Vietnam veterans share struggles with late-onset PTSD
By JOANNE VIVIANO | The Columbus Dispatch | Published: October 12, 2017
COLUMBUS, Ohio (Tribune News Service) — Ray Szymanski has nightmares — some so violent that he once broke a support board beneath the king-sized mahogany bed in his Lancaster home.
They're flashbacks of the time he spent serving on U.S. Navy riverboats in the Mekong Delta during the Vietnam War.
"One of them is when I hardened: Forty-three men were killed on one boat," he said.
It was the young sailor's first week in Vietnam. The boat took five rocket hits.
"I jumped on the boat, and I was sloshing in blood," Szymanski recalled. "I remember throwing up to the point it hurt."
There are other flashbacks.
He starts to tell the stories, but tears wash away the words.
"You lose it," he said.
The 73-year-old suffers from late-onset post-traumatic stress disorder. It's a form of PTSD with symptoms that don't rear up in full force until years after the traumatizing events.
He's not alone.
About 8 percent of people who serve in the military go on to develop PTSD, said Heather Axtell, who oversees trauma recovery in the behavioral-health service at the Department of Veterans Affairs' Chalmers P. Wylie Ambulatory Care Center on the Northeast Side.
That means that about 700,000 veterans of the Vietnam War, which ended more than 40 years ago, have struggled with the disorder.
And that's just the ones who seek treatment. Often, that doesn't happen until veterans retire, losing the jobs and family responsibilities that have distracted them from the worst of the symptoms. Late-onset PTSD might be brought on by financial or job difficulties, the birth of a child or the loss of a loved one, or the need for medical care. The viewing of a realistic war film, the death of a war comrade or a visit to the Vietnam Veterans Memorial in Washington also can trigger the disorder in some veterans.
Inspired by PBS' 10-part documentary series "The Vietnam War," The Dispatch is exploring late-onset PTSD in partnership with WOSU-TV's "Columbus Neighborhoods." On Thursday night, the television program will feature the story of veteran Russ Clark of Clintonville, whose PTSD struck 25 years after he returned from Vietnam.
Veterans often experience symptoms when they enter a phase of life that gives them time to reflect, said Kenneth Yeager, clinical program director of the Stress, Trauma and Resilience program at Ohio State University Wexner Medical Center.
"As people age, they begin to think about their lives, where they've been, what they've done, who they've come in contact with," Yeager said. "Sometimes those memories can be stressful; sometimes they can be upsetting."
Veterans might have nightmares or intrusive thoughts triggered by odors, lights or sights. They might isolate themselves and be reluctant to leave the house to avoid crowds or noisy places. Many struggle with the pop of fireworks. Some might avoid seats at a restaurant that leave their backs turned to strangers. Others might avoid funerals or looking at photos or medals from their time in the military.
"There's a sadness for how things were, for many of them, prior to the military, prior to some of these trauma experiences," Axtell said. "They thought maybe things would be different for their lives."
Unlike other veterans, she said, those who fought in Vietnam usually have more long-standing problems that have led to more life disruptions. Some might feel ambivalent or hopeless about making changes.
Clark served in Da Nang from July 1969 to August 1970 as a Marine Corps officer. He lost five men.
He held his PTSD at bay for more than two decades.
"I had successfully buried all the symptoms and gotten on with my life, my education, my family, my career," the 71-year-old said. "And then some other stressful events took place in the mid-'90s.
"Vietnam caught up with me."
For Clark, memories include the hot, humid, alien environment; the insects; the combat. There was the loss of his men. There were the civilian casualties, including the time he saw an American truck run over a Vietnamese child. And there was the afternoon when he saw a helicopter fall out of the sky. Being the first on the scene, he and other Marine officers saw the shattered, scattered bodies.
He later suffered from insomnia, anger, depression, anxiety, alcohol abuse and hopelessness. Loud noises, the smell of burning diesel fuel, the whir of helicopters all brought back painful memories. Although he had had the symptoms for years, he had managed them somewhat.
But when he faced the devastating loss of a marriage and adverse changes in his career, his world came apart.
"The things I had depended upon, and the ways in which I had been able to suppress the old memories and the old symptoms, those were no longer effective," Clark said. "So I was left stranded in a lot of ways."
Szymanski's PTSD symptoms began surfacing three decades after he returned from Vietnam.
"I just clammed up. I didn't feel there was anybody to talk to," he said. "For 30 years, I bottled it up."
He spent money, buying expensive things that he didn't need, from cars to furniture. It was an addiction that didn't ease the pain, but only prolonged it.
"Finally, in '99, a few times I thought about ending it all," Szymanski said. "I would always write pros and cons, and the pros usually won, except for the last time — the cons won. I realized I needed help."
Talking with a doctor at a Veterans Affairs hospital in Southern California over three months helped. He opened up.
The older Szymanski got, the more that things surfaced. When he retired, the flashbacks started coming in with full force.
Szymanski has memories of the men who died in his arms, the three times when he should have lost his life, the rocket hits, and the goriness of the day when he and his fellow sailors were part of 28 firefights. He remembers ambushes as his crew beached, the things he had to do in self-defense.
And he's haunted by a nightmare in which he's being tortured by Viet Cong guerrillas bent on getting even.
Two or three years ago, he again asked for help, this time at the Northeast Side Veterans Affairs center. He began taking antidepressants, and he entered one-on-one counseling in which he role-played, wrote out and read aloud his experiences, and revealed things he'd never told anyone.
"You have to bring it up. You can't let it fester, because it'll destroy you," Szymanski said.
One form of treatment is cognitive processing therapy, which focuses on helping veterans change their thoughts, said Yeager and Axtell. Negative thoughts are challenged.
Another way to treat PTSD is with "prolonged exposure," Axtell said. She said veterans are given homework that helps them cope with things they've been avoiding. For example, they might be asked to go to a grocery store when it's likely to be bustling.
"We're not trying to take away the event. The event happened. It's always going to be there," Axtell. "What we're doing is we're helping the individual cope better."
Still, it remains a challenge to understand PTSD and come up with effective treatments, Yeager said.
"I don't think we understand the full impact of PTSD on the individuals who suffer from it only because, unlike other disabilities, this is not an overt, obvious disability," he said.
Clark reached his low point, becoming suicidal, some 20 years ago and knew that he needed a hand.
He's able to cope after undergoing counseling and psychiatric treatment at the VA center on the Northeast Side. He was prescribed a regimen of medications that helped him sleep and overcome depression and anxiety. He attended group therapy, where he was able to share his stories with other veterans who could identify.
His recovery also included a 12-step program, his faith and finding ways to help others.
"I found that the past didn't have to define my future. I found that the war described me, but it did not define me. I found all those things," said Clark, a minister for the United Methodist Church.
Every year, he meets up with men with whom he served. They still call him "Lt. Clark," and some are still dogged by PTSD.
"Some have done well in life," he said. "Others are still struggling with those symptoms and still captured by the spirit, the demonic spirit of Vietnam."
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