The long wars in Iraq and Afghanistan have put considerable strain on members of the all-volunteer U.S. military. Some of that stress is reflected in an increased need for psychological counseling for troops returning from long and multiple tours of duty in the war zones. In Focus, VOA's Al Pessin looks at how the Defense Department is addressing the problem.
Colonel Terry Walters, a doctor and commander of the Wounded
Warrior program at one of the largest U.S. military bases, recently
sent a message to her bosses at the Army medical command.
Colonel Terry Walters:
"We're going to be short of psychiatrists. But we need even more than
our normal complement of psychiatrists to deal with this surge of need."
Colonel Walters' "surge of need" at Fort Bragg, North Carolina is
coming because of the end of the surge in Iraq, as thousands of troops
deployed to support the new counterinsurgency strategy last year return
to their home base.
Colonel Terry Walters:
"One of the lessons we've learned from Iraq is that there are no front
lines, that everybody is exposed to stress. What we're doing is we're
sending perfectly normal individuals into combat, which is, by
definition, an abnormal situation."
Colonel Walters says the Army is sending her some extra psychiatrists
and psychologists, but sometimes it is difficult to get soldiers to
admit they need counseling.
Colonel Terry Walters:
"There is a belief out there in our society and especially in the
military that, 'Oh, just pull yourself together, pull your socks up,
and rock on [i.e., get on with your life].' I think there are
significant numbers of soldiers who are not seeking care because of
this perceived stigma, which we're trying to do a lot to combat."
U.S. Defense Secretary Robert Gates is among those trying to spread the word.
Robert Gates:
"You're tough and you go into the hospital when you receive a physical
wound. That doesn't mean you're weak in some way. And so why wouldn't
you when you've received a psychological wound? It's the same
difference. They're all wounded."
Secretary Gates has described a proposal to award Purple Heart medals
to troops diagnosed with Post-Traumatic Stress Disorder, or PTSD, as
"an interesting idea". A Pentagon committee has rejected that proposal
in the past, but it is taking another look at the issue. The Purple
Heart is awarded to troops wounded in combat, and several senior
officers have been quoted as opposing the expansion of the criteria to
include PTSD.
But the Pentagon is fighting the idea that psychological wounds are
less significant than physical ones. It has established a Center of
Excellence to spread understanding of the impact of combat stress and
information on what commanders and doctors can do to help.
Loree Sutton:
"We work very hard to help our leaders as well as our service members
understand that treatment really works, and it's a sign of strength."
Colonel Loree Sutton is the Director of the Center of Excellence.
Loree Sutton:
"Part of our challenge is to help families, help individuals, warriors,
help communities understand what are the normal, what are the normal
reactions, the human responses to stress. If we don't understand what's
happening, it's scary. You know, the flashbacks, perhaps the
nightmares, the jumpiness. And so what we have to communicate to folks
is to help them understand these are normal signs of healing from
trauma. No, you're not going crazy."
The experts also want the troops to understand that post-traumatic
stress is not necessarily Post-Traumatic Stress Disorder. They say it
is only a "disorder" if symptoms persist after treatment, and it is
only a disability if it prevents the sufferer from returning to work or
resuming other aspects of their lives.
But the Defense Department has come under criticism for not providing
enough high-quality treatment to the troops who need it. A recent study
by the RAND Corporation says that 300-thousand of the one-and-a-half
million U.S. troops who have served in Iraq or Afghanistan have
symptoms of Post-Traumatic Stress Disorder or major depression. The
study also says that only about half of the Iraq and Afghanistan war
veterans who have PTSD symptoms, depression or traumatic brain injury
have sought treatment, and that only half of those veterans received
adequate treatment.
Terri Tanielian was co-leader of the study.
Terri Tanielian:
"Service members will report a number of barriers to getting care. We
found that of the top five barriers, three of those were associated
with concerns about the career repercussions of seeking mental health
care."
The Chairman of the Joint Chiefs of Staff, America's top military
officer, Admiral Mike Mullen, has joined the effort to convince troops
that seeking counseling will not hurt their careers.
Mullen:
"I hear it everywhere I go -- the belief that admitting to the need for
counseling and assistance or the fact of having received it only
penalizes you and stifles your career. Good people, many of whom have
seen combat up close and faced its grim reality, whose courage is
absolutely unquestionable and who deserve only the best physical and
mental health care we can provide, are actually willing to deny
themselves that care out of the fear that doing so hurts them and their
families in the long run. Nothing could be further from the truth. And
it's time we got over that."
But it is an uphill battle among commanders and ordinary troops.
As part of the effort, the U.S. government recently stopped requiring
people applying for security clearances, including members of the
military, to state whether they have ever had psychological counseling
for combat stress.
At Fort Bragg, North Carolina, Colonel Terry Walters is getting the
extra psychologists she will need during the next few months. But, she
says, there is a broader issue to address.
Colonel Terry Walters:
"There's no easy answer to fix this. There is a significant lack of
behavioral health providers across the United States, not just in the
military. I would like to think we do a little bit better than general
society."
And Colonel Walters says even with the extra staff on base, there will
be an added burden on civilian psychologists in her area this summer to
help care for the returning soldiers.