In Army culture, especially in the elite unit filled with rangers and paratroopers in which I served, asking for help was showing weakness. My two Bronze Stars, my tours in Airborne and Special Operations units, none of these would matter. To ask for help would be seen as breaking.
But, finally, when in the middle of the day I was forced to hide, shaking and crying in a concrete bunker, railing against the noise and the images in my head, and when I understood that to continue was to endanger the soldiers I was sent to Afghanistan to lead, I asked for help.
Today, right now, we need to get more soldiers to ask for help. Reducing the stigma attached to mental health issues is the first step. When soldiers see their peers ridiculed, accused of malingering or cowardice, they don’t seek the help they need.
Maybe that’s why, in the first half of 2009, more American soldiers committed suicide than died in combat.
This is an important issue but more than stigma is involved as a barrier to help. I have been personally involved in at least six suicides by military members, but only one of them could be directly attributed to unresolved combat stress. The others were more likely from failed relationships, though combat stress may have played a role. That’s why we are focusing on marriage and family enrichment through programs such as “Strong Bonds” and the “Yellow Ribbon Reintegration Program”, and they are helping to stop some of the suicides.
We become most vulnerable to suicidal ideation when we lose sight of who is important to us and of goals to live for. In other words, when we know we are needed or have personal aspirations, we are less vulnerable to suicide. Combat Stress complicates this, but it can be mitigated when we can think of even ONE positive aspect of the experience. I know a soldier who lost his feet, but loves to tell the story of how a buddy saved his life. He will be ok. I know another soldier who could only grieve over a child dying in a firefight he was involved in. He only began to heal when he reflected on that fact that he is still alive and could help others who have seen worse.
The biggest obstacle to seeking help is being put “on profile” by the medics, or having one’s security clearance suspended. Being on a medical profile limits one’s duty and is like being sidelined when you live to be in the game. One can feel useless. The security clearance issue comes up when it is renewed, and you have to answer truthfully whether you have been treated for a mental illness. This can be a career killer! What soldiers and airmen forget is that the question only applies to a DIAGNOSED MENTAL ILLNESS, and not counseling for mere combat stress. I also doubt that every diagnosed condition would kill a security clearance, but few would take that chance.
What folks need to remember is that combat stress or post-traumatic stress is NORMAL and will NOT hurt one’s career. Left untreated or unresolved, it can become PTSD and THAT might hurt one’s career, or one’s life! So treatment will save a soldier or airman’s career, not kill it, by preventing PTSD, and can save marriages, even one’s life. Our warriors ofter forget this.
The other thing folks forget is the absolute confidentiality of the chaplain. Military chaplains are NEVER allowed to disclose confidential counseling under penalty of USMJ, so soldiers and airmen can go to a chaplain trained in pastoral care for combat stress and there will NEVER be paperwork, let alone a “profile” or an embarrassing answer to a security question, or even a stigma. Nag your stressed out warrior-friends to see their chaplain!
Keep praying for our warriors, but remember, they need our GRATITUDE, not our pity. Gratitude honors a sacrifice, pity only acknowledges suffering. Please honor our warriors with gratitude.
Blessings,
Fr. Wes
Thank you for serving our military members, Fr. Wes!
I helped my daughter complete her security clearance paperwork last month and it specifically excludes combat stress and relationship counseling in the mental health section. Hopefully more service members will avail themselves of both if they need it.
