Evidence of meeting #28 for Veterans Affairs in the 39th Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was soldiers.
A recording is available from Parliament.
NDP
Peter Stoffer NDP Sackville—Eastern Shore, NS
Thank you, Mr. Chairman, and merci, madame.
A few years ago, Mr. St. Denis and I had an opportunity to go to Bosnia. We met one of the interpreters for the Canadian Forces, and she was a very attractive 24-year-old woman. I could just imagine what went through her mind when she was 14 and a nurse's assistant, and what she went through. I asked her how it was back then. She said, it's not something we talk about; it's something we have to live with. There was no help for her or the thousands of young people in Bosnia. They didn't have psychologists or anyone to help them. I can just imagine what our troops experienced back then and the concerns they have.
Are you aware of any program of the previous or current government to assist those people in countries we go to? I know we're short in helping our own people, but if we don't offer some sort of psychological counselling to young people in Afghanistan or Bosnia, then they could end up becoming the terrorists of tomorrow. Are there any programs that you're aware of where we can assist in helping those young people get through? If a soldier is there for six months and comes back with post-traumatic stress disorder, can you imagine what it's like for the people who go through this every day, almost? It must be very tragic.
I have two other quick questions. How do you separate real PTSD from someone who might be faking it? I had one person call me up a while ago who served a tour over in Cyprus. I checked, and he had seen no combat. He even admitted it. He heard so many stories from other people that he lived it himself, almost. He wanted to get that disability for the PTSD, if you see what I mean. How do you separate the real PTSD from that of someone who may be trying to fake it a bit?
Also, one person in Halifax told me that it is possible to transfer your PTSD on to a family member. Is it possible to do that? A soldier comes home after he or she has witnessed such terrible things; they've related these things to their spouse in a way that maybe wasn't appropriate, and then the spouse now develops some form of strain because of that.
Psychologist and Professor, University of Montreal, As an Individual
Let me start by answering your first question about civilians and what happens to them as a result of living through horrific events on a daily basis. If our soldiers are experiencing post-traumatic stress syndrome, one can imagine that civilians are also experiencing it. You're completely right: we have a lot of scientific data indicating civilians do indeed suffer from post-traumatic stress syndrome for years and years.
You can imagine all the women who have been raped. Rape is used as a weapon in times of war in many countries and the victims suffer for many years from post-traumatic stress disorder. As far as treatment is concerned—and that, after all, was your question— for several years there was an organization called Psychologists Without Borders which set about training people locally to provide services to the population. You can understand how tough it was for this organization to survive. Nowadays, the psychologists are part of well-entrenched organizations such as Doctors Without Borders. These psychologists don't attempt to treat locals through an interpreter, rather they spend more time training local psychologists, social workers and doctors who are familiar with the local culture and values and who will be able to help locals for many years in the future, even if our organizations have left.
So the answer is yes, from an international standpoint there is an increasing amount of interest around post-traumatic stress syndrome even within organizations such as Doctors Without Borders.
Let me now turn to your final question—I'll come back to your second question in a moment—which was whether post-traumatic stress disorder can transfer from one individual to another.
Well, indeed it can. In fact, we were aware of this in the 1950s, 1960s and 1970s when studies were carried out on the cross-generation transmission of post-traumatic stress syndrome afflicting concentration camp victims. Among Jews, who lived in concentration camps for years, the presence of post-traumatic stress syndrome was even observed among second and third generations. There was a lot of fear and terror associated with the Germans and weapons, and the incidence of symptoms of depression was far more pronounced among Jewish people than among other populations, even though they weren't themselves subjected to the trauma. They had heard about it or, since many victims didn't talk about it, suspected it.
There has been a lot of talk, particularly in the United States, about compassion fatigue which is a syndrome many health care professionals suffer from. Such people are in constant contact with victims, so much so that they are no longer able to listen to stories of horror and they develop flashbacks about things that did not even happen to them. For example, constant references were made to the situation in Rwanda in my department, references for example to women who were shredded, and I myself started seeing them when I watched the news because I had heard these stories told over and over.
