Veterans Affairs Committee on Feb. 27th, 2007

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

You are actually saying there are horrors that are so great that no matter what personality you are, you are going to suffer some kind of PTSD. Then it's only determined by what your physical capability will be to heal afterwards whether it's going to be chronic, long-term, or short-term.

[Dr. Pascale Brillon]

Exactly. Some traumatic events are universally traumatic, in more than 85% of the cases. I'm referring to torture, gang rape, and certain combat experiences, especially barbaric ones. Even when a person displays very few pre-traumatic factors and maintenance factors, the level of trauma is significant, even crucial.

Obviously, the higher the number of factors in each category, the longer and more severe the convalescence is, and the more refractory a person will be to therapy, so on and so forth.

[The Chair, Conservative, Rob Anders]

Mr. Sweet, you were right. I am going to cut you off.

Mr. Stoffer, you may take five minutes, if you would.

[Peter Stoffer, NDP, Sackville—Eastern Shore, NS]

Thank you, Mr. Chairman.

Years ago there was a television show called M*A*S*H, and there was a psychologist who showed up as well. He was in uniform and he was on the front lines, so he could witness what the troops were witnessing. Do we have psychologists over in Afghanistan, so far as you're aware, on the front lines?

[Dr. Pascale Brillon]

To my knowledge, there aren't any. Once again, I would refer you to people in the army. I do not believe that there are any military psychologists. There are social workers, psychiatrists, doctors and military chaplains, but to my knowledge, there are no military psychologists working on the ground.

[Peter Stoffer, NDP, Sackville—Eastern Shore, NS]

It appears through your testimony today that we don't have enough people like you and with your training in this country to assist not just the veterans but their families as well. Obviously there must be tremendous stress levels on people such as you. It must be trying to hear these stories, day in and day out.

My question may be of a personal nature, and if it's not appropriate you could just say you don't want to answer. But how do you and people of your training and your education relieve the pressure valve, apart from turning to substance....? Hearing these stories day in and day out and trying to help other people must be very demanding for you personally. Who looks after you?

[Gilles-A. Perron, Bloc, Rivière-des-Mille-Îles, QC]

Me.

[Peter Stoffer, NDP, Sackville—Eastern Shore, NS]

What do psychologists do to relieve the pressure so that they don't have that transfer themselves?

[Dr. Pascale Brillon]

That's a good question. Indeed, if we want to recruit more psychologists, we want to make sure that they are able to treat soldiers and victims without becoming affected themselves. Of course, when I go home at night, I don't rush to put on the movie Full Metal Jacket. I've been exposed to that kind of thing enough during the day. Obviously, we want to be careful with our human resources, I'm talking about people who work with soldiers and victims.

During training, psychologists and interveners learn how to remain vigilant to ward off professional fatigue, what is commonly known as compassion fatigue. I talked about this earlier. One has to ask oneself how one can decompress during the weekend, talk about other things, or in my case come to Parliament rather than listen to my clients' horror stories. By diversifying one's activities, one can remain in a profession for a long time.

What I say to the people I train is that this job is like a marathon and not a sprint. One has to pace oneself in order to remaining the profession for a long time. To remain empathetic towards victims and open to their distress, one must be available, and learn how to take care of oneself. Usually, this is rather effective.

[Peter Stoffer, NDP, Sackville—Eastern Shore, NS]

If you were in charge, how many additional people do you think our military would require right now just to meet the anticipated injuries that may be coming back? I mean the injuries between the ears. It's always interesting to note when you hear of an incident such as a car accident and they say that nobody was injured. That is physically, but they never talk about the mental injury.

It's anticipated that a lot more of these soldiers from Afghanistan will come back with mental injuries, or the injury between the ears. How many more people do we require in order to anticipate the additional workload that people like you will have to endure?

[Dr. Pascale Brillon]

That's very difficult to judge. In fact, that is why I spent a lot of time providing training at Valcartier and at Hôpital Sainte-Anne. We know that our soldiers are coming back soon, and we have to be highly effective in order to treat them quickly.

In fact, we already know that a problem is about to arise. We realize that once those serving in Afghanistan return home, we will have to set aside those who served in Bosnia and Rwanda. We cannot treat 25 patients per day: we can only see 6. Already, we already know that we will have to put aside the older cases to at least deal with the new ones as quickly as possible. In fact, the earlier we provide treatment, the better the prognosis. We absolutely have to be able to see them when they come back.

