“Not All Wounds Are Visible” : Military Veterans and PTSD

From May through the 4th of July, communities across the country are honoring our military veterans with events and awareness campaigns of all kinds. South Wasco County residents and businesses can participate locally by supporting the Poker Run on June 13th which will raise funds for veterans’ support organizations.

June is also “PTSD Awareness Month,” reminding us all that an important way to support our combat veterans and families is to learn more about PTSD, and about the many local and national programs, projects and services dedicated to addressing the “invisible wounds” of persistent post-traumatic stress.

Statistics provided by the Department of Veterans Affairs estimate that PTSD occurs in 11-20% of Veterans who served in the war in Iraq, 10% of Desert Storm Veterans, and 30% of Vietnam War Veterans. Actual figures are widely thought to be much higher, since these figures include only VA documented cases of PTSD diagnosed and treated at VA facilities. The figures don’t represent the countless current or former servicemembers who have either never sought help, or who may have been diagnosed and treated by private therapists, counselors or physicians.

In addition, the nature and culture of military experience has historically discouraged servicemen and women from seeking help for symptoms resulting from either combat-related or sexual trauma (it is estimated that over 70% of women and 30% of men experience sexual violence in the course of their military tours of duty), and secrecy vows required at discharge make it difficult for veterans to talk about their experiences even in confidential settings. And, as veterans will say, the world of military combat is its own reality, entirely different from the world of everyday civilian life and experience. It is a transformative experience, and soldiers come back from it profoundly changed, into a world which may thank them for their service, but which cannot even begin to imagine that experience, much less understand its effects.

While a diagnosis of PTSD is made based on a specific set of criteria which it is beyond the scope of this article to describe, typical symptoms include high anxiety, feelings of guilt, depressed mood, difficulty with focus and concentration, being easily startled and alarmed, quickness to anger, racing and repetitive thoughts, feeling “on edge,” difficulty sleeping, sensory flashbacks, and difficulty connecting emotionally with friends and family. These symptoms result directly from exposure to acute or repeated physical and psychological trauma, which causes physical changes in the brain.

Too often (but understandably) a veteran may turn to alcohol or other drugs to numb the overwhelming symptoms, which then creates additional problems, as do many of the medications typically prescribed by a VA health system which is itself overwhelmed .

The good news? An increasing number of governmental and private, non-profit organizations offer a range of healing and support services for combat veterans and their families, many of them at low or no cost. In Wasco County, the Veteran’s Support Office in The Dalles helps veterans with everything from navigating the VA to connecting with other education, health and support services which may be available. They are also the host organization for “Home Fires Burning,” a group which responds to the needs of families and widows of military veterans. (http://www.co.wasco.or.us/county/dept_veterans.cfm)

On June 20th in The Dalles, the Oregon Employment Department will be hosting a “Veterans’ Resource Day”—a kind of information and services fair for disabled veterans and their families (check The Dalles Chamber of Commerce events calendar for details).

For Post-9/11 warzone veterans in Oregon and Southwest Washington, the “Returning Veterans Project” (based in Portland) provides free (yes, FREE!) counseling and other health services. Services are donated by the licensed professionals themselves, and volunteers include providers in South Wasco County. For more information, visit http://www.returningveterans.org/

Other organizations offer hunting and fishing opportunities in our area. “Project Healing Waters Fly Fishing, Inc.” works through local fishing club chapters to provide “physical and emotional rehabilitation of disabled active military service personnel and disabled veterans through fly fishing and associated activities including education and outings” (from the project website). Visit www.projecthealingwaters.org for local contact information. And “Outdoor Adventures for Military Heroes (which the Poker Run will help support) organizes hunting trips in Wasco County for wounded combat vets.

Thanking our military veterans for their service is an important gesture, to be sure. But we owe our warzone veterans much more: we owe them our active engagement in the ongoing challenges of “coming home.”

In the words of Paul Henderson (no relation), a combat veteran of the war in Vietnam and founder of “Soldier’s Heart” (www.soldiersheart.net), the “soul wounds [of PTSD] are sacred and, properly tended, can lead to wisdom and transformation.”

