CENTER FOR DEFENSE INFORMATION

A Different Kind of Enemy

11 June 2008

American Soldiers Face Mental Health Challenges After Returning Home.

By Brett Schwartz, Washington Prism Contributing Writer

 

     Winston Churchill once said, "Never, never, never believe any war will be smooth and easy, or that anyone who embarks on the strange voyage can measure the tides and hurricanes he will encounter." The consequences of these tides and hurricanes often times remain with the soldier long after he or she returns home from the battlefield. Sometimes the effects are physical, forcing a veteran to adapt to life in a wheelchair or learn to function with a missing limb. However, in many cases, soldiers return home with what a recent RAND report describes as the "invisible wounds of war." These are the psychological wounds resulting from experiencing firsthand the horror and dangers of combat. They are "often invisible to the eye, remaining invisible to other servicemembers, family members, and society in general," states the report, released in April.

     Due to medical advancements and improved hospital care, many more soldiers today are surviving injuries that might have killed them in past conflicts. However, the cruel irony of recovering from these wounds is that these soldiers may then face a different kind of enemy once they return home -- the enemy of depression and mental trauma. Even soldiers who were not physically injured during their deployment may have experienced what researchers call "combat stressors," scientific jargon for the all-too-real experiences facing military personnel during warfare. These may include being attacked, seeing death, and having a comrade killed or injured.

     Five years ago, the term "Posttraumatic Stress Disorder" (PTSD) was perhaps familiar only to mental health experts and researchers. Today, however, it has entered our nation's lexicon as more and more soldiers return home from Iraq and Afghanistan with mental distress. The National Center for Posttraumatic Stress Disorder describes PTSD as an anxiety disorder that may occur following a traumatic experience, causing a victim to feel "scared, confused, or angry." PTSD, first diagnosed by scientists in the 1970s, can be initiated by a variety of experiences besides military combat. These include experiencing physical or sexual abuse and life-threatening accidents or disasters.

     The alarming percentage of soldiers returning from the post-Sept. 11 wars who show symptoms of PTSD has brought the issue to the national stage. According to RAND, their April report is the "first large-scale, nongovernmental assessment of the psychological and cognitive needs of military servicemembers who have served in Iraq and Afghanistan over the past six years." The statistics paint an alarming picture of the far-reaching impact of this mental trauma as well as the inadequacies of the medical system that is in place to care for the soldiers upon their return. Using data from 1,965 military personnel who served time in Iraq and Afghanistan, the researchers extrapolated that around 300,000 servicemembers are experiencing PTSD and/or depression from their experiences on the frontlines and exposure to combat. By October 2007, 1.64 million Americans had been deployed as part of Operation Enduring Freedom (in Afghanistan) and Operation Iraqi Freedom. These statistics reveal then that close to 20 percent of those returning from these conflicts do so with some degree of mental scarring. The report also concludes that around 320,000 of the deployed personnel may have been the victim of a traumatic brain injury (TBI), caused predominantly by the abundance of improvised explosive devices (IEDs) that have become the weapon of choice for insurgents in both countries. Particularly concerning is the revelation that over 50 percent of those who may have experienced a TBI did not get professional treatment for it. The report also argues that for the servicemembers who did get medical attention for mental trauma, "just over half received minimally adequate treatment."

     These sobering statistics reveal that scores of returning military personnel are facing damaging mental trauma alone and without sufficient support and guidance. For too many veterans, this struggle has ended in suicide. A groundbreaking investigative report by CBS news correspondent Armen Keteyian in November reported that 120 people who at some point served in the U.S. military take their own lives each week (based on reporting from 45 states), resulting in 6,256 veteran suicides in 2005. The statistics gathered by CBS also revealed that veterans between the ages of 20 and 24 (those who have served in Iraq, Afghanistan and other locations since Sept. 11) were the demographic most likely to commit suicide -- at a rate three times that of civilians the same age. The startling numbers have convinced some observers that eventually more soldiers and veterans of the post-Sept. 11 wars will die by suicide than in actual battle. In early May Dr. Thomas Insel, the head of the National Institute of Mental Health, told reporters that it was "quite possible that the suicides and psychiatric mortality of this war could trump the combat deaths."

     These statistics are "painful and upsetting," commented Dr. Lisa Firestone in a recent interview with Washington Prism. However, she feels that these numbers show "only the tip of the iceberg" in terms of the problem. Firestone, the director of research and education at the Glendon Association, points to multiple, extended deployments to the dangerous and ill-defined battle zones of Iraq and Afghanistan as the major factors resulting in PTSD and suicidal tendencies among some soldiers. Dr. Jameson Hirsch at East Tennessee State University agrees that the "horrific experiences of war" no doubt play a major part in the development of these mental traumas. He adds, however, that these pressures are further amplified by "the existence of a military culture in which suicide is viewed by some soldiers as a viable solution to problems...whereby soldiers feel they must be 'strong' and show no weakness," he wrote via e-mail. Firestone believes that this attitude is also a reason many male soldiers in particular do not seek out help. "Men generally are more resistant to getting mental health help," she says.

