Most of us in civilian service for the mentally ill are shielded from mental illness in the military. We also usually do not receive any training or education on the unique aspects of military mental health. Meanwhile, reports continue to emerge that mental illness, especially PTSD, continues to escalate in the troops in the Middle East and on their return home.
Less well-recognized is the PTSD that can emerge in the caregivers attending to the continuing exposure to unprecedented survivable physical injuries and/or mental trauma. To complicate this problem, available services are still inadequate, stigma against asking for help is still high, and obtaining benefits still difficult. The Federal Court in San Francisco has recently accused the VA system as “incompetent in handling PTSD and other conditions”.
Other than the recent killing of Osama bin Laden, general news coverage about Iraq and Afghanistan has seems to have diminished over time. The public seems less effected or concerned, especially since the 2008 economic crisis. Paradoxically, whatever concern that has remained may be further diminished by bin Laden’s death, as it provides a sense of celebration and closure for many.
This is also a world and culture different than ours. I know some of this first-hand, for I once served in the military, though not in a time of war. I was stationed in Anniston, Alabama from 1975-1977. When we physicians were oriented by the base commander, we were told: “it’s not if, but when, there will be another war, and your job will be to support the troops."
In the military, that priority can cause agonizing decisions for psychologists and physicians, since support of the mission takes ethical priority over patient care, as may have occurred in any cooperation with the “enhanced interrogation” of designated terrorists. Now it still seems uncertain how much, if any, that sort of interrogation helped in the quest for bin Laden.
Many years later, I’ve come to realize that the commander’s prediction has come true over and over. But, if anything, he may have downplayed our responsibility. Supporting the military must include one’s life outside of the military. Though I am grateful that my children have not had to face the dangers of serving in a war zone, and respect critics and conscientious objectors to war, I was honored to have served and still get chills when the Army song is played in public.
This upcoming Memorial Day holiday should be an especially poignant time for us all to support the military. Memorial Day was begun as a ritual of remembrance and reconciliation after the Civil War. This year is the 150th anniversary of the Civil War. Many feel we have reminders of that in the political conflicts between our two political parties.
In our time, Memorial Day has come to commemorate United States soldiers who have died while in military service. On September 11th of this year, we will also have the 10th year anniversary of 9/11/01 and the ensuing engagement of our troops in Iraq and Afghanistan that has added so many military deaths.
Memorial Day should always have powerful emotional meaning for us, and this Memorial Day may even be more so due to those special anniversaries. This day is an opportunity to express eternal gratitude in a gesture of solidarity. It can be an expression of collective grief, not only at the loss of the future for the dead soldier, but also for the loss and alteration of the lives of those who knew and loved the person who served. We have a chance to memorialize what they sacrificed for us. We can also mourn the loss of our ideals for global peace.
For those of us working in behavioral healthcare in any capacity, not only should we join in this ritual in some way, but more. Knowing the inadequacy of services inside and military and VA system, especially for the rising prevalence of PTSD (which is even worse in women), we can advocate in many ways:
- We can advocate politicians to do more to establish necessary services
- We can advocate that those with PTSD be eligible to receive the Purple Heart, even though their wartime wounds do not meet the eligibility requirements of being physically visible
- We can advocate for President Obama to write letters of condolence to the families of soldiers who have committed suicide
- We can advocate for all of us to donate some pro bono time to fill in the cracks wherever practically possible
Across our own institutions of care, we can recall and discuss certain kinds of deaths in the military, including:
- The approximate 6,500 suicides among veterans each year
- The increasingly record-breaking number of suicides among active duty soldiers
- The future deaths that will be caused by suicides related to prior war-time service
- The deaths of those killed on November 5, 2009 at the Soldier Readiness Center at Fort Hood by the psychiatrist Nidal Hasan
Lastly, consider a moment of silence, and perhaps prayer, as you finish reading this piece and with your staff. Thank you.