This article was originally published in De Oppresso Liber Magazine in January 2013 and is being republished here after the recent VA scandal and resignation of General Eric Shinseki to highlight the dilemma still facing our military and veterans ...
Abstract
On average, one military member and 18 Veterans commit suicide each day, and post-traumatic stress disorder (PTSD) is a significant factor in many of those deaths. The negative stigma surrounding PTSD and military mental health treatment exist partly because the brave men and women who make up our military are hesitant to seek mental health treatment from military practitioners. Our young men and women in the military are returning from deployments having experienced horrifying events, either directly or as an observer. PTSD incidence is reported to be as high as 20 to 30 percent of our military returning from recent combat. 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. The negative stigmas regarding PTSD and Veterans are perpetuated by the media. As long as these stigmas are perpetuated in the media, young heroes, our military and veteran men and women, will continue to die. We need a positive dialogue started in this country, educating the public, our elected officials, and military leaders, about the problems in military and Veteran mental health treatment and figure out a way to fix them soon! We also need leaders willing to give our men and women in uniform the confidentiality they need when seeking treatment for their problems, be it PTSD, depressions or anxiety. We need leaders who are going to do the right thing and end the negative stigmas against PTSD and seeking mental health treatment in the military … now, today, before one more American hero dies by their own hand!
By C.T. Sorrentino, LtCol, USAF (Ret)
On average, one military member and 18 Veterans commit suicide each day, and post-traumatic stress disorder (PTSD) is a significant factor in many of those deaths. We as a nation waste billions on political campaigns, needless government spending, and personal luxuries each year, while many of our nation's heroes go jobless, homeless, and with inadequate mental health treatment, while almost 7,000 of them choose to end their lives ... that is correct, nearly 7,000 MILITARY AND VETERANS COMMIT SUICIDE EVERY YEAR!
Being a Veteran of multiple combat operations over my 20-year career in the Air Force and a licensed professional counselor, practicing psychotherapy and treating military, Veterans, and “civilians” (everybody else) with anxiety disorders, including PTSD, and depression for nearly 30 years, I have a unique insight into the military, combat, and the effects both can have on the human psyche.
PTSD has been around as long as humans have been exposed to trauma, and as long as there has been war, having been called many things over the centuries, including exhaustion, railway spine, stress syndrome, shell shock, battle fatigue, combat fatigue, traumatic war neurosis, and, most recently, post-traumatic stress disorder or PTSD for short.
Combat stress reactions appeared as early as the 6th century BC when the Greek historian Herodotus reported one of the first descriptions of a PTSD-like incident:
During the Battle of Marathon in 490 B.C., an Athenian soldier who had suffered no combat injuries, became permanently blind after witnessing the death of a fellow soldier.
A more accurate diagnosis of this reaction would be “conversion disorder” rather than PTSD, but it is an indication of the dramatic impact a traumatic event can have on a human being nonetheless.
Many people think only of combat when they think of PTSD, but there are many causes, traumatic experiences, that can lead to PTSD symptoms, including accidents, physical and sexual assault/abuse, terrorism, as well as many others. According to Department of Veteran Affairs (VA) estimates, seventy percent of the population will experience a trauma extreme enough to qualify for a PTSD diagnosis over the lifespan. Oddly enough, also according to the VA, only 6.8% of all Americans will develop PTSD during their lifetimes, or roughly 10% of those experiencing a trauma. Recent Veterans of the Iraq and Afghanistan Wars, on the other hand, suffer an incidence rate of 13.8%, nearly twice that of the general population.
PTSD is a medical diagnosis as defined by the Diagnostic and Statistical Manual, 4th Edition, Text Revision (DSM-IV-TR, APA, 2000) and the symptoms of PTSD include 1) hyper-arousal (exaggerated startle response, difficulty sleeping or staying asleep); 2) avoidance (avoiding things previously enjoyed or that remind the individual of the trauma); and 3) re-experiencing (flashbacks, nightmares or night terrors, daydreaming about the trauma). An individual must experience a trauma so severe that the individual experienced extreme fear, helplessness or horror and the threat of death or serious injury in addition to all of the three symptom areas listed above (more than one symptom are required for diagnosis in two of those areas) in order to be officially diagnosed by a licensed clinician with “PTSD”.
Ignorance and bureaucratic processes, having needed changing for decades, if not centuries, are the cause of this stigma killing our young American heroes. A stigma, because the brave men and women who make up our military are hesitant to seek mental health treatment from military practitioners. They are hesitant and afraid, and rightly so, because their careers and/or security clearances could be at stake if they seek treatment from a military provider.
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 AFTER I pinned-on my silver oak leaf and knew I would be retiring (meaning "they" could not hurt me). I spent four years in four different combat zones during my career, including "boots on the ground" in the Middle East one month before 9/11 and during the first year of Operation ENDURING FREEDOM, and the stresses of combat took their toll, although not enough to receive a PTSD diagnosis, thankfully.
