I was talking with some V.A. colleagues, and they were telling me how the new vets coming back from Iraq & Afghanistan are a very different breed from the Vietnam vets they saw decades ago.
Of course, it’s a different situation in many ways. With Vietnam, the country was totally divided and we took our anger out on each other, and on the vets, who came back. The vets were very angry about being sent out to kill people and then getting castigated for it once they got home. We traumatized them all over again.
On the other hand, this new group of soldiers are appreciated by society at large, for putting themselves at risk – even by people who aren’t particularly happy about the wars. That’s one lesson we sure learned the hard way: not to take the politics of war out on the troops who fight them.
Of course, most of our Vietnam troops were draftees. Nowadays we have an all-volunteer army. (But then again, a lot of the reservists and National Guardsmen thought they were signing up to get some extra money and help out in national emergencies. Little did they know they’d be away from their families and careers, on their fourth rotation, fighting real people on foreign soil. So this is a complicated point and not as straightforward as it looks.)
Also, back in the 60’s, we didn’t know a whole lot about PTSD and our Vietnam troops didn’t know what was happening to them. Based on what we knew from World War II, we tried to prevent them getting PTSD by limiting their time of service to a year (for Marines, it was 15 months). And, sure enough, they came back with a smaller incidence of PTS. But 2-3 years later, lo and behold, they developed delayed onset PTSD and the percentages were right back to being the same as WWII - somewhere between 22%-35%.
(In any combat situation, the estimates are that 95% of exposed people have symptoms immediately afterward. Gradually these subside over 90 days for most people, even without treatment. But after about 6 months, there’s a core number - between 22% - 35% - that can’t get past their symptoms on their own and need help. It will be interesting to see, now that we have women in combat too, whether these stats stay the same.)
This new group in Iraq and Afghanistan knows what’s happening to them, to a much greater extent. There’s been a push to educate the troops and the general public about posttraumatic stress and this new kind of traumatic brain injury, thanks to a strong commitment to the mental health of our troops, found in both the DoD and the VA. Secretaries Gates and Shinseki have been working hard at destigmatizing mental health issues, in ways never seen before. So that’s another lesson learned from Vietnam, and no small matter.
There’s also, frankly, a different kind of drug abuse going on. These troops are given legal drugs by docs who are now placed downrange with them. The drugs keep them de-stressed enough to keep functioning. They come back home accustomed to anti-anxiety pills, and to a lesser extent, to anti-depressants and pain pills. So many are dependent on them and want to continue with them after their service. This is different from the Vietnam vets who abused multiple illegal drugs and got in trouble with the law for it.
And finally, with many of the Vietnam vets, by the time they came into the V.A. seeking treatment, they were in their 30’s and more amenable to counseling than these younger soldiers in their twenties. They’d started thinking about their lives in a more reflective way, especially when they started having combat stress-related difficulties with their relationships and their jobs.
For the younger troops coming back from Iraq & Afghanistan, there’s an impatience with the talking cure. They want to get on with their lives and won’t spend time talking and reflecting and pondering. They’re saying, “Don’t make me a career patient. I need to get to work. I need to help take care of my kids. I cannot come in during your office hours of 8-4 for a 12-week course of Cognitive Behavioral Therapy. Give me a pill or a relaxation audio to calm me down, and let me get back to my life.”
Keep in mind that two separate surveys - one at the Durham V.A. and one at the Phoenix V.A. - established that these new vets prefer getting their help via audio self-help by 72-75%. - through their own iPods or MP3 players. (That’s another difference: this is a population that’s comfortable with downloads.) Medication scores next highest at around 55%. Last on the list? Yep, you guessed it: sitting with a therapist.
So now that we’re learning about these barriers to receiving help - some quite positive, by the way (What’s wrong with not wanting to be a career patient, by the way?)- there will hopefully be much more widespread use of self-administered guided imagery downloads - shown at multiple research sites to reduce symptoms like little else, while being a pleasant and self-rewarding experience for the vet - not to mention inexpensive and useable even in remote locations.
We are getting so much more interest and openness in guided imagery than even a year ago, from both the DoD and the VA. These are great trends, very hopeful. I do believe we’re gonna seriously help a lot of vets.
Take care and be well,
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