It was recorded in ancient Greek and Roman literature. In the 1600's a Swiss physician coined the term "nostalgia" to refer to soldier's conditions. Soldiers returning home from the Civil War were said to be afflicted with "soldier's heart" and "exhausted heart." After World War I doctors started using the words "shell shock." By World War II, they were using the terms "battle fatigue," "combat fatigue" and "gross stress reaction." In 1946 a U.S. Army-funded documentary, Let There Be Light, followed 75 soldiers with "psycho-neurosis" who were being treated at a psychiatric hospital. After seeing it, the military banned the film and it was declassified. In the 1950's, when the first Diagnostic and Statistical Manual of Mental Disorders, the encyclopedia of psychiatric terms used by professionals, was published, the condition "gross stress reaction" was used to describe the condition combat soldiers returned home with.
And that's where things were in the mid 1960's when Dennis Hughes got his draft notice. He was a recent Schenley High School graduate.
"I was a young kid, 18, about to turn 19, so I wasn't ready for that," he said.
He spent more than a year in Vietnam.
"They tried to overrun the base camps. That was one of the worst sights I encountered, and sure, I was scared to death, because they were overrunning those camps … and I can see it as though it was yesterday," he said.
Less than a week after coming home, he was working and trying to live as normal a life as he could. He says it was what he was told was the right thing to do, but he struggled.
"Once you're in a combat zone, you're never the same. They do various things — a lot of them mask what they have seen, whether it's alcohol or drugs, because at that time, people didn't want to hear nothing about … so when you went to Vietnam, that was the attitude people got. They were calling us 'baby killers' and all that kind of stuff, and here we are thinking we did the right thing and we've got to come home and be confronted with these situations," he said.
But despite his outward and inward struggles, it wasn't something he talked about. It wasn't something people talked about, not in the military, not within most families, not openly with other veterans. Even if they did talk about it, there wasn't a proper diagnosis for them. The medical diagnosis that is used now — post-traumatic stress disorder (PTSD) — wasn't included in the DSM literature until the 1980's. It wasn't until then that Dennis Hughes says he got his life together — and it wasn't until the 1990's that he found care at the VA. Now he sits on local and state committees and runs support groups.
"By me being a vet, we tend to feel what they're feeling even if it's a different time and a different place," he said.
While the struggles of Vietnam-era veterans have been continuously documented and the diagnosis of PTSD continues to be revamped in the soon-to-be-published new version of the DSM, there is a new generation of veterans coming home that are struggling.
There are myriad problems. Stigma still exists. In 2005, there were 14,000 mental health professionals at the U.S. Department of Veterans Affairs. Now there are more than 21,000. That may not be enough. With two lengthy combat-heavy conflicts, there is a shortage of specialists to help with cases of PTSD and other disorders, such as combat stress or adjustment disorder. Even though President Obama increased mental health funding to the VA from $5.2 billion in 2011 to $6.2 billion in 2012, it just may not be enough, not to mention not every veteran wants to or can access the VA easily and effectively.
Among the measures the military has undertaken include preventive measures, such as sending behavioral health specialist and social worker Lt. Col. Tom Stokes to Afghanistan. He's been in the military for 30 years.
"Combat stress units have been around for years, but more recently have taken on a more significant role and have been more accepted in the military community. It's not what it was 20 or 30 years ago. With more operational stress, more combat stress, multiple deployments, there seems to be more of a need and acceptance for the combat stress units," he said.
From April 2010 to May 2011, he was deployed to the Pakteer region of Afghanistan with the US Army Reserves where he traveled to austere regions to intervene with people who were suffering from combat stress or operational stress. He now works at the VA in Pittsburgh.
"When you come back home you don't have a combat stress unit, you don't have a Lt. Col. Stokes coming out to you, it's up to you to seek treatment, to seek what you need to do to readjust, in a healthy way. And that's where the problems occur, beccause you come back here, and I can speak from experience, you can feel rather anonymous and lonely and isolated," he said.
Although he wasn't necessarily in combat, he said he too had his own struggles when he returned to the United States.
Because of the extremities of the wars, Stokes said returning to a civilian life is especially difficult, and because of multiple deployments, in many situations, it almost doesn't make sense to the soldier to turn it off if they know they might get sent back. In some cases, people get a PTSD or other diagnosis between deployments, and go off to serve another tour with the same symptoms.
"It's hard to turn that adreneleine off when you come back, too, because it's very high for very long periods of time, and it's hard to turn that off, so where does a person turn? Where does a soldier turn?" said Stokes.
That's the issue Michael Zimmerman was facing when he came home from a deployment in Iraq in 2004. He had joined the Marines while he was still in high school four years earlier. He worked as a specialized electronic technician and a prison guard.
"We got bombed a lot. We got rocketed. A lot of the airplanes I was on took small arms fire, AK 47's, and at one point I was maybe a half hour outside an RPG attack and, as an enemy prisoner of war detention guard, would go on the prisoner transfer convoys between a localized detention facility and the Abu Ghraib prison, so we took fire a couple of times," he recalls.
When he came home, he had problems, problems he said started while he was serving. He had trouble sleeping, was jumpy and had quick reactions.
He didn't want to do much, and when he tried to do "normal" things such as go on dates, he couldn't go to anything with say, fireworks. It brought back too many memories.
"I was really removed from the military element and I really felt no connection, I didn't have friends, I couldn't make friends, I had a really hard time connecting and I didn't like it," he said. "I didn't know what to do but I didn't like it, so that's what tipped me over to go and get help."
He had some struggles with the VA, waiting months to get mental health treatment, years for a disability claim to go through, and a complaint filed against a psychiatrist who showed insensitivity. But he has also made great strides: he no longer has trouble sleeping and has been treated for adjustment disorder. Getting to where he is now, he says, wasn't easy.
This spring, Zimmerman will graduate with his masters in social work. He's interning at the VA and Allegheny County's veterans court, and lives in a well-tended house with his wife, a rescued greyhound and a new baby. By all measures, he's doing well, but as a member of the National Guard/Army, he could get deployed again.
"It's still kind of scary," he said. "I think that my previous deployment and training and the de-escalation tricks and tools I've learned through going to therapy at the VA make it a little less frightening, I know that I'm still an electrician, I won't be in a firefight, but there is always that opportunity that there would be a stray rocket or mortar or for that matter, I get volunteered out to be a prison guard again, but I'm more hopeful that's not going to be the case."
One of his hopes is that as a social worker who is a veteran he'll be able to fill a void: that of being a veteran who knows what another veteran is going through.