40 Years Later: Addressing PTSD Among Older Combat Veterans
In 1969, after serving 10 months in Vietnam, Tony Viana brought home shrapnel still lodged in his body. He also brought home an altered state of mind.
“I had never been hypertensive or jittery, but after I got out, I’d say to my girlfriend at the time that I feel apprehensive,” Viana said, “like something ominous [was] about to happen.”
Noises startled him. He had ringing in his ears. But aside from acknowledging the evidence of his physical injuries, doctors at the Veterans Administration (VA), which later became the Department of Veterans Affairs, told him there was nothing wrong with him. And while his private doctor prescribed medication to ease his nerves, Viana would wait nearly 40 years before returning to the VA to be diagnosed with Post-Traumatic Stress Disorder (PTSD).
Although symptoms of PTSD usually begin occurring within the first months of experiencing a traumatic incident, it can be years before someone has an accurate diagnosis. For Vietnam veterans who served before the military understood and was prepared to assist with the effects of the condition, being diagnosed with PTSD later in life presents distinct challenges for older veterans and the counselors who serve them.
Living with PTSD as a Veteran
PTSD was recognized as a psychiatric disorder in 1980, more than 10 years after Viana returned home and five years after the war officially ended.
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the disorder can be caused by the exposure to death, threatened death, actual or threatened serious injury, and actual or threatened sexual violence. Nearly 50,000 service members died in battle in Vietnam during the war, while an additional 10,000 who served in the country died from other causes. About 150,000 service members also sustained nonmortal injuries.
Those living with PTSD persistently re-experience the traumatic event, leading to both psychological and physiological responses that can create distress or functional impairment. For example, Viana experienced hypervigilance. For others, PTSD may cause intrusive thoughts or visual or auditory flashbacks that leave them easily startled. At the same time, they may also struggle with negative thoughts about their participation in the conflict, as well as feelings of isolation or self-blame, which can be especially true for veterans who served in Vietnam, due to the mixed support for the conflict.
About 31 percent of male American veterans who served in the country of Vietnam experienced PTSD at some point in their lifetime, according to the National Vietnam Veterans Readjustment Study. And while most Vietnam veterans living today are both mentally and physically healthy, a 2013 study on the long-term health effects of the conflict found that approximately 1 in 10 veterans who served in Vietnam — more than 283,000 people — experienced PTSD symptoms four decades later.
Dr. Dawn M. Wirick, the daughter of a Vietnam veteran and a veteran herself, counsels older combat veterans. She has seen the effects of unaddressed and untreated trauma which can sometimes cause PTSD later in life.
Dr. Wirick, who also serves as a clinical training director and core faculty member in the online master of arts in counseling program at the Family Institute at Northwestern University, noted many older veterans may experience psychological issues like depression and anxiety, but that PTSD distinguishes itself through visual and auditory flashbacks which can lead to jitteriness and panic attacks. However, she finds that the most frequent symptom of delayed-onset PTSD that her clients experience is chronic sleep disturbance.
Fifty-two percent of combat veterans with PTSD who participated in the National Vietnam Veterans Readjustment Study reported having nightmares often.
“What they end up telling me is down the road, when they retire, once they aren’t so busy, they start having recurring nightmares,” Dr. Wirick said. “Everything starts to come into the conscious of the dream world.”
Why the Delay?
A complicated mix of factors contributes to delayed PTSD. Unlike veterans today who chose to enter the military, many Vietnam veterans were drafted into a conflict that was deeply unpopular and returned to a population who was divided over the war.
“When we got back, we were in sympathy with people that said this is an unjust war,” Viana said. “But it was kind of traumatic upon my return. Half of the people that I met praised you for your service and the other half scorned you for your service.”
Dr. Wirick said many of her clients believed that they couldn’t talk about their experiences because of the hostility surrounding the conflict. They were forced to repress those feelings because they felt like the enemy, which created more complex psychological reactions to their time in combat. Stigma, she noted, was also common among men of the Vietnam generation who were told to “man up” about depression or anxiety. Those repressed feelings later surfaced when they attempted to reintegrate into the lives they led before the war.
