“ … So, I grab my shotgun and brace my foot against the bedroom door… and I start hollering, ‘I know you’re out there. I’m gonna shoot you!’ And they just stand still, like, ‘Oh, it’s just some girl. She’s not gonna do anything,’ right? … So, I’m hollering. My voice is getting hoarse, and finally I say, ‘I’m gonna shoot you,’ and I chamber a round into my shotgun. As soon as I do that, I hear them run through the vertical blinds to my patio.”
Laura Stephens pauses for her umpteenth drag off a cigarette and flicks ash onto a growing gray pile in a glass ashtray on the coffee shop’s patio table. Her hazel eyes sparkle as she tells of the midnight robbery at her Henderson apartment.
“They were lucky they ran out, because I would have shot them and had no problem with it,” Stephens says, raising an eyebrow slightly. She rattles off what the thieves managed to steal anyway. “That was very traumatic for me,” she says.
Trauma has become part of Stephens’ life, a phantom roommate to replace the ex-husband and the daughter she now sees only during custody visits. After two tours of duty in Iraq as an Army medic, she came home with severe post-traumatic stress disorder, or PTSD. Department of Veterans Affairs doctors have declared her 70 percent disabled and 100 percent unemployable. Smoking isn’t the only reason Stephens sits outside. In the small, half-filled coffee shop, she’s likely to suffer a panic attack. To her, it feels like too many people, too many unknowns, and nowhere to hide.
This is a textbook case of PTSD—a condition that affects people who have experienced great danger and an accompanying sense of helplessness or horror. In the aftermath, the disorder can cause flashbacks, emotional withdrawal or hyper-arousal. These states, in turn, can lead to agitation, insomnia, irritability, paranoia and many other problems.
Research suggests medics are among the military personnel most commonly afflicted with the disorder, and more women—civilians or military—have it than men. The reasons seem to be contextual: Medics, for instance, are regularly confronted with gruesome death. Stephens recalls holding a friend mortally wounded in combat. Unable to do anything to help, she just watched him die.
Every story, every case of PTSD is unique, but there are more Laura Stephenses out there than you might think. The disorder is a growing public-health problem, suggested by a 35 percent rise in the number of veterans receiving mental-health services since 2007.
And it’s a national problem with strong local resonance. Nellis and Creech Air Force bases are out of sight, out of mind for many Las Vegans, but this is a military town. Nellis employs a workforce of 9,500 and counts a total military population of 40,000. Nearly a quarter-million U.S. veterans live in Nevada, including 66,500 who served in recent wars, from Desert Storm through Iraq and Afghanistan. The VA estimates that 10 percent of men and women who served in the Gulf War and Afghanistan have PTSD, and 20 percent of those who served in Iraq do.
“This is a big issue,” says Dylan Wint, a neurologist and psychiatrist at Las Vegas’ Cleveland Clinic Lou Ruvo Center for Brain Health. It could, he says, be the second-biggest problem—after Alzheimer’s—that professionals in his field face. (Wint spent two years working at a VA hospital in Gainesville, Fla., and half of his University of Florida residency focusing on psychiatric problems in veterans.) In addition to the high volume of cases, he says, problems stem from the disorder’s unpredictability. Symptoms may emerge any time from a few months to several decades after the trauma; elderly veterans still show up at medical centers seeking treatment for sudden bouts of sleeplessness, uncontrollable crying and other effects of experiences as far back as the Korean War, when PTSD was still called “shell shock.”
The disorder is hard for laypeople to understand. This can have tragic consequences, as in the case of Stanley Gibson, a disoriented Gulf War veteran who was shot to death by Las Vegas Metropolitan police in December 2011 when he, according to reports, didn’t respond appropriately to their commands. The profoundness of that tragedy is matched by the day-to-day struggles of victims and their families. Last summer, the Institute of Medicine of the National Academies released an initial assessment of treatment for PTSD in military and veteran populations. It reported that veterans with the disorder have higher incidences of domestic violence, divorce and aggression than those without it; they also have higher rates of underemployment and unemployment. Post-traumatic stress is associated with drug abuse, alcohol abuse, anger and aggressive behavior.
Beneath the community and family tension, there’s the individual pain. A study published in the July issue of Injury Prevention found that suicide among veterans is on the rise, increasing 80 percent from 2004 to 2008. Researchers noted a correlation between suicide and mental-health issues, including PTSD; 40 percent of the suicides in 2008 were linked to combat in Iraq and Afghanistan.
Everyone agrees that soldiers such as Laura Stephens, who put their lives on the line to defend our country, deserve to be taken care of when they come home. But is Las Vegas doing enough to help those who are suffering in our midst?
Learning from its failure with traumatized Vietnam soldiers, the VA made dramatic changes to provide better care for the 2.4 million men and women who have served or are serving in Iraq and Afghanistan. It has set up crisis lines and 300 centers across the country that offered mental-health services to 1.3 million veterans in 2011. It has a separate call center dedicated to teaching friends and family how to encourage vets to get help. The government is pouring millions of dollars into research and treatment for mental-health issues of its military service members.
