The following is from the APNA California Chapter's September/October Netletter:

Inspirational California Psychiatric Nurses
Linda Stanley, MSHS, BSN, RNC

Retired Major NC USAF

As Interviewed by Jolie Gordon-Browar

In the first of a recurring series on inspirational leaders in APNA California, here we focus our attention on one of our own superstars. Linda Stanley is a fairly new member to APNA but she has certainly made an impact.  Her heartfelt and honest discussion about her experiences as a military nurse and the effects of Post Traumatic Stress Disorder have pushed her to the front lines, so to speak, of those we want to know more about.  We hope you enjoy learning more about her and her passion for those she serves.  We thank her for her courageous service to our country and her continued fight to care for our silent wounded warriors.

Please give us some background on your career...what influenced your decision to become a nurse and why did you choose military nursing?
I decided to become a nurse after the birth of my first child.  I saw how a nurse could influence the whole birthing experience and always loved the sciences and people.  So I decided to go back to school to get my BSN.  I originally chose military nursing for the travel but ended up staying due to the camaraderie, teamwork, and service to others.

What are your current career plans?
I am going back to school to become a nurse practitioner in mental health so that I will be able to help other returning veterans with Post Traumatic Stress Disorder.  I am starting the Psychiatric NP program at the University of San Diego this fall.  Now my thoughts turn to other medics and veterans facing this condition alone and wonder how this was has affected them personally and professionally.

When did you become an APNA Member and why?
Once I knew I wanted to change direction in my nursing career, I looked for a bridge to help me see the current practices, issues, and problems facing our mental health NPs.  APNA has been that bridge and the support for my career change.  I have been so impressed with the interaction of the members, the journal articles, and the APNA All-Purpose Discussion Forum.  To be able to tap into the "hot topics" facing the psychiatric community on a daily basis has been most beneficial to me as a new member.

You have been active within the California Chapter and on the APNA Member Bridge.  Can you tell us about your personal experience in caring for and living with PTSD?
I was deployed to Balad, Iraq in 2006.  When I returned from Iraq I was overwhelmed by the homecoming prepared by my flight.  (I was in charge of the largest OB/GYN flights in the US Air Force.)  My initial return to work was uneventful.  I was happy to be back and easily returned to my responsibilities as flight commander.  I had no problems sleeping or adjusting.  Six months later, I was on a plane headed to the Kunsan Air Force Base.  I arrived at Kunsan mid-tour so I was out of sync with the rest of the group and without a support system.

My job in Kunsan, Korea was demanding since I was the flight commander of medical services, mental health, the healthcare integrator, the case manager, and eventually the group practice manager.  Shortly after arriving at Kunsan, I began to have horrible nightmares.  I was crying all the time in my room.  I could not concentrate and I isolated myself.  Sometimes I felt like I was in a different body.  I wondered "Where was the old me?"  I had never been depressed or had anything like this before.  I felt like a part of me died in Iraq and I didn't know how to get it back.  At the same time, a part of me was born there.  There, I felt very alive and was finally doing what I came in the military to do - taking care of people who really needed me.
The medical part of my deployment never upset me; instead, it was the highlight of my career.  It was the human side of war, the pain, the grief, and the loss I saw on people's faces that still bothers me the most.

I knew that I was having problems, but felt unable to seek help at mental health due to my position as their flight commander.  I sought help from the base chaplain whom I felt I could trust.  I have to be honest though, I still had to be strong and hide my symptoms of PTSD because I didn't want to appear weak.  I refused to cry in front of him.  That was something I did alone in my room.  I thought I could conquer this problem on my own.  When I returned from my mid-tour, 90% of the medical group had rotated and again I was the odd man out.  I decided to talk to my new chief nurse about my deployment-related sleeping problems.  I remember seeing a vacant look in his eyes.  It's the same look you see in people who have recently deployed.  He had just returned from being a critical care air transport nurse in Iraq.  As I talked to him I felt tears in my eyes and noticed that he started to tear up too.  I fought back my emotions because I got the impression that he was not ready to talk about it.  Perhaps he didn't want to appear weak.  He just looked at me and we both ignored our feelings.  The conversation ended and we never discussed it again.  I don't think he was able to help me because I think he was struggling too.  I always felt I was the weird one for being so "weak" so I never shared it again for a long time.  I was always showing the "stiff upper lip," focusing on reticence vs. the cost of emotion expression, something I struggle with, being an officer and a nurse. 

I finally realized that my sleep issues were not going away.  I knew the Army was offering counseling at Seoul, so I called up there and asked if I could be seen on my own.  They made me an appointment with a social worker.  They had me fill out a questionnaire but I am sorry to say I didn't feel that I could answer all of the questions accurately. 
I finally got the right help for my PTSD and made lots of progress, but it wasn't easy.  There were two things that pushed me to seek help one last time.  First was a sentinel event that occurred on my unit (the death of a patient).  Second, it was finding out, after much investigation, that being diagnosed with PTSD would not jeopardize my retirement.  During the course of my treatment I have spoken to many others too afraid to seek the help they need.  I know they suffer in silence, but hopefully by sharing my story, it will encourage others to see that there is life after PTSD. There is such a thing as post-traumatic growth and that they can live again if they get help.

Address the stigma attached to the diagnosis of PTSD, and what nurses can to do combat it.
The stigma still exists no matter how much we deny it.  My hope is we can find a way to ensure our caregivers and veterans receive early intervention and that some level of counseling is required to remove the stigma of those seeking help.  If everyone must go, then there is no shame or fear.

PTSD is not just an issue for military personnel.  What other groups are at risk?
PTSD does not develop from combat alone.  Sexual or physical abuse, terrorist attacks, accidents, and natural disasters can all be that traumatic event that can trigger this disorder.  Women have a higher risk factor for developing PTSD but many feel this is due to the increased risk of sexual assault.  Multiple exposures to traumatic events such as multiple deployments can increase your risk for PTSD.

Where can nurses go to get more information?
1.  Department of Veterans Affairs National Center for Traumatic Stress Disorder.  DOD has a web-based educational program to assist providers who provide care to military members who have PTSD or some type of combat stress.
2.  afterdeployment.org
3.  Wounded Warriors Project
4.  Defense Centers of Excellence for Psychosocial Health and Traumatic Brain Injury

Final Thoughts:
I predict that, as the focus shifts from the purely psychological perspective to a biochemical change in the brain, the stigma will lessen because people will see that it has nothing to do with being weak.  I hope that on the way to this perspective, mental health providers will not shortchange the non-pharmacological treatments, because the can and do change brain chemistry as well as medications. I hope that providers always help instill a sense of hope in their patients versus a sense of futility at the incurability of PTSD, and help keep their patients from adopting a learned helplessness attitude where they believe now they are sick and they are incapable of taking care of themselves or anything else.  I got help because I felt empty inside; no matter how hard I tried, I couldn't get 'better' by myself.  I needed to be healthier for my job, my family, and myself.  I hope I will be able to help others get help by sharing my story.

Read more from California's Netletter