"Anxious for Christmas Morning?": Why We Need a New Way to Talk About Veterans’ Symptoms

Mental health is messy and complex. Unlike many aspects of our physical health, there are no blood tests that can determine if we have a mental health disorder. Most diagnoses are based solely on what symptoms a client reports.

In a world where mental health issues continue to be a taboo topic, there’s not enough familiarity with mental health disorders for people to know when to seek treatment. Or, if they do seek treatment, clients and providers are not always speaking the same language.

I have been immersed in the world of mental health, both personally and professionally, for so long that it’s hard to remember what “normal” people know. Like many mental health providers, I try to bridge the possible knowledge gap by providing helpful lists of common symptoms.

Lately, I’m questioning how helpful those lists may be.

For the past few years, a large portion of my work has been with Veterans (or soon-to-be Veterans) who have applied for VA Disability Benefits. I evaluate Veterans for possible mental health diagnoses and submit a report to the VA.

My report includes a symptom checklist that is used by the VA to assign the Veteran’s disability rating. Since their disability rating directly affects their monthly compensation, my accuracy on that checklist is important.

So, I ask my Veterans about each of the symptoms on the checklist. I am likely one of the few examiners to do this, though I wish that weren’t the case. It seems unreasonable to expect someone to know what symptoms to bring up and/or to remember to bring those symptoms up during the exam.

In going through that checklist with my Veterans, I have learned an important lesson. Those “helpful” lists of common symptoms may be helpful for some people (or possibly just for other mental health professionals), but those lists are relatively meaningless to Veterans. We are NOT speaking the same language.

Do you remember learning what hungry feels like? I do. I remember telling my mom that my stomach hurt, and since it was almost dinner time, she told me that I was probably just hungry.

Every once in a while, I think about that moment. Somehow, I learned the word that described what I felt inside. It boggles my mind to think about. But clearly, we have all had millions of moments like that. Somehow, by the time we’re adults, we all know what it means to feel hungry. Can you even imagine not knowing?

I’ve been dealing with anxiety since about 3rd grade. I don’t remember when I learned that what I was feeling was anxiety.  And to me, feeling anxious is no more foreign than feeling hungry. Anxiety is another universal human experience. It never even occurred to me that anxiety is NOT one of those words that we all learned along the way.

It makes sense, though. Of course, we all know hungry. People are very open about feeling hungry. There’s (often) no shame about feeling hungry.

We don’t have that same openness about feeling anxious. If no one is talking about it, how are we supposed to learn what it is?

To me, anxiety is obvious. So I was dumbfounded when my first Veteran asked me for clarification: “What do you mean by anxious? Like, I’m anxious for Christmas morning to come?”

Anxiety is the most frequent symptom that Veterans ask me to explain.

At least half of my Veterans are dealing with near-paralyzing anxiety on a regular basis, yet they would have never thought to describe it as anxiety.

So, how are they supposed to know when or how to ask for mental health treatment?

To help with this, I've created a checklist of 25 common symptoms in a language that makes sense.