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Mark C. Russell, Ph.D., ABPP Headshot

Investigating the Root Causes and Negligence in a Military Mental Health Crisis

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Honorable ladies and gentlemen of the 112th U.S. Congress, on behalf of all veterans past, present, and future, and as a proud father of two Afghanistan War vets, you have our deepest appreciation and utmost respect for your tireless efforts and loyal advocacy for all who have worn the uniform in service of their country. Just in 2012 alone, whether compelling the military to investigate its incompetent and unethical practices of diagnosing or un-diagnosing of PTSD, lambasting the VA's persistent stonewalling in processing disability claims, nurturing reactive policy changes in how the military deals with war stress injuries such as suicide, PTSD and traumatic brain injury (TBI), or dealing with another after-the-fact disclosure of massive shortages in mental health staffing, your steadfast efforts reflect great credit upon yourselves as the people's representatives, and bring honor to the Nation. We Thank You!

On a more somber note, I have been trying to re-connect with congressional members for several years including back on active duty and openly battling the military zeitgeist while wearing the uniform of a Navy Commander and attempting to prevent or at least mitigate the current and future mental health crisis [1]. I was in a unique position of being on the ground-floor of the recent mental health crisis, witnessing top leaders actively ignore well-documented psychiatric lessons of war, engage in public deception, and routinely fail to do what was possible to avert or limit the impending catastrophe. Moreover, none of the policy changes today will likely preclude another betrayal of the warrior class, unless you dig and pull up the roots, and I know where to dig.

I will communicate the untold story of the origins and culpability in the current mental health travesty in a series of blogs until such time as a congressional investigation is conducted or the general public has been made fully aware. Allow me to digress.

The Proverbial Elephant in the Room

Or more aptly, the Brontosaurus in the room as Congress, military institutions, and members of the warrior class all attempt to navigate through the turbulent waters of military mental health care, dealing with one evidentiary report after another about escalating suicide rates, interpersonal violence, traumatic brain injuries, PTSD, substance abuse, medically unexplained symptoms, traumatic grief, perpetrator trauma, misconduct stress behaviors and atrocities, homelessness, etc., what has been conspicuously missing-in-action in the national discourse, is what actually led to the current mental health crisis in the first place? Who knew, or should have known what, when, and what did they do, or not do to prevent or mitigate the crisis? And why? Such questions have never been fully investigated in this, or any other U.S. Congress-however it's critical to do so in order to understand what truly needs to be fixed!

The Promise and Duty to "Care"

The promise or duty to care for the mental health needs of the warrior class has become a well-worn cliché as when the Assistant Secretary of Defense for Health Affairs testifies that "The burden of Service members deployed on our behalf includes substantial psychological challenges. We in the Department of Defense Military Health System join the nation at large in our gratitude to all of our Service members and their families. We are grateful for their personal sacrifices and for their contributions to security and freedom around the world. They have answered our call -- we must answer theirs!" -- the question is, have we? Have we ever?

History Repeats Itself: Broken Promises and another Mental Health Crisis

Unfortunately, delivering on the sacred commitment to provide the best available mental health care, along with world-class medical treatment to those sent in harm's way, has been anything but honorable. Since the turn of the century, a military mental health crisis has arisen after every major armed conflict, earning the oft repeated phrase "psychiatric lessons learned and relearned and lessons unlearned" alluded to in nearly every historical treatise on combat stress including the U.S. Army's own Textbook on Military Medicine: War Psychiatry [2]. As two American Army psychiatrists quipped after the Second World War (WWII), "neuropsychiatric casualties should be as predictable as gunshot and shrapnel wounds" [3].

However, over the past one hundred years, and particularly since WWII, military medicine and the Nation itself, has repeatedly failed to adequately plan and prepare for the inevitable outcomes of modern warfare, in striking contrast to caring for medical wounds. Consequently, each war generation of the modern era has suffered epidemics of war stress injuries, suicide, interpersonal violence, homelessness, unemployment, impaired health functioning, and incarceration, many of which the result of unidentified, untreated war and traumatic stress injuries.

You see unless someone cares enough to really dig down, and search hard to understand the "why," we will be condemning future generations to the same fate as our grandparents, parents, ourselves, our children, grandchildren, and so on.

Institute of War Stress Injuries and Social Justice

No disrespect intended, however the past eleven years has made me quite cynical and distrusting of leaders to do the right thing, particularly when it comes to investigating the root causes of the current and past mental health crises. Fortunately, on June 1, 2012, the first-ever Institute of War Stress Injury and Social Justice was established at Antioch University Seattle, with nationally renowned experts actively being sought to serve on an Advisory Board. Antioch's Institute of War Stress Injuries and Social Justice is the only known domestic or international academic entity dedicated to the study, identification, advocacy, and elimination of contributing factors responsible for cyclic failure to meet the mental health needs of the warrior class and end the cycle.

Antioch University has a 158-year tradition of progressive education and advocacy for social justice as reflected by the timeless dictum from Antioch's prominent founder, Horace Mann, who in 1859 challenged our collective moral consciousness to "Be ashamed to die until you have won some victory for humanity." One way of the other, the truth must be told before the bullets stop flying and national amnesia sets in, yet again..

References

[1] Russell, M. C. (2008). Urgent request for independent inquiry into unresolved grievances ICO Department of Defense (DoD) mental health care and complaint of reprisal. Certified mailed to Congressional representatives of Washington State: Senators Murray and Cantwell; House Representatives Inslee, Larsen, Baird, Hastings, McMorris-Rodgers, Dicks, McDermott, Reichert, and Smith.
[2] Jones, F. D. (1995). Psychiatric lessons of war. In Jones, F. D., Sparacino, L. R., Wilcox, V. L., Rothberg, J. M., & Stokes, J. W. (Eds). Textbook of Military Medicine: War Psychiatry.
[3] Beebe, G. W., & Appel, J. W. (1958). Variation in psychological tolerance to ground combat in World War II. Washington, D.C.: National Academy of Sciences.