When I was growing up, World War I was less than 40 years previous, and men who had fought in the war were in their late 50s. We used to hear about people who were “shellshocked” and never really recovered. The horrors of World War II were too great to even describe as “shell shock,” and families and concerned citizens would visit the wounded either in veteran hospitals or long-term “rest homes” and state mental hospitals. When our soldiers got home from Vietnam, “shell shock” had turned into drug addiction and homelessness. Posttraumatic stress disorder had not entered the lexicon of mental-health diagnosis.
The front of the New York Times’ Sunday edition has an expose of the Warrior Transition Unit. The Times piece describes men being verbally abused as if they are in basic training and receiving very little psychotherapy. Men are saying that the treatment has made their situation worse.
The weapons of war and insurgency have added another problem, Traumatic Brain Injury. The force of blasts from improvised explosive devices have produced brain injury and caused problems that were unimaginable during the previous two world wars. Physicians have been working on recovery strategies since the syndrome has been identified.
Now, Congress has recognized the problem and is requiring a medical examination before discharge from the military for those suspected to have PTSD or TBI. This week, Congress held a hearing to learn about what is being done for our soldiers who have had these injuries.
A whopping $500 million has been granted to study PTSD and TBI, and the government has invested in resiliency training programs so soldiers are better prepared for the stresses of combat and deployment. Immediately after a soldier sustains a head or neck injury, the military performs an evaluation for concussions (maybe the NFL should do the same!).
This is a military that does not want a repeat of what happened post-Vietnam. For inpatients in the transition units, there are reports that there is not a lot of help. For outpatients, the military has adapted to the technology era with a program in telepsychiatry. In addition, National Guard units are working with the Pentagon to support the families and soldiers of the National Guard.
For those who have already been separated or discharged, the Department of Defense has encouraged soldiers to review their discharges and to appeal. This is very new for the department and is a welcome addition. In the old days, once you were out, you were out. It was difficult to get appropriate care from the veteran hospitals. Maybe you could, and maybe you couldn’t.
There have been amazingly innovative programs for helping our soldiers, including immediate intervention right in the war theater itself to prevent PTSD. This program was begun with Operation Iraqi Freedom. Now, there are virtual-reality programs to help soldiers learn to find improvised explosive devices as well as to recover from the mental injuries and fear after a battlefield injury.
Clearly, the military has missed some big ones such as Maj. Hasan, a psychiatrist. He might not have been missed had he not been a medical doctor who worked in mental health. It was a huge miss – one that cost many lives. Now, it appears that some units are using innovative techniques and others and drugging and humiliating our soldiers.
Some in the Pentagon have been open to ideas and new technologies. Others have done a modern-day version of the old mental-hospital movie, “The Snake Pit.” Many of the decisionmakers grew up in the shadow of Vietnam and have seen the hopelessness and homelessness of our broken veterans. Determined to not let that happen with returning soldiers, the Pentagon and Congress have taken action. Some of the actions have been cutting-edge, and some are cutting the edge of depression and desperation even deeper.
The least we can do as a country is commit our resources to our injured soldiers. The time has come for us to recognize that blasts and the stress of war are as real as injuries from bullets. How we do it? With new ideas and treatment or with old ideas and medications that will make a difference to thousands of soldiers and their families.