Once a Warrior Always a Warrior

Hoge, Charles W., MD. Once a Warrior Always a Warrior. Guilford, CT: Globe Pequot, 2010.
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Charles W. Hoge, MD, Colonel, U.S. Army (Retired) is considered to be one of the
leading experts in the fields of PTSD and mental health impacts of war. Hoge received his
Bachelors at Sarah Lawrence College and then is MD at the University Of Maryland School Of
Medicine. Dr. Hoges expertise spans psychiatry, trauma, public health, and infectious diseases.
His articles in The New England Journal of Medicine and The Journal of the American Medical
Association are the most frequently cited medical articles about the impact of the present wars in
Iraq and Afghanistan. His 20 year military career includes a two year span as a Public Health
Service Officer at the CDC, a six year time period where he directed field studies to prevent
tropical diseases in deployed troops, and he served his last 12 years as an Army Psychiatrist. He
was also deployed to Iraq in 2004, where he travelled the country to improve combat stress
control services. He now lives in Washington D.C. with his family.

For this source Im using the introduction and the first section of this novel. The
introduction, titled Postwar Transition-Readjustment, focuses on the struggles faced by many
soldiers returning home from war. I enjoyed reading this section at the beginning of this novel
because it provided a brief and early insight on some effects of PTSD before getting too involved
in the novel itself. The introduction specifically outlines a variety of social effects that PTSD can
cause such as, problems with authority in the workplace, strain between spouses and family upon
returning from the frontlines, and a distancing between friendships and outside relations. It also
goes into good detail about the stereotypes of PTSD, creating a divisible line between proven
facts about PTSD and myths. It states that more often than not, a lot of soldiers will not develop
PTSD, but they still come back from combat zones with enhanced reflexes and a sterner and
more direct aura about themselves. This behavior can be attributed to an overstimulated fight or
flight response developed over months of high stressor situations but does not always develop
into PTSD.
The second part of this novel I plan on using is titled Combat Stress and Post-Traumatic
Stress Disorder. This section goes on to give a brief history of PTSD and all of the other
pseudonyms it has gone by in the past. Its in this passage that he begins to gear his novel
towards actual veterans suffering from PTSD, talking to the audience as more of a psychiatrist
than an actual author. He includes firsthand accounts and experiences of other military personnel
that he has come across during his tenure as an Army psychiatrist. He also added several
disturbing quotes taken from affected veterans about the struggles they face in their everyday
lives. While this section was very helpful, I feel like I could have obtained the same information
by just researching the history of PTSD itself.

Whenever there are crowds I start feeling like Im in Iraq and I have to get out of the
fast

-Junior Enlisted Soldier, Post-Iraq

I keep having this nightmare where I am sleeping in one of those kerosene-soaked
tents and Im on the only bunk bed on top with rounds coming in

-Junior Enlisted Soldier, Post-Iraq

War F*cked me up mentally. I have bad dreams and I see all kinds of mad ill shit. I see
dead people. Sometimes I get angry and pissed off and just want to kill somebody.
-Junior Enlisted Soldier, Post-Afghanistan

Reflection:
I relatively enjoyed reading this novel. While it was more geared towards and audience that
actually suffers from this condition, several sections provided vary reliable information. It was
also a good book because the author is such an accredited expert in his field. He was able to
utilize his education, work history, and past experiences to give his novel a more personable feel,
like he is sitting down and having a conversation with the audience.

Living with PTSD and how it affects Daily Life

Patton, Donnie C., III. "Living with PTSD and How It Affects Daily Life." Personal interview.
18 Mar. 2016.

