In the same way terrorism and war dominate the news, they never completely exit a combat soldier’s mind. Once home, some veterans struggle with recurrent nightmares and the inability to sustain jobs or relationships. They will often self-medicate in an attempt to dull the memories of the horrors they experienced during combat.

In an effort to control those devastating effects, Edgardo Padin-Rivera, PhD, has spent decades developing healing techniques to help veterans recognize and manage the specters of war in all their forms.

As chief of Psychology Services at the Louis Stokes Cleveland VA Medical Center, Padin-Rivera has the perfect résumé for treating veterans with Post-Traumatic Stress Disorder (PTSD). He has a doctorate in psychology from Vanderbilt University and has completed internships at Stanford University and the Veterans Administration (VA) Palo Alto Health Care System. With almost 30 years at the Cleveland VA, he started as a counselor at Veterans Outreach Centers and then transferred to the medical center to specialize in treating substance abuse before assuming his current position in 2004.

Possibly his most relevant qualifications, however, aren’t even on his résumé.

Edgardo Padin-Rivera, PhD chief of Psychology Services at the Louis Stokes Cleveland VA Medical Center

In 1967, Padin-Rivera served as a helicopter door gunner in the 174th Army Airborne Brigade for several months before working as clerk in a combat company, where he was responsible for sending letters home to notify families of young mens’ deaths. He returned home just in time to descend into a multi-year miasma of anger, alienation, relentless frustration, job loss, family trouble, loss of faith and jail time, all of which are key indicators of PTSD.

“I may not be best therapist in the VA,” says Padin-Rivera, “but a lot of the veterans think I am and want to talk to me because I’m a veteran.”

At the time he struggled with his post-combat demons, his chronic ailment still hadn’t been accepted as a formal medical diagnosis. It was known as the Post-Vietnam Syndrome until 1980, when Post-Traumatic Stress Disorder officially took its place in the Diagnostic and Statistical Manual of Mental Disorders.

For veterans who find their way to the VA, gaining control of their PTSD starts with a thorough assessment. Underlying the disorder is an inability to process their traumatic experiences facing death into benign memories, according to Padin-Rivera. Instead, it becomes an inescapable part of their lives and thoughts every day. There are now 22 symptoms associated with the disorder. If an individual has at least nine of them, they can be diagnosed with PTSD.

“If a person has six or seven of those symptoms, which we would call subclinical PTSD, we bring them in and work with them,” Padin-Rivera says. “We don’t really care about the technical diagnosis, because we don’t have to for veterans who need care.”

After the initial assessment, VA counselors determine which of three primary therapies, which vary depending on the individual, will most benefit the veteran. The central focus of PTSD therapy is re-exposure or a return to the traumatic event or events that are the underlying cause of the disorder.

“Basically," says Padin-Rivera, "we ask the veteran to return to the event, consider it and figure out what they went through, what that meant to them and how that shaped them today.” Therapies that help vets untangle those memories include prolonged exposure, cognitive processing therapy and eye movement desensitization reprocessing, all of which vary in intensity and complexity. The VA also incorporates a variety of treatments to heal the whole person, whether he or she has physical problems or is dealing with issues such as addiction or marital discord.

Whichever treatment method is employed, one of the most successful components to the VA's programs, Padin-Rivera says, is veteran peer-to-peer counseling. In 2000, the Cleveland VA began hiring or recruiting volunteer veterans who had dealt with PTSD themselves and trained them as certified counselors to work with their fellow vets.

Louis Stokes Cleveland VA Medical Center

This is critical because veterans have more respect for someone who is empathetic to combat exposure. The empathy component is so important, Padin-Rivera adds, that the VA teaches nonveteran therapists to never say to a veteran, “I know how you feel,” or, “I understand what you’re going through,” since that’s the fastest way to lose a vet's attention and respect.

One of the veteran volunteers, Jack Prest, served as a combat infantryman in the 82^nd Airborne Division during the Vietnam War. He returned to Cleveland in 1968 and worked a series of jobs before opening his own collision repair shop in North Olmsted, which he operated for 25 years. He closed when dealing with employees and customers became intolerable. Then he opened a health club with a partner but quickly got out of that. Restless and looking for a way to help people, Prest became a firefighter and paramedic in Olmsted Township in his mid-40s. Then, in 2000, he herniated two discs carrying a 300-pound patient and had to retire. He got a job working in the emergency room at St. John Westshore Hospital.

“I realized that I needed to stop drugging and drinking,” Prest says. “So I traded one addiction for another and worked 24/7.”

He didn’t have any friends, had been drinking and abusing drugs since returning from Vietnam, loved his family but had been extremely strict in raising his children, and he admits to episodes such as being “escorted out of Home Depot by police for going off on a totally incompetent sales person in the plumbing department.”

Finally, his doctor at the Cleveland Clinic, who was treating him for Agent Orange- related sarcoidosis, threatened to haul him to the VA for PTSD treatment if he didn’t go on his own. After assessment, Prest earned a 100 percent rating for PTSD and was approved for treatment.

For the past 12 years, he’s enjoyed his role helping other veterans go through the same treatments and counseling he is in, both individually and in groups. Veterans, particularly those of the Vietnam War, are especially suspicious of “the government,” and often lump therapists into that category and distrust them since they know nothing about combat. Prest serves as the bridge between the two.

“I tell them you don’t need someone who knows about combat, you need someone who knows about treating PTSD, and the VA therapists are experts at that,” Prest says.

Several times a year, he works closely with another veteran peer counselor, Robert Croom, who also served in Vietnam, to take the veterans through a once-a-week counseling and support program for 10 weeks. (There is a more intensive 10-week residential program for veterans needing total immersion in therapy.) Prest carries a three-ring binder with him that’s packed with notes he’s taken, charts, handouts about understanding triggers and how to react to them, how to maintain a stable, daily routine and other helpful advice for veterans to teach them how to manage their PTSD and enjoy a better life.

“I’m not a motivational speaker, but I try to get them fired up about recovery,” says Prest. “There’s no magic pill to cure PTSD, but you can recover. So, every day, I work at my PTSD.”

“There is no real cure for people who have gone through this type of trauma,” adds Padin-Rivera. “So we teach people to be masters of those memories instead of having those memories be masters of them.”