The ignored story of the PTSD nurse
This article appeared in the September / October 2021 issue of Discover magazine under the name of “Frontline Fatigue”. Become a subscriber for unlimited access to our archives.
In February 1945, US Naval Nurse Dorothy Still was a prisoner of war in the Japanese-occupied Philippines. Along with 11 other Navy nurses, Nurse Still treated civilian inmates in a prison camp where food was scarce and the guards brutal. Few of the detainees weighed more than 100 pounds and most died of malnutrition.
On the night of February 22, Nurse Still and the other inmates watched as their captors set up weapons around the perimeter of the camp and turn the barrels inward. Other guards dug shallow graves. The inmates had long suspected that the camp commander was planning to slaughter them all, and it seemed the rumors were coming true. Still, Nurse Still and another Navy nurse made it to the infirmary for the night shift. They had little medicine or food to offer their patients; comfort and kindness were all they had left to give.
Nurse Still heard gunshots the next morning at dawn and assumed the massacre had started. She braved herself to peek out of the infirmary window and saw parachutes slipping on the ground. The liberation had arrived just in time! US and Philippine forces quickly evacuated the 2,400 detainees to safety.
But that wasn’t the end of Nurse Still’s journey. She was haunted by the horrors she witnessed in the prison camp, and the trauma marked her for the rest of her life. Today, nursing leaders and advocates say the problem of not meeting nurses’ mental health needs has once again reached a critical point. Nurses have been on the front lines of the COVID-19 crisis, but most are not receiving comprehensive mental health screening or treatment. Nursing advocacy groups and academics studying PTSD in nursing warn that failure to address the mental health needs of nurses could lead to a nursing shortage, just like after World War II.
Taken a prisoner of war in 1942, Dorothy Still and 11 other Navy nurses provided medical care amidst the brutal suffering of the Los Baños internment camp. (Credit: courtesy Bureau of Medicine and Surgery)
Suffer in silence
Back in the United States, Nurse Still was assigned to speak at the war bond collections for the three years she was a prisoner of war. She found the experience disturbing and requested a transfer to Panama, but her memories followed her to her new post. Sometimes she was depressed. Other times, she couldn’t help but think about how much she had been through. She sometimes cried unprovoked and struggled to stop crying once she started. On the advice of her fiancé, she made an appointment with a marine doctor.
During her appointment, Nurse Still told the doctor that she had been a prisoner of war for more than three years and requested a medical discharge due to the trauma she suffered. The doctor asked when Nurse Still had been released; the date was the same as the flag raising at Iwo Jima. The doctor said these men were heroes, but Nurse Still was a woman and a nurse and, therefore, did not suffer. Denied treatment, Nurse Still left the appointment shaking. She swore she would keep her pain to herself.
Navy nurses were not the only medical providers taken prisoner during World War II. Sixty-six US Army nurses as well as hundreds of doctors, pharmacists and medical assistants have also been held captive in the South Pacific. But by the end of the war, as the United States prepared to welcome home millions of men and women who served their country, mental health treatments were limited – and reserved for men. The nurses, it was supposed, did not suffer from it.
At the time, the U.S. military was the largest employer of nurses and had established an expected code of silence regarding how nurses responded to their own trauma. In 1947, an article in the American Journal of Psychiatry claimed that a military hospital was a controlled environment that isolated nurses from the brutality of war. The author of the study claimed that nurses’ mental health needs were “less complex” and that nursing fulfilled women by responding to their natural instinct to care for men: “They provided a service that satisfied the passive needs of men. And who identified these women with the mother, wife or lover at home.
Many nurses, including Nurse Still, have responded to the lack of mental health treatment by leaving both the military and nursing. The late 1940s saw a shortage of nurses as hospital admissions increased by 26 percent. The shortage persisted until the late 1960s when wages began to rise.
