Only 40 percent of the troops who screened positive for serious emotional problems sought help, a recent Army survey found. Nearly 60 percent of soldiers said they would not seek help for mental-health problems because they felt their unit leaders would treat them differently; 55 percent thought they would be seen as weak, and the same percentage believed that soldiers in their units would have less confidence in them.
The foregoing paragraph is from an important article in today's Washington Post by Dana Priest and Anne Hull entitled The War Inside and subtitled "Troops Are Returning From the Battlefield With Psychological Wounds, But the Mental-Health System That Serves Them Makes Healing Difficult". I can think of no more important article in today's papers to read and consider than this, so I am devoting my daily diary to a topic with which others normally deal.
Priest and Hull begin their article by making the issue personal, connecting it with one person:
Army Spec. Jeans Cruz helped capture Saddam Hussein. When he came home to the Bronx, important people called him a war hero and promised to help him start a new life. The mayor of New York, officials of his parents' home town in Puerto Rico, the borough president and other local dignitaries honored him with plaques and silk parade sashes. They handed him their business cards and urged him to phone.
But a "black shadow" had followed Cruz home from Iraq, he confided to an Army counselor. He was hounded by recurring images of how war really was for him: not the triumphant scene of Hussein in handcuffs, but visions of dead Iraqi children.
Yet even though Cruz had the support of the psychologist who examined him, who
wrote that Cruz was "in need of major help" and that he had provided "more than enough evidence" to back up his PTSD claim. His combat experiences, the letter said, "have been well documented."
his claim was denied by the VA on grounds that he had psychological problems before he entered the service and that he had not proved he was ever in combat, despite his service as a scout and a commendation medal with valor - a designation that can only be awarded under combat conditions. He is offered only group therapy, with session not available on weekends or late enough for him to be able to keep his job and still attend.
The foregoing is but a brief look at the detail Priest and Hull use to set the scene. They then lay out the problem clearly in two brief paragraphs:
Jeans Cruz and his contemporaries in the military were never supposed to suffer in the shadows the way veterans of the last long, controversial war did. One of the bitter legacies of Vietnam was the inadequate treatment of troops when they came back. Tens of thousands endured psychological disorders in silence, and too many ended up homeless, alcoholic, drug-addicted, imprisoned or dead before the government acknowledged their conditions and in 1980 officially recognized PTSD as a medical diagnosis.
Yet nearly three decades later, the government still has not mastered the basics: how best to detect the disorder, the most effective ways to treat it, and the fairest means of compensating young men and women who served their country and returned unable to lead normal lives.
Here I note that I served on active duty at the beginning of the Vietnam buildup, in 1965-and 1966. While I served only stateside I encountered those who had been in combat, and there were those who were suffering from what we now call PTSD. It is an issue for which those in the Vietnam era did NOT get the proper attention or service. Priest and Hull illustrate this with several paragraphs on one vet from that era, which I will quote in full to establish the problem:
Former Lance Cpl. Jim Roberts's underlying mental condition was overlooked by the Marine Corps and successive health-care professionals for more than 30 years, as his temper and alcohol use plunged him into deeper trouble. Only in May 2005 did VA begin treating the Vietnam vet for PTSD. Three out of 10 of his compatriots from Vietnam have received diagnoses of PTSD. Half of those have been arrested at least once. Veterans groups say thousands have killed themselves.
To control his emotions now, Roberts attends group therapy once a week and swallows a handful of pills from his VA doctors: Zoloft, Neurontin, Lisinopril, Seroquel, Ambien, hydroxyzine, "enough medicine to kill a mule," he said.
Roberts desperately wants to persuade Iraq veterans not to take the route he traveled. "The Iraq guys, it's going to take them five to 10 years to become one of us," he said, seated at his kitchen table in Yonkers with his vet friends Nicky, Lenny, Frenchie, Ray and John nodding in agreement. "It's all about the forgotten vets, then and now. The guys from Iraq and Afghanistan, we need to get these guys in here with us."
"In here" can mean different things. It can mean a 1960s-style vet center such as the one where Roberts hangs out, with faded photographs of Huey helicopters and paintings of soldiers skulking through shoulder-high elephant grass. It can mean group therapy at a VA outpatient clinic during work hours, or more comprehensive treatment at a residential clinic. In a crisis, it can mean the locked-down psych ward at the local VA hospital.
"Out there," with no care at all, is a lonesome hell.
How serious is the problem we are confronting now?
By this spring, the number of vets from Afghanistan and Iraq who had sought help for post-traumatic stress would fill four Army divisions, some 45,000 in all.
But that is the tip of the iceberg.
They represent the first wave in what experts say is a coming deluge.
As many as one-quarter of all soldiers and Marines returning from Iraq are psychologically wounded, according to a recent American Psychological Association report. Twenty percent of the soldiers in Iraq screened positive for anxiety, depression and acute stress, an Army study found.
And to what do they return? It is almost impossible to describe quickly all that Priest and Hull present. There are an insufficient number of mental health professionals on active duty (the number of active duty licensed psychologists has dropped from 450 to 350 with many unable to handle the stress of the patients they are seeing), and many counselors are improperly trained to deal with the problems they are encountering. In one case they write about a doctor whose specialty is aerospace medicine who basically thinks PTSD is over-diagnosed and thus opposed recognizing its existence in the personnel for whom he was responsible. When the military personnel are discharged and enter the VA system, they are enter what can only be described as a netherworld - a bureaucracy that
chronically loses records and sags with a backlog of 400,000 claims of all kinds
and whose methods for determining the existence of PTSD
had little basis in science
and were applied inconsistently at best.
