It’s been 50 years since the last American troops departed from Vietnam and Gary Gordon is still facing the kind of battles that some veterans know all too well.
Some days Gordon, who was 19 when he joined the military, can talk about what he experienced during his two tours of duty as a radio operator during the war and how the memories haunt him now.
On one of those recent days, he participated with several other veterans from various conflict eras at the eighth Annual San Antonio Combat PTSD Conference in a panel about the post-traumatic stress disorder (PTSD) they continue to experience as a result of combat duty.
Other times, Gordon reserves his strength for the fight within, a fight for which he’s getting assistance from others seeking to better understand PTSD and the stigma some associate with it.
In 1983, Congress mandated that the Department of Veterans Affairs conduct a study of the psychological effects of participation in the Vietnam War, “a remarkably complicated task,” said Terence Keane, director of the National Center for PTSD Behavioral Sciences Division and associate chief of staff for research & development at VA Boston Healthcare System.
San Antonio is home to the South Texas Research Organizational Network Guiding Studies on Trauma and Resilience, founded in 2008. But everyone, including the many veterans it serves, just calls it STRONG STAR.
A multi-institutional research consortium funded by the Department of Defense and Veterans Affairs and other agencies, STRONG STAR works to prevent, detect, diagnose and treat mental health conditions in service members, veterans and first responders.
Alan Peterson is a professor of psychiatry and behavioral sciences at UT Health San Antonio and director of STRONG STAR, which has become a national hub and network for PTSD-related research and treatment.
The annual conference it hosts attracts researchers, practitioners and military leaders from around the world to network and learn the latest in the field of treating PTSD.
Some of the research underway seeks to understand why the rate of PTSD among Black and Hispanic service members is higher than among white veterans, and also what characteristics make a service member resilient in the face of trauma.
Evidence so far has shown that the strength of the veteran’s relationship with his or her mother appears to have an effect on resilience, Keane said.
Measures to prevent PTSD in the first place are what those who work in the field want to see most, Peterson said. “The best prevention really is good military training.” But the science so far is limited and some believe full prevention might not be possible.
Treatment essentially works best when it occurs soon after trauma exposure, according to the research, even when a soldier is still “in theater,” Peterson said.
But once a person has returned home, studies also show the available treatments and therapies work equally well no matter how long ago the trauma was experienced.
Some of the most effective treatments being used for individuals with PTSD include prolonged exposure therapy and cognitive behavioral therapy, which Peterson said gets the biggest reduction in symptoms.
Researchers are looking at what can be added to that and studying the effectiveness of things like a nerve-blocking agent that temporarily blocks the stress reaction and an esketamine nasal spray medication.
During the recent conference in San Antonio, the PTSD Center’s Keane charted the course of psychological trauma research from the Vietnam era through today. Despite 40 years of work and treatment focus, he said, “the vast majority of people with PTSD … do not receive any care at all.
“There are barriers to care: There’s stigma, there are costs, and there’s geography that compel people to stay away,” he said, adding that even those who do seek help often don’t get evidence-based care.
“This is something that we as a country need to overcome,” Keane said. “We need to destigmatize these things and we need to support people as they move forward in their lives.”
Each war era has a unique stigma associated with seeking care for PTSD, Peterson said. “If you think about the Vietnam veterans … the stigma was not [about] getting care, it was not even letting anyone know that you served there.”
When Navy veteran Hakim Mathis returned home from a deployment to Afghanistan in 2010, his wife noticed he was hostile and distant.
“My daughters wanted to hug me but I wasn’t ready,” he said. “I didn’t want to get too close. I slept downstairs.”
Cognitive behavioral therapy at STRONG STAR helped, Mathis said after he participated in the veteran panel. “If it hadn’t been for them, I would have been a totally different person.”
Unlike many during the late 1960s and early 1970s, Gordon said he experienced a fairly welcoming and supportive homecoming to Lubbock where he had grown up and ran high school track before joining the Marine Corps.
But because so many of his fellow soldiers who worked alongside him in very dangerous missions did not make it home, Gordon suffered a severe case of survivor’s guilt.
He used alcohol to chase away the nightmares. “I discovered a wonderful little propensity for Scotch,” he said.
Gordon had just graduated from college and was working as a counselor at a Vet Center when PTSD criteria was first published in the early 1980s. He recognized himself in the criteria and sought help.
Seeing the signs in themselves — avoidance, detachment and hypervigilance, for example — today’s active duty service members sometimes tend to reach out for help just before they separate or retire from the military.
But the timing has to do with the stigma associated with seeking care earlier in their career, said Samantha Marasa, a post-doctorate fellow and provisionally licensed psychologist with the STRONG STAR center at Fort Cavazos near Killeen.
“A lot of people wait until the very end or until they get out to receive help for PTSD because there are concerns about, ‘Will I lose my job?,’ ‘I’m going to be judged,’” she said. “I hear it every day.”
STRONG STAR is currently conducting 30 different trials to study, understand and find new treatments for PTSD. Every year, about 200 to 300 people participate in those trials, Peterson said.
Those studies have contributed to about half of the existing scientific literature on combat-related PTSD and the PTSD Center’s list of 78 therapies, Keane said.
“We now have a mountain of evidence as to why certain people develop PTSD and others do not,” Keane said. “It’s now up to us, the community of clinicians, investigators, scholars, to apply this information in ways that will help the people that we are charged to help.”
This article has been updated to correct the surname of Gary Gordon.
