TREATMENT

The primary objective when considering treatment for PTSD is to create an atmosphere which will allow the veteran to work through the traumatic event. Also essential is an atmosphere of trust and caring. Because of the degree of survival guilt, and because of the continuing battle between the combat and civilian selves, it is first of all essential to "support an attitude, of pride at having survived and done a good job in an extreme situation...One must reframe the destructive attributes as having been positive and adaptive in the insanity of the combat situation." (B. Goderez, 1985) In essence, the veteran needs to be reminded that abnormal behavior in an abnormal situation is normal. War was an abnormal situation. Given that information, it is necessary for him to know that indeed his behavior was normal. He needs also to see himself not as a victim, not as an executioner, but as a survivor. (R. Lifton, 1976) "It is important to remember that time, rather than healing all wounds may actually see them intensify ... symptoms may show a greater frequency now than when originally diagnosed." (M. Friedmann, 1981)

In many cases therapy must continue indefinitely, and this often means periods of hospitalization. Even after prolonged periods of change, there may be some unexpected stress, an anniversary reaction, or periodic depressions which will create the need for further or continued treatment.

What appears to be a most successful treatment is the traditional "rap" group which allows for the necessary social supports from his peers. The "rap" groups are comprised of other Vietnam veterans, with similar feelings and experiences. Often the groups offer the first opportunity toward personal and social recovery.

In conjunction with treatment for PTSD must be treatment for an alcohol/substance abuse problem. The two are too closely aligned to be treated separately.

The 700,000 member Disabled American Veterans (DAV) was the first to recognize the enormity of PTSD associated problems. It funded and founded research which in turn resulted in the Vietnam Veterans Outreach Program in 1978. These programs provide much needed counseling, both individual and group, for not only the veteran but significant others as well.

The Outreach Centers are not bound by traditional systems, and the autonomous program was developed because the VA was not able to handle the special needs and sensitivity of these young warriors' experiences. When considering treatment of the veteran, we must also consider treating the entire family unit, both through education and therapy.