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COLUMBIA – Twenty veterans in the United States commit suicide every day, according to the most recent data. But some argue that data is flawed and the real number is considerably larger.

Regardless, suicide has become an epidemic facing military men and women returning home.

Veterans face many challenges in their transition back to civilian life. KOMU 8 News spoke to several veterans and military experts who said the greatest of these obstacles is related to post traumatic stress disorder (PTSD).

The U.S. Department of Veterans Affairs defines PTSD as a health problem developed after experiencing or witnessing a traumatizing event. These trauma events can be related to military combat, a natural disaster, a car accident or sexual assault.

“About 8 million people experience PTSD in any given year,” said Dr. Grant O’Neal, a licensed psychologist at the Truman VA Hospital. “PTSD is a diagnosis that any of us could experience, given the right situation.”

O’Neal said, although anyone who experiences extreme trauma can develop PTSD, it is a particularly widespread health crisis for American veterans.

Some of the most common symptoms are invasive flashbacks, nightmares, sudden mood swings and feeling perpetually “on edge.”

The core of the issue:

David Hammer, a Vietnam veteran and spokesperson for Warriors’ Journey Home, said war often forces soldiers to make decisions in which either option would carry severe consequences.

“It’s inevitable that, if you’re in combat, you’re going to experience something that there’s no way you can have prepared for,” he said.

In other words, soldiers routinely find themselves in lose/lose scenarios.

Lt. Gen. Richard Harding said PTSD has been a consequence of every war in the last century, but it is more prominent today.

Two main reasons: the advent of consecutive combat tours and the rise of insurgent warfare.

First, Harding said, the relatively new practice of serving consecutive deployments has a profound effect on men and women in the military.

“Today, it’s different,” Harding said. “We don’t have a draft any longer, we have an all-volunteer force, and the people that raise their hand and say ‘send me,’ they go for repeated tours in the combat theater.”

Harding said the repeated “back and forth” between deployment and home is mentally taxing.

“It’s not one and your done, it’s two, three, four and five,” Harding said. “And that wears on their psyche after a while.”

Secondly, Harding said, a change in the nature of warfare has led to an increase of diagnosable PTSD.

For most of the 20th century, Harding said, battles were primarily fought in a traditional setting: two opposing sides meeting in a mutually understood field of combat.

“Warfare today, particularly in Afghanistan and early in Iraq, is more of a fight against an insurgency,” Harding said. “The enemy knows where we are, but we don’t necessarily always know where the enemy is. So, you live in that constant anticipation that you’re going to enter combat, even when you go to bed at night.”

Insurgents often employ small, guerilla forces that favor quick surprise attacks, many times in populated areas.

Harding said this constant, looming uncertainty of combat is much more mentally exhausting than more traditional, fixed warfare.

This new combat style, paired with the on-and-off nature of multiple deployments is the main reason the younger generations of veterans demonstrate more symptoms of PTSD, he said.

Hammer, however, cited a different factor as the heart of the problem. He said his greatest issue was with the U.S. military’s training criteria.

The military needs to spend as much time teaching soldiers how to live at home, as it does teaching them to kill overseas, Hammer said.

Until something changes, soldiers are going to keep killing themselves, he said.

Coming home doesn’t help:

Harding said, men and women in the military often assume, if they can just get home, their minds will heal.

“You tell yourself, ‘If I can just get home to Mom and Dad, it will all go away in a few weeks,'” he said. “That’s the human brain that’s being deceptive. PTSD doesn’t go away on its own.”

Elizabeth Powers, a recently-retired veteran who served in Iraq, Afghanistan, Qatar and Kuwait, said veterans find little relief when they leave the military. She said the transition into civilian life is abrupt, with overwhelming confusion and uncertainty.

“When you have your friends beside you being killed, and then you see your friends, when you come home, killing themselves,” Powers said. “Who do I turn to? Most of my family’s deceased. That’s when you yourself start thinking of suicide.”

Powers said too many veterans are getting lost in the transition back home, and something has to change.

Kenny Eskew, a veteran who served in Iraq and Afghanistan, said symptoms of PTSD can come on “like a light switch.” He said a veteran could appear totally fine one day, and then be gone the next.

Eskew checks in with his old platoon regularly, because he fears what they will do to themselves in their darkest moments.

“You never know if your interaction with that person is going to be their last interaction on the face of this earth,” he said.

Advice for veterans, from veterans:

Bob Bosma is a Vietnam veteran who now lives in Boonville. As a medic, Bosma found himself in many chaotic situations. He said, though he was awarded a purple heart for his physical wounds, his mental wounds went unaddressed for years.

“The reason that many veterans avoid getting treatment for post traumatic stress disorder is because of the assumption that is a mental defect, that they’re crazy or something,” Bosma said. “That avoidance makes it worse.”

Bosma and Hammer both said a major hurdle in the fight against veteran PTSD is overcoming the stigma surrounding the disease.

