Two men wait in a foxhole during the Vietnam War. They pass a cigarette between grubby fingers. They talk of the ladies back home.

The men are great friends. Partners in war, John Weatherill, the Post Commander of VFW Post 2669 said.

But then a mortar shell lands in their foxhole. One of the men survives untouched and the other is killed.

“He has to live with that all of his life,” Weatherill, a veteran of the Vietnam War, says of the surviving man. “And he asks, ‘Why did he die and not me?’”

Stories like these come out at the VFW Hall in Port Orchard. The man whose friend died in the foxhole is one of 7.6 million living Vietnam Veterans and one of 22 million military veterans overall.

The veteran, a man who regularly attends the VFW says Weatherill, is also one of an unknown number of veterans who have suffered for decades with post traumatic stress disorder.  And though many older veterans are starting to seek counseling and open up about their experiences, Weatherhill says, a stigma of long ago laid in place still persists.

“Real men don’t discuss what is bothering them, that was the attitude,” Weatherill says. “That’s bogus, they do cry.”

Old Problem

Post-traumatic stress disorder (PTSD) is an anxiety disorder that can arise after any person has experienced a traumatic life event such as a rape, a car crash, childhood abandonment or the occurrences of war.

The causes and symptoms of the disorder are vast.

“Symptoms of PTSD can be terrifying,” reads the Department of Veterans Affairs’ website on the overview of the disorder. “They may disrupt your life and make it hard to continue with your daily activities. It may be hard just to get through the day.”

Basic symptoms often fall into three main categories. First, reliving, a symptom which includes flashbacks and nightmares. Second, detachment, which encompasses feeling detached and disinterested. Finally, arousal, causing sufferers difficulty concentrating and outbursts of anger.

Of course, the anxiety disorder has been around as long as traumatic experiences have occurred. But it wasn’t until the late 1970’s when scientists began studying the thousands of men who returned from the Vietnam War that the disorder first entered public consciousness. And now, with the VA reporting PTSD as the fourth most common service-related disability for service members receiving benefits, PTSD is a widely recognized disability. Active duty military members are screened and tested for PTSD when returning from Afghanistan or Iraq. The disorder is routinely talked about in the media and just as routinely used incorrectly when talking about veterans.

And while many veterans, both of Iraq and Afghanistan, but also the Vietnam War and  prior wars, are seeking help, Weatherill says, there are still millions of living veterans who came back in a different time. A time where PTSD wasn’t screened for and tested upon returning home.

“The government didn’t understand combat stress at the time,” he said. “They never even thought about it. In the three years I was in Vietnam and in the (National Gaurd) afterwards, it never came up.”

New Treatment

As recognition of PTSD and the number of veterans affected by the disorder gains media attention, the variety of treatment options increases. Jerry E. Butler, MEd, is a counselor at private practice in Bremerton who treats PTSD and other anxiety disorders. Butler previously worked at the Bremerton VA Clinic and at the Seattle VA from 1993 to 2009. When asked what  options are available for the treatment of PTSD, he can rattle off a bevy of options without much hesitation. Cognitive processing therapy, prolonged exposure therapy, medication, group therapy, family therapy, and others are all part of the mix.

“What treatment we use goes in to what rewards them personally,” he says. “We shape it to the individual.”

Butler mentions that relaxation methods, like yoga and meditation, have shown evidence of helping PTSD sufferers. He says a 10 week program at the Seattle VA focusing on meditation and mindfulness has shown a lot of recent success. Participants practice meditation techniques, as well as study meditation literature.

“It has had really good results, both here and nation-wide,” Butler said.

Ron Pero, a Tacoma based certified instructor of Transcendental Meditation, works with active duty military through the Warrior Transition Battalion, a group providing medical care, advocacy and leadership to soldiers who are wounded or otherwise injured, at Joint Base Lewis McChord. Pero teaches the meditation technique that is meant to directly dissolve accumulated stress with deep, coherent rest to veterans suffering from PTSD. While hesitant to say too much without the army’s prior approval to speak with a reporter, he did say many of the activite military he treats are seeing the enormous, positive affects of meditation. He imagines that the meditation would help older veterans as well.

“Among the soldiers I’ve taught, some have had immediate, amazing benefits,” he said.

Another therapy gaining recognition among counselors treating PTSD over the last decade or so is called Eye Movement Desensitization and Reprocessing. A form of therapy created to treat distressing life experiences, EMDR is an eight-phase treatment process that begins by targeting the disturbing event. The trained EMDR therapist then asks a patient to focus on an image and, while remembering the negative event, the patient follows that image as therapist moves it side to side. After this process, the client is asked to report on what the movements and the negative event caused the patient to think of. Eye-movements are repeated, along with different, involved phases of the therapy.

