On Veterans Day, the focus is on the challenging needs of Hawaii veterans — mental-health issues and homelessness, among others — and the range of services supporting their return into our society.

Post traumatic stress disorder became well known only after the Vietnam War, and didn’t even enter medical terminology until 1980, but it has been around for millennia, with different names, or with no name.

In World War II and the Korean War, it was called battle fatigue or combat fatigue; in World War I it was called shell-shock; in the Civil War it was called soldier’s heart or soldier’s nostalgia. Without giving it a name, Shakespeare wrote about it in his play, "Henry IV." Were we to give a name to the cause of the downfall of Homer’s tragic heroes, Odysseus and Achilles, that name would be PTSD. There are, of course, many causes of PTSD — rape, auto accident, fire, tsunami, abuse — but today, I focus on combat-related PTSD.

Combat-related PTSD affects every aspect of the warrior’s life. Note that I do not say "victim" here, because some of what we call symptoms of PTSD are in fact life-preserving skills in the combat zone, and this sets combat-related PTSD apart from PTSD due to any other form of trauma.

One of the cardinal signs of PTSD is hyper-vigilance — "too much vigilance" — always being on guard. In combat, there is no such thing as hyper-vigilance. You learn that you can trust only your battle buddies, and no one else. Discipline is all-important. You care for your gear obsessively; everything must be perfectly in its place. You sleep but lightly, so you can react immediately.

You learn not to feel any emotions except anger, and just enough fear to give you warning of danger.

You learn this over months, or perhaps years, and then you come home. And you cannot turn it off; you cannot escape the patterns of behavior that have saved your life and those of your fellows. You know you are home, but your body still gives you warning of danger, and you cannot ignore those warnings; you look for the danger, don’t see it and instead of being relieved, you sense that the danger is there but you cannot find it.

Your anxiety increases. You trust only your battle buddies, because only they can help protect you. Your family complains that you treat them like your soldiers, not understanding that you are only trying to keep them safe. At home, everything must be in its place, because you have learned that it can cost lives if something cannot be immediately found. You no longer feel close to others, no longer feel "normal" emotions; only rage, anxiety, depression, guilt and numbness. And you don’t understand why others don’t feel the same way. You fit in nowhere but the combat zone.

No one goes to war and remains unaffected by it; it is only a matter of in what way and to what extent it interferes with one’s life.

With multiple deployments, the impact builds. Some are affected by one deployment; for others it may take several. But the impact builds, often unnoticed. You drink more to escape the feelings, to calm yourself, to relax, to sleep, to escape other people … and you drive others away, including your loved ones. And you have been taught to always "drive on," to "tough it out." It is difficult to ask for help. What will your fellow warriors say? Will they still respect you?

Until relatively recently, there were no truly effective treatments for PTSD. In the decades after it was recognized following Vietnam, many treatment techniques were tried, with scant success. Thus, many of our Vietnam veterans still suffer from PTSD.

In recent years, however, evidence-based treatments for PTSD have been developed; evidence-based means that the techniques have been extensively tested in different locations, by different clinician/researchers with different patients. There is actual evidence that they work. The Department of Defense and the Department of Veteran Affairs have each made substantial commitments to provide those evidence-based treatments. Trainings in these techniques are frequent, and they are offered at most DoD and VA medical facilities.

In Hawaii, DoD clinics on each military installation provide outpatient treatment, and provide treatment via telehealth to outlying locations throughout the Pacific Basin. The VA provides outpatient, evidence-based treatment at each of its community-based outpatient clinics (CBOCs), outreach clinics and Vet Centers, located on the neighbor islands, Guam, Saipan and American Samoa.

The VA also boasts a residential program for severe PTSD, the only such program in the Pacific Basin, serving both veterans and active duty members. And like the DoD, extensive telehealth services are available to outlying locations.

This is not to suggest that the problem is solved; regrettably this is far from the truth. But now there are effective treatments available to the men and women who have served us. The greatest challenge is convincing our heroes to come for help.