Peer review on Travis’ Paper:Post-Traumatic Stress Disorder (PTSD)
What is PTSD:
Post-Traumatic stress disorder (PTSD) is a psychiatric disorder formed by traumatic events that people experience. The cause may be a single event such as rape, an experience such as war or a long term experience such as domestic violence. When thinking of PTSD people often relate the disorder to soldiers returning from war because of what they experienced, but soldiers are not the only people that are affected by post-traumatic disorder. This disorder can be caused by many different traumatic events other than war, such as; natural disasters, rape, terrorist attacks, serious accidents and other violent personal assaults. According to the American Psychiatric Association (APA), “post-traumatic stress disorder affects 3.5 percent of adults and one in eleven people will be diagnosed with PTSD in their lifetime” (American Psychiatric Association). With post-traumatic stress disorder, the affected people tend to have intense disturbing thoughts linked through the traumatic event they experienced during their life and can last long after the event has finished.
The American Psychiatric Association lists some ways people are affected by PTSD, which include; “flashbacks or nightmares; they may feel sadness, fear or anger; and they may feel detached or estranged from other people. People with PTSD may avoid situations or people that remind them of the traumatic event, and they may have strong negative reactions to something as ordinary as a loud noise or an accidental touch” (American Psychiatric Association). To be diagnosed with PTSD, a person must experience symptoms for more than three months after the traumatic event happened. Also, post-traumatic stress disorder can happen through second hand events, such as experiencing the death of a loved one or constant exposure of traumatic events that police officers can encounter.
It would be difficult to give a timeline on post-traumatic stress disorder and when it first became present due to the fact that it is related to the experience of trauma. According to Crocq’s article, “From Shell Shock and War Neurosis to Post Traumatic Stress Disorder: a History of Psychotraumatology”, the earliest account of PTSD was in 1980 when it became a household name with its addition into the Diagnostic and Statistical Manual of Mental Disorders (DSM-111) published by the American Psychiatric Association. Before post-traumatic stress disorder was diagnosed as a disorder, it was labeled as other terms such as; shell-shock, war neurosis and soldier’s heart (Crocq 2000). Due to industrial advances that were later used in wars, these advances seemed to be the lead factor of the development of PTSD because of the disasters that came from it. For this reason, post-traumatic stress disorder can be looked at as a “man-made” disorder.
“World War I (WWI) was the first modern war fought with massive industrial means. The role played by WWI in advancing the knowledge of psychotraumatology in European psychiatry may be compared to that of WWII and the Vietnam War in American psychiatry” (Crocq 2000). “PTSD first entered the public sphere in the legacy of the Vietnam War. According to the United States Department of Veterans Affairs’ National Center for PTSD, about 30% of Vietnam War veterans suffer from PTSD. The center estimates that the diagnosis is shared by 11% to 20% of veterans of Operation Iraqi Freedom (“the Iraq War”) and Operation Enduring Freedom (“the Afghanistan War”)” (Gansel 2014). With the development of PTSD, the disorder has been put on trial in numerous cases, in trying to acquit defendants based on insanity, mitigate charges and to prove a mentally ill veterans should receive treatment rather than incarceration. Since PTSD symptoms can be treated and have come a long way since the beginning of using electronic shock to treat PTSD, treatment should be an alternative to incarceration. Don't use plagiarised sources.Get your custom essay just from $11/page
The options for the most effective types of treatment have been advocated by the United States Department of Veterans Affairs National Center for PTSD. “The most effective treatments are cognitive behavioral therapy (“CBT”), including cognitive processing therapy (“CPT”) and prolonged exposure (“PE”) therapy, eye movement desensitization and reprocessing (“EMDR”), and selective serotonin reuptake inhibitors (“SSRI”) as medication” (Gansel 2014). According to Gansel, CPT is the most effective treatment which consists of working with a therapist to understand and make sense of the trauma, PE involves discussing the trauma repeatedly, EMDR which focuses on hand movements, tapping and sets of eye movements in order to help the subject relax and change reactions to memories of trauma and SSRIs which are a type of antidepressant medication that is effective in treating PTSD. “The successes of treatment options are well established. About 40% of veterans with PTSD are cured with behavioral cognitive therapy alone” (Gansel 2014). Unfortunately, this treatment success rate is lower than when a civilian partakes in treatment. “Factors that may explain the lower success rate include resistance to seek help due to the stigma attached to mental health in the military and a military mental health system that lacks the resources to meet the demand of active members and veterans’ ‘ (Gansel 2014).