The hub of public assistance for local veterans is the VA Southern Nevada Healthcare System, which includes the new $600 million, 1.3 million-square-foot hospital on North Pecos Road. The 90-bed facility offers treatment for mental health, along with inpatient services, surgery, clinical support and other programs. It also has a 120-bed nursing home.
Besides the hospital, the VA operates five primary-care clinics, four specialty clinics and a handful of other facilities—such as a center for women’s health and one for the homeless—throughout the Valley. The Las Vegas Vet Center on Jones Boulevard and Sahara Avenue offers counseling services for combat veterans and their families.
Despite the improvements, the VA is still falling short in reaching all former soldiers with PTSD. The Institutes of Medicine study found that treatment was only received by a little more than half of the U.S. service members and veterans who served in Iraq and Afghanistan and have been diagnosed with the disorder.
Jacqueline Casey, a Kuwait and Iraq war veteran living in Las Vegas, says she waited as long as six weeks to get appointments when she looked to the VA for help with her PTSD in 2008. She ended up finding a therapist outside the system.
Part of the problem is a local shortage of mental-health professionals trained to deal with PTSD, says Dr. Lesley Dickson, a psychiatrist who has worked with Veterans Affairs throughout her career. Veterans prefer clinicians with some military background, and there are even fewer of those.
In March, the VA began hiring 1,900 new clinicians and support staff nationwide specifically to deal with mental-health cases, but only 26 of those positions are for Las Vegas. Even if enough personnel were hired, Dickson says, the Valley would not have the space for them to work. Of the new hospital’s 90 beds, only 22 are in the mental-health unit.
The VA designates certain facilities for certain specialties, and Las Vegas is not funded for research and development related to PTSD, according to psychiatrist Ramanujam Komanduri, the VA Southern Nevada’s chief of staff. He says local patients who need intensive or long-term care are usually referred to facilities in California.
Another problem is the city’s lack of a medical research university, which would help support robust research programs. The cutting-edge work, Dickson and Komanduri say, is being done at VA-affiliated university hospitals in cities such as Los Angeles and San Diego.
One remarkable example of forward thinking in the West is Dewleen Baker’s research on risk and resiliency. Baker, a doctor at the VA’s Center of Excellence for Stress and Mental Health in San Diego, is studying 4,000 Marines to learn why, after being exposed to the same situations, some combat veterans get PTSD while others don’t. A dozen other studies are under way at the San Diego VA as well, including research on the usefulness of telemedicine, therapies for older veterans and treatment during combat.
The center’s work has resulted in the VA’s widespread adoption of two treatments: cognitive processing therapy and prolonged exposure. Skilled in both, San Diego VA psychologist Carie Rodgers is part of a team traveling around the country, including Southern Nevada, to train other providers in the methods. She describes it as the nation’s largest-ever organized effort to train psychotherapists.
“In cognitive therapy, what we do is figure out what they’ve been telling themselves that makes them feel so rotten and teach them how to challenge their own thinking,” Rodgers says. This method helps patients become aware of what they’re thinking and how it impacts what they feel.
Prolonged exposure is more action-oriented. Say, for example, a vet was traumatized by a roadside bomb explosion and is now afraid to drive. Given that driving is pretty safe in San Diego, Rodgers might send that vet out to drive. If it triggers anxiety, then she would have him talk about the details of the traumatic memory repeatedly, so he can process the feelings and lose the fear.
Therapists are also experimenting with nontraditional approaches. For instance, eye movement desensitization and reprocessing uses controlled eye movements to shift thoughts and feelings from one side of the brain to the other. Another method, hypnotherapy, helps patients relax sufficiently to let down the psychological barriers preventing them from confronting and resolving their trauma.
Meanwhile, yoga, meditation, acupuncture and similar Eastern practices are getting a lot of attention as tools for dealing with symptoms such as sleeplessness, hyperventilation and difficulty focusing. “When I couldn’t see my therapist all the time at the VA,” Jacqueline Casey says, “they would at least send in a Shaolin monk to do tai chi with us.”
Another local Iraq war veteran, Christian Gabriel, tried many styles of therapy and found them annoying. He learned to cope with his depression, drinking binges and sleeplessness through painting and sketching. Now a successful artist, Gabriel is helping set up an art therapy program at the VA hospital.
Of course, PTSD is not just a scientific, or even medical, issue. It’s a community issue. Several nonprofit programs are striving to fill gaps in the VA’s available care. The Veterans Consumer Advisory Council connects vets, their families and caregivers with the mental-health support system and advocates for better service from the VA and other providers. The Regional Transportation Commission of Southern Nevada, meanwhile, has created a special bus line to the new VA hospital and offers reduced fares for veterans.
The influx of veterans returning from Afghanistan continues, and the VA predicts that the number of new PTSD cases will keep growing. The availability and sophistication of PTSD treatment in the Valley will have to grow with it.