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.