After three years as prisoners of war, the Navy nurses were released in 1945. Here, they speak with Admiral Thomas C. Kinkaid after their release, and are shown next to the plane that brought them from the South Pacific to Hawaii. (Credit: US Navy Bureau of Medicine and Surgery)
An impending crisis
The COVID-19 pandemic has meant that for the first time since World War II, the vast majority of American nurses are involved in the fight against a common enemy. It’s a demanding and emotional battle that advocates say adds deeper stress to an already grueling job.
Across the country, nurses have cared for deceased COVID-19 patients who do not have family support at their bedside due to restrictions on visitors. “Nurses are often the ones who serve as loved ones and help the patient through the end-of-life journey,” says Holly Carpenter, senior policy advisor with the American Nurses Association.
In addition to caring for dying COVID-19 patients, Carpenter says, many nurses were not properly equipped during the height of the pandemic with the personal protective equipment needed to avoid infection. These nurses lived in fear of being infected or spreading the virus to loved ones at home.
And in addition to these stressors, nurses still have to deal with the usual demands of the job. “There are things that have always existed: long shifts, sometimes mandatory overtime, a workload heavier than you are comfortable with, having to work during breaks or lunch time. , having to arrive early and stay late, ”explains Carpenter.
Before the pandemic, studies estimated that up to half of nurses in intensive care suffered from post-traumatic stress disorder (PTSD). Since the start of the pandemic, researchers have found that the crisis has amplified symptoms of mental health problems. A 2020 study in General Hospital Psychiatry found that 64% of nurses at a New York City medical center reported experiencing acute stress.
“The acute stress included symptoms such as nightmares, the inability to stop thinking about COVID-19 and a feeling of numbness, detachment and alertness,” says Marwah Abdalla, study leader, clinical cardiologist and assistant professor of medicine at Columbia University Medical Center. “It is worrying. We know that if these symptoms persist for more than a month, it can lead to PTSD. ”
Some nurses suffered from PTSD before COVID-19, but pandemic conditions have amplified mental health issues. (Credit: Eldar Nurkovic / Shutterstock)
A person is diagnosed with PTSD if they meet the criteria set out by DSM-5, the official manual for the psychiatric profession. Criteria include experiencing, witnessing, or learning about a traumatic event (such as death, serious injury, or sexual violence); intrusive symptoms like dreams and flashbacks; avoid reminders of the event; negative changes in thoughts and moods; and changes in behavior. A person can also develop PTSD if they are repeatedly exposed to the details of a traumatic event.
Suffering from undiagnosed or untreated PTSD is a life-changing condition with various ramifications, and may cause a nurse to leave health care. “We are potentially creating an occupational health care crisis,” says Abdalla. “This has long term implications for the healthcare industry and our ability to provide adequate healthcare to our patients.”
Carpenter says healthcare organizations need to be proactive in screening nurses for symptoms related to anxiety, depression, and PTSD. These screenings should be kept confidential and accompanied by assurances that a nurse’s license or employment will not be compromised. Organizations must also work to de-stigmatize the diagnosis and treatment of mental health.
“Historically, nurses have always been viewed as healers and helpers,” Carpenter says. “They feel they have to be strong for others. What do you do when the hero needs help? “
For Nurse Still, help never came. She left the Navy and nursing, got married and had three children. She returned to nursing in the late 1950s after the sudden death of her husband and needed to support her family.
It wasn’t until the 1990s that she began to talk about her experiences in interviews with oral historians and documentary producers. She also wrote a memoir, but kept the story light and did not disclose her considerable suffering.
The profession has grown since Nurse Still’s appeal in the 1940s for mental health support was rejected. “We recognize complete PTSD, compassion fatigue and nurse burnout. It’s now chronicled and we understand it, ”Carpenter says.
Now the challenge is to encourage every nurse to seek and receive help. Otherwise, advocates warn, their health and well-being will continue to deteriorate and history could repeat itself as stressed nurses leave a strained profession.
Emilie Le Beau Lucchesi is a journalist in the Chicago area and author of It’s Really War: The Incredible True Story of a Naval Medic in the Occupied Philippines.