My name is Dr. Celeste Thirlwell, and I'm an executive health team member of the non-profit organization Mission Butterfly. We are a caring group of Canadians dedicated to improving the quality of life of the men and women who selflessly protect, assist, and serve the Canadian public. I'm a psychiatrist and sleep medicine specialist with a background in neurosurgery, neuroscience research, and pain management. I'm grateful for the opportunity to address the committee.
It is unjust that veterans with PTSD, their families, and their communities continue to suffer without adequate assessment, treatment, and support. The imperative for optimal and innovative treatment of veterans suffering with PTSD is an issue of social justice, military priorities, and federal leadership.
PTSD has been called shell shock in World War I, combat stress reaction in World War II, and during the Vietnam War was finally coined post-traumatic stress disorder. Now, in the DSM-5, the diagnostic manual of the American Psychiatric Association, there are four components to PTSD. The first is rear-experiencing, such as flashbacks and nightmares. The second is avoidance. The third is negative mood and cognitions, which includes hostile, aggressive, and even paranoid thinking. The fourth is behavioural arousal, such as hypervigilance, hyper-arousal, and sleep disturbances.
The issue of treating and diagnosing PTSD remains an elusive opponent, both clinically to us, and to military and other services around the world. A key component that has recently been published about is the disorder of sleep. When we train our military personnel, we set them in a combat-ready mindset, which means that their sympathetic nervous system, their fight-or-flight system, is set to overdrive. They are set to “on”. Their neuronal circuitry has been set to “on”, and has been trained to be on. When they come back from combat zones, even where there was no danger, they still perceive danger. Their “off” system, which is called the parasympathetic nervous system—it's like the brakes—is nowhere to be found. What Mission Butterfly has developed is a comprehensive, integrative system to boost that “off” system, that parasympathetic nervous system, so that we can reprogram the neuronal circuitry in these military men.
When we speak about neuronal circuitry and retraining, the shame and the guilt—many of those things that keep veterans from even coming forward for treatment—get put to the sideline. This is neuronal retraining. The good news is that we can reset the neuronal circuitry. The bad news is that it takes time and it takes an integrated approach. Pharmacology alone will not work. Behavioural management alone will not work. We need a comprehensive approach, such as that designed by Mission Butterfly.
The other thing these men need, and that I've read since I presented my literature to you, is a mission. They need a new mission. These are people who were trained to protect and serve. They come home, and there's no protection goal and no service goal. The men and women who are doing the best in the U.S. now are independent veterans who have banded together to find goodwill missions, such as helping to rebuild schools and houses. These are people who are ready and willing to serve, and who need a mission. Not only do we need to calm down their nervous systems and retrain them from the mindset of combat-ready, which is the fight-or-flight, and to boost the “off”—relax and restore, you're safe now—but we also need to heal their hearts. For their hearts to heal, they need a mission.
We all need a goal in life; we all need a mission. Without that, life is not worth living. Without that, we see the suicides.
Thank you.