​​​​​​​​​​​​​​Catherine Revak, a first-year doctoral student in clinical social work at the University of Pennsylvania, was seated comfortably toward the back of the room at the Penn Bookstore.​​​​​​​She listened intently as former military personnel shared their experiences during “Sacrifice and Service: When Women Come Marching Home,” a panel discussion on the obstacles involved with making the transition back to civilian life, particularly among female veterans. Some of those challenges involved the vast differences in workplace communication, becoming a parent and common mental-health issues among veterans, including post-traumatic stress disorder.

A licensed social worker at Penn Hospice, where many of the patients are veterans, Revak earned her master’s degree from Penn’s School of Social Policy & Practice in 2016.

The School “was a perfect fit for me. My master of social work degree was met with a concentration in veterans’ mental-health care, and my doctorate thesis will expand on veterans’ issues as well,” says Revak, who completed her bachelor’s degree in gender and sexuality studies at Penn’s College of Liberal and Professional Studies.

She was also there for personal reasons.

At 17, Revak enlisted in the Air Force. She served on active duty from 1993 to 1997 and has experienced some PTSD symptoms firsthand.

As a member of Vets at Penn, she says discussions like this one advance its mission.

“This panel expands the female-veteran narrative and engages in topics surrounding clinical care, which will continue to humanize our veteran experiences,” Revak says.​​​​​​​In addition to showing clips from “Blood Stripe,” a film about a female combat veteran who fights to overcome PTSD, the panel featured a diverse group, including one with a strong connection to Penn: Jennifer Peters, a former Navy officer who earned her master’s in public administration from Penn’s Fels Institute of Government.

Other panelists included a retired Army officer, Penny Cromwell, who participated in Operation Iraqi Freedom and Operation Enduring Freedom; Rebeca Cruz-Esteves from the Army National Guard; Myra Fields-Rouse, who spent 22 years in the Army; and Darcel Rideout, who served for 10 years in the Pennsylvania Army National Guard and is now an advisory-board member at the Steven A. Cohen Military Family Clinic at Penn, which has treated more than 300 patients in the last year for conditions such as depression, anxiety, grief or loss, relational problems and PTSD.

“People with PTSD feel alienated,” says explains Edna Foa, a professor of clinical psychology in the Psychiatry Department in Penn’s Perelman School of Medicine. “They feel as though nobody understands them anymore because they went through something terrible that no one else has gone through. “They are isolated emotionally.”

Foa has dedicated her career to understanding anxiety-related disorders, such as PTSD.

She is also the director of Penn’s Center for the Treatment and Study of Anxiety, which treats people with anxiety-related disorders using evidence-based cognitive-behavioral therapy.

Foa says there are four clusters of PTSD symptoms.

These include persistently re-experiencing the traumatic event, avoidance of trauma-related stimuli afterwards or staying away from situations that might trigger reminders, negative thoughts or feelings after the trauma and trauma-related arousal and reactivity after the trauma, or hypervigilance.

Other indicators might include nightmares, avoiding intimate relationships, feeling “on alert” all the time, trouble concentrating and difficulty sleeping.

Sometimes, because people are so busy with work and family life, the symptoms are temporarily pushed onto the back burner, so they may come and go, in a sense.

“Many times, later on in their 50s, when they’re not as busy with daily life, the symptoms come to the forefront,” Foa says, adding that triggers may include a lot of stress or an anniversary of the trauma.According to the National Center for PTSD, Department of Veterans Affairs data indicates that nearly 20 percent of the female veterans who served during combat in Iraq and Afghanistan have been diagnosed with PTSD, and certain symptoms are more common in women than men. For instance, while men are more likely to feel angry, women may experience depression, anxiousness, difficulty feeling emotions and a desire to avoid things that remind them of the trauma.

“In Iraq,” Foa says, “it was dangerous to drive on highways, but now, in Philadelphia, it’s not–-other than a traffic accident. It’s unlikely that you will face an explosive device, but people with PTSD avoid driving on highways. Or, they might go to a supermarket at 2 a.m. to avoid being in a crowded place. It feels safer for them.”

While women have more PTSD than men in terms of the general population, she adds, the majority of people who experience trauma do not develop PTSD.​​​​​​​

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Common PTSD Symptoms 
After a traumatic event, most people get better in time. 

The National Center for PTSD suggests seeking help if symptoms like these last longer than three months, cause great distress or interrupt work/home life: 

• Nightmares 
• Increased heart rate 
• Flashbacks
• Staying away from places that may remind you of the trauma
• Avoiding large crowds 
• Trouble concentrating 
• Difficulty sleeping 
• Feeling alienated or emotionally isolated 
• Hypervigilance or feeling “on guard” all the time​​​​​​​ 
• ​​​​​​​Anger​​​​​​​​​​​​​​

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​​​​​​​Although trauma survivors may experience some symptoms of PTSD, in most cases they dissipate over time, Foa says, adding that people can experience symptoms here and there, but these feelings do not interfere with their daily lives.

If the symptoms are interrupting one’s work or home life, cause great distress or last longer than three months, the National Center for PTSD suggests seeking help.

The Center for the Treatment and Study of Anxiety at the Penn Department of Psychiatry offers treatment for PTSD and other anxiety-related disorders.

Outpatient facilities like the Cohen Clinic provide free confidential, personalized and evidence-based behavioral health care for veterans and military family members with no long waits. Regardless of role or discharge status, the clinic opens up its doors to welcome those veterans who may not otherwise have access to care.

The Department of Veterans Affairs is also addressing PTSD.

“Right now, every patient at the VA is screened for PTSD and the VA has made a serious effort to disseminate evidence-based treatment,” Foa says.

After completing her D.S.W., Revak plans to continue to work with veterans and to enlighten other clinicians about veterans’ mental-health-care concerns.

“There is a concerted effort by medical professionals,” Revak says, “to improve veterans’ mental-health care, inside and outside of the VA. But, here’s the point of contention: you are trying to help a population who has been taught that self-reliance and strength are virtues.”

The panel was co-sponsored by Penn’s Office of Affirmative Action and Equal Opportunity Programs along with the Steven A. Cohen Military Family Clinic, which is based at the Perelman School of Medicine.

“Our event honors the service of women veterans,” says Ralph De Lucia, the associate director of the Office of Affirmative Action and Equal Opportunity Programs. “Our panel looks to paint a universal portrait of trauma and war’s cost to the individual and society.”​​​​​​​​​On-Campus Resources for Veterans: 
Help Line
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Penn Behavioral Health 24/7 hotline: 888-321-4433

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215-898-7021

Office of the Chaplain
215-898-8456

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