Brian Smith has migraines every day. He suffers from Traumatic Brain Injury. His night terrors keep him from sleeping. He does not like bright lights, but has become immune to it because he has to.

“I have seen things most people probably will never see other than on television,” he said.

Smith enlisted in the Army a year after high school graduation, in 1988. After eight years, and losing two friends in combat, he returned home to a problem more than five million Americans face annually — Post-Traumatic Stress Disorder.

Post-Traumatic Stress Disorder, or PTSD, is a relatively new term in describing what soldiers have experienced since the conception of war. The Diagnostic and Statistical Manual of Mental Disorders (DSM), a coding handbook used by health care professionals, defines PTSD as “exposure to a traumatic event that meets specific stipulations and symptoms from each of four symptom clusters: intrusion, avoidance, negative alterations in cognitions and mood, and alterations in arousal and reactivity.”

The symptoms that compromise the disorder actually emerged during World War I but no clinical tools were available to diagnose it. Instead, the military used stigmatizing labels to describe the soldiers’ emotional suffering. Servicemen were soon diagnosed with “shell shock.” According to the Smithsonian, “Early medical opinion took the common-sense view that the damage was “commotional,” or related to the severe concussive motion of the shaken brain in the soldier’s skull.

But as the war raged on, the military found that many men experiencing neurotic symptoms — amnesia, trouble sleeping, migraines — were nowhere near explosive blasts. In 1918, doctors treated soldiers with chronic cases of “war neurosis.” Aside from the physical injuries of an explosion, they also experienced paralysis and deafness. In World War II, soldiers suffered stress breakdowns. Men admitted to psychiatric care were diagnosed with “exhaustion.” With varying symptoms, doctors struggled to diagnose soldiers in fear they were malingering, or exaggerating illness to avoid the war.

“There were no organic manifestations,” Muhlenberg history professor Dr. Dan Wilson said. “[Many] doctors held the same stance: If there was no physical wound, the soldier suffered from cowardice or malingering.”

With more soldiers falling ill to this mysterious disorder, a common goal emerged among military administration: get soldiers back to their unit as quickly as possible. It was more important to have men on the line than to figure out the plague that was sweeping across every branch of the military.

The 1968 DSM, published during the halfway point of the Vietnam war, failed to produce a category for psychiatric problems produced by battle.4 Doctors did not have a true diagnosis for the increasing influx of patients. Insurance companies were unable to cover the cost of treatment. With the returning Vietnam veterans experiencing the same psychological suffering as those soldiers before them, the issue refused to be swept under the rug. A 1972 New York Times article “Post-Vietnam Syndrome” described the concept now known today: delayed trauma, rage, alienation, guilt, difficulty readjusting.

In 1980, PTSD finally appeared in the DSM.

It is estimated that around 1.8 million Purple Hearts have been awarded to soldiers since its establishment in 1932. That is 1.8 million soldiers recognized for bravery. But what about the psychological injuries? The Pentagon, along with the Military Order of the Purple Heart, refuse to award soldiers who suffer from PTSD with this honor. According to the journal article “War Trauma, Politics of Recognition and Purple Heart: PTSD or PTSI?” former and current military personnel agree: “Despite the high rate of psychologically injured soldiers among American veterans…some said they would be ashamed to wear the PH medal if it is awarded to veterans with PTSD, and that it would insult those veterans who suffered a “real injury.”

Post-Traumatic Stress Disorder has become the normalized term to encompass the variety of symptoms people experience. According to PBS NewsHour “the term was devised in an effort to legitimize the suffering of Vietnam veterans, convince insurance companies to pay for treatment, and bring an umbrella of trauma syndromes…under one moniker.” But now this name may change again because of a new concern.

The ‘D’ in PTSD, the dreaded word ‘disorder’, elicits the stigmatizing implication that what veterans suffer from is fixed and unchanging. They may be less likely to seek help from this.

Two pioneers in reevaluating PTSD’s label, Dr. Frank M. Ochberg and Dr. Jonathan Shay, emphasize an injury model and a new name, Post-Traumatic Stress Injury. “We physicians believe that brain physiology has been injured by exposure to some external force, not that [they] are just anxious or depressed by tragic and traumatic reality,” they said in a letter to The American Psychiatric Association (APA) in an initiative to rename PTSD.

Instead of thinking of PTSD as a pre-existing condition, research suggests the trauma that soldiers experience during war literally affects the brain’s composition. Ochberg and Shay explain that PTSD isn’t simply feeling traumatized by an experience that happened in the past, but rather those experiences actually alter the brain’s memory pattern.

Further research shows a connection between veterans who experience Traumatic Brain Injury (TBI) and the development of PTSD as a result, finding “those who reported little to no PTSD symptoms before deployment and who experienced a mild TBI during deployment had nearly twice the probability of having PTSD after deployment than what was predicted.”

In 2012, scholars and advocates pleaded their case to the APA in the wake of an updated DSM’s publication. Their voices were not heard, though some progress was made. PTSD is not longer classified as an anxiety disorder, but it is still labeled as a disorder under a newer classification: trauma and stressor related disorders.

The criteria for PTSD is now defined, but it doesn’t banish the stigma or confusion on how to teat a veteran with this illness. Smith, with thick arms like a tree trunk, bald head, and steely gaze, is one of those veterans.

