Mending a Soldierâ€™s Heart Written, Designed, and Photographed By Nate Becker
DEDICATION The following book is dedicated to the millions of veterans who have risked, damaged, and lost their lives fighting for the United States.
ACKNOWLEDGEMENTS Thank you to Tessa Fisher for taking time out of your busy schedule to discuss Post-Traumatic Stress Disorder, to Ramon Ontiveros for sharing your trauma, and to Bob Kenyon for letting us into your home and your history.
TABLE OF CONTENTS Foreword.................................................................10 Chapter 1: A Soldierâ€™s Heart...................................13 Chapter 2: Trauma Triggers....................................15 Chapter 3: Caring, Not Curing................................16 Chapter 4: Complications and Complexities...........20 Chapter 5: The Need for Change............................23 Works Cited.............................................................29
FOREWORD I have always been interested in psychology, the study of the mind. I come from a long line of doctors, many of whom are either psychiatrists or psychologists. My dad is a psychiatrist and I have always taken an interest in his work. I also took a psychology class my sophomore year of high school, which I found quite intriguing. From this class, I learned a significant amount about this field of research and medicine. Posttraumatic stress disorder (PTSD) is something that I have been aware of for quite some time; however, until recently, I did not know much about it. Several months ago I read an article in the New York Times called “Back From War, Fear and Danger Fill Driver’s Seat.” This article focuses on a post-combat veteran named Susan Max who suffers from PTSD. Max, who used to love driving her maroon Mustang, now has trouble behind the wheel because of the trauma she endured in Iraq. She avoids small parking garages without convenient escape 10
routes as well as curbs, subconsciously worrying about roadside bombs, a very real threat she faced while overseas. I had always thought of the disorder as uncommon and something that was embellished in movies and stories. I had never considered the impact it may have on everyday tasks, such as driving. I decided to research PTSD, mainly interested in the daily lives of veterans afflicted with the disorder. I began my search for possible interviewees and was able to interview Tessa Fisher, a psychiatric social worker at the Veterans Affairs Hospital in Palo Alto, CA. She had much to say and many thought-provoking vignettes to share. Fisher discussed how PTSD is often under diagnosed because there is a stigma against having it and many veterans refuse treatment. Because of the isolating nature of PTSD, I found it extremely difficult to get veterans to come forward and talk about their disorder. I realized that changes needed to be made regarding the general stigma and treatment of PTSD. The first step in bringing change is spreading awareness
World War II belt buckle
and that is the goal of this book. This book contains images from my research, including photos of people I interviewed, places I visited while conducting these interviews, and memorabilia that are significant to the topic. The content of this book will give readers background regarding PTSD, such as history, causes, symptoms, and treatments. It will also explore different factors involved in determining the severity and curability of the disorder. Finally, it will discuss how the macho culture of the military makes it difficult for veterans with PTSD to accept their diagnosis and seek treatment.
“I never knew what PTSD was until April 20, 2009. When they discharged me from the service, they said, ‘Ramon, you’re just suffering depression, that’s all.’ I wanted to kill myself. That’s how bad it was.”
A Soldier’s Heart
“Patient says he was in Iraq 2004-2005. Patient says when he thinks about Iraq, he sees things in color like a movie. Patient says he feels apathetic and has ‘no interest in anything anymore.’ Patient says he does not like to see other people and does not trust them. He says he does not get along with bosses. Patient says he almost killed his nephew when he got out of the military, when his nephew sneaked up behind him. Patient says he does not sleep, usually 2 to 3 hours a night, and has nightmares. Patient says he avoids war movies, loud noises, and crowds of more than 3 people. He says he starts sweating and gets agitated. He says ‘my short term memory is shot.’ He says he forgets everything. Patient says when he wakes up at night, he checks doors, is hypervigilant” (Fisher). This excerpt was taken from a screening for Post-Traumatic Stress Disorder (PTSD) at the Veterans Affairs (VA) Hospital in Palo Alto, CA.
