Archive for December 29, 2009

We Are Letting Our Soldiers Down – Therapy Not Prison!

For those young men who were lucky enough to return from the trenches following the First World War, they faced, on mass, the trauma of having endured some of the worst fighting in human history.  Veterans suffered from nightmares, anxiety, guilt and despair.

At the time ‘mental illness’ was seen as deeply stigmatising.  Talking therapies were promoted for the new form of suffering that became known as ‘shell shock’.  In turn the post war reorganisation of mental health services for veterans, changed the way mental health services were offered to the whole population, a reorganisation that can still be felt to this day.

For most veterans though, they were left to reintegrate with mainstream society as best they could, without any formal support or help.  The result was a collective trauma on society that was acted out for generations to come.  My own grandfather fought in the trenches.  He also lost a son in the Second World War.  I am without doubt that this family trauma of warfare affected my parents, and, in turn, me.  Such ‘generational trauma’ is the price paid by the whole of society by decisions to go to war.

Men’s mental health, of course, has never really been seen as very important.  The mental health of our soldiers even less so.  Society still expects soldiers to put themselves in harms way, kill or be killed, and endure the indignities of combat, and return and reintegrate without our help or support.

A recent survey indicates that up to 20 000 veterans of the Iraq, Afghanistan and other recent conflicts, are currently serving sentences within the criminal justice system.  Of those, 8500 are serving custodial sentences.  That’s 1 in 10 of the prison population.  Why are ex servicemen so highly represented in the criminal justice system?

The main reason is what was formally known as ‘shell shock’ and, given the inability of government to resource services, the ways veterans are forced to cope with it.  In one survey of veterans in the criminal justice system, the majority of veterans serving sentences had turned to drink and drugs to cope with their symptoms.  About half of them were suffering from post traumatic stress disorder or depression as a result of their service.  Most were convicted of violent behaviour especially domestic violence.  In acting out their own trauma, society is also traumatised, and just like the First and Second World Wars, will continue to be passed through the generations to come.

As a therapist who has worked with men caught up in war zones, I can vouch that listening to the tales these men tell, hearing the horrors they have endured, can be truly horrific.  That the work is hard is no excuse, however, it should still be done.  If we as a society are content to send our young men to war, we owe it to them and their families to look after their emotional welfare when they return.  Prison is no place to send our heroes.

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Heterosexual Men Often Test Too Late for HIV

Today is International AIDS day, but if you’re straight, this concerns you, so don’t turn away!

When I was a young man, I was heavily involved in the service provision of men with HIV. At that time there were no treatments, and men died tragically young. Things are different know. The treatments for HIV are becoming so effective that, if caught early, HIV can be seen as a chronic manageable condition, and the person can expect a normal lifespan.

The qualifier in the above statement, ‘if caught early’, is the crucial thing here. The British HIV Association estimate that a quarter of HIV deaths were a direct result of patients being diagnosed too late.

One benchmark test in measuring the health of people with HIV is known as the CD4 test. This is a measure of the overall level of immune system ‘CD4’ cells in the body. The more of these cells the better. If the measure of these cells drops below 200 then the patient is at risk of developing opportunistic infections that are AIDS defining and life threatening. Starting treatment with CD4 counts below 200 is also a predictor of poorer response to anti retrovirals.

Nearly half of heterosexual men diagnosed with HIV are diagnosed with their CD4 counts below 200. This is concerning.

The popular perception has always been that HIV is a problem in the gay community. This is indeed true. HIV, however, does not respect sexuality, and the numbers of heterosexual men with HIV are increasing.

What can you do about it? Well if you are heterosexual and have had sex without a condom, I suggest testing annually. You are putting yourself, and your future partners, at risk if you don’t. HIV tests are free and can be obtained from your local sexual health clinic. Many clinics offer same day testing services. The service is confidential and they will be in the best position to offer you follow up care and support should you receive a positive result.

Remember, to benefit from treatment you need to start early, that means testing regularly.

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