The authors were, of course, responsible for exposing what was happening at Walter Reed. A report commissioned in the wake of that outpatient scandal found
"There is not a coordinated effort to provide the training required to identify and treat these non-visible injuries, nor adequate research in order to develop the required training and refine the treatment plans."
and the acting surgeon general of the Army wants to double the number of mental health professionals and increase their pay in order to address the problem.
But the problem is not yet fully developed. For one thing, there is a reluctance, particularly on the part of the officer corps, to avoid the stigma of seeking mental health assistance. The authors lay this out in a very blunt fashion:
Only 40 percent of the troops who screened positive for serious emotional problems sought help, a recent Army survey found. Nearly 60 percent of soldiers said they would not seek help for mental-health problems because they felt their unit leaders would treat them differently; 55 percent thought they would be seen as weak, and the same percentage believed that soldiers in their units would have less confidence in them.
Lt. Gen. John Vines, who led the 18th Airborne Corps in Iraq and Afghanistan, said countless officers keep quiet out of fear of being mislabeled. "All of us who were in command of soldiers killed or wounded in combat have emotional scars from it," said Vines, who recently retired. "No one I know has sought out care from mental-health specialists, and part of that is a lack of confidence that the system would recognize it as 'normal' in a time of war. This is a systemic problem."
Officers and senior enlisted troops, Vines added, were concerned that they would have trouble getting security clearances if they sought psychological help. They did not trust, he said, that "a faceless, nameless agency or process, that doesn't know them personally, won't penalize them for a perceived lack of mental or emotional toughness."
Priest and Cruz not only introduce their subject by focusing on one soldier, Cruz. They return to him to illustrate in detail the nature of the problem. Despite having had problems he was allowed to reenlist and given a bonus, then later
Seven months after his reenlistment ceremony, the Army gave him an honorable discharge, asserting that he had a "personality disorder" that made him unfit for military service. This determination implied that all his psychological problems existed before his first enlistment. It also disqualified him from receiving combat-related disability pay.
There was little attempt to tie his condition to his experience in Iraq. Nor did the Army see an obvious contradiction in its handling of him: He was encouraged to reenlist even though his psychological problems had already been documented.
I will not quote further. It is an article for which you should make the time.
And I cannot offer the kind of insight on this problem that our own Ilona Meagher has given us.
But I am a citizen. I am a former serviceman. First and foremost, I am a human being.
We cannot ask others to suffer like this on behalf of supposed national goals and not be willing to fully care for them. We should have learned this lesson from Vietnam, and apparently we have not. Perhaps it is a function of how little of our civilian leadership actually served in the military. Perhaps it is that there are so few now on active duty who themselves served in that conflict, which after all ended more than 3 decades ago, although the senior leadership - both enlisted and officers - would have served with many who had been in country, and who should have been able to understand the cost paid by those who served.
And in our discussions about what the war is costing us we must insist on properly accounting for the price being paid by those who serve. Here I do not merely mean that sufficient funds for medical and psychological care, sufficient trained personnel. If we cannot properly staff military activities without sending back those who have already suffered psychological damage, then we cannot continue our armed occupation. If it is against international law to subject those who are captured to inhumane treatment or to deny them appropriate medical attention, surely it must be wrong (even if not specifically illegal, which it well may be) to send into combat situations those with severe medical problems. I use the term medical advisedly - PTSD is a recognized condition. And those who would deny our military the proper diagnosis and treatment and/or who send them back armed into a hostile situation may well be guilty of crimes against humanity on two counts. First, their mistreatment of our military, which unfortunately might be the only thing that some would acknowledge. But also, under the doctrine of command responsibility they then become responsible for any wrongdoing by those troops, wrongdoing for which in reality the psychologically damaged troops should not themselves be held responsible.
Consider the number who have served, and what they have encountered. Recognize that sometimes the symptoms do not fully appear for months after leaving the theater. Remember that we have been sending units back with less than one year out of Iraq, and with their personnel not being fully screened and even if screened properly treated. We are exacerbating whatever problems already exist.
I entitled this "the coming deluge." We may see an exponential expansion of the number of people who develop PTSD. Were we to treat them all properly the cost will become very expensive, although we cannot morally deny treatment on the basis of cost. We should not be seeking to reject such claims, but rather, given the reluctance of many to seek treatment, we should be actively reaching out and screening to ensure that we are not missing those suffering its effects. The long-term impact of those not properly treated is potential a much greater problem than the cost of treating them. That is the real deluge.
And it is also how we may have already broken much of the Army and the Marine Corps. We have allowed far too many to suffer the insults and injuries associated with PTSD without properly addressing what has happened to them. That makes them less effective as military personnel, more likely to violate standards of conduct, for less productive in civilian life after discharge, . . . you get the picture.
I hope you will all read the article. I hope you will ensure that your members and senators read the article. I hope and pray that this article will have a similar impact as did the earlier article by Priest and Hull on Walter Reed.
But all of that is insufficient.
If this is the price we as a society are paying, it is too high. Add this on top of the 3,500+ deaths, the 20,000+ permanent physical injuries, the destruction of Iraqi lives and property, the loss of respect around the world for this nation. When will it be enough?
And when will our members and senators acknowledge that what we are doing is so morally wrong on so many counts?
Let us not abandon those who have already suffered because of the dishonesty and corruption of the leadership of this administration. Let us fulfill our responsibility to care for those who went in harm's way ostensibly on our behalf.
And unless we want to face a deluge hard to comprehend, let us move NOW to stop the continuing madness that only worsens this problem.
Peace.