Defining Depression
A Painful Lack of Wounds
The National Institute of Mental Health defines depression as a mood disorder that causes distressing symptoms that affect how you feel, think, and handle daily activities, such as sleeping, eating, or working. To be diagnosed with depression, symptoms must be present most of the day, nearly every day for at least 2 weeks (Depression, 2016).
Post-traumatic stress disorder has been directly linked to depression in veterans. Feelings of isolation are far too common in the veteran community and PTSD has been proven to only worsen these symptoms. However, the majority of servicemembers will never actually see combat. If this is so, then why are so many veterans suffering from depression? Why do 22 veterans a day take their own life when they had no diagnosis of PTSD? Dr. Christopher Bailey describes this misfortune as "a painful lack of wounds". Athena du Pre's book Communication About Health describes "personal identity" as a relatively enduring set of characteristics that defines a person (de Pre, 88). Often, this identity is has been altered greatly in veterans after time in service. After studying veterans who suffered from depression but had no diagnosis of PTSD, Dr. Bailey discovered what many veterans described as insecurities with their masculinity due to being assigned a non-combatant duty. These types of assignments often leave veterans feeling they missed their chance at being a hero which leads to feelings of regret after service. These feelings of regret are also described as "survivor guilt" (Bailey, 223-224).
Post-Traumatic Stress Disorder
PTSD is defined, as per va.gov, as an anxiety disorder involving re-experiencing trauma through vivid flashbacks, nightmares, and terrifying thoughts, avoidance of trigger events, psychological disassociation or “numbing,” and hyper-intense reactions to everyday events. Combat veterans are far more likely to develop PTSD than non-combat veterans. It is important to remember that PTSD is NOT a sign of weakness. PTSD often begins soon after a traumatic event but it is not uncommon for it to develop years later as well. Veterans are also more likely to develop PTSD later in life if they are experiencing high levels of stress, and less likely to develop if they have a strong social support. According to va.gov, there are 4 different types of symptons for PTSD:
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1. Reliving the event. You may have bad memories or nightmares. You even may feel like you're going through the event again. This is called a flashback.
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2. Avoiding situations that remind you of the event. You may try to avoid situations or people that trigger memories of the traumatic event. You may even avoid talking or thinking about the event.
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3. Having more negative beliefs and feelings. The way you think about yourself and others may change because of the trauma. You may feel guilt or shame. Or, you may not be interested in activities you used to enjoy. You may feel that the world is dangerous and you can't trust anyone. You might be numb, or find it hard to feel happy.
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4. Feeling keyed up (also called hyperarousal). You may be jittery, or always alert and on the lookout for danger. Or, you may have trouble concentrating or sleeping. You might suddenly get angry or irritable, startle easily, or act in unhealthy ways (like smoking, using drugs and alcohol, or driving recklessly.
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PTSD may also lead to depression, anxiety, hopelessness, and shame in veterans. This is why it is so important to understand the early signs of PTSD to prevent further symptons.
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Depression amongst Veterans
Diagnosing depression can be somewhat complicated often due to the lack of any physical symptoms of the illness. According to the Mental Illness Research, Education, and Clinical Center, depression can only be diagnosed through a clinical interview unlike other illnesses that can be tested in a lab or through a CAT-scan. Unfortunately, this is a major reason many do not seek out treatment for depression in the early stages of the illness. However, extra measures can be taken to ensure the patient does not have another illness causing depression such as a brain tumor or thyroid problems (MIRECC, 2-4). According to the health library found on va.gov, the average age for depression to begin is mid-20's, but can begin at any age. It is important to understand that many service members discharge from the military around this age, often finding themselves struggling mentally while trying to adapt to a dramatically new lifestyle. Depression can also differ from patient to patient where some experience a rapid amount of episodes in a short period of time while others suffer for years without relief. It is also important to understand that generally, the number of episodes a patient may experience increases with age. This may be why, according to the VA, that 65% of veterans who commit suicide are over the age of 50.
what else can Cause Depression?
First and foremost, it is important to understand that depression CAN be hereditary, according to the National Institute of Mental Health. Veterans should always know if either of their parents suffer or once suffered from depression to better evaluate themselves. However, there are many other factors that can lead to depression. The VA Healthcare system lists other factors that may lead to depression which includes environmental stressors, life events, biological factors, and psychological vulnerability to depression. In du Pre's book, she discusses socioeconomic status. This "status" change that veterans face after discharge can lead to struggles financially, difficulties with adapting to school, and unemployment (du Pre, 125). These factors can also lead to depression if they are not addressed in the early stages. She also discusses the intersectionality theory. This theory can be useful in understanding how veterans feel trying to adapt in a culture where they no longer feel "normal". The military life is so dramatically different that it is a culture shock when returning to what many believe will be a relaxing civilian lifestyle. An article from Nueroimage also describes the lasting impact that that traumatic brain injury can have on veterans, often leading to depression later in life. According to this article from the Journal of Brain Function, 20% of veterans who served in Operation Enduring Freedom or Iraqi Freedom suffered mild traumatic brain injury. Blast exposure is the leading cause of concussion in these OEF/OIF veterans which has been linked to depression and other mental illnesses down the road (Taber & Hurley, 1-3).
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Remember, PTSD does not discriminate. Any traumatic event in ones life can lead to PTSD. Treatment should begin immediately if diagnosed to prevent further complications.
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It may seem unfair surviving a life-threatening situation while others did not. Survivor guilt is common among veterans. Goodtherapy.org defines this guilt and discusses how to cope.