Photo by Linda Reno
Matt Cook, a veteran of the war in Iraq,
plays with Shooter 5. He finds stress relief
in the companionship of his pet.
PTSD: A Quiet Battle
By Elisabeth Kristof
AUSTIN—Former Army Staff Sergeant Matt Cook says he was eight months into his second Iraqi deployment when a massive explosive hit his patrol vehicle. He and his unit were blasted off the road. Cook suffered a concussion so strong that it suspended his motor skills. He couldn’t lift his arms or move his body. Sweat poured down from the top of his head, but he thought it was blood. “I just sat in my chair thinking, ‘I’ve had enough of this already,” recalls Cook. “But the 19-year-old kid sitting next to me was just laughing and laughing.”
Cook is quiet a moment and then says, “Everybody deals with war differently.”
After his 13-month deployment, Cook returned home to Texas, which as a state ranks third in number of military personnel serving in the Global War on Terror, according to TexVet, a veteran affairs Web site. A year later, he became one of the estimated 30 percent of veterans from Iraq and Afghanistan who will be diagnosed with Post Traumatic Stress Disorder, or PTSD, according to the American Psychological Association. While the disorder is a common thread among many Texas veterans, the way it’s expressed in each individual is unique. Though often linked in the media to violent behavior, mental health professionals say the disorder involves much more than fits of rage or aggression. And because of the varied symptoms, veterans often go untreated.
The misunderstanding of PTSD is, in part, because it’s a relatively new diagnosis, says Karen Hutchins, PTSD specialist at Cicada Treatment Services. Formerly called shell shock or war fatigue, PTSD was not an official mental health condition until the Vietnam War. “It’s a new title, but the symptoms are ancient,” says Hutchins. “We’ve seen them in all the wars,” she says.
Post Traumatic Stress Disorder is an anxiety-based disorder that causes people who experienced a terrifying event to persistently overreact to specific triggers. It appears as a cluster of symptoms—anxiety, depression and disassociation are but a few. “It’s typically not as flamboyant as the violence shown in the news,” says Hutchins “It’s a lot more insidious.”
“I only know one guy who got violent after coming home,” says Cook. “The majority of us just have our quiet symptoms. We are dizzy. We can’t sleep. We carry a lot of guilt that we’re alive.”
Treatment can vary depending on the symptoms patients display, but cognitive therapy combined with anti-anxiety medication is a common approach. However, a wide range of barriers, from stigma about a diagnosis to long wait times at treatment centers prevent at least 60 percent PTSD veterans from seeking help, according to the APA.
For soldiers who want a clear explanation for their experience, the broad scope of the illness can be baffling. “I don’t even know what it means to have PTSD,” says Cook. “It’s just a label someone gave me.”
One veteran, a Texas marine, who preferred his name not be used in order to protect his identity from his current employer who is unaware of his condition, says that three years after returning, he’s still haunted by the experience of holding his best friend in his arms as he died after a black BMW crashed head-on into their patrol vehicle and exploded. “It’s the worst thing in the world to lose one of your brothers,” he says. “Everyone deals with it differently, but if anyone says they are not bothered by it, they’re lying.”
War exists in a reality separate from daily life, and for returning soldiers, the rapid transition between worlds is a weighty challenge. To address this problem, the Department of Veterans Affairs created a debriefing class—a ten- day-long seminar discussing anger issues and flashbacks to heal the damage of months of warfare. The Texas marine says when he got home, he went through this demobilization course. “They told me, ‘Don’t get drunk. Don’t beat your wife. Have a nice day,’” he says.
In a combat situation like Iraq where enemies are often hard to clearly identify, the high-stress levels experienced can overwhelm the senses. “You are so stressed all the time over there because it’s a war with no front lines,” says Cook. “Coming back, it’s so hard to unwind.” He says adjusting to being in Iraq was easier than the adjustment of returning home.
Sleep disorders are common but often-unreported symptoms of the disorder. Cook says his lack of sleep is the one thing that really worries him. On average, he gets three to four hours of sleep each night. Inability to sleep is one of the condition’s most portentous symptoms because professionals rarely think to look for PTSD if a client complains of trouble sleeping, says Hutchins. But, it’s also one of the most deadly, proven to cause breakdowns and suicides, even more than flashbacks. “If you don’t get enough REM sleep, eventually you’ll end up feeling psychotic and you might well end up killing yourself,” says Hutchins. Every seven minutes someone with PTSD commits suicide, she says.
Personal relationships often suffer the most for soldiers with the disorder. Their greatest loss, says Hutchins, is their ability to connect. “Relationships are out the window,” says the Texas marine. “It’s too hard to relate to people.” Cook says he was once a sympathetic, romantic person, but those qualities are lost now. “These are things I want back,” he says, “but I just don’t feel them.”
Intangible symptoms make it hard for soldiers to recognize they need help. Even after being diagnosed with a traumatic brain injury, Cook says he feels guilty filing for disability. “A lot of guys are reminded every day when they wake up that they’re disabled,” he says. “My problems are nothing in comparison.”
