Males, war and PTSD

Our VOINCAs the wars in Iraq and Afghanistan grind on, another threat is growing here at home. And though it’s invisible, it has the same potential to spawn abuse, maiming and death.

This threat targets the families and loved ones of untreated or poorly treated soldiers suffering from posttraumatic stress disorder and other emotional conditions triggered or exacerbated by war.

North Carolina touts itself as the “most military-friendly state,” and the numbers—limited and hard to find though they are—seem to support that slogan.

According to the Institute for Southern Studies, the Tar Heel State has sent more soldiers to Iraq and Afghanistan than any other. In addition, North Carolina is listed as one of the top eight states in the nation for recruitment. The institute also reports that as of 2005, more than 12 percent of the nation’s war fatalities—nearly one in eight U.S. soldiers killed overseas—were from North Carolina.

North Carolina at War, a March 2007 study by the institute, found more than 2,200 members of the Army’s 82nd Airborne Division (based at Fort Bragg, N.C.) deployed in Iraq and Afghanistan. The report tallied more than 40 of those soldiers killed and 450 injured in the two wars. North Carolina has also sent one of the largest detachments of National Guard troops to Iraq. Deployment peaked at 6,000 in January 2005—the state’s biggest mobilization since World War II, according to the study.

Getting help with PTSD

by Stephen Snow

Posttraumatic stress disorder (PTSD) is a specific diagnosis based a collection of behaviors. Similar difficulties could also cause severe distress and result in behavior that hurts the person and/or others, including acute stress disorder, associated features of PTSD (or disorders of extreme stress not otherwise specified: DESNOS) and a wide range of anxiety and depressive disorders such as generalized anxiety disorder and major depression disorder.

People with these conditions are also more likely to actively self-medicate by abusing substances such as alcohol, marijuana, cocaine, crack cocaine, heroin, methamphetamines and prescription medicines.

A key indicator of extreme stress is whether a person is able to regulate or manage his or her emotional states. If emotions cannot be managed or contained effectively, it is generally time to get some help.

Many therapists in the Asheville area and the western mountains provide some level of counseling to help deal with the symptoms of PTSD or extreme stress. But few provide free or low-cost services. The following list identifies providers whose services may be offered free or on a sliding scale. Most are locally or regionally based.

Where to start

For real emergencies, dial 911 or go to the nearest hospital emergency room.
VA Medical Center (Asheville). Go to admissions at the VA Hospital—or, for emergencies, to the emergency room. Bring a copy of your DD Form 214 (certificate of release or discharge from active duty) to prove eligibility for services. 1100 Tunnel Road; call 298-7911 or toll-free (800) 932-6408.
Greenville Vet Center (Greenville, S.C.). Serves combat veterans specifically (bring DD 214) and accepts walk-ins. The Vet Center also sponsors a spouse/significant other support group the first Thursday of every month. 14 Lavinia Ave., Greenville, S.C.; (864) 271-2711.
Asheville Buncombe Community Christian Ministry (Asheville). Offers several programs for veterans. To reach the case-management staff, call 299-8701; to inquire about the Veterans Restoration Quarters and Transitional Housing, call 298-7952.
• Western Highlands Network (WNC). State screening facility for people needing intensive outpatient community support, serving an eight-county area (Buncombe, Henderson, Madison, Mitchell, Polk, Rutherford, Transylvania, Yancey). If you have Medicaid or no insurance, telephone screening and referral to a community support agency. In Buncombe County, call 225-2800 or toll-free (800) 951-3792; emergency services after hours 252-4357 or (800) 951-3792; more information at
All Souls Counseling Center (Asheville). Provides counseling only to uninsured clients; sliding-scale fee based on ability to pay. 23 Orange St., Asheville. Call 259-3369.

