By Rich McManus

On the Front Page...

The American West, which once gained a reputation as wild during frontier settlement, is earning that title anew as surprising portions of its reservation-based populations struggle to cope with the sorrows brought on by PTSD — post traumatic stress disorder — much of it a sequel of military service in Vietnam and other traumatic events.

Continued...

So explained Dr. Spero Manson, professor of psychiatry and head, American Indian and Alaska Native Programs, University of Colorado Health Sciences Center, Denver, in his talk, "Wounded Spirits, Ailing Hearts: The Legacy of PTSD Among American Indians," given Nov. 12 in Masur Auditorium.

After warmly greeting the audience in the tongue of his native Chippewa Pembina tribe, Manson presented results of two major NIH-funded studies conducted during the 1990s showing that American Indian populations in both the desert Southwest and Northern Plains suffer higher incidence of trauma, thus elevating their risk of PTSD, than do either white populations or other large minorities such as blacks and Hispanics.

Dr. Spero Manson (l) of the University of Colorado Health Sciences Center meets with NIH director Dr. Elias Zerhouni in Masur prior to Manson's talk.

He punctuated the lecture with a variety of video segments in which Vietnam veterans and their loved ones recount — with hollow-eyed desolation — bouts of depression, nightmares, flashbacks and inability to experience normal emotion. Factor in the poverty of the reservation, its few cultural resources and the enormous distances between population centers, and the result is a landscape desperately in need of healing.

Manson, a medical anthropologist who has enjoyed more than 25 years of NIH support, reported that, nationally, around 6 percent of men and 10-14 percent of women experience PTSD at some time in their lives. PTSD is an anxiety disorder, the consequence of witnessing extremely traumatic events such as war, violent attack, catastrophe and abuse. It is characterized by emotional numbing, hyperarousal, flashbacks to the precipitating event and intrusive negative emotions. Between 30 and 40 percent of those who are exposed to trauma go on to develop PTSD, Manson said. As one ex-GI described it, "Something's wrong, something's missing. You feel guilty, angry, horrified. I can't seem to shake it. It's one of those things that's always there."

Said another Vietnam vet, "What we believed in [from our upbringing] wasn't what we participated in...Things just didn't add up. I was taught to be brave, unafraid. Now I'm afraid all the time, of things that have happened. I am tired of doing the PTSD shuffle."

The first study Manson described was the American Indian Vietnam Veterans Project, mandated by Congress in 1990. "That study found that PTSD is a highly prevalent and definable disorder in this population...and that the United States is not equipped to cope with it." The total study sample was 621 individuals, roughly half from the Dakotas and half from the Southwest. "The PTSD prevalence rate was significantly greater [in the study population] than in their white counterparts," Manson said, "or in blacks or Hispanics." Some 30-35 percent of American Indians are veterans, compared with a national average of about 11 percent.

Exposure to combat turned out to be the most powerful predictor of PTSD. Manson stressed that it is the environmental exposure to trauma, not one's intrinsic cultural identity, that predisposes a person to PTSD. As evidence, he cited an inner-city Detroit study that found the same high prevalence of PTSD.

When the data got a bit dry, Manson segued to video footage: a woman recounting in horror the transformation that occurred in her sleeping husband when he awoke from a nightmare, grabbed her and slammed her to the floor, not realizing that she was a loved one, not the enemy. One man, wearing a Vietnam vets ballcap, admitted, "When I hug my kids, there's a barrier that I can't get through...I think they sense it sometimes."

"PTSD is an extremely isolating illness," Manson explained. "The victims are irritable, they can't take crowds, they are easily startled. The daily consequences are dramatic."

Further, victims' sense of self is ruptured, Manson said. Relationships suffer as patients remove themselves from the social fabric that could help sustain them.

The two most prevalent forms of government care, Manson continued, are Public Health Service/Indian Health Service hospitals and Veterans Administration facilities; the former are relatively close by, often built on reservations, while the latter are usually at some distance. Nevertheless, Manson showed, VA facilities are more often used when patients are worried about issues of stigma or confidentiality. As one person told him, "I'd rather be thought drunk than crazy."

As a result of Manson's studies of help-seeking behavior for a variety of problems including physical complaints and ADM (alcohol, drugs, mental health) difficulties, the VA has adopted a policy of reimbursing clients for traditional healing services, he said.

The second large study Manson described — the Cante Waste Oyate and Shandiin Project, a study of the "epidemiology of trauma exposure" — was also funded by NIMH and data were collected in the late 1990s from a larger study sample of some 3,100 subjects from the same two areas — desert Southwest and Northern Plains.

The newer study shows that in subjects ages 15-54, the lifetime exposure risk of witnessing at least one traumatic event was 60 percent in the Southwest and 70 percent in the Northern Plains. This compares with an average lifetime exposure prevalence of 61 percent for men in the U.S. and 51 percent for women. So in American Indian country, the women's risk is about as high as the men's. "Indians experience trauma and its aftermath more often than the U.S. as a whole," Manson said.

He and his colleagues are now looking more aggressively at "therapeutic dynamics" for PTSD, and "how to stage the healing process." Manson is using such technologies as "telehealth and tele-education" to reach people in distant locales, and has sponsored videoconferences on the topic of PTSD. Lately his team is finding that PTSD may add to risk of coronary heart disease incidence. He left the audience with the metaphor of an American Indian healer who used his ponytail braids to illustrate the difficulty of treating traumatized individuals: the healer began unstringing his braid, one strand at a time. "This strand represents the mind, the next represents the body, and the third, the spirit. How am I going to bind these all up into a single strand again?"

Manson said his studies of PTSD are only going to become more germane as the U.S. copes with the aftermath of 9/11 and prepares to welcome back its veterans of the Iraq War.