Memorial Day commemorates the soldiers who died in every war, and the act of celebrating their valor provides some comfort to their families and loved ones who honor their memory. Living soldiers, though, also endure unspoken agonies: chief among them post-traumatic stress disorder (PTSD) and the less-publicized but equally wrenching military sexual trauma (MST).  While these two “invisible wounds” are not what most typically come to mind when we think of battle scars, they do mark indelibly those who experience them, and help and understanding for them are often very hard to find. In many ways, these are in danger of being our invisible casualties of war.

Su san Avila-Smith (at left in photo, with the author), is a former Army linguist who has experienced both these traumas personally (and wrote about them for WVFC last October).  As a veterans’ advocate for those with MST and PTSD, she knows intuitively the struggles other veterans face, and where she can step in to offer guidance, support, and a workable plan. For that reason, her phone never stops ringing. In an impromptu visit to her home in Seattle recently, I chuckled when CNN called her and left a voicemail message – clearly not for the first time. A quick Google search of her name turns up almost two dozen pages of hits;  her professional bio is equally extensive, with approximately 4,000 claims settled on behalf of fellow veterans suffering from MST, PTSD or both.

(The Department of Veterans’ Affairs defines military sexual trauma as sexual assault that occurs against the servicemember’s  will. These assaults can be brutal, and gang rapes are not uncommon. With MST, there’s also a sense of double betrayal: first, that the assault occurred within the military family, where servicemembers are supposed to look out for each other—“have each other’s backs”—and second, the harassment and intimidation that sometimes results from reporting the assault can wreck a servicemember’s military career or ultimately force them out of the service.)

Last week, Avila-Smith and I attended a week-long Clinical Training Program at the National Center for PTSD, on the VA campus in Menlo Park, California. Part of what made the trip special for Susan was that ten years ago she was an inpatient in the women’s residential treatment program, which was the first such program in the nation.  What made it special for me is that I got to be there with Susan, who’s such a consummate veterans’ advocate.

Sobering Statistics

While PTSD “enjoys” a relatively high profile these days – a fact that veterans both celebrate and bemoan – military sexual trauma still flies pretty much below the radar. The average person may remember the horrific case of Maria Lauterbach, a Camp Lejeune Marine who was assaulted and murdered by a fellow Marine with whom she had been involved. But the problem is much more widespread than is commonly believed, and military sexual trauma and PTSD frequently go together. According to what we learned in the program, approximately one in five female patients at the VA report MST.

Sexual trauma, clinicians admit, is a powerfully toxic stressor, and predisposes those who suffer it to PTSD. In a study of Gulf War veterans, women who had suffered MST had a five times higher probability of developing PTSD; for men, the chances were six times as high.

It  may come as a surprise that such trauma is prevalent among men in the military. We learned that men comprise fully half of all MST cases treated by the VA. For fiscal year 2007, those numbers meant more than 47,000 men with MST diagnoses and more than 45,000 women. Another sobering statistic: in 2007, the VA tallied over 320,000 health care visits from veterans who screened positive for MST.

That’s where Susan comes in. As long as military sexual trauma continues, veterans will continue to find her and plead for her services. While she might like to train others and move on, the simple fact is that most people couldn’t handle the intensity of the veterans’ desperation, isolation, and need without being sucked into the undertow themselves. Which isn’t to say Susan always manages to stay above that malevolent energetic pull. She’s battled breast cancer and various other significant health crises, including her own PTSD. But she finds a certain amount of salvation in the fight. And the need for a veterans advocate who understands as a fellow sufferer is great indeed. As her friend, I’m glad to see her embrace a certain amount of self-care and frequent humor. Yet I also worry that there are too few Susans amidst too great a need.

A Report from the Field

The sixteen of us in the week-long program, most of us women, included many still in uniform. But it was clear from the start that Susan knew much more about the topic than anyone else in the class. That resulted in some eyes being opened to the extent of the problem, and to the practical steps to take in addressing the need.

One of the active-duty women in her 50s took me aside at one point to share her growing realization, after being bombarded with so much high-quality information and training about PTSD, that she also struggled with having suppressed painful memories of her own. In other words, she said, PTSD wasn’t just a problem for her soldiers, whom she processed in and out of deployments. It was also a problem for her.  Step One was acknowledging her personal stake in the struggle.

At one point, toward the end of the training, an instructor presenting a program on PTSD and spirituality showed a DVD clip from Lioness, a recent film documenting women Iraq veterans who—contrary to most Americans’ belief about women in the military—had seen combat. The clip shown was perhaps the most riveting scene from the movie, in which one very unassuming young woman veteran describes the difficulty of shooting and killing a combatant, and the painful aftermath of questioning whether what she did was morally right.

It’s a tough segment to watch, although there are others—like the scene of a number of Lionesses sitting in a living room, watching a sanitized film about early days in the invasion of Iraq on the History Channel, which had edited them out of the picture. What was more ironic, though, was the instructor asking who had previously known about the movie and seeing only Susan and myself raise our hands. Not even the active-duty military in the class had seen it, even ones tasked with addressing their fellow veterans’ mental health needs before and after deployment.

As the class watched the Lioness clip, seeing one female Iraq war veteran wrestle with her obvious PTSD from combat, one of the female veterans, who had usually held herself to the perimeter of the class, suddenly disappeared. Without missing a beat, Susan and another female veteran, a former Marine now a social worker, went to find her and offer their support. “Leave no man behind” became “Leave no other female veteran behind.” It was powerful to observe, and as a civilian, I could only admire what seemed like both personal and professional concern on their part for a sister who was suffering.

New Media Creates a New Community

After a more or less continuous barrage of media attention on the subject over the past few years, Americans are beginning to have at least a cursory understanding of what PTSD is and how it affects our returning service members. MST, however, is much further off the radar for the average person, and as Susan says, it’s an ugly topic—not one that most people want to discuss.

Bringing sufferers together so they can draw strength from one another is a daunting task. Women veterans with MST typically isolate themselves far from social support networks. “We have a group for women veterans with MST,” an employee at a Vet Center in Concord, California, told me recently, “but because of the social isolation of these women, it’s very, very hard to get them to come.”

Susan and women veterans she’s trained have gotten around this, somewhat, by creating online communities where veterans with MST and PTSD, female and male, can share their stories and draw comfort from one another. Comfort, and also direction: filing and finalizing their benefits claims, achieving some peace of mind by addressing the root causes of their injuries, and seeing financial compensation that may help them get on with their lives. One such community is VetWow (the “Wow” was originally for “women organizing women” until Susan and others realized how many male veterans were involved); another is the robust community that Susan has created on Facebook, echoed lately by similar posts on Twitter.

Over time Susan and other advocates’ effectiveness may well lie in embracing social media to create the type of communities that may only be able to exist online, yet still offer a tremendous measure of support for those involved. Whether or not military sexual trauma “goes away” in our lifetime—and there’s no reason to believe it will—advocates like Susan will continue to bring constructive hope and help to those in need wherever they’re found: in the classroom, escaping from a painful image that cuts a little too close to home, or online. And while the military with a capital “M” may never fully appreciate the service that advocates like Susan provide, it’s no exaggeration to say that many veterans know they owe their lives, and whatever fragile peace they’ve made with their experiences, to people like her. I’m proud to call her my friend. And I’m very glad that she continues to pass the results of her painful personal education on to others who can benefit from it most directly.