A commentary by William C. Shelton

(The opinions and views expressed in the commentaries of The Somerville News belong solely to the authors of those commentaries and do not reflect the views or opinions of The Somerville News, its staff or publishers.)

The average Iraq War vet has had less ‚Äúdown time‚Äù from the threat of death than veterans of any previous U.S. war.  93% report being short at; 89%, being attacked or ambushed; 95%, seeing dead bodies.  These experiences produce hidden injuries that family, friends, and neighbors can help to heal.  Help may involve respectful listening, collaborative problem solving, and connection to needed services. 

An essential part of healing is discharging the horror at the center of the trauma.  Continually pushing these experiences away from conscious memory and from the attention of loved ones is exhausting and makes them unavailable to be worked through.  Yet, they are often extremely difficult to share with others.  Doing so requires re-experiencing ugly and paralyzing feelings.  Those who have experienced intense trauma also feel shame, guilt, and the irrational conviction that this happened because there is something deeply wrong with them.  Another common reaction is ‚Äúsurvivor‚Äôs guilt,‚Äù which is exactly what it sounds like.

When encouraging a friend, family member, or coworker to talk about his experiences, one must be extremely thoughtful.  It is critical to have such conversations in an environment in which he can feel as safe, comfortable, and trusting as possible, an environment that is in every way a contradiction to that of the trauma.  It is also important that she not feel forced to talk.  The vet may initially need to talk about such matters with her comrades or a counselor.

Friends and family‚Äôs normal impulse is to throw a welcome-home party, but the returning vet may most need rest and respite, so he should be asked if this is something that would be welcomed.  Being explicit with him in all matters is helpful, including stating what one wants from him.  The key is not to blame or demand. 

In her absence, arrangements and expectations within the vet‚Äôs family and workplace will have changed.  Explicitly discussing with her these changes and how she can reintegrate reduces stressors, while simultaneously building the trust and communications skills that can help her to discharge traumatic distress.

When the time is right to discuss traumatic experiences, expressions of pity, or even sympathy, will kill the conversation.  The most important attitudes to communicate are interest and basic respect for the vet and what he has experienced.  Strong reactions to the horrific things that he describes may unconsciously reinforce feelings that he is apart from, and less worthy than, ‚Äúnormal‚Äù human beings.  Listening without interruption or judgment is essential.

Certain behaviors are common among those who suffer acute stress reactions.  It‚Äôs important to recognize them as normal and not overreact or take them personally.  They include

§ Being edgy, easily startled, or constantly on guard;
§ Feeling sad, guilty, or abandoned;
§ Feeling withdrawn and detached while having difficulty trusting others and sharing control;
§ Having trouble concentrating or sleeping;
§ Experiencing bad dreams, flashbacks, shock, or numbness;
§ Feeling incapable of happiness;
§ Driving aggressively;
§ Avoiding anything that reminds one of the trauma; and
§ Using alcohol or substances to “self medicate” these conditions.

A majority of survivors recover in weeks or months.  But for 20% to 30%, these reactions will persist and may worsen, producing diagnoses of Post Traumatic Stress Disorder (PTSD).  We don‚Äôt yet know why some recover and others struggle, but we know that it‚Äôs not because of any weakness.  Nor does PTSD discriminate among cultures, races, ages, or sexes.

When these conditions persist and worsen, caring family and friends should encourage the vet to get expert help.  They must insist, if he poses a danger to himself or others.

Department of Defense and Veterans Administration policy makers seem to be discouraging PTSD diagnoses.  But my experience of front-line caregivers is that they are responsive and caring. 

Iraq and Afghanistan vets can get immediate help with combat stress at the Vet Center, 665 Beacon St., Boston, without any potentially damaging information reaching their service unit.  Calling 617 424-0665 beforehand will eliminate waiting.

Returning vets can also get help at the VA outpatient facility, 51 Causeway St., 617-248-1000. They will first be required to register as a VA patient.  Applications are available at www1.va.gov/health_benefits.  Vets with PTSD symptoms too severe to wait for the outpatient facility‚Äôs daily 1:00 PM intake sessions should go directly to the VA emergency room in Jamaica Plain.

The Trauma Center is a great organization where I was first diagnosed and treated for PTSD many years ago.  They may be reached at 617 232-1303 or traumacenter.org.

Finally, Somerville Veteran‚Äôs Services Director Frank Senesi, a former marine and a PTSD survivor, is warmly responsive to any vet.  Frank is both a great listener and provides effective referral to needed services. He may be reached at 625-6600 ext. 4700.