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Hello friends.

I'm Jason Eden's your host of Lakeland Currents.

Thanks for joining the conversation again and thanks for your ongoing support of Lakeland Public Tv.

Service men and women across the country make significant sacrifices for our communities and our country.

However those sacrifices can exact a real personal toll sometimes in the form of post-traumatic stress or PTS.

Service members have a significantly higher likelihood to experience PTS than the civilian population.

My guest today will help us better understand PTS.

And how the Minnesota National Guard supports and treats those service members wrestling with it.

Ms. Daniel Breitfeld is the director of psychological health at the Camp Ripley Training Center.

Major Michael Moore is the field surgeon for the Minnesota National Guard.

And Mr. Anthony Housey works in public affairs at the Camp Ripley in installation.

Welcome all three of you I really appreciate you making time for our conversation today.

Thank you, Thank you.

So first of all Daniel let's start with you.

I'm curious, can you just tell me generally what is PTS?

What's the definition of PTS?

Daniel: So, it can be military related or it can be any type of trauma in in a civilian's life as well.

That that creates any type of nightmares, flashbacks, avoidance of anything that would heighten that physiological response within your body and create any type of distress.

And so what happens is in our brain we have the fight-or-flight mechanism.

In the amygdala and when we go through a traumatic event it activates the amygdala.

When anything sort of relates to that traumatic event and really that's the pure form of post-traumatic stress.

Is any time that we went through something our body then reacts the same way, if it looks similar.

So, yes combat veterans tend to have a more prevalence in that diagnosis because they're exposed to so many different traumatic events.

Although veterans would never tell you they're traumatic events, they're just doing their job.

So, that's really how how we see it in the military too.

Is any type of trauma, it could be combat related.

We definitely see a lot of military sexual trauma and then the post-traumatic stress that follows that as well.

So, those are the two types we see here at Camp Ripley most of the time related to the military.

Jason: We've been using the term post-traumatic stress, my next question is potentially for you Daniel, potentially for you Major Moore.

Is it a disorder?

Daniel: According to diagnostic and statistical manual version 5, it is.

A lot of us in the field don't tend to put that D at the end and call it a disorder.

Because a lot of us see it as a natural reaction from the body and from our mind to any type of traumatic event.

And so putting the disorder on it creates more stigma and so you'll hear it reference both ways.

But for for most of us in the field, we just really call it... this is what happens when you go through a traumatic event, your body naturally adjusts to be able to survive.

The next thing it's kind of like Darwin's Theory right?

Theory of evolution in a sense.

But our body does that with any type of trauma so, I don't know that it's a disorder.

I guess it's an opinion question.

I guess.

Jason: Say Major Moore, I want to follow up with you.

I'm hearing from Daniel that post-traumatic stress is really a result of a natural response, the fight-or-flight response.

And I was wondering if you could tell us a little bit more about that from the perspective of the field surgery?

Micheal: That's absolutely correct.

The symptoms that a soldier or you know anybody in who would experience with PTS, is something of your body's own doing.

So, stress hormones can actually cause those symptoms.

Racing heart, rate increased blood pressure.

Some folks can even go as far as to have hallucinations other manifestations like loss of sleep.

You know people can seek out drugs and alcohol to try to treat this.

They self-medicate as you say.

So, it's definitely something that is of the body's own doing and everybody deals with it in a different way and everybody experiences it in a different way too.

So, you know you and I could have the exact same experience happen to us but my body might process the stress related to that differently than you might.

So, it's a very difficult to wrangle diagnosis and it it requires a lot of patience on behalf of the providers and our social workers and counselors.

And from a medical perspective I can sit here and throw facts and data at you.

High blood pressure, Coronary Disease, Diabetes.

When it comes to things like PTS, it there is sort of a gray area and they're because of that individual variation.

So, it can be a little bit more difficult to quantify at times too.

Jason: Let's try and quantify this a little bit.

