Mental health sufferers learning not to give up
By Hank McIntire. Previously published in VALOR, July 2017.
Nick Adams loved his work as a helicopter mechanic with the 2-211th Aviation of the Utah Army National Guard. For 12 years he kept UH-60 Blackhawks in the air, most of the time at home station in West Jordan. He did the same in Kuwait and Afghanistan during his deployments for Operation Enduring Freedom.
In 2008 in Kuwait, Adams serviced the Blackhawks at Camp Buehring, and then the helicopters flew to hotspots in Iraq as part of Task Force Ghostrider. There he didn’t have much contact with the enemy, but in 2011 when the scene moved to Bagram Airfield, Afghanistan, all of that changed for him.
“We were rocketed 30 times in the nine months I was there,” he recalled. From the sound of the insurgent-launched mortars, Adams and his fellow mechanics got pretty good at guessing where the inbound rounds were headed. At the time they seemed more of an annoyance than a threat.
“I would be in the middle of a repair and they would yell at us to take cover,” Adams said, not wanting to quit working and seeing it as more of an interruption than anything else. Fortunately, none of the rounds ever came close, but the constant threat of rockets took an emotional toll on Adams, both at the time and today in the form of post-traumatic stress disorder, or PTSD.
Now as outreach coordinator for the Provo Veterans Center, the long-since-discharged, thirty-something Adams works through his own PTSD and helps other service members and retirees to do the same. Adams calls himself a “recruiter,” talking to veterans and seeing what benefits they are eligible for and whether they have a service-connected disability.
The veterans he runs into at Yellow Ribbon celebrations and other briefings he gives are drawn to his ready, scruff-surrounded smile, close-cropped haircut, and approachable manner. It also helps that Adams himself has struggled after coming home from a combat zone and understands what these men and women are seeing and feeling.
“The key is for veterans to recognize that something isn’t right and to do something about it,” explains Adams. “The problem is that many don’t think they have a problem.”
A long history
Recognizing PTSD in oneself or in others could very well begin with knowing its history and how the understanding of the condition has evolved.
In the United States, the first known cases of PTSD were documented during the Civil War, when it was known as Da Costa’s syndrome, or “soldier’s heart,” which manifested itself through a higher resting heart rate, resulting from soldiers being on edge constantly and having to be prepared to fight at any moment.
Dr. Steven Allen, coordinator of the PTSD clinical team with the VA Salt Lake City Health Care System, suggests that cases of PTSD may go back much further — perhaps even to the time of the Trojan War. He cited the work of Dr. Jonathan Shay, who wrote Achilles in Vietnam: Combat Trauma and the Undoing of Character. In that book, Shay concludes that there is a strong similarity between the behavior of soldiers described in Homer’s Iliad and military members’ behavior during Vietnam.
“Shell shock” was the name attached to the reaction to combat stress in World War I. Allen explained that the mortars used in trench warfare of that conflict produced over-pressurization waves, which caused changes in the nervous system of combatants. From that time, it was been accepted that sufferers experience an actual physiological change in their bodies.
“Both the Civil War description and the World War I explanation of this condition are not far from our current understanding of PTSD,” said Allen. “And in World War II the condition was described as battle fatigue or combat neurosis, which implied a weakness in a soldier’s emotional makeup as the cause. Similar conditions were observed in Korea and Vietnam, but sufferers were not attended to very well.”
A breakthrough in the study — if not the treatment — of what we now call PTSD occurred in 1980 when a landmark “confluence of ideas,” according to Allen, brought together the understanding of battle-related psychological symptoms and the research into the emotional and physical condition of women following sexual assault. At that time the American Psychological Association coined the term, “post-traumatic stress disorder.”
Suffering and avoidance
According to the Department of Veterans Affairs website, ptsd.va.gov, “PTSD is a mental-health problem that some people develop after experiencing or witnessing a life-threatening event, like combat, a natural disaster, a car accident or sexual assault. And at its core, says Allen, “is the avoidance of focus on traumatic events.”
While PTSD commands much attention from sufferers, loved ones and professionals, Allen cautions that no one should overlook other multipliers of its effects. These include what he calls “moral injury,” which involves putting a person into a situation of violating the values they grew up with, such as killing someone. Even conditions such as survivor’s guilt, which affected many who returned home after service in Vietnam, can also add to such suffering.
“Issues such as the transgression of what is ‘right’ can plague people, even if it wasn’t a traumatic experience,” Allen explained. “And anyone can develop PTSD if the exposure is long enough.”