Staff Sgt. Donnie C. Patton III, U.S Army (Retired), is an ex-Army Ranger who, during
his 22 year military career, has operated on six different continents, experienced combat in three
different wars, and conducted countless classified operations during his time with the Rangers.
He experienced and survived arguably some of the harshest climates in the world, from the
frozen winter forests of Alaska to the hot desert streets of Fallujah and Bagdad, Iraq. During his
service, he collected multiple countless campaign ribbons, three Purple Hearts, and two Bronze
Stars for valor and preforming above the call of duty.
Staff Sgt. Patton was born and raised on a farm in the mountains of North Carolina. He
spent his childhood harvesting tobacco with his father, but always would escape to the woods
after his chores. It was hear where his Cherokee Grandfather taught him the ways of nature, how
to shoot a rifle, and how to move silently through the forest. In high school he displayed his
remarkable athletic ability as an All-State runner on the schools track team. After graduation, he
enlisted in the Army as an infantry scout, where he excelled in every aspect. He was then
nominated by his superiors to attend jump school in Georgia, where he earned his paratrooper
winds and was assigned to the infamous 101st Airborne Division, also known as The Screaming

Eagles. After his tour in Operation Desert Storm from 1990- 1991, Patton was recruited to
attend Army Ranger School in Alaska. After graduating from Ranger school in 93, Patton was
sent on several covert operations across the globe. After 9/11, he was one of the first soldiers on
the ground during the invasion of Iraq, where he went on to complete four tours of duty. His last
tour of active duty was in Afghanistan in 2009. He retired from the Armed Forces in 2010 and
now works as a Park Ranger at Kings Mountain State Park. Staff Sgt. Patton was not only a war
hero, but also a loving and caring father and husband. He has always been my hero, and has been
a perfect role model for both myself and my younger brother. He is my inspiration for writing
about this subject, because like many veterans, my father has begun to suffer from PTSD. I chose
this subject so that I may further my knowledge about PTSD in general and so I may begin to
understand what he is going through. I also decided to interview him and use him as a source for
my thesis.
During my interview with my father, I decided to focus on questions about how his PTSD
affects his daily life. One of the biggest things that he has trouble with are loud noises. This
could be anything from fireworks to heavy objects suddenly slamming on the floor. They cause
him to cringe, and sometimes even have minor flashbacks to events he experienced during his
active duty. Oddly enough, he repeatedly stated that the sound of gunshots dont really bother
him much. When I asked my father how PTSD has begun to affect him physically, he starts
talking about his nightmares. These happen about every other night and sometimes its just the
same dream over and over again. Very solemnly he recounts tells me that he often sees the men
he has killed over the years, standing in front of him in a line, all with hollow eyes, sometimes
with their fatal wounds spilling blood. Also, he constantly dreams about many of his friends
being killed in combat and feeling helpless because he cannot ever save them. Over the past few

years his dreams on rare occasions evolve into full on sleepwalking flashbacks. Ive personally
witnessed my father trying his to fend off an entire group of Taliban from behind the couch firing
a broomstick like a rifle. These occurrences adds a lot of stress on the family and my father has
event went to a therapist a few times. I also asked my father about how his PTSD has affected his
social life. Now granted my father has always been somewhat of an introvert, a very reserved
man whose few words can carry a lot of weight. Recently, he describes himself as feeling cut off,
or misunderstood by society. Sometimes, when people complain it angers his because he feels
like they dont understand what its like to have a real reason to complain. My father gave me an
example of an incident at work few days prior. All that idiot did the other day was sit in his
office and bitch about all the paperwork he had to finish! Now son, Ive sweated my ass off in
110 degree weather in 50 pounds of gear in a Humvee with no air condition for damn near 24
hour shifts, and I aint ever complained as much as that worthless S.O.B.. Needless to say, I
dont think my father is very fond of his coworker. He finished our interview talking about all his
buddies down at the VA and how they understand what each other is going through. He talked
about how they go to therapy meetings together and also go hang out from time to time at the
bar. It also doesnt hurt that my father brought home a kitten that he found at work, which he
raised himself and joking calls his comfort kitten.

Reflection:
I found this interview with my father very helpful. It was the first time we sat down and had a
man to man conversation about his war stories. I also now have a better understanding of what he
is going through mentally on a day to day basis. The interview itself was very emotional and I
feel like I can use a lot of his person experiences to further my research and improve my thesis.