     Not surprisingly, this issue has become a key concern on Capitol Hill. In May, the House Committee on Veterans' Affairs held a hearing called "The Truth About Veterans' Suicides" as a follow-up to a December hearing that focused on the plan of action by the Department of Veterans Affairs (VA) for addressing the crisis. Committee Chairman Bob Filner, D-Calif., was highly critical of the VAs handling of mental health and suicidal patients, particularly after an e-mail written by Dr. Ira Katz, the deputy chief for the VA's mental health office, became public during a class-action lawsuit in San Francisco. Dated Feb. 13, 2008, the e-mail reads:

Shh! Our suicide prevention coordinators are identifying about 1000 suicide attempts per month among the veterans we see in our medical facilities. Is this something we should (carefully) address ourselves in some sort of release before someone stumbles on it?

Filner directly addressed Katz and the secretary of veterans affairs, Dr. James Peake, during his opening statement at the hearing. He told Dr. Katz bluntly, "You are not performing your job in an effective way." As for the VA in general, Filner said: "What we see is a pattern that we have seen going back to the days of atomic testing, Agent Orange, depleted uranium, Persian Gulf Illness, traumatic brain injury, post-traumatic stress disorder, suicide, homelessness. The pattern in deny, deny, deny. Then when facts come to disagree with the denial, you cover-up, cover-up, cover-up." Officials at the VA have argued that it has been difficult to keep up with the drastic increase in the number of liability claims as a result of the higher demand from veterans of the wars in Iraq and Afghanistan, as well as from those who served in Vietnam who are getting older. 838,000 claims were filed with the VA in 2007 alone, a 45 percent increase from the 579,000 filed in 2000 prior to commencement of the "War on Terror."

     This is no excuse, says Aaron Glantz, author of "How America Lost Iraq" and editor of the website "The War Comes Home" which focuses on veterans issues. Glantz told Washington Prism that the government should have mobilized personnel and resources at the VA the same way the military mobilized troops in preparation for the invasions of Afghanistan and Iraq. He accused the George W. Bush administration of caring only about its image and instead of supporting the veterans, has actually "buried them under a mountain of paperwork." Glantz also says that there has been too much emphasis on the stigma of mental health preventing troops and veterans from seeking support. He feels this argument has at times been put forward by the government and VA "to excuse their incompetence," noting that he has known veterans who "have sought out the mental health help and it has been denied to them."

     A breakthrough on this issue may come over 2,800 miles from Washington in a federal courthouse in San Francisco, California. At the time of writing, U.S. District Judge Samuel Conti is deliberating on the class-action case Veterans for Common Sense v. Peake, the lawsuit that brought to light Dr. Katz's February e-mail. The plaintiffs, the veterans groups Veterans for Common Sense and Veterans United for Truth, are hoping that Conti's decision will result in a fundamental change in the way the VA operates and responds to veterans. Glantz says he has "more hope for this lawsuit than anything else" in making a positive change because it will "force politicians to pay attention" to the issue of veterans' rights beyond the mere rhetoric emanating from Washington. Conti should make a ruling sometime this summer, perhaps as early as June. Regardless of the ruling, the losing side will most likely appeal the decision and the case could find its way to the Supreme Court.

     "The military and the VA should bear the lion's share of the burden in providing effective and timely intervention and prevention programs for enlisted soldiers and veterans," wrote Dr. Hirsch at East Tennessee State. "However, they may not be able to do it on their own and should enlist the assistance of the nation's scientists and researchers to assist them in their fight against suicide deaths," he continues. All of those interviewed for this article agreed that more can be done both at the federal level and within the military to provide soldiers with all the necessary skills and coping strategies during and after wartime. Still, this change will take time given the size and complicated bureaucracy of the military and the VA. "I fear that such bureaucratic separation, paired with a militaristic approach to a very 'human' problem, might cause a solution to be a long time in the making," warns Hirsch.

     Following CBS's report in November, Sen. Daniel Akaka, D-Hawaii, issued a statement reflecting his concern about the veteran suicide statistics: "For too many veterans, returning home from battle does not bring an end to the conflict. There is no question that action is needed." It will take more than words, however, to make a change. As more and more veterans return home with these "invisible wounds," it is the responsibility of the government that sent these men and women off to war to provide them with the best healthcare and support upon their return. Anything less than that surely runs counter to the ideals and principles of the United States.

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