Posted on Mon, May. 12, 2008
Tracking down answers to combat-stress illness
Philadelphia Inquirer - Philadelphia,PA,USA
By Tom Avril
Inquirer Staff Writer
When Joseph Boscarino returned from Vietnam in 1966, it seemed as if the war came home with him.
Many of his fellow veterans in his New Jersey hometown battled drug problems and nightmares. Some committed suicide. He says his own twin brother, who went to war the following year, came back a changed person - debilitated by anxiety and delusions.
"We were expected to soldier on," Boscarino says. "We did the best we could."
Today, those symptoms are well-known as post-traumatic stress disorder (PTSD). And Boscarino, 62, has made it his life's work to understand the problem.
Now an epidemiologist, he is among the organizers of a national conference to be held tomorrow on the still-mysterious illness, at Geisinger Health System in Danville, Pa.
The event's focus is on getting the best care for veterans from rural areas, where there are fewer mental-health services available and where family doctors may be less familiar with the symptoms of combat stress. Rural vets are well-represented among the National Guard troops and reservists serving in Iraq and Afghanistan.
But misunderstandings about the illness persist in rural and urban areas alike, say Boscarino and other experts who are slated to speak tomorrow.
Some still see the problem as the result of a weakness in character, or perhaps a lack of self-discipline, says keynote speaker Charles Figley, director of the Florida State University Traumatology Institute. It is neither.
"It's an injury," says Figley, himself a Vietnam vet. "Its effects can be permanent unless something is done pretty quickly."
Just what should be done is a matter of debate.
In a review of medical literature completed last year, an Institute of Medicine committee found no evidence that drugs have been effective against the disorder. Some forms of psychotherapy also remain unproven, the committee members found - though they emphasize that with more careful scrutiny, some of these current therapies may indeed turn out to be beneficial.
Boscarino, who grew up in working-class Paterson, N.J., and served with an Army artillery unit in Vietnam, is determined to find the biological underpinnings of the disease.
There is evidence that genetics play a role. Other research suggests that those with higher intelligence are less likely to succumb to PTSD. Still other scientists contend that some cases of the disorder are in fact a different condition defined by several of the same symptoms: mild traumatic brain injury.
Last year, Boscarino reported a curious finding: Vets are more likely to suffer from PTSD if they are ambidextrous. The results, from a study of 2,490 men who served in Vietnam, were published in the journal Psychosomatic Medicine.
But Boscarino's twin brother, John, is not ambidextrous, and he has the same genes. Why would one brother be severely affected by the war and the other not?
The epidemiologist declined to talk about his brother's case in detail, but said his twin was likely exposed to a higher level of stress, having seen heavy combat in the 1968 Tet offensive. After years of refusing treatment, he is now getting help at a VA facility, Boscarino said.
Whatever the cause, severe stress leads to hormonal changes and inflammation, which in turn can have lasting consequences.
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When they came home, they seemed to find plenty of reasons to "just get on with their lives" as their lives fell apart. They got jobs and lost them. They got married and divorced, tried again, and yet again. The Vietnam vets with PTSD lived all these years with the nightmares haunting them and flashbacks tracking them down to remind them they were there. While they left the Vietnam war, it never left them. Wars, since the beginning of time, never really ended for too many of the warriors.
Charles Figley of Florida State University Traumatology Institute said "Its effects can be permanent unless something is done pretty quickly." This is true but what he did not say was that like any wound, it gets worse left untreated. It digs deeper into the soul, cutting away at the emotions that produce feelings of joy, hope, love, passion and often compassion. Getting the good emotions frozen out, room is made for the bad feelings of mistrust, anger, fear and apathy.
PTSD is a wound that leads to an infection of sorts. When we get an infection, the body goes into overdrive to kill it off. For a while, it manages to do just that. But the body tires of fighting the invader off. Weakened by the battle raging within, PTSD claims more and more of humanism. With treatment, the infection of PTSD stops getting worse. The sooner the treatment begins, as with all infections, the less harm is done. The body is aided in recover. The depth of the scar left behind is predicted by the length of time between wound and treatment.
Yet in all of this, as time is vital, it is not hopeless. This I've seen in my own husband.
He came home in 1971 from Vietnam. He was not officially diagnosed until 1990 and not treated by the VA until 1993. All those years, PTSD ate away at him and he got worse. Once he received the help he needed, he stopped getting worse and recovered to the point where he can enjoy things and is living a life instead of dying a very slow death. The same man I watch die, now goes out to the deck of our pool and screams my name so that I can see a magnificent sunset in the endless Florida horizon.
While he is an example of hope for all, I often wonder if he had been treated even as late as 1984 when I married my best friend. The signs of PTSD were there, but he was working, he was still enjoying a lot of things when PTSD was mild. I am sure that had he received the help he needed back then, when the secondary stressor hit, he would have survived it better and stronger than he did. The secondary stressor hit him so hard, he went over the edge the very night it struck. I miscarried our twins and had to beg him to come back to the hospital. He was convinced that it was because of Vietnam and Agent Orange. He blamed himself.
Many veterans have mild PTSD or dormant PTSD sleeping just under the surface. Signs are mild, often occasionally awakening. For them there are nightmares and flashbacks but the rest of the signs can be hard to spot. They usually begin with backing off from the things they enjoyed doing before. They will be vigilant walking into rooms where other people are. They seek out the booth and place themselves so that they can see the doorway in restaurants. They may avoid going to movie theaters where they are in a room with strangers they cannot see. If they do go, they will be unable to relax and find reasons to get up during the movie.
For us, we loved to go over our friend's house to get together with a bunch of others he had known since before Vietnam. We'd play cards and other games, laughing and truly enjoying the company of our friends. When PTSD hit him with a vengeance, he no longer wanted to be with them and when he did go over their house, we didn't stay long. He laughed less, talked less and began to drink more. He would have one or two beers after work before, but then it was one or two six packs a night.
We went through all of this even though I knew what it was, what was happening to him and us, but I was unable to get him to go for help. This is one of the biggest reasons I push for them to get help as soon as they see any signs of PTSD. There is no time to waste. Suffering gets worse the longer they wait for help. If my husband had been helped, he would have still been working and our marriage would have not gone through the hell it did. We would have been enjoying all these years together instead of spending most of it suffering through it. The first two years of our marriage were good ones and the last six years have been better, but all the years in between were like living in a nightmare that seemed to have no possibility of ending.
The financial burden on us added to the stress between claims being denied and finally approved. His claim was finally approved in 1999. It took a couple of years before the medication and therapy began to create positive changes in him but they did happen. Even after all those years of a slide into hell. If you are looking for hope of a lifeline then think of him. If he can recover some of what he was, anyone can and remember as soon as you seek help, PTSD looses it's power to claim more of you.
Senior Chaplain Kathie Costos
International Fellowship of Chaplains
Namguardianangel@aol.com
www.Namguardianangel.org
www.Woundedtimes.blogspot.com
"The willingness with which our young people are likely to serve in any war, no matter how justified, shall be directly proportional to how they perceive veterans of early wars were treated and appreciated by our nation." - George Washington