This patient exhibits many signs of PTSD, a relatively common anxiety disorder that can be caused by a traumatic, life-threatening event. Ramon Ontiveros served in the United States Navy and was stationed in Da Nang, Vietnam from 1967 to 1970. Ontiveros said, “I never knew what PTSD was until April 20, 2009. When they discharged me from the service, they said, ‘Ramon, you’re just suffering depression, that’s all.’ I wanted to kill myself. That’s how bad it was” (Ontiveros). His symptoms were initially misdiagnosed and he did not seek treatment until roughly forty years after he was released. The American Psychiatric Association (APA) did not recognize PTSD as a mental disorder until 1980, when PTSD was added to its Diagnostic and Statistical Manual of Mental Disorders (DSM) (Friedman). However, people have been aware of this disorder for centuries. Before the APA recognized PTSD as a valid disorder, leaders and doctors simply viewed its symptoms as cowardice or weakness. During the civil war, PTSD was referred to as “soldier’s heart,” during World War
I it was called “combat fatigue” or “shell shock,” during World War II it was known as “battle fatigue” or “gross stress reaction,” and as recently as the Vietnam War, PTSD was diagnosed as “post-Vietnam syndrome” (The History of Post-Traumatic Stress Disorder). The symptoms of PTSD can be divided into four main categories. The first entails reliving an event through flashbacks, which can often be triggered by sounds or sights. The second category involves the avoidance of anything that may trigger memories of the event. The third entails emotional numbness and difficulty expressing feelings, often to avoid memories of the event. The fourth category involves hyper arousal, always being on the prowl for potential danger (What is PTSD?). It is often difficult for veterans to adjust to civilian life after the war. Tessa Fisher, a psychiatric social worker at the First Step Substance Abuse Program at the Palo Alto VA, said, “It’s very hard to adjust to the monotony and boredom of ordinary life, as well as feel like you can never 13
be a part of humanity again based on what youâ€™ve seen and doneâ€? (Fisher). Having PTSD makes this adjustment even more complicated. It is an isolating disorder and can make relationships difficult. People with this disorder often get little sleep due to nightmares recalling the traumatic event. The work environment can be quite difficult for people suffering from PTSD because it contains many stimuli. Driving can also be particularly problematic be
cause there is a lot of trauma associated with driving during the war. While at war, much of the driving involves the transportation of explosives, constant vigilance about roadside bombs, and continual worry about the possibility of death. PTSD can make daily life quite difficult for those suffering from the disorder. There is currently research being done on potential treatment methods and medications that can help with the various symptoms.
There are many factors that can shape a single case of PTSD, but this disorder makes daily life a grueling task regardless of its symptoms and severity. Due to its isolating nature and the stigma surrounding it, PTSD tends to be under diagnosed and under treated. Changes need to be made regarding care and the general shame that is associated with it in the Army.
Ramon watches performances at the Menlo Park VA
Chapter 2: Trauma Triggers
Pistol from World War II
Ramon drinking a beer in Santa Claus costume
In order to properly investigate treatment methods for PTSD, it is important to understand its causes. This disorder is often associated with veterans and combat, but it can stem from causes that are not associated with war as well. Any situation that is potentially life threatening can trigger PTSD. Some of these events include: combat or military exposure, child sexual or physical abuse, terrorist attacks, sexual or physical assault, serious accidents, and natural disasters (What is PTSD?). Several known factors can determine the severity of each case of PTSD. Some of these variables include: the intensity and length of the trauma, loss of someone close, injury, proximity to the event, strength of reaction, control over the event, and help and support after the event (What is PTSD?). 15
Caring, Not Curing This disorder, like many mental disorders, tends to be under diagnosed and under treated. This is likely due to the isolating nature of PTSD and the fact that many people who have it do not want to admit that they have symptoms and do not seek treatment. Tessa Fisher described this common denial: “There’s a guy in the program now who’s in the Army and I think he did two or three tours and he hasn’t got any diagnosis even though he clearly is suffering from it. He came back I think in October of 2010, couldn’t find work, started drinking, and started drinking more to the point where he lost everything. He’s like a nice, regular, ordinary kid from an ordinary family but he was to the point of living in his car and he just said, ‘You know, especially in the Army, you’re the guys who go with the guns and kick down the 16
Ramon talks with friend at the Menlo Park VA
doors and shoot people. You can’t admit to having PTSD. You’re considered a complete failure’” (Fisher). Those with PTSD have trouble discussing their feelings and often repress the traumas of their past. Ramon Ontiveros said, “Never wanted to talk about it. First time I’ve talked about my Vietnam trauma was 3 years ago, April 29, 2009. Didn’t want to talk to anybody. I never talked to my mother, my father, my six, seven brothers, one sister, I never wanted to speak about it to nobody. That’s deep, deep, buried, didn’t want to talk about
it, didn’t want to think about it. It changed me that much” (Ontiveros). Although PTSD cannot be completely cured, treatment can help to diminish its symptoms. There are a number of effective treatments for this disorder. Cognitive behavioral therapy (CBT) has been found to be the most successful treatment. There are different treatment methods within CBT, such as cognitive therapy and exposure therapy. Cognitive therapy assists patients in overcoming problems by identifying and altering unproductive thinking, behavior, and emotional
“Never wanted to talk about it. First time I’ve talked about my Vietnam trauma was 3 years ago, April 29, 2009. Didn’t want to talk to anybody. I never talked to my mother, my father, my six, seven brothers, one sister, I never wanted to speak about it to nobody. That’s deep, deep, buried, didn’t want to talk about it, didn’t want to think about it. It changed me that much.”