I'm curious to know you know within the Minnesota National Guard how prevalent is PTS?

How many diagnoses are given, you know in a given year for example?

Can you tell us just a little bit about how prevalent it is in our state?

Daniel: I don't know that I could quantify it myself and tell you how many diagnoses we give within a given year for post-traumatic stress.

Because we're not the only providers that they see to get and obtain that diagnosis.

So, I wouldn't be able to quantify that.

There's I don't know that there's one way that we track that in the guard.

Just because it's always constantly a moving target.

So ,if a soldier goes to the the VA for help or to a civilian doctor sometimes we don't even know that they're being treated for post-traumatic stress.

So, it would be very difficult for us to track that.

Jason: Interesting.

Well, I want to follow up on that, so I'm hearing you say that vets who may have received a diagnosis of PTS, may not have received it through the guard through the Minnesota National Guard, is that correct?

Michael: Yes.

Jason: Well if it is a diagnosis that's received through the Minnesota National Guard, how does the guard support and treat those members that are wrestling with PTS?

Daniel: So the diagnosis if we were to diagnose that, we would start with a full psychosocial assessment.

And we have five mental health professionals on staff that do offer free mental health counseling and services to our currently serving veterans and military here within the state.

And so, how it would work is they set an appointment, we do our psychosocial assessment.

We make the diagnosis and truly from there the options are there's a variety of options.

I guess based on the severity of the symptoms.

And so really that's part of the assessment too, is like how bad is post-traumatic stress impacting your life?

Is it to the point where you're drinking every day and that you have anger issues and you're and you're having a hard time keeping a job?

And coming to drill is a huge struggle for you know... and to the point where you're having suicide thinking.

And so that's worst case scenario and at that point then the options are different than someone who says "Yep, I have post traumatic stress."

"You know I have flashbacks when we have to do convoys because it reminds me of my time in Iraq."

"But other than that I'm able to hold down a job.

I'm able to come to you know drill do my my job and ultimately deploy."

Then their options are different.

And so we have to be prepared to respond to worst case scenario or best case scenario.

And how we service our soldiers with post-traumatic stress.

Michael: So, rough statistic there's about eight million people in the united states, this is the civilian and military that suffer.

That suffer or have suffered from PTSD on a yearly basis.

And about 11 to 20 soldiers that served in operation enduring freedom 11 to 20 out of 100 have reported some type of PTS symptoms.

So, and I can tell you from my personal experience you know, my encounters with these soldiers that we tend to catch them at annual screenings.

Called Periodic Health Assessments and we have a cyst of questions that they have.

A questionnaire that they have to fill out and based on their responses they can get a score and that can help me in advance kind of determine their severity.

But also just sitting down with them and talking to them really helps me to get a gauge on how significant the the problems they're going through are.

So, we try to cast a pretty wide net out there.

But you know as you can see a lot of people probably just say no, on a lot of these screening questions.

And they slip through.

So, that data I gave you is probably understated, it's probably even higher than that.

Jason: So, that being a conservative estimate I guess.

I'm curious how do you see PTS manifesting?

Whether it's in the military or the civilian population as you mentioned?

Some people might slip through the cracks of your assessments?

So what kind of indicators might you see for someone who's fallen through a formal, you know falling through the cracks of a formal assessment?

Michael: So, when soldiers are referred to me for just about any medical condition, I always do a very small mental health screening no matter what.

Even if it's for a non mental health related issue.

And I can catch some that way.

Sometimes they are coming out into the medical system for related issues like, they'll test positive for drugs on a urinalysis or they'll show up to drill intoxicated on alcohol.

Something of that nature and then they gotta come through and they gotta get a medical exam.

And at that point I get a lot of time with them and get to sit down and talk.

Because I strongly believe a lot of the self-medicating behavior behind alcohol abuse and drug abuse it's exactly that.

It's you know people aren't drinking necessarily for fun, they're drinking to kind of medicate some of the emotional pain that they're going through.

