by Molly Ivors
I've blogged before about post-traumatic stress disorder, but it still seems to be an infuriatingly invisible issue to the vast majority of Americans. And that's far from accidental. Like the the secret coffin returns and the nonexistent military funerals, we hide our vets away, only really seeing them when George Bush comes a-courtin', as he did last week.
Last spring, the Boston Globe did an excellent piece on PTSD in which they note, among other things, that the Iraq/Afghanistan war is unprecedented in American history for the number of wounded soldiers to every dead soldier. In World War II, two soldiers were wounded for every one killed. In Iraq/Afghanistan, it's 16:1. The military disputes these figures, preferring, as the Globe's Charles Sennott notes, "to calculate only those wounded in direct combat, which would make the ratio in Iraq 1 dead to 8 wounded, and still place it as the highest killed-to-wounded ratio in American history."
One of the reasons for the wide area of disputed numbers is that battlefield injuries tend to be visible, like these. Mental effects, which can be equally debilitating, are all but invisible. Also, they tend to have delayed onset: if you lose a limb, you pretty much notice right away, but you can go on without your soul for months sometimes without anyone else being able to tell, sometimes even yourself, if you're numb enough.
In a recent HuffPo post, veteran Jon Soltz takes on a recent Army study which finds that soldiers serving in this clusterfuck of a war are far more likely to report problems six months after coming home than right away. Estimates vary between active-duty soldiers and Reservists, but they're between 20 and over 40%.
That's a really fuck of a lot of people.
Soltz points to the visible/invisible divide I've been noting:
Just because mental injuries cannot be seen, it doesn't mean they are less severe. And yet, as a nation, we treat mental injuries like that, when it comes to our veterans. Imagine if we had veterans in the streets with untreated third-degree burns, blown off limbs that weren't sewed up, and gaping open wounds with organs hanging out. This country would never forgive this Administration and those in Congress who voted against increased VA funding. And yet, we have a very similar situation, when it comes to untreated mental injuries, and a system that allows our veterans to deal with it on their own.
Let's define terms: "On their own" means through drugs--legal and illegal--and alcohol, private psychiatric help (if they can afford it--the effects of PTSD tend to impact employability and thus insurance coverage), the VA (if they can wait six months), spouses, girlfriends and boyfriends (if they can stand to stick around--many can't), family, friends (though I'm assured by one young vet I know that you don't talk about "that stuff" in front of people your own age because they'll "think you're crazy"), and sometimes, through suicide (Iraq and Afghanistan vets commit suicide at about twice the national rate).
What's weird, as Soltz notes, is that this seems to be news to the people in charge of planning for VA services. In The Boston Globe story linked above, Paul Sullivan, a former researcher for the VA, tried desperately to sound the alarm.
In 2004, Sullivan led an effort to create a more seamless way to track veterans through their transition from active military duty to the VA system. The so-called Seamless Transition Taskforce also sought to project costs and kinds of needed care. Sullivan said his report, published in January 2005, was watered down in the editing, but that its core message was clear.
"This was bureaucratese for, 'Hey, we've got a train wreck coming!' " he said.
By summer 2005 the warnings were growing louder. One all-out alarm was sounded in a July 25, 2005, memo to the VA's under secretary for health from the Committee on Care of Veterans with Serious Mental Illness.
The committee, comprised of a panel of specialists in PTSD and VA mental health providers, presented a plan to increase funding for mental health programs.
But the plan was not implemented, according to members of the committee and consultants who worked for it. The funding for mental health has not kept up with the onslaught of veterans reporting psychological problems.
The VA spokesman, Phil Budahn , said that Sullivan's research at the VA was solid, but that his interpretation of data and much of the criticism he and others are voicing is "alarmist."
Well, we're now eight months down the road from Sullivan's "alarmist" criticism, and where do we find ourselves? According to that Army study, cited in the Washington Post, just about where you'd think.
Initial screenings "substantially underestimate the mental health burden," according to the study, which adds to growing evidence that more than a quarter of recent Iraq combat veterans are grappling with various psychological problems.
"Soldiers reported more mental health concerns and were referred [for treatment] at significantly higher rates" several months after their return, says the study, written by Col. Charles S. Milliken and Col. Charles W. Hoge of the Walter Reed Army Institute of Research and Jennifer L. Auchterlonie of the Army Center for Health Promotion and Preventive Medicine.
The study concludes that the Army should intervene earlier with mental health care for combat veterans -- reservists, in particular -- and their family members "before symptoms become chronically entrenched." But it also casts doubt on the effectiveness of the treatment for PTSD in what it calls today's "overburdened" military medical system, finding "no direct relationship of referral or treatment with symptom improvement."
I'm with Soltz: it seemd like this issue should be a no-brainer for anyone with anything like a decent moral compass. "Where's the outrage?" he asks. I would add "where are the leaders willing to take this issue on?"
Well, here's one.
Presidential contender John Edwards is introducing a $400 million plan Monday to help veterans with post-traumatic stress disorder, including those recently returned from combat in Iraq and Afghanistan.
Under Edwards' plan, veterans could seek counseling for post-traumatic stress disorder outside the Veterans Health Administration system; the number of counselors would increase; and family members would be employed to identify cases of PTSD.
........
A recent study of Veterans Affairs records showed that the number veterans with PTSD increased by almost 20,000 during the last fiscal year _ a nearly 70 percent jump.Edwards said the Bush administration's extension of tours to 15 months has only exacerbated the situation, and he promised to increase the time given to service members between deployment. A Defense Department study earlier this year showed that inadequate time stateside led to higher rates of PTSD or aggravated mental stress from service in the field.
Edwards' campaign said there are too few trained counselors in the networks available to veterans. As such, they avoid seeking care because of the wait or the stigma. Instead, Edwards said he would increase counseling and training for counselors and allow veterans to seek treatment outside of the existing system.
The VA currently has a backlog of as many as 600,000 claims, increasing delays for initial treatment by up to six months, according to the campaign. Edwards pledged the entire backlog would be eliminated by Memorial Day 2009 _ four months after he might take office _ and would cut the processing time by half.
I've been digging on John Edwards lately, though admittedly for sort of a silly reason. Still, he's talking about issues that matter, like this, and like poverty, and to me, that's dead fucking serious.
(For some interesting historical readings of shell shock in WWI, read this 1917 paper by W.H. Rivers, who served at Britains Craiglockhart War Hospital during WWI and the wide variety of documents on "shell shock," as it was then known, at The World War I Document Archive, the baby of our beloved fellow Atriot GWPDA.)