Veterans Affairs Committee on Feb. 27th, 2007

[Dr. Pascale Brillon]

This is really difficult for me because I really am not part of the army. I am really independent of the entire system. I provide training outside the system, and it would be very difficult for me to say how much money should be spent on psychological training or on research in that field.

Nevertheless, I know people who work there, I am aware of their qualities... I am thinking of Dr. Brunet or Dr. Guay, who are specialists in trauma in the Canadian Forces. These people are very highly qualified. I am sure that they could do much more research and much more work on the symptoms of our soldiers. They could try out strategies and evaluate their efficiency.

So, as you put it so well, what kind of money should be invested to have more psychologists immediately available at the time of incidents or afterward, etc.? In addition, what kind of effort should we make to provide the researchers with equipment? Providing psychological treatment is fine, but it is even better if we know that the treatment works. For years, we thought that debriefing was working, but just recently, after thorough testing, serious drawbacks were detected. Therefore, it will be very important to test the results of the psychological treatment.

That being said, military personnel is not an easy subject for research, because the results are not popular from the political perspective. A certain percentage of our soldiers have post-traumatic stress disorder, and a certain percentage of these still have it 2, 5 or 15 years later. Nevertheless, it would be very interesting to get the data so that they can get better service.

Your first question was about the collaboration between Canada and other countries on research. Am I right? Was it about research, or about treatment?

[Bev Shipley, Conservative, Lambton—Kent—Middlesex, ON]

Yes.

[Dr. Pascale Brillon]

Was it about both?

[Bev Shipley, Conservative, Lambton—Kent—Middlesex, ON]

No, research first.

[Dr. Pascale Brillon]

Scientific research is always considered at the international level. When I publish articles in English, they are distributed all over the world. When Dr. Guay or Dr. Brunet publish articles, the same applies. These people provide training abroad, they receive training and they attend conferences and scientific presentations all over the world.

One of the most important conferences that we attend is the International Society for Traumatic Stress Studies conference, held once a year in the United States. Here, scientific researchers from all over the world who are specialized in post-traumatic stress disorder gather to exchange their findings.

Yes, there is a great deal of communication going on in this scientific field. We are increasingly interested in what others are doing. I know that many military psychiatrists have been trained in veterans' hospitals in the United States to learn clinical practices from others. Research is already very much at an international level, but what can we do about clinical practices? How can we learn more about what others are doing? There is no need to reinvent the wheel each time. We can take advantage of the experience of others, as we are doing more and more.

However, it takes money to send psychologists or psychiatrists to the United States for training and to bring them back. It costs money. There are many who find it difficult to attend international conferences and receive training for post-traumatic stress in the armed forces. Funds must be provided so that our psychologists and psychiatrists can afford to get training abroad and to come back.

[Bev Shipley, Conservative, Lambton—Kent—Middlesex, ON]

In identifying people with PTSD and the treatment of people with PTSD, are we making progress?

[Dr. Pascale Brillon]

Yes, absolutely. We are making great headway in Canada because we have gone far in a very short period of time. However, a tradition has already been established in the United States. Let me say that there has been a great deal of progress since I obtained my doctorate 10 years ago. We must continue.

[Bev Shipley, Conservative, Lambton—Kent—Middlesex, ON]

Thank you. I understand.

[The Chair, Conservative, Rob Anders]

They'd all like to keep going, but of course they have time limits.

Now over to Mr. Cuzner for five minutes.

[Rodger Cuzner, Liberal, Cape Breton—Canso, NS]

Thank you very much.

Doctor, it's been an excellent presentation here today, and some great questions right around the table.

I know for everybody around the table, when we went to school, there was what we know now as ADD or ADHD, but they used to just be the bad little buggers who couldn't sit still for most of the class. So as we learn more about PTSD and become better at recognizing the actual cases, since statistics have been taken, and over the various conflicts that not only our own soldiers but our allied soldiers as well have been in, are the numbers increasing as warfare changes?