responses. Exposure therapy is often used in dealing with anxiety disorders and exposes the patient to the feared object or context in a safe environment until they are acclimated to the stimuli (What is PTSD?). Medications have been proven to work in addition to CBT. Selective serotonin reuptake inhibitors (SSRIs), which are a class of anti-depressants, are often used in treating depression, anxiety disorders, and personality disor-
The entrance to the Palo Alto VA
ders. SSRIs have been found to effectively treat patients suffering from PTSD (What is PTSD?). There is currently research be ing done on further treatment methods that can be applied to patients suffering from PTSD, some more controversial than others. The United States Food and Drug Administration (FDA) authorized the first study regarding MDMA, commonly known as â€œEcstasy,â€? as a potential prescription treatment for PTSD
in November 2001. The feelings of openness associated with Ecstasy will help patients overcome their emotional instability and recover by diminishing fear, depression, and anxiety (Morgan). Obtaining conclusive results from such studies can be a lengthy process. This is because psychology research is only an approximate science and there are an infinite number of variables.
Chapter 4: Complications and Complexities
There are many variables from one case of PTSD to the next. Because this disorder is caused by something as general as a traumatic event, the possible origin of PTSD can differ greatly. There are also other factors that may alter the effects and likelihood of this disorder. These elements include personal characteristics, spirituality, and timing of treatment. Everyone copes with trauma differently, in part because personal characteristics vary from one individual to the next. Most studies concerning personality traits are carried out following the traumatic event. Therefore, it is not easy to make any definitive conclusions about the correlation between personal characteristics and the development of PTSD. 20
Photos of Ramon in costume
Photo of Ramon with three of his brothers
However, a study regarding the effect of pre-deployment personality traits on the development of PTSD was published in The American Journal of Psychiatry. Five hundred seventy-two male veterans completed a survey prior to the United Nations Protection Force mission in the former Yugoslavia from 1993 to 1995. The personality traits of negativism and psychopathology were found to have an impact on the symptom severity (Bramsen). Spirituality can take many
Plaque outside the Palo Alto VA
forms and has many definitions. For some, spirituality takes the form of religion or religious beliefs, but more generally it refers to deeply held feelings and beliefs that are considered sacred. Spirituality can affect how people view a traumatic experience and, therefore, how they cope with the trauma. Spiritual beliefs may govern the way in which survivors make meaning out of the traumatic experience. Research has indicated that negative interpretations of God can be connected with poor clini-
cal results (Spirituality and Trauma: Professionals Working Together). Symptoms of PTSD usually develop shortly after the traumatic experience, but they may not occur until months or years later. One might assume that the timing of treatment for PTSD would play a role in its severity or curability. However, a major study carried out by Israeli researchers indicates that beginning therapy shortly after the event versus waiting a few months produce similar results (Levin).