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, 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 to those returning home, many times caused or hastened by experiencing the effects of an improvised explosive device (IED), 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 man or woman "loses his or her 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 less 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 United States and elsewhere. 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 clinician, be it a psychologist, psychiatrist, licensed professional counselor, or licensed social worker.
Unfortunately, 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. Therefore, it is no wonder that an uneducated and psychotherapy-ignorant public, so desperately in need of professional treatment, misunderstand and fear the many highly qualified, licensed, certified clinicians, helping and saving lives every day.
Our young men and women in the military are returning from deployments having experienced horrifying events, either directly or as an observer. There are estimates that as many as 50 percent of those returning from combat come home suffering from a mental health issue of one kind or another. PTSD incidence is reported to be as high as 20 to 30 percent of our military returning from recent combat. Yet many, if not most, do not seek treatment because they are afraid that doing so will damage their careers.
I have seen it firsthand in my own career, in my private practice and non-profit, and with soldiers recently returning from Iraq and Afghanistan. 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. Many of these individuals, both the so-called leaders and the individual suffering from a mental health issue, 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 currently, 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 psychological treatment received, 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 brave, 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 which apply to confidentiality in the private sector could also apply in the military: danger to self or others; child, spouse, elder abuse; and criminal behavior would still need to be reported. Threats to National security and good order and discipline are two military-specific areas that may need to be added to those limits of confidentiality, and I do not believe anyone would argue against that. Nevertheless, military members would then 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 they so desperately need and deserve.
The Joint Chiefs of Staff (JCS), Service Secretaries, Secretary of Defense, and President of the United States are going to have 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 implemented across the military. It will take several years for our military men and women 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! Our American heroes deserve no less!
The negative stigmas regarding PTSD and Veterans are perpetuated by the media. The film, television, and print (hardcopy and online) industries are at least partial contributors to Veteran joblessness, homelessness, and, ultimately, suicide. With unemployment rates for Veterans hovering at least five percent higher than non-Veterans, we must ask ourselves why.
Because non-Veterans, not having had the opportunity to serve in the military, do not understand the our culture, and rightfully so. What they also do not understand is that the trash the media is spewing about Veterans and Veterans with PTSD or TBI is that we are dangerous! Veterans, particularly those with PTSD, are regularly portrayed in films, television series, TV news, magazines, newspapers, and blogs as being aggressive and threatening at the very least and homicidal maniacs on the other end of the continuum. Veterans “are nuts” and about to blow our corks at the drop of a hat and go off on innocent civilians, possibly whipping out an automatic weapon and killing dozens, as was the case in the spring of 2012 when an Army Staff Sergeant killed 17 Afghanis after multiple deployments, TBI, and PTSD, having seen his buddy’s leg blown off just the day before.
Recently having read an article entitled: "IS GETTING HELP A CAREER KILLER?" in a large weekly military magazine, I noticed that in a little more than one page, the author managed to hinder any progress we have made in recent years toward reducing the negative stigma. The article highlighted why airmen and other military members need to be afraid, very afraid, of seeking mental health treatment, or even worse, talking about it!
The article’s author wrote about an Air Force NCO (non-commissioned officer) who had sought help for alcohol abuse and depression, and educated other airmen, telling them about his battle with alcohol (which he is currently winning, by the way) and other mental health issues. His supervisor, an obvious Neanderthal, virtually ended this airman's career by making statements about his alcoholism in his enlisted performance report (EPR) and marked his rating down, both career-ending behaviors. The NCO in question, a master sergeant (E-7), appealed his "referral" EPR to his superiors and the Inspector General, but was unsuccessful. Not surprising and not promoted!
Most everyone in the Air Force, Army, Navy, and Marines have heard plenty of horror stories like the one described above and now have one more...a page and a half's worth in national weekly military publication. As long as these stigmas are perpetuated in the media, young heroes, our military and veteran men and women, will continue to die. For the first time in recorded history, more people are dying by suicide in the military than are being killed in combat!
The space taken up by that particular article could have been better utilized by providing accurate information about the PTSD and the associated stigma(s), identifying what the implications of the stigma(s) are (e.g. suicides), and analyzing realistic proposals regarding what we can do about them. We need a positive dialogue started in this country, educating the public, our elected officials, and military leaders, about the problems in military and Veteran mental health treatment and figure out a way to fix them...soon!
The stigma surrounding Veterans has affected my own life as well. Having had a disappointing experience in the private sector, I returned to a local state university on the Post-9/11 GI Bill to become a school counselor. After 4 semesters and 27 units completed with a 4.0 GPA, being inducted into the Phi Kappa Phi National Honor Society in April 2011, I was called into a meeting with my advisor, a woman of color I had only met on three other occasions. I thought that she was going to congratulate me on my honor, but that could not have been further from the truth.
