PTSD And Older Veterans
From as long ago as Homer's ancient story of the battle between the Trojans and the Greeks, and the times of the Bible and Shakespeare, military personnel have been confronted by the trauma of war. With the release of the movie, Saving Private Ryan, the reality of war trauma came front and center for veterans, their families, and our society at large. The phrase, "war is hell," only begins to describe how terrifying and shocking war is for hundreds of thousands of American military personnel.
How does war affect normal, healthy military personnel?
War is a life threatening experience that involves witnessing and engaging in terrifying and gruesome acts of violence. It also is, for most military personnel, a patriotic duty to protect and defend their country, their loved ones, their values and way of life. The trauma of war is the shocking confrontation with death, devastation, and violence. It is normal for human beings to react to war's psychic trauma with feelings of fear, anger, grief, and horror, as well as emotional numbness and disbelief.
We know from numerous research studies that the more prolonged, extensive, and horrifying a soldier's or sailor's exposure to war trauma, the more likely that she or he will become emotionally worn down and exhausted--this happens to even the strongest and healthiest of individuals, and often it is precisely these exemplary soldiers who are the most psychologically disturbed by war because they are able to endure so much of it with such courage. Most war heroes don't feel brave or heroic at the time, but simply carry on and do their duty with a heavy but strong heart so that others will be safer--despite often feeling overwhelmed and horrified.
So it is no surprise that when military personnel have severe difficulty getting over the trauma of war, their psychological difficulties have been described as "soldier's heart" (in the Civil War), or "shell shock" (in World War I), or "combat fatigue" (in World War II).
After World War II, psychiatrists realized that these problems usually were not an inborn "mental illness" like schizophrenia or manic depressive illness, but were a different form of psychological disease that resulted from too much war trauma: "traumatic war neurosis" or "post-traumatic stress disorder" (PTSD). Most war veterans are troubled by war memories, but were fortunate enough either not to have "too much" trauma to recover from or to have immediate and lasting help from family, friends, and spiritual and psychological counselors so that the memories became "liveable." A smaller number, had so much war trauma and so many readjustment difficulties that they now suffer from PTSD.
How is it possible to have PTSD 50 years later?
Because most World War II veterans for example, came home to a hero's welcome and a booming peacetime economy, many were able to make a successful adjustment to civilian life. They coped, more or less successfully, with their memories of traumatic events.
Many had disturbing memories or nightmares, difficulty with work pressure or close relationships, and problems with anger or nervousness, but few sought treatment for their symptoms or discussed the emotional effects of their wartime experiences. They were expected by society to "put it all behind them," forget the war, and get on with their lives. But as they grew older, and went through changes in the pattern of their lives -- retirement, the death of spouse or friends, deteriorating health and declining physical vigor -- many experienced more difficulty with war memories or stress reactions, and some had enough trouble to be considered a "delayed onset" of PTSD symptoms--sometimes with other disorders like depression and alcohol abuse.
Such PTSD often occurs in subtle ways: for example, a veteran who had a long successful career as an attorney and judge, and a loving relationship with his wife and family, might find upon retiring and having a heart attack that he suddenly felt panicky and trapped when going out in public. Upon closer examination, with a sensitive helpful counselor, he might find that the fear is worst when riding in his car, due to some unfinished trauma memories of deaths among his unit when he was a tank commander.
What should I do if I or an older person I know has PTSD?
First, don't assume that feeling emotional about past memories or having some of the normal changes associated with growing older (such as sleep disturbance, concentration problems, or memory impairment) automatically mean PTSD. If a conflict veteran finds it important, but also emotionally difficult, to remember and talk about war memories, help him or her by being a good listener -- or help find a friend or counselor who can be that good listener.
Second, get information about war trauma and PTSD. The Department of Veterans Affairs' Vet Centers and Medical Center PTSD Teams offer education for veterans and families--and they can provide an in-depth psychological assessment and specialized therapy if a veteran has PTSD. Books such as Aphrodite Matsakis's I Can't Get over It: A Handbook for... (Oakland: New Harbinger, 1992) and Patience Mason's Home from the War (High Springs, Florida: Patience Press, 1998) describe PTSD for veterans of all ages and for other trauma survivors, and its effect on the family.
Third, learn about the specialized therapies available at Vet Centers and VA Medical Centers. These include medications to help with sleep, bad memories, anxiety and depression, stress and anger management classes, counseling groups for PTSD and grief (some particularly designed to bring together older war veterans to support one another in healing from war trauma or prisoner of war experiences), and individual counseling. Involvement of family members in the veteran's care and in self-care for themselves also is an important part of treatment.
Richard J. Bonwick and Philip L.P. Morris, "Post-Traumatic Stress Disorder in Elderly War Veterans," International Journal of Geriatric Psychiatry 11: 1071-1076 (1996)
Lee Hyer, Mary N. Summers, Lorraine Braswell, and Stephanie Boyd, "Posttraumatic Stress Disorder: Silent Problem among Older Combat Veterans," Psychotherapy 32(2): 348-364 (Summer 1995)
Paula P. Schnurr, "PTSD and Combat-Related Psychiatric Symptoms in Older Veterans," PTSD Research Quarterly 2(1): 1-6 (Winter 1991)
Francis I. Snell and Edgardo Padin-Rivera, "Post-Traumatic Stress Disorder and the Elderly Combat Veteran," Journal of Gerontological Nursing 23(10): 13-19 (October 1997)
National Center for PTSD