“To this day, every time I smell firecrackers or fire arms being shot, I feel like I am right back there. All I have to do is close my eyes and I see the whole scenario over and over again. I can’t erase it.”

Hundreds of thousands of US veterans are not able to leave the horrors of war on the battlefield. They bring the combat home and re-experience it in their minds each and every day, no matter how much time has passed.

“I don’t like people. I just live my life.”

Many PTSD veterans live a life riddled with divorce, unemployment, and loneliness because they are unable to form lasting social networks within civilian life. It is not uncommon for a war veteran plagued with PTSD to desire a solitary life in the mountains. One informant described Montana as the ideal locale – far away and quiet.

“I should have buried him.”

This veteran is still tormented by the fact he did not give an honorable burial to a fellow soldier. He knows he would have met a similar fate if he tried to leave his foxhole; yet his inability to act haunts his memory. He asks himself everyday why he didn’t even try to honor his fallen comrade. He also has never been able to justify why he wasn’t the soldier left unburied on that remote Pacific island.

“I didn’t even have the motivation to kill myself.”

Many of these men and women believe their situation will never improve. Some contemplate suicide as their only relief from the symptoms of PTSD. A number of the veterans we spoke with had thought about or even tried to end their own lives. They also participate in risky activities, threatening their life in a deliberate yet indirect way.

“I always feel like there is someone behind me – following me.”

Being on edge is the only way to survive in combat. Unfortunately, many PTSD veterans are unable to readjust within the civilian world. Everyday life becomes a battlefield.

Something as mundane as walking through a crowded grocery store aisle can be a source of intense anxiety for a veteran suffering from PTSD. Overwhelmed by a feeling that the shoppers behind them are enemies, PTSD veterans always feel as if they are under attack. A trigger as simple as the clashing of shopping carts can make them jump in fear of an imminent explosion. They are forever at war.

OUTREACH

Over the course of 4 months, South Bend veterans with Posttraumatic Stress Disorder (PTSD) have revealed their daily realities to us, five undergraduates at the University of Notre Dame. In conjunction with a course taught by Dr. Daniel Lende entitled Researching Disease: Methods in Medical Anthropology, we have engaged in community-based research with members and supporters of PTSD, Vets, Inc. Here, with the approval and encouragement of these vets, we seek to give their experiences a well-deserved voice.

We’ve come to understand that PTSD is a debilitating condition. However, there tends to be a general lack of understanding of the condition itself as well as its symptoms, diagnoses, and treatments. Here are some things these PTSD veterans want every person to know:

Many older veterans have suffered from PTSD for decades without ever knowing they had the disease. These men and women insist that their quality of life would have been significantly improved with early intervention. This has been supported by numerous studies, which suggest that diagnosis soon after the traumatic event is critical for positive, long-term outcomes. Traumatic memories tend to become resistant to treatment over time. The quicker the symptoms can be addressed, the better the outlook for a PTSD veteran.

A clinical diagnosis serves as a profound moment for a veteran with PTSD. It confirms and validates the symptoms experienced by the individual. One informant describes his diagnosis: “It was like a nail on the head. Finally someone knew.”

Veterans with PTSD often believe that they are “crazy” before a formal diagnosis by a healthcare professional. Previous to having a diagnosis, these men and women have the symptoms but no explanation for their cause. They begin to question their sanity. They ask, as one veteran phrased it, whether or not “it’s all just in [our] heads.”

A formal diagnosis is an empowering facet of PTSD treatment because it lets veterans know that there is a physiological and psychological basis for their behavior. War has changed their brains and there are ways of learning to cope with those changes.

More than anything else, a diagnosis lets them know that they are not alone.

Many of the vets expressed that feeling alone in handling their condition and the isolation that often results are the most painful aspects of PTSD, often making it difficult for many PTSD vets to ask for help and seek treatment. Group therapy among PTSD veterans is a vital component of treatment because very few civilians have seen and experienced the same events that these men and women have. Nor can civilians understand the trials and tribulations of living with PTSD caused by war trauma. In this way, it can be seen that many PTSD veterans will only talk about their experiences with other veterans.

We have received direct feedback that group therapy benefits many of the veterans, as it provides an avenue for them to speak openly about their suffering. While many veterans destructively turn to alcohol and drugs as a means of coping, group therapy provides a healthy alternative and is an outlet for them to express their anger, fear, guilt and countless other emotions attributed to PTSD. In confidence they can tell each other things that they haven’t even told their husbands or wives. In the group they are getting these things out in a sensible manner. Telling their stories matters.

An important question in regards to group therapy is how it can be improved in order to provide the most benefits for the veterans that are returning home from war. The VA and several other organizations are examining what aspects of group therapy may be altered to make it as effective as possible for providing PTSD treatment to veterans.

One approach that veterans in South Bend are attempting is peer counseling. Those with PTSD consider a commitment to helping other veterans to be a central facet of managing the disease. Older members of the group want to reach out to soldiers returning from Afghanistan and Iraq with PTSD. They know better than anyone what it is like to live with PTSD and want to stress the importance of receiving early treatment. By counseling young veterans, these members hope to prevent a lifetime of suffering which they themselves had to live through. This then helps to validate their own suffering.

The peer counseling doesn’t just benefit one side of the relationship, however. By instilling them with some agency over the disorder, the counseling provides a method of coping in addition to more standardized treatment for the older group members. More generally, this emphasis on helping other veterans simply by making them as aware of PTSD as possible underscores the importance of awareness in the effort to improve its diagnosis and treatment among all veterans.

AWARENESS

The substantial impact of PTSD on the lives of veterans afflicted by it makes greater understanding of this disorder of utmost necessity. With knowledge about PTSD, returning veterans can seek the early diagnosis and treatment they need, giving them a chance to reclaim their quality of life. Although many veterans we spoke with stressed that PTSD never goes away, with treatment, including group therapy, counseling, or medication, veterans can avoid a life ravaged by isolation, drug and alcohol use, depression, and the countless other daily struggles of PTSD.

Awareness and understanding can also foster the support of families that is often necessary to motivate vets to seek the treatment they need. Increasing the visibility of the prevalence of the disorder among veterans and working to remove the stigma associated with it can help veterans get the support they need and deserve. Finally, awareness among the general public will give veterans an additional level of acceptance and advocacy that may work to reduce the impact of PTSD on their lives.

A true knowledge about all aspects of PTSD needs to rise amongst veterans, their families, the public, and our policy-makers, so veterans currently suffering with PTSD and the soldiers returning from Iraq and Afghanistan may acquire the help needed to fight back in the war that rages within their subconscious.

For more information on PTSD and how to seek treatment please visit the helpguide. To learn more about the veterans of PTSD, Vets, Inc., who so graciously shared their stories, visit www.ptsdvets.com.

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Written by: Christina Del Guzzo, Megan Ericson, Daniel Graciaa, Casey McNeill & Mark Quaresima

Acknowledgements: Many thanks to Dr. Michael Sheehan, PTSD Vets, Inc., and the many veterans who opened their hearts and shared their stories with us.