The physical and psychiatric effects of war can linger long after veterans return to American soil. Last weekend, a 76-year-old veteran committed suicide in the parking lot of a veteran’s affairs medical center, where he had been a patient.According to The New York Times, Peter A. Kaisen was “unable to see an emergency-room physician for reasons related to his mental health.” The hospital, however, reportedly said there was no evidence that Kaisen sought treatment at the hospital prior to the incident.
Veterans in the U.S. face a series of challenges: from mental-health issues and suicide, to unemployment, and widespread homelessness that even a major push by the Obama Administration has yet to fix. The proportion of veterans diagnosed with mental-health or substance-use disorders have increased substantially in recent years; in 2014 risk for suicide was 21 percent higher among veterans compared with civilian adults, and suicides by veterans comprise 18 percent of all suicides nationally. The Department of Veterans affairs has been under fire for more than two years following a national review that uncovered issues at facilities across the nation such as high patient wait-times.
John Cowart, a veteran himself, worked for 30 years as a social worker before retiring from the Veterans Affairs Medical Center in Asheville, North Carolina. He has helped those who fought in conflicts dating back to the Spanish-American war, most notably arranging reunions and trips for veterans with PTSD to visit the national war museums in Washington D.C. I spoke with Cowart about the challenges that many veterans face while reintegrating into civilian life, and how American attitudes towards veterans have changed since the hostile homecomings of those who served in Vietnam. The interview that follows has been lightly edited for context and clarity.
Adrienne Green: How did you get this job and how long have you been doing it?
John Cowart: When I got out of the army, I got my master’s in social work from the University of Georgia, but even being a veteran I didn't really see myself working for the Department of Veteran’s Affairs (VA). To be honest, it reminded me a lot of the army. Things came full circle, and I had an opportunity to work for the VA down in Atlanta when they started opening veteran centers. Now, counseling centers for people returning from combat that are not hospitals are viewed as more accessible. I continued with the VA for 30 years, until I recently retired.
Green: What was your experience in the army like?
Cowart: I was in the army for three years during Vietnam, and bureaucratic might be one way to describe it. People who are in the army [are like] government property. A civilian may not like their job, but if they stop going to it, eventually their employers will get rid of them. In the army, they'll come pick you up. I'm proud of my service, but a career in the military wouldn't have worked for me.
I'm not a Vietnam combat veteran; I worked in the medical corps as a medic, and that's probably why I was interested in working with the veterans. Even back then, without any formal training, I could see that we were sending home psychiatric casualties—people who would need help—so I was compelled to be part of that.
At the VA, I actually had more autonomy to do the things I thought I really needed to do [to help] than I probably would have had in the private sector. I think my time in the military certainly gave me some instant credibility with a lot of veterans. I understand the military culture. I understand some of what they went through, even though I didn't participate in combat. There's a different language and a different culture, so it helps if you understand that.
Green: What motivated you to be a VA social worker for 30 years?
Cowart: There was a poem by Walt Whitman called “The Wound Dresser,” and it’s one of my favorites. When Whitman was a nurse in the medical tents during the Civil War, he wrote a letter to his mother and he told her that he discovered his faculty for being present with other people's pain, even to their death. That kind of empathy is something that I really related to. I'm meant to be present when someone's troubled, and being part of the solution hopefully. I’ve always felt compelled to make a difference. Social work is a natural place for that.
Cowart: I think the difficult homecoming experiences that Vietnam veterans had. It was a difficult time during the 1960s and 1970s. A lot of people blamed the veterans for the war, and that was a misplaced blame. It was difficult for veterans to come home, and go back to their families, back to work, or find a place where they felt like they fit in. That's really not just Vietnam veterans; those coming home from combat have always had a difficult time putting that experience behind them. The way that we are treating our returning veterans now is certainly different. I think current veterans are getting a lot more respect.
Green: What makes you think current vets get more respect?
Cowart: For example, I was flying back from a conference and the captain got on the intercom and said, "Just want to take a moment to recognize some special passengers today." He recognized some active duty folks that were on the flight with us, and everybody on the plane erupted in applause. As much as I think that's a very good thing, I'm thinking, "Boy, that would have never happened with returning Vietnam veterans." In fact, quite the opposite. There's been a shift in our culture towards veterans, and I think that there's some collective shame about the way that Vietnam veterans were treated. It also probably has to do with the fact that now we have an all-volunteer army and there's no draft.
Green: You’ve worked with veterans from almost all of the wars in recent U.S. history. How is assisting veterans from earlier wars different than treating the veterans of today?
Cowart: I don't know that there's really a whole lot of difference. One-hundred-and-fifty-one years ago, when Lincoln gave his second inaugural address he charged the nation to, “care for him who shall have borne the battle and for his widow, and his orphan.” He was talking about the American people. The real healing happens in the community, not so much on the grounds of the VA hospital.
I see more of that happening these days with all the grassroots organizations. People really recognize that it's our collective responsibility to help these people when they come home to re-enter their lives and society. We understand a lot more about neurochemistry now, and what happens to the brain whenever someone experiences a trauma. It's been helpful, but it's still about people connecting with each other and the relationships that we build with each other.
Green: Has the increased awareness of mental-health issues changed how you do your job?
Cowart: Obviously some of that's got to help. The stigma that's always been attached to seeking mental-health treatment has prevented a lot of people from getting that help. The military itself, even though they screen for folks that might have problems, there's still an overriding stigma that's attached to how you deal with the trauma of war.
For a lot of men, it's to not talk and not feel. One of the clinical symptoms of PTSD is to shut down emotionally—it's pretty easy to do—but you're going to pay a heavy cost in your relationships with family. You won't be the husband or the father that you could be. I think some people are able to reach out and get help, but we're still not there.
Green: What are the most challenging and rewarding parts about your job?
Cowart: To be present with someone else's pain, you sometimes run the risk of becoming vicariously traumatized yourself. I certainly couldn't take all these problems home with me in the evening; I'd never make it. Maintaining healthy boundaries was always a challenge.
The rewarding part of course is being able to see those lives turn around, and people be able to be fully engaged and be present in their life. They get to decide what that life looks like, and it’s wonderful for them to recognize that the work they've done with you has contributed to that. Sometimes, you never see that [closure] because it might happen after the work, but that's always been rewarding. I’ve also taught at The University of North Carolina School of Social Work for 18 years; inspiring young social work professionals to do the work is probably what I enjoyed the most.
Green: How has your work defined your personal identity?
Cowart: I have been able to do a lot of reflection about the work, and it’s not so much on what I've done but who I am. I retired last year, and one of the first things I did was go to Vietnam with a Habitat for Humanity crew. Because Vietnam had a lingering presence in my life for so many years, I wanted to have a different relationship with that place. I wanted it to be a positive relationship. So now when I think about Vietnam, I think about the experience of building a house for that family. All of that really speaks to who I am. My work and who I am are really not easily separated. Someone once said that social workers never retire.