Cases Tied to End-of-Life Changes : Stress Problems Show Up Among Veterans of WWII

Ex-Marine Philip Covert, a former prisoner of war, had classic symptoms of post-combat stress. He had always wrestled with restlessness and insomnia, but his problems intensified about three years ago when a stroke forced him to quit work.

Hanging around the house with nothing to do, he became depressed. Whenever he saw his wife and daughter in conversation, he imagined that they were saying bad things about him behind his back. He grew morose and angry, unable to sleep.

But Covert, unlike thousands of veterans presently experiencing the serious disorder of post-traumatic stress syndrome, did not fight in the Vietnam War. He is 64 and a veteran of World War II, who was captured by the Japanese when they invaded Wake Island in 1941.

However, his most serious symptoms did not emerge until almost 40 years after he returned home.

What’s more, Covert does not appear to be an isolated case. As celebrants mark the 40th anniversary of the Japanese surrender ending World War II, mental health professionals both inside and outside the Veterans Administration are reporting a whole new pattern of post-traumatic stress cases.

For many aging WWII veterans, the stress of major end-of-life changes--such as retirement, in Covert’s case, or the loss of a loved one, or the onset of a major illness--has brought on or aggravated the disorder by leaving them vulnerable and less equipped to cope with the memories of their war experiences.

“I think it is a more pervasive disorder than we recognize,” said Dr. Harold Dickman, assistant professor of psychology at Oregon State University, who has treated WWII veterans. “I think it has always been there, but we just haven’t recognized it.

“Unlike Vietnam veterans, WWII veterans have been able to suppress it--many of these guys became workaholics or alcoholics, or both. Then they retire, or lose a spouse, or their health begins to fail. It gets worse as you get older--and then it becomes almost unmanageable.”

Delayed stress--although widely associated today with Vietnam veterans--followed both world wars, although it was less defined and more contained. It was not called post-traumatic stress disorder then, nor did doctors know how to treat it. After WWI, troubled veterans were said to have “shell shock.” After WWII, it was “combat fatigue” or “war neurosis.”

These after-effects of combat were thought to be transient--insidious, but not permanent. Indeed, most soldiers returned home to a hero’s welcome, went to work, reared families and got on with their lives.

Or so it seemed.

Many Find Ways to Cope

Dr. John Lipkin, the VA’s associate director for mental health service, said that veterans often find everyday ways to cope with the psychological trauma stemming from their war experiences.

“But, with changes in circumstances, with losses that can include family, friends and ambitions, people’s expectations for themselves and for their future change,” he said. “For some, these changes are gradual and not too much trouble. But, for others, those were the things that enabled them to get up every morning. When those things become weaker as coping mechanisms, sometimes something happens.”

Because there have been no formal studies of post-traumatic stress disorder among WWII veterans, no one knows exactly how many veterans had it, or have it now. Many afflicted veterans have probably been diagnosed as having other conditions--alcoholism, for example.

“It’s often written off as something else,” said Dr. Arthur Arnold, chief of psychiatry at the Phoenix VA hospital. “They tend not to mention their war experiences. Unless you’re alert to it and ask questions, you’re not going to find out. They tend not to understand what’s going on.”

Learning to Spot Disorder

A small group of mental health professionals has learned to recognize the disorder by treating individual veterans or encountering it when conducting related research. Covert, for example, did not realize his depression was war-connected until he began participating in a POW study at the Charleston VA Medical Center, where the relationship between his 45 months in captivity and his current behavior first became clear.

“All we have is anecdotal studies of people who seek treatment,” said John Russell Smith, director of the VA’s Center for Stress Recovery in Cleveland. “If we extrapolate from the Vietnam population, only 5% will have a stress disorder. But, when you’re talking about 5 or 6 million people, that still leaves you with about 300,000. So, even with a conservative guess, you’re talking about a significant number of people who need to be treated.”

Certainly, the anecdotal material offered by mental health experts is chilling:

--A 65-year-old veteran who drove a tank in the Philippines underwent coronary bypass heart surgery five years ago. The day after the operation, he awakened in his hospital room to a view from his window of a body of water that reminded him of the sultry Pacific jungles where he had once fought. Suddenly, for the first time in more than 40 years, old images returned--and he became panic-stricken. Since then--he is about 70 now--he has experienced regular combat flashbacks.

--A former POW who barely survived the Bataan Death March returned from war and functioned well for four decades, despite disturbed sleep and a tendency to become a workaholic. After the war, he continued to maintain a close relationship with another POW who had been in the same prison camp--and with whom he had made a survival pact during their captivity. Recently, his friend committed suicide, and the surviving POW began experiencing severe stress symptoms.

