Stress, Suicide and Homicide: How Do We Help Our Veterans Cope?
In the aftermath of the tragedy at Fort Hood last week, too many people are focusing on the religious affiliation of the alleged perpetrator, rather than on a more important and pressing issue: the lack of adequate psychosocial care for women and men in uniform. It matters not that the individual who will be charged with these heinous crimes had not been in combat; his long-term and very intimate association with the combat wounds of others clearly seem to have left him seriously damaged.
So why do these dangerous public examples of mental problems of servicemen keep happening, and why are we not doing more about it? Why do so many veterans and their families complain they are not getting the help they need with psychological problems?
Our military and Veterans' Administration facilities are swamped with massive numbers of veterans with physical injuries and serious mental health problems. As with all previous wars, it takes time to gear up after hostilities begin to provide requisite veteran services. It also takes public support to fund those services, and insist on excellence in their delivery.
There's been plenty of time, and lots of lip service paid to "supporting the troops," but the sad reality is that service members and veterans are not receiving the care they need.
In today's Veterans Administration health care system, there are not enough trained psychiatrists, psychologists, social workers and other mental health professionals to treat over 300,000 veterans already diagnosed with PTSD. Additionally, there are many other physically disabled personnel beset by psychological trauma who need care, not to mention the many veterans having real difficulty readjusting to civilian life.
These warriors return as changed persons to jobs, families, marriages and communities in which they experience real alienation and conflict. Unemployment, divorce, family violence, deep emotional anxiety, drug abuse, prison, depression and suicide are too often the result.
We as a nation don't really understand mental illness and deep emotional distress in general and we give insufficient attention to its causes and likely course. We tend to feel deep-down that those with emotional problems are somehow weak, undisciplined, maybe malingering, and even perhaps genetically defective. We don't fund mental health treatments adequately, nor do we devote sufficient research and development funds to finding better ways to help people learn to overcome it.
For some time now, Senator Tom Coburn (R-OK) - who professes to "support the troops" - has single-handedly blocked passage of an appropriations bill which would increase spending for our nation's military veterans. This kind of political posturing may win him votes in some quarters, but it condemns honorable veterans to mediocre medical care, at best, or none at all, at worst.
Mental health problems in the military are misunderstood, even by the military, recent events would argue. A soldier as part of his training learns to be hard and to suppress emotion, deny fear, ignore feelings, keep a stiff upper lip. Disciplined to obey orders and to engage in even the most terrifying or repulsive acts, he survives to the extent that he focuses on the team, the mission, and on carrying out the acts of war he was trained and ordered to do. Deemed necessary for combat, the culture demands that orders be followed no matter how dangerous, how destructive of others (or self), and how it much it makes the soldier do things he or she would never do in civilian life.
Some individuals, after prolonged exposure to the external threats of combat, and physical and spiritual exhaustion, find that their learned ability to deny and suppress emotions no longer works, and new troubling thoughts begin to raise questions about the purpose of it all, the morality of the acts they have committed, or a deep-seated fear that they might be terribly wounded or not even survive. This undermines the lessons of boot camp and the person is often left with nagging, relentless conflict and fear.
Without adequate help, that conflict and fear can become toxic to them and others.
The persistent wars on two fronts over the past seven years have shown that some soldiers who never even "leave the wire" experience stress symptoms similar to, or sometimes worse than, those involved directly in firefights, mortar attacks, or roadside bombs. It seems not at all far-fetched, then, that the alleged shooter last week, who'd never been deployed, but spent the last few years listening to the physically and psychologically maimed recount their horrors to him on a daily basis, lacked the necessary training to identify his own descent into the nightmare of untreated combat stress reaction.
This is unacceptable. American military personnel, who freely volunteer to serve, deserve the best medical/psychological care available, both during and after their time in uniform.
Far too many veterans are languishing without adequate care, across the United States. It should not be a crap-shoot as to whether a veteran will live close enough to a "good" V.A. Hospital, or whether she or he will get "the good therapist." There should be no argument whatsoever about funding top-flight research and treatment programs for all military personnel and their families.
