Combat can wound the mind as well as the body. In some cases, when the physical wounds have healed, emotional and mental pain remains, sometimes increasing with age.

According to Leslie Schaeffer, Support Services Manager, Bereavement and Veterans Coordinator with Bethesda Hospice Care, aging combat Veterans describe hiding painful thoughts, emotions, and images in what they call a “mental lockbox.” “When they come back home from combat, they try to settle into a normal life of finding a job and raising a family,” Leslie says. “Often they don’t want to think about, much less talk about, their combat experiences.”

Then, she says, when the Veteran reaches retirement and life starts slowing down, some of these memories can start to resurface. “Some can integrate their war experience into their life through acceptance or finding some resolution for things that cannot be accepted,” Leslie says. “For others, it’s not so easy.”

Post-Traumatic Stress Disorder

Amid the horrific memories of combat, one source of debilitating emotional pain is called moral injury, which results from performing an act in combat or failing to prevent an act that goes against the soldier’s personal values or ethics. “This can make a Veteran question his or her basic values and belief systems,” Leslie says.

Leslie also notes that military training emphasizes mental toughness and stoicism, meaning that soldiers don’t complain about or acknowledge emotional pain. Denying its existence doesn’t cause it to go away, and often will express itself in deep depression and anxiety called post-traumatic stress disorder (PTSD).

”PTSD changes how the brain processes and responds to information and events,” Leslie says. ”It can trigger nightmares, flashbacks, and feelings of constantly being on edge. This is taxing physically, mentally, and emotionally.”

There are many symptoms associated with PTSD, including:

  • Feeling on edge all the time
  • Repeated angry outbursts
  • Nightmares and flashbacks of traumatic events
  • Sleeplessness
  • Feelings of guilt or shame
  • Being easily startled
  • Loss of interest or pleasure
  • Distancing oneself from others
  • Difficulty focusing
  • Fatigue
  • Major weight changes
  • Feelings of worthlessness
  • Aggressive or reckless behavior
  • Self-medicating with alcohol or drugs

The Stigma of Vietnam

Compounding the problem of PTSD for a Vietnam Veteran is the disrespectful way these Veterans were often received when returning home from the conflict.

“Many of these Veterans would change out of their uniforms before landing in the U.S. and leaving the airport,” Leslie says. “Some would deny that they had fought in Vietnam to avoid being questioned about or abused for their service. This heightened their sense that they couldn’t share what had happened to them in combat.”

The Importance of Knowing the Veteran’s History

The above context is important for professional counselors and therapists, as well as family members, to know when trying to help a Veteran with depression.

According to Leslie, medical professionals are now focusing on identifying Veterans who may need help by asking when and where they served in the military. “The vast majority of Veterans are not going to ask for help,” she says. “Therefore, we need to know something about the history and conditions of the conflict they fought in so we can draw them out. This enables us to find out much earlier if we need to start screening the Veteran for depression.”

Treatments for Depression in Veterans

Leslie says the best evidenced-based professional treatment for Veterans with severe depression is a combination of medications and cognitive behavioral psychotherapy that identifies the negative thoughts and beliefs a Veteran feels and then replaces them with positive, healthy thoughts, which in turn produce positive experiences and emotions.

The support of family members is crucial in treating depression in Veterans. “The family can provide a window of opportunity for their Veteran to talk about his or her experiences,” Leslie says. “Just ask them, ‘Is there anything you want to talk about? Anything troubling you about your time in service?’” She says the tone should be undemanding, and it should be clear that the Veteran has an accepting environment to share what he or she is feeling.

Leslie also encourages Veterans to talk to other Veterans, citing VFW and American Legion posts as good sources for sharing. During the COVID-19 pandemic, family members of Veterans can contact a local post of one of these organizations to discover what support is being offered while still providing for the safety and health of their Veteran loved one.

If you or your senior loved one need extra support, contact us to learn how our St. Louis-based senior care communities and in-home services are helping senior Veterans.