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Kent and Conroy say they sometimes have to resort to tough words to get patients up and practicing another day.

Conroy knows that the soldiers’ injuries extend beyond the physical.

‘I’m not crazy’

“Not only are they coping with the loss of limbs but also with the effects of being in a war zone and how that’s played on their minds,” she says.

Some suffer from post-traumatic stress disorder, but don’t want to admit it for fear of being stigmatized, she said.

Although some of the stigma has lessened since Vietnam War veterans made the disorder more well-known, many still do not seek treatment for fear of hurting their career, says Paula Rose, RN-C, a mental health nurse.

Still, she has seen the newest veterans much sooner than veterans from past conflicts, and that has made a difference in rehabilitation. The disorder is better known and soldiers, their families, and the military more quickly recognize when a patient needs help. Soldiers from Iraq have not yet had time to develop the destructive adaptive behaviors to deal with the disorder that Vietnam veterans have, she says.

Rose also works within an interdisciplinary team at the San Diego Vet Center, one of 206 centers that treat veterans suffering sexual trauma or post-traumatic stress disorder referred through the VA in outpatient settings, like a strip mall storefront rather than a hospital. Originally a grassroots peer support movement started by Vietnam veterans, the centers became authorized and professionally staffed in the 1980s, Rose says.

The psychologists, nurses, and therapists treat clients from a range of ethnic and economic backgrounds, but they all exhibit the same symptoms: irritability, rage, hyper-startle reactions, a numbing of emotions, and a physical flashback to the original trauma. Many isolate themselves, feeling more comfortable at home. Some isolate themselves emotionally because they are so fearful of losing people they love.

“I call it a symphony with variations on the theme,” she says. “You always know what the melody is, even if it’s played by different instruments or at a different tempo.”

Because the conflict in Iraq is ongoing and has prominence in the news, in political debates, and in conversation, veterans of the war can experience stressful associations, Rose says.

Rose starts by securing a patient’s trust, then moves on to the education portion of her job: demonstrating through literature and studies that the reactions these veterans are having are the textbook reactions of people suffering from PTSD, she says.

“There’s a sense of relief, of ‘I’m not crazy,’” she says.

Breaking through to patients to provide that sense of relief is the challenge faced by nurses and others in the field of rehabilitation. Finding out exactly what each patient wants and needs can be tough because soldiers are trained to set their feelings aside to do the job they’ve set out to do, Kent says.

“Sometimes it’s hard to get out of that he-man mode and say, ‘I have a problem,’” she says. “You have to have a rapport with them that allows them to talk to you and express their needs.”

The sooner a nurse can break through the shell, the sooner rehabilitation begins, and all nurses agree that time is an important factor in a patient’s success.

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