"I believe in a sacred contract between our country and America's veterans and military families. We must stand by those who stand by us. When our service men and women sacrifice so much to defend our freedom and secure peace around the world, we have a moral obligation to take care of them and their families."-- John Edwards
Our Veterans are in serious trouble. Their suicide rates are way up. Paul Rieckhoff has been posting about this, and CBS is finally giving it some necessary attention:
In the meantime, there's a lot, as laypeople, we can do to help veterans, even when they're dealing with serious mental illness.
This is a metaphor I commonly use when talking about mental illness:
Think of the human psyche as something which needs to be supported in order to avoid falling into an abyss. Most of us have support of some sort, both internal and external. We have a great deal which we need to balance, so picture someone on a platform above this abyss which needs balance and structure to keep us from falling off when small things (minor gusts of wind) and major things (hurricanes and tornadoes) threaten our sense of balance and self.
Most of us have strong mechanisms. We not only have the platform, but we have guy wires holding it in place, and keep it well maintained and patched (internal mechanisms). We also have external support (nets and ladders) which can catch us when we do fall, (as any one of us is bound to do from time to time, no matter how well designed our platform).
People with mental illness have that platform, but it's not well-maintained. The effort of maintaining it is too complicated for them, so they can fall through the holes more easily. The platform itself is patchy, and they can fall off it from time to time, but from day to day, many of them manage fine. If, however, a small wind blows by, it's more of a threat than it is to the rest of us. If a large gust comes by, it could mean major trouble.
There's always a ladder, and when trouble comes, there are ways to climb out, but not everyone has the skills to find that latter or to know how to get back out of that abyss again. Some are so scared of everything that the ladder itself is seen as a threat. A rare few are so scared of the stability that they leave the platform willingly and never intend to come back to it.
Mental illness happens for a variety of reasons, and it manifests itself in multiple ways. But at its core, it's almost always about finding ways to cope with the complexities of the world around us, and not everyone knows how to do that.
This connects with the concept of Psychological Adequacy: the ability to handle and withstand various stresses that come at us from time to time. Not everyone can handle the same kind of stress in the same way, but with good support and the right kind of assistance, anyone's ability to withstand external pressures can be improved.
As a society, we find physical injuries disquieting at times, but we are used to seeing them. Once, when giving a presentation to a group of medical students, one of the other presenters was a veteran who'd lost both his arms in an electrical accident some decades earlier. He showed up, went to introduce himself to me and held out one of his metal appendages to shake my hand. This was a new experience for me but I shook his "hand" and didn't think much of it after the fact.
Later, when talking to the group, he mentioned how he does that as a matter of routine. People meet him and think "do I talk about the hook? Do I look at the hook? Do I avoid the hook?" They don't know what to do or say about it, so he just puts it right up to them so they can actually touch it for a moment and just get the whole "what do I do/say/think about the hook" thing out of the way and over with. He was right -- it worked perfectly well. I was completely at ease around him from the moment I actually touched the prosthetic.
Physical injuries are complicating to social interaction, but once you get past them, they're not very complicated at all.
Mental issues are infinitely more complex, and they tend to touch a certain fear and lack of confidence inside of us and make it much harder to progress. But really, they're just injuries: damage from experience, chemistry, genetics, etc.
The problem is that they're injuries which are easy to hide, which most of us prefer not to think about, and which can take time to manifest, sometimes surprising the victim as well as everyone else, and sometimes our first instincts as humans do little to solve the problems.
Treating everything as though it's normal, for example, might not actually help. When people dealing with extreme trauma are thrust suddenly into an environment of extreme normalcy, it's sometimes difficult for them to find their place. If the normalcy is so enforced (with the intent of making someone feel at home or comfortable), it can actually make things worse, playing off of the internal sense that if you don't feel at home or comfortable that there's something wrong with you.
In the meantime, as IAVA reports, the professional component of this is far from adequate:
90% of military psychiatrists, psychologists and social workers reported no formal training or supervision in the recommended PTSD therapies, and there is a general shortage of trained mental health professionals in the military. The Pentagon screens returning troops for mental health problems via an ineffective system of paperwork. Studies have shown that many troops are not filling out their mental health forms, that there are serious disincentives for troops to fill the form out accurately, and that those whose forms indicate they need care do not consistently get referrals.
Let's talk again about that platform-- even if you come out of combat completely intact from a physical level and never suffer a direct attack, you know you're in danger while there. This weakens your platform. If you kill someone, even if you're in no direct danger yourself, your psyche probably suffers some wounds. If your friend or a member of your unit is killed or injured, this does damage as well. If you're injured and alone for a period of time, not knowing how it's going to turn out, that's got to cause problems.
But here's the thing: all of these wounds are invisible and to people suffering from them, they can take on the form of unexplained fears, terrors and nightmares.
Think about what this means to someone who's a trained soldier: you've got the experience to stare death in the face, but you can't sit in a restaurant without having your back to the wall because your hands shake when you can't see the whole room you're in. You've survived 110 degree heat, sniper attacks, land mines, IEDs, but you get home and you almost go off the road when you hear a car backfire.
And you don't want to talk about this with the people you love and care about because they've done so much to make you feel at home and you're terrified and you don't want them to be terrified, too, because you're the strong one and you've always been the strong one.
But there's nowhere for you to go because the VA doesn't have the resources to provide you with adequate care and even if they could get you in right away, they're not training their staff to recognize the symptoms.
And you don't know enough about other soldiers who are surviving with the same thing you're holding onto, holding in and your platform isn't just weak now; it's getting ready to collapse. But you don't see it because you don't want to see it and no one around you sees it because they want you to be well and happy and are so invested in you being well and happy that they just don't have the ability to separate themselves out and be objective about it.
And it's not just that you're scared, but terrified of it.
So what do you do?
What's happening in Iraq and Afghanistan isn't just about the damage to the thousands of soldiers who have died, or even those who suffer physical debilitating physical injury. It's also about the tens of thousands who, whenever they eventually come home, will be facing their own demons. The more we avoid dealing with what's to come, the worse it will be for our veterans, their families, their communities and their friends.
None of this happens in a vacuum. The damage on the soldiers is bad enough, but when you factor in the damage to families and communities, it's incalculable.
I don't have wisdom about this. I don't have a magic solution. I don't have a quick fix. I just know that unless we take it seriously, we're in really big trouble.
I started this with a quote from John Edwards. He's my favorite in this race, but I'm sure other Democrats have great positions on this, too, and I'm glad to see you all posting links to your own favorite candidates' point of view in the comments, but I'm going to close with one more quote, from Edwards' policy position on the treatment of PTSD:
Once our service members become veterans, we have to make sure the system doesn't fail them. As president, Edwards will create a new national chain of care to ensure that no veteran again falls through the cracks. Because many veterans receive treatment outside the VA system, this chain will coordinate treatment and benefits in outreach centers and clinics in every county where a veteran resides, both within and outside the VA network. Edwards will also improve training for health personnel to recognize and treat PTSD; establish uniform standards for mental health care to address the wide range of quality of care; increase counseling resources within TRICARE and VA networks and permit access outside of the networks; and ensure that outreach is extended to family members who can help recognize symptoms. Caring for the newest generation of veterans must be accomplished without neglecting the continuing needs of veterans from previous generations.
It's a damned fine start.
(This diary was crossposted to Green Mountain Daily)
UPDATE: In the comments, DWG references an excellent diary from yesterday with some great facts and figures about this