POST-
TRAUMATIC
STRESS
DISORDER

Like an Irish band whistling through the air--Whe-e-e-o--o-o!--rockets are on you quick. If you are lucky, there is still time to jump for cover before they hit.

One of the most profound memories of the Vietnam War for combat veteran Edward (Robbie) Robinson was leaning over a 19-year old kid with a chest wound received in combat near the Demilitarized Zone (DMZ). "Don't let me die! I want my mom!" he cried. Robinson, of the 3rd Division, 9th Marines, knew there was nothing he could do. So he cradled him in his arms, gently murmuring, "it's okay, mommy's here." When he died, "the best part of me died with him," Robinson said. "To this day, I tell my wife, and she understands it, that I can never be close to her in an act of love the way I was holding that kid in my arms!"

It was war's tender moments that brought tears to Robinson's eyes. Recalling the brutalities--a buddy blown to pieces by a booby trap-"can stir up flashbacks so real that you can smell the gunpowder, the death, the decaying bodies, the jungle." For him, the war was not over. Post traumatic stress disorder (PTSD) helped it linger on.

According to Dr. Clifford Levin, a clinical psychologist at the Mental Research Institute (MRI) in Palo Algo, Calif., the trauma that produces PTSD, such as that experienced in combat, holds the memory in an excitatory fashion, and the natural mechanisms that occur during sleep to reduce that excitement don't work. Stimuli in the environment trigger the trauma, and with it comes old thoughts like, "maybe I'm to blame for my buddy getting shot," said Levin.

It was Robinson's 18th birthday on July 7, 1968, the day he boarded the USNS John J. Pope in Oceanside, Calif., to go to Vietnam. He had just finished advanced infantry training at Paris Island, trained on rifles--the M-14 and M-16.

Seventeen days later, he hit the beach at Da Nang and headed for Dong Ha in the Quang Tri Province just below the DMZ in what was known as leatherneck square. He was a "grunt" and soon got in the thick of the terror and bloodshed.

Being in a combat zone was "growing up real quick. But you don't grow up, believe me," said Robinson. "You're dealing with some very tender psyches, very fragile, vulnerable young men--18, 19, 20 years old. And you're exposing them to the kind of brutality that only exists in somebody's worst dream." Fresh out of high school, with values just being worked on, most who fought in the Vietnam War had never been away from home before.

The average age of those who went to Vietnam was 19.2 years. "It was the youngest U.S. war ever fought," said Dr. Francis Abueg, Research Clinical Psychologist at the National Center for Post-Traumatic Stress Disorder (PTSD) in Menlo Park. The average age for World War II was 26.

During World War II, men went and returned as a unit with time on the way home to readjust. In Vietnam, "you go over alone, you overload, and you come back alone," said Robinson. "One day you're shooting a machine gun, the next day you're back home." Vietnam produced more victims of PTSD, than any other U.S. war.

Without a moment's notice, Robinson digresses to January 1969. He's back in the war. "Artillery, you can hear it way up in the mountains. 'B-o-o-o-m! B-o-o-m! B-o-o-o-m!' Then you start looking because you've got maybe three or four seconds to run before it lands."

Next he's out on a reconnaissance mission, walking through the jungle in the steamy heat, "suddenly, the guy 50 or 60 yards ahead steps on a booby trap. You get his brains and his body matter sprayed onto your shirt. You spend a half hour making out a casualty report and trying to put what's left of his pieces of flesh into a sandwich bag."

"In 30 minutes the chopper is going to come. The troop is going to move out again. Maybe next time you will walk into an ambush," Robinson said. "You just never know. All these things are going through your head, but the consistent thought is, 'I've got to stay alive because I'm no good to myself dead and I'm certainly no use to my friends if I crack under pressure.'"

Full-blown PTSD effects 15 percent of the 3.1 million men and women who were involved in combat in Vietnam, according to a National Vietnam Veterans Readjustment Study (NVRS) done in 1990. One-hundred seven thousand of those live in the western U.S. These numbers include only those who are receiving treatment, said Abueg. Only a small portion who have it are getting help. Another fifty percent have partial PTSD.

PTSD's core symptoms--emotional numbing and reduced capability for intimacy, reliving the experience through flashbacks or dreams, difficulty sleeping and exaggerated startle responses--are the same across all traumas--combat, prisoner of war experiences, rape, abuse, natural disasters, incest, homelessness--any type of trauma. Symptoms haven't changed since the original descriptions of PTSD in Homer's time, said Dr. Charles Marmar of the University of California San Francisco (UCSF) PTSD Program. They have been exhibited with every war since.

The psyche is not set up for war, says Robinson. Response to combat has no consistency. Some cope better than others. A guy could be a hero one day and break the next.

During the Civil War, the most destructive war in American history, according to Richard Gabriel in his book No More Heroes, 6,000 soldiers were discharged from the Union army alone for a psychiatric condition known as "nostalgia". Other men exhibiting psychiatric ailments were escorted to the gate of a military camp and turned loose to wander the countryside to die. They were considered to be cowards or weak.

