Geriatric Mental Health Disaster and Emergency Preparedness

324 Geriatric Mental Health Disaster and Emergency Preparedness
spectrum with depression (American Psychiatric Association, 2000). Different
symptoms of PTSD may manifest at different stages in the lives
of many veterans. Agitated depression in younger, more virile years may
manifest as vegetative depression in later years. The young, angry, and
isolated veteran often does not lose his anger but either learns to channel
it into constructive activities or becomes more deeply entrenched in depression.
While intrusive memories and nightmares continue to a lesser degree,
the geriatric combat veteran may express a deeper feeling of nostalgia.
These reminisces sometimes are accompanied by a clarification of an internal
emotional conflict around guilt and shame—guilt about things done
or left undone or shame about oneself as inadequate, defective, or weak.
Alongside these feelings is an alternative self-image of strength as a survivor
under horrible conditions. The PCL-M (Weathers, et al., 1991), which
was completed by a sample of all three cohorts at the Brooklyn VA campus,
suggests that symptoms continue over time to meet the criteria for severe
PTSD even though some symptoms are not as distressing as in the past.
Reestablishing a civilian life—including providing for a family, seeing
one’s children launched, and watching one’s children’s children grow—on
some level removes the feelings of fear, failure, and survivor ’s guilt. Ironically,
these successes, including perhaps the shock of having lived so long,
challenge the fundamental belief of a foreshortened future rather than a
happy life entrenched in a depressive symptom of negative thinking. The
ever-present question, “Was I good enough?” was aptly expressed by Private
Ryan at the conclusion of his silent journey in the movie Saving Private
Ryan (Bryce & Spielberg, 1989). Acknowledging how much time one
has left in this world lessens the mechanism of avoidance and propels the
geriatric combat veteran into a purposeful use of therapy. While such questions
are normal for the general population, most do not seek out therapy
or become increasingly anxious. For those with untreated PTSD, the shock
of retirement, the unstructured time available for reflection, and enforced
limits on daily activity due to health are a few factors that may lead combat
veterans into treatment at this stage in their life’s journey.
The impact of war, terrorism, and threats of continued terrorist activity
brings anxiety to the fore in the general population and particularly in
the geriatric veteran population. As older veterans see images of young soldiers
on the news, they feel a strong identification with their old unit and
their personal experiences. They may re-experience the anxiety and dread
of combat, and they also may grieve for those now in combat. Feelings of
helplessness, frustration, and vulnerability return. The impact of these
memories and their associated feelings is evident particularly in those vet-