Man.

I Don’t Have PTSD (Or Do I?)

By Mary Tendall

“I don’t have PTSD!” That is a common statement I’ve heard from a majority of Vietnam veterans upon an initial meeting. There’s long been a stigma attached to the term PTSD, and I agree that it’s not pleasant to be categorized into a diagnosis that encompasses so many complex aspects of the impact from combat. The term for many has also meant the same as, “crazy, homeless, out of control,” or worse. How unfortunate – but in fact, there is now a more modern title that probably is more sensible called Combat Operational Stress. (COS). In other words, the stress one experiences following combat which influences the operation of the mind and body and spirit.

A veteran who thought he didn’t have PTSD

Everyone who has experienced combat whether in the bush or not, must admit to feeling the impact of the experience following the return home, so when Dale, a Vietnam veteran called me with the secure understanding that he did not have PTSD, I was intrigued. Knowing he had served in Vietnam, I was curious about why he had called. He said that although he had never suffered following his return home, he had lately become “just too tired to work on my marriage or spend time with family,” even though he was clear that he still loved them.

Dale had always looked at the guys with the PTSD label as the ones who couldn’t cope. He knew he wasn’t one of those guys.

He said that he just didn’t care about things the way he used to before retirement, and liked to just be left alone. He also admitted that he has had frequent intrusive memories of his time in Vietnam, thanks to the Internet. “I start thinking of my time in Nam, and it seems like yesterday, and at the same time a lifetime ago. It wipes me out trying to just figure out who I really am.” Dale had always looked at the guys with the PTSD label as the ones who couldn’t cope. He knew he wasn’t one of those guys, which is why he hesitated calling me. In fact many people who suffer from PTSD don’t realize it.

The usual symptoms

Here are some of the symptoms that Dale described that would link his current issues to his combat experience:

  • Recurring thoughts of certain missions and losses of men from his unit.
  • Nightmares that may or may not be about combat in Vietnam, but which symbolize his inability to provide safety for those important to him, including family members.
  • Avoidance of large crowds, especially with strangers. In contrast, he admitted that he had loved rock concerts before he went to Vietnam.
  • Anger outbursts when provoked at home or while driving, which were beyond what the situation called for.
  • Irritability when stressed.
  • Avoidance of small spaces, such as in the middle seat of an airliner or the middle section of a theater.
  • More recent lack of interest in taking trips or socializing.
  • Recent increased desire to isolate with his computer or in front of the television.
  • Decrease in feelings of joy or laughter.
  • Restless sleep and lack of appetite.
  • Increased intake of alcohol, although not yet to the point of abuse.

After creating the list, Dale said that most of the list had always been there, but that he was able to have a decent life, and was certainly never one of those homeless guys. He was stunned to discover that his symptoms qualified him for the dreaded PTSD diagnosis, but we both preferred to normalize the impact of combat – and he called it “Senior Citizen Combat Stress.” That was good enough for me.

Retirement age brings many changes

It’s important to point out that hitting retirement is often a time of reflection and re-evaluation of our lives. Those memories and thoughts often provoke mixed feelings about the present and the future, and can cause depression if they sit there unattended. If there are unresolved issues and traumatic episodes, they will often come screaming out at a time in life when there are fewer interruptions and distractions. A war-time experience compounds the odds of experiencing discomfort later in life.

I showed Dale how the brain is programmed into combat mode, but doesn’t get deprogrammed upon returning home. He found that fascinating, and was open to learning ways of de-triggering his symptoms without shutting himself down. I gave him some reading ideas that helped him to realize that he was not alone with many of his behaviors, and explained that his recent experiences were shared by many other Vietnam veterans at retirement age. Dale wasn’t open to joining a group, but was willing to talk to some of his war buddies online. He was relieved to hear that they had many of the same experiences of increased distress as they got older. One was still in denial, and that helped Dale realize how much his war buddy sounded like him before he sought help.

How Dale made things better

Although there are countless examples of veterans who are now sensing anxiety not consciously experienced earlier in life, I’d like to stay with Dale’s experience, and refer to his list of symptoms with a way to re-frame his challenges into a vehicle for healing.