Specifically with combat veterans it is wrong to assume that each one comes back with PTSD. Allen suggests that the “Rambo” stereotype, that veterans pose a danger to others, is a myth that does a disservice to all concerned. “Most vets are not going to get in trouble with law enforcement, and PTSD alone does not increase a potential for violence,” Allen said. “But adding alcohol and drugs to the mix can worsen the situation.”
Symptoms and triggers
There are four groups of symptoms that Allen has observed in his clinical work with veterans suffering with PTSD:
Re-experiencing the trauma — this may include thinking about it, mental images or dreams, and fitful sleep
Avoidance — staying away from things that remind the person of the trauma
Psychological — difficulty thinking, pulling back from other people, and negative thoughts about the world
Hyperarousal — nervous system on alert to threats, road rage, acting out, angry outbursts, sleep disturbance, nightmares, and risk-taking behaviors
Depending on the individual, PTSD symptoms might not manifest themselves for years, or they may come and go over time, according toptsd.va.gov. This is the case for many veterans whom Nick Adams serves at the Provo Vet Center.
“In our center I’m seeing a 70-30 mix of Vietnam veterans and those who served in Operation Enduring Freedom/, Operation Iraqi Freedom (OEF/OIF),” said Adams. “The younger veterans aren’t quite there yet, but they are slowly starting to trickle in,” added Adams. “And when they do, they say, ‘I should have come in years ago.’”
“Those who served in Korea and Vietnam seem to have developed coping mechanisms, but as they retire they have more time to think, and they seek treatment,” said Allen.
“For me personally, I had to recognize that sounds and smells were some of my triggers,” Adams explained. “I love and hate fireworks at the same time. If I know the sound is coming, I’m fine with it; but when it’s unexpected, it can set me off. And when I go eat at an Indian restaurant with my buddies, the smell of curry also takes me back.”
Intervention and treatment
Allen is pleased at the progress both in interventions and their levels of success. There is a wide variety to include evidence-based treatments (EBT), prolonged exposure (PE), and cognitive processing therapy (CPT). “We’re seeing some very effective treatments and a significant reduction in symptoms within 12-14 weeks,” he said. “A large part of it is helping people confront memories and reduce their power over them as individuals. We can’t undo what has happened, but disruptive symptoms can be lessened.”
“Treatment is like an onion; it takes peeling back the layers,” said Adams, describing both his own healing and his observations of others.
Group therapy offers a solid supplement to individual counseling. Adams and Allen listed a number of group interventions available in both Salt Lake and Provo centers to include groups for PTSD recovery, relaxation, movies, board games, and even coffee chats. Spouse-support groups and parenting classes also help partners and families understand what the PTSD sufferer is going through.
Community resources are also a big part of the PTSD-response toolbox. Adams has a binder full of business cards as evidence of the partnerships the Provo center has forged: outdoor-activity groups, the Disabled American Veterans, National Ability Center, Utah National Guard family-assistance centers, Utah Department of Military and Veterans Affairs, the United Way, local hospitals and dentists, and the VA, which funds the center.
Help and hope
The military and supporting organizations like the VA and Vet Centers have made great strides with PTSD understanding and intervention, but it is difficult to transform a military culture that has historically equated psychological and emotional struggle with weakness. Although there are more resources than ever for both sufferer and supporter, there is still a reticence on the part of some veterans to seek help.
Allen is hopeful that we are turning a corner, however. “The stigma of PTSD is alive and well, but it’s diminished to some degree,” he said. “Veterans are learning that along with maintaining your equipment, you have to maintain yourself.”
For his part, Adams does his best to reassure currently serving members that seeking help will not damage their career or affect their security clearances. He points out the veteran centers are under different reporting requirements, and the help they provide is 100 percent confidential.
“It’s not too late,” Adams assures those who struggle with PTSD themselves or who are watching their family member soldier on with symptoms. “Getting help is the best decision you can make,” he would say to any veteran who doesn’t feel quite right after returning from the fight. “It will change your outlook. No, it’s not going to fix everything, but it will make it easier. Give it time.”
And for spouses or family members Adams is equally hopeful. “Be patient and be supportive,” he says. And above all, “Don’t give up.”
Hank McIntire served 26 years from 1988 to 2014 with the Utah Army National Guard and U.S. Army in both military intelligence and public affairs. He is currently an assistant professor in the Department of Communication at Utah Valley University.
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