Wednesday, June 06, 2007

Another War, Another PTSD Epidemic

Nick was never the same after Vietnam. He would lapse into deep depressions. He let his teeth go, chain smoked cigarettes and pot and drank way too much booze, fought with his wife and would leave home for days at a time after suffering nightmares about the people that he had killed and seen killed.

I was one of the very few people who knew about Nick's Vietnam experience. It was horrific -- skippering a Navy river boat that patrolled the Mekong River.

You know what I'm talking about if you've seen "Apocalypse Now." Nick lived "Apocalypse Now."
It helped that Nick (his real name) was married to a drug counselor who worked with psychiatrists, and he was diagnosed fairly early on with Post Traumatic Stress Disorder (PTSD) from his Vietnam experience. Even with the military's tough standards, he was an obvious candidate for 100 percent disability and got it with little hassle.
Nick couldn't hold a job, although he did remarry after he destroyed his marriage to the drug counselor, and became a house husband to the children he had with Wife No. 2.

But the demons that he brought home from the war were never far away and he battled them until his lungs packed in from cigarettes at age 60.

* * * * *
Emily is a psychiatrist nurse who works in mental health outreach for the Veterans Administration.

Her clients are predominately Vietnam veterans like Nick, although she has a few Korean War and even World War II veterans. The wave of vets from Iraq and Afghanistan with PTSD and other problems is just breaking on the shore, and while Emily has enormous respect for the psychiatrists and other professionals with whom she works, she knows that the VA -- with its overweaning bureaucratic managers, outmoded ways and overworked and under-resourced professional staff -- is unprepared to deal with this epidemic.

I have known Emily (her real name) for over 25 years. She is a consummate professional who wears her heart on her sleeve but does not abide those damned bureaucrats, whom she blames for the VA’s inability to adapt to the times, let alone prepare for that wave of what is conservatively estimated to be several hundred thousand new PTSD cases that will be diagnosed in coming years.

"The VA is very conscious of potential suicides," she was saying during a long chat after we bumped into each other in a supermarket parking lot the other day.

"But they obsess on identifying these people, not figuring out how to treat them. They’re statistics.

"We used to have to ask each client if they were thinking about killing themselves during each visit," Emily continued as I tried not to think about the fate of the two pints of ice cream that were melting in the hot sun beating down on my shopping cart.

"A new regulation came down the other day that finally addressed the problem," she noted without a hint of irony. "It stated that we only had to ask them once a year if they were thinking about killing themselves.

"It’s so typical."

* * * * *
According to a landmark 1988 study, Nick was among the 30.9 percent of Viet vets who suffered from PTSD at some point after returning home and among the 15.2 percent who displayed symptoms at the time they were examined 20 or so years later for the study.

While I welcomed the study as a long overdue acknowledgement that there were an awful lot of Nicks out there who needed help and the timing coincided with and brought welcome publicity to a project on Philadelphia area vets that I supervised, I always was uncomfortable with the numbers.


Because I knew for a fact that only about 15 percent of all GIs in Vietnam ever saw combat, and even allowing for the occasional whacked out mess cook or file clerk, 30.9 percent and 15.2 percent seemed way too high.

With all due deferrence to Nick, I was proven right, but I wasn't happy about it.

A reexamination of the 1988 study summarized last year in Science magazine concluded that the original numbers were indeed way too high. The new study found that 18.9 percent of Viet veterans suffered from PTSD at some point and 9.1 percent at the time they were examined.

Researchers dissected the original study and did a comprehensive check of the military records of the vets who were examined. While acknowledging that non-combat servicemen sometimes had bad experiences, including medics who cared for the wounded in facilities far from combat, the researchers found that many of the vets had PTSD-like symptoms before they went to Vietnam, frequently nightmares.

So why am I not happy?

Because as good as it has been to set the record straight and know there are only about as half as many Nicks, the timing sucks. And after all, we're still talking about a quarter million vets.

The Bush administration (and Clinton administration before it) has been quietly cutting back on veterans' health-care benefits, and as Emily notes the VA network is overburdened and underfunded, while mental health services in general in the U.S. are inadequate, let alone for vets who have special needs.

Even with the subsequent Walter Reed Army Hospital scandal click (here and here for my takes), a major consequence of the study has been that it has been used by bean counters as a rationale to further cut back on veterans' services at a time when that new wave of vets in need are returning home.

