Veterans: Emotional Injury

Q: Dear Frank, What do you make of recent news articles about high rates of suicide, PTSD, and other alarming statistics among military serving in Iraq and Afghanistan?

A: I am deeply concerned. While I always want to emphasize the positives — that most of our troops do NOT come home with PTSD and most of our military families lead healthy, fulfilled lives– we simply must do more to prevent emotional injury, stigma, and alienation. I recently met Tom Mahany, a stonemason who attended West Point, served in Vietnam, and now campaigns tirelessly to improve our deployment policy and to honor veterans with PTSD. Tom believes that the “Stop Loss” program should be stopped. That program gives the Pentagon the authority to retain troops, to recycle them to the front over and over, and to place a profound burden on young families who live under pressures that we never had in previous wars. I wrote the following in support of Tom’s campaign:

“The military and military families are currently threatened with a remarkably high rate of psychiatric casualty, including suicide, substance abuse, depression and a combination of traumatic brain injury and PTSD. These conditions have secondary effects on spouses, children and family units. Left uncorrected, this condition will eventually undermine the morale, resilience and fitness of our military and will alienate advocates for our military. I cannot say with scientific certainty that the stop-loss policy causes the high psychiatric casualty rate, but it appears implicated.”

Beyond the deployment issue, we still have stigma and silence. PTSD is a hidden wound, and it still is misunderstood, under-recognized and insufficiently treated. My most recent patient who I’ll call Gary returned from Iraq with a fair amount of anger and anxiety, but he stuffed it down and said little about the incidents that haunted his dreams and returned in unwanted memories. He served in the national guard, saw combat, patrolled streets with IEDs, was ordered to shoot suspicious civilians and, on several occasions, came close to killing children. People were killed in front of him. One was beheaded. But after returning home all this became normal memory. He could recall details, but the details didn’t come out of the blue and capture him. Three years passed, in civilian life. Then he was in a car crash. He and his friend had minor injuries. The driver of the other car needed attention, and in a daze, Gary attended to him. Then Gary blacked out. When he awoke, his Iraq war episodes returned with the full force of military PTSD. We have talked this over, tried a few medications (for insomnia and an irritable depression) and seem to be making progress. Gary isn’t embarrassed about PTSD. He isn’t at risk for re-deployment. He doesn’t care one way or another about medals. He just needs help getting into school, having tuition covered, and becoming an EMT. He’ll be a great EMT. He instinctively moves toward danger and knows he can help at an accident scene. I’m not sure how typical or atypical Gary is. I know that my efforts as his doctor are atypical. I’ve arranged for him to see a friend of mine who is a retired vice president of the community college that can train him to be an EMT. This man served in the Navy and will do what ever is possible to mentor a young man who wants to transition to a public service career. I’m not doing EMDR or Counting or other forms of re-exposure because the military memories are receding on their own and the first concern right now is a path to permanent employment. We have “destigmatized” PTSD between us, but realize that his classmates may not fully understand his military experience. We will talk about that, as issues emerge. I anticipate some anger management challenges in a classroom environment. Gary hasn’t exploded, physically or verbally, but he is a aware of strong feelings. I’ll try to be available every week until he has a feeling of confidence and competence in a new role. I’m optimistic. So is he.

But, there simply aren’t enough of us to go around — doctors who can provide the meds that are useful, who understand PTSD, who can help a young man negotiate a whole new life while placing memories of a foreign war into the past, where they belong. Our job is eased considerably by the visitors to Gift From Within who know about PTSD and who are willing to support those who sacrifice and suffer.

Here’s a link that Tom Mahany sent me with his note, “Best Commercial Ever.”

Webcast: Should PTSD be considered an injury?

Frank Ochberg explains why he feels that a person with PTSD deserves to be
treated with dignity just as we would treat a person with a physical injury to their arm or leg.