|HOME | PRESS | SPONSORSHIP | JOIN OUR TEAM ||
John J. Kruzel - American Forces Press Service
A chorus of voices in the Defense Department has underscored the need to remove the stigma attached to military people seeking mental health care.
With as many as one-fifth of the more than 1.7 million servicemembers who have served in Iraq and Afghanistan reporting symptoms of post-traumatic stress disorder, or PTSD, countering troops' aversion to treatment is a chief concern.
"We have no higher priority in the Department of Defense, apart from the war itself, than taking care of our men and women in uniform who have been wounded, who have both visible and unseen wounds," Defense Secretary Robert M. Gates said in May.
But as one Army survey presented to Gates last month reveals, nearly half the soldiers polled believed they would be seen as weak if they sought treatment for their invisible injuries. While the overall Army attitude has become more accepting of mental health care recently, the Defense Department's effort to remove the stigma is an attempt at remolding a deeply entrenched aspect of military culture.
In an interview last month, Gates described a common perception that rank-and-file troops have of PTSD, an anxiety condition that manifests itself in a range of emotional and behavioral changes that persist for more than six weeks after experiencing a life-threatening, traumatic event.
"People basically say, 'Suck it up and get on with the job,' … without realizing that people who have PTSD have suffered a wound, just like they've been shot, and need to be treated," Gates told the Pentagon Channel.
During his two-year tenure, Gates has overseen several department programs aimed at shedding light on PTSD and moderating troops' attitudes about treatment. He has praised the Army for taking the initiative among the service branches.
In July 2007, the Department of the Army instituted a "chain-teaching" program that required every soldier in the force -- from the most seasoned commander down to the most junior enlisted soldier -- to learn about the symptoms associated with PTSD and mild traumatic brain injury, and the need to seek treatment if afflicted.
At the time of the launch, Army Chief of Staff Gen. George W. Casey Jr. highlighted the importance of researching and preventing PTSD and mild traumatic brain injuries, which have been described as the "signature injuries" of the wars in Iraq and Afghanistan.
"Combat is inherently brutal and difficult, and it impacts humans in different ways," Casey said. "We have made significant improvements in the identification and treatment for PTSD and mild TBI, but we must aggressively work research, prevention and treatment of these injuries and encourage soldiers and their families to seek treatment."
Army Secretary Pete Geren, speaking at a Pentagon roundtable on troop care this month, said that educating the 900,000-strong force has helped to start conversations about mental health within units.
"That's done a great deal to get soldiers comfortable talking about those kinds of issues with each other, and to enable them to spot the symptoms in themselves, spot the symptoms in others and name them, and not just deal with this generalized sense of anxiety," he said.
"Stigma is a challenge," Geren added. "It's a challenge in society in general. It's certainly a challenge in the culture of the Army, where we have a premium on strength -- physically, mentally, emotionally."
The Army has made strides over the past two years in creating a climate that is more amenable to mental health services, according to a report showing the change in soldiers' attitudes toward treatment in 2006 and 2007. The survey showed soldiers in Iraq had become more open to seeking mental health care, though the stigma clearly still is intact.
The results revealed the following:
Army Brig. Gen. Gary H. Cheek, director of the Warrior Care and Transition Program that presented the findings to Gates, said the military embraces tenacity and toughness.
"But it can work against you," Cheek said. "I don't know that we'll get to where a guy that was shot and a guy who has PTSD will ever be viewed in the same stature.
"Over time, I think you're going to see a lot of positive change, a lot of emphasis by leaders, a lot more soldiers seeking care and a lot more successful treatments," he continued. "But I don't know how far we'll get in terms of [changing] overall culture.
Leaders are trying to reduce the stigma and are encouraging soldiers to take the step and seek help, because it's likely to be more effective that way, he said.
Navy Adm. Mike Mullen, chairman of the Joint Chiefs of Staff, suggested that the perception of mental health could be softened if the services institute mandatory emotional screening to complement physical evaluations.
"I believe we can alleviate (this problem) by making everyone undergo screenings so no one has to raise his or her hand," he said last month at the annual Association of the U.S. Army conference here.
Mullen, speaking on the heels of a visit with dozens of PTSD-afflicted troops at the Veterans Affairs hospital in Palo Alto, Calif., said the disorder can be difficult to diagnose and that many servicemembers are wary of seeking treatment that is sometimes seen as taboo.
Mullen said some of the roughly 30 troops with whom he met had sought help, only to find they were forced to go to unreasonable lengths to prove their cases before being referred for treatment of their invisible wounds.
"It really bothered me to see what they had to go through just to get into the program -- essentially bottoming out, like they were in an alcoholic or drug rehab regimen," he said. "We shouldn't be letting that happen."
Mullen said his wife, Deborah, has found in talking to spouses that they, too, are sometimes affected by PTSD-like symptoms. Many of these military spouses claim that they, too, are hesitant to volunteer for assistance because they worry about its impact on their family member's career.
The chairman emphasized that the military needs to lead the charge in stamping out negative associations that society has tied to the pursuit of mentalhealth treatment.