You can imagine that some spouses might also develop some post-traumatic symptoms. So I'd urge you once again to invite Dr. Guay, who is a researcher with the Canadian army, and who will be able to give you statistics. From a clinical point of view, I can tell you that we have observed that the spouses of some servicemen and women have a fear of Arabs, that is of people of Arab origin, for example. Event though they have never gone to Afghanistan nor seen the horrors that go on, they can no longer stand Arabs. Unfortunately, such spouses blame the population in general because, in their eyes, these people are the reason why their husbands were sent to Afghanistan, why they almost died and why their children almost didn't see their fathers again.
We also observe avoidance of some stimuli. We've observed various fears and symptoms of depression among troops' family members.
Now let me come back to your second question, which is perhaps the toughest. How can you distinguish between someone who is genuinely suffering from post-traumatic stress syndrome and someone who is merely pretending? We do have data and experience to fall back on based on the fact that we regularly see people with post-traumatic stress disorder. You have to realize that only a very small number of people are going to imagine they have, or pretend to have, post-traumatic stress syndrome. The reason is that post-traumatic stress disorder is stigmatized. Even though there is financial compensation for life, it certainly is no gold mine, that's for sure. It's a disorder which is also very poorly looked upon by other troops in the forces.
Also, you'll understand that the diagnosing military psychiatrist has seen a lot of troops. So he's able to ask the right questions so as to distinguish between a genuine case of PTSD and one that's fake. The psychiatrist will consider what type of nightmares the individual is having, how chronic the post-traumatic stress disorder is and a comparison will be made between what the client is saying and what he said two, or five months earlier. You start to become quite an expert at making the distinction.
Conservative
Conservative
Betty Hinton Conservative Kamloops—Thompson—Cariboo, BC
Thank you for this very interesting presentation. I was making notes throughout it. I was actually pleased to hear you mention Bosnia and Rwanda, because the same sorts of situations happened there as are happening today.
Also, you touched on it a bit, but the firemen in our country and the police face the same kinds of horrors that you're describing--burned children, and things that you don't think you're ever going to have to come face to face with. This is a very difficult situation for all concerned.
We have five operational stress institutions in Canada: Ste. Anne's Hospital in Montreal, la Maison Paul-Triquet in Quebec City, Parkwood in London, Deer Lodge in Winnipeg, and Carewest in Calgary. I'd like to ask you later on if you think that's enough or if you think there need to be more, but there are some other things I wanted to get into on this question.
I don't know how you would deal with someone who is used to looking at a child as a child and now suddenly they're in a situation where a child is actually strapped with explosives and prepared to blow themselves up, and the same with women. That's what's happening to many of our soldiers. Those are completely different scenarios from what they're ever used to. That must be very difficult.
One of the other things I wanted to mention is that aside from the psychological damage, if you find yourself in a situation all the time where the adrenalin is pumping through your body, you can deplete the adrenal glands, and that has a negative effect on the way you're dealing with things emotionally as well. When you've depleted that and you have nothing to rely on anymore, because you've used this “flight or fight” syndrome so often, it has to take its toll as well.
Those are just comments I wanted to make, and Doctors Without Borders sounds wonderful. I happen to have a sister-in-law who's part of a group, Nurses Without Borders. She's been in all the parts of the world that you've just talked about--a much braver woman than I am, I must tell you.
But how do you think Veterans Affairs Canada can contribute to changing the negative stereotype for veterans who suffer in silence from PTSD? We can't help them if they don't come forward. How do you think Veterans Affairs Canada could contribute to making that less of a stigma?
Psychologist and Professor, University of Montreal, As an Individual
If you don't mind, I'd like to come back to one of the comments you made which I found very interesting. And I'll take this opportunity to answer your question at the same time.
One very important thing that you mentioned is that there is a big difference between the two types of trauma—and I did not refer to this in my presentation—type 1 and type 2. Type 1 refers to a single incident: a woman is walking down the street and she's raped; a person goes to a bank and witnesses an armed robbery.
Our troops are often subject to this type of trauma, they're subject to type 2 trauma. Type 2 involves repetitive events: marital violence, incest. Physicians with Doctors without Borders are constantly in contact with horrors. This means something altogether different for our servicemen and women. It means that if they want to last for nine months—and that's roughly the duration of their rotation: from six to nine months—they also need to protect themselves emotionally. For many troops, this will mean dissociation. That means that they cut themselves off emotionally from what is going on around them and continue what they have to do. When they get back, many of them will have gaps in what they remember. It's also difficult from a therapy point of view because you have to ask them to re-experience certain emotions, to "reconnect", whereas when on active duty, the way they tolerated the horror was to "disconnects". So there's that type of trauma, and it means that if an individual "disconnect", he or she comes across as being strong.