So, that's a lot of times how it'll manifest.

Sometimes they'll just completely say no on all of their periodic health assessment and I'll just take a look at them and from and, granted I I'm trained in internal medicine.

That's what I did my residency in.

And in med school and in residency I had a course on psychiatry and I did a rotation in psychiatry as a resident.

But my training isn't vast by any means.

So I'll miss a lot of stuff too but I think given some of that exposure I can pick up on um the way a person carries themselves.

A blunted affect lack of eye contact, things of that nature.

I can pick up on it and say I just don't think everything's right here.

And sometimes I can get that little bit of information out and then I can refer them on to our counselors up at Ripley.

And they can get a lot more out of them than I can fortunately.

Jason: Well I want to follow up with those service members that may be struggling with acute or long-term PTS.

We know unfortunately that among the service member population there's a high rate of folks taking their own lives.

My understanding from the veterans affairs that nearly 20 service members take their own lives on a daily basis.

And my question for you all is, is that a result of untreated PTS?

Or what are your reactions to those statistics within the context of PTS?

Daniel: I think we could attribute some of it to post-traumatic stress and I think that when I talk about suicide and completed suicides it goes hand in hand, with just the overall total well-being of the person in general.

And really looking at the holistic view of their life.

Generally you know they have more than one sort of thing out of balance in terms of like finance, families, family stressors, relationship stressors.

You know post-traumatic stress then also just makes it more of a catalyst for those types of suicide behaviors and thoughts.

And so really looking at some of that stuff then as a holistic view post-traumatic stress is a slice of the pie.

And it's more than just a slice, I mean people who have post-traumatic stress tend to you know score higher on our risk assessments in terms of suicide, when we assess that.

Because the post-traumatic stress could be untreated and then it creates that hopelessness and then they just don't know how to control what's going on with them and their body and within their mind.

And so they start to feel hopeless and then they start to kind of go up that path to suicide ideation, and you know for some obviously attempt.

So, yeah I would say it has a lot to do with it.

Generally trauma has in the civilian population we know that trauma is a big consider takes a is a considerable contribution to you know just that whole path of overall physical and mental health anyway.

So yeah it's a contributor but not the end-all be-all type of of predictor for suicide behavior.

Jason: Major Moore, I have a question for you before our conversation today.

I was doing a little bit of research and preparation for our conversation and the title field surgeon was unfamiliar to me.

And so my question for you is, are those service members that are experiencing PTS, are they only combat veterans or are there folks that are a part of the military community that are experiencing PTS due to other experiences?

I was wondering if you could speak to your own personal experience a bit as well?

Michael: Yeah absolutely, regarding the field surgeon thing I think that's just a tag that the army puts on all of us doctors in here.

I'm not a surgeon, I'm an internist.

So, but anyway regarding your question.

You know I find that a very significant portion of soldiers that score high on PTS scores during my health assessments, they are not related particularly, if they're younger soldiers.

So, a lot of our under 24 soldiers have never deployed to Iraq Afghanistan.

So they don't have combat related injuries they come in here with their own, with their own past horrible experiences.

They may have been a victim of sexual assault when they were younger.

And they came into the army and they did fine and then all of a sudden this horrible experience manifested itself while they're serving.

So, and I think it's important for military providers to keep in mind that not everybody that has PTS in the army or in the military in general is from combat.

A lot of it is stuff that they brought in with them and we just have to have a lot of patience and be very open-minded about it.

Daniel: I see that a lot myself.

If we were going to do a pie chart on how many post-traumatic stress diagnoses I give in any given year.

I would say I give more post-traumatic stress diagnosis to younger soldiers in that age bracket, that have not been to combat but have childhood trauma that they come into the military with.

And you know we're kind of a breeding ground for those those those kids that came from those homes that had experienced trauma.

Because they're looking for a sense of belonging, they're looking to have a sense of protection.

And they're easily are able to put their needs and their own life on the back burner in order for the common good of someone else and that's all.

