‘You Have to Feel the Pain . . . Before the Wound Is Actually Healed’ : Hospital Program Aims to Bring Peace to War-Tormented Veterans

The setting is peaceful, on a lake surrounded by Douglas firs. But peace is far from the minds of the war veterans who meet here to unload decades of violent and fearful thoughts and feelings.

For many, it’s the first time since the war that they’ve felt free to cry.

“Some of these people haven’t felt in years,” said Anne Gregory, manager of nurses for the post-traumatic stress disorder (PTSD) program at the Veterans’ Hospital at American Lake, herself a Vietnam veteran.

“The fact that some of these people are still sane is remarkable. PTSD is treatable, but it takes time,” Gregory said.

An estimated 470,000 of the 3.14 million vets who served in Vietnam suffer from PTSD, and 80% of those never have sought mental help, said American Lake director Ray Scurfield. His is one of 14 relatively new programs in this country trying to help PTSD victims. Three percent of its participants served in Korea and World War II, the rest in Vietnam.

Sleepless Nights, Flashbacks

In the company of other vets and a professional staff of 23 that includes 13 veterans, men who never quite left the war behind tell of sleepless nights, flashbacks, guilt over having killed, guilt over having survived, uncontrolled anxiety and rage and the isolation they feel.

Holding hands, they ride in Huey helicopters in maneuvers similar to those commonly used in the war. The sound of the rotors and rush of wind was enough for one to tearfully recall his last flight in a Huey, a trip that ended in an ambush and the deaths of 18 of the 35 men in his squad.

Some go on an Outward Bound trip and push their limits in rapids in search of new perspectives on their abilities and their lives.

Many vets are hearing for the first time that it is human to feel what they feel, and that anyone who has experienced severe trauma--the Holocaust, for example, or even major earthquakes--can feel the same way.

And it is the first time many have let go--the birth of a long period of healing, forgiveness, learning to live with memories, trusting themselves and others and hoping for the future.

‘Afraid of Them Dying’

“They’re digging things out of me here that I didn’t even know were issues,” said Dan Collins, 42, of Tacoma. “You look at somebody and see them blown to hell, and they’re not there.

“It’s a convenient way not to make friends, because I’m afraid of them dying . . . . I avoid people . . . for that and other reasons.

“That’s the nice thing about this place. They confront you on it and you have to face what’s going on inside of you.”

Scurfield said any victim of severe trauma can develop chronic symptoms that can include intrusive imagery, numbing, helplessness, fear that leads to rage, fear that leads to grief, anger against authority and “the system,” inability to control emotions and actions, broken relationships and work histories, depression, anxiety, hypervigilance and sleeping disorders.

They sometimes express those symptoms and other times avoid expression altogether, as they probably did at the time the trauma took place. This leads to physical and emotional isolation and confusion over personal responsibility, self-worth, relationships, work--even play.

Eight-Month Waiting List

The 11-week program at American Lake, begun in 1985, has served 350 so far and has an eight-month waiting list. Applicants must have served in a war zone, have received some counseling already and be drug- and alcohol-free. It costs the Veterans Administration $107 per patient per day.

Participants learn about controlling anger, anxiety and stress and about substance abuse and PTSD. They also examine prewar experiences that may have contributed to their war reaction, war-zone trauma, and their postwar years.

They even look at the benefits of trauma: intense comradeship, emotional and spiritual insights and heightened sensitization to life’s horrors and to political behavior, Scurfield said.

“By going back to the wound, you finally realize that you have to feel the pain, the grief, the loss, before the wound is actually healed,” said Leonard Horst, 42, of Sequim. “You’ll always have the scar, but at least you have acceptance and forgiveness.”

Outpatient Counseling Urged

All are encouraged to attend outpatient counseling for six months to three years to consolidate gains made in the program, Scurfield says. Failure to do that can easily mean backsliding and renewed isolation.

Veterans listen carefully when Scurfield explains how their anger probably stems from fear. How they had to go to Vietnam at a time when they would have been undergoing a lot of change anyway and so were especially vulnerable. How they are the only ones who can change the crazy life patterns.

“The rage is justified, but you still need to let go of it,” Scurfield said. “If how you’re going to feel or what you’re going to do is determined by someone else, you’re not in control . . . . I’m not saying don’t fight, you must . . . not let the symptoms control you. Open a valve and release some of it without hurting yourself.”

The understanding and definition of the disorder continues to evolve. How successful American Lake and PTSD treatment are is anybody’s guess without a better follow-up system and more coordination among the 14 programs, said Scurfield, a doctor of social work who did psychiatric work in Vietnam.

Increased Aid Urged

A lot more money and programs are needed, especially in the West, Scurfield testified before Congress last summer. Special emphasis should be placed on professional support for veteran self-help groups in geographically isolated areas, where many choose to live because of low, fixed incomes.

Scurfield lays the delayed response in identifying and treating PTSD--a disorder professionals now believe has always existed among trauma victims--to naive psychology trends, right-wing beliefs that common knowledge of PTSD would undermine the country’s ability to defend itself and concerns over the immense potential financial strain of treatment.

In a recent survey sent to 180 American Lake graduates and answered by 85, a majority had been helped in self-esteem, relationships and in understanding that they have the responsibility and ability to change. But a significant minority reported no real change in depression, anxiety, relationships and intrusive symptoms.

‘Program Should Be Longer’

“I definitely needed another tuneup and more time,” said Richard Fairfield, 39, of rural northeast Utah. “It took me 20 years to get as screwed up as I was . . . . If they had helped me 20 years ago, I wouldn’t be here. The program should be longer.”

Ten percent of participants have returned once, Scurfield said.

Despite its admitted weaknesses, Steve Petty, a VA social worker in Loma Linda, Calif., and a member of a congressionally mandated PTSD committee, says American Lake is considered on the cutting edge of treatment.

“These people know what’s going on,” Fairfield said. “When I wake up at 3 a.m. drenched in sweat and have to talk, they’re there.”

It is the only program with a special support group for children of Vietnam veterans, and it is the only one that incorporates the helicopter rides.