Related services

Domestic Violence
Helpmate (Asheville). Maintains 24-hour crisis line (254-0516) for help or will direct you to services in your own county. Counseling, support groups, advocacy and shelter. Call 254-0516; more information at
Child abuse
Buncombe County Department of Social Services (Asheville). A primary place to report abuse and protect children from further abuse or neglect. By law, citizens are required to report abuse or neglect if they believe it has taken place. Call 250-5900 during business hours, 252-4357 or 211 evenings, weekends or holidays;
Child Abuse Prevention Services (Asheville). Provides counseling services to abused and neglected children and their families. Call 254-2000;
Sexual assault
Our VOICE (Buncombe County). Provides free shelter, support, advocacy and counseling for sexual-assault victims; 24-hour crisis line at 255-7576;
Substance abuse
ARP-Phoenix (WNC). Affiliated with the Sisters of Mercy Urgent Care and serving 16 WNC counties with comprehensive substance-abuse intervention, detox and counseling, as well as other mental-health services. Call 254-2700;

Other state/national resources

NCCareLINK. A new statewide Web site established to provide information about programs and services across North Carolina for families, seniors and youths, with many links to resources for veterans. Associated with the Department of Health and Human Services’ toll-free CARE-LINE, toll-free within N.C. at (800) 662-7030 (English/español); local or out of state, (919) 855-4400 or (877) 452-2514 (TTY-dedicated), Mon. – Fri., 8 am. to 5 p.m. Web site:
The Wounded Warrior Call Center. A hot line for injured or ill Marines (current and former) and their families. (877) 487-6299.
National Suicide Prevention Lifeline. Call and press “1” to be connected with round-the-clock access to mental-health professionals who focus on veterans. (800) 273-TALK (8255);
SAVE (Suicide Awareness Voices of Education). Working to prevent suicide through public awareness and education, and serving as a resource for those affected by suicide. Emergency line: (800) 273-8255;
Vets 4 Vets. A peer-support group for recent veterans. (520) 319-5500;
National Veterans Foundation. Nonprofit, nongovernmental organization that gives assistance, information and resources to all veterans. Call (888) 777-4443 (9 a.m. to 9 p.m. PST, seven days a week);

The state’s close ties to the military reflect a pattern seen throughout the southern United States, according to the institute. Its study found that 42 percent of U.S. troops were born in one of 13 Southern states, and 56 percent were housed at military bases in the region.

So when I read the recent Reuters report that after five years of war in Afghanistan and Iraq, nearly 40,000 soldiers have posttraumatic stress disorder as defined by the U.S. military, I shuddered at the implications.

According to the Pentagon, the number of PTSD sufferers in the armed forces has shot up from 9,549 in 2006 to 13,981 in 2007—a 46.4 percent increase. No surprise there: War is hell, and living with trauma is like living in hell; traumatized people are constantly at war.

This has significant implications for veterans and local mental-health professionals in Asheville and Western North Carolina.

PTSD is a mental-health condition that can result from wartime trauma, such as being physically wounded or seeing others hurt or killed.

Symptoms can include irritability, outbursts of anger, difficulty sleeping, trouble concentrating, nightmares, hypervigilance and an exaggerated startle response. People with PTSD may also constantly relive the traumatic events, with images (commonly known as flashbacks) playing over and over in their heads.

In recent years, the Pentagon has been pressured to enhance PTSD treatment amid criticism its programs were inadequate, and it is now scrambling to recruit more therapists. There have also been reports of Pentagon “diagnosis tampering” and deliberate misdiagnosis to keep the PTSD numbers down. For now, however, let’s go with the numbers we have: They’re bad enough.

So what accounts for the dramatic rise in PTSD?

The U.S. Army says the numbers reflect the military’s enhanced awareness of the disorder. The Army’s surgeon general notes the increase in troops seeing combat. Other experts cite extended tours of duty that expose troops to additional trauma.

And as recruiting has become more difficult, standards have been lowered. Recruits with histories of trauma have been sent to war, even though they are more susceptible.

PTSD could be called a normal reaction to repeated, extreme stress. There are two main types of traumatic stress: event-driven (hurricane, car accident, sexual assault) and chronic or complex (child and adult physical, sexual or emotional abuse, war, neglect). And if a soldier has experienced trauma before enlisting, it becomes extremely likely that wartime experiences will trigger that trauma or make it worse.