--A former WWII medic, described as “devastated” by his inability to save lives while under continuous fire on a South Pacific island, spent his postwar years drinking. “I saw him after he had been in and out of VA hospitals as an alcoholic,” recalled Arnold, who treated him in Phoenix.

‘Put Himself Into a Coma’

“No one had ever asked him about his war experiences. They thought he had a drinking problem. This guy poured out to me that he had been dreaming about this for 40 years--the fact that he couldn’t save all those men who had been blown to bits. He drank all day to put himself into a coma,” Arnold said. “This was chronic (post-traumatic stress disorder) unrecognized.”

--One WWII veteran spent his postwar years frequenting bars and picking fights. In addition, he had an explosive relationship with his teen-age son. Psychiatrists learned that, when riding in a jeep through the city square of a small German town during the war, he spotted a soldier coming out of a building with a weapon. Instinctively, he fired. When he drove over to look at the body, he discovered that he had killed a teen-ager. He sat over the body and sobbed. His doctors now theorize that his own son, a young blond teen-ager, reminds him of the one he killed.

--A successful lawyer who had been a bomber pilot during WWII had flown in the mission that bombed Dresden. He had been without symptoms for 35 years, but his son, a former helicopter pilot in Vietnam, developed post-traumatic stress disorder and entered a treatment program. Father and son began talking about war. The father, reading a book about the breaking of the German code, learned for the first time that the Allies went ahead with the Dresden bombing--even though they knew the city no longer had any strategic targets--because canceling it could have alerted the Germans that the code had been broken.

Film Sparks Nightmares

Soon after finishing the book, the son and his father went to see the film “Slaughterhouse Five,” which contains documentary footage of the Dresden devastation. Suddenly, the father began having nightmares. Shortly thereafter, he joined his son in treatment.

When an incident occurs in later years that brings on symptoms, experts say, the feelings are likely to be closer to those of wartime than of the present, especially if the veteran has never allowed himself to confront the earlier experience.

Arnold said that veterans who saw many of their companions killed in war may be vulnerable to the death of close family members back home. “The symptoms are apt to be the grief of the loss in combat, not the current loss,” he said. “Elements of the original experience come back again and flood the awareness.”

Smith, of the VA stress center in Cleveland, said that traditional “rules of war” help veterans deal with psychological trauma. The fighting is conducted for a purpose, he said, and postwar rituals such as medal ceremonies and victory parades allow veterans to “separate war deeds from civilian actions.”

“A WWII veteran can say, ‘Oh yeah, those kinds of things happened in my war. War is hell--but we had to stop Hitler, or we had to stop the Japanese.’ ”

Stress Varies With Groups

Dr. Valerie Holmstrom, chief of psychology at the VA Medical Center in Charleston, where she treats Covert, said that WWII veterans do not appear to be suffering from delayed stress with the same intensity as Vietnam veterans. The WWII generation, she said, benefits from lower divorce rates and a more consistent employment record. But, she said, “most of them were not symptom-free.”

Covert says that his close marriage, which has survived the fact that he and his wife sleep in separate rooms because he is so restless, has helped him cope with his war-related stress. “I asked my wife a lot of times if she’d be better off without me,” he says. “She tells me no, over and over, that she wouldn’t.”

Although some WWII veterans suppressed their stress symptoms for years through work or other activity, others have experienced unabated symptoms since their discharge.

Gunnar Sacson, 67, a photoengraver from Lake Bluff, Ill., has always had nightmares about his 41 months as a Pacific theater POW and a participant in the Bataan Death March--a period when he was beaten and starved and forced to watch as others were shot or hanged.

Happens Spontaneously

“Some (of the nightmares) are of the Death March or of the burial detail,” Sacson says. “I have this other dream: I’m coming home and, when I get home, no one’s there. I have flashbacks of the Death March, where I’m walking it again. I could be cutting the lawn and it could happen. But it doesn’t scare me the way it used to.

“I functioned but I was always a loner. I didn’t want to be around people. If I was in a crowd, I wanted to hide in it. When I was marching along, the Japs loved to club you and beat you up. I always hid in the crowd. For years, I couldn’t even stand the sight of an Oriental face.”

When he returned home, he told the VA of his problems. “They sent me away,” he said. “ ‘Don’t worry about it,’ they said.”

The VA did not establish a nationwide program to deal with delayed stress for WWII veterans comparable to the “storefront” centers for Vietnam veterans, but it makes psychiatric and social services available through VA facilities. “The VA is actively trying to meet the medical and psychiatric needs of the aging veteran population,” the VA’s Lipkin insists. “But the answer is not a new, special program.”

Holmstrom, of the Charleston VA center, said: “No one claims to cure (post-traumatic stress disorder). It is considered a chronic disorder. But a person can learn to cope and adapt much better.”