I suspect – just hunch – thqt the increased in this nightmare is in substantial part due to the change in a soldier’s function. In earlier wars, there were bad guys whom you shot before they shot you.This is straightforward and keeps one’s moral and ethical world in order. Now it is not clear who the bad guys are; they aren’t even recognizable. In fact, the good guys now undertake to negotiate with the bad guys and we try to make bad guys into good guys. Moreover, the soldier has become of necessity and planning, a social agent and negotiator who is charged with treating people well who may at the very moment be planning to blow him and his buddies up. And I suspect that having women everywhere in the platoons makes an even tenser atmosphere. In short, the soldiers moral and ethical world has become vastly more complex, the inherent tensions vastly increased, and the consequences of playing the game wrong exhausting in its realities. Real war does less damage than this amorphous, vague dueling with shadows. L
I have a different take on this. I think the problem is multifactorial:
1. Prior to Vietnam, when a soldier went to war he went out with the full backing of the American people who received him back as a hero, and a man. Veterams were given preference for jobs, were treated with respect, and therefore were integrated easily into the US mainstream. The draft ruled them for two years, but after that they could go home free and clear, “honorably discharged”. Or, if they wished they could make a career of the military, and could leave with a pension after 20 years. After Vietnam, soldiers have not had the backing of America (except briefly during the first Iraq war). They are greeted with suspicion as being mentally unstable, and are less preferred for employments than their age mates who spent the same set of years in college. Thus, to some extent PTSD is a stress disorder made worse by a almost universal sense of injustice, and personal disrespect felt by our service men, who find that they are LESS employable then folks who did not serve.
2. Second, we have a volunteer army that signed up mostly to get educational benefits. Many of them are former reservists. Although they theoretically enlist for 3 years, they can be called up for another five years (eight total). It used to be unheard of that reservists be called up more than once, now they are called up multiple times which makes it difficult to hold a civilian job. In addition, the stress of multiple deployments (some folks are on their 4th tour) puts enormous strains on families. Calling abusive overwork of existing personel who have already honorably served, “PTSD” further disrespects our armed forces. If a war is that important, Congress should have the guts to call up the draft, so that the burden of that war is shared by everybody, not just the unlucky few who signed up in an earlier era, under different expectations, and now find they cannot leave honorably, without being “medically discharged” (which a diagnosis of PTSD will do).
3. I think the problem is not soldier being unwilling to talk to psychiatrists but psychiatrists having very little to offer besides prozac, and notes that might end up in your personel record. Such notes will not immediately derail a career, however since it has become popular to get rid of soldiers between 12 and 19 years in service (thus keeping them from the pension they normally have earned after far less in the way of combat deployments) the slightest ding on your personal record is cause for alarm. You definately don’t need “conduct disorder” or “bipolar” or “explosive disorder” on your record if you are trying to make it to 20 years. Since a psychiatrist is forced to put down SOMETHING down, in order to GET PAID, this is EXACTLY the sort of thing that will end up on your record. You think they will just put down “combat stress?” You wish. It was easier before the advent of computers. Then, if you slugged your messmate, he would probably slug you back, and you would both peel potatoes for 3 weeks, and nobody would know outside of your unit who would laugh at you both. Now if you raise a hand in a threatening fashion, you get to sit in counselling learning “anger management” while taking medications that will calm you but will also make it slightly harder to engage executive functioning. There was a great deal LESS psychopathology before we had psychiatrists. (Doesn’t anybody else remember what life was like 40 years ago?) The combination of the drill sergeant who simply set his own rules, and the chaplain who was always present, and where confession was inviolate allowed a great deal more freedom to be angry and sad, and then GET OVER it, then the current system of asking everybody “Are you depressed? Are you suicidal? Let’s talk about it”. Why would anybody who was frightened and grief stricken over watching a buddy die want to go yammer to some white coated nincompoop about “how did that make you feel?” What can a psychiatrist POSSIBLY know about war? A soldier would get more support from his male collegues who shared the same experiences.
I think much of the emphasis on suicide prevention makes suicide more attractive not less attractive to soldiers, especially young ones. This is certainly the case with drug rehab programs for teenagers, and it is the case for juvenile justice programs for teenagers. Folks who have no contact with shrinks end up less damaged.
http://www.time.com/time/health/article/0,8599,2003160,00.html
http://www.time.com/time/health/article/0,8599,1914837,00.html
If America wishes to lower the suicide rate among servicemen she should:
1. Limit tours. Currently anybody who signs up has to be in the individual ready reserve and subject to indefinate call up for 8 years. This is bogus. The period is too short to get a pension and too long to simply get in, see some action, learn some skills and then get on with your life. Some reservists have been called up 4 x in 8 years. A reservist should enlist for a 3 year period and not be called up more than once. After all, they need to maintain employability in the civilian sector. A full time soldier might be permitted to enlist for 5 years, with the expectation that they would not have more than two tours in that time. If the army can’t keep their units manned under such guidelines, then the draft needs to be called up. If the American people don’t want to be drafted, then they need to vote to STOP funding the war.