The Need for Change Recent findings from the National Comorbidity Survey show 5% of men and 10% of women in the United States have PTSD. These findings demonstrate the astonishing prevalence of this disorder. PTSD is much more common in post-conflict settings such as Algeria (37%), Cambodia (28%), Ethiopia (16%), and Gaza (18%) (Friedman). This data demonstrates the significant correlation between violence and the development of PTSD symptoms. PTSD, like many mental disorders, varies greatly from one patient to the next. “Trauma can come in many different forms for people and I think there’s the traumatic event and then there’s how someone handles the trauma. And one person may be subjected to a traumatic event and while they may be initially traumatized, they don’t go on to develop PTSD. But someone else, because of certain characteristics they may have, does develop
Photo of Ramon and some of his family members
PTSD as a result of that trauma” (Becker). Each survivor experiences distinct traumatic events of differing magnitudes. Everyone has different personal characteristics that may either help or hurt him or her in the face of trauma. Some are spiritual, and depending on the ways in which they interpret the trauma, it may be advantageous or disadvantageous. Survivors also undergo differing treatment methods and receive different kinds of support. All of these factors can affect theseverity and the curability of PTSD. The nature of the military
makes it difficult for veterans to come forward and seek treatment when suffering from PTSD. Soldiers are expected to be fearless and feel no pain. The emotional disconnect soldiers are often forced to undergo when in the war zone makes it all the more difficult to express their feelings and get treated. There have been instances of veterans with PTSD lashing out in recent news. These outbursts have negatively impacted our society and foreign relations. On March 14, 2012, Abel 23
Gutierrez, a twenty-seven-year-old Iraq War veteran suffering from PTSD, shot and killed his elevenyear-old sister in Gilroy, California. Gutierrez then took his own life. He is also suspected of shooting his mother whose body was discovered near a highway in San Benito County a week later (Newman). On March 10, 2012, Army Staff Sgt.
Robert Bales killed 16 Afghan civilians in their homes. Bales is likely suffering from PTSD and claims to have no recollection of the incident. He is currently being detained at the Midwest Joint Regional Correctional Facility at Fort Leavenworth, Kansas (Dao). Both of these incidents occurred within a week of each other. There is no telling how
many more episodes there will be in the near future if changes are not made. The government needs to test post-combat veterans more thoroughly and treat them more vigorously. The military must also inform enlisted soldiers of the symptoms of PTSD and urge soldiers to come forward and seek treatment.
Bob Kenyon shows off his helmet from World War II
“I have you to thank for the opportunity to talk to you and to listen to me. But remember the best gift you can give any veteran is empathy and support and to say you’re proud of what they did.”
Ramon Ontiveros looking at paintings at the Menlo Park VA
Ramon Ontiveros dressed as Santa Claus
Ramon Ontiveros posing with his brother
Ramon Ontiveros showing off his vest and patch
WORKS CITED Becker, Thomas. Personal interview. 27 Feb. 2012. Bramsen, Inge, Anja J.E. Dirkzwager, and Henk M. Van Der Ploeg. “Predeployment Personality Traits and Exposure to Trauma as Predictors of Posttraumatic Stress Symptoms: A Prospective Study of Former Peacekeepers.” Psychiatry Online. The American Journal of Psychiatry. Web. 18 Mar. 2012. Dao, James. “U.S. Identifies Army Sergeant in Killing of 16 in Afghanistan.” The New York Times. The New York Times Company, 16 Mar. 2012. Web. 19 Mar. 2012. Fisher, Tessa. Personal interview. 1 Mar. 2012. Friedman, Matthew J. “PTSD History and Overview.” U.S. Department of Veterans Affairs. U.S. Department of Veterans Affairs. Web. 18 Mar. 2012. Levin, Aaron. “Timing of Certain PTSD Treatments Doesn’t Appear to Be Crucial.” Psychiatry Online. American Psychiatric Association. Web. 18 Mar. 2012. Morgan, David. “Ecstasy Helps Treat PTSD Patients, Trial Finds.” CBS News. CBS Interactive Inc., 19 July 2010. Web. 18 Mar. 2012. Newman, Bruce. “Body of Martha Gutierrez Found Near Pacheco Pass Highway.” Mercury News. San Jose Mercury News, 22 Mar. 2012. Web. 29 Mar. 2012. Ontiveros, Ramon. Personal interview. 13 Mar. 2012. “Spirituality and Trauma: Professionals Working Together.” National Center for PTSD. U.S. Department of Veterans Affairs. Web. 18 Mar. 2012. Sulek, Julia Prodis, and Lisa Fernandez. “Gilroy Police: Iraq War Veteran Killed Sister, 11, Then Himself.” Mercury News. San Jose Mercury News, 16 Mar. 2012. Web. 19 Mar. 2012. “The History of Post-Traumatic Stress Disorder (PTSD).” Psychiatric Disorders. Psychiatric Disorders. Web. 18 Mar. 2012. “What Is PTSD?” National Center for PTSD. U.S. Department of Veterans Affairs. Web. 18 Mar. 2012. 29