(Part one of a series)
In the mid-19th century, survivors of traumatic railway accidents exhibited a group of symptoms--anxiety, nightmares and extreme "startle response"--that in England came to be called "railway hysteria."
Many combat veterans of the American Civil War suffered "soldier's heart," a term that arose in 1876. The symptoms included extreme startle response, rapid heartbeat and "hypervigilance."
Following World War I, it became clear that some veterans were suffering lasting psychological damage. They were "shell-shocked." In World War II, it became "combat fatigue."
In 1952, the American Psychiatric Association published its first Diagnostic and Statistical Manual of Mental Disorders. Included in DSM-I was a condition called "stress response syndrome." It accounted for the psychic aftermath of trauma, but there was scant association with the nightmares, intrusive memories and social dysfunction--often followed by alcoholism and suicide--suffered by veterans of World War II and now the Korean War.
In 1968, DSM-II deleted the "stress response" diagnosis in favor of "adjustment reaction to adult life."
In the 1970s, psychiatric advances and the experiences of returning Vietnam War veterans made it clear that the trauma of war raged on in veterans' hearts and minds even decades after combat.
PTSD Codified in 1980
In 1980, "post-traumatic stress disorder" (PTSD) was added to DSM-III and the VA added PTSD to its diagnostic codes in April of that year. DSM-III was revised to DSM III-R in 1987 and again, to DSM-IV, in 1994.
According to DSM-IV, a traumatic event that can lead to PTSD involves "a threat to one's life or physical integrity and a subjective response of fear, helplessness or horror." The symptoms may include a persistent re-experiencing of the event, avoidance of things associated with the event, significant distress and increased arousal, impaired social or occupational functioning, emotional numbing (failure to process emotional information), disturbed sleep patterns and threatening nightmares.
PTSD is a "delayed stress reaction" that may surface years or decades after the initiating event.
Ken Moore, a service officer at the VET Center in Rochester, N.Y., puts it this way:
"Let's say a service officer meets a 52-year-old Vietnam combat veteran and asks him when he was in Vietnam." 'Last night,'" the veteran replies.'"
Many veterans don't want to be labeled, don't want people to think they're crazy. But I tell them that no one needs to know other than me, or their doctor, or their brother veterans. - Ken Moore
"Part of the problem is the veteran facing up to having PTSD," says Moore, who also is the hepatitis C national coordinator for Vietnam Veterans of America and national vice president of Veterans Aimed Toward Awareness. "Many veterans don't want to be labeled, don't want people to think they're crazy. But I tell them that no one needs to know other than me, or their doctor, or their brother veterans."
Moore says that dealing with PTSD might be easier if a veteran could go to a mountaintop, sit there and scream, or "just throw it all up and get it out of your system." "But it's not that easy," he says.
Age May Trigger Symptoms
Peter Ziarnowski, Ph.D., coordinator of the PTSD program at the Canandaigua, N.Y., VA Medical Center, says that as Vietnam veterans age, some who had never experienced PTSD symptoms may start having them. In other words, advancing age may be a risk factor for veterans who in earlier years may have been able to cope more successfully.
Ziarnowski says that some Vietnam veterans well into their 50s are just now coming to the VET centers for the first time.
Retirement may present a problem. PTSD may have been like a wave that--like a surfer--you could ride and stay ahead of when you were younger. - Dr. Peter Ziarnowski
"Any stressor in life--a death in the family, a new job--may stir emotions," says Ziarnowski. "Retirement may present a problem. PTSD may have been like a wave that--like a surfer--you could ride and stay ahead of when you were younger. But as you get older, the wave catches up to you."
According to Ziarnowski, many veterans may have unconsciously dealt with PTSD by becoming workaholics. But in retirement, having more free time means that the "wave" is more likely to catch up with you. And declining health in later years may also render a veteran more vulnerable.
"Just talking and listening to others is helpful. I tell a lot of guys they
need to just come to the group sessions--don't talk, just listen. There they
find out that they are not crazy, that others are experiencing the same
things. As they listen for the first time, their eyes light up."
Ziarnowski says that "exposure therapy," in which patients are re-exposed to
a representation of a trauma, no longer is considered credible. While
returning to Vietnam as a tourist might be useful for some, visiting the
Vietnam Veterans Memorial (the "Wall") in Washington, D.C., might be a
better "exposure therapy" and help veterans deal with "unfinished emotional
business."
PTSD and the VA
But resolving the emotional aftermath of combat may be easier than getting compensation for it from the VA.
"What makes it more difficult is what you have to go through to get a claim through the VA," says Moore, who helps veterans with claims. "It takes 370 days to adjudicate a claim. You can appeal a claim that doesn't go through, but that takes another year."
Moreover, says Moore, the VA will pay a claim only if the veteran can point to a specific event. PTSD is presumptively service-connected for holders of the Purple Heart, Bronze Star, Silver Star and Combat Infantryman's Badge. But just having been in a combat zone is not enough, no matter how horrific one's experience might have been.
"PTSD is not curable," says Ziarnowski. "But as with any chronic disease, such as diabetes, you can live with it if you manage the symptoms."