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Collateral Damage: How Can the Army Best Serve a Soldier With Post-Traumatic Stress Disorder?

February 6, 2009

On 19 March 2008, the Army marked the fifth anniversary of the invasion of Iraq. Since October 2001, approximately 1,640,000 U.S. troops have deployed as part of Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF).3 While advancements in medical care have saved numerous lives on the battlefield, we are faced with a growing number of Soldiers who are suffering with psychological injuries as a result of combat operations. Over 20 percent of the veterans returning from Iraq and Afghanistan have Traumatic Brain Injury (TBI), Post-Traumatic Stress Disorder (PTSD) or both. A recent study by Rand Corporation determined that about one-third of returning servicemembers report symptoms of mental health problems or cognitive issues.4 As the war wears on and these Soldiers continue to endure multiple combat tours without treatment, what is the impact on our Soldiers and their families? Are the Army and the Veterans Administration ready for the onslaught of Soldiers seeking mental heath care in the near future?

PTSD is a wound the surgeon never sees, yet proper diagnosis and treatment are instrumental in helping Soldiers integrate back into their families and communities. According to the Mental Heath Advisory Team IV (MHAT-IV) final report dated 17 November 2006, 20 percent of OIF 05–07 Soldiers and 15 percent of OIF 05–07 Marines screened positive for one or more mental health issues.5 By December 2006, one in four Soldiers discharged after serving in OEF and/or OIF had filed disability claims, and more than 40,000 have been diagnosed with PTSD. 6 As multiple deployments have become the norm and Soldiers are seeking ways to deal with cumulative doses of combat, how effective is the Army in diagnosing and treating PTSD? What steps are unit leaders taking to ensure that their Soldiers are getting the treatment they need and to reduce barriers to care and dispel the stigma associated with PTSD? How confident is the Army leadership that everything has been done to prevent Soldiers with PTSD from returning to combat 2 without the proper medical care? As the war goes on and the number of Soldiers returning with mental health concerns continues to rise, is the Army being proactive to ensure that sufficient numbers of behavioral health professionals are available to diagnose and treat Soldiers with PTSD? Finally, is the Army support network standing by to assist Soldiers and their families before, during and after deployment?

While many assume the answer must be yes, there are Soldiers who are unable to find this network or count on their leadership to assist them with their psychological disorders. They end up dealing with the mental health situation alone. Case in point: A 31-year-old sergeant, father of two, who was undergoing treatment for excruciating headaches, died alone in his barracks room.7 We cannot allow our sons and daughters who defended our nation in a time of war to suffer by themselves with personal tragedies such as domestic violence, homicide and suicide that emerge as they return to this great nation and reintegrate into society. PTSD is an injury that is hard to diagnose and more difficult to treat; as a result, most cases go untreated and will seriously impact the lives of our heroes for years to come. The global war on terrorism has brought to light the importance of the psychological health of military servicemembers, their families and survivors. The Department of Defense (DoD) created a Task Force on Mental Health with the mission to identify shortfalls, produce actionable recommendations and assist the military in rapidly developing and implementing a plan of action to identify, diagnose and treat servicemembers afflicted with PTSD.

This paper will examine the roots of PTSD and its historical significance; capture from Soldiers’ testimonies the trials and tribulations of dealing with PTSD and how it affects them; examine what the Army studies have revealed; and recommend what the leadership should do to best serve Soldiers with PTSD now and in the future.

How does the Army best serve a Soldier with PTSD? Clearly, with the wars in Iraq and Afghanistan now in their sixth and eighth years, respectively, and expected to last well into the first quarter of the 21st century, it is paramount that we find the answer. We must not only properly diagnose and care for Soldiers with PTSD, but also develop preventive measures so that we do not send them back into combat. We begin by understanding the history of this condition now called Post-Traumatic Stress Disorder.