Eve King-Hill, a counselor in Bremerton, said she has learned about EMDR from Sandra Paulsen, PhD, who is an EMDR facilitator at the Bainbridge Institue for Integrative Psychology on Bainbridge Island. King-Hill said EMDR, or reprocessing therapy, is accepted for treating old trauma and new trauma. She said the treatment is so effective, she is told to instructs veterans that EMDR can so rapidly cure PTSD, that they may no longer be eligible for disability for the disorder from the VA.

“EMDR is the best treatment for post trauma problems,” she said. “After successful EMDR series session, the symptoms are gone.”

King-Hill says as new forms of therapy are accepted by veterans and others suffering from PTSD, the old norms, such as exposure therapy that attempts to reassert the patient with the event that spurred the PTSD, such as a car for a car crash, are disappearing.

“There is a lot of data out there that show that exposure therapy isn’t there,” she said. “It helps the same percentage of people that get better on their own.”

GETTING PATIENTS IN

But while new forms of treatments are having an affect, to what degree they are helping the majority of sufferers is still unkown. Dr. Jessy A Ang, MD, is a psychiatrist working at a private practice in Tacoma. He does not offer his patients classes in transcendental meditation, and he says while many people believe EMDR works, the long term outcomes of the treatment are undetermined.

Ang says it is hard to imagine what older veterans suffering with PTSD are going through. Vietnam Veterans, who  helped open the doors for studying the disorder, had to deal with the stresses of coming back into a society that didn’t accept them above and beyond what they saw at war, Ang says.

“Vietnam veterans were rejected from our society when they returned,” says Ang. “For many years they couldn’t even acknowledge they were veterans, much less talk about the things they saw.”

Increased media attention and acknowledgment of PTSD has helped many long-retired veterans seek out help, Ang says. Treatment can differ for older generation veterans, only because they come to treatment with a different set of experiences, a different set of years, than younger veterans. Ang says treatment is typically a combination of the correct medicine and a counseling options that melds with the veteran’s personality.

As far as success in treating older veterans, Ang says a good family support system is key.

Scott Swaim is a counselor contracted with Veteran Affairs to help treat Veterans with PTSD. He is also an Air Force Veteran. His military experience helps build a bond and a trust in counseling, he says. He agrees with Ang that treating older veterans is different than treating theyounger generation simply because of the years gone by.

“If you’re a Vietnam era veteran you have different experiences,” he says. “Some of our veterans come in and haven’t talked about their trauma for forty years.”

Swaim says older veterans have started to come in for different reasons. First, recognition of PTSD in society helps brings people in. Also, he says as veterans’ lives slows down and veterans age, they have more time to think about things.

VFW member Jake Jacobson was in the Marine Corps for Vietnam. While he saw some things, he says, he has never suffered from PTSD.

“All I do is get out of bed in the morning and make sure my feet are on the ground and I’m OK,” he says.

Jacobson is split on the idea of the disorder. Jacobson speaks of friends from Vietnam who came back “pretty shell-shocked.” But while there are definitely people with problems, he wonders if individuals are taking advantage of the increased awareness.

“You’ve got more people like Dr. Phil saying ‘You’ve got problems,’ so they think they have it,” he says.

Swaim said getting veterans of any age to become aware there might be an issue is the hardest part of treating PTSD. He says then and still, the prevailing attitutde in the military is like Weatherill spoke of: Real Men Don’t Cry.

“The buck-up mentality is still in the military,” Swaim says. “It hasn’t gone away. It’s still a stigma in mental health.”

Changing the name of PTSD, perhaps getting rid of the word ‘Disorder’, could go a long way in changing both old and new attitutdes about seeking help.

“Words matter,” he says. “If they didn’t matter, we wouldn’t be talking.

Getting someone in the door, Swaim says, is the highest priority when treating someone with PTSD. Past that point, whatever treatment works for them is what should be given.

As attitudes slowly change, and older veterans begin to think about incidents that seem long past, it’s imporant to keep an open ear and an open mind, says Weatherill. Whether it’s a friend in a foxhole, a IED in a truck in front, or a wounded civilian crying out, war can affect. War is hard and brutal. And should be talked about.

“Every individual is different,” Weatherill says. “Whether it will affect me, it might not affect my brother. You’ve got 50,000 men lined up, you will get a different reaction out of every one.”