In a Belgian town in the winter of 1944, just days after his arrival, Fred Kempski watched as a truck rumbled along a cobblestone street. Uncovered in its cargo hold lay the corpses of dozens of American soldiers.
"They were stacked, maybe 30 or 40 of them, and all you could see was their boots sticking out the back," said Kempski, 88, of Deer Park, who left the Army with the rank of sergeant. "And I could never get out of my head their boots wobbling together," he added, eyes wide, hands outstretched in wobbling pantomime.
Nearly seven decades later, anxieties born from his World War II experience still shatter Kempski's sleep. He won't take out the garbage after dark, still anxious over long-ago nighttime attacks. And driving near heavy trucks troubles him so much he sometimes pulls over to avoid them.
"You wake up in a sweat and it's as if it is happening to you all over again," Kempski said of nightmares he has as often as once a week. "You're back in a devil's world."
Decades after surviving horrific battles and seeing friends killed, some veterans in their 60s, 70s, 80s and even 90s continue to display psychological wounds more often associated with returning Iraq and Afghanistan War veterans a third their age. The older veterans point to their own experiences as a map of what may lie ahead if the psychological needs of today's returning veterans are not addressed.
Millions show symptoms
Experts say America's 6.7 million veterans older than 65 are twice or more likely to be suffering from post-traumatic stress disorders than are non-veterans of the same age group. Studies show PTSD among combat veterans and former war prisoners can be 10 or more times that rate among civilians.
World War II veterans exposed to moderate or heavy combat had 13.3 times greater risk of PTSD symptoms than those who experienced less combat when measured 45 years later, according to Combat-Related Post-Traumatic Stress Disorder Symptoms in Older Men, a 1994 study published in the journal Psychology and Aging. And the National Vietnam Veterans Readjustment Study in 1990 found that 35.8 percent of Vietnam battle veterans showed active PTSD.
"I don't think you ever heal," said Joe Cognitore, 66, commander of the Rocky Point branch of the Veterans of Foreign Wars, who still weeps over the death of a friend who saved his life during an ambush in Vietnam's central highlands.
PTSD is diagnosed when patients repeatedly relive a traumatic experience, avoid situations that remind them of it, and react with extreme anger or fear to emotional triggers, said Dr. Paula Schnurr, deputy director of the Department of Veterans Affairs' National Center for PTSD.
Although its symptoms have been described among U.S. soldiers since at least the Civil War, PTSD was not acknowledged as a distinct disorder until 1980, Schnurr said. Veterans displaying psychological symptoms were said to be suffering from "shell shock" or "battle fatigue." Relatively few received psychological help.
"When these veterans came back and PTSD was highest, there was no label for it," Schnurr said. "The expectation was people would get on with their lives. Many suffered silently and coped as best they could."
Relief through expression
Lee Steedle, 88, of Oakdale, coped by writing.
Steedle, a mortar squad leader who served 31 months in Europe, eventually published a collection of war narratives -- "Mark Freedom Paid."
"I found the bad dreams I had about combat almost disappeared once I could put them down on paper and get rid of them," said Steedle, a sergeant in the Army who still doesn't discuss war details with non-vets. "I could look at the words on the page and say that was then, not now."
Kempski, who has since found some relief by drawing and painting war scenes that haunted him, said he began to feel troubled almost immediately after seeing the truck in Belgium.
He returned home after the war, resumed his job as a painter for the Long Island Rail Road, started a family and had three boys.
But by the mid-1950s, his anxieties had become unmanageable. Thoughts of suicide rattled him so badly that Kempski, an orphan since childhood, checked into a Veterans Administration hospital to spare his family from witnessing his death. He said he has been receiving psychotherapy on and off ever since.
"I was like a zombie," he said. "I wouldn't shave or nothing. My wife didn't know what to do. The biggest thing was no sleep."
With psychological disorders occurring in as many as one in five returning Iraq and Afghanistan veterans, policymakers are increasingly convinced that early interventions are critical to protecting veterans from long-term problems. The Pentagon has implemented various "resiliency programs" over the past several years, to teach coping skills to stressed enlistees. And the VA is boosting the size of its psychological staff nationwide, including a 47 percent increase since 2007 at the Northport VA Medical Center.
Trauma worsens with age
Census figures show that more than 40 percent of all U.S. veterans -- some 9.2 million in all -- are 65 or older. As more veterans hit retirement age, see loved ones fail, or endure the death of old battle buddies, traumatic memories often fill the void.
"It's starting to emerge now with Vietnam veterans, as they begin to retire and have more time on their hands," said Denis Demers, 65, of Bohemia, who worked as a psychiatric corpsman in Da Nang and now organizes peer-to-peer counseling groups for veterans. "They are finally done with the busy phase of their lives, and that's when the bad thoughts come back."
An administrator at the Long Island State Veterans Home in Stony Brook recalled a former resident who, after decades of reticence, finally opened up about his role as a WWII pilot.
"As he approached death, he recalled killing many, many people and it upset him," said Jonathan Spier, associate administrator of the 350-bed geriatric facility. "He had kept it repressed for almost 70 years. It was as if he wanted to unburden himself."
POST-TRAUMATIC STRESS DISORDER'S HISTORY
Post-traumatic stress disorder was first listed as a diagnosis in 1980. Its symptoms have been described since antiquity. Writing about the 490 B.C. battle of Marathon, the historian Herodotus wrote of an uninjured Athenian warrior who went blind when a soldier next to him was killed. Blindness, paralysis and other "conversion disorders" can arise from PTSD's extreme emotional stress, according to experts.
Before 1980, observers used various terms to describe PTSD. In 1678, Swiss doctors referred to "nostalgia" among soldiers displaying "melancholy, incessant thinking of home, disturbed sleep or insomnia, weakness, loss of appetite, anxiety, cardiac palpitations, stupor, and fever." German doctors referred to it as "homesickness." PTSD sufferers often were referred to as malingerers. In World War II, doctors treating distressed soldiers blamed the increasing use of heavy artillery, and used the phrase "shell shock."
Of the 2 million Americans who fought in World War I, 159,000 were at least temporarily deactivated for psychological reasons, 70,000 of them permanently, according to the Vietnam Veterans of America.