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Joseph Bobrow Headshot

Invisible Injuries of War: What Heals and Who's Listening?

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We all know the story of the Three Little Pigs: The house made of bricks proved to be the strongest. The flagship DoD facilities built by the Intrepid Fallen Heroes Fund, the Center for the Intrepid in San Antonio, Tex.,
and the National Intrepid Center of Excellence or NICoE, in Bethesda, Md., are state-of-the-art facilities. I have visited them, met their leaders, and seen the service members receiving excellent care. Having also contributed the invaluable Fisher Houses for service members' families, the Fund is now planning to build a total of nine treatment centers for brain injuries and psychological disorders at the largest military bases, at a cost of over $100 million, which they will raise as they did the previous $150 million.

By catalyzing public attention, the Fund is not averse to using public embarrassment as a motivator. Martin Edelman, an original Fund Board member, said that building things for the military could "force it's balky bureaucracy to act." Given the urgency of the issue, the thousands needing care and the tens of thousands soon to be needing care, I have no argument with the Fund's tactics.

But stop and think a minute. How long has it taken governmental health entities, Congress, the military, private and public funders and the general public to even begin to recognize and address the dangerous tendency to see only the visible injuries of war and to ignore the unseen wounds? We humans privilege what we can see. It is far more difficult to grasp the powerful impacts that escape the eye such as the PTS continuum and mild-moderate TBI. Might this factor now be at play in what kinds of resources are funded? I think the answer is yes.

In five years of caring for thousands of post 9/11 vets and families, our data has convinced me that most potent force in combating PTS and related unseen impacts of war trauma is hidden in plain sight: the experience of community and a trustworthy network of peer support. Why? Because this is what bonds service members to one another in the war zone and family members and caregivers on the homefront. We can and must leverage it to facilitate the most healing and empowering transition to civilian life.

The DoD medical command is strapped for staff and funds and this situation will become worse not better over the next few years. According to the recent Institute of Medicine report, the Department of Defense has "a woeful lack of information on the effectiveness and related costs of its post-traumatic stress disorder treatment programs, despite having spent millions of dollars on various initiatives to address psychological health and traumatic brain injury." Programs must address the whole person, including the family and wider support systems such as the community.

Although forcing the Pentagon's hand is not in itself objectionable, the question I raise is a pragmatic one: Is the 100 million dollars for the nine centers on military bases, and the hundreds of additional millions of dollars needed to properly staff, fund and maintain excellence at these centers for decades to come, the best use of these massive financial investments? I maintain that the answer is no.

The New York Times article refers to these nine centers as a "network." We need networks alright: real, empowering and durable support networks of veterans, spouses, parents, teens and other family members. Networks of professional care providers and family caregivers. Isolation kills and community heals. Troops come home to a community, not a series of isolated services. A safe place of welcome, belonging, and understanding, without judgment -- a true home -- is a palpable but ignored and therefore invisible factor. Brick and mortar structures in no way guarantees a real home.

By our estimates, the cost of building such genuine support networks is at least one hundred times less expensive than the cost of providing care at the facilities the Fisher's are generously funding. And this doesn't include the facilities themselves. These figures should give us pause. Effective programs that leverage peer support community-building are going unfunded: witness third location decompression programs (a modern version of the World War II "slow boat home") proven successful by Israel and other U.S .allies, the Specialized Care Program Track II for Combat Trauma Syndromes of the Deployment Health Clinical Center, the Coming Home Project, and others. Promising start-ups like GratitudeAmerica and the Dixon Center for Military and Veteran Community Services have learned the value of mobilizing community forces. Established programs like Easter Seals are beginning to innovate along community-building lines.

Let's not forget: In the story of the Three Little Pigs, the brick shelter itself was finally not enough to protect the pigs. The wolf devised a cunning plan, to enter through the chimney. The pigs had to tap into their own intrinsic resources to assure their safety. The demons of post traumatic stress likewise will not be sated by a physical structure. There needs to be a "there there" -- a durable connective tissue of belonging, mutual support and respect, skilled care, and unconditional love. Optimal environments for connecting, healing and learning. Communities. We know how to build them. They are effective and hundreds of times more cost effective than the alternatives being built as we speak. It's not to late to consider this viable essential natural resource that supports and enhances veterans' own intrinsic healing pathways. Let's prove Winston Churchill wrong, when he said, "You can always count on Americans to do the right thing, after they've tried everything else."

It's generally good policy not to look a gift horse in the mouth. Just be sure to demand what really works. Stand up, DoD! Don't just accept what is offered, no matter how stupendous. All that glitters is not gold. Access the knowledge you have that is hidden in plain sight: The heart and soul of military service is a sense of team, of community, and the love for and of one's buddies. They are also the royal road to healing the unseen injuries of war.