Repeated extreme stress can significantly compromise daily living: Many people suffering from complex trauma become substance abusers, and men in particular also tend to abuse others.

In Western culture, women are often socialized to internalize their trauma, whereas men are taught to externalize it. To simplify a complex situation, this often shows up in treatment as follows: Traumatized women tend to internalize their pain, hurt themselves and develop somatic illnesses, while men tend to externalize their pain, “armor themselves” and hurt others. This despite the growing number of suicides among returning Iraq War veterans.

Further complicating the picture is many men’s rejection of both medicine and talk therapy, which they see as signs of weakness. Real men, they believe, live by a set of bumper-sticker rules: Tough it out, brush it off, get over it. I hear this again and again from both men and their worried/frightened partners.

They could not be more wrong. In fact, it takes tremendous courage to face the fears trauma creates. The courage to be a man is the courage to seek help for problems that won’t go away on their own.

Not everyone exposed to trauma develops PTSD; most don’t, in fact. But for those who do, the cost to them and those around them can be exceedingly high.

And as more veterans return to WNC, here are the outcomes we can expect to see: increased child abuse and domestic violence, substance abuse and homelessness. The invisible threat will become an all-too-visible war at home—with tragic consequences.

We may leave the war, but the war doesn’t leave us.

[Stephen Snow is a licensed professional counselor in Asheville who specializes in treating child and adult chronic trauma and also domestic violence. He can be reached at]



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5 thoughts on “Males, war and PTSD

  1. Gordon Smith

    Thanks for highlighting the occurrence of veterans with PTSD. As a paneled TRICARE (military insurance plan) provider, I can assure you that the number of cases of PTSD I’m seeing is rising rapidly.

  2. Joshua Brunhoff

    I appreciate your article. I served in support of Operation Iraqi Freedom from March 19, 2003 until May of 2003. I believe that all Marines in my unit have some sort of development of PTSD. I like to call it Post Traumatic Stress. I don’t believe it is a disorder. I believe it to be completely normal for the human mind to react in the manner it does. I saw combat and saw things I wish I had never seen. At the same time I am thankful for what I saw and experienced because I no longer take advantage of things that everyone else does. I have come far from when I first arrived home. At first, I turned to alcohol. That was a mistake. Now, because I have great friends and family, and I asked for help, I have learned moderation. I also explain my flashbacks to my closest friends and my fiance. They of course probably don’t want to learn of these experiences but they do it because they want me to be happy. I wish all those veterans out there the best and hope they find a way to cope with the things they experienced.

    On the note of getting the VA and other organizations to properly treat the “disorder”, I have written a small essay at Knol. Please take a moment to read it and it might motivate you to contact your legislators.

    Semper Fidelis,

    Joshua Brunhoff

  3. Stephen Snow


    You are quite right in stating that post-traumatic stress is a normal reaction to overwhelming events. That is exactly the definition. The ‘disorder’ part comes in diagnosing someone for treatment and is a ‘medicalization’ of the problem. (the levels of stress do have a ‘disordering’ impact on people’s behavior, so in that sense, it’s correct). One of the least understood aspects of traumatic stress is its lag time; sometimes it can be years before the true depth of the trauma surfaces because we have an amazing ability to cope and adapt. But remember this: we can bury our problems, but we bury them alive. They will have their day, and we can either deal with them on our time or theirs, but deal with them we must.

  4. sathe

    Killbut : Killbut is a place to get advice and information on mental health problems, depression, anxiety Prevent Suicide, Help depressed and more. It is a place where you can find people who are experiencing similar problems and share them to help get you through this difficult time.
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  5. The Beast

    The great thing about serving in peacetime is that it totally protects you from developing PTSD from any event that occurs during your time in service. Just ask any combat vet who has a PTSD diagnosis, he’ll tell you. Well, not just ANY of them. A small handful will say that it’s MAYBE possible in a few cases. Those are the vets who claim for themselves a special kind of PTSD, the holy “Combat PTSD”.

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