Recognizing the Hidden Wounds of War

I had the privilege this week of presenting some awards, on behalf of the incredible staff at the Didi Hirsch Community Mental Health Center, to some folks who have done amazing work in trying to reduce the stigma of Post-Traumatic Stress Disorder (PTSD) among men and women in uniform.

The Erasing the Stigma Media Award went to Anne Hull and Dana Priest of the Washington Post, for their powerful series about poor conditions at Walter Reed that energized a national debate about soldier and veteran care. The Erasing the Stigma Leadership Award went to Dr. Bridget Cantrell and Chuck Dean, for their amazing work in helping servicemembers comprehend and seek help for PTSD-related issues.

By sheer coincidence, it was also a groundbreaking week for the way the Department of Defense handles PTSD among its ranks. First, there was the announcement by the Secretary of Defense:

A year ago last February, the Army inspector general concluded that a number of soldiers were not seeking help, in part because they felt that seeking mental health help would endanger their security clearance and perhaps their career...So we undertook about eight months ago to get that question changed, so that it would be clear to soldiers filling out that form that any counseling that they had sought, associated with their combat stress, was not going to count against them in terms of getting their security clearance. We have finally succeeded in doing that.

This seems like a minor thing, but it's not. The wording of the mental health question on the government security questionnaire (normally referred to as "Question 21") directly contradicted the importance of servicemembers seeking help for PTSD symptoms as soon as they manifested. Now, at least, all of the DoD's official documents are speaking with one voice, and that voice is urging troops to get the help they need.

And some other voices are joining in too:

Senior military officers could be talking about their emotional struggles on YouTube and MySpace this year, in a Pentagon campaign to urge troops into counseling for wartime mental problems..."I've talked with a number of (senior leaders) already and we already have folks who are standing up and ready to come forward and tell their story," said Col. Lorree Sutton, an Army psychiatrist who heads a new center for psychological health and post-traumatic stress disorder, or PTSD. "We can talk about how important it is," she said. "Ultimately, troops and families _ they want to see leaders walking that talk."

I am very excited about this coming campaign - if DoD delivers on the promise above, it has the potential to be a tectonic shift in how men and women in the ranks view post-traumatic stress. Prior to this The message from senior leadership on this topic has always been a little off-kilter: "We want soldiers to get help", "Troops shouldn't be afraid to get the help they need." The unspoken aspect of this was that mental health counseling and assistance was something that other people besides these high-ranking folks did. Now, if we can have some flag officers and senior NCOs walking the talk, maybe we can finally get some forward traction on this problem.

There is one more step that I'd like to urge DoD to take that could have huge impacts on the perception of mental health issues in both the Armed Forces and society as a whole. PTSD is a combat wound - we already treat it as such for the purposes of medical evacuation, readiness for combat, and post-service disability assessments. So let's take it one step further - make anyone with a diagnosed manifestation of PTSD that in any way impairs function eligible for the Purple Heart.

The current criteria in existence for the Purple Heart would not have to be changed - nowhere do those criteria specify severity of wound, or how the wound was physically inflicted. They only require that the servicemember be wounded or killed in action - in fact, the criteria spend far more time spelling out which "actions" qualify than in addressing the character of wounds. Nor would this action debase or cheapen the Purple Heart - in fact, the award has already evolved significantly from its original establishment in 1782 as a Badge of Military Merit. Whether the change was including wounds wrought by terrorist acts or allowing awards for friendly fire, the changes each addressed an overlooked aspect of the wound that needed to be honored by the nation.

PTSD has remained a hidden wound for too long. DoD's new campaign is a huge leap in the right direction of erasing the stigma of this affliction, and properly recognizing this hidden wound with the Purple Heart is the next logical step.

Comments

[Siryn]

Very insightful, Ray. I'm so glad to hear that the Army is trying to do something real to take care of its people.

[RadioResearch]

P.S.

The real awards should be given to all of those Vet Center PTSD counselors who have been working on this problem for years. Most of what you are talking about was pioneered years ago by Viet Nam veterans, but as you know we are seen as "losers" with character flaws and PTSD was considered to be the venue for whiners and malingerers - my how far we have come since this recent war.

[RadioResearch]

Thanks for this blog on PTSD as it is long overdue.

I'm glad that the pentagon has finally waken up and realized that they have a problem here. They can't get enough recruits so they have to maintain the force that they have, including those with PTSD. Unlike the Viet Nam war they can no longer afford to dismiss those with PTSD and have at least recognized that it is not a character flaw but an actual "head injury" in that prolonged periods of combat produce elevated levels of cortisol and, over time, shrink the hippocampus resulting in a variety of neurochemical changes and abnormalities.

Like those same Iraq vets, I too refused to get treatment for what I knew was going wrong inside me but I did not want to lose my TSC clearance and job. That in turn led me to hide it for years for fear that my government job and clearance would also go - something that eventually happened to me so these Iraq soldiers fears are real.

However, I disagree that PTSD should be a qualifier for the Purple Heart. Indeed, even though I suffered a brain injury from a direct hit of a 122mm Rocket round, it drew no blood and I was thankful for that, I would not accept a Purple Heart if it was given to me. Nor should you advocate for this as I have seen far too many severe injuries of combat vets to equate PTSD to a combat wound.