POW Aftereffects In McCain Unlikely

Washington Post: Research Shows Past Trauma Probably Won't Affect GOP Candidate's Life Span

(Washingtonpost.com)  This story was written by David Brown.

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Sen. John McCain's 5 1/2 years as a prisoner of war in North Vietnam undoubtedly changed the course of his life. But now that he is 71, that remote trauma seems unlikely to shorten his life span or to lead to mental or physical conditions that are not already apparent.

That is the implication of a body of research on the lifetime effects of captivity and war trauma and the anecdotal experience of the small group of naval aviators imprisoned with McCain at the notorious "Hanoi Hilton."

The Republican presidential candidate's medical records dating to 2000 will be opened for view by the media today in Phoenix. The Arizona senator's multiple cases of melanoma, a potentially lethal skin cancer, are likely to dominate the documents. (Read more about McCain's medical records.)

Although some experts have speculated that sun exposure during his imprisonment may have led to his cancer, the records are unlikely to speak directly to the effects of his years as a prisoner of war. Despite his painful and harrowing captivity, McCain has never received a diagnosis of post-traumatic stress disorder (PTSD), campaign spokeswoman Jill Hazelbaker said, and research suggests that the syndrome has been rare in American aviator POWs who served in the Vietnam War.

The records being released today contain "no psychological material because McCain has not been treated for anything related to that in the time frame of records we are releasing," she said.

Common sense suggests that any candidate who is campaigning vigorously is unlikely to have a serious disease that has not already declared itself, experts said.

"The demands of the modern campaign are so significant that if one can get through them, one can assume they are as fit as need be," said Mark S. Litwin, a surgeon and "survivorship expert" at UCLA's Jonsson Comprehensive Cancer Center in Los Angeles.

Nevertheless, McCain's years as a POW -- he was released in early 1973 -- constitute a distinctly unusual health variable among presidential aspirants.

There are no published studies of longevity among American POWs who served in Vietnam. Studies of Australian prisoners, however, found that they had slightly increased mortality in the years and decades immediately after the war, particularly from accidents, suicide and substance abuse.

Studies of U.S. troops captured during World War II and the Korean War also found higher death rates in the early decades after their release, mostly from tuberculosis and cirrhosis of the liver. Once past that period, however, former captives' longevity was scarcely different from that of other veterans.

The most obvious effect of McCain's captivity is in his arms. He broke both of them and a leg after ejecting from his bomber in 1967. Inadequate treatment of the injuries, as well as torture by his captors in Hanoi, left him with a decreased range of motion in his arms -- evident in the shrugging appearance of his shoulders.

At the prison, which received its sarcastic Hanoi Hilton nickname from the Americans held there, McCain was repeatedly beaten, bound and placed in prolonged solitary confinement.

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CBSNews.com Reports: Critics Try To Make McCain's Age An Issue

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Since his repatriation in 1973, he has occasionally been examined at the Robert E. Mitchell Center for Prisoner of War Studies, run by the Navy in Pensacola, Fla. However, Hazelbaker said this week that the senator "has not for many years participated in any POW follow-up."

The center saw 470 of 666 POWs who served in Vietnam and has also seen prisoners from World War II, Korea, the Iranian hostage crisis, the Persian Gulf War and the current wars in Iraq and Afghanistan.

Very little information about them has been published. For example, it is not known how their longevity compares with that of other veterans or non-veterans.

A 1996 paper, one of the few studies to appear in a scientific journal, reported that naval aviators imprisoned in Vietnam had eight times as much nerve and muscle damage as non-imprisoned fliers, probably a result of shackling and torture. They had slightly more joint and back disorders, as well.

Over a 14-year period, 4 percent of the aviator POWs, all of them officers, experienced PTSD. Research on World War II prisoners found that officers as a group had far less psychological trauma than enlisted men.

More recently, the Pensacola center helped identify something called "late-onset stress symptomatology" or LOSS, which came to light after 562 combat veterans -- about 300 of them POWs -- answered a long questionnaire. The syndrome involves the return of troubling memories late in life, along with emotional anguish and guilt, often triggered by retirement and friends' deaths.

LOSS shares with PTSD a re-experiencing of traumatic events and some of the physical "hyperarousal" that accompanies it. But it does not include "emotional numbing" and the avoidance of activities that trigger the intrusive thoughts -- two key features of PTSD.

"As the veterans reached their later years, they began to experience combat-related thoughts and feelings as they faced the changes and challenges of aging," said Lynda A. King, a researcher at Boston University and the local Veterans Affairs hospital, who has studied LOSS. "We saw it as something much broader than PTSD."

The idea that war trauma might return to haunt old age has been raised by other researchers, too. A 2001 study of 177 POWs in the Minneapolis area who served in World War II and Korea found that over a four-year period, the number of men reporting PTSD symptoms rose from 27 to 34 percent, and the severity of symptoms increased. Eleven percent said they had experienced symptoms, seen them disappear and then reemerge with advancing years.

