{"id":111038,"date":"2021-01-26T18:06:57","date_gmt":"2021-01-27T01:06:57","guid":{"rendered":"http:\/\/www.lankaweb.com\/news\/items\/?p=111038"},"modified":"2021-01-26T18:06:57","modified_gmt":"2021-01-27T01:06:57","slug":"post-combat-depression-pcd-4","status":"publish","type":"post","link":"https:\/\/www.lankaweb.com\/news\/items\/2021\/01\/26\/post-combat-depression-pcd-4\/","title":{"rendered":"Post Combat Depression (PCD)"},"content":{"rendered":"

By Dr. Ruwan M Jayatunge M.D\u00a0\u00a0<\/em><\/strong><\/span><\/h2>\n\n\n
\"\"\/<\/figure>\n\n\n\n

The concept of\nPost Combat Depression (PCD) is not new. There are many historical records to\nprovide that combatants manifested depressive symptoms after the war. The\nfeeling of guilt and despair plays a major role in post-combat depression. For\ninstance, King Dutugamunu went into a depressive type of reaction soon after\nthe Wijithapura battle. The king\u2019s emotional worries were later healed by a\nmonk. Similarly, Napoleon Bonaparte developed depression while he was in exile\non the island of St Helena.  <\/p>\n\n\n\n

Post combat\ndepression is evident among some combatants who were exposed to traumatic\nbattle events. Apart from common depressive signs, PCD is usually characterized\nby unresolved mental conflicts, survival guilt, negative interpretation of\ncombat events, and a pessimistic outlook on the post-combat environment. \nThe component of depression was evident to Dr. Mendez Da Costa who introduced\nthe term Irritable heart during the US Civil War and Lt Col (Dr) Fredric Mott\nwho coined the term Shell Shock during World War One. <\/p>\n\n\n\n

Sometimes\ndepression is obvious among the servicemen who were exposed to traumatic combat\nevents. In addition to depressive symptoms, they can have anxiety-related\nfeatures.  In common, terms depression is a medical condition leading to\npersistent feelings of worthlessness, hopelessness, guilt, agitation, and\nindecisiveness. Depression can occur following negative life events, physical\nillnesses such as thyroid imbalance or diabetes mellitus. <\/p>\n\n\n\n

Post combat\ndepression (PCD) usually takes place mostly as a result of traumatic combat\nexperiences with negative cognitive interpretations.  A depressed soldier\nexperiences deep unshakable sadness and diminished interest in most of the\npersonal, as well as military, activates. Depression can dramatically impair a\nsoldier\u2019s ability to function in field situations. A soldier who develops\nsevere depression may appear so confused frightened and unbalanced.  <\/p>\n\n\n\n

Depression is\na mood disorder in which pathological moods and related vegetative and\npsychomotor disturbance dominate the clinical picture. The term Post combat\ndepression has been used for the first time in the publication PTSD Sri Lankan\nExperience\u201d and described as a group of symptoms such as anhedonia (feeling of\nsadness and loss of ability to experience pleasure) low energy, decreased\nlibido, reduced life interests, somatic pain, alienation, numbing, self-blame\nand survival guilt that is experienced by combat soldiers after exposing to\ntraumatic battle events. <\/p>\n\n\n\n

Depression\ncauses a disturbance in a soldier\u2019s feelings and emotions. They may experience\nsuch extreme emotional pain that they consider or attempt suicide. \nLearned Helplessness in the Battle Field could be described via Psychologist\nSeligman\u2019s research work. Seligman (1975) was studying the effects of learned\nhelplessness, which is associated with depression. He studied the series of\nescape mechanisms of doges when exposed to electric shock. In this study, many\ndoges did not attempt to escape although there were escape paths. Instead, they\nsuffered eclectic shocks and remained helpless. Seligman stated that learned\nhelplessness is a factor in depression. The learned helplessness model proposes\nthat the depressive posture is learned from past situations. Soldiers on the\nbattlefield act in a certain way as Seligman doges when exposed to traumatic\nevents. Sometimes they do not take any positive measures to change their\nsituation. Also, they hardly take measures to detach from depressive\ncomponents.  Beck (1979, 1983) hypothesized that depression-prone\nindividuals possess negative self schemata which he describes as a cognitive\ntriad\u201d. Combatants with PCD often have a negative view of themselves may be as\na result of the acts that they have committed on the battlefield or may be due\nto low recognition of post-military service by society. They see their\nenvironment as overwhelming filled with obstacles and failure. Also, they have\na pessimistic outlook of the future.  <\/p>\n\n\n\n

