The recent coverage of Post Traumatic Stress "Disorder" in veterans is long overdue and brings out important aspects of this affliction that affects millions of veterans, their families and friends, as well as others in our society. I am compelled to ponder this in honor of yet another brother who finally succumbed to a war wound of the soul long ago, who found final peace by his own hand.

By calling post traumatic stress, this natural response to the fight or flight chemistry of our brains, a "disorder," it automatically stigmatizes those who are affected by PTSD. It's no wonder that half of our recent veterans affected by PTSD will not seek help for now, in large part because of that stigma of a "disorder" or a weakness, and the implications that go with it professionally and personally. The psychological/emotion/physical response to the horrors of war are every bit as much a wound to be expected, as the bullet or bomb that mangle the physical bodies of those thrust into harm's way.

While the physical wounds of our veterans are treated in a relatively responsible manner by our culture and the VA does great work with limited resources, the treatment of psychological wounds is woefully inadequate, poorly administered, discouraged by some VA officials, and too often lacking in effectiveness over the long haul. Hundreds of thousands of veterans are returning from Iraq and Afghanistan with PTSD and traumatic brain injury. If we made the simple leap to acknowledge that people are suffering from a natural response to being thrust into abnormal conditions, by renaming PTSD to Post Traumatic Stress Response or Reaction, perhaps more would seek help in a timely manner, instead of waiting for decades, if ever, for treatment like most Vietnam veterans have.

The responses to post traumatic stress are as individual as the personal experiences and the individuals themselves. For some, the visual, sounds and smells of a moment will linger and will never leave them a night with good sleep. The trauma of watching brothers and sisters turned into bloody corpses will haunt some and for others turning the brothers, sisters, fathers, mothers, and friends of others into bloody corpses will remain for all of their days and nights. Some have suffered a crisis of faith that will linger, still others a sense of betrayal by those who sent them or allowed them to go into wars that they found to be unjust. Some will experience all the above and more.

The manifestation of PTSD can be delayed, for weeks, months, years or decades. Oft times, the emotional will cause physical manifestations which will in turn exacerbate emotional manifestations in a negative feedback loop. While many may appear unaffected, their perceived strength may too, hold a silent, deadly emotional time-bomb or cluster bomb that may or may not go off if one too many stresses of life finally trip the release.

To add insult and injury to injury, there are the betrayals that also occur when "safely" back home, when help is not there or woefully inadequate, when family and friends are too scared to open wounds, tip-toe in complicit silence or leave in fear or helplessness. It is also a major betrayal when VA counselors accuse them of merely seeking benefits when they merely sought long needed help, or deny help outright.

When a service person expresses concern for their mental well being the common refrain of their superiors is to "Suck it up...get back out there." When they are veterans, it has been documented that higher ups in the VA are intent on denying as many PTSD cases as possible. A March 20 e-mail put it bluntly "Given that we are having more and more compensation seeking veterans, I'd like to suggest that you refrain from giving a diagnosis of PTSD straight out. Consider a diagnosis of adjustment disorder, R/O PTSD. Additionally, we really don’t have time to do the extensive testing that should be done to determine PTSD..." The author of that e-mail, Norma J. Perez, PhD, was at that time, the coordinator of the PTSD clinical team at the Temple, Texas VA medical center.

The recent expose' that 32,000 veterans have been put at greater risk of suicide and mental breakdowns from experimental PTSD drugs underlies another inadequacy of treatment options and betrayal of trust of the system. It was criminal to take three months to notify veterans after the Chantix suicide link was known. One of the veteran victims in that Chantix experiment, James Elliott, of suburban Washington, suffered a mental breakdown and near-lethal confrontation with police which he blames on Chantix. Elliot's near-fatal incident occurred in February, nearly three months after the VA knew the truth about the suicide link, but before notifying veterans. Even when they sent the warning letter to veterans, the word "suicide" was omitted. Elliott said the failure of the VA to inform him of Chantix's possible side effects made him feel like "a guinea pig, lab rat, disposable hero." That betrayal goes deeper than systemic indifference to invisible wounds. While the VA fails in its duties, the Vets Centers are staffed by competent, caring and capable help.