PTSD and Criminal Culpability:
There have been many studies about soldiers returning from war and developing post-traumatic stress disorder. One main symptom that veteran’s with PTSD experience is the ability to total control of their actions due to the disorder tricking them into believing or triggering a belief that a threat is present (Hamilton, 2011). If this happens, there is a strong risk that they resort to using violence, but it can be seen as if their actions are out of their control.
According to Hamilton, 2011, “After returning stateside, many of them have been involved in violent encounters which appear to be the result of PTSD-based cognitive impairments in which they automatically respond to perceived threats or suffer dissociative flashbacks to being in combat” (Hamilton, 2011). Because post-traumatic stress disorder may trigger uncontrollable violent reactions, which are related to war experiences, they are susceptible to being charged with criminal behavior. A person with PTSD may lack criminal culpability due to the fact that his or her act was not voluntary.
“Generally, violent crimes (or crimes of social harm) must have five elements (Actus reus, concurrence, Mens rea, causation and social). If an element is missing, a prosecution will fail (or to out it another was the defendant has a defense – that there is no crime)” (Hamilton, 2011). The two elements which are directly related to a defendant’s criminal culpability are; the mens rea and the actus reus. Mens rea, as discussed before, is the culpability or blameworthy state of mind of the defendant and the actus reus is the criminal act or omission. In order to satisfy Actus reus requirement of the act committed must be done so voluntarily or as the result of a willed muscular action. Actus reus has been said to be the foundation of criminal culpability because it exemplifies the voluntariness of committing an act. Clarify and expand
“Criminal law theorists conceptualize an involuntary act as one without blame, and thus not deserving societal condemnation or punishment” (Hamilton 2011). This theory presents the issue of someone committing a crime without the willpower to stop and if they should be punished for their actions. Which is an issue present with people that suffer from PTSD. The definition of what makes an act voluntary can be vague when determining a person’s culpability when committing a crime. The “mental capability” as opposed to Mens rea, of a person also plays a role in the actus reus because it has to do with consciousness, will and control, the three requirements of what can cause a voluntary act. “The Model Penal Code refers to a voluntary act in connection to consciousness, explaining that “an ‘act’ committed while a person is unconscious is in reality no act at all “for criminal culpability” (Hamilton, 2011). There is some debate on what constitutes total unconsciousness and whether partial consciousness can lead to involuntary acts. Therefore, according to Hamilton, “one court described an involuntary act as when “the individual’s conscious mind has ceased to operate and his actions are controlled by the subconscious or subjective mind” (Hamilton, 2011) This indicates that an individual is not in control of how their subconscious mind acts and can commit involuntary acts. If a person’s subconscious is controlling them when they seem to be in an unconscious state, it has been argued that they are not culpable for their actions.
Automatism
Automatism refers to involuntary acts when dealing with culpability. Distinguishing the difference between automatistic actions and non automatistic actions is both complex and controversial. According to Hamilton 2011, “This is because automatistic behavior can occur in individuals who are conscious, as meaning being awake and aware (which in common parlance would signify consciousness), but their actions are otherwise involuntary for criminal law purposes’ ‘. Automatistic acts can be caused by several different factors including; organic brain disease, hypoglycemia, epilepsy, concussion and even acute emotional disturbance. All these factors can lead to a person acting reflexively, where the person can be conscious of their actions, but do not have the control to stop them. “Two common types of automatistic actions, those resulting from reflex and those from a dissociative state, are relevant to a PTSD-related involuntary act” (Hamilton). Acting in a reflexive way is considered involuntary because the individual holds no mental control over their actions.
Reflexive state PTSD can be best explained as how the military trains soldiers for a war. “The military’s success in developing such a high firing rate is due to training — still in use today — designed to develop a reflexive “quick shoot” ability” (Jordan 2019). Putting soldiers through this training has a lasting impact even outside the war. When a soldier needs to complete the training, the target he shoots at will immediately drop to the ground, showing that it was hit. As well as simply completing the training, the military awards soldiers that are very successful in the training, making it a learned behavior for the soldier. “Furthering positive reinforcement, in the vein of operant conditioning, comes through a kind of token economy, where Soldiers are given badges indicating their level of weapons proficiency as well as being treated more favorably for promotion. This reflexive “quick shoot” training is achieved through the effective application of classical conditioning by the military” (Jordan 2019).
