Photo by Dawn Jones-Garcia
An Air Force veteran bides time in the Austin VA Outpatient Clinic.

Austin’s VA Clinic Treats Invisible Injuries

By William Gest
AUSTIN—In his office at the Veterans Affairs clinic in East Austin, psychologist Nathan Denny sees young veterans who have returned from conflicts in Iraq and Afghanistan with invisible mental scars that, when untreated, often lead to homelessness, drug abuse, domestic violence and suicide. Denny, who has been treating veterans for 37 years, said that his patients have always faced the additional challenge of a culture that doesn’t understand their injuries. "In the past, the general public was not accepting of mental problems,” he said, “and neither was the VA."

The military environment specifically hasn’t always provided the best support for the invisibly wounded. Soldiers returning from conflicts with post-traumatic stress disorder or other mental health problems have faced peers and supervisors who not infrequently looked down on them as ungrateful or even traitorous. Seeking mental health care often alienated fellow soldiers and sealed off future promotions. "The mythology of military service,” said Denny, “is that if you do your duty, and do it well, you'll be okay.”

But times may be changing, however slowly. While stigmas persist today, Denny claims the VA and the military as a whole is waking up to its tragic effects and taking measures to ensure that veterans get the mental health care they need, greatly expanding capacity and reaching out to veterans still clinging to the fear that friends and superiors will ostracize them for seeking aid.

Treating these invisible injuries is a daunting task. A recent study by the nonprofit research group Rand Corp. found that 18.5 percent of the 1.7 million people who have served in Iraq and Afghanistan suffer from depression or stress disorders. In addition, 19.5 percent suffer from poorly understood traumatic brain injuries, physical damage to the brain that causes a wide range of symptoms ranging from severe to subtle.

East Austin’s VA clinic opened its doors in 1991 in response to Travis County’s burgeoning veteran population, which now numbers over 60,000. Acting administrator of the clinic Pamela Cole said servicemen and women stationed at nearby Fort Hood become well acquainted with the city and many choose to live there after their time in the service.

In its early days, the center saw about 200 visits a month. Now, it sees over 1,500, a never-ending stream of veterans returning from the conflicts in Iraq and Afghanistan, which have surpassed 6 1/2 years with no end in sight. The total staff has tripled since the center opened, but the clinic still struggles to keep up.

“We are bursting at the seams,” said Cole. “It’s just not stopping.”

Many of those new staff are social workers and mental health professionals brought on to help returning soldiers readjust to civilian and family life. This process is often complicated by post-traumatic stress disorder and other mental health problems caused by the particularly brutal nature of the current conflicts. Fighting against an insurgency means that soldiers are subjected to constant combat stress and the knowledge that anyone could be an enemy and attacks could come at any time.

Cole, whose career with the VA stretches back to the Vietnam War, said the clinic’s mental health wing, where 30 mental health professionals offer treatment for post-traumatic stress disorder as well as group and family therapy, reflects a new awareness in her department that the most enduring injuries sustained in war are often inflicted on veterans’ minds, not their bodies. ”In past wars, it’s been pushed under the table,” she said. “With this conflict, it’s brought back into the open.”

Denny saw his first patients in 1971 – mainly middle-aged World War II veterans, struggling with the horrors they had seen in aftermath of Allied bombing campaigns. Today, the psychologist said, America’s recent conflicts have led the department to accept mental health as a vital part of veteran care. “If a person gets adequate treatment,” said Denny, “it greatly moderates the impact on their lives. But we’re short on the technology to make people truly whole again.”

The clinic also struggles to overcome the legacy of the VA’s past shortcomings, such as the recent neglect scandal at Walter Reed Army Medical Center in Washington, D.C., where overcrowding forced injured soldiers into squalid outbuildings infested with rats, insects and mold. “A lot of vets are afraid to come to the VA because of the horror stories they’ve heard over the years,” Cole said.

In an effort to counter such fears, the clinic employs social workers such as George Kraber to help convince veterans to come to seek help. Once Kraber has persuaded them to come to the clinic, he said, he meets new patients at the door and helps them complete the imposing amount of paperwork required to receive care. According to Kraber, much of his job consists of simply spreading the word that the clinic exists and can help. “It’s surprising how many people don’t know we’re here,” he said.

Reflecting on a career dedicated to trying to clean up the fallout from decades of armed conflict, Denny said that despite the challenges and the constant stream of new patients with depressingly familiar problems, he does not allow himself to be discouraged by his work. “If a fellow can make it to my office, I can help him,” he said. “What is discouraging is that there is no end to these wars.”