr Brian O’Toole’s research on the physical and mental health of Australian Vietnam War veterans has revealed that Post-Traumatic Stress Disorder (PTSD) still prevails more than 30 years after military service. He explains why this chronic illness differs from other psychiatric diseases, how it affects those close to the veterans, and what it might mean for the descendants of PTSD sufferers.

By Tim Groenendyk

Brain O’Toole

"The brain is just too good - it won’t let you forget." Dr Brian O'Toole, Director, Vietnam Veterans Family Health Study

“Post-traumatic stress disorder is the only psychiatric diagnosis with a recognised external cause. Trauma,” said Dr Brian O’Toole, Director of the Australian Vietnam Veterans Family Health Study, which is based at the Brain and Mind Research Institute.

“But what constitutes trauma? And the answer is: It is the inescapable encounter with death.”

When Dr O’Toole commenced his longitudinal study on Vietnam War veterans it was the first time anyone had looked into the health of a cohort of returned servicemen in Australia.

Post-traumatic stress disorder (PTSD) is a chronic disorder which is, in the main, treatment-resistant.”

“As humans age your physical health deteriorates but epidemiological research has shown that depression and anxiety improves for older age groups.

“On the basis of that you’d expect PTSD would get better with time but that’s not what we’ve found.

“It in fact got worse with time. Not just PTSD but depression as well, which is very highly co-morbid with PTSD.”

“The brain is just too good - it won’t let you forget. And the emotions that come with the memories are very hard to extinguish.”

Although servicemen deployed in Vietnam in bomb disposal (the Royal Australian Engineers, or “sappers” as they are known) had a lower mortality rate than the infantry, they had a higher rate of PTSD after the war.

“If you are in fear of your life for long periods of time then it will generate PTSD. Contact with death is the key, but it doesn’t actually have to be a direct confrontation. Months of fear can have a serious effect on the psyche.

“Just 8 or 9 months in an environment where every time you step outside the safety wire and you don’t know which step is the one that sets off the bomb might be enough to cause PTSD.”

O’Toole’s research revealed that the health of the wives of Vietnam veterans was also affected by their servicemen husbands suffering PTSD.

“The prevalence of generalised anxiety disorder (GAD) in the women is very much higher than would be expected from Australian population data. And there were only two veteran characteristics that predicted it in our analysis.

“If the veteran had suicidal ideation it increased the risk of GAD in the spouse by six fold. If he actually had an attempt and was unsuccessful then it actually reduced GAD risk by about 70%.

“These women are walking on eggshells. They’re dealing with damaged veterans.”

O’Toole says that the reduction in the wives’ anxiety could be from the “relief that comes with an expected suicide attempt that was not successful. It could also be because of treatment interventions that finally saw the veteran into psychological care.”

O’Toole argues that the prevalence of inflammatory diseases - asthma, eczema, arthritis, and hypertension - strongly associated with PTSD suggests it may affect the immune system, reinforcing research reported overseas.

Furthermore, his team has just submitted an NHMRC grant application in order to study the genetic susceptibility to PTSD and its potential transmission by looking at the blood of fathers, mothers and children.

“There’s some suggestion that PTSD itself won’t actually change gene structure but it may change genetic expression.

“The next phase of our work is to try and look at the biological basis of, first of all, PTSD and secondly to see whether it’s transmissible psychologically within families or genetically via things like gene expression.

“All that the government wanted to know in the early days of the research was ‘what’s the number? In other words, how many people do we have to care for?’ But it’s a lot more complex than that, unfortunately.

“You can’t send people to war and get away with it. You can’t kill and get away with it. You just can’t do it. It’s what every government needs to know.”