There’s still so much we don’t understand about war vets and PTSD, or Post-Traumatic Stress Disorder.
Why some experience it, but so many others don’t.
Why one vet can have symptoms right away, while another can be fine for years.
Now older generations of veterans from World War II, Korea and Vietnam are showing us that PTSD can actually be triggered late in life.
Especially when veterans are dying.
Wide awake, but the nightmares persist
When Brenda Jackson was really little, she'd get up in the night and find her dad, wide awake, holding his head in his hands.
"My dad was Lenwood Long. He served in the Pacific in World War II, and he saw a lot of combat," says Jackson. "Ironically, we could never get him to talk about that time. We knew that he suffered, but we did not recognize it as PTSD."
Jackson is now 73, a retired nurse practitioner living outside St. Petersburg, Florida.
She remembers her father was more reserved when he got back from war. The family knew he had trouble sleeping – hence the nights spent with his head in has hands.
But it wasn't until a stroke landed him in the VA hospital that they realized the extent of his trauma.
First, he started having nightmares while he was wide awake.
"And my dad was shaking and crying and he was seeing it right outside his window," says Jackson.
"And I said 'Daddy, is this real or is this just a dream?' And he said 'No, it's real.'"
For the first time, Jackson's dad told her what he'd seen in his nightmares ever since he came back from war.
"What it was, was as soon as they went over [from the U.S., my father's unit] immediately went into combat. And in the foxhole they had dug, the man beside my dad was shot in the head right beside him. And all his life, that was his nightmare."
"Everything shifts at the end of life"
Jackson's father was changing in other ways, too. He'd never had a short temper, but now he was snapping at his family, at the VA staff.
So they brought in Deborah Grassman, a nurse practitioner who's been working with VA hospice patients for decades.
"Everything shifts at the end of life," says Grassman. She recently spoke to groups in Lansing and Ann Arbor.
"Our conscious mind gets weaker. Our unconscious mind gets stronger. That has huge significance, because it means that the conscious mind doesn't have the strength to keep those memories boxed up anymore. So they start seeping in."
Grassman says she sees this kind of change all the time in older vets: their whole lives, they've been fighting to keep a lid on their trauma.
But old age changes that.
Whether it's retirement, losing a loved one, confronting death and looking back, something about growing older can trigger traumatic memories.
It's such a common symptom pattern that there's even a name for it now: Late Onset Stress Symtomatology, or LOSS.
From the U.S. Department of Veteran Affairs online National Center for PTSD:
"LOSS differs from PTSD in that LOSS appears to be closely related to the aging process.
People with LOSS might live most of their lives relatively well. They go to work and spend time with family and friends.
Then they begin to confront normal age-related changes such as retirement, loss of loved ones, and increased health problems. As they go through these stresses, they may start to have more feelings and thoughts about their military experiences."
Or in the words of researchers at the Boston VA:
"LOSS is a hypothesized phenomenon among older veterans who:
(a) experienced highly stressful combat events in early adulthood;
(b) functioned successfully throughout their lives, with no chronic stress-related disorders; but
(c) begin to register increased combat-related thoughts, feelings, reminiscences, memories, or symptoms commensurate with the changes and challenges of aging, sometimes decades after their combat experiences. "
So how many vets are dealing with LOSS?
It's hard to tell.
But early studies show it could be fairly common.
One group of researchers found that nearly 1 in 3 older vets and ex-POWs from WWII and Korea were currently experiencing PTSD.
Healing, and the hope of a more peaceful death
For more than a decade now, VA nurse Deborah Grassman has been traveling around the country, presenting her findings about older vets and PTSD to hospice and veterans' groups.
She says this time in veterans' lives - as they're entering hospice, and grappling with the end of their lives - is a fertile time for healing, even as it may be triggering earlier trauma.
Some of her advice is technical:
- Avoid Valium-type drugs that may increase feelings of helplessness in vets, since helplessness can actually act as a trigger for PTSD
- Be sensitive to whether older vets are reliving war experiences, in which case you want to avoid using trigger words (she recounts a VA nurse saying they were going to "blow up" an air mattress next to a vet's bed, which sent the older vet into a panic)
But primarily, Grassman says there's an opportunity here to let veterans tell their stories.
"A lot of times what I will say to people is just a simple question. I'll say, 'I'm just wondering, is there anything that might still be troubling you from that war?' And then sit quietly. And then the story comes," she says.
For Brenda Jackson, she believes her father was able to have a peaceful death, thanks to their new understanding of late-onet PTSD.
"I began to acknowledge to him that we understood [he had suffered]," she says.
"And we told him we would give him the time, and we wanted to be with him and we would not leave him. And then one Sunday, they have memorial services for the vets that have died over the last three months. And we had that on on the TV in the hospice room. And when they played taps, my dad took his last breath."