Having to hide sexual orientation in service to nation can result in long-term PTSD:

Of those gay servicemembers who had to hide their sexual orientation while serving in combat in Vietnam that developed PTSD, some had significant readjustment problems as a result.  "This is primarily due to the lack of social supports, within military, and in the veteran population at large.  Very few gay and lesbian veterans are active and open in their local American Legion, or VFW.  Many are alienated from their heterosexual counterparts, families, and rely on the LGBT community and connections they make."  Dr. O'Brien said that he believes that countless LGBT combat veterans' issues have gone unattended, and many may have succumbed to substance abuse, or subsequent suicide as a result of the societal ostracism.  

For older gay veterans, this sense of isolation is also made worse by the lifelong fear of closeted persons of being "outed," and possibly fired in civilian life.  "This is a constant in every LGBT individual's life, regardless of military service however, as a result of DADT, and the previous wording in the ban on homosexuals, experience the intrusive thoughts, and fears they felt during their military careers of being systematically humiliated and dishonorably discharged if "outed." Those who were discovered to be LGBT, and in violation of the ban on homosexuals that have been in place since World War II that were dishonorably discharged, tended to have much lower levels of employment and additional adverse effects on their post-military readjustment.  Following a lifelong sense of societal isolation, shame, and humiliation some of these veterans are now finding their way into treatment at Vet Centers."  One individual Dr. O'Brien worked with came in seeking a discharge upgrade more than 50 years after being coerced into a dishonorable discharge for being a homosexual.  Some 40, or 50 years after their service, veterans are finally coming to Vet Centers seeking help in getting a discharge upgrade in order to be eligible for medical benefits which they desperately need at age 50 - 60, having no other health benefits due to their lifetime of under-employment.  

Many of these gay veterans, according to Dr. O'Brien, lacked the social camaraderie of traditional veterans associations and moreover often were also alienated from their families.  "As a result of this lack of normal support networks, many gay Vietnam veterans never successfully reintegrated into society and civilian life after their service.  Such gay veterans were frequently found to have low self esteem and unable to fully appreciate their valued contributions as service men and women."   Although the Veterans Administration does not discriminate, according to Dr. O'Brien, many gay veterans believe that it does based on their experience while in the military, and consequently have stayed away and never got treated following their service.   The Vet Center multi-cultural outreach program, which he and others have pioneered, tries to overcome  this problem and brings in families and significant others of all groups, including LGBT veterans and partners for groups and other comprehensive and inclusive treatment modalities.

What these treatment sessions have revealed is that gay service members on active duty, particularly in a combat zone have had a constant fear of being outed, fragging (intentional 'friendly fire'), and harassment.  More recent gay veterans have been more openly accepted within their command units and thus felt more assimilated and integrated than in previous combat situations.  However, the homophobia from the top of the chain of command down has remained unchanged administratively.

The discriminatory policy induces a sense of shame and leads to low self esteem:

Treatment sessions with veterans have revealed that gay servicemembers suffer from a unique situation brought on by a policy that requires them to hide their orientation and keep a constant secret while constantly hearing homophobic policy that says that they are unfit, unwanted, and unsuitable for the service they have devoted themselves to.  The constant, repeated, implied shame has led to lifelong low self esteem, affecting employment, relationships, lifestyle, and healthcare avoidance that continues into  old age.  "Let's not let this current generation of LGBT veterans suffer the same fate," he concluded.

John Tatarakis, MS, MPH, a Psychiatiric / Mental Health Clinical Nurse Specialist and Patient Care Team Coordinator, has dealt with two distinct groups of veterans requiring mental health treatment in the aftermath of their military service: Those in their 20s and 30s currently transitioning back to civilian life and suffering social dysfunction; and those from ages 50 to 88 suffering long-term problems long after their service.

Treating social stigma and isolation caused by DADT policy is a Public Health Issue:

Older gay veterans have been found to have the least social support.  During their military service, in their youth, they learned to compartmentalize the segments of their life in order to hide their gay identity. This led to a lifetime of compartmentalization resulting in the failure of developing a social support network.  In older age and ill, never having belonged to traditional veterans' associations, they were unaware that they could get healthcare from the VA.

In treatment groups for older gay vets run by Mr. Tatarakis, these vets for the first time in their long lives have begun to see their long-ago service as having been honorable and that they therefore deserve the same healthcare treatment as other veterans for their illnesses.  In these groups, older gay vets have been able to talk openly for the first time with others who have had the same experience.  And thereby their long-delayed post-combat service re-socialization begins when they form bonds and a support group of their own in which they feel understood for the first time by those with a shared experience.  While in the military, these vets had never been able to get close to their peers and form the normal supportive bonds because they feared saying too much and being outed.   In later years, many had  become further isolated due to the loss of close friends to AIDS. Now, via these groups, forty or more years after their service, they at last find peers with whom to form a support network.

For many of these stoic older gay veterans, the symptoms of PTSD, which originated in their combat service, did not emerge until after their retirement decades later, after they lost those close to them to AIDS, and found themselves isolated, ill, and in need. They had no idea that they could turn to the VA for assistance and treatment because they believed that the VA did not treat their issues and that they would be discriminated against.  Hence, there is a long-term public health issue that has resulted from the ban on gays serving in the military, which evolved into the current  Don't Ask Don't Tell policy, which perpetuates the social stigma and isolation of these proud patriotic volunteers.

Ray Chism, a Vietnam-Era veteran, described his experience as a gay Black man in the service and as a veteran.  He had enlisted in the Air Force at age 20 and served four years.  He immediately realized that he had to compartmentalize his life and suffered ongoing stress from having to constantly be careful.  He knew that if he were known to go to gay areas he would be court martialed.  So he devoted his efforts, successfully, to "keeping my nose clean," and completed his duty with an honorable discharge and got the benefits he deserved.

Later, he moved to New York City to care for his ill uncle and joined the Army Reserve.  During the course of that second service, his living arrangement with his uncle was questioned and investigated.  In the end, he was denied the opportunity to reenlist and was given a 'Less Than Honorable' discharge.  "The USAR stuck it to me," he said, speaking freely at last.

For minorities, the discrimination against gays serving their country is all too familiar:

"My service was as honorable as any other reservist's," Mr. Chism told us, speaking out at last after what he said had been a life of secretive stress and fear of being harmed because of who he is.  "Being gay is no different than being left handed.  And discrimination is no different whether you are gay, or Black or both."  His experience as a Black veteran, he said, made him very aware that America does not uphold the principles of our constitution, the relevant passage of which he quoted from memory.  "The pursuit of happiness," he said, includes the right to be able to live freely with his partner without fear of discrimination.  Until Americans see gay people as normal as being right handed, the hate and hurt will continue.  In his experience, "the world has not changed very much, but it is changing" ever so slowly.  He urged the university students to carry on changing the world.

The conference was organized by public health students including Adrian Guzman, Todd Sekuler, Alison Lin, Molly Franks, Andrea Sifferman, Kate Jerman, and Alexa Prussin. Assistant Professor Miguel Munoz-Laboy also helped to facilitate a final discussion on the role of public health professionals in serving the needs of invisible and marginalized populations.