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Freedom veteran, who fought more than two years to access proper PTSD treatment after being denied by the VA. And the more psychologically damaged the soldiers, the higher the tab. Aside from the costs of care associated with adverse mental health outcomes, PTSD's effect on the central nervous system can compromise general health as well, increasing a patient's vulnerabili- ty to hypertension and atherosclerotic heart disease, thyroid dys- function, immunologic disorders and infection, and chronic pain. Besides medical problems, PTSD exacts social costs as well. While vets make up about 13 percent of American males, they constitute an estimated one-third of all homeless men in the U.S. This year, the VA will have resources to serve 100,000 of the anticipated half-million homeless vets. Nearly half of all male Vietnam War veterans diagnosed with PTSD have been arrested or served jail time at least once, while more than a third served time more than once, the adjustment survey showed. Of those, 11.5 percent have been convicted of a felony. For Ralph Stewart, the story told by these figures is a familiar one. Follow- ing his return from Vietnam, the Cali- fornia resident spent years in the penal system for drug use and petty violence. Eventually, after a diagnosis of PTSD, counseling, and group therapy, Stew- art's symptoms stabilized and he returned to college and a semblance of normal life. But, says the former GI, too many psychically injured soldiers have not. "A lot of friends who fought with me really sank after Vietnam," he said. "No one could explain what was happening to them. Nothing like that to make you feel alone." Even in cases where medical and social support is available, shame about their condition often hinders psychologically-hit veter- ans from getting help. Compounded with fear of how a PTSD diagno- sis would hurt military standing or future employment, many soldiers simply never seek treatment. According to a 2004 New Eng- land Journal of Medicine report, just 23 to 40 percent of U.S. vets at risk for PTSD sought professional help for their condition. "Many are mistrustful," said RN Laura Berg. "They're just not coming in. They feel, 'The government lied to me about what we were getting into, why would I go to the government for my health- care?'" Instead, the Albuquerque VA's PTSD team hears about trou- bled young vets from other sources, she says. "We have grandmothers and mothers calling from as far as 400 miles away saying, 'Please help my son. He's not the way he used to be.'" For the many GIs who don't have relatives calling, it may be left to RNs and other primary care workers to track them down, as evi- denced by the national VA website's current bulletin entitled "Help for Veterans with PTSD." Written by the National Center for PTSD, it lists signs and symptoms by which the disorder can be recognized, and resources for vets who may suffer from it. For vets, early recognition is important, both for most effective treatment and for their financial solvency. "Vets have only a year of free healthcare after returning here," Berg said. "If they return with PTSD and are connected with services during that year, it will be cov- ered thereafter. But if they don't come in during that first year and they start having symptoms later, they're charged a co-pay." Knowledgeable nurses can play a major role in recognition of the disorder. "We do a lot of referring. Knowing the diagnostic scales are important," Berg said, adding that it's very helpful for vets suffering from symptoms to hear a nurse say, "'It's not just you. You're not going crazy. It may be PTSD." In addition to just the experience of combat, Berg reports that many returning soldiers have suffered amputations—the literal loss of a part of themselves—that further contribute to disruption of self. "It's challenging, I know. But nurses should step forward and say what they're seeing," added Berg, who greatly admires many of her seasoned colleagues, like RN Charles Kaimain, who have been work- ing with PTSD patients for many years, and written articles about their work. Berg's own comments to the press have not come without cost to herself and her career. Early this year, she was investigated for "sedition" by the VA, after writing a letter to the editor of her local paper as a VA nurse, criticizing the Bush administration's handling of the Hur- ricane Katrina aftermath, and the Iraq War. Her computer was confiscated, and she was reported to the FBI. This summer she received an apol- ogy from a VA administrator, and, notably, the VA itself has of late come to some of the same conclusions as Berg, recently announcing that a staggering 35 percent of Iraq War veterans have already sought treatment for emotional problems. A national debate is brewing about just such announcements, with critics saying such figures are inflated. They assert that the sys- tem gives returning vets a major incentive to claim combat-related psychological injury by rewarding them with higher benefits, a con- troversy not unlike the welfare rights battles of the Reagan and Clin- ton eras. The clamor has led to a major ongoing VA review of PTSD diagnosis, treatment, and compensation. As a result, the benefits of aging vets from previous wars have been threatened and, in many cases, their pride offended. "I didn't ask for that check," one Vietnam veteran told a PBS New- sHour reporter. "If you want to jump in my head and live how I live, I'll give you the check, and I'll go back to the coal mines and make my $60,000 a year. If I could sleep. If I could get along with people and not get wild and crazy." As returning PTSD -affected soldiers and refugees face their ghosts, RNs across the country will be involved in their struggle to regain their lives. The upside, says Berg, is that this time around, there's more public information available and more understanding about PTSD than after the Vietnam War. As a result, more patients who need it are seeking help. "As nurses, we can help families," she said. "We can help them stay together, and keep people in the workforce. If we're able to, we're not going to lose quite the generation we did in Vietnam." ■ Caitlin Fischer is a San Francisco Bay Area writer, research historian, and instructional assistant at Berkeley City College. Diana Reiss is a physician assistant and an associate of the Center for Investigative Reporting, and has written for Salon, Hippocrates, and other publications. O C T O B E R 2 0 0 6 W W W . C A L N U R S E S . O R G R E G I S T E R E D N U R S E 21 "A lot of friends who fought with me really sank after Vietnam. No one could explain what was happening to them. Nothing like that to make you feel alone." —ralph stewart, veteran