For now, I think we'll be able to see them. I, for one, supervise psychologists and psychiatrists working in the Canadian armed forces. Those are the people who will be able to tell you more. In any case, these people have asked to receive training as soon as possible, before the soldiers come home. Unfortunately, because of their workload, they are going to have to suspend the cases underway.

[Peter Stoffer, NDP, Sackville—Eastern Shore, NS]

I have a final question. Is it easier for a man to speak to a woman psychologist or a male psychologist?

[Dr. Pascale Brillon]

That depends on the people concerned. For many men, to meet with a male psychologist makes them competitive, especially if the psychologist is a military man. Some fear being perceived as weak, or in many cases, gay. They wonder if the psychologist views them as a deserter, or as they say in the army, a "dodger".

In fact, some soldiers say that their colleagues are simply seeking financial compensation. They view those who seek help as not following through on their military convictions, not "real" soldiers. Often, soldiers find it easier to meet with a woman.

[Peter Stoffer, NDP, Sackville—Eastern Shore, NS]

And for a woman soldier?

[Dr. Pascale Brillon]

I have the impression that it's easier for women to see a female doctor, whether military or civilian. What is important is that she be a trained psychologist or psychiatrist.

[The Chair, Conservative, Rob Anders]

Thank you.

The chair is going to exercise some prerogative here. It is Conservative time, so I'd like to ask a few questions.

I realize the value in what you've laid out for pre-emptive dealings and then things when people just come back from theatre. Of course, we have a lot of soldiers who haven't had the benefit of either of those, so there are people who are dealing with it much later.

I'll also say that the way I relate to this is in terms of rape scenarios and things like that, because constituents of mine have approached me about some of these things. I haven't served in combat, but I have dealt with or talked with them about some of their experiences.

How do you encourage a horse to drink from the trough? You can lead a horse to water, but you can't make it drink. How do you deal with that in terms of some people who may be reluctant to seek help, in the case of soldiers or rape victims, but nonetheless you can tell they're exhibiting all the characteristics--the alcoholism, the depression, the lack of sleep, and everything else? How do you get them there? How do you get them to accept it? How do they learn to overcome the triggers or minimize the traumas that affect them, and so on?

[Dr. Pascale Brillon]

I hope I've understood your question correctly. You will tell me whether I have, based on my answer.

When military personnel are suffering from PTSD, how can we ensure that they recognize the symptoms themselves and come for treatment?

In fact, we hope that the COs will recognize the signs in their men. The COs often are very fatherly towards their men. Good officers have a great deal of empathy and are very attentive to the health of their men. We hope that, when it comes time to tell personnel that they are suffering from a trauma, that they will take the first steps. We also hope that this disorder will be increasingly recognized within the armed forces, so that military personnel can themselves recognize their own symptoms. So to date we have been talking about two sources of referral: the CO and the soldier himself.

The third source of referral is the spouse. Sometimes the spouse will tell her husband that he is unbearable at home and that this has been true since he returned from Afghanistan. In some cases, she gives him the choice between getting help or getting a divorce. Many people come for that reason. They are very resistant, but they come nevertheless because if they do not their spouse will leave them.

In some cases, the spouse wakes up at night because her husband cries out in his sleep. Some military personnel believe for a few minutes that they're still in Afghanistan; they grab their spouse and run with her into the basement to protect her. It's as if they were still on mission and they know it. Furthermore, the spouse is often the one who is able to accurately assess how much their spouse is drinking. He thinks it's just a little beer and that it's not really serious.

In short, we typically have three sources of referral: the CO, the military personnel themselves or their families. When the family sends the individual for treatment, it's a necessity.

[The Chair, Conservative, Rob Anders]

Understood. I was intrigued by your comment as well with regard to the transferring between generations. I'm thinking of the situations in the armed forces where you have what are known as “army brats”. In a sense it's a family word--generation after generation serve in the armed forces. Maybe one of the best ways we can deal with that is to just have Stéphane Guay come and talk to us with regard to the spouses and stuff. I think that would be an interesting thing. It's one thing to deal with the soldiers, but then of course there are the spouses who have to be dealt with as well in terms of the after-effects. That could even affect the children of military personnel as well.