When home, after these kinds of experiences, the veteran, beset by sleeplessness, flashbacks, anger and self-doubt, and seeing how much he feels alienated from what was once comfortable and joyous, often falls prey to self-pity, blame of others and feelings of rage which sometimes turn to violence, or depression and withdrawal.
Problems in marriage, conflicts with children, difficulties in finding satisfying work now that he has many new unevaluated and un-integrated competencies, a sense that he no longer understands himself or can get himself to do anything, difficulty in getting medical help, feeling like an outsider in his community, tempted by alcohol and drugs, he has few of his previous satisfactions from marriage, friendships, family, work and the camaraderie of the group. Talking about it all is so painful, he avoids it and this leads to greater isolation.
Now in civilian life and lacking the exo-skeleton of the military order and culture to help make his choices, he faces an entirely new challenge of learning -- how to develop the softer side of his nature.
To cope with his marital, career, and spiritual dilemmas, he must use his internal strengths, he must develop his capacity for psychological insight into his problems, become more aware of the needs of others, and expand his understanding of relationships. Moreover, he must take initiatives to learn to understand his emotional side, learn about his predictable problems, gain experience with emotional problems whose solution require a very different language, process, specialized knowledge, and an internal way of approaching problems that he may never have learned before. And much of this is directly contradictory to what the military and his combat experiences taught him.
Clearly he needs expert help, someone to help him understand his problems and to guide his understanding of his feelings, his thinking about new concepts and knowledge and to facilitate his movement toward new behavior, as he defines his new options, choices, goals, and tries things, fails and succeeds and learns from both.
But psychotherapy and counseling, the current treatment methods have several limitations. They require time and the services of well-trained professionals in many individual or group sessions. The VA has done it well over the years, but it is expensive and time consuming and this severely limits its availability to many who need help.
Also, psychotherapy and counseling are by their very nature talk-centered forms of learning, and thus a rather inefficient form of learning unless talk is accompanied by opportunities to get information in other ways, see others performing the new behaviors they need to learn and be able to practice new methods of communication and problem-solving in the protected setting of a classroom.
Thus the new challenges now faced by the military hospitals and the VA and the mental health agencies of America include how to create new learning programs to extend services that can help persons with mental health problems learn about their softer sides and how to gain insight into their feelings and problems, learn new ways of defining and perceiving them, acquiring new knowledge of how to cope with them and engaging in observed behavioral exercises to practice new, more effective interpersonal communication, or conflict resolution strategies or decision-making strategies that can be specifically applied to the predictable problems veterans face as marital partners, as parents, as workers, as developing persons facing new tasks of development, as health care recipients and as members of a community.
Fortunately in creating new programs to extend psychological learning and supplement psychotherapy, much progress has been made in developing better methods of making use of cognitive and behavioral therapy concepts by other delivery methods. There has been extensive work in the development of models for learning Life Coping Skills which deliver new therapeutic learning through carefully researched and designed multimedia exercises in small groups that help a person acquire new concepts, new knowledge and expand his behavioral repertoire in coping with such predictable problems as career choice, marital communication, parent-child disciplinary rules, time management etc.
Using these models of learning, new workshops could also be focused specifically on such problems as marital communication or planning or on helping people develop a greater systematic understanding of their interests, aptitudes, values and personality which are relevant to sound career and educational choices, or helping a father practice the application of clear consistent rules in dealing with a behavioral problem of his son or daughter. Or helping a person develop self-discipline by practicing ways of coping behaviors by viewing modeling video vignettes and role-playing new roles with video playback and peer feedback. With a learning model that engages the learner in actual new activities and experience, the learner learns early that he must be an active participant in his own learning.
