Although military prohibits openly gay, lesbian people from serving, retired gay vets can expect to get fair treatment from VA
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| A U.S. Marine boards a plane to leave Vietnam in 1969. Soldiers today in Iraq and Afghanistan are serving longer tours of duty and so may be more likely to suffer PTSD than were their counterparts in Vietnam, who served one-year rotations. (Associated Press) |
Gays and lesbians serve in the military, despite the policy known as “Don’t ask, don’t tell.” And they suffer the same physical and psychological wounds as their straight colleagues.
About 25 percent of returning Iraq and Afghanistan veterans received mental health diagnoses, according to a study of the first 100,000 veterans seen at facilities operated by the Department of Veterans Affairs. But since the VA is likely to see the more severe cases, extrapolating data from those results should be done carefully.
But the VA study, presented at the 135th annual meeting of the American Public Health Association in Washington, D.C. just prior to Veterans Day, is just one of many pieces of information helping to bring the veterans’ situation into sharp focus.
Dr. Evan Kanter, staff psychiatrist in the PTSD Outpatient Clinic of the VA Puget Sound Health Care System, said, “The most common [of mental disorders] were post-traumatic stress disorder (PTSD), substance abuse and depression. The younger the veterans are, the more likely they are to have mental health conditions.”
Estimates of the occurrence of PTSD range from 12 percent to 20 percent. With the number of troops deployed to combat zones passing 1.5 million last summer, and the VA having treated only 52,000 persons, it is clear that many vets are not receiving the help they could use.
Dr. Kanter said there is “a dose response” with PTSD to the intensity and duration of the trauma experienced. In Vietnam, soldiers served a single one-year rotation in the country unless they volunteered for further duty. But soldiers today face “unprecedented multiple deployments to Iraq,” which further increases the risk for the disorder. More than a half million persons have been deployed two or more times.
Gay and lesbian veterans face the added burden of dealing with sexual orientation in a military context that often can be hostile to them. Sometimes that means hiding their sexual orientation and in the process depriving themselves of the comfort and support of a partner or extended community that might help them through their recovery.
The VA in Washington state and Montana surveyed 445 gay and lesbian veterans, from all times of service and for all types of medical and psychological services. It found that 36.2 percent had been investigated for their sexual orientation. Some 14.8 percentwere isolated from their unit for that reason, and 2 percent were incarcerated, while 11.7 percent were forced into a psychiatric evaluation of their sexual orientation.
Overall, 16 percent “said they were forced to leave the military due to their sexual orientation,” the survey found.
Evaluaton and recovery
Evaluation immediately upon return from deployment suggested that 5 percent of active duty and 6 percent of reserve personnel had a significant mental health problem. When reassessed three to six months later, 27 percent of active duty and 42 percent of reserve personnel were found to have some sort of mental health issue.
Kanter said there are two reasons for the difference in outcomes: “At the time of return, people want to get home and get to their families. They perceive that if they answer yes to the question, it is going to take time [and delay their return home]. So, there is tremendous under-reporting. The other is that PTSD and other mental health conditions have an insidious and delayed onset.”
Kanter is guardedly hopeful that a greater understanding of PTSD and earlier intervention will result in better outcomes than those seen from the Vietnam era. But significant barriers to accessing care remain, he said.
Perhaps the most difficult to overcome is the attitude of the typical twenty-something solider returning to civilian life, Kanter said.
“It is hard to get a 22-year-old to come in to see the doctor for any reason. The stigma of PTSD and mental illness in general runs very high,” he noted. “There also is a lot of distrust, avoidance and denial that are inherent in the disorder. People are worried about their military careers and that if they get a mental health diagnosis, they will be drummed out.”
Sexual orientation can add another barrier for those who are still on active duty. But it should not be a deterrent to seeking help for those who have been discharged.
The VA has a policy of nondiscrimination on the basis of sexual orientation and many consider it welcoming environment, particularly in non-urban settings where local practitioners and institutions may not be as enlightened or as knowledgeable.
Dr. Kanter stressed that recovery from PTSD is a process that takes time. Successful coping strategies include limiting exposure to triggers such as news coverage of war; restoring balance in one’s life; attending to physical and emotional needs; and limiting use of alcohol and stimulants.
Learning about trauma and its effects is “critical” for the vets and their families, as is repeated, gently urging them to get help, Kanter said, adding that it is important for health care professionals to not frame the discussion in threatening terms of psychiatry but rather as “post-deployment stress, readjustment, reintegration,” as a part of total care.
The literature on PTSD shows “that when they are exposed to the same trauma, women are twice as likely as men to get PTSD,” he said.
Iraq is the first conflict where women are serving in large numbers. However, when pressed as to whether he has seen differences in PTSD between male and female veterans, Dr. Kanter said he has not yet seen enough women in his own practice to know for sure.
It is possible that women who volunteer for military service are not representative of the general female population, he said, and so they may be more naturally resistant or their training may have made them more resilient to the psychological traumas that lead to PTSD.
This article appeared in the Dallas Voice print edition November 9, 2007