That brings me to your final question: how can we as Canadians improve their condition and lessen the stigma? That will be difficult, because "disconnecting", going about your business without feeling emotions, and not being afraid, are examples of behaviour which are considered strong within the Canadian armed forces. In therapy, they're told that courage is not about not being afraid, it's about feeling the fear and doing it anyway. Feeling emotions may actually be an example of strength. So in order to promote healing, you have to get them to take the opposite approach to what they did to tolerate the horror and, sometimes, go against the grain of what is thought in military circles.
Our troops are extremely useful. They have to do horrible things, but policies are what they are and a decision is made to send them to fight because it's important for our country. They're very proud of that. Coming back traumatized is, for them, a sign of real weakness. They would have liked to have done what they had to do for their country without feeling any weakness. We have to show them that having post-traumatic symptoms is not necessarily a sign of weakness.
Gen. Dallaire has helped a lot with this. I think we need to be more aware that we're at war, and we need to decorate more soldiers and consider that they have done their duty to their homeland, even if they have post-traumatic symptoms, and not just decorate and recognize soldiers who didn't feel a thing. I don't know if I've expressed that well.
Bloc
Conservative
Betty Hinton Conservative Kamloops—Thompson—Cariboo, BC
That happens today. Post-traumatic stress sufferers are decorated on a regular basis, because they've been in very seriously war-torn countries, and so their recognition is there.
But let's go back a bit. We have World War II, we have Korea, we have Bosnia, we have Rwanda, and probably other places around the world that aren't coming to mind right now. We now have Afghanistan. So what can Veterans Affairs Canada do to change that negative stereotype? What do you think Veterans Affairs Canada could do to make it more palatable for soldiers who are suffering from these kinds of horrible stresses to be more comfortable about coming and saying, “I'm suffering from this; I need help”?
I recognize that it's not just soldiers. I sit at a committee that's full of men, so you're going to be my ally on this one. Women who have emotional problems—
Psychologist and Professor, University of Montreal, As an Individual
If I may, I'd like to talk about the difference between a soldier and a police officer or ambulance attendant. Ambulance attendants and firefighters who suffer post-traumatic stress disorder get the public's support. Police officers have a lot of trouble confiding in me that they were involved in a shooting and that despite this, they're still called meatheads or pigs out in the streets. In the same way, it's really hard for our servicemen and women to tell themselves that they went off to fight, that they risked their lives, but that they can't be sure they have the public's backing.
If they're going to fight and risk their lives, they need to feel that they are part of something. Perhaps they even need to come back as heroes. Many parents have asked us if they can at least be sure that if their son were to die at war, the entire population would see him come home under the flag, on television. They wanted to be sure that the country would support their son.
And that's your job, from a political point of view. If you're asking me whether, from the psychological point of view, it would be good if our troops felt more support from the public, then the answer is yes. If you're asking me from a psychological point of view if more can be done to ensure they're acknowledged and decorated whether they come back dead, alive or ill, the answer is still yes.
Conservative
Betty Hinton Conservative Kamloops—Thompson—Cariboo, BC
I'd love to go on, but he just told me I'm cut off.
Conservative
The Chair Conservative Rob Anders
Such is the way of the committee.
Mr. St. Denis, for five minutes.
Liberal
Brent St. Denis Liberal Algoma—Manitoulin—Kapuskasing, ON
Thank you, Mr. Chair.
I commend my colleagues for their excellent questions, and Dr. Brillon, your responses have been very helpful.
In simplest terms for us, mostly novices at this issue, we see something that happens physically--a gunshot wound or something broken--and in a comparative way that's what's happening in the head. Something has been broken. From your experience, can you quantify and say that half of the time or three-quarters of the time we can, by interventions, make people better again? Is there enough commonality among the cases? Is every case unique, or is there enough commonality among the different PTSD cases that you could say, if we put the typical victim on this regime of repair, most of the time they're going to come out okay?