I guess secondary effects of childhood trauma is those things that come out of people's personalities.

And so yeah I mean for sure I'd say 70 of the post-traumatic stress diagnosis I give in a year are in that age bracket versus our combat veterans.

But I can say this if they've had childhood trauma and they go into a combat zone they are far more at risk for a post-traumatic stress following combat.

Than they did if they did not have any type of childhood trauma.

Michael: For some reason and we have a lot of different theories about this but our younger soldiers that have never deployed in addition to the PTS stuff, they are also higher risk for suicide.

Force for whatever reason the older soldier that is deployed and has come back and even if they have PTS or other problems ,anxiety, depression..

They're less likely statistically to commit suicide than the younger non-deployed soldiers or soldiers without a history of deployment.

And there's a lot of different theories and I don't want to speculate.

And I think it's because it's kind of an age and wisdom thing, you know a younger soldier may not think that there's hope and they don't think that there's resources out there for them.

And the older soldier might understand.

The other thing too is we're reservists at the end of the day, you know someone like myself we do a lot more time in the military than just one week and a month.

But most soldiers are one weekend a month, two weeks in the summer.

And we don't have access to them all the time.

So that's a lot of folks fall through the cracks too you know.

Active duty federal soldiers they're there 24 7.

They got 24 7 access and our guys have access 24 7 too but I think just not physically being around the military environment all the time.

And not having that supervisor, that squad leader, that sergeant to say check up on them every day and say hey how's it going.

You know they fall through the cracks.

So, that is an extra additional difficulty that being in the national guard adds to all of these PTS issues.

Jason: That's really interesting.

I'm glad you made that distinction Major Moore.

I want to follow up with how it is that the guard and the department of defense potentially on a more general basis is treating those service members that are wrestling with PTS?

So, I was wondering if you could speak specifically to what the Minnesota National Guard does in terms of treatment?

Daniel: Yeah so, the great thing about the Minnesota Army National Guard and my position is that, we have training dollars for people like me that are you know a civilian or if you're still in to get paid to do different types of training.

And so one of the best things that myself and two other members of my team have done, is get trained in accelerated resolution therapy.

And what that is, is a very short-term treatment for post-traumatic stress.

But it's an effective treatment.

Every provider at Walter Reed has now been trained in it and so we're hoping that the department of veteran affairs also starts to endorse this, as a good effective treatment for post-traumatic stress.

But really what it does is, it takes those memories and that physiological response from post-traumatic stress that is stored in our amygdala and it takes it and puts it into the prefrontal cortex.

Which is our fact based part of our mind and so the physiological response goes away with this treatment.

I see a reduction in the nightmares, the hyper vigilance, definitely the flashbacks and any other type of physiological response that comes along with them thinking of their trauma.

So, that's one way.

We also do free counseling for Minnesota Army National Guard soldiers here at Camp Ripley, Cottage Grove and various places around the state.

We do virtual thanks to COVID, we were able to get that funded rather quickly last year.

So, that we can do virtual counseling sessions.

So, if you're in International Falls and you need a counselor and you're in the Minnesota Army National Guard we're just one click away and you can have a session with one of us mental health professionals.

The other thing we do is a 24 7 crisis helpline.

So, there's five of us on my team and one of us for seven days will stay on call 24 7 for a number for them to call and access a mental health professional.

So, those are the services.

Jason: Okay, would you be so kind as to repeat the name of that treatment accelerated?

I'm sorry I didn't catch it all.

Daniel: Accelerated Resolution Therapy.

Jason: Okay.

Thank you for sharing that, I appreciate that.

Major Moore, I was wondering if you could react to the perception that those folks that are struggling with PTS are sometimes over medicated?

Michael: I feel that may come from a side of just lack of lack of evidence, lack of general knowledge about the topic.

I know there's a lot of stigma even today with all the strides we have we have made in acceptance of mental illness and psychiatric problems.

