The inner war
THE FIRST step in dealing with post-traumatic stress disorder among active-duty troops and veterans of the Iraq and Afghanistan wars is often the most difficult: getting soldiers and Marines to acknowledge that they need help. Troops worry that they will be stigmatized by a diagnosis of PTSD or, if they are heading home, that admission of a problem will slow their return to their families. The US military must take stronger measures to ensure that PTSD is detected in a timely way, and the Department of Veterans Affairs needs to provide more resources to treat veterans who reach out for assistance.
In these wars, as in past ones, the experience of combat takes a toll on many in the form of flashbacks, depression, anxiety attacks, and sleep difficulties. A war like Iraq, in which it is difficult to tell friend from foe, and with civilian casualties virtually inevitable, creates special problems. Between mortar attacks on buildings housing US personnel and the ambushes and bombings of convoys, all troops are vulnerable. According to a 2004 study in The New England Journal of Medicine, one out of six soldiers returning from Iraq has symptoms of major depression, anxiety, or PTSD. Representative Martin Meehan of Lowell, a senior member of the House Armed Services Committee, is convinced that PTSD will be the major medical problem of the Iraq war.
The military is more alert than it was during the Vietnam War to the need to address PTSD and other mental health problems in the field. Yesterday, 83 members of the 883d Medical Company, a combat stress control unit, held a farewell ceremony in South Boston as they headed toward the company's second deployment in Iraq. The 883d began as a malaria-fighting unit in World War II.
Officers of the company, one of nine such units the Army has posted to Iraq, see their task as twofold: helping individual soldiers or Marines and educating commanders in ways to relieve stress among their troops. With individuals, said Colonel John Looper, a psychiatrist at McLean Hospital in civilian life who served in Iraq in 2003, the stress control teams of the 883d help troubled soldiers understand that the reactions they have are ''what happens in a war." Looper, who is not part of this deployment to Iraq, said yesterday that such units are heavily utilized by the military. ''All have been there, are there, or will be there," he said.
Meehan, who spoke at the ceremony, has sponsored legislation that would help to ensure that fewer cases of PTSD go untreated when troops return to the United States. His bill would require that all soldiers returning to civilian life undergo a thorough mental as well as physical examination. The mental health screening now provided is just a form to be filled out. Meehan said that if an examination reveals the need for treatment, it would typically be provided when the soldier is back with his family, so that soldiers need not be concerned that revealing symptoms during an examination would delay their reunions with their loved ones.
Meehan wants the $3 billion that the Department of Veterans Affairs annually spends treating PTSD and other forms of mental illness to be at least doubled. His bill would require the VA to help soldiers who need treatment get it on an outpatient basis from non-VA providers if they live far from any VA clinics. Earlier this year, the Government Accountability Office reported that it had surveyed seven VA medical centers, and officials at six of them said they were concerned that they would not be able to meet veterans' increased need for PTSD treatment. The VA's own special advisory committee on PTSD reported in 2004 that the department's capacity to treat PTSD had deteriorated prior to the start of the Afghanistan and Iraq wars.
One element of Meehan's plan is included in the House version of a defense spending authorization bill. It would commit the Defense Department to create a media campaign to raise awareness of combat-related mental disorders and substance abuse, helping to reduce the stigma surrounding them. His measure would also have the military create peer-support programs at military bases to educate troops, their families, their colleagues, and their commanders on warning signs for these conditions, which can include nightmares, sleeplessness, and tensions in family and work relationships.The 883d company is making its own efforts stateside to make sure that returning soldiers and their families get help with PTSD if they need it. In a pilot program, members of the unit have been making calls to Reservists who are back home. ''The majority are doing a great job adjusting," said Lieutenant Laura Curtis, ''but some need support." Those who need support are referred to appropriate services. Under Meehan's bill, the VA would be mandated to conduct its own outreach, increasing awareness among veterans of the mental health services it offers.
Such follow-up activities are crucial, said Looper. The ''post" in post-traumatic stress disorder, he said, has to do with the fact that the symptoms can be delayed for some time after the events that caused the trauma.
The presense at yesterday's ceremony of friends, family members, and elected officeholders like Meehan -- and representatives from the offices of Senator Kennedy and Representative Stephen Lynch -- is indicative of the support that soldiers have when they are sent to serve this country in a dangerous, complicated war. But such support is hollow if it does not include every possible effort to detect the mental health problems that combat creates, to destigmatize them, and to make treatment available in every corner of the country. Congress -- and President Bush -- should back not just Meehan's public awareness program but also his full package of proposals to strengthen treatment of combat-related mental disorders.