“I’m on medications,” he said. “I do self-injections every day. These are things I have to live with on a day-to-day basis. I’ve been working with a therapist at the VA [U.S. Department of Veterans Affairs] and gradually I’m trying to get to where I can work and communicate and in therapeutic ways talk it out.”

Many times, the veterans themselves struggle to understand what is happening to them. “You have to take your time,” Smith said. “You have to have patience when it comes to talking to someone with PTSD.”

The stigma of PTSD develops from the complexity of understanding it. The illness is hard to trace, and the ‘D’ in PTSD encompasses the possibility of a pre-existing condition, not just an injury from war. “Back then it wasn’t ideal to figure out why this guy had this problem,” Smith said. There are so many factors that play into this mental health issue. “What’s wrong with him? Was it early childhood? Was it something he saw that intensified when he went into combat? How long has it been rooted?” he said.

No matter what the root of the problem is, the answer is not to write veterans off. Or throw medication at them. “At first I didn’t want to go the VA, because I didn’t want to be heavily medicated,” Smith said. “They diagnosed me with PTSD. They had me on 900 mg of Lithium and 1500 mg of Depakote.” Lithium is used for the treatment of bipolar and depressive disorders. Depakote is an anticonvulsant used to treat migraines.

Smith eventually stepped away from these medications. He found the solution to dealing with his PTSD to be an internal matter. “I can change if I allow myself to change,” he said. “If I’m willing to open myself for suggestions to change, then I don’t need to have myself medicated, to have a disease or illness or disorder, define me.”

Secluded from a team atmosphere, veterans are often left feeling alone when assimilating back into society. No one understands the battle inside their minds. “When you have comrades that you see every single day of your life, that you go to battle with, that you do everything with, you have a bond,” Smith said. “That camaraderie, when it’s taken from you, that hurts.”

When Smith decided to pursue a college degree, Muhlenberg’s Wescoe school was there to welcome him into another team. Wescoe’s focus on camaraderie within academics mimics the military’s emphasis on teamwork according to Joseph Kornfeind, Director of Veterans Affairs at Muhlenberg.

“We rely on good team development not only from our culture here at Muhlenberg but also understand the military creates a great team environment,” Kornfeind said. “We join forces with that. Veterans can be placed on any team and do extremely well because they have that talent and skill [of teamwork].”

The Wescoe school is just one of twelve local schools participating in Academics for Veterans, a Lehigh Valley alliance group that seeks to provide education and career options for veterans. “This is the first time ever that the area colleges have formed this group that is totally committed to help the veterans regardless of what school they go to,” Kornfeind said. “A lot of the time when you talk about colleges, we compete for the student. But in this case, we look at the best interest [for the veteran].”

To further support veterans, the Wescoe school supports the Post 9/11-GI Bill, which provides up to 36 months of benefits for education. This partnered with the additional benefits of the Yellow Ribbon program allows a veteran to pursue a goal that wasn’t readily available before. “[The GI Bill] pays for college and books. It even provides a living stipend,” Kornfeind said.

Even though Smith no longer had his comrades from the Army, he found a new team who encouraged and motivated him. Muhlenberg’s faculty work with the administration and registrar for veteran students who are unable to complete assignments in time due to PTSD episodes or symptoms. For some veterans, seeing an incomplete or a failing grade for something they cannot control only adds more stress. A veteran with emotional distress is not seen as a burden, but revered for their determination to come back to school.“When we have our faculty meetings, we do recognize issues. We pass on things to instructors for what they can look for,” Kornfeind said. “We look at classroom settings.”

When Smith started classes, he utilized the Office of Disability services for help. “I started taking my tests down there [ODS offices],” he said. “I had a tutor.” During his third semester, Smith took a medical leave of absence. “I had a breakdown where I isolated myself and had to take off a semester. It was very traumatic for me. I didn’t know how to cope. I wasn’t able to communicate. I was in a dark place in my life. I wasn’t able to open up.”

Encouraging veterans to pursue an education means accepting the circumstances they bring with them as a non-traditional student. “If we’re looking for that enrichment of what people bring to class, then we have to be prepared for what people bring to class,” Kornfeind said. “[We want them] to understand that they can bring a lot of what they experienced in the military into the classroom.”

Despite his struggles, Smith was not inhibited from receiving an education. “I’ve come too far in my life to shut myself off to the world, more importantly to the people that cared,” he said. “If I can’t internalize what gifts were given to me and if I continue to use my PTSD as a crutch, I won’t succeed. I know I have it, but I don’t use it as a crutch. I wanted to fight through this to the best of my ability. I felt that if I can fight through this, and I’ve fought through a lot, and had the adversity to fight it, I can get through this.”

This internal strength pushed Smith to persevere. Though he stopped using ODS services, he recognized Muhlenberg’s strides for accommodating veterans. “The school helped tremendously and I’m grateful for that,” Smith said.

A Public Health major and Psychology minor, Smith plans to be an advocate for those who don’t have a voice. Like the veterans who are silenced by their PTSD and their critics, he wants people to understand they have a choice for how they deal with an issue, and that their voice matters. That they deserve to be heard. “I would like to help other people that are less fortunate,” he said. “I had a problem with drugs and alcohol. I would like to be able to go into schools and be an advocate for those who don’t understand there are more important things in life than drugs and alcohol.”

“I hope I get that opportunity to represent those kids and help them transition from that lifestyle into the type of lifestyle I have,” Smith said. “I don’t want them to be like me, but to let them know they do have a voice. They do have a decision.”



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