During World War I, the term used to describe psychiatric reactions to war was "shell shock." The military treated men with it as close to the front as possible then sent them back out to fight, says Gabriel. This procedure, called "forward treatment" was developed by the Russians in the 1905-6 Russo-Japanese War. Psychiatric casualties during World War I, were considered to be those with a weaker character.

To reduce psychiatric casualties in World War II, draftees were screened to weed out the "weak," said Gabriel. Still, psychiatric casualties, which totaled 37.5 percent of those in combat, were the single largest category of disability discharges.

In the Vietnam War, most psychiatric casualties on the field were due to "nostalgia". The rate of psychiatric discharges was 12.6 percent. The military practiced "forward treatment" on a large scale. Vietnam was a different kind of war, according to Rose Sandecki, Nurse Clinician at the Veterans Administration Hospital in San Francisco. Because of the camaraderie, or esprit de corps, in Vietnam, many of the men with physical or psychiatric injuries would get treated at a medical facility and then go back to the war. They felt they had to take care of their buddies.

Effectiveness in combat, according to Gabriel's book, has nothing to do with heroics. The reason soldiers are motivated is because they don't want to let the men in their unit down.

"Being exposed to the unconditional loyalty of the men you're fighting with," is what Robinson remembered most about the war. He says that when looking for friends even now, he looks "for that kind of loyalty. If somebody rolls a grenade into the room are they going to jump on it? Do they measure up?" He's often let down.

It was allegiance to his buddies that prompted Vietnam veteran Jack McCloskey to form Vietnam veteran support groups in the early 1970s to help men deal with the psychiatric repercussions of the Vietnam War.

McCloskey, an ex-Marine medic, was involved in Vietnam Veterans Against the War in the late 1960s when he began to see a pattern among many Vietnam vets. With so many of them using alcohol and drugs, abusing themselves and their spouses, he knew something was wrong. He began holding rap groups in 1971. The vets involved were called "Twice Born Men" after Philip Berrigan's description of those who came out of prison or war and began to work through their fears.

As those in McCloskey's groups started talking about what they were going through, they realized things that the things they had to do to survive in Vietnam were common to all. "A whole range of emotions were opened up to a generation of men, raised on John Wayne, who were told the only feelings they could have were angry or horny," McCloskey said.

The men, and the women--many who had served as combat nurses in Vietnam, who came to the groups, found they were not alone. Some of the women were exhibiting more extreme symptoms since they had no break in the war. PTSD, then called 'the Vietnam Syndrome,' began to make itself known. These groups, which McCloskey later integrated into "Swords to Plowshares" when he started it in 1974, became the model for the Veterans' Administration (VA) rap groups in "Operation Outreach" to treat veterans with PTSD.

"The large number of men and women in the groups are what gave PTSD credibility," said Sandecki. The numbers prompted studies by the medical profession, and in 1980, PTSD became a part of the psychiatric bible, the Manual of Mental Disorders (DSM-R-III).

McCloskey, later a mental health counselor at the Progress Foundation after working with Vietnam vets for 23 years, saw a distinct difference between those who had experienced "a one-shot trauma" such as an accident or rape and those who had been exposed to trauma over a period of time. What combat veterans go through is more akin to the "battered women's syndrome," he said.

"Brutality comes in different forms," said Robinson who worked as a clinical dependent counselor of broad-based c lientele. In the most extreme cases of spousal or child abuse he added, "I see the real ugliness I've been exposed to in combat."

More than 80 percent of those seen at La Casa de Las Madres, a San Francisco abused women's center, exhibit PTSD symptoms, according to the community education director Edie Resto. "What they've been through is a combat zone, only the war is at home."

PTSD symptoms show up in abused women who go to sleep and wake up in sweats," said Resto. Some can't concentrate, and they sleep too much. Some are antisocial, get into fights, forget appointments. When the stress is extreme and they can't cope or react, some women turn to drugs or alcohol to escape the stress.

Many Vietnam combat vets exhibit similar behavior patterns. Inability to become intimate is the most pronounced symptom McCloskey had seen in vets. "For a lot of these guys, Vietnam was the first time they were ever intimate with someone, and later those people were hurt or killed," he said. years later, they are having problems with relationships.

Two percent of the U.S. population, not including veterans of war, have PTSD, according to a Center for Disease Control study done in Atlanta, Ga.

Most people with PTSD have experienced loss, said Robinson's wife Elizabeth Robinson Anello, who worked as a practicing psychotherapist and Social Work Director at the Tom Waddell Clinic in San Francisco. It's related to the loss of life, a job, a home. For seven years Anello has worked with the city's homeless who "in the streets experience every day as a combat zone."

