The word "PTSD" had barely left the mouth of Fort Hood's commander late Wednesday when, across the nation, many veterans with those symptoms and doctors who treat the malady understood they faced a renewed battle: a resurgence of the stigma that comes with that diagnosis.
The Fort Hood tragedy -- 16 wounded and four killed, including identified shooter Ivan Lopez, a soldier being evaluated for PTSD -- is precisely the type of event that makes combat veterans cringe. Many worry they'll be further mislabeled as dangerous time bombs, as the next to snap, and that post-traumatic stress will again be misrepresented and misunderstood as a condition that sparks public, violent outbursts.
"That is not what post-traumatic stress is or what it does," said Ingrid Herrera-Yee, a clinical psychologist in the Washington, D.C. area who treats veterans diagnosed with Post Traumatic Stress Disorder and other mental health issues as well as their family members and civilians. Her husband, Army National Guard Staff Sgt. Ian Yee, spent three combat deployments in Iraq and Afghanistan.
"Yes, there is anger and irritability (associated with PTSD), but it's usually internalized. You're more likely to see it as someone who is withdrawn, anxious and numb, who's lost interest in life. Some veterans explain it to me this way: 'The last thing you want is to go out and lash out," said Herrera-Yee, adding: "Just like any victims of a trauma -- rape or domestic violence -- they can become fearful of their surroundings, but they're not going to react angrily toward their surroundings. For them, it's all about avoidance."
For years, Pentagon brass and branch commanders have urged troops and veterans to seek mental-health help if they feel the need, while repeating the message that, if they do see a doctor, they will not be viewed as weak but as strong. That campaign seems to have finally dented the macho-military mantra that every soldier can handle his or her own business. Many veterans are turning to doctors to begin addressing post-service anxiety issues, often fueled by repeated or long deployments.
But they usually do it quietly and privately. PTSD still seems to carry an unspoken social scar, veterans say, and it is still largely misunderstood by many civilians.
"This is very taboo and many vets feel more (like) outcasts when something like this happens because they have weapons (and) they have PTSD, and they aren't going to go shoot anyone," said Logan Edwards, a Marine veteran from Iowa who served eight months in Iraq and who later was diagnosed with PTSD.
"They manage their symptoms and can handle firearms around them without shooting anyone or themselves," said Edwards, 26.
Doctors employed by the U.S. Department of Veterans Affairs prescribed Edwards with Oxycontin, benzodiazepines and anti-depressants for three years, he said, adding the pills only heightened his symptoms. After considering suicide, he admitted himself into a VA hospital for three months but that, too, failed to cure him. Edwards ultimately turned to marijuana which, he said, instantly soothed his post-combat anxiety symptoms and allowed him to rebuild his life.
"I have been given every anti-depressant that's on the market and almost all of them made me more aggressive, anxious, short tempered, suicidal and (gave me) homicidal thoughts -- within two or three doses," Edwards said.
"I remember calling the VA after a few days of trying to manage on (the pills). It got to the point I was breaking things and ripping doors off the hinges in my house because my anger would just go zero to 100 within seconds," he added, blaming the drugs not the PTSD.
Fort Hood commander Lt. Gen. Mark Milley told reporters late Wednesday that Lopez, who served four months in Iraq during 2011, was being treated for "behavior health (and) mental health issues" and that "he was currently under diagnosis for PTSD but he had not yet been diagnosed for PTSD."
In her practice, Herrera-Yee said she has seen conventional pharmaceutical medicines help some veterans with PTSD. But she also is aware that some of those drugs "can cause extreme side effects" including suicidal ideation.
Lopez shot and killed himself after allegedly committing the base attacks.
"The Fort Hood headlines everywhere today are using the words 'PTSD' and 'troubled.' I completely understand that, as human beings, we all search to find an answer around something this tragic," said Herrera-Yee, the 2014 National Guard Military Spouse of the Year. "But focusing on PTSD could affect service members who would otherwise seek help for these symptoms in the future -- and those who are carrying the diagnosis today.
"This rush to judgment is unfair. There are so many unknowns about this soldier. But (veterans and troops) woke to the news blaming PTSD as the cause," Herrera-Yee said. "And so, yet again, they're being looked at as people who may have the potential to act out violently which, by and large, is not the experience. By and large, they are suffering in silence, usually within their homes, often alone."