I'd like your thoughts on that.
Psychologist and Professor, University of Montreal, As an Individual
There have been a lot of scientific studies on the effectiveness of our work, but not from a military standpoint. In Canada, research has only just begun on the effectiveness of mental health services in the military, and these studies are often deemed confidential. So they aren't published in scientific journals. If we look at international science reviews, you'll see that mental health services provided one month after the initial traumatic event are effective for level three, that is the long-term level. There have been many studies carried out to determine the effectiveness of treatment where rape victims, armed robbery victims, police officers and ambulance attendants receive 14, 20 and 30-session treatments. We know that these strategies work. After 30 years of scientific research on the psychology of trauma, we're able to document this.
Nevertheless, we're faced with a challenge. The populations tested as part of this research are "pure". You're looking at one victim, one serviceman who experienced a single event, who is neither clinically depressed nor an alcoholic, who doesn't have any personality disorder or seem to be suffering from stress. This must be considered in a research environment. If you want to test the effectiveness of the treatment, you have to study the "purest" population out there. The problem is this population doesn't normally turn up at our clinics. Scientific studies on what we call at-risk populations, or populations suffering from complex post-traumatic stress, are just starting to be seen. But as far as "pure" populations are concerned, we know that therapy works.
When doesn't therapy work as well? Well, there are a lot of additional stress factors that need to be taken into consideration. The first factor is social support, spousal support, and support from society and the country as a whole. Dr. Guay is a specialist in this area and will be able to tell you about this, if you're interested. Do I feel that I am supported by my country? A lack of social support, comorbidity, depression and alcohol can all make the symptoms worse. We also know that the way a person thinks after a traumatic incident plays a key role. Being ashamed of what you did in combat is also a factor.
A very interesting study was conducted by highly specialized veterans' hospitals in the United States. Thirty years after the Vietnam war, what are the key characteristics displayed by veterans who live at home and are well-adjusted, and what are the predominant characteristics of veterans who are hospitalized and still suffering from post-traumatic stress syndrome? The primary factor is national support. The second is feelings of shame and guilt about acts that were carried out. This is fascinating and helps us a great deal in targeting the way we treat military personnel.
A soldier may come home and say that he is ashamed of what he did. That was especially the case in the Vietnam war. The country didn't support the troops. They came home and were considered murderers, killers of children and civilians. Huge demonstrations took place in New York, Washington and Boston. Not only did the troops think they'd get killed, but when they came home they weren't even heroes, they were murderers. That was an aggravating factor when it came to post-traumatic stress disorder. Now we have a better understanding of what these aggravating factors are and we are now able to integrate them into our therapies. Now, I told you about the factors which make it harder for therapy to work: shame, guilt, comorbidity, and a lack of support.
Conservative
Bloc
Jean-Yves Roy Bloc Haute-Gaspésie—La Mitis—Matane—Matapédia, QC
Thank you, Mr. Chairman.
Please excuse me, I've lost my voice.
Ms. Brillon, I've heard you talk about social support, societal support, and the support that a country needs to give its troops. Let me tell you about something I've often heard from Canadians and Quebeckers which might surprise you.
There is a huge difference between what is happening now and what occurred from 1914 to 1917 and from 1939 to 1945, when conscription was the norm. Many of the people who were involved in these two wars had no choice and didn't necessarily have any will or desire to go to war: they were forced to do so.
That's not true of our troops today. Today's troops are individuals who have made a rational decision to enlist in the army. They initially made the decision knowing full well that one day they might have to go to war or be part of a peace-keeping mission. I make a distinction between the people I referred to earlier and someone who makes an adult decision to go to war and then expects support from his or her society or country. Basically, when individuals make such a decision, they know full well that one day they may have to shoot at someone or that they may be shot at themselves. This wasn't the case from 1939 to 1945. Nor was it the case from 1914 to 1917 because these people were forced to go to war.
I'm not saying that we shouldn't support our troops, but I want to know whether people are sufficiently aware, when they decide to enlist in the army, of what may happen to them. If I decide to drive at 160 km/hr, I know that I may kill someone or get killed. Obviously, the same is true if I choose to enrol in the army.
