THE STIGMA KILLING YOUNG AMERICAN HEROES is based on ignorance and bureaucratic processes that have needed changing for decades, if not centuries. The brave men and women that make up our military are hesitant to seek mental health treatment from military practitioners because they are afraid, and rightly so, that their careers and/or security clearances could be at stake if they did. I served in the Air Force for over 20 years, retiring in 2005 as a lieutenant colonel, and experienced the stigma firsthand. I would not and did not seek help for post-deployment anxiety and depression UNTIL I pinned-on my silver oak leaf and knew I would be retiring (meaning "they" couldn't hurt me). I spent four years in four different combat zones, including "boots on the ground" in the Middle East one month before 9/11 and the first year of Operation ENDURING FREEDOM.I recently returned from Fort Riley, Kansas, home of the 1st Infantry Division, better known as "The Big Red One", where I provided counseling to soldiers returning from Afghanistan and Iraq. Two of the battalions I worked with suffered high numbers of casualties, the 2nd Battalion, 34th Armor Regiment (2-34) and the 4th Squadron, 4th U.S. Cavalry Regiment (4-4 CAV), with several killed in action (KIA) and many more wounded in action (WIA). Dozens of brave young men and women received purple hearts, having lost limbs and suffering other wounds, many invisible to the naked eye.
"Not all wounds are visible", with traumatic brain injury (TBI) and Post-Traumatic Stress Disorder (PTSD) making up the majority of injuries of those returning home, many times caused or hastened by experiencing the effects of an improvised explosive devices (IEDs), the current weapon of choice of Taliban and Al Qaeda terrorists. When a young man loses his leg, he is considered a hero, and rightly so. But when a person "loses their mind", either through physical damage to the brain as is the case in TBI, or emotional damage as we see in those who have experienced severe trauma in combat, those coming home with PTSD, they are portrayed as weak or as malingerers by their comrades, or worse, the officers responsible for their health, safety, and well being.
Looking down on or thinking les of those who seek help for mental health issues has been a problem in the military for centuries, but is also a problem in our modern, technologically advanced, contemporary culture here in the US (and elsewhere). Post-Traumatic Stress Disorder (PTSD) has been around since the beginning of the human race and has been called many things over the centuries including exhaustion, railway spine, stress syndrome, shell shock, battle fatigue, combat fatigue, and traumatic war neurosis. According to Wikipedia, "reports of battle-associated stress reactions appear as early as the 6th century BC. One of the first descriptions of PTSD was made by the Greek historian Herodotus. In 490 BC he described, during the Battle of Marathon, an Athenian soldier who "suffered no injury from war but became permanently blind after witnessing the death of a fellow soldier." Although this reaction would more accurately be diagnosed as conversion disorder rather than PTSD, it is an indication of the dramatic impact a traumatic event can have on a human being. Many people think of combat when they think of PTSD, but there are many causes, traumatic experiences, that can lead to symptoms, including accidents, physical and sexual assault/abuse, terrorism, as well as many others.
Ignorance in regard to psychotherapy and counseling is nothing new, and few people are enlightened enough to understand that it is a sign of strength, not weakness, to seek help or treatment from a qualified, licensed cliniician, be it a psychologist, psychiatrist, licensed professional counselor, or licensed social worker. There are many unqualified and unscrupulous individuals taking advantage of people weakened by emotional stress and the turmoil of modern life, and they have given psychotherapy a bad name. You can read more about these individuals elsewhere in this blog, so I will not elaborate here. However, it is no wonder that the many highly qualified, licensed, certified clinicians out there helping and saving lives every day are misunderstood, even feared by the uneducated and ignorant public so desperately in need of professional treatment.
Our young men and women in the military are returning from deployments having experienced horrifying events, either directly or as an observer. Estimates range from 20 to 50 percent of those returning from combat suffer from a mental health issue of one kind or another. The incidence of PTSD has been reported as high as 20 to 30 percent of military returning from recent combat. Yet many, if not most, do not seek treatment because they are afraid they will damage their career.
I have seen it firsthand in my own career, in my private practice and non-profit, and with soldiers recently returning from Afghanistan. Either their leaders, who can be squad and platoon leaders (enlisted) or company, battalion, brigade, and division commanders (officers), do not understand the devastation TBI and PTSD can cause in a person's life. Or they simply refuse to acknowledge the pain and suffering, maintaining the ridiculous macho bravado and reputation of a "real soldier" or "real man" who does not ask for help. These young men and women may even have a caring and compassionate chain-of-command now, but do not know whether the beliefs and attitudes of their "next" unit's leadership will be as flexible and understanding. Because mental (behavioral) health treatment in the military IS NOT CONFIDENTIAL and becomes a permanent part of an individual's medical record, ANY TREATMENT becomes a matter of record for future leaders to hold against an individual or a reason to deny a coveted security clearance. It is no wonder young soldiers, airmen, sailors, and Marines are afraid to step forward for treatment, and no wonder that suicide rates among military members has skyrocketed.
Until military and civilian leaders understand the connection and impact the negative military mental health stigma has on our force's mental health and morale, these needless deaths will continue. When you are anxious, depressed, sleep-deprived, and suicidal with nowhere to turn, the options are limited, particularly when you are a skilled marksman with easy access to lethal weapons.
There is no reason military members cannot have the same rights and protections as the average citizen when it comes to confidentiality in psychotherapy. What does the military have to gain except complete, 100 percent control over their people, by allowing confidential communications between therapist and client in the military? The same restrictions that apply to confidentiality in the private sector would also apply in the military: danger to self or others; child, spouse, elder abuse; and criminal behavior would still need to be reported. But military members would know that anything else they say would remain confidential, allowing them to open-up, develop a trusting relationship with their therapist, and get the help the so richly and desperately deserve.
I challenge the Joint Chiefs of Staff (JCS), Service Secretaries, Secretary of Defense, and President of the United States to "do the right thing" and end the negative stigma associated with military mental health care by allowing the limited confidentiality described above to be instituted across the military. It will literally take years for our military to trust the system and routinely seek treatment for the problems caused by the rigors and stress of military service, but WE MUST START SOMEWHERE, WE MUST START TODAY! They deserve no less.
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