Wartorn 1861-2010

Wartorn 1861-2010. Dir. James Gandolfini. HBO, 2010. Documentary.

James Gandolfini was born in Westwood, New Jersey on Sept. 18, 1961. Gandolfini, was
an American actor and producer, most famously known for his role as Tony Soprano, an Italian
American Mafia boss, in the HBO series The Sopranos which aired from1999-2007. He received
three Emmy Awards, three Screen Actors Guild Awards, and one Golden Globe Award for Best
Actor in a Drama Series for his performance on the show. His other roles included mob
henchman Virgil in True Romance, enforcer and stuntman Bear in Get Shorty, "Wild Thing"
Carol in Where the Wild Things Are, and Albert in Enough Said. James Gandolfini died while on
vacation in Sicily at the age of 51 on June 19th, 2013.

In 2010 James Gandolfini partnered with HBO to produce Wartorn 1861-2010. In this
documentary, HBO interviews a wide range of subjects, from active duty service members, to the
families of servicemen that have committed suicide. This documentary provides verbal testimony
of the trials and tribulations experienced by World War II and Vietnam Veterans, and also written
evidence of PTSD that dates all the way back to the Civil War. The documentary starts with the
story of a young union soldier. They follow his journey throughout the Civil war through the
letters he sent home to his family. Gradually, his personality in the letters begin to change, and he
starts to talk about the side effects that war is having on him, many of which are now recognized
as symptoms of PTSD. Eventually, after coming home from the battle front, the young Union
soldier commits suicide. The film then moves on to the personal and group interviews with old
World War II veterans, where they describe the horrors they saw during combat and how it
forever changed them. They go on to tell how they were completely different men when they
came home from war, and how many of them still have nightmares to this day. As the
documentary continues, these stories are repeated by both Vietnam and Iraq Veterans alike.

Must you carry the bloody horror of combat in your heart forever?
-Homer, The Odyssey
I wont have the hospitals cluttered up with theses sons of bitches who havent got the
guts to fight Send that yellow son of a bitch back to the front line.
-General George S. Patton, World War II

Reflection:
I found this source very educating. This documentary was created to educate the public on the
prevalence of PTSD and how serious it can actually be. The video also effectively outlines

societies view on Shell Shock or melancholy through history; from expecting veterans to
man up and suck it up, to finally becoming aware of the problem and offering affected veterans
the help they need. Because of this film, I am now more aware of the different views society has
had towards PTSD through history. I also know that PTSD is not a new disorder at all, but
instead has been occurring in American soldiers for generations.

Anger, dissociation, and PTSD among male veterans

entering into PTSD treatment

Kulkarni, Madhur, Kathrine E. Porter, and Sheila A.M. Rauch. "Anger, Dissociation, and PTSD
among Male Veterans Entering into PTSD Treatment." Journal of Anxiety Disorders (March 26,
2012). MEDLINE/PubMed. Web. 25 Mar. 2016.

After hours of searching, I couldnt find any extra information on the authors. All I found
was a brief job description on the peer reviewed article. Dr. Kulkarni is now at Center for Health
Care Evaluation, VA Palo Alto Health Care System, and Department of Psychiatry and
Behavioral Sciences, Stanford University. Katherine E. Porter works in the Ann Arbor
Healthcare System, and Dr. Rauch works in the VA Research Dept. at the University of
Michigan. Her work was supported by a Career Development Award (CDA-2) from the

Department of Veteran Affairs, Veterans Health Administration, Office of Research and

Development, Clinical Sciences Research and Development.