“None of [my clients] ever defined one of their primary roles in life as being a Vietnam combat veteran,” Dr. Wirick said. “What they talked about was the identity of being a husband, a son or a father.”
Dr. Wirick said events such as retirement, separation from a spouse, and the sudden loss of a child or another loved one could trigger mental health conditions, nightmares, and PTSD. Many of the clients she has worked with turned to drugs and alcohol to numb and blunt that trauma and reduce the vividness of flashbacks in nightmares in order to get sleep. As a response, PTSD tends to be treated with drugs and behavioral interventions that address issues such as alcohol abuse and excessive anger rather than the underlying cause of these behaviors.
“Most of the time behavioral interventions are used and sedatives are prescribed to help sleep and mask these nightmares,” Dr. Wirick said. “And that doesn’t work because when you are dealing with the mind, the unconscious and the subconscious are going to spill over during sleep.”
Triggering events also include changes in health. Vietnam veterans are coping with the long-term physical effects of war, with many suffering from diseases related to exposure to rainbow herbicides which were used to clear forests in Vietnam between 1962 and 1971.
“I can’t even talk about [Agent Orange] now without occasionally getting that taste,” Viana said. “It may be psychosomatic, but I still get that vinegary, oily taste just thinking about it.”
The use of herbicides like Agent Orange has been linked to a number of cancers and serious health conditions. The Department of Veterans Affairs is uncertain how many service members were exposed to these chemicals, but veterans who served in Vietnam between January 9, 1962 through May 7, 1975 are presumed to have been exposed and can seek disability compensation for conditions related to exposure.
The Challenge of Trust
Dr. Wirick believes delayed-onset PTSD can be addressed using a psychodynamically-oriented model. Encouraging veterans to embrace the benefits of therapy and counseling can be a challenge when working with this population who may not see counselors or therapists as credible. She noted that her clients consistently say that they prefer to work with helping professionals who are also members of the military.
“I come from a military family, so I can relate to the disbelief. They think ‘How could you believe me if you haven't had my experience?’ ” Dr. Wirick said. “But I tell [veterans] that if you keep your experiences buried, it's just going to get worse, and it's going to intensify your already difficult chronic pain and irritability. It doesn't help your outlook on life.”
Veterans don’t want to hear “psychobabble,” she added. They want somebody to listen to their story and tell them that it is their right to feel the way that they are feeling. She noted that engaging in peer support groups can help to eliminate the sense of isolation that can be very dangerous to veterans. And, she believes that telehealth can play an important role particularly for homebound veterans who may not be able to travel.
Above all, she said that veterans need to feel a sense of belief from those who they engage with on the topics of PSTD and trauma.
“It’s important for society to understand and believe PTSD is real. Just because they can't see it does not mean that it doesn't exist,” Dr. Wirick said. “That's an issue that all of the veterans I worked with of any era have discussed.”
Although the Department of Veterans Affairs gets a “bad rap,” she believes that they have made a concerted effort to partner with states to provide local services for veterans and encourages those who may be suffering to seek out help.
It took decades for Viana to return to the VA where he could talk through and rationalize his experiences. But he believes it was worth it.
“I never was gung-ho with veteran stuff. I never talked about my experiences,” he said. “But now I have because I see that there is a purpose to it.”
Veterans or those concerned about a veteran experiencing an emotional or mental health crisis are encouraged to visit the Veterans Crisis Line Website or call their 24/7 hotline at 1-800-273-8255.
Treatment for PTSD is currently governed by the U.S. Department of Veterans Affairs. Veterans who may be impacted by PTSD or professionals who would like to learn more about how they can help veterans diagnosed with PTSD can access a clearinghouse of information and resources by visiting the National Center for PTSD, located on the U.S. Department of Veterans Affairs website.
Vietnam veterans who would like to learn about how they can advocate for increased support for veterans with PTSD can visit Vietnam Veterans of America, a nonprofit that offers a comprehensive range of programs and services that address the needs of this population.
Citation for this content: Northwestern University's Online Masters in Counseling program.