Geriatric Mental Health Disaster and Emergency Preparedness

318 Geriatric Mental Health Disaster and Emergency Preparedness
citizen-solider/veteran and citizen provider, created an opportunity for
the veterans to apply Shakespeare’s words from King Henry V, Act 4,
Scene 1—“teach others how to prepare.”
Just as New York City and the United States have adapted to the realities
of a post–September 11 world, so too geriatric veterans have adapted.
While they often re-experience feelings of vulnerability as a result of
September 11, veterans are utilizing what they learned on the field of battle
and in therapy. Many veterans who are in therapy for PTSD at our
Brooklyn VA Hospital PTSD program have chosen a path of healing. This
path requires them to accept rather than deny their actions or inactions
during war. Combat veterans on this path progressively learn to recognize
their maladaptive avoidance behavior and to examine their beliefs
about their actions. This process teaches veterans to challenge faulty thinking
about the past that supports irrational core beliefs about themselves.
The end result of this process is a more realistic self-image. Combat veterans
are able to access valuable life lessons to live by and to pass on to
others, lessons previously inaccessible as a result of their avoidance of the
traumatic material.
The events of September 11 functioned as the touchstone in reshaping
the framework of therapy with geriatric combat veterans diagnosed
with PTSD. In our work, we speak of healing rather than cure, symptom
reduction rather than remission. A person may heal from the most painful
and debilitating aspects of trauma, but inasmuch as the memory lingers
after the level of distress has been reduced significantly or neutralized,
the person lives with the trauma. The memory of a lived event cannot be
excised from the mind, and so cure is not a fitting concept to apply. Similarly,
PTSD symptoms as subjectively experienced and objectively measured
may be reduced with therapy to a subthreshold level for combat
trauma.
INTRODUCTION
This chapter introduces the reader to three generational cohorts of older
American veterans. The similarities and differences among these three cohorts,
as well as the hopes and values characteristic of each, are discussed.
The purpose of this chapter is to offer the reader a basic impression of
this population as seen through the lenses of clinical observation and experience
rather than of research. There is a small but excellent body of research
on these three age cohorts conducted by the National Center for