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Mind games over
Iraq
By David Isenberg
It increasingly appears that when GI Joe
and Jane come marching home from their tours in
Baghdad they will, among other things, be
scheduling appointments with psychiatrists.
US
military medical officials say that 30% of troops
returning from Iraq have developed stress-related
mental health problems three
A young man's
death in Iraq
Among the many emails he
receives, Tom Engelhardt, editor of TomDispatch,
found one from Chris Christensen, an airline
pilot and veteran of the Vietnam War,
particularly poignant. Christensen discusses the
death in Iraq of the son of a friend, and speaks
of how video games influenced the youngster.
Click
here
for
Christensen's
letter. | to four
months after coming home. A survey of 1,000 troops
found problems
such as anxiety, depression, nightmares, anger and
an inability to concentrate.
The 30%
figure is in contrast to the 3% to 5% diagnosed
with a significant mental health issue immediately
after they leave the war theater, where the US has
about 150,000 troops.
A smaller number of
troops, often with more severe symptoms, were
diagnosed with post-traumatic stress disorder or
PTSD, which is a serious mental illness. For those
who have seen combat, about one in 10 suffers from
PTSD.
As a diagnostic term, PTSD came into
existence in the aftermath of the Vietnam War to
describe the various mental ailments experience by
returning American servicemen.
Mental and
emotional health issues have become a serious
enough concern that the Pentagon has put into
place post-deployment assessments to monitor
troops for PTSD and related illnesses.
These assessments and other mental health
initiatives at both federal and state levels are
part of an effort to avoid the long-term mental
health problems that afflicted many Vietnam
veterans, whose disorder was initially not even
recognized upon their return from combat.
Unlike then, the Pentagon and the Veterans
Administration are trying to be proactive, rather
then reactive. To that end they have published the
Iraq War Clinician Guide; developed by members of
the National Center for PTSD and the Department of
Defense. It was developed specifically for
clinicians and addresses the unique needs of
veterans of the Iraq war. The executive summary
states:
A variety of factors including
personal and cultural characteristics,
orientation toward coping with stressors and
painful emotions, pre-deployment training,
military-related experiences, and
post-deployment environment will shape responses
to Operation Iraqi Freedom. Furthermore,
psychological responses to deployment
experiences can be expected to change over time.
The absence of immediate symptoms following
exposure to a traumatic event is not necessarily
predictive of a long-term positive adjustment.
Depending on a variety of factors, veterans may
appear to be functioning at a reasonable level
immediately upon their return home particularly
given their relief at having survived the
war-zone and returned to family and friends.
However, as life circumstances change, symptoms
of distress may increase to a level worthy of
clinical intervention. Even among
those veterans who will need psychological
services post-deployment, acute stress disorder
and PTSD represent only two of myriad
psychological presentations that are likely.
Veterans of Operation Iraqi Freedom are likely to
have been exposed to a wide variety of war-zone
related stressors that can impact psychological
functioning in a number of ways.
Soldiers
departing a war zone are typically given a health
evaluation as they leave combat, but the army is
only now instituting a program for follow-up
screenings.
In fact the military plans to
screen all troops who serve in Iraq and
Afghanistan for post-traumatic stress disorder and
other combat-related health problems within three
to six months after they return home, William
Winkenwerder Jr, the assistant secretary of
defense for health affairs, said recently.
The Pentagon plans to spend nearly $100
million to make sure all returning troops take
part in the program and get help if they need it,
Winkenwerder said.
An army study made
public last week found that at least 10% of
service members surveyed in Iraq last year
reported experiencing post-traumatic stress
disorder or other acute mental problems. A study
reported last year in the New England Journal of
Medicine found 17% of all troops who served in
Iraq and Afghanistan experienced post-traumatic
stress disorder, severe depression or anxiety, but
most didn't seek medical care for fear of being
stigmatized.
Another study published in
the Journal in March found that as many as one in
four veterans of Afghanistan and Iraq treated at
Veterans Affairs (VA) hospitals in the past 16
months were diagnosed with mental disorders, a
number that has been steadily rising.
Dr
Michael Kussman, the deputy under secretary for
health at the Department of Veterans Affairs, said
24,000 veterans from Iraq and Afghanistan had been
diagnosed with mental health problems due to their
combat experiences. More than 14,000 have sought
treatment at VA medical centers for mental
disorders or drug and alcohol problems related to
combat experiences, he said.
But care for
the troop's mental health is not just something
that starts when a soldier returns home from the
war. The military has about 200 mental health
experts in Iraq, grouped in what the army calls
"combat stress control teams". Such teams are
required per Army Field Manual No 22-51, which
notes, "Combat stress control is now recognized as
an Army Medical Department functional area for
doctrinal and planning purposes."
These
teams are deployed at six US bases across Iraq and
talk with troops after battles to try to prevent
suicides and diagnose troops who should be
evacuated from of the country because of mental
health problems.
To help soldiers cope,
the army has revamped its routine for returning
warriors, easing them back into domestic life
after the prolonged pressures of a war zone.
Unlike the past, where soldiers were more or less
left to fend for themselves with regard to their
mental health, now they are encouraged to ask for
help.
Outreach starts before soldiers
reach home soil and continues with two weeks of
mandatory classes and a month of voluntary
counseling for issues ranging from stress and
anger management to marriage enrichment. Three to
four months after their deployment, the army
formally surveys how troops are doing.
The
first version of the program began in May 2003; it
has been evolving since then.
It remains
problematic whether the government will actually
be able to pay for the mental health service being
put into place. Earlier this year, until
Republican leaders in Congress finally managed to
make it clear to the White House that veterans
health services were no place for deficit
reduction, the administration was pushing to
restrain spending on military benefits and the
Veterans Administration's budget.
Due to
the surge in demand of new veterans, the wait for
VA medical services can be more than six months.
Democrats proposed expanding mental healthcare to
all VA hospitals by 2006 but it is not clear if
that will make it into the final budget.
And the VA itself is sharply divided about
how to care for returning service men and women.
In the last decade, VA hospitals across the
country have sharply reduced the number of
inpatient psychiatric beds, replacing them with
outpatient programs and homeless services, which,
officials say, cost less and are just as
effective.
But veterans' advocates and
even some VA psychiatrists say the hospitals are
ill-equipped to deal with veterans who need the
most extensive help for psychosis, substance
abuse, suicidal impulses and PTSD.
On
March 29 the Los Angeles Times published a letter
by Bruce L Kagan, staff psychiatrist at the
Greater Los Angeles VA Healthcare System. He
wrote:
The Times account of decreased
funding for veterans' mental healthcare (March
20) leaves the impression that the state of this
care is a matter of "debate". But the Government
Accountability Office and the Veterans
Administration's own special committee on
post-traumatic stress disorder in October 2004
warned that the "VA does not have sufficient
capacity to do this. Approximately 15%
of Iraq veterans will experience this disorder and
another 15% will experience major depression, both
conditions associated with severe morbidity,
prolonged disability and significant mortality
(suicide).
Despite the existence of highly
effective treatment for these disorders, most
veterans will not receive effective treatments
because of fear, stigma and lack of treatment
facilities and providers. The VA has repeatedly
cut funding for mental health and post-traumatic
stress disorder. There has been no significant
spending to accommodate the 300,000-plus soldiers
who will suffer from severe mental health
disorders on their return from Iraq.
David Isenberg, a senior analyst
with the Washington-based British American
Security Information Council (BASIC), has a wide
background in arms control and national security
issues. The views expressed are his own.
(Copyright 2005 Asia Times Online Ltd. All
rights reserved. Please contact us for information
on sales, syndication and republishing.)
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