ASSOCIATED / RELATED SYMPTOMS

Guilt

Many veterans are consumed by overwhelming feelings of guilt; feelings which take several forms:

• Guilt for acts which they have committed, albeit necessary acts.
• Guilt for things he did not do, which his conscience would not allow him to do.
• Guilt more appropriately referred to as Survivor Guilt, perhaps the most devastating of all. Survivor guilt has created an intense conflict within the veteran. "Why am I here? Why did I survive when others did not?", are frequently asked questions. Such questions and doubts invariably led him down a path of self destruction and/or violence, and inevitably fashioned for him a painful and guilt-ridden existence.

Sleep Disorders

Inability to sleep, or brief intermittent periods of sleep is a common secondary symptom of PTSD. Intrusive nightmares may interrupt and bring an abrupt halt to a brief but sound sleep.

The sleep disorders are also not surprising when one considers how necessary it was for the GI in combat to remain alert and vig-ilant, catching a few hours of sleep while someone else stood guard. He now feels the need to be always on guard for the unexpected. He learned his survival techniques well; so well that they continue to disrupt his daily living and sleeping patterns.

Hypervigilance

Ever on the alert, ever surveying his surroundings, the veteran never lets down his guard, a skill so necessary in combat. One veteran described an incident in which a buddy was killed because he felt he let down his guard. He has vowed never to allow that to happen again and remains constantly vigilant and on guard. (CBS Reports, The Wall Within, 1988)

When venturing into public places such as restaurants, a quick surveillance is always necessary to insure a seat with his back against the wall, giving him the ability to "check out" everyone in the establishment. His hypervigilance is a pervasive and constant companion.

Exaggerated Startle Response

A sudden clap of thunder, a backfiring car, or any sudden noise may send the veteran scrambling for cover. His startle response is the result of memories relating to the persistent and often unexpected sounds of mortar, artillery, or small arms fire. The responses may be frightening and embarrassing and are yet another reason for isolation.

Flashbacks/Intrusive Thoughts

A traumatic event associated with Vietnam may be reexperienced; such experiences are commonly referred to as flashbacks and involve intrusive recollections of the event or recurrent disturbing dreams. There may also be occasions in which the veteran becomes disassociated from reality, an occurrence which may last anywhere from several seconds to several hours, or in extreme cases even days. The veteran firmly feels he is reliving the original trauma or experiencing the event. Many times these events are exacerbated by anniversary dates. (R. Lifton, 1973)

Such episodes may typically be triggered by the all too familiar sounds of a helicopter flying overhead, by familiar smells, or even a rainy day, a reminder of the prolonged monsoon rains in Vietnam. Some, unable to cope with the intrusive thoughts, leave their familiar surroundings and escape to a safer place, often the woods. There they can be alone, without the risk of hurting others.

For many veterans, flashbacks are a reminder that they were once in Vietnam, but a constant reminder none the less.

Alcohol/Substance Abuse

Perhaps the most difficult symptom to separate from PTSD is alcohol/substance abuse. In fact, for many, it is inseparable. "It isn't just substance abuse. it isn't just PTSD. It's both, insidiously wrapped up in one another," says Steve Bently, Chairman of the VVA PTSD and Substance Abuse Committee. "Alcohol and other drugs have successfully aided Vietnam veterans in covering their feelings for years. The biggest problem ... is that alcohol quits Working after a while".

"The 'Trauma tries to surface, though the individual suffering the trauma tries to keep it submerged," he continues.

In 1988, the Centers for Disease Control concluded that Vietnam veterans were far more likely to suffer from depression, anxiety, and alcoholism with nearly 500,000 having experienced severe PTSD symptoms. (Veteran, September 1988)

Drinking and drugging appear to compound the symptoms of PTSD, which compound the symptoms of addiction, resulting in increasingly painful readjustment problems and progressively worse addiction ... Unless both conditions are appropriately dealt with, there will be little lasting relief from either condition. (Brinson and Treanor, Veteran, September 1988)

A sad commentary is that those veterans seeking treatment for alcoholism and PTSD at Veterans Administration hospitals were given treatment for either one or the other. Perhaps sadder is the fact that treatment in the VA hospitals has consisted primarily of chemical restraints. More often than not those restraints were addictive drugs which intensified rather than alleviated the symptoms. As stated by Steve Bently, "Alcohol treatment that denies a veteran his or her experience of Vietnam is unpardonable." To deny his experiences is tantamount to denying his existence.

Substance abuse is also a major factor of homelessness among veterans. The numbers of homeless Vietnam veterans is estimated to be between 82,000 and 110,000. (Veteran, September 1988)