The war comes home
A Vietnam vet worries about his injured son’s mental health after fighting in Iraq
By Patti Carmalt-Vener 06/27/2013
I’m a 64-year-old Vietnam veteran who was exposed to combat. I am grateful to not only have come home safely, but also to be able to cope fairly well with the experience. Many guys I’ve known came back depressed and fearful, often turning to drugs and suffering for a long time. My son, Raymond, was in the Army, had multiple war-zone deployments to Iraq, survived blast-related injuries and was discharged due to physical and mental disabilities. While his physical and mental difficulties are healing, he still has nightmares and trouble sleeping. He is edgy, tense and guarded, and has recurring memories of tragedies he endured. He sees doctors regularly for his physical injuries but downplays his emotional symptoms. He’s resistant to psychiatric/psychological treatment; it’s as if seeking help will bring him dishonor. (Neither my wife nor I have ever felt that way or communicated this to him.)
I worry that he’s ashamed of being discharged and may be comparing himself to me. Since I functioned well after war, why didn’t he? Our daughter-in-law, Cynthia, is as concerned as we are and confided to my wife that he doesn’t seem as caring and loving or have much sexual desire. He refuses to talk to her about what he experienced and she feels closed out. Along with depression, could he also be suffering from Post-Traumatic Stress Disorder (PTSD) or maybe even Traumatic Brain Injury (TBI)?
I’m positive he’s not using drugs nor has he been violent but he does have angry outbursts. I plan to talk to him about getting help but first want to be clear how to approach him.
For starters, make clear to Raymond that there’s no valid way to compare the diagnosis and treatment of previous veterans with returning veterans from Iraq and Afghanistan, as they have substantially different psychological profiles including age, marital status, legal history and diverse deployment experiences, as well as different stressors from home, including occupational status and family obligations.
Raymond needs to understand that his symptoms are quite common. Exposure to extraordinary trauma or life-threatening events can result in negative behavioral and emotional outcomes with PTSD, a common psychological consequence. PTSD symptoms were recorded in the Civil War, World War I and II and at the end of the Vietnam War. PTSD was also legally established and diagnosed in all veteran populations still alive including World War II, the Korean conflict, the Persian Gulf and recently those returning from Afghanistan and Iraq. This condition is not unique to war veterans, but it is present in veterans more than any other population. Between 2005 and 2009, the number of soldiers discharged for having both a physical and mental disability has increased 174 percent. Further, a recent Pentagon analysis found that in 2009 mental disorders triggered more hospitalizations among military troops than any other medical condition, including physical injuries from battle.
Veterans that were either resistant or denied treatment often had years of chronic psychological symptoms, including mood and substance abuse disorders. Due to this serious problem, the law was changed in 2010 to reduce the difficulty for veterans to get treatment for PTSD. It’s crucial that Raymond seeks mental health services.
PTSD has many symptoms that generally fall into three categories: (1) re-experiencing the traumatic events, often flooded with intrusive and horrifying images, sounds and even smells; (2) avoiding/numbing experiences such as becoming emotionally cut-off, unresponsive, detached and estranged and hyper-arousal, whereby feeling constantly in danger; and (3) hyper-vigilance, which can include sleep difficulties.
There is a significant increase of TBI in veterans from Iraq and Afghanistan, especially for those who survived blast-related injuries. Research shows a possible link between TBI and PTSD but it’s not clear as to whether PTSD develops before, after or independently from TBI. For many veterans, the inability to remember important details of their injury/experience presents a major diagnostic challenge.
Treatment for TBI includes medications given for depression and anxiety as well as psychotherapy. Treatment for PTSD often has to start with the veteran and care provider together establishing the value of recovery by agreeing upon specific outcome goals, identifying specific behaviors they want changed and establishing therapeutic rapport early on in treatment. Individual, group, family and marital therapy sessions are helpful insofar as positive outcomes, depending on the individual patient’s situation. Anger and aggression are common manifestations, and treatment should include anger management tools such as self-monitoring of anger and learning the specific triggers both internally (i.e., personal thoughts) and externally (i.e., environmental cues). It should also be noted that suicide is a high-risk factor and safety assessments need to be included in treatment.
Please know that all my good thoughts and wishes go out to you, Raymond and your whole family. He’s very lucky to have you as his father.
Patti Carmalt-Vener, a faculty member with the Southern California Society for Intensive Short Term Psychotherapy, has been a psychotherapist in private practice for 23 years and has offices in Pasadena, Santa Monica and Canoga Park. Contact her at (626) 584-8582 or email firstname.lastname@example.org. Visit her Web site, patticarmalt-vener.com.