Good afternoon, ladies and gentlemen, and my fellow veterans. I greatly appreciate the opportunity to be able to speak to this committee.
To start off with, I'm going to just take you through a 40-year journey that I've been on since 1976 when I first entered into medical practice, eventually joining the Canadian Forces.
I started doing assessments and treatments for PTSD in 1993, and this was after research that I had done in 1992-1994 on one CER, 1 Combat Engineer Regiment; the 2nd Battalion of the Royal Canadian Regiment; and the 2nd Battalion of the Princess Patricia's Canadian Light Infantry that were deployed to the former Yugoslavia. At that time we basically found that about 15% of our UN peacekeeping troops coming home were showing signs of post-traumatic stress disorder.
Over the course of my career, I've managed to assess and treat veterans, as well as serving members, from World War I, World War II, Korea, Vietnam, Cambodia, Central America, Haiti, the former Yugoslavia, with Srebrenica, the Medak pocket, Sarajevo, Cyprus, the Golan Heights, etc., up to and including Afghanistan and both Gulf wars.
In 1993, as a result of my initial research, I had recommended to the Canadian military that we develop multidisciplinary mental health clinics at the brigade level to deal with the predicted significant increase in mental health casualties. General Dallaire's advocacy and support in the late 1990s resulted in the creation of the operational and trauma stress support centres in the Canadian Forces at the major bases across Canada. Eventually, this evolved into the Veterans Affairs-funded operational stress injury clinics.
I was part of a mental health team that deployed to Rwanda in the latter part of the summer of 1994. We were sent there as a result of my initial research with the Yugoslavian veterans, with the prediction that in Rwanda we'd have increased casualty rates.
It was interesting that while we were there, the rates of things like PTSD and depression were next to zero. There were, however, a lot of symptoms—and it was like, and was called, Nightmare Friday—like very serious and vivid dreams every Friday when we were taking the mefloquine. I originally deployed with the expectation that we would follow up on these troops at six months and a year later, but the Canadian military decided not to do that. This is unfortunate because there were medical personnel who had deployed on that tour who I knew personally who ended up committing suicide in subsequent years. My assumption was always that it was PTSD because I, like everyone else at that time, did not feel that mefloquine would be a problem once it was stopped.
I witnessed first-hand members of the mental health team I deployed with become paranoid, isolative, and inappropriately threatening, while taking mefloquine, to the point that one of the members pulled out a knife beside me at a team meeting and was playing with it in a threatening manner.
After our team redeployed home, a Canadian Airborne Regiment member, Corporal Scott Fraser Smith, committed suicide by a C-7 gunshot at the Kigali Stadium in Rwanda on December 25, 1994. An investigation into this suicide never really determined what caused it. Was it PTSD from his Gulf deployment, his deployment to Somalia and Rwanda and the expectation that the unit was to deploy to Croatia after in 1995? Was it the mefloquine? Was it a combination? Was it that combination in addition to the alcohol, because we were allowed to drink back then? Were there other stressful situations going on? We don't know.
In 1996, January I believe, I forwarded a letter to the committee members. I wrote a letter to the Somalia Inquiry wishing to testify and inform the inquiry, as well as members of government and the Canadian Forces medical system, about the effects of mefloquine, and my thoughts that it was affecting the Canadian Airborne Regiment members and their behaviour in Somalia, up to and including the death of Shidane Arone.
It was interesting because at that time, prior to my going to testify, my commanding officer came into my office and actually was giving me crap, saying that I shouldn't have volunteered to testify and that the Surgeon General at that time, General Wendy Clay, was quite upset that I had volunteered.
It was very interesting that approximately one week before my testimony the inquiry was shut down. At that time, in 1996, neither the government nor the Canadian Forces ever had an opportunity to look at this and do something about it.
I also forwarded a letter from 1998 to the committee, which I wrote through my chain of command, expressing my concern about the Canadian Airborne health issues. I requested a medical follow-up of all members of that unit, but it was never acknowledged and never attempted.
The lack of support from the government and the Canadian Forces, and the way the Canadian Airborne was treated upon their homecoming and their regiment's subsequent disbandment, guaranteed that there would be medical casualties up to and including suicides.
I want to change direction here just briefly. I'm not an expert on mefloquine. My area is PTSD, but I want to talk a little bit about brain disorders.
There is a great overlap between post-traumatic stress disorder; other anxiety disorders; major depressive disorders; mefloquine, both long-term and short-term; and traumatic brain injuries. We don't know exactly what is happening. We do not know the electrical physiology, and we do not know the physiology of what is happening. What we do know, with more modern techniques like the quantitative EEG analysis, which gives a three-dimensional electrical view of the brain, and functional MRIs, is what areas of the brain are affected.
The problem is that it would be like your saying you have chest pain and therefore I am going to diagnose you with chest pain. Well, there are a whole lot of things that cause chest pain.
In the brain, where we are right now is where medicine was with the rest of the body a century ago. We're just starting to have the technology to move forward so that we're more accurately able to diagnose. The DSM-IV and DSM-5, which psychiatrists use, is a descriptor. It does not give you the actual pathology. Like any descriptor, it can encompass a whole lot of things.
We have soldiers coming forward suicidal, with bad dreams, irritability, aggressiveness, and anxiety. That can be any number of diagnoses. There is a huge overlap.
I want to mention our current treatment techniques. Pharmacotherapy as well as the talking therapies have significant failure rates. There is nothing that treats any of these disorders to a large extent beyond about 60% success.
Dr. Mark Gordon is an interventionist endocrinologist who specializes in traumatic brain injuries as well as PTSD, and he is looking at blood chemistry and hormonal and neural steroidal abnormalities. For instance, we now know there are certain metabolic pathways that are abnormal as a result of TBI, PTSD, and, I think, chemicals such as mefloquine.
Dr. Marty Hinz is another gentleman in the U.S. who is using transmitter precursors rather than antidepressants. It's interesting because antidepressants long-term can actually deplete neurotransmitters, and when you try to take someone off an antidepressant, all their symptoms come back.
For just another moment, if you can bear with me, I want to talk about the unknown fallen. These are our military members who return to Canada, retire, or are medically released and then eventually die from their medical disorder, whether it's a physical or brain disorder, or by suicide months or years later. They are often unnoticed, not acknowledged, and frequently alone. They receive no mention in the Hall of Honour, yet they served their country and ultimately died as a result of their service.
Briefly with regard to suicidality, suicide certainly increases with a diagnosis such as PTSD; 49% will think about suicide. Mood disorders, TBI, mefloquine, complicated diagnosis, PTSD, TBI, chronic pain, alcohol: I don't see very simple cases. Most importantly there's a perceived lack of support whether that's at the military unit, the government unit, or with Veterans Affairs. Denial of claims has a huge impact and increases suicidal risk in veterans. I can spend the better part of an hour giving you examples of the denials and subsequent suicides that I've been aware of.
I'm aware of the time. I've forwarded a copy of this to the members of the committee, and I'd be happy to discuss any of the issues I've listed.
Thank you.