There has been an obvious change from our Second World War veterans to what our soldiers deal with today. Are the numbers of instances increasing or decreasing? Can you make a comment on that and rationalize the numbers, why they are going that route?

[Dr. Pascale Brillon]

This is difficult to evaluate, because we had the means to evaluate post-traumatic stress disorder in the 1980s, between 1980 and 1985, but we have no data on the number of cases of post-traumatic stress disorder for the Second World War. There is little data on Vietnam veterans because the research was just beginning at that time. From now on, we will be able to document those cases. If our research can show the number of Canadian veterans who currently have post-traumatic stress disorder, in 10 years, we will be able to compare the figures with those of future wars. We will be able to determine whether the new kinds of warfare are more harmful and devastating and we will know what factors should be included in our practice, in our vision of the armed forces and in the training that we can provide the soldiers to bring the figures down. Therefore, it is very hard to tell if there is an increase in the number of post-traumatic stress disorder cases, because we had no way of detecting them in the past.

[Rodger Cuzner, Liberal, Cape Breton—Canso, NS]

I guess it's trying to establish a base from which to measure that. I think you would want to measure just to see if in fact what you're doing--the preparation of the soldiers prior to entering combat or whatever--is successful.

The other thing I want to ask you about is the involvement of the families. I would imagine that this would be a case-by-case type of initiative, but how do you engage the family in the treatment of a veteran who may be dealing with the syndrome?

[Dr. Pascale Brillon]

We are trying to give an increasing role to family members. Once again, I would encourage you to invite Dr. Stéphane Guay, who is specialized in the role of the family and of the spouse with regard to post-traumatic stress disorder. He works at the Louis-H. Lafontaine Hospital in Montreal and at the Sainte-Anne Hospital for veterans. He could really be of great help to you.

I know that more and more attempts are being made to create groups that include spouses who meet with the soldiers and discuss things with them. In addition, groups are created solely for spouses. We are trying to increase the family's role because we know that a traumatic event has a ripple effect. The impact does not only occur at the point where the rock hits the water, but it makes waves in families and through the entire social fabric. We know for a fact that therapy improves when spouses participate. We know that spouses also need help and they often suffer from distress. Therefore, we create groups to help them.

Once again, let me encourage you to invite someone who is within the Canadian Forces and who could give you the latest updates.

[Roger Valley, Liberal, Kenora, ON]

I'll take the 30 seconds.

[The Chair, Conservative, Rob Anders]

All right.

[Roger Valley, Liberal, Kenora, ON]

Just very quickly, you didn't get a chance to answer my second question. I wanted to know, because the first 24 hours, the first week, or the first month when a solider drops a machine gun and is coming back here.... I know that in the forces what they do now is probably different from what somebody like you who actually has to treat the result does. Can you tell us what you think should be in the first decompression, debriefing, whatever you want to call it? Later on they may not take counselling, but at least at that time they're still in the forces. And are we doing the right thing now?

[Dr. Pascale Brillon]

This is interesting. In fact, the challenge is in finding out how we can help them while they are members of the Canadian Forces.

Currently, if someone can be hired as a soldier, he must be available for deployment, which means that if he is hired, he can be sent anywhere. This is what is currently required of the members of our forces. It is difficult to suspend a member of the forces from duty. In fact, as a member of the forces, he must be available for deployment at all times.

Perhaps we should look at ways of creating more links between veterans and the armed forces in this respect, so that a soldier's condition does not deteriorate while he is still in the forces. They only get psychological treatment when they become veterans, but then it is too late. They should be treated earlier.

People are becoming a little more aware of this, but in my opinion, more efforts must be made to treat them earlier, while they are still uniformed members of the armed forces. This would avoid a crystallization of the post-traumatic stress disorder by the time that they receive treatment as veterans.

[Roger Valley, Liberal, Kenora, ON]

Thank you.

[The Chair, Conservative, Rob Anders]

Thank you.

Now we're over to Mr. Sweet for five minutes.