Soldiers are molded to fire their weapons in a reflexive manner due to the training, something the military did not necessarily intended for, but happened due to the classical conditioning methods. “Classical conditioning consists of pairing a neutral stimulus with a particular response as a consequence of being paired with an unconditioned stimulus. A prime example of classical conditioning in the military is basic rifle marksmanship training. In rifle marksmanship training the targets are the unconditioned stimulus, and pulling the trigger after a target comes up is the unconditioned response” (Jordan 2019). This accustoms a soldier to be ready to fire their weapon simply because they are staying alert and not just because a target is present. Being in a situation where soldiers need to shoot based off of a reflexive response makes their reactions based off of trauma in the battlefield. “The application of military training in combat is best described by the Army Manual for the Infantry: “[c]haracterized by extreme violence and physiological shock, close combat is callous and unforgiving.” The manual further describes the ground-combatant’s role as “the point of decision.” Combat forces soldiers who are already conditioned to fire to make split-second decisions regarding whether a person is acting with hostile intent” (Jordan 2019).
When soldiers return from war and are placed back into society, this style of training does not escape them, but continues to manifest within which can cause major problems for veterans. “Through the application of highly effective military training, combat veterans have been conditioned to kill and respond to threats with violence. Military training conditions a reflexive “quick-shoot” response through the application of methods that mirror classical conditioning” (Jordan 2019). Society triggers high stress situations for veterans, where a reflexive action can be made outside the control of the individual. “Society places veterans in high stress and traumatic combat environments. These combat environments often require split-second decisions about a person’s intent based on their actions, with pressure from the targeting rules and stated mission to respond to perceived threats with violence” (Jordan 2019). When in society, veterans can have a perception of threat that their lives or lives of loved ones and friends are in danger, combining that with the exposure of violence during war is what leads to PTSD in veterans.
Some courts have also accepted dissociative type automatism. “The American Psychiatric Association defines a dissociative state as “a disruption in the usually integrated functions of consciousness, memory, identity, or perception of the environment” (Hamilton). Acting in a dissociative state means an individual can be acting in an automatistic while lacking awareness, due to their response to stimuli and are completely unaware of performing the act. For soldiers like Bratcher, the threats of civilian life, while much different, are nonetheless capable of triggering the physiological effects that lead to the dissociative states and flashbacks inherent in PTSD (Jordan 2019). Jessie Bratcher, an Oregon National Guardsmen, shows an extreme case of dissociative post-traumatic stress disorder, who shot and killed Jose Ceja Medina. Bratcher shot Medina six times when Medina was on his porch. “Bratcher, who served as a machine gunner in Iraq, would tell his attorney that during the shooting he felt like he was in Kirkuk, Iraq, and that the screams of Medina’s fourteen-year-old nephew, were to Bratcher, the screams of an Iraqi woman” (Jordan 2019). Veterans that go through dissociative PTSD have a difficult time distinguishing between reality and make believe, often putting themselves back into a state of trauma they experienced during combat.
Dissociative post-traumatic stress disorder can be seen in individuals other than combat veterans. “Dissociative phenomena occur in a substantial proportion of individuals with PTSD, and include emotional numbing, psychogenic amnesia, depersonalization and derealization symptoms” (Felmingham, et. al, 2008). “Critically, within military and veteran samples, as well as other trauma-exposed samples (e.g. incarcerated youth, individuals exposed to motor vehicle accidents, physical or sexual assault, childhood abuse), PTSD+DS has been associated with greater PTSD symptom severity, depressive and alcohol abuse symptoms, and psychiatric comorbidity” (Boyd, et al. 2018). First responders have also been found to experience dissociative symptoms, but there are far less studies regarding their experiences. “DSM-5 also introduced the dissociative subtype of PTSD (PTSD+DS), reflecting approximately 15-30% of individuals with PTSD who experience significant dissociative symptoms of depersonalization (feeling as though one is separated from one’s own body) and derealization (feeling as though things around you are strange or unfamiliar)” (Boyd, et al. 2018).