Part of this guilt comes from military conditioning. Soldiers are taught to give without complaint, but they aren’t often taught about self-care, says Dr. Kristi Cannon of Austin’s BrainWise Neurofeedback and Wellness Center. But seemingly insignificant things can build to become serious issues. “What worries me the most are the quietly desperate PTSD people,” says Hutchins. “They don’t get caught up with the police or beat their wives, but they are stuck in their pain.”
Many veterans shy away from treatment because of the stigma attached. “I hate the victimization of soldiers, especially in the media,” says Cook. “Whether the war is right or wrong, we made the decision to fight,” he says. The Texas marine says the public conception of the disorder is inaccurate. “It’s not an illness that makes you crazy,” he says. “It’s a normal reaction to an abnormal situation.”
Both Cook and the marine eventually sought treatment, but realized overcoming their inhibition to get help was only the first obstacle in accessing treatment. It took the marine 13 months to get his benefits approved. Cook says he feels sure his claims will be denied by the military, despite being diagnosed by the Department of Veteran Affairs with both post-traumatic stress and a traumatic brain injury. “A lot of guys don’t get approved. There’s really nothing to back up your claims with, other than your past experiences,” he says.
“Getting diagnosed and getting benefits are two separate things,” said Joe Luther, substance abuse counselor at an Austin VA Outpatient Clinic and Vietnam War veteran. There are two parts to the VA, he says: the Healthcare Administration, which provides medical care, and the Veterans Benefits Association, which distributes benefits. Between the two, he says, is a substantial divide. Even though a doctor will diagnose a veteran with PTSD, the benefits association still requires veterans to write down detailed accounts of their war experience and stressors, which it evaluates to determine benefit eligibility. “They have the doctor’s opinion, but they make soldiers re-prove their disorder to someone who is not even an M.D.,” says Luther.
Many mental health professional and veterans also share the belief that the while the VA doctors provide quality services, the department has difficulty keeping up with the needs of returning soldiers. Michele Riggs, licensed professional counselor at Austin’s Samaritan Counseling Center, says there’s great need for additional community support because the VA clinics are so backlogged. Cook agrees. “The doctors are great,” says Cook, “but they’re so overwhelmed.” When Cook signed up for therapy, he was provided with a one-hour counseling session every three weeks. He went twice before quitting because he felt therapy wasn’t effective. “There’s so much waiting,” he says. “I’d rather just deal on my own.”
Veterans for Common Sense and Veterans United for Truth, two nonprofit advocacy groups, say that because the VA is struggling with a backlog of 600,000 benefits claims, Iraq and Afghanistan veterans with PTSD are not receiving the care they need. Last month, they filed suit, in San Francisco’s U.S. District Court, against the department for failing to provide these veterans with adequate mental health services.
Austin VA services, however, recently expanded mental health programs. Luther says the Austin Outpatient Clinic has changed dramatically in the past year. Luther was the only substance abuse counselor serving a roster of 10,000 clients until six months ago when the VA hired four additional counselors, he says. A new facility 30 percent larger than the current outpatient clinic, solely dedicated to mental health services, is also in the works, scheduled to open in the next few months. By 2010, the Austin VA plans to unveil a new veterans center building, doubling the size of their facilities, says Luther, adding: “The rubber is actually on the pavement now. We’re making traction with these changes, not just giving lip service.”
New programs have also emerged to help lighten the VA’s load. The San Antonio Foundation has provided grants for local treatment centers, like St. Mary's University in San Antonio and the Samaritan Counseling Center in Austin, to provide veterans and their families with free alternative treatment options.
Yet the ever-increasing need for mental health services leaves providers in a constant struggle to keep up. There will be a greater number of veterans returning from Iraq with PTSD than from Vietnam, says Luther, because of the personal nature of the Iraq war. “There is a difference,” he says, “between firing randomly into the jungle and firing into an apartment building—you get a closer view of the atrocities of war.”
Whether it’s because the subtle nature of its symptoms, the stigma against the disorder or the inability of services to meet demands, the resulting price of allowing PTSD to go untreated is steep, not just for individuals, but for society as a whole. Dr. Randall Lyle, associate professor of counseling and human services at St. Mary’s University in San Antonio, says left untreated, these struggling veterans won’t be productive participants in the economy, will hinder the success of future family members and will cause crisis healthcare to become extraordinarily expensive. Hutchins says all of society loses when PTSD remains untreated, because even the most driven people with untreated PTSD can’t live up to their full potential. “We’re losing a lot of talent,” she says.
The Texas marine sees the costs of the disorder most in the small limitations it imposes on his daily life. Negative effects can be triggered by an array of everyday occurrences, so he makes it a practice to avoid crowded places, is terrified of driving and in restaurants or other public spaces he is only comfortable when sitting with his back against a wall.
Cook says the war was a rite of passage and he wouldn’t hesitate to do it again. And he may. An inactive reserve member, he faces the possibility of a third tour until his term of service expires in August 2009. “I don’t worry about the symptoms getting worse—I just expect they’re going to,” he says. He is no longer undergoing treatment of any kind. “I suppress a lot,” he says, shrugging his shoulders. “Seems alright.”
Veterans are afraid to share their horrors because people recoil from what they hear, says Hutchins. But to move on, they’ve got to tell their story, in detail, more than once, she says: “If they lived through it, then it’s my obligation to at least listen to it. It’s a collective obligation to listen.”