2. Have public acknowledgements of servicemen, and bring back respect for patriotism. It should be normal for a country that is at war (and guess what, we are at war) for every church to pray for the safety of our servicemen, and for their speedy return home. It should be normal at all public venues for people to ask “Are there any servicemen here in this theatre/ rock concert/ ball game? Please stand up. Ladies and Gentlemen please lets have a big round of applause for the courageous men and women who risk their lives for our freedom.” Far more important than “affirmative action for race or sex” should be “affirmative action for military service” for both jobs and entrance into higher education.
3. We should replace the shrinks with chaplains, and the psychotherapy with confession. Because suicide is not due to some “chemical imbalance” to be rectified with SSRIs. The whole ridiculous business of calling the gamut of human emotion “chemical imbalances” would be hilarious were it not so damaging. Suicide is the ultimate expression of Despair, which is a mortal sin. It is best treated with confession, prayer, exercise, a supportive community and the avoidance of all triggers that lead to the sin of despair. That is the province of a priest, not a psychiatrist.
Clueless,
I appreciate your insight, though I have a slight disagreement on a couple of your observations. I think you are right about the PTSD stigma, which is one of the reasons we refer to “Combat Stress” rather than “Post Traumatic Stress”. Also there is a SIGNIFICANT difference between mere stress and a stress disorder.
The latest research on the subject now points in the direction of RESILIENCY. In other words, one who has recovered from combat stress is STRONGER emotionally than one who was never exposed to begin with. We see this a lot in the medical profession, in law enforcement and in other environments where exposure to trauma is part of the job. The Israeli forces have worked with this model for years, inoculating their soldiers from trauma as they are exposed to it. As clergy we have had similar training through CPE (Clinical Pastoral Education). Dr. Dave Grossman writes eloquently on the subject in his book “On Combat”, specifically regarding the profession of arms. His work helped form the basis for “Warrior Resiliency Training”, developed in Bagdad, which we now give to our deploying soldiers and airmen. Thus combat vets can once again be seen as having the emotional advantage. Also, only a small percentage of Vietnam vets (like in other wars) really had PTSD, but it sells newsprint, so we are left with the impression that all warriors are messed up.
I have a slight quibble regarding Vietnam. Interestingly, available research suggests the percentage of PTSD victims is fairly consistent in each of our recent wars, going back to the Civil War. In earlier days it was called “shell shock” or “the 1000 yard stare” or “combat fatigue” but the symptoms and later disability was the same. Except perhaps for the Civil War, all of our enemies cheated by hiding among civilians, targeting the innocent, torturing our POW’s and using children as body armor. Using children is the favorite tactic of our current adversaries. This would explain the consistency of trauma in war. You are right to note that those who know they did the “right thing” or found meaning in what happened were more resilient.
I also disagree slightly with the motivations of those who enlist today. Education benefits and the like do make serving attractive, the there is no doubt among Army reservists and guardsmen that they WILL deploy. It has become an expectation. You are right, however, that the frequency and length of deployments have wreaked havoc in military families, but sadly this is due to a force structure that is WAY too small. Thank you congress!
I believe the higher suicide rate we are seeing is due to the higher divorce rate in our military families and to a broader cultural acceptance of suicide in our ever-more toxic culture, especially among young people.
Finally, chaplains DO bring more to the table for our warriors than a therapist, but not merely due to the sacramental role. We also have a LOT of specialized training specifically dealing with combat stress mitigation, suicide intervention & prevention, marriage enrichment and other pastoral matters, way beyond what parochial clergy typically receive. We are not licensed therapists, but we are trained. It’s like the difference between a trauma nurse and a doctor. We as chaplains can intervene, while the licensed therapist can offer longer-term care for the most serious conditions. Like with a nurse, often intervention is all that is needed.
Thanks for the post. You added a lot to the subject! 🙂