This article focuses on the prevalence of anger and disassociation displayed by returning
male veterans. These observations come directly from research that has been conducted by the
Dept. of Veterans Affairs. The article states that anger that originates from PTSD is associated
with numerous negative consequences, including impulsive aggression, poorer treatment
outcomes, substance misuse, and increased aggression. In recent studies of both Veteran and
civilian populations, trauma survivors who report higher levels of anger are more likely to meet
criteria for PTSD. Also, research has shown that anger levels are significantly higher in combat
veterans that are diagnosed with PTSD than combat veterans that have not been affected. As for
disassociation, the article defines it as having difficulty to integrating thoughts, feelings, and
experiences into consciousness and memory. The VA studies found that increased dissociative
symptoms both during and after trauma exposure are related to a higher level severity of PTSD
in veterans.

Identifying anger and dissociation as avoidance and maladaptive coping strategies

involved in the maintenance of PTSD symptoms can be a critical part of effective
treatment for PTSD.

Reflection:
Overall, this peer reviewed article was helpful, but also very hard to understand. While it gave
valuable insight on some of the emotional and mental symptoms of PTSD, some of the 0words
used by the authors are pretty advanced. This source gave me a lot of information that I can

utilize in the section of my thesis that will focus on the mental struggles that veterans face after
their return home.

The effects of temporal unpredictability in anticipation

of negative events in combat veterans with PTSD.
Simmons, Alan N., Taru M. Flagan, Marc Wittmann, Irina A. Strigo, Scott C. Matthews, Heather
Donovan, James B. Lohr, and Martin P. Paulus. "The Effects of Temporal Unpredictability in
Anticipation of Negative Events in Combat Veterans with PTSD." Journal of Affective Disorders
146.3 (2013): 426-32. MEDLINE/PubMed. Web. 25 Mar. 2016.
I was unable to find any specific details on any of the authors in this journal.

This peer reviewed article focuses on unpredictable episodes or flashbacks experienced

by some veterans diagnosed with PTSD. It gives a brief background of what specifically triggers
these flashback, and how they can be prevented. The article describes several different symptoms
of PTSD. The article then goes into specific detail about certain experiments theyve conducted
in order to test their theories. They conducted their tests on two groups of 15 combat veterans,
one group that has been diagnosed with PTSD, the other group is not. They subjected each group

to an MRI and recorded the brain activity of every veteran. The results showed that the right
anterior insula was the only region that showed increased activity in the PTSD than in the nonaffected group for the interaction.

Reflection:
To be honest, this resource was not very useful at all. The authors used very eloquent language
throughout his journal, which made it very hard to understand for someone who is not an expert
in this field. The article also did not provide near as much information on the effects of PTSD as
I thought it would.

The long-term costs of traumatic stress: intertwined

physical and psychological consequences

Mcfarlane, Alexander C. "The Long-term Costs of Traumatic Stress: Intertwined Physical and
Psychological Consequences." World Psychiatry 9.1 (2010): 3-10. PMC. Web. 26 Mar. 2016.

There was not any additional background knowledge about this author. (It took me 20
minutes just to find a picture of him)

This article, written by Alexander C. Mcfarlane, starts with a brief synopsis on the history
of PTSD, starting during the post WW I era. He moves through the past century and talks about
the development and progression of PTSD research, and how far weve come since the first
diagnosis. He explains how PTSD can also be associated with the onset of other physical
conditions such as chronic musculoskeletal pain, hypertension, hyperlipidemia, obesity and
cardiovascular disease. Most experts agree that the conditions are a direct result of the intense
traumatic stress an individual has been exposed to. He also introduces a brief explanation of his
theory of why some veterans do not begin to feel the effects of PTSD until years later, sometimes

even decades after returning home. Mcfarlane then begins to transition in his journal, and begins
to explore the evidence about the delayed effects of traumatic stress and their burden on both an
individuals mental and physical health.

Reflection:
I found this article somewhat helpful. It gave me a better insight on the actual physical effects
PTSD can have on an individual, and also named a few physical conditions that I can extend my
research towards. Overall the author did a decent job explaining what PTSD is and how research
has evolved over the last century. I also was unaware of the fact that veterans can start
developing PTSD years after they experience a traumatic event. I was under the previous
impression that PTSD was a rather immediate condition that developed right after periods of
traumatic stress.