Geriatric Mental Health Disaster and Emergency Preparedness

336 Geriatric Mental Health Disaster and Emergency Preparedness
Subjective experience of PTSD: 90% of WWII, 80% of Korean War,
and 80% of Vietnam veterans reported exacerbation of PTSD symptoms
since 2001 (Veterans Affairs, n.d.).
We have continued to provide an annual psychoeducational session
and open discussion with each of the cohorts around the issues of safety
planning. The beliefs and fears about future acts of war or terrorism are often
the content of the group process. The results of a survey conducted in
2009 indicate that a significant number of veterans continue to meet the
criteria for chronic and severe PTSD. These results suggest that for the
population of geriatric combat veterans diagnosed with chronic and severe
PTSD, most of whom were in treatment prior to September 11, there is
marginal qualitative change in their beliefs and behaviors. As was stated
previously, incremental gains are understood as improvement in this population.
The combat veteran in general may subjectively experience an increase
in symptoms of PTSD even after 50 years and participation in therapy
(Schnurr, 1994). The veteran, as well as his or her family members and
health care provider, may note increased anxiety in the face of the current
global situation. This particular population may be more profoundly affected
by such changes, which may manifest as an exacerbation of a preexistent
condition that may or may not have been diagnosed and treated.
For some within this population, a belief that was either left unspoken
or said in hushed tones in the sanctuary of the clinical office has come
to haunt them. That belief, born of fear or guilt or shame, is that somehow
war has followed them home—it is here now. The inner battle they have
lived through personally on a daily basis is matched externally in world
events. The enemy within exists externally, and both are beyond their
control.
Suppressed feelings of helplessness and powerlessness surface and
require attention. These veterans also express specific hopes that civilians
will better understand at least some parts of their wartime experiences
and treat them with more compassion and less criticism. This desire to be
understood and received applies to their own families, many of whom
have reacted to the veteran’s behavior without fully comprehending its
origins or meaning. The desire to be understood and accepted is indisputably
fundamental to all human beings, and it is no less true of combat
veterans. Finally, many see the present situation as an opportunity to confirm
the values they acquired in combat: there are some things worth fighting
for and worth the cost of peace of mind. But many, although they