I want to draw a bit on your questions about the civilian versus the veteran population in terms of PTSD. My background is in neuroscience. I'm a neuroscientist first, a clinician second. Much of what medicine runs on now is dogma. Wars have been won with innovation; we need medical innovation.
What's happening is that when the brain is in PTSD fight-or-flight mode, it's in the reptilian brain, the lower part of the brain, and it cannot access higher centres to use for CBT, to use to see how you connect to other people. Where the civilians might not be in the same fight-or-flight mode, a military person is in fight or flight. Until you take them out of that fight-or-flight mode, many of the treatment modalities we use for common civilians will not work. That's why I emphasize taking them out fight-or-flight mode.
Please refer to Stephen Porges' polyvagal theory. It will explain to you the fight-or-flight mode being stuck in this brain stem, the reptilian part of the brain, where the autonomic nervous system disregulates, going into the limbic system where the emotional part of the brain is and not being able to access the frontal brain, where there are societal cues. When we're stuck in fight or flight, we can't access those other parts of the brain and our executive manager can't control the emotions. It can't control the fight or flight, which is why we see these anger outbursts and physical outbursts.
Part of polyvagal theory also talks about attachment, and this is what we've done: we've detached these servicemen, through training, from their heart so they can kill. To reintegrate them back into society, you have to undo that programming to get them to reconnect with their hearts, which is why I suggested we do it through positive missions. That is why the dog therapy is so effective: they can finally attach to a trusted entity, a trusted being. Part of our therapy also uses horses, equine therapy, which has been shown to be very successful, and followed with neurofeedback. That also has to speak to attachment. When you take them out of fight or flight and they learn to reattach, they can use the executive processing again, but as long as they're stuck in fight or flight, we're not getting anywhere. That can be from physical trauma, mental trauma, emotional trauma, drug trauma, viruses, or bacterial trauma.
That's the beauty of sleep studies. We can pick that up before they go into service, while they are in service, and after service, which is why we have sleep studies as part of our program, so I can actually see just how unstable the fight or flight is. It's called the autonomic nervous system. It was believed that you couldn't control it, but you can through yoga and other modalities that we use. They've shown scientifically that we can boost the parasympathetic nervous system. That's why it's so important for us, as you were suggesting, to screen before they go into service, while they're in service, and once they come home. When they get off the plane, immediately have a sleep study, and a scan as well.
I would also suggest using SPECT-II, which isn't well regarded and necessarily in the mainstream field, but in cutting-edge neuroscience, SPECT scanning is also showing very subtle changes and different connectivity of the brain. There are subtle connectivity processes that change and aren't picked up by regular MRIs and might not even be picked up by PET.