My question is whether these individuals—and this comes back to Gilles' question—are sufficiently aware of what may end up happening to them when they actually sign a contract with the army, whether it be the Canadian, American, French or any other army in the world. That's my question. Are they made aware of these risks? Don't we romanticize things, in a way? I remember the old slogan: "Sign Up, You'll Travel". You will indeed travel, but you'll find the travelling very tough when you go to Bosnia or places like that. Are these people really made aware of what they'll be facing?
Psychologist and Professor, University of Montreal, As an Individual
You know, when an 18-year old enrols... Well, when you're 18, whether you're a soldier or not, you're invincible. Whether you're behind a steering wheel or a gun, you're invincible. So, you've got troops that sign up when they're 18, who have grand national values and who want to save the world. Police officers, for example, have similar personality traits: they want to save people. This is quite ingrained in them. Now, when you enlist at 18 and you feel invincible, that it's all a big adventure, that you're not going to die and that if you were to die you'd do so in dignity and glory, you stay in the army. But when you're 41 and you've got two children aged 3 and 5, that's no longer true. Obviously that changes the way troops perceive war.
As a psychologist, I'm against all war. Politically, that's different, but as a psychologist, I'm against all war. On the other hand, if my country decides to go to war, well, we need to support our troops 100%. Either you send them to war-torn countries and support them 100%, or you don't send them at all. What I can tell you as a psychologist is that if you send them based on a political decision, well then you need to support them psychologically 100%. Does that answer your question?
You talked about awareness.
I believe that they are aware of what they're doing, and that they accept the risks. And these aren't the type of people to make big demands about wanting support. We're not talking about those kinds of people. When they enrol, and they end up living for example in Rwanda one year, then in Haiti, or Bosnia the next, they're going to manage just fine. But when they get to Afghanistan, for example, then something happens. A soldier might see his or her fellow soldier step on a mine and get blown up. Troops like that come and see me and they tell me that it's just too much, and they can't take it anymore. They can just no longer bear the memory of having brain splattered all over their hands. They just can't process it. They can't deal with it. So there are the type of people who have already served, for whom things went well, but who snapped over some incident.
Bloc
Bloc
Jean-Yves Roy Bloc Haute-Gaspésie—La Mitis—Matane—Matapédia, QC
I'd like to put one last question.
I understand that you are not in the armed forces, but in your opinion, is the current training given to our soldiers, that is very much focused on physical fitness and strength, etc...
Excuse me?
Bloc
Jean-Yves Roy Bloc Haute-Gaspésie—La Mitis—Matane—Matapédia, QC
Nothing for the brain, as he says.
I would not go so far as to say that, but is this training psychologically adequate for the work that they will have to do on the ground? Is there too much physical training and not enough mental training?
Psychologist and Professor, University of Montreal, As an Individual
Much more could be done in the way of mental training.
Soldiers say that they want to be fit. Fitness requires daily training. Some even speak of extreme fitness.
We have started telling them that they could also be mentally fit; and mentally fit does not mean fearlessness and insensitivity. This is something new. This means being connected and open, because we know that completely repressing one's emotions is far more hazardous.
At first thought, it seems as if repressing your emotions and charging ahead will protect you. Now we know that this is not the case. Therefore, much more work could be done in creating programs for developing mental fitness, certainly.
Bloc
Conservative
Conservative
Bev Shipley Conservative Lambton—Kent—Middlesex, ON
Thank you, Doctor. It has been a very interesting morning.
You talked about the number of dollars that are required, the amount of money that it takes to do the research. Can you tell me how much cooperation and coordination there is between Canada, the United States, and other countries that are dealing with the same thing? How do you make that work so that we aren't lone rangers, funding research on top of research, on top of research?
Secondly, dollars for treatment is separate from dollars for research. I'm not sure I've yet understood that distinguishing part of your comments, so I'd like to have that.
I can't get over, actually, how much you are emphasizing the significance of support, what that means to an individual in our Canadian Forces. One of the comments was about a plane and taking the money away. I think they're two separate issues. I think we obviously have to equip them properly so that it takes away some of those issues of not being well equipped or not being well prepared, but I think it's a separate issue in terms of dollars for treatment, pre-, post-, and in the long term.
Those are just a couple of questions. Perhaps you'd deal with those first, please.
