National Nurses United

10/11/06 1:10 AM Page 16 Berg, an RN who until recently worked for the VA, reports that many of the New Mexico reservists she sees who are called up for duty are unprepared to process the horrors of war, particularly the gruesome deaths of civilians. "They see Army vehicles running over women and young children in the street," said Berg. "Some have been inside the vehicles themselves. It's against their ethics. They come back home, and can't relate to their wives and children. They're hollowed out. It's a 'soul sickness.' We have a generation of people that are being hit in a very tough way." In today's era of global conflict, the number of patients with warrelated trauma has soared. Their wounds are not just physical, but mental. According to a 2006 U.S. Defense Department study, one in six soldiers returning from the Iraq War currently suffer from severe depression or post-traumatic stress. Myers and scores more veterans have become the proverbial "canary in the mines," their post-war experiences a glimpse of what lies ahead for GIs diagnosed with PostTraumatic Stress Disorder or PTSD, fast becoming one of the bleakest—and least anticipated—health issues of the decade. Yet even as Berg and her colleagues treat an ever-growing number of traumatized veterans, the government is failing to factor in the costs of this mental healthcare into war budgets. With inadequate funding and facilities, the care of combat-affected GIs is increasingly relegated to primary and urgent care units, where staffs are often better trained to treat pneumonia, chronic diabetes, and skin lacerations than psychological breakdowns. In addition, a growing number of PTSD patients are women, who may present symptoms differently or require adjusted approaches to treatment. For the first time since the Vietnam War, outpatient RNs are having to quickly come up to speed on PTSD's signs and symptoms, and push to get survivors the psychological services they need. The question nurses are asking is, are we prepared? Where will vets get treatment? Who will treat mentallydamaged soldiers ineligible—or ashamed—to seek psychiatric help? As it stands now, the answers are grim. "As a nurse who has worked at the VA with returning vets, I'm certain the public has no idea of the additional economic and human costs of PTSD," said Berg. Combat-linked trauma has existed as long as humans have made war, according to Dr. Jonathan Shay, outpatient psychiatrist at Boston's Veterans' Affairs Hospital. Virtual textbook descriptions of PTSD can be found in literary works as early as Homer's Iliad, in which Odysseus, his psyche ravaged by war, is unable to return to normal family life for two decades. A thousand years would pass before the malady was codified in psychiatric lexicon. In the U.S., the problem was first identified among World War I, World War II, and Korean War vets. Families welcoming soldiers home encountered profoundly damaged men: chronically tense, clinically paranoid, and often unable to maintain jobs or carry on social relations—some prone to violence. The war heroes' condition, known as "shell shock," and "battle fatigue" elicited shame and social stigma. The Vietnam War, a longer conflict, left so many GIs psychologically maimed that PTSD symptoms could no longer be hidden. By 1974, the disorder was formally named. By 1980, it entered the Diagnostic and Statistical Manual of Mental Disorders as a variant anxiety disorder. According to the National Vietnam Veteran's Readjustment Sur16 REGISTERED NURSE vey (NVVRS) completed in 1988, 12 years after the war ended, 15.2 percent of all male and 8.1 percent of female veterans had been officially diagnosed with Post-Traumatic Stress Disorder. Translation: Nearly 500,000 male (of the 3,140,000 who served in Vietnam) and 610 female vets (of 7,200) suffered from PTSD. To be diagnosed with PTSD, patients must meet four criteria: a history of "reexperiencing" the trauma (with associated panic symptoms such as dyspnea and palpitations) along with chronic social avoidance and withdrawal, emotional numbness, and hyperarousal—amped-up startle reflexes or hypervigilance in anticipation of fight or flight. Today, with the huge number of GIs suffering from PTSD, its effects can be seen in American communities everywhere, from homeless veterans on urban streets, to those still hearing explosions in the nighttime silence of small towns. Privately, the PTSD-affected endure insomnia, horrific flashbacks, chronic fatigue, and often, post-traumatic depression. For those grappling with coincidental psychiatric illness, PTSD compounds the problem. West Virginia veteran Jim Kirchmar, 57, who battled PTSD's symptoms for 37 years since he left Southeast Asia, is well aware of the daily strain on his family. W W W. C A L N U R S E S . O R G OCTOBER 2006 AP PHOTO/LAWRENCE JOURNAL-WORLD PTSD

• Cover