Many soldiers\nbecome emotionally shattered witnessing the death of their buddies. Sometimes\nthey hold responsible for the deaths of their friends. These soldiers always\nquestion their conscience. Often they say to themselves it\u2019s unfair for me to\nlive since I could not save their lives or they have gone because of my error,\nI don\u2019t deserve to live, etc. These are the common self-blame patterns that can\nbe seen among the soldiers with PCD. They carry the memories of their dead\ncomrades for decades.  Many depressed soldiers use natural defenses\nagainst self-attacking shame by striking out at others, attacking others by\nbeing critical, sarcastic, or abusive. Alcohol and substance abuse can be a\nprevailing feature of PCD. Depressive behavior clearly has a powerful\ninterpersonal impact. The affected servicemen have deteriorated interpersonal\nrelationships in the battlefield. On certain occasions, the combatant\u2019s family\nmembers too feel this distance and coldness.  <\/p>\n\n\n\n

Depression\nrepresents a masochistic lifestyle. Soldiers with post-combat depression suffer\nfrom a lack of assertion and outwardly directed aggressiveness. Aggression\nturned inward mechanism is a universal explanation for depressed behavior.\nFreud\u2019s concept of aggression turned inward model or depressed affect is\nderived from retroflection of aggressive impulses directed against an\nambivalently loved internalized object was actually formulated by his student\nCarl Abraham.  As the psychoanalyst, Carl Menninger elaborates suicide is a\nmurder in 180 degrees. Soldiers are taught to be aggressive. Killing is a part\nof military training. Therefore aggressive tendency and will to kill the enemy\nis an accepted component in the military culture. Sometimes this\noutward-directed aggression turns 180 degrees and PCD soldiers shoot\nthemselves. Frequently soldiers with post-combat depression go in to various\ntypes of self-harm including risk-taking behavior. <\/p>\n\n\n\n

At the height\nof the depression, they can take their own lives. Very often these soldiers use\ntheir weapons to commit suicide.  Undiagnosed and untreated depression can\nlead to many complications on the battlefield. At the height of the depression,\ncombatants with PCD can go into fugue states. When they are under fugue states\nthey become numbed and can be disoriented. <\/p>\n\n\n\n

This is the\nstory of a soldier who went into a fugue state as a result of overwhelming\ndepression during the Eelam War. This combatant was found by a group of\nsoldiers when he was wandering and heading towards the enemy lines. When questioned\nhe had no idea how he came out of his bunker. In addition, there was no trace\nof his weapon. Probably he must have dropped it in the jungle. When he was\nreferred for a psychiatric assessment, he denied any kind of substance abuse.\nThere was no history of dissociative disorder. But he was depressed following\nthe deaths of his platoon members. His depression was undiagnosed and untreated\nuntil he went into the depressive fugue.  <\/p>\n\n\n\n

Physical\ninjuries, Disabilities, and PCD go hand in hand. A large number of soldiers who\nsustain physical injuries and become disabled can go into post-combat\ndepression. This category describes depression that occurs in response to a\nmajor life stressor or crisis. Stressful events such as physical injury and\ndisability often appear to be triggered by the temperamental instability that\nprecedes clinical episodes.  <\/p>\n\n\n\n

PCD can be\ntreated with medication and psychotherapy. Antidepressants are effective in\nPCD. Psychotherapy is an effective treatment for PCD. Cognitive Behavior Therapy\nor CBT focuses on the identification of distorted perceptions that patients may\nhave of the combat and themselves changing these perceptions and discovering\nnew patterns of action and behavior. PET or Rational Emotive Therapy helps to\nchange the irrational and illogical thoughts such as survival guilt held by the\ncombatants. RET is an approach that focuses on altering the client\u2019s patterns\nof irrational thinking to reduce maladaptive emotions and behavior. <\/p>\n","protected":false},"excerpt":{"rendered":"

By Dr. Ruwan M Jayatunge M.D\u00a0\u00a0 The concept of Post Combat Depression (PCD) is not new. There are many historical records to provide that combatants manifested depressive symptoms after the war. The feeling of guilt and despair plays a major role in post-combat depression. For instance, King Dutugamunu went into a depressive type of reaction […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":true,"template":"","format":"standard","meta":{"footnotes":""},"categories":[68],"tags":[],"class_list":["post-111038","post","type-post","status-publish","format-standard","hentry","category-dr-ruwan-m-jayatunge-m-d"],"_links":{"self":[{"href":"https:\/\/www.lankaweb.com\/news\/items\/wp-json\/wp\/v2\/posts\/111038","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.lankaweb.com\/news\/items\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.lankaweb.com\/news\/items\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.lankaweb.com\/news\/items\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.lankaweb.com\/news\/items\/wp-json\/wp\/v2\/comments?post=111038"}],"version-history":[{"count":0,"href":"https:\/\/www.lankaweb.com\/news\/items\/wp-json\/wp\/v2\/posts\/111038\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.lankaweb.com\/news\/items\/wp-json\/wp\/v2\/media?parent=111038"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.lankaweb.com\/news\/items\/wp-json\/wp\/v2\/categories?post=111038"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.lankaweb.com\/news\/items\/wp-json\/wp\/v2\/tags?post=111038"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}