Returning Veterans

I began my training as a psychology trainee in Veterans Administration psychiatric wards, working with men returning from combat in Vietnam.  Posttraumatic Stress Disorder did not yet exist as a psychiatric diagnosis, even though combat stress reactions had been observed and reported in medical literature for a long time. One of the primary responsibilities of our psychiatric team was to evaluate each veteran and assign a diagnosis, without which a veteran could not qualify for service-connected disability benefits. We struggled repeatedly with the diagnostic manual and with each other, trying to find what we saw in our patients in the official list of psychiatric disorders.

Meanwhile, out on the wards, the patients gathered over card games and coffee and talked about Vietnam. They talked incessantly to each other and to me of terrible things they had seen and done, and terrible things that had been done to them and to their friends. Some spoke with anguish, some with rage, many laughed, and some showed no feelings at all. The combat experiences they discussed were seldom if ever regarded by the psychiatric staff as the primary cause of the veterans’ problems. I wish I had known then what I know now about PTSD, but from the veterans I learned a lot.

Since then, combat-related traumatic stress has become a topic of enormous interest to mental health professionals and scientists. Within the past fifteen years we have gained a basic understanding of how trauma affects the brain, body, mind, interpersonal relationships and spiritual life of a veteran. We have developed an array of therapeutic strategies and demonstrated their effectiveness in treating the long-term effects of traumatic stress. Even a veteran who has lived with chronic PTSD for decades now has a chance of achieving significant recovery.

I am very excited by the rapid expansion of knowledge and clinical skills in the field of trauma treatment. Even so, what was true at the start of my training remains true today. My primary teachers have been the veterans who sought my help.

Most current treatments target the PTSD symptoms associated with fear, anger and grief. Feelings of shame and guilt about one’s actions in a combat zone have received relatively little professional attention. I personally have accumulated a lot of professional experience treating veterans and law enforcement officers who struggle with these issues as a result of harming or killing human beings in the line of duty. I am one of a small number of psychotherapists outside the VA system who have specialized expertise in the treatment of issues associated with the experience of taking another person’s life.

I also have worked since the beginning of my career with people who have been injured at work, and who have developed chronic health problems, physical disabilities and related emotional issues as a result. I have been invited on a number of occasions to train law enforcement personnel and disability agency personnel on the psychological aspects of physical injuries. In recent years I have begun working with people who have mild to moderate traumatic brain injuries.

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