When dealing with an individual that has post-traumatic stress disorder plus dissociative symptoms (PTSD+DS), their cognitive functions become greatly disrupted. “Dissociative symptoms are associated with worse cognitive functioning across domains of memory, attention, and executive functioning among individuals with PTSD. Notably, cognitive impairment has been associated with reduced psychosocial functioning (Jaeger et al., 2006) and decreased ability to carry out instrumental activities of daily living (McCall & Dunn, 2003) among individuals with depression, even after accounting for depressive symptoms” (Boyd, et al. 2018). Dissociative states can make veterans act in a way of self defense when no real danger is present. “As applied to a veteran suffering from PTSD who has committed a crime, veterans tend to engage in crime because of the [*567] (Links to an external site.) survival mode derived from combat. According to John P. Wilson and Sheldon D. Zigelbaum in their 1983 study of 114 Vietnam veterans, this survival instinct manifests itself in three modes: the dissociative reaction, the sensation seeking syndrome and the depression-suicide syndrome” (Gover 2008).
PTSD and War Veterans
PTSD for the War Veteran:
According to Hafemeister and Stockey 2010, an estimate of 7.7 million American adults that suffer from PTSD due to natural disorders and violent accidents, which is a major cause for concern. “One out of every five veterans returning from Iraq develop PTSD throughout their lifetime” (Hafemeister and Stockey, 2010). Expand Due to the impact war has on an individual, “PTSD is associated with a life-threatening or highly traumatic event, war veterans who have been placed in such circumstances during combat are prime candidates for developing PTSD” (Hafemesiter and Stockey 2010). “Veterans may be especially susceptible to PTSD symptoms-such as dissociation, exaggerated startle response, irritability, and impulsive behavior-that may be linked to violent acts and related criminal behavior, a diagnosis of PTSD may be the foundation for efforts to negate criminal culpability by asserting a related “mental status defense” (Hafemesiter and Stockey 2010).
PTSD and Vietnam Veterans Impact of Guerilla War:
A study was conducted to see the number of veterans that suffer from PTSD from the Vietnam war and the numbers are shocking. After the Vietnam war, it became the first time that post-traumatic stress disorder was acknowledged by the United States military. The war itself yielded a new style of war that soldiers have not yet seen, theis new style was the main reason so many soldiers died causing a lot of trauma to the ones that survived. This new style of war was guerrilla warfare, used by the Vietnamese. “The very nature of guerrilla warfare expands the number of combatants placed in danger, encompassing both soldiers directly involved in the fighting and those working in what had traditionally been a relatively removed and safe logistical capacity” (Hafemesiter and Stockey 2010). This warfare made it very difficult on the American soldiers to distinguish who the enemy was, if they were Vietnamese civilians or Viet Cong operatives, often leading them to adapting a survivor mode state of mind. Unfortunately, for many this state of mind would not change when they returned home, causing most of them to endure psychological problems (Hafemeister and Stockey, 2010). The symptoms that these veterans experienced were clinically significant stress reactions. These composed of “recurrent dreams of events, distress caused by exposure to certain events or symbols, continued efforts to avoid thoughts and feelings, feelings of detachment, a restricted range of affect, insomnia, a sense of a foreshortened future, hypervigilance, and concentration problems” (Hafemesiter and Stockey 2010). Between 500,000 and 1.5 million Vietnames Veterans suffer from PTSD.
The veterans that suffered from PTSD and coming back from the Vietnam war, had difficult times staying out of criminal trouble. Support “Surveys conducted in the early 1980s indicated that Vietnam War veterans in the United States suffering from PTSD displayed a high rate of criminal behavior compared to that of the general population” (Hafemeister and Stockey 2010). This is due to the distortion of reality post-traumatic stress disorder has on the veterans. A distorted reality a veteran can go through is reliving a traumatic time they had in the war, while trying to live their life. This distortion of reality can be so vivid that the individual can behave as if they were back at that particular time in their life, where the trauma occurred. Although an individual may be able to realize that it is a flashback, they may not have complete control of their actions. “The National Vietnam Veterans Readjustment Study of 1988 found that 480,000 of the veterans returning from Vietnam had developed PTSD” (Hafemesiter and Stockey 2010). Another war was studied for how veterans were affected by PTSD and this was the Iraq and Afghanistan war.