What's more, if the workshops are well designed and based on a careful understanding of how veterans view their problems and what they need to learn to solve them, the workshops can be used with thousands of veterans in hundreds of institutions. Moreover, there is a further saving of funds since the Life Coping Skills Workshops, as expert systems of learning, can be delivered by specially trained masters degree or even bachelor degree level adult educators or counselors instead of much more expensive doctoral level psychotherapists.
If you want to honor the sacrifice and service of America's veterans, contact your elected representatives - and especially Tom Coburn - and demand that they support the troops by providing for the care they richly deserve, and for which so many have paid with their blood.
God bless America and her women and men in uniform.
Winthrop R. Adkins, PhD, Prof. Emeritus of Psychology, Columbia Univ. served as a naval officer and interned in three VA hospitals. He is the author of Life Coping Skills programs in use throughout the USA. Former Army Capt. Luis Carlos Montalván served two tours in Iraq, was wounded in combat and has experienced various forms of treatment within the systems of the VA, DOD and private sector. He is a freelance journalist and veterans' advocate.
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A friend of mine in AA near Camp Pendleton got an education of PTSD Soldiers started showing up. They had started drinking , couldn't sleep, had nightmares, and some didn't know if they could go back. One young man couldn't go to the beach - The sand reminded him of Iraq. He slept with a gun under the bed. Another friend in a gated community had an officer as a neighbor that would pace up and down at all hours without saying anything. This is not meant to be an attack on the military but it made me take a look at what the real costs of war are. We need to take care of our veterans and active military personel. I think we have to consider these costs when we consider a war-
I have never been so close to taking my own life as I've been since being medically retired from active duty and made to jump through hoops by the Department of Veteran Affairs. I cannot promise I will not take my own life but what I can say is if I choose to do so it will not be for naught. I will find a way to make light of what is occuring in the Department of Veteran Affairs as files are lost, treatments are not being administered in a timely manner, and soldiers who such as myself who have taken lives in defense of our country and bear physical and mental wounds, which have scarred our souls and hearts, are left to fend for themselves. They employ counselours with little understanding of what we have been through who love to serve lip service and hear themselves talk. It is beyond frustrating it is infuriating and it has been this way for over a year since I was medically retired from the Army. I didn't hesitate to take life and put my own at risk....Wh
Excellent points and very well taken. For a moving example of the effectiveness of therapeutic understanding for those who have experienced combat-related trauma, see the letter from military psychiatrist Dr. Russell Carr in my recent Huffpost blog, "Understanding the Traumas of War." Here is the link:
http://www
Our military men and women need and deserve much more of the kind of therapeutic understanding that Dr. Carr has been providing!
Why do you believe that his religious affliation is irrelevant when there is plenty of evidence to the contrary ?
Excellent article. I also think it would be very good if veterans can learn together their new skills since they have the same background and are therefore comrades. In this way they could have a net of comrades also back in civilian life - which would be very helpful to them as I assume.
Another point is to work on the acceptance of therapy for veterans within society as well as within the army - As a veteran below stated, they can kiss their military career goodbye if they seek help for mental problems! And this is absolutely not fair towards these courageous people.
We have a successful US Army, PTSD treatment center that provides a vast range of methods and approaches to improve the quality of lives, health and realationships for our Warriors. Our program includes 6 months of treatment, 35 hrs. a week, and aftercare for 30 warriors at a time. We are an experimental and experiential integrative health center that also includes the conventional treatments. I believe that all of our wounded warriors get bettter and 60% return to the Force, fit for duty.
We are relatively new as we've only been in operation for just over 2 years, but our soldiers wil tell you that the Ft. Bliss Restoration & Resilience Center helps them cut through these devastating symptoms and reduce the mental, physical, emotional and spiritual injuries and anguish. Would be great if we had these services available for everyone who returns from the stress and trauma of war. Our warriors deserve the best we can offer as a country, and our R & R Center is the best program right now. We also work with the whole family and feel great love and respect for everyone who enters our program. And, we are grateful for all of the ancillary services of support offered in our Ft. Bliss and Wm. Beaumont Army Medical Center.
http://www
Thank you for reporting the need for more health services for our Vets and for the neglect that has been part of our history.