“A lot of veterans feel stigmatized by seeking help, so they are often reluctant to do it,” Hammer said. “It’s fairly common for veterans to start to isolate themselves, which is not a good way to deal with depression.”

Bosma said veterans need to understand PTSD is a mental illness, not a mental weakness.

O’Neal said, like with any disease, patients with PTSD will benefit from seeing a medical professional. He said veterans need to understand the importance of being proactive with their condition and must not self-medicate.

“Help is available, treatment is available,” O’Neal said.

He said, in addition to the Truman VA Hospital on MU’s Campus, the VA also has eight community-based outpatient clinics across Missouri.

In addition to seeking professional help, Hammer said veterans should connect to fellow vets, which can create a vital support structure.

“You will never get the comradery that you do in the military, anywhere else,” Eskew said. “Staying in contact lets them know that you still remember them, and each one of them has a place with you.”

Hammer said confiding in a fellow veteran has powering healing effects.

“Seek help,” Hammer said. “Find and build a community around yourself, people you can trust and talk to. The first part of healing that’s really essential, is telling your story.”

Hammer said his organization, Warriors’ Journey Home, brings veterans in the same area together so they can establish a local community of support and encouragement.

Harding said Welcome Home, Inc. employs a similar strategy. He said veterans work well in collaborative environments where they know their burdens are understood.

“They need to stay shoulder-to-shoulder with their brothers and sisters in arms who have already transitioned back into civilian society,” he said.

Hammer said veterans need to understand their symptoms will not go away with time or avoidance.

“Realize that you can’t change it,” Hammer said. “You can’t change your past by wishing for a different one. Learn to cope with it and move on.”

Bosma said, even after years of treatment, he still lives with his condition.

“The nightmares are still there,” he said. “The memories are still there. Certain days in Vietnam that were very traumatic still come back to me. Things that creep into my life uninvited at times.”

Despite this, his effort has been worthwhile.

“The process of getting help actually makes life better. It’s worth doing it, even though it may hurt in the onset; in the long run it’s good therapy.”

Advice for civilians:

Though the decision to pursue healing is ultimately up to the veteran, there is much that can be done by civilians to assist veterans in need.

Hammer said it all begins with education.

“Educating the public is something that’s very essential,” he said. “It’s a topic that a lot of people just aren’t comfortable with. And since veterans aren’t comfortable talking to someone who’s skeptical or doesn’t understand, we don’t have the two-way exchange between those who are coming home and those who sent them.”

Hammer said a lack of education greatly contributes to the toxic stigma surrounding PTSD and moral injuries.

“I’m not so sure that a lot of civilians truly understand what the veterans have gone through,” Hammer said. “I think that it’s such an uncomfortable thing for everyone to deal with, that, for most people, people just don’t know what to say.”

Eskew said even well-meaning civilians can often make things worse for veterans.

“A lot of people, the first thing they ask when they find out that you’re a veteran is, ‘Well, did you go to war?”‘ Eskew said. “And if you say ‘yes,’ then they want every little detail of what you did when you were there. It makes it hard. Because you don’t want to talk about it, but you also want to do the best that you can to not be rude.”

He said there’s no way for civilians to truly understand what combat is like. So, instead of asking questions, it’s better to just listen.

“Whenever you’re talking with a veteran, the biggest thing is don’t try to pry for information,” Eskew said. “There’s a whole lot of stuff that we can’t talk about, or we don’t want to.”

Eskew said, civilians don’t need to pry for answers to show they care. He said the best thing is to just offer small gestures of encouragement.

“Check in on them,” Eskew said. “You don’t have to bring up the past or anything like that. But, it’s amazing what a simple phone call, text message or Facebook message or whatever out of the blue, that could be the turning point for them.”

Hammer said, if someone wants to help, they should educate themselves on the true nature of PTSD, and take the time to get to know a veteran.

“My advise would be, to the civilians, read up a little bit,” Hammer said. “Find out what PTSD and moral injuries are, and get to know a veteran in a non-judgmental way.”

Harding said federal services like the VA Hospital are very important for veterans. However, he said, it’s the local community that bears the single greatest responsibility.

“Community involvement is what gets us across the finish line,” Harding said. “The other governmental agencies, sure, they get us down field, but if you want to score, you’ve gotta involve the community.”

Powers said she has experienced wonderful community support, and for her, it has made all the difference.

“I know I have always appreciated the handshakes, especially as a woman veteran,” she said. “The support has been phenomenal.”

Powers said, as a veteran who is currently homeless, that compassion gave her hope.

“I know veterans truly appreciate your support,” Powers said. “Because if it wasn’t for you, I don’t know what would have happened.”

To donate to homeless veterans in Columbia, contact Welcome Home.

To learn more about PTSD, and how you can help veterans, check out this reading list by Warriors’ Journey Home.