When Mary Smith (not her real name) married Fred (not his real name) in 1974, they had known each other for nearly 10 years. They were high school sweethearts and had dated each other exclusively for most of their college years and until their marriage.

The only time they spent apart was the two and a half years that Fred spent in Vietnam from 1967 to 1970. Mary noticed there was something different or odd about Fred when he returned home.

"When he first got back, he was a little withdrawn, but that evened out after about a month or so," she said. "Then he got back in school to finish working on his degree and everything seemed all right."

Fred was graduated from college in 1973 and took a job teaching. He moved on to a job in industry the next year for higher pay. The two were married and seemed to have the ideal life. But a year after they were married, Mary was awakened by a frightened Fred one night.

This episode began a long and unfamiliar journey for them.

"He was crying like a baby, and it woke me up," Mary said. "He was sobbing and shaking, and he was still asleep. I was afraid to wake him up, because I didn't know how he would react. So, I laid there beside him and just held him until he stopped crying. When I tried to talk to him about it the next morning, he looked at me like I was crazy. He didn't remember it. He didn't know what I was talking about."

Several weeks passed before Fred had another episode like the first one. And then they started coming more frequently, sometimes three times within one week. Upon awakening, he never remembered the experiences and could not recall the dreams.

"I finally taped him one night and played it for him the next day," Mary said. "He couldn't believe it. He still couldn't recall what he was dreaming about or why he was crying, but at least he knew that I wasn't crazy or lying to him."

Because Fred had no memory of the incidents, Mary had to convince him that he should seek some help. Eventually, he went to a psychologist who suggested the he should see a psychiatrist.

"Fred saw that doctor for about five years, and he put him on medication that quieted his nerves but he never found out what was causing the crying fits," Mary said. "But in 1995, almost 15 years later, we finally got some answers. The doctors told us it was probably post traumatic stress disorder, although they wouldn't commit to that diagnosis. And they increased the dosage of the same medication that Fred was taking. Now, he hasn't had an episode in more than five years. So, whatever they're doing seems to be working."

The National Center for Post Traumatic Stress Disorder was created within the Department of Veterans' Affairs in 1989. The center was created in response to a congressional mandate that the needs of veterans with military-related PTSD be addressed.

Established as a diagnosis in 1980, PTSD is defined as symptoms that last at least a month after experiencing a major trauma. The symptoms include re-living the trauma, feeling numb and withdrawn, and having forms of anxiety that interfere with daily life.

Some of the complications of PTSD is found in the fact that it often occurs in conjunction with other disorders such as depression, substance abuse, memory problems and other problems of mental and physical health.

Although it became an acceptable diagnosis in 1980, it is not a new disorder. Written accounts of similar symptoms go back as far as ancient times, and there is documentation in historical medical literature from the Civil War ascribing PTSD-like symptoms to a disorder known as "Da Costa's Syndrome." And there are numerous descriptions of PTSD symptoms in medical literature on combat veterans from both world wars and survivors of the Holocaust.

According to the Web site of the National Center for Post Traumatic Stress Disorder, PTSD has subsequently been observed in all veteran populations that have been studied, including World War II, the Korean Conflict, the Vietnam War, the Persian Gulf populations and the United Nations peacekeeping forces deployed to other war zones around the world."

The National Center for Post Traumatic Stress Disorder estimates that 7.8 percent of Americans will experience PTSD at some point in their lives, with women twice as likely as men to develop it. It further points out that approximately 30 percent of men and women who have spent time in war zones experience PTSD.

Tools for assessing PTSD are still being developed and researched, but it is generally thought that the best way to diagnose the disorder, like all psychological disorders, is to combine findings from structured interviews and questionnaires with physiological assessments.

The multi-method approach helps address concerns that some patients might be either denying or exaggerating their symptoms.

A variety of forms of psychotherapy and drug therapy is used to treat PTSD.

There is no definitive treatment and no cure, but promising treatments include behavioral therapy, group therapy and exposure therapy which involves having the patient relive the trauma under controlled conditions.

Drug therapies help ease symptoms of depression and anxiety and help with sleep. The most widely used drug treatments are the selective serotonin reuptake inhibitors, such as Prozac and Zoloft.

"I've been very satisfied with the treatment Fred has gotten through the VA," Mary said. "But I'm very demanding with his doctors about his treatment, because I'm the only one who has seen him going through those spells. He hasn't had one in about five years. I just hope his medicine keeps working. From talking with other people, I know that you just have to keep going until you find that thing that works for each individual case."

The Web site of the National Center for Post Traumatic Stress Disorder, which can be found at http://www.ncptsd.org, contains a wealth of information and links to other sites for those interested in PTSD.

T&D Staff Writer Thomas Brown can be reached by e-mail at tbrown@timesanddemocrat.com or by phone at 803-533-5532.

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