To suffering combat veterans themselves, he says (and I will let his words be the last), You have entered on the warrior’s path, but you may be struggling to see where it leads. You may not know how to complete your initiation from young fighter to warrior elder. A mature warrior is of great value to society, but you may not feel valued. Your soul may be stuck in the training camp or on the battlefield where it witnessed harsh and heartbreaking realities. As you have protected society in times of threat, it is society’s job to protect and tend to you now that you are back from military service. It is our responsibility to share any burdens of grief, guilt, and anger you may carry because of the things that were done to you, the things you saw, or the things you did in our name.

Thinking About Your Drinking?

In my February column on “Aging Gratefully,” I wrote about my mother’s recovery from alcoholism as one of the key ingredients in the “recipe for happiness” that she developed for herself in her later years. Since alcohol and drug use affect most people’s lives in one way or another, I thought I might spend a little more time on the topic of alcohol use problems in particular, and on options for taking action.

While many people who use alcohol use it in moderation without ever have use-related problems, no-one who drinks is immune from the potential for overuse and dependency. A guy who’s had no more than a beer or two on weekends for 30 years may find himself drinking gradually more heavily after the death of a spouse, as a way to cope with grief and loneliness. A gal who has enjoyed a glass of wine with dinner may find herself starting earlier and drinking more, as my mother did, to cope with a job or family life which has become more and more overwhelming. Or some health problem (depression, chronic pain, or a cancer diagnosis, for instance) can be the trigger for starting to use alcohol less for recreation and more for medication.

Alcohol use disorder (AUD) is the current medical term for the condition that is diagnosed when a person’s drinking causes distress or harm…yet the person continues to drink. It is a condition that has gone by many different names since humans first discovered fermentation, somewhere around 8000 BC. Alcohol use disorders range from mild to severe, and generally become more severe when left untreated, perhaps in part because of the multitude of health and relationship problems that overuse can cause, which in turn increases life stress.

How do I know if I have a problem? A qualified health professional (a primary care provider, some mental heath professionals, or a certified addictions counselor) can conduct a formal assessment of your symptoms, and online assessment tools can help with self-evaluation (check out the one at RethinkingDrinking.niaaa.nih.gov.). And of course family and friends may already be giving input—listen to what they have to say!

What are some options? While people generally think first of 12-step programs or residential rehab, huge advances in research and treatment approaches over the past several years have resulted in many additional, effective ways to take charge of an alcohol problem. AA has, without a doubt, helped untold numbers of people recover (I personally know many people who would probably not be alive without it). But AA is not for everyone, in part because its approach is not a fit for some peoples’ spiritual beliefs or their personal recovery goals. However, support groups (AA or others) are often an important part of recovery for many people, as well as behavioral therapy, spiritual counseling (they don’t call alcohol “spirits” for nothing!), and medication, either alone or in combination with other approaches.

And if you are struggling with the way someone else’s drinking affects you, by all means seek help for yourself, whether or not the drinker is ready to seek help for him/herself. See your doctor, talk to a counselor, join a support group—there’s help out there for you, too.

A note on medication: For many people, alcohol or drug use and dependency develop as a consequence of using what’s available to cope with depression, anxiety, anger, chronic pain, illness or other intense and persistent physical or emotional experiences. For these people, antidepressants (or other mood-regulating medications) can sometimes be an important part of effective treatment, by treating the underlying problem for which drugs and alcohol use began as a “solution.” In addition though, there are now also medications (Naltrexone is one) which work by directly affecting the receptors that create the brain’s “interest” in alcohol. Unlike Antabuse (an older medication which works by simply making the user very ill if they use alcohol while taking it) these newer medications work by diminishing the desire to drink itself, or to overuse when drinking. They are non­addictive, not mood-altering, and can be used alone or in combination with other forms of treatment.

Start with your primary care provider. For anyone thinking about treatment, talking to a primary care physician is an important first step: she or he can help to evaluate drinking habits, evaluate overall physical and mental health, help make a plan, provide information and treatment referrals, assess if medications for alcohol (or other medications) may be appropriate, and prescribe and monitor them if so.

The bottom line? Alcohol use problems are highly treatable, and without a “one size fits all” approach to either goals or to treatment methods. It’s also not necessary to “hit bottom” as was once thought. So, if you are even curious about whether or not alcohol might be able to play a less central role in your life or the life of someone close to you, take some action to find out more about the options: do some research on-line (http://www.niaaa.nih.gov/ is a great place to start), talk to your primary care physician, or talk to a friend in recovery. As AA members like to tell newcomers, “You have nothing to lose but your misery!”