When I entered the room for the meeting, my advisor was seated with another professor I had never seen before. The mood in the room and the tone of the conversation quickly enlightened me that I was not there for a “pat on the back”. My advisor stated that she felt that I was “aggressive and threatening” and that if it “didn’t stop”, my “status in the program would be in jeopardy”. Having always treated fellow students, professors, and administrators with nothing but dignity and respect, I was flabbergasted! I asked her for some concrete examples of my “aggressive and threatening behavior”, but all she could come-up with was “it’s a perception, that’s all, a perception”.
After the meeting, I filed a complaint with the university’s Office of Affirmative Action based on the fact that she threatened my status in the program based on a false “perception” of me being “aggressive and threatening”. All Veterans, anyone who would fight for their country and sometimes have to kill our enemies, must be “aggressive and threatening”, right? I filed the complaint in May 2011 and the Head of the Office of Affirmative Action only harassed and insulted me, accusing me of being bigoted and racist! The Deputy Chancellor for Diversity then refused to investigate my complaint. I filed an appeal with the President of the University of Missouri in August 2011 and was immediately promised a response from “general counsel”, but I still have not received that response. Because of the aggressive, threatening, and intimidating environment that was created, I have not returned to complete the three courses required to complete my Educational Specialist (EdS) degree and become licensed as a school counselor.
When will all of this insanity stop? When will the population, our elected officials, government agencies, even our very own Departments of Defense and Veterans Affairs and military comrades, end these negative stigmas? Stigmas against Veterans in general, and those unfortunate enough to return with PTSD and other debilitating mental health conditions, must be addressed now!
The answer to many of our problems, including how we perceive and treat PTSD, is to clarify our core values, then act on them. It sounds extremely simple, and it is. The primary problem with our world, nation, military, and selves is an alienation from our core values or not having defined any in the first place. It appears as though people, in general, have become extremely self-centered in recent time. It seems to be all about ME...ME...ME…how is this or that going to affect me? Guess what folks, there are other people in the world and last time I checked, the world did not revolve around any single person or group.
Values are signposts, directions, not something that can be attained like a goal. Without values, you cannot form goals and if you have neither values nor goals, how can you possibly act in any other way than impulsively...selfishly? Therein lies the problem. With no values, no direction, people will react emotionally when confronted with a situation, and because self-preservation is an innate human condition, that reaction will normally be of a selfish nature.
We must clearly define and understand our values if we are going to succeed as a human race. Our men and women in uniform must memorize their service’s Core Values, which, in the Air Force, are: 1) Integrity; 2) Excellence; and 3) Service before self, but do they really understand what they mean as they apply to behavior, to combat? If you clearly understand what your core values are, when confronted with a situation, difficult or otherwise, you can confidently act in accordance with those values, without even thinking...REACTION! Know your values cold, react appropriately and selflessly when required. Values lie at the core of my therapy for PTSD and other mental health problems, and this is a cursory explanation at best, so I will go on to discuss the processes in-depth in future articles about my proprietary treatment to anxiety, including PTSD, depression, and other problems: Body-Mind-Behavior Therapy (BMBT).
Our world, our society, and our military are in the state they are in because we have no direction, no values, and no real leaders leading us, teaching us, or acting as role models, mentors, for positive core values. Our leaders are perpetuating the negative stigmas I have been discussing here because many continue to reinforce and condone them, doing nothing about them. It should be rather obvious, but people comfortable seeking and receiving mental health care are far less likely to resort to suicide than those who are chastised and ridiculed for doing so.
The Army recently threw $1.5 million at a study to determine how to reduce the suicide rate in the military. We do not need to waste millions on research to know how to stop suicide or end these harmful stigmas, we need leaders who are going to stand-up and say “enough is enough!” We need leaders who will give our men and women in uniform the confidentiality they need when seeking treatment for their problems. We need leaders who will not condone the harassment and peer pressure keeping our men and women in uniform from seeking the mental health treatment they so desperately need and deserve. We need leaders who are going to do the right thing and end the negative stigmas against PTSD and seeking mental health treatment in the military … now, today, before one more American hero dies by his or her own hand!
Key Words: anxiety, depression, disorder, help4vetsptsd, hero, heroes, killing, leaders, media, military, post-traumatic, ptsd, stigma, stigmas, stress, suicide, values, veterans, vets
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New Yorker Magazine reported (Greenberg, 2013) that “It’s been just over twenty-five years since Prozac came to market, and more than twenty per cent of Americans now regularly take mind-altering drugs prescribed by their doctors. Almost as familiar as brands like Zoloft and Lexapro is the worry about what it means that the daily routine in many households, for parents and children alike, includes a dose of medications that are poorly understood and whose long-term effects on the body are unknown. Despite our ambivalence, sales of psychiatric drugs amounted to more than seventy billion dollars in 2010. They have become yet another commodity that consumers have learned to live with or even enjoy, like S.U.V.s or Cheetos.”
