Independence Day can be a time to celebrate and honor those who have served in the military and helped to preserve the free America that July Fourth commemorates. There's cookouts and family gatherings and American flags and finding the best spot in the middle of the crowd to view that fireworks display just after dark.
For some veterans, however, the very things that make the Fourth of July a holiday can also make it a nightmare. According to Jim Hillman, a Carroll County Veterans Services Program Coordinator and an Army veteran, just sitting on a blanket amid a crowd at the Carroll County Farm Museum can be difficult for soldiers dealing with Post Traumatic Stress Disorder, or PTSD.
"For some of us, those crowds represent situations where you can't see everything that you need to see. There could be something bad that's going to happen and you couldn't do anything to protect yourself or your loved ones because there are too many people, too much stuff going on," Hillman said. "You get anxious, you get all wound up. It's fight or flight … it can create a very stressful situation."
It's not just crowds that can be problematic, but fireworks that can remind veterans of gunfire, insensitive questions from friends or family members, or even the martial elements of July Fourth celebrations themselves, according to Erin Romero and Erika White, both of whom are psychologists with the Department of Veterans Affairs' Maryland Health Care System and treat veterans dealing with PTSD. They said that by learning the signs and symptoms of a loved one who might be dealing with PTSD, families and friends can make sure the Fourth is not a painful time for the veteran in their lives.
A first step for both families and veterans themselves, White said, is learning about PTSD, beginning with the fact it is only the name that is new — soldiers and civilians have been dealing with the symptoms of PTSD for centuries.
"PTSD is a relatively new disorder within our nomenclature and our diagnostic system," White said. "People have only had a name for it since 1980, but it has been called different terms over the years — shell shock or battle fatigue."
PTSD's classic symptoms, which always stem from a traumatic experience, according to Romer, can include nightmares and intense reliving of memories of the trauma, heightened sense of threat from the environment, avoidance of things that remind a person of the trauma, and a constant state of physical arousal and feeling on edge.
"How we understand it is someone being stuck in a natural recovery process," Romer said. "Most people who experience trauma will have re-experiencing of that event right afterward, having nightmares and the memory [of the trauma] coming up out of the blue. With PTSD, those symptoms stick around longer and negatively impact their life and functioning."
Research has shown that symptoms of PTSD do not get better on their own, Romer said, and that the sooner a person gets help the better their response to therapy. Hillman believes it's important that all veterans and their families learn about PTSD so that they can make sure a person dealing with symptoms gets help.
"It's very important that we all understand what those symptoms are," Hillman said. "Not only does it help a soldier know that when he feels like that [it might be PTSD] … it helps the family understand that perhaps this vet needs some help."
Recognizing the symptoms of PTSD in oneself or in a loved one allows people to develop a coping strategy for the possible difficult aspects of the July Fourth holiday, according to both White and Romer. Family gatherings can be planned so that it's OK if the veteran needs to withdrawal from the group for a while, according to White. Romer said that noise-canceling headphones could be used to help diminish the sound of fireworks.
"Knowing the schedule of fireworks, not just family fireworks but those in the county, [can help]," Romer said. "Like many of us, if the veterans have an explanation, they can head off the body's responding."
Stress reduction techniques can also be helpful in preparation for the holiday Romer said.
"Most people have coping skills they have for stress … be it mindfulness, or breathing, talking to people or exercising," Romer said. "Whatever is soothing for them, make sure they do that on the week of the Fourth."
Not everyone who might be dealing with PTSD is necessarily aware that they have a problem, but Romer said negative thoughts or feelings coming up around the holiday could be an indicator of PTSD.
"For the vets who may not know they have difficulties, if they are feeling some apprehension or worry about the upcoming holiday, or anxiety or apprehension about something they cannot identify, that can be a clue," she said.
Help is available for veterans who believe they might be suffering from PTSD: In Carroll, Hillman and his colleague Jeff Collins at the Carroll County Veterans Services Program will happily connect veterans with support groups and other resources to help them get on the path to better health. The Baltimore VA Medical Center offers a Mental Health Assessment and Referral Walk-in Clinic daily, and both vets and their family members can call the Veterans Crisis Line at 800-273-8255.
It's important, Hillman said, to recognize the problem and beginning the process of treating it, rather than trying to push down the symptoms and ignore them. He's seen veterans try to ignore their PTSD for decades, only to have to one day come around and deal with it.
"The key thing that I would say you need understand is what the symptoms are, and then we all need to understand that it doesn't get better by itself," he said. "[Avoidance] works for a while but not forever. Pretty soon, you have to confront it — with help."
More information on PTSD is available at the National Center for PTSD website at http://www.ptsd.va.gov.
Veterans or their families who need help dealing with PTSD can call the Veterans Crisis Line at 800-273-8255. Veterans may also go to the daily, 12:30 p.m. Mental Health Assessment and Referral Walk-In Clinic on the sixth floor of the Baltimore VA Medical Center, 10 North Greene St., Baltimore