The naval aviators who were imprisoned in Vietnam are in their 60s and 70s. Both now and in the years immediately after their release, they have seemed unusually resistant to psychological damage from the experience.

The lifetime prevalence of PTSD in all the Pensacola POW studies is 24 percent. In the naval aviators, however, it was 4 percent from 1979 to 1983, when the disorder was most likely to appear.

Prisoners in other wars suffered PTSD much more frequently.

A 1997 study of 262 POWs from World War II and the Korean conflict, both officers and enlisted men, found that 54 percent had PTSD sometime in their lives, and 30 percent still had it decades later.

The most severely traumatized group were prisoners held by the Japanese during World War II. Many were starved and worked nearly to death, were tortured and saw fellow soldiers executed, and were transported in the airless holds of "hell ships" that were unknowingly bombed and torpedoed by their countrymen.

Eighty-four percent experienced PTSD at some point, and 58 percent still had it in late middle age. For them, the researchers said, developing a mental illness was essentially normal.

Everett Alvarez Jr., a Vietnam POW who went on to serve as deputy administrator of veterans affairs in the Reagan administration, remembers attending meetings of those Pacific war veterans and thinking how different they were.

"They would say, 'We come to these meetings because we understand each other,' " he recalled this week. "They would say, 'We had marriages that have failed; we've lost jobs. We can't relate to others, but we can relate to each other.' "

For many reasons, including pre-captivity training and the cohesiveness of the group, Alvarez and his fellow officer POWs have managed to largely escape severe psychological damage.

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Video: Will Ageism Dog McCain?

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Alvarez was the first pilot shot down over North Vietnam and was held the longest. He was released on Feb. 12, 1973, after 8 1/2 years. One of his compatriots at the Hanoi Hilton was McCain.

Alvarez sees his fellow captives fairly frequently and campaigned for McCain in 2000. He says he has seen no late-appearing PTSD and no LOSS in his contemporaries.

"There is no regression; it is all going forward, it is all business," he said last week. When they talk about their problems, the subjects are "regular geriatric issues."

Alvarez, 70, retired from the Navy in 1980 and now owns and runs a management services company. He spoke this week on his cellphone while walking to a meeting in downtown Washington. He was asked whether he thought anything about McCain's imprisonment might give voters pause.

"Hell, no," he said from the sidewalk. "John is one of the guys who did his job."

[lvdragonlady-2009]

I totally disagree with this article. My ex was in vietnam in the 60''s and to this day, he still has flashbacks and bad dreams. Now maybe, since Mac was in the air bombing folks instead of on the ground being shot at, that would make a difference but since the ex was not a POW, I would think that the flashbacks could be worse then the ones that an Army person, on the ground, would have. But I could be wrong.

[wardoglrs]

In the name of patriotism, we have participated in a planned deception to create a state of permanent war. In the name of profit, America has been sacrificed on the altar of the god of war, to create a global empire based on the mass-marketing of death.

%u201CWe are opposed...by a ruthless conspiracy that relies primarily on covert means for expanding its sphere of influence--on infiltration instead of invasion, on subversion instead of elections, on intimidation instead of free choice, on guerrillas by night instead of armies by day. It is a system which has conscripted vast human and material resources into the building of a tightly knit, highly efficient machine that combines military, diplomatic, intelligence, economic, scientific and political operations.

Its preparations are concealed, not published. Its mistakes are buried, not headlined. Its dissenters are silenced, not praised. No expenditure is questioned, no rumor is printed, no secret is revealed. It conducts the [war] with a war-time discipline no democracy would ever hope or wish to match...%u201D %u2013John F Kennedy, 1961.

"Anyone who would sacrifice freedom for security deserve neither". Ben Franklin (paraphrased)

"I would rather die with the constitution clinched in my fist, then live with shackles on my feet" Greywolf

[greatdrivew]

It''s odd how when McCain competed against Bush in 2000 that the Bush/Cheney/Rove camp depicted McCain as a deluded ex-POW with lingering trauma and PTSD issues. But now, he''s their candidate. I guess McCain must have gotten all that stuff straightened out.

[lsm2008]

What kind of a fool would think that if you are POW of war, that they would be sitting back for 5 years playing cards and eating BON BONS for enjoyment. What do you think their captures were doing with them? I''m sure not all were evil but I can''t imagine that they were in anyway good to them either. For one if they had been at all humane, the ones that needed urgent medical care for broken bones would have taken care of that, but apparently they did not.
If your ID ptsVeteran means that you served at one point, you should be ashamed to even make comments like that to other veterans. My husband is Retired Navy and even though he did not in 22 years of service come even close to living such a horror as these men had, he would never state such an opinion about anyone in that situation.

[ptsdveteran]

Had McCain had any real combat flying experience, maybe he wouldn''t have been shot down. Crashing several good planes in training should have said enough. How about the U.S.S Forestal. When he fired off a rocket causing many deaths and casualties. I really don''t think he was tortured in captivity. He is the one that broke his arms amd leg ejecting.vietnamveteransagainstjohnmccain.com says it all.