PTSD still a remnant of war for many Vietnam veterans

From The New York Times:

SPRINGFIELD, Mass. -- On Aug. 26, 1966, Philip Van Cott’s Marine unit was ambushed in the jungles of Vietnam, a trip wire went off, a bomb exploded and shrapnel pierced a hole in his right hand. Mr. Van Cott (pictured), whose squad was in constant firefights during his five months in the jungle, was helicoptered to safety. He spent seven months in Japanese and American hospitals as the wound healed, completed his two-year tour in the States, then was honorably discharged.

In the years since, he has been married to the same woman, Karen, for nearly four decades, had two sons and a grandson, held several jobs, bought a home, owned a restaurant, spent 20 years with the post office and in 2006 at age 60, retired.

Nowadays, he paints in his studio several times a week, swims and lifts weights, attends 7:30 Mass on Sunday mornings, and travels with his wife. Every other Thursday, for the last 10 years, he has driven to the Veterans Administration Vet Center here where he gets therapy for post-traumatic stress disorder in connection with his Vietnam combat service.

He first went for help after threatening a supervisor at the post office, and nearly losing his job. “I had rages, and I was getting worse,” he said. “I was constantly embarrassing my family, screaming and hollering at people.”

He got into fistfights at Little League and high school football games. At night, asleep, he’d have nightmares, break into cold sweats, scream and flail at his wife. “It’s been going on so long, now she hears me wind up and wakes me before I do it,” he said.

When a V.A. psychiatrist diagnosed the disorder, Mr. Van Cott did not believe it — Vietnam was so long ago. They had him join a therapy group for Vietnam veterans. “I figured these guys were doing it to collect a disability check,” he said. “It took two to three years before I started realizing what I was doing was crazy.”

He now takes medications for anxiety and depression. And in therapy, he works on anger control. His wife thinks it’s helped, but he’s not sure. “I don’t know if you can escape what you are,” he said. In mid-August, he stormed out of a session at the Vet Center because he was sure his therapist was snubbing him. “He was late for our appointment, then walked by three times without saying anything,” Mr. Van Cott said.

While studies estimate as many as 20 percent of those now returning from Iraq and Afghanistan suffer from P.T.S.D., it is veterans like Mr. Van Cott, from a war nearly a half-century ago, who still dominate the administration’s P.T.S.D. caseload. In 2008, of the 442,695 people seen at veterans hospitals for P.T.S.D., 59.2 percent were Vietnam-era veterans, while 21.5 percent served in the Iraq, Afghanistan or Gulf wars.

The most authoritative study conducted on the disorder and Vietnam veterans, in 1988, the National Vietnam Veterans Readjustment Study, estimated that at the time, 500,000 of the 3.14 million Americans who served in Vietnam had P.T.S.D., and a total of 1 million had experienced it at some point.

Even as Vietnam veterans now enter their 60s and begin to die off, the number seeking P.T.S.D. treatment is growing — up 11.6 percent from 2003 to 2005, the latest figures available. “We have new Viet vets coming in every week,” said David Bressem, who runs the Vet Center clinic here and is Mr. Van Cott’s therapist.

On so many fronts, the country still pays for the Vietnam War. A veteran diagnosed with P.T.S.D. may receive over $3,000 a month if judged 100 percent disabled. That stipend comes out of the veterans compensation and pension system, which this year is expected to pay $44.7 billion for a variety of benefits, with the biggest share going to veterans of Vietnam and the current conflicts.

In Mr. Van Cott’s case, his therapist believes his problem predated the war (Mr. Van Cott was a tough kid who grew up on the streets of Brooklyn and liked to fight) and then was severely exacerbated by war.

Mr. Bressem said a large number of the Vietnam veterans he sees were slow to get help. P.T.S.D. wasn’t accepted as a formal diagnosis by the American Psychiatric Association until 1980 — years after many of the soldiers returned — and it took many more years for the V.A. to build the extensive mental health outreach system that exists today.

Karen Van Cott said that for first 20 years of their marriage, her husband never spoke of Vietnam. Only in the late 1990s, when he began going to reunions of Mike Company 3rd Battalion 7th Marines and she overheard the conversations, did she begin to understand his rages.

Said Mr. Van Cott, “I thought you go to Vietnam and kill a few people and forget about it. I thought guys who complained were full of it.”

Mr. Bressem said the aging Vietnam veterans who walk into his clinic are often in crisis — a third divorce, a lost job, an arrest — and have built up a lifetime of bad habits.

“That’s me,” said Mr. Van Cott. “I’ve been like this so long, I don’t know any other way.”

Mr. Bressem said they’re trying to reach the Afghan and Iraq veterans right away to prevent bad habits from developing. Asked how a veteran could still experience P.T.S.D. 40 years later, the therapist — himself an Army helicopter pilot shot down and severely wounded in Vietnam — turned to Mr. Van Cott and said, “How many firefights were you in?”

“Three or four a week.”

“And how long before you were wounded?”

“Five months.”

“Do the math,” Mr. Bressem said. “That’s 70 times in five months someone was trying to kill Phil here. Pretty intense experience.”

Mr. Van Cott said that during his tour, he knew about a dozen men who were killed. His Marine unit was the subject of one of the great Vietnam documentaries, “A Face of War,” by Eugene Jones, who followed the soldiers for three months of combat. Of the 18 Marines the film focused on, 12 were wounded (Mr. Van Cott is seen being hit and going down in the film); one was killed; and only five got out of Vietnam without a physical wound. There are also scenes of Vietnamese villages being burned to the ground by Mr. Van Cott’s unit for cooperating with the enemy and Vietnamese peasants dying.

When people ask how World War II veterans adjusted to civilian life in an era without a P.T.S.D. diagnosis, Ms. Van Cott mentions her father. He fought in North Africa, was honorably discharged, worked two to three jobs at a time to support his family and in his late 40s had what was then called a nervous breakdown — probably severe depression. He spent several weeks at a V.A. psychiatric hospital. “They sent you away back then,” she said. “They called it shell shock.”

At his most recent therapy appointment with Mr. Bressem, Mr. Van Cott started by discussing why he’d stomped out of their previous session angry. “Three times you walked right past me and ignored me,” Mr. Van Cott said.

“I passed you on my right side,” said Mr. Bressem. “Notice anything about my right eye?” Mr. Bressem is blind in the right eye, from his war wounds.

“I was talking to you,” Mr. Van Cott said.

“These don’t always work,” Mr. Bressem said, fingering his two hearing aids — also vestiges of the war.

“Geez,” Mr. Van Cott said. “You sound like my wife — you’re saying it’s not all about me. I spend my life apologizing to people.”

The session lasted an hour. Sometimes Mr. Van Cott talks about Vietnam; this time he didn’t. As he drove home on Interstate 91, some young punk tailgated him, then raced past. Mr. Van Cott started to raise his voice, his eyes flared, but then he let it go.