Dale came to realize that if he didn’t want to attend large gatherings, he was no longer obligated to do so.

Talking to his buddies triggered memories, but he was grateful to hear about them, and planned a very small reunion with three guys to talk about their after-war stories in addition to old times.

Dale learned about some relaxation tools to use when triggered. And his physician prescribed an antidepressant, and Dale reported that it was helping him to work through his feelings, rather than reacting to them.

While looking at his avoidance issues, Dale came to realize that if he didn’t want to attend large gatherings, he was no longer obligated to do so. He talked to his family, and they all agreed. When his family gave him the option of going to Disneyland with the grandkids, he chose to go.

Dale scheduled events with his family and friends that he could tolerate, and let them know which ones he wanted to decline. They all needed the clarity ahead of time so that there was no resentment or guilt emerging right before an event. In the past Dale had agreed to many events and outings, only to cancel at the last minute, causing angst for all family members.

When engaged in front of the television or on the computer, Dale was able to offer a specific time he would break to spend time with his wife or others in the home. His wife told me that was a godsend to have that scheduled ahead of time. “I was able to quit nagging, and we both liked that,” she said.

Once a week Dale and his wife take time to do something that will make them laugh or smile. It could be a movie, a visit to a nice vineyard (Dale is a wine collector), or a ride to a beautiful lake. They take turns deciding where to go.

Dale got connected to a VA clinic, and was put on a healthy diet. He found that the diet contributed to better energy levels. I helped him eliminate his nightmares, and his sleep has improved dramatically.

Dale’s alcohol intake is now limited to one to two glasses of wine in the evenings with dinner. His doctor is fine with that, since he is not on any strong medication.

I highly encourage those who feel alone to find ways to be of service in the communities. VA facilities welcome Vietnam veterans to talk to the young men and women in VA hospitals and clinics.

While Dale initially worried about his withdrawal, he was able to reframe it into something positive. Withdrawing from the old tensions and feelings that interrupted healthy thoughts is a good thing. It’s a time to slide away from the old demands which no longer hold one accountable. It’s a time for laying the old baggage to rest, while acknowledging that it played a role in your past for a reason. And while withdrawing in this way, there is room to replace the things that took up so much physical and emotional space with a renewed look at the future.

Dale is fortunate to have a life partner, and he’s not burdened with financial challenges. I highly encourage those who feel alone to find ways to be of service in the community. VA facilities welcome Vietnam veterans to talk to the young men and women in VA hospitals and clinics. Communities have many homeless programs that need volunteers to help bring food and clothing to others. Many veterans need rides to appointments at the VA for medical needs. Ask your nearest veterans service officer if you can help. And finally, find a way to bring pleasure into your life. Joy is one of the best healing medicines out there.

PTSD: Not just for Vietnam veterans

Of course Vietnam veterans are not the only people who experience increased stress and anxiety at retirement age. It’s a common symptom of getting older in our times. The lack of extended family and purpose, along with unresolved losses and other traumatic events can be a real challenge. In Dale’s case, after Vietnam, he was able to distract himself when old memories threatened to surface. He could disguise many of his stressful symptoms into irrational thinking. Example: “I’ve never liked crowds, so you go without me,” and he numbed his feelings with the television, the computer, daytime sleeping, or with alcohol.

There’s good news. At this stage in life it’s important to realize that many of the previous work-related and social obligations are no longer necessary. There’s time to redefine your future so that instead of distraction and avoidance, you offer to yourself the opportunity for joy and pleasure


You are invited to contact Mary Tendall with comments and/or questions regarding PTSD. Her e-mail address is maryten@jps.net.

*Names and some situations in this article have been changed. Some photos may include models who have no real-life relationship to the story or any PTSD issues.

 

Mary TendallMary Tendall, MA LMFT, has worked for over 20 years with combat veterans and their families, as a licensed psychotherapist, specializing in combat-related PTSD. She has consulted for the Gulf War Resource Center, National Public Radio, and Newsweek. She continues to work with combat veterans and their families, and is affiliated with several national non-profits whose goal is to help veterans, such as VietNow, Soldier’s Heart, Train Down, and America’s Heroes First. She can be reached by e-mail at maryten@jps.net.