[David Sweet, Conservative, Ancaster—Dundas—Flamborough—Westdale, ON]

Thank you very much, Mr. Chairman.

Thank you very much, Doctor, for your very enlightening presentation and for your answers to the questions you've had to field here so far.

Just to carry on with the same theme about sensitizing our forces, there was a book published some time ago called Psychology: The Purchase of a Friend. It wasn't meant to demean the profession of psychology; it was more to illustrate the importance of the debriefing nature of a friendship.

Are there some things that can be done? Has there been research in the area of taking it right down to the grassroots and actually educating those who are in the regular forces on recognizing PTSD and the importance of dialoguing with their colleagues, etc.?

[Dr. Pascale Brillon]

Yes, many things could be done about that. Once again, I suggest that you invite colleagues who are in the armed forces.

As someone from the outside, I can say that it would also be useful to invite soldiers who are suffering from post-traumatic stress disorder, or soldiers when they return from missions. Their testimony could effectively help other members of the forces, they could give feedback regarding their experience, and they could describe their current condition. These are the kinds of activities that could bring about greater awareness.

Post-traumatic stress disorder was only discovered recently. For that reason, I had to write two books. Post-traumatic stress needed to be recognized and more clearly identified. The École polytechnique de Montréal, Dawson College, our forces that are currently much less involved in peacekeeping than in offensive military action, have all contributed to recognizing the existence of post-traumatic stress disorder.

Nevertheless, we are dealing with a very tough culture, one that is very severe, a culture that stresses strength and endurance and that denigrates emotion. If we recognize the negative impact on the health of soldiers, if we view post-traumatic stress disorder as something that can be cured or treated and not as a sign of weakness, it will be very helpful.

[David Sweet, Conservative, Ancaster—Dundas—Flamborough—Westdale, ON]

You were talking about pre-emptive measures, but you focused on pre-emptive being after the trauma happened and before the symptoms became too severe. But there are things we can do pre-emptively prior to going into the theatre of conflict that would sensitize them or give them that psychological fitness that you're talking about.

[Dr. Pascale Brillon]

Oui.

[David Sweet, Conservative, Ancaster—Dundas—Flamborough—Westdale, ON]

Okay. Then to my last question, because I have that feeling from the chairman that this is going to be chopped.

You said that right at the moment you don't have the capability of knowing which personalities would be predisposed to post-traumatic stress disorder. But is there research going on right now to see, as we get these cases, which people are more likely to be affected and, of course, less likely? Of course, you can tell the outcome would be to stream them into the positions where they would best fit.

[Dr. Pascale Brillon]

Yes. More and more studies are being done internationally to identify the factors that cause a predisposition to post-traumatic stress. Some have been identified. We know that someone who has symptoms of depression and anxiety as well as a very rigid world view could be considered as being at risk.

Once again, the early diagnosis of such cases is difficult. Some people might have these symptoms without ever exibiting PTSD, because they have never come across a sufficiently traumatic event. However, there are people who do not seem to be predisposed, but who go through traumatic events serious enough to make them suffer from PTSD.

Let me give you an example. The University of Montreal did a study on post-traumatic stress disorder among women who have been raped. Eighty-five per cent of women in the study showed symptoms of post-traumatic stress disorder a month after being raped. This shows that the predisposing factors do not play much of a role.

We believe that long-term cases of PTSD can be predicted by considering three factors: the factors previous to the traumatic incident, the incident as such and the treatment after the event. PTSD is caused by all three types of factors. An intense trauma can affect everyone, whether they are predisposed or not, the seriousness of the trauma will cause PTSD. If a trauma is less serious, it can cause PTSD if I am strongly predisposed, and treatment plays an important role.

Do you understand? Do you see what I mean?

Consequently, PTSD can be predicted by the number of factors in each category. Do I have many predisposing factors? Was it a major traumatic incident? Do I have much support following the incident? These were mentioned earlier: social support, my way of living with the trauma, how others treat me, and comorbidity. Obviously, with more factors in each category, I am at greater risk.