Do you have any thoughts or comments on that?

[Dr. Pascale Brillon]

I will go back to what I said earlier.

With regard to transgenerational transmission, we noted that the children and grandchildren of concentration camp victims also showed symptoms of distress. The second or third generation also show signs of post-traumatic stress. PTSD symptoms can contaminate not only the family but also the children and grandchildren. We have learned this from our observations in the only longitudinal study we have, meaning concentration camps.

I completely agree with you, we must watch for symptoms in the family, in order to provide it with support. We know that this helps military personnel to return to active duty. We also know that, if the spouse is involved, if she is doing well and receiving support, this will greatly assist the serviceman in sticking with his therapy.

[The Chair, Conservative, Rob Anders]

My time is up.

Mr. Perron.

[Gilles-A. Perron, Bloc, Rivière-des-Mille-Îles, QC]

Mr. Chairman, I want to ask you for seven minutes, since I'm going to spend the first two providing information.

Dr. Brillon, I want to share some information regarding individuals suffering from PTSD in the armed forces. I have had the opportunity to question anglophone military commanders. We were told, at first, that the percentage of soldiers suffering from PTSD was between 4% and 6%. I was told that it was 10% for francophones. National Defence told me that it was 0%. These people do not recognize or do not want to recognize the existence of PTSD.

In a meeting with a commander at National Defence, I was told that military personnel suffered from severe depressions. When I asked him what the symptoms were, he told me that the service men were less attentive, that they tended to isolate themselves, to drink and take drugs and have family problems. He also told me that, in some cases, they kill themselves. I told him that these were PTSD symptoms.

I am not a psychologist, but, since 1998, I have taken an interest in young veterans suffering from PTSD, because they are like my kids: they are the same age as my son. I have met hundreds of them. Some were still in the armed forces at Valcartier. During these meetings, we were separated by a curtain so I could not identify them. They were afraid of losing their job. I don't know what the situation is like elsewhere in the country, but in Quebec, from what I gathered, many servicemen sign up at the age of 18 to earn money or make a career for themselves rather than drawing on employment insurance or on another such program. We need to acknowledge this.

Generally, these young veterans said that they did not get any support from the Department of Veterans Affairs. They said that they had served their country and risked their lives, but that they had not been able to get help, and the few that did waited a long time for it. I understand them.

For example, only five beds at the Sainte-Anne Hospital are reserved for individuals suffering from PTSD. If we treat them like second-class citizens, I wonder what we would need to do to treat them like first-class citizens.

I would like to hear your comments on this. I apologize for getting on my soapbox, but this is nothing new. Perhaps that is why I do not suffer from PTSD.

[Dr. Pascale Brillon]

No doubt it helps.

The percentages you mentioned apply to the general population. The prevalence of post-traumatic stress disorder among the general public is between 8% and 14%. Typically, the number of women suffering from PSTD is higher because they are more exposed to sexual traumas. We know that sexual traumas are generally associated with more severe symptoms.

If we were to conduct a study in Ottawa, we would see that approximately 10% of the population have been victims of armed robbery or a car accident. So I find it surprising that the percentage for such a high-risk population, the Canadian armed forces, is the same.

[Gilles-A. Perron, Bloc, Rivière-des-Mille-Îles, QC]

Those are the figures that the CF gave me. I don't know whether they are correct.

[Dr. Pascale Brillon]

I think those percentages are low, in actual fact. However, I do not have any research data on the armed forces. Dr. Guay, however, may be able to provide you with more information.

I should also say that there is a great deal of shame and stigmatization in the Canadian armed forces. Research can only be done if people answer. Some female soldiers told me that they had experienced horrors, and had been raped. They told me, however, that they had no intention of talking about it, since they already had to work twice as hard to remain in the army and not be considered as second-class soldiers.

We need to understand that it is difficult for researchers to get an exact percentage because of the shame that soldiers feel, because it is not easy to assess them and because it is not necessarily a desirable percentage, politically speaking.

[The Chair, Conservative, Rob Anders]

Mr. St. Denis, for five.

I just want the committee to consider this as the last set of questions, because we have a small bit of business.