Cover Story Article

Special to Veterans Advantage

Barbara V. Romberg, Ph.D. is a licensed clinical psychologist and the founder and president of Give an Hour

Memorial Day—a day set aside to commemorate U.S. men and women who died while serving our country—is fast approaching. This past Memorial Day we are well aware that many of our young men and women are suffering and some are dying because we are failing to ensure that they receive the mental health care they need, both in theater and here at home. The recent tragedy at Camp Liberty in Baghdad highlights the need for our country to come together around this issue. We must reduce the stigma associated with seeking mental health care by military personnel. For those of us in the mental health field, it is perfectly clear that there should be NO stigma attached with seeking help for what is a normal human reaction to the horrors associated with war.

Everyone is affected by the experience of combat. As the Army’s chief of staff, General George Casey, stated in a recent briefing about the Camp Liberty shootings, "Combat deployments are inherently stressful," (USA Today, May 16). Gen. Casey went on to suggest that Sgt. Russell—who shot and killed five fellow soldiers—was most likely suffering the consequences of multiple deployments piled on top of other life stressors. Gen. Casey was quoted as saying, “I can’t believe that the stress of three combat deployments, added to personal and family situations and stresses, is not some type of a contributing factor."

So the question is not who needs assistance but how can we ensure that all service members receive the type of support and assistance that is right for them. Not everyone develops post-traumatic stress, but everyone is affected in some way. Therefore, we need to think of combat stress as forming a continuum. Some individuals will have a mild reaction to the experience of war and perhaps mild symptoms of anxiety, depression, and irritability. Others will have moderate symptoms possibly including substance abuse, moderately intense anxiety and depression, and explosive anger. Finally, perhaps a full third of those who see combat will develop serious symptoms of post-traumatic stress that will affect their functioning, in the field and upon return home. Most of those who serve—whether they experience mild, moderate, or severe reactions and symptoms—will face challenges in their relationships. Many will struggle with the day to day adjustments to life back home. Those who face repeated deployments increase their risk of developing severe symptoms with each additional exposure to war and trauma.

Given that we know that everyone who experiences combat is affected psychologically and that possibly a third of all of those who go to war return with significant consequences of their service, we must change the way that we think about, talk about, and respond to post-traumatic stress. First and foremost, we must drop the term “disorder” from the initial reaction or set of symptoms that a returning warrior has to combat. Post-traumatic stress is a descriptive term that implies the natural consequences of experiencing trauma. Post-traumatic stress disorder suggests that the symptoms experienced are pathological, whereas we now understand that these symptoms are a manifestation of our brain’s reaction to intense, overwhelming, and often extremely disturbing stimulation. Flashbacks, emotional numbing, irritability, anxiety, depression—these are all reactions we would expect someone to have who has been involved in the horrific activities associated with war. Only if we fail to respond to and fail to assist those who are exhibiting these symptoms do we run the risk of allowing the development of a full blown disorder, which can become both chronic and disabling.

One way to move toward a different perspective on the impact that combat has on the mental health of those who serve is to assume that post-traumatic stress is a likely outcome of serving in the military during a time of war, just as loss of life is a potential risk of joining our armed forces when we are involved in a military campaign. We don’t give our men and women in uniform the benefit of doubt. Our military personnel are willing to lay down their lives for our country. We must give them the tools they need— including education about post-traumatic stress—and trust that they will continue to choose to defend our freedom.

The military is not, however, the only institution at fault here. We in the civilian community fail to acknowledge that post-traumatic stress is a very real hazard for those who serve. This is not a huge surprise given that we fail to acknowledge this reality for others in our society who are in high-risk occupations including police officers, firefighters, and other first-responders. As a culture, we are uncomfortable with discussing mental health in general and still believe that seeking counseling or treatment is a sign of weakness and certainly of pathology. This perspective is amplified in the military culture where discipline, self-reliance, and mental toughness are qualities that are required and highly valued.

The military is doing much more than ever before in its attempt to address the mental health issues associated with exposure to combat. For example, in an effort to prevent severe psychological stress, the Army is conducting resilience training known as Battlemind throughout its ranks and during different phases of deployment. As reported in the Washington Post (May 17, 2009), Battlemind is a program designed to toughen soldiers psychologically for war. The program works by introducing military personnel to the combat experience before they deploy. Richard Keller, who leads the program at the Walter Reed Army Institute of Research in Silver Spring, was quoted as saying, “We show them what the deployment experience can be like, what things you might see, smell, think, feel, hear—all the sensory inputs...so they are not taken by surprise." Although this is an important step in the right direction, it is just that, and many more are needed.

Congress is also attempting to address this issue through a number of hearings designed to explore related concerns such as whether the Department of Veterans Affairs is successful in reaching out to OIF/OEF veterans as they return to our communities. While these various hearings attempt to address important pieces of the overall puzzle, they actually miss the primary problem—that no single agency, organization, or sector can completely care for the men, women, and families who serve our country, especially during a time of war. We must move well beyond the notion that we can solve this issue by throwing money at various programs developed by the VA or DoD. We need a comprehensive plan—a kind of public works project—to ensure that all of our communities, military and civilian, are able to assist and support military personnel and their families while they are serving and when they return home.

Give an Hour, providing free mental health services to military personnel and their loved ones, at www.giveanhour.org.

Editors Note: Give an Hour is a strategic partner of Veterans Advantage. For more on our partnership, click here.

Veterans Advantage is also hosting a special online PTSD Transition Center for its members, with customized news and resources to help in this vital area.