PTSD and Iraq and Afghanistan Veterans:
The Iraq and Afghanistan war also sent home soldiers that would adapt post-traumatic stress disorders. Just like the Vietnam war, in Iraq and Afghanistan, new war tactics were adapted by the enemy causing harm to the American soldiers. The newest tactic that was developed by the Iraqis was the use of terrorist warfare. “These reports indicate that the nature of the enemy’s action evolved: enemy forces moved away from small- unit infantry engagements toward more hit-and-run attacks that used improvised explosive devices, mortars, or rocket-propelled grenades” (Hafemesiter and Stockey 2010). These new tactics had a horrible effect on the soldiers that would cause a lot of trauma to them when returning back to civilian life. To go with the new tactics of warfare that soldiers experienced, the long and repeated deployments also caused significant harm to their mental well-being. Luckily, the veterans from Iraq and Afghanistan had more support from the civilians in their country when they returned home. Also, the knowledge of PTSD and its effect on soldiers is greater than what it was after the Vietnam war. “The different perceptions of this war and the increased understanding of PTSD may enable Iraq and Afghanistan veteran defendants suffering from PTSD to better employ this diagnosis as a basis for reducing or avoiding criminal culpability” (Hafemesiter and Stockey 2010). With the knowledge learned, veterans can have a better chance of avoiding criminal culpability in a crime that they had no control in committing.
Special Treatment for War Veterans:
Trying to find the right treatment for a veteran is much more difficult than trying to find the right treatment of a civilian because a veteran most likely experiences a greater deal of trauma. This statement does not undermine the importance of treating an ordinary civilian for their PTSD, but only means to explain the veterans should be offered special treatment. “The National Center for PTSD, operated by the United States Department of Veterans Affairs, distinguishes between “community violence” trauma and “military trauma.” Community violence refers to a wide range of trauma including “riots, sniper attacks, gang wars, drive-by shootings, workplace assaults, terrorist attacks, torture, bombings, war, ethnic cleansing, and widespread sexual, physical, and emotional abuse” (Gansel 2014). Community trauma is used to explain the trauma that is experienced by civilians in community violence, leading them into a possible diagnosis of post-traumatic stress disorder. “Exposure to community violence is a cause of PTSD in civilian children, adolescents and adults. In fact, 7% to 8%of Americans will have PTSD at some point, and about 5.2 [*157] (Links to an external site.) million adults have PTSD every year. However, the particularities of combat make veterans especially vulnerable” (Gansel 2014).
Post-traumatic stress disorder has become an epidemic among combat veterans. “The National Center for PTSD estimates that PTSD occurs in about 30% of Vietnam veterans, and in about 11% to 20% of Iraq and Afghanistan War veterans. Of the Iraq and Afghanistan War veterans who had enrolled in veterans’ healthcare systems between 2002 and 2008, 37% were diagnosed with mental health issues, 22% of which were for PTSD. The unique causation element of the PTSD diagnosis makes it a service-connected illness” (Gansel 2014). To be diagnosed with PTSD it requires a causation element that, “the person has been exposed to a traumatic event in which the person experienced, witnessed, or was confronted with events that threatened death, serious injury or the bodily integrity of that person or others, and that person responded with intense fear, helplessness or fear” (Gansel 2014). Along with combat, military training conditions have been linked to post-traumatic stress disorder diagnoses because of what the soldiers are put through.
“Military training conditions soldiers to behave aggressively and violently; these traits, while necessary for survival in a warzone, can lead to criminal behavior at home. Modern military training involves the breakdown of soldiers’ psychological resistance to killing, desensitizing them to the act of killing, and conditioning them to reflexively take another’s life when a certain set of circumstances exist ” (Gansel, 2014). The goal of this training is for the military to prepare its soldiers to act in a lethal way without question or hesitation. An example of the effect it has on a veteran is the story of a Vietnam veteran killing his brother-in-law and his response to what he did. “When a Vietnam veteran was asked whether he was aware of the wrongfulness of his actions when he murdered his brother-in-law while in a PTSD dissociative state, he responded: “Are you kidding? They gave us ice cream for that” (Gansel 2014). As you can see, the veteran is clearly not in a suitable mental state and if it is combined with the military training, creates a major problem for veterans in civilian life. “This ingrained military training, coupled with the mental illness many soldiers develop in service, creates a class of defendants that deserve extra attention in the criminal justice system. Consequently, the United States justice system must take responsibility and create paths to treatment for soldiers whose service-related PTSD lead them to commit crimes” (Gansel 2014). Veteran’s with post-traumatic stress disorder clearly pose a greater threat to the community than a civilian with post-traumatic stress disorder. Veterans deserve to get special treatment in trying to combat their disorder and learn to live a normal life. They should not be pushed into incarceration when dealing with the trauma they experienced during military training and military combat. “The United States military transformed these men and women into soldiers and placed them in especially traumatic situations” (Gansel 2014).