But today we still have a lot of stigma on mental illness and the National Guard is a slice of the national culture, the national population.

So, we a lot of our soldiers and supervisors and officers carry those same misconceptions.

And so anybody that would say you know somebody is over medicated.

It's a tough question because perhaps somebody might be more over medicated that's really it's really kind of the psychiatrist that's managing their medications that's their job to to manage the side effects.

But if they're talking about, oh well this is this is an attitude problem or this is a this is a work ethic problem.

And you need to you know get your boots on and get out there and work.

I think that might just be a little bit of society's bias and a little bit of lack of knowledge.

Jason: So, well we only have a couple minutes left here and I want to be sure that I ask a couple more questions.

I have one for you Mr. Housey.

I'm wondering what does the camp and perhaps the national guard in general do to connect with those vets who may have fallen off the radar?

We know that there are a lot of service members who have become homeless.

And I'm wondering what does the National Guard do to connect with those folks.

Who are less successful but may be suffering from PTS?

Mr. Housey?

Anthony: Well yeah, thank you.

So the military community doesn't really stop when you leave the organization or start for that matter.

I mean a lot of people that we bring into our fold is families, families of service members, families of veterans.

So, where you know especially the Minnesota National Guard but the military in general, we don't try to keep as close to contact with our veterans and what not.

As are currently serving service members.

We do try to maintain that family focus.

We try to stay in our networking circles and see where we can help.

You know a lot of our resources have to go to our currently service service members first.

Because they are a priority for their for themselves to be mission ready.

As far as the you know my job in the public affairs office, it's my job to communicate the themes and messages from our leaders and how they want to maintain that connection and maintain the availability of those resources.

You know as Major Moore brought up there is still quite a bit of a stigma out there.

When I was a young soldier there was definitely a huge stigma and it's gotten better.

It's gotten better as our military kind of ebbs and flows through its different cycles.

And the opportunity for communication the opportunity for getting that information out there has of course increased.

You know one of one of the biggest talking points is how to be able to communicate that, how to be able to openly share that information without compromising yourself or or putting your career at risk.

And that's all part of the communication.

Jason: Before people are deployed to a conflict zone are they warned about the risks of PTS?

So, they can recognize it themselves and seek help if necessary.

Michael: Absolutely, before any soldier goes overseas from the private that just got out of basic training, all the way up to generals you have to go through a pre-mobilization process.

And part of that process is a series of different classes and what things you have available to you, what resources and mental health wellness is a big part of that.

And I just deployed two years ago and we had a half a day on health and mental health wellness resources.

So, I think there was pretty decent education on not only what resources but what to look for while you're over there.

If you start having these kind of symptoms or if you see your body having these kind of symptoms.

When to seek help.

So, I think that's definitely better.

Because as a younger soldier when I was enlisted man in the 90s, we didn't get that.

We got taught how to shoot a gun and then it's all about to get on a plane.

So, that was about it.

Jason: Well the final quick question is, many of us of course have service members in our lives, in our communities if we know of someone that's experiencing challenges that may be PTS.

What can we do in our in our own communities?

Daniel: The biggest thing is is understanding where they've been I guess for them to be able to be comfortable with you them being able to tell you the story.

And being able to feel not judged for the things that they did while they were in service.

And so the biggest thing I can say is empathy.

And giving them that space and the time that it takes sometimes for veterans to trust and be able to open up and talk about some of the things that they've done.

So, empathy for sure and then just all those small things that we can do to earn people's trust.

You know just even asking like hey today is your year anniversary of being back from deployment.

How are you doing?

And stuff like that.

Those things go a long way for a veteran that you notice and that they feel like they they still exist within our community.

Jason: Thank you.

Well we'll have to wrap it up there.

I want to thank all three of you for joining me today, I really appreciate your time.

Daniel: Okay, thank you.

And thank all of you for joining me.

Once again, I'm Jason Edens your host of Lakeland Currents.

Be kind and be well.

We'll see you next week.