For the homeless as well as the veterans suffering from PTSD, angry verbal outbursts and physical aggression are not uncommon. Often, it's an endless cycle that some of the sufferers try to "end" with heavy drinking, drugs or suicide. One-third of Anello's caseload in San Francisco was exhibiting PTSD. Living in shelters, on the street, "homeless people develop a paranoia," Anello said. "Many are not sleeping well. They become very vigilant at night so they don't get hurt." Carrying belongings everywhere they go "represents their personal space in the world." Wearing lots of layers is practical, but it's also protective--"The more I can layer myself, the more I'm protected against the outside world", underlies how they feel, Anello said. "It reminds me of the Vietnam combat vets who 20 years later still walk around wearing uniforms and military paraphanelia, hiding behind dark glasses and gear."

"War is hell," said Robinson. "No one comes out of it 100 percent." Some wounds are worse than others, but the psychological wounds go deep, they're harder to get over than the physical. Still, Robinson volunteered to go back to Vietnam after he was discharged and returned to the States in 1969.

"It's like a woman who's been abused by her husband," said Robinson. She goes back to him again because she loves him. " My buddies couldn't make it without me. I had to go back to help them out," he said. When he broke his femur in five places in an automobile accident caused by drinking just just before he was scheduled to return to Vietnam, he was laid up for nine months. He never returned to Vietnam.

Cocaine, metamphetamines, valium, morphine and alcohol kept him from facing his PTSD symptoms for 15 years. It was his way of coping with his horrible dreams. "When you stay loaded, it's difficult for those things to break through," he explained. As his PTSD became more acute, "being medicated just wasn't enough."

According to the NVRS study, 25 percent of those who have PTSD from the Vietnam War suffer from alcohol dependence. Seven to eight percent are into drug abuse.

Robinson didn't talk about Vietnam for 15 years. When he first came home from Vietnam, he turned to alcohol and drugs instead. His startle responses were chronic. There were many sleepless nights. He never got rated for PTSD. The VA wouldn't rate him because of his drug abuse, "despite the fact that it started in Vietnam when the military gave me a quarter grain of morphine every four hours when I was hospitalized."

A song, a word, "old Rascal's music from the 60's" can bring flashbacks for Robinson. "Even now, when I go on a picnic down in the woods, I'm looking because when you're in the jungle, you never fixate on an object because it will move on you." He feels particularly violated as a Vietnam veteran. "I can never trust Washington, D.C. again," he said.

When Vietnam veterans returned to the States from Vietnam, the older generation told them they had lost the war. Their peers called them baby killers. Robinson was spit on when he stepped off the plane in San Francisco. The woman sitting next to him on the plane home to Philadelphia, wouldn't talk to him after she found out he had been in Vietnam. His family knew he was coming, but when he got home the lights were out.

For McCloskey, "it was easier for me to love Vietnam vets than for me to love my wife." After 23 years of working with veterans, he finally went into therapy himself. "My PTSD symptom was still being a medic. My therapist told me I was still trying to save the guys in Vietnam."

PTSD doesn't go away, said McCloskey. He realizes that "it's going to be with us the rest of our lives." Whenever McCloskey got depressed, he had a recurring nightmare where he reached into his medical bag to get a bandage. "When I open it up, it turns into a body bag."

Robinson got most of his early help through Operation Outreach groups and therapy. He has gone to 12-step groups to deal with drug and alcohol abuse. Being involved in the theater arts also helped him deal with PTSD. Group therapy has been widely used as PTSD treatment. Abused women helping women, veterans helping vets, develops community and support for those with PTSD.

The VA uses groups as an essential part of treatment for combat-related PTSD, said Dr. Howard Lipke, Chief Psychologist at the North Chicago VA Medical Center. They also use conventional psychotherapy for some patients.

The use of Eye Movement and Desensitization and Reprocessing (EMDR), developed in 1987 at the MRI in Palo Alto, has rapidly increased in the VA, said Lipke. "We're using EMDR with at least 100 PTSD patients at the North Chicago VA Center. And it's quite effective," he added.

With EMDR, a therapist has a person hold a traumatic thought in mind--what they saw, heard, smelled, any physical sensations or emotions. By focusing on the thought, "they light up that part of the brain that holds old memory," Levin said. A therapist then has them add eye movements and track out fingers in front of the eyes so they have saccadic eye movements (rapid jumps from one fixed point to another, as in reading). "Some of those walls that have walled off old memory come down and the brain starts to process memory again in a natural, healing way."

McCloskey said that Vietnam veterans have as great a potential for violence as anyone in this country, but he added that they also have the most potential for bringing about positive social change. If they work through their feelings, they are often more nurturing than men who have never been through the trauma of war. It's related to the tenderness they found they could feel for those dying in Vietnam.

"If I was lifting a body, it was always done in the most gentle fashion because this bag represents somebody's son," said Robinson. "If there were some way we could transfer that deep nurturing you feel for your buddies dying on the field of battle and point them to those on the street, what a better world it would be."

"I buried those feelings for so long, those female instincts," he recalled. The tears came long and hard. Then he added, amid the tears, "I can now turn to a woman and say, 'I know what it's like to be somebody's mom!'"

"Burning of the Marriage Hat is a powerful book that uses the medium of fiction to explore serious social issues." --Cynthia Parkhill, Lake County Record-Bee
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