Post traumatic stress responses and reactions are a complex mix of mind, body, and spirit that cannot be simply erased by denial, or the "right words" or "right pharmaceuticals", or the right rhetoric. It is poorly understood how some can come through relatively unscathed, while others are scarred for life. Can anyone be truly raised to experience the hell of war without being affected? Can anyone who has never seen the worst of humanity, ever understand what it is like? Is there a way, after being raised with the highest moral upbringing, to come home unscathed in the spirit and soul after taking lives? Can anyone truly be adequately trained to be pushed well beyond our physical or emotional limits, day after day, with repeated deployments, to come home to divorce, isolation, and the need to emotionally vacate the heart, to survive? Can those who have never looked at a gun as a potential sweet release from pain, understand that lingering pain? Is the slow motion suicide of the bottle or needle, any less tragic or real than those who took the quicker route? As the old MASH theme song put it..."Suicide is painless..it brings on many changes.."

Over half of Vietnam veterans have experienced full-on PTSR or partial PTSR at some point in their lives. Nearly 1,700,000 Vietnam vets have carried the psychological wounds of that war for decades. Triggers like the images from the Iraq invasion, sonic booms and other loud noises, smells, and numerous others, bring back the symptoms long after those demons were thought to have been tamed. WW II veterans sought help in droves after watching "Saving Private Ryan" brought back long hidden memories and emotions. Almost half of Vietnam vets suffering from PTSD have been arrested at least once, and 40% still self-medicate with alcohol or other substances. The VA estimates that nearly 200,000 veterans are homeless on any given night, 400,000 at some point in a year, and veterans account for 23% of all homeless people in America. Returning Iraq and Afghanistan veterans currently have little hope to fare better unless something drastically changes in our system. PTSD, or PTSR will rarely go away or be held at bay without aggressive and effective management/treatment and support by all. While there have been small strides to more adequately address this issue, with a bankrupt economy, will we prioritize to provide all resources necessary to fully address the proper care of the overwhelming numbers returning with their hidden wounds?

The VA was forced to acknowledge veterans are attempting and committing suicide at alarming rates when a RAND Corporation report released in April reported as many as 1,000 veterans committing suicide per month. With that and the homelessness and domestic violence too common among our veterans, it is a moral and social imperative that all Americans take this epidemic extremely seriously and demand better. The stigma must be removed to allow all who need treatment, to seek it. The National Coalition for Homeless Veterans suggests that "Veterans need a coordinated effort that provides secure housing and nutritional meals; essential physical health care, substance abuse aftercare and mental health counseling; and personal development and empowerment. Veterans also need job assessment, training and placement assistance." Veterans also need the highest and best standards for those who are charged in administering counseling, the state of the art in treatment options and protection from unscrupulous pharmaceutical companies preying on the system. There may never be the miracle cure-all for post traumatic stress, but there must be a life-long commitment to help manage it by those who care, and those who are charged with our responsibility to Veterans.

Regardless of our various views on these recent wars or Vietnam, we must come together to demand competent, timely, and effective treatment and management options for PTSD(R) for all we have sent into harm's way. We should be able to show some compassion for and resolve to help the homeless and incarcerated veterans who would be far less likely to be in those situations had they not served. Flag decals and yellow ribbons will not be sufficient to help people fully return from war. When those in political leadership positions repeatedly vote against crucial VA budget increases at a time of increasing demand and advocate privatization of the "collateral" damage we have done to our veterans, there is systemic indifference in our leadership that is breath-taking in it's hypocrisy and must be rectified as well. This is part of the cost of war that all must bear either by our inaction, or pro-activity, and with the greatest resolve to do right by those who have sacrificed.

I urge all Americans to monitor Lawyers for Warriors, Veterans for Truth, or your favorite veterans advocacy groups and keep informed of the latest legislation, expose and replace those politicians of empty rhetoric and hypocrisy, and demand that we do what is right and truly honor those who served and sacrificed.

Denny Haldeman
Soddy Daisy
dennyh@bellsouth.net