I hope your research will trickle into the civilian healthcare systems which have very little understanding of even how to diagnose let alone treat PTSD.
Thank you for this article, you make excellent points. and Note the comment from the veteran who states that if you show up on the shrink's couch you can kiss your military career goodbye. That's is a crucial yet insufficiently addressed part of the equation. We expect our armed forces to be strong and resilient of course and the traditional though apparently changing culture of machoism has made it such that one is supposed to become a trained killing machine, see and endure atrocities for months at a time and return to everyday live unscathed. We expect our armed forces to be superhuman. The military culture must change. it's a sad yet frequent commentary on a system (and the armed forces are but one such instance), when it takes a tragedy to push for reconsideration of procedures and.or beliefs.
While I heartily agree with the rest of this piece, I disagree with this part:
"It matters not that the individual who will be charged with these heinous crimes had not been in combat; his long-term and very intimate association with the combat wounds of others clearly seem to have left him seriously damaged."
I think this was unnecessary to the article anyway. But it is by no means clear that his contact with patients really had anything to do with his own apparent mental break. Unless you know something I don't. I mean, you don't see orthopedic surgeons and burn specialists doing this sort of thing, and what they see is every bit as grim as what a psychiatrist sees. We may never know what actually drove this guy to do this, but to say that he was damaged by association with combat-related psychiatric injury goes way too far. It could just as easily been a very unfulfilling personal life, and there's more evidence for that.
We don't. Most of those killing themselves are not seeking help, and the v.a. has no plan in place to follow up on returning war vets.
As a veteran I can assure you that the military will offer psychological counseling for all who ask for it, and will hospitalize them if need be. BUT as a veteran, I can also assure you that if you show up on the shrink's couch, you can kiss your military career good-bye.
i am sorry but the military didn't offer me any help after i was in the scud that hit the Aujan complex and i didn't receive not even a mental evaluation. I did not even receive the Purple Heart and Soldiers medal that i was recommended for after saving several soldiers from a the burning building with rounds going off. I am still asking for help for PTSD and Depression i was diagnosed with but can't even go to the VA. But every Holiday i hear the same thing about we need to help our hero's but we i contact some one for help i don't hear anything back.
This is really not fair! I appreciate that you state this hear - and I would also suggest to write it to your representatives, the White House, all the veteran's committees etc..
Because all those people need to know what is really going on and what is more, you need and deserve the help. The best of luck and God bless you.
Dr. Adkins indicates troops need extensive, costly psychotherapy. Yet I haven't seen any evidence that psychotherapy actually cures PTSD. Isn't it possible that we humans are not really meant to bomb, poison, rape, and murder our own kind? Other animals do not systematically attack members of their own species. Wolves, for example, even though carnivores, will not prey on other wolves.
It could be that PTSD results when humans kill large numbers of humans. Wouldn't it be wise to prevent PTSD by ending this practice?
Actually, other species do kill their own. Chimpanzees will kill others from another clan. Chickens will peck other chickens to death without any provocation. Alpha males in some species will kill off their rivals while they are young and weak.
You really can't completely cure it. The goal is to function and have a happy fulfilling life. There is significant research which shows counseling is really the only effective treatment. There are medicatons which help the depression and anxiety that go with it. In the early stages some have tried medications which help decrease the phsysiological affects of the trauma hoping to lessen the effect later on. Yes, not going to war to begin with would seem the best solution, I certain agree. The effects on the civilians in the other countries are troubling as well.
One big problem that all of our returning soldiers face is that if they do seek any extra counseling (besides whta is required) they will never be promoted and their military careers are over.
It doesn't really help things when one of the Psychiatrists who is supposed to be helping our soldiers to cope with their issues runs around the country telling them that Infidels (which means them) need to have their heads cut off and boiling oil poured down their throats...
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