I was talking recently with some V.A. colleagues, who were telling me how the new vets coming back from Iraq and Afghanistan are very different from the Vietnam vets they saw decades ago.
Of course, it's a different situation in many ways. With Vietnam, the country was totally divided about the war, and we took our anger out on each other, and on the troops we sent out to fight. They in turn were furious about being told to kill people and then getting castigated for it when they got home. We traumatized them all over again.
This new group of soldiers are generally appreciated and acknowledged for putting themselves at risk -- even by people who aren't particularly happy about the wars they're fighting. That's one lesson learned, anyway: not to take the politics of war out on the troops.
Of course, most of our Vietnam troops were draftees. Nowadays we have an all-volunteer army. They can at least feel it was their decision to be there, and that sense of self-efficacy might add to some emotional resilience. (But then again, a lot of the reservists and National Guardsmen thought they were signing up to get some extra money and help out with a few national emergencies. Little did they know they'd be sent away from their families and careers for months on end, perhaps on their fourth or fifth rotation, fighting real people on foreign soil. So this is a complicated point and not as straightforward as it looks.)
Also, back in the 60's, we didn't know a whole lot about PTSD and our troops didn't know what was happening to them. Based on what we understood from World War II, we tried to prevent them getting PTSD by limiting their time of service to a year (for Marines, it was 15 months). And, sure enough, they came back with a smaller incidence of posttraumatic stress. But two to three years later, lo and behold, they developed delayed onset PTSD and the percentages were right back to being the same as WWII -- somewhere between 22-35 percent.
Sidebar: In any combat situation, the estimates are that 95 percent of exposed people have symptoms immediately afterward. Gradually these subside over the next 90 days for most people, with or without treatment. But after about six months, there's a core number - between 22 - 35 percent -- that don't get better on their own and need help. It will be interesting to see, now that one in nine soldiers exposed to combat are women, whether these stats stay the same. There is considerable cross-cultural evidence from natural disasters around the globe to suggest that women and children are more vulnerable to PTSD than adult men, given exposure to the same traumatic event. Sorry girlfriends, I don't like it any better than you do.)
This new group of active military in Iraq and Afghanistan knows what's happening to them, to a much greater extent. There's been a push to educate our troops and the general public about posttraumatic stress as well as TBI's (traumatic brain injury), thanks to a renewed commitment to the mental health of our troops, found in both the Department of Defense and the V.A. Secretaries Gates and Shinseki have been working hard at destigmatizing mental health problems, in ways never seen before. So that's another lesson learned from Vietnam, and no small matter. Still, career soldiers still worry a lot about stigma.
There's also, frankly, a different kind of drug abuse going on downrange nowadays. Our current troops are being given legal drugs by docs who are placed in the combat theatre with them. The drugs keep them de-stressed enough to keep functioning. They come back home accustomed to anti-anxiety pills, and to a lesser extent, to anti-depressants and pain pills. So many are dependent on them and want to continue with them after their service. This is different from the Vietnam vets who abused multiple illegal drugs and got in trouble with the law for it.
And finally, with many of the Vietnam vets, by the time they came into the V.A. seeking treatment, they were in their 30's and more amenable to counseling than these younger soldiers in their 20's. They'd started thinking about their lives in a more reflective way, especially when they started having combat stress-related problems with their relationships and their jobs.
For the younger troops coming back from Iraq and Afghanistan, there's impatience with the talking cure. They want to get on with their lives and don't want to talk, and reflect and ponder. They're saying, "Don't make me a career patient. I need to get to work. I need to help take care of my kids. I cannot come in during your office hours of eight to four for a 12-week course of Cognitive Behavioral Therapy. Give me a pill or a relaxation audio to calm me down, and let me get back to my life."
Keep in mind that two separate surveys -- one at the Durham V.A. and one at the Phoenix V.A. -- established that these new vets prefer getting their help via audio self-help by 72-75 percent -- through their own iPods or MP3 players. (That's another difference: this is a population that's comfortable with downloads.) Medication scores next highest at around 55 percent. Last on the list? Yep, you guessed it: sitting with one of us therapists.
So now that we're learning about the new barriers to receiving help -- some quite positive, by the way (Indeed, what's wrong with not wanting to be a career patient, anyway?), I expect the V.A. will get more flexible in how it offers services. And there will hopefully be much more widespread use of self-administered guided imagery downloads -- shown at multiple research sites to reduce symptoms quickly and pretty dramatically while being a pleasant and self-reinforcing experience for the listener. Not to mention inexpensive and useable even in remote locations.
We are getting so much more interest and openness to guided imagery than even a year ago, from both the DoD and the VA. These are great trends, very hopeful. I do believe we're gonna seriously help a lot of vets.