The Tears They Cry: Women Veterans and PTSD

My friend, Marsha, is the oldest of seven and the daughter of a World War II combat veteran. Marsha's father, like most men of his generation, spoke very little about his war experiences, and what happened in the war was never directly known by most of his children.

Like many in her generation, Marsha studied nursing. The military trolled schools of nursing for recruits, desperately in need of women to care for the injured and dying in Vietnam. As with most of her fellow students, Marsha had no experience in traumatic nursing. And, when she found herself in Vietnam, war was all she heard and smelled, even when she closed her eyes.

Marsha worked 12-hour shifts in the intensive care recovery room — a semi-circular rubberized structure with tubes that blew in air to keep inflated — and prayed she didn't do anything wrong. The intensive care beds were emptied as quickly as possible to make space for the next batch of patients. Unless the men were burned, they were typically gone within 24 hours.

In addition to death and dying, Marsha experienced incoming rocket attacks. In order to temporarily escape, most of the nurses wouldn't leave their rooms at night; they would understandably hide away, listening to music, writing letters and reading books. But Marsha didn't want to hide.

Because nurses weren't issued weapons, Marsha bought an M-16 from a nurse who was leaving the country. She didn't ask the nurse where she got the gun, but she knew it worked. Unfortunately, it didn't provide Marsha the comfort she needed. She drew 365 boxes on a piece of paper for the days of the year she had to serve. She'd get up every morning and color in a square, and wait.

Approximately 7,500 American women served during the Vietnam era. Many, like Marsha, were nurses, but some filled other clerical or personnel positions. While post-traumatic stress disorder (PTSD) has been well-studied among men who served in Vietnam, the women who served during that time have been relatively neglected. It's understandable that the men who served our country during Vietnam got greater attention — there were far more of them, and their military jobs put their lives at greater risk. But giving more attention, support and resources to the women who served in Vietnam does not take away from our men.

Until recently, no large scale population-based study had examined the rates and predictors of PTSD in those women, with particular attention paid to their common and unique war-zone experiences. But findings published online in October in JAMA Psychiatry indicate that women who served in Vietnam meet current and lifetime criteria for PTSD at higher rates than previously documented: 13.5 percent and 16.9 percent, respectively.

This comprehensive Health of Vietnam-Era Women's Study, funded by the Veterans Administration (VA), documents the long-term effects of wartime exposures in women, including verbal or physical sexual harassment, sexual assaults and compulsory pressure to perform their jobs under enemy fire. And sadly, the negative mental health effects of military service have followed these women for six decades.

What can we do for these women, decades after Vietnam?

All VA health care providers — not just those in specialty mental health clinics, but those in primary care clinics and every other department that treats women — need to screen for PTSD in these older women. They need PTSD treatment, even — perhaps especially — all these years later. Haven't they served and suffered in silence enough?

But perhaps the biggest implication of these findings is for the next generation of military women: a population that is large and rapidly growing.

What do these results mean for them? Early and improved interventions can prevent the late-life mental health consequences of war for women. Surely we don't want more generations of military women reaching grandmother status with untreated signs and symptoms of PTSD.

My friend Marsha suffered for sure. After returning from Vietnam, she struggled to find purpose, traveling the U.S. and camping out in a van. She picked lettuce with migrant workers and spent time living as a homeless person, searching for nightly shelter and a place to shower.

Eventually, she married another Vietnam vet and found her calling. Since the VA, typically at that time (and some might say even today) was a man's organization, Marsha recognized that women veterans needed a place of their own and that their psychological and, at times, physical safety warranted it. Through many years of advocacy and lobbying, she raised enough financial support to start a mixed gender transitional residence for 50 veterans at a VA in rural Pennsylvania, the first of its kind and now a model for other programs.

Marsha speaks for women veterans who have no voice and for those to whom no one will listen. She has taken up the sword for those who suffer or are in pain, those who can't find their way out of the box they've trapped themselves in or those who are afraid to open the door to a new life, for those who can't forgive themselves and those who forget to eat, for those nobody cares for and the ones who are lost to themselves.

We need to help them.

Joan Cook, who teaches psychiatry at Yale School of Medicine, wrote this piece as a Public Voices Fellow at The Op-Ed Project.