Bobby Muller, president of the Vietnam Veterans of America, who was paralyzed from the chest down in Vietnam, puts exactly the right spin on things:

"The fact is, that veterans suffering mental health problems have been under assault, the diagnosis has been continuously attacked in terms of its legitimacy, funding has not been ramped up to handle these problems for vets returning from Iraq, and now people will see this study and say, ‘Oh look, the problem is not as bad as we thought it was.' "

* * * * *
Ilona Meagher talks and writes about PTSD and frequently opens book events by listing a few of the 80 or so names for the disorder in the popular lexicon. These include Old Sergeant Syndrome, Railway Spine, Buck Fever, Swiss Disease, War Syndrome and that oldie but goodie – Shell Shock.

The multitude of names tell us a couple of things:

* Each generation has to rediscover the horrors of PTSD.

* Each generation does not want to have to deal with it.

Part of this is because there is genuine disagreement among doctors about what exactly PTSD is.

This makes it even more of a political football at a time when the U.S. is deeply entrenched in an increasingly unpopular war being run by a president who has been notably insensitive the suffering of the men and women he has sent into combat.

Part of this also is that "cowardice" is never far away in discussing PTSD.

The notion that "you have to be a man" and not admit to pain or emotional distress runs deep in the military psyche. While I did not expect my sergeant to kiss my boo-boo or read me a bedtime story, my one (non-combat) injury while serving in the Army was treated with disdain and ridicule.

Meagher (her real name) cuts to the chase when she writes:

"The reality is that combat PTSD – or whatever we once called it, or whatever we’re going to call it next – calls into question the human reliance on war to solve our problems.

"While we may wish that our smart bombs and our superior military power will so overwhelm our enemies that our wars can be clean, quick and painless – and without any blowback on us or those we’ve sent to fight in them – there’s no debating that war trauma has always existed, and it will exist as long as we wage war. In many aspects, the war trauma of today can be more debilitating that that of previous eras . . . but a lingering shock to the system following combat has been a common thread that ties each generation to the next."
* * * * *
Nick would go fishing when he would run away from home, sometimes to a "secret" pool on a slow-running creek during trout season, and sometimes to the ocean where he would let the air out of the tires of his old GMC truck, drive onto a desolate stretch of beach and surf fish to his heart’s content.

Like I said, I was one of the very few people who knew about Nick’s Vietnam experience. I suppose that’s because he respected me because I could talk intelligently about the weather (Nick always had The Weather Channel on at home), would put up with his bullshit when he was in one of his moods and had known his first wife and would gently tease him about her in an effort to get him out of his funks.

We were sitting in the neighborhood townie bar one afternoon. Nick was especially melancholy and had little to say as he chain smoked Malboro Lights and sipped on rum and Cokes in seven-ounce rocks glasses.

A creature of habit, Nick always drank rum and Coke in a seven-ounce rocks glass with a certain amount of ice. He drove bartenders crazy over the ice and had to train newbies if they gave him too little or not enough. Nick had calculated how much ice it took to keep the drink cold but not dilute the rum before could finish it. He also always wore an open-collar shirt, never a T-shirt, and dressed immaculately even as his teeth were falling out, a reflection I suppose of a need for order because of the utter disorder of his bloody tour on the Mekong.

I was drinking a beer, watching the smoke from Nick’s cigarettes slowly ascend through shafts of sunlight toward the nicotine-stained ceiling while silently looking forward to a state-mandated indoor smoking ban that would soon take effect (and, Nick declared, drive him out of the townie bar and down the road to the bar at the American Legion post) when he asked me if I had ever seen a dead person.

I explained that I had seen a few in the Army and many more as a longtime big-city newspaper reporter and editor. Fire and murder victims, mob hits, a plane crash, that kind of stuff.

He then asked me if I had ever seen a dead child.

Once in my youth when a kid fell into a water-filled construction ditch and drowned. Twice at a fire scene, I replied.

"But never a child with a sucking chest wound," he said, referring to an unfortunate consequence of being hit with a rifle round that opens a massive hole in the chest and collapses the lungs.

No, I replied.

Nick looked away from me. When he turned back a single tear had formed in the corner of one eye. It rolled down his cheek and splattered on the bar.

A week later, he had left this mortal coil and finally was at peace.

1 comment:

chamblee54 said...

We have made great strides in saving wounded on the "battlefield"( is that word maybe obsolete for this conflict?).
However, these soldiers, many with brain trauma injuries, are coming home to the rest of their lives. Are we ready?
The time to think about this, and to prepare, is before the shooting starts.