"We simply must press ahead to remove this stigma," Mullen said. "That is best led by battalion commanders and command sergeant majors and general officers who knock on the door -- having been in combat - saying, 'I need help.' Because if those who we lead see us do that, they, in fact, will follow."
Even though deployed servicemembers and their families have been "exceptionally strong" for more than seven years of war, their resilience masks an underlying brittleness, Mullen said.
"It is a grim reality of war that people die or come home forever changed," he said. "Who is making sure they get the support - emotional, financial, medical, spiritual - that they need to move on with their lives? "They need people in charge, and also accountability, to make sure they are responsive to real needs -- needs that are changing."
In perhaps its most direct attempt to deal a blow to the stigma, the Defense Department changed a controversial question on its security clearance form that required applicants to divulge their mental health history. The rationale for revising the language in the form's Question 21 was that officials believed it was preventing some people from seeking counseling for fear that it might affect their careers in the future.
Defense Department security officials said at the time of the May announcement that no one had been denied a security clearance based solely on the fact they received mental health counseling. But the perception that receiving care would jeopardize a security clearance, combined with the stigma of having to acknowledge the care on the form, may have been preventing some from receiving needed care, officials said.
"Our people see it as a major blemish on their record," David S.C. Chu, undersecretary of defense for personnel and readiness, said at a Pentagon news conference. "It is one of the highest reasons given on these surveys for why people don't seek mental health care."
Gates hailed changing Question 21 as an important step, but characterized it as one tactic in an overall strategy that must also include military leaders acting as role models.
"Fundamentally, it's a leadership issue in terms of setting an example of senior officers -- even acknowledging that they may have had to seek help and so on, and kind of set the example that way," Gates said in his recent Pentagon Channel interview.
"I think the role of really everyone in the chain of command is important here, but particularly for our more junior enlisted, the role model of their [non-commissioned officers] is really critical here," he said. "They're going to be the most likely to spot somebody who's got a problem and be willing to encourage them to seek help for it."
The department is making headway, the secretary said. "But this is a very strong culture, and it's going to take time," he added.
In an effort to showcase testimonies of troops who have benefitted from treatment, the Defense Department recently launched a DVD series titled, "A Different Kind of Courage." The video series is part of a concerted push to investigate new treatments in a campaign designed to assist wounded warriors suffering from PTSD and traumatic brain injury.
"It's a good tool that provides a number of vignettes of servicemembers who talk about their experiences," Army Brig. Gen. Loree K. Sutton, director of the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury, said in an interview last month.
The concept runs counter to the stereotypical image of the stoic troop who fights not only through physical pain, but also psychological distress, she said.
"Part of our effort really is aimed at transforming our culture -- to move from what has been a very illness- and medically focused culture -- and absolutely broadening it to where we're focused on resilience, on performance, on those things that individuals, families, leaders and communities can do that will both maintain their wellness [and performance]," she said.
Some $300 million has been invested for research into psychological health and brain injuries. Funding is helping to treat a military engaged in Iraq and Afghanistan in counterinsurgency-type operations, which Sutton characterized as "one of the most psychologically corrosive environments known to warfare."
"You're not sick if you need a little [psychological] tune-up," Sutton said. "You're experiencing normal responses to clearly what is beyond the pale of human experience. It is beyond what most folks could ever even imagine. And, of course, our troops are doing this repeatedly."
To prepare warfighters in the pre-deployment phase and further reduce the stigma, the Army has established "Battlemind" training. This regimen is designed to raise the level of importance associated with soldiers' mental fitness on par with physical conditioning.
"Battlemind training [is] probably the only mental-health training that has actually been validated and shown that people who got it have less severe symptoms upon their redeployment," said Brig. Gen. (Dr.) Rhonda Cornum, the Army's assistant surgeon general for force projection.
Those who complete the Battlemind training also feel more comfortable seeking mental health treatment, Cornum said at a Pentagon discussion on troop care this month.
Speaking at the Association of the U.S. Army conference last month, Cornum said the high rate of post-traumatic stress disorder is one of the driving forces behind the creation of the wider- ranging appraisal.
"Being 'Army Strong' is, in fact, being more than just physically fit. A lot of it's in your head," she said. Cornum added that instances of PTSD are about twice as high in people engaged in combat than those who deployed but were not involved in direct combat.
Cornum recommended that the Army evaluate comprehensive fitness as aggressively as it does physical fitness. Similar to the way the Army grades physical health along an axis, scores will be meted out for mental and emotional capacity.
Strong fitness in these latter realms is characterized as high levels of resilience, adaptability, self-confidence and agility. On the other hand, if soldiers exhibit stress, insecurity, immaturity or a lack of discipline, they might receive a poor score.
Soldiers who register a mid-level score may undergo education or training, while those with ratings just below average might receive some form of therapeutic regimen. The Army will step in when soldiers need direct intervention, Cornum said.
The general said the most vulnerable demographic is members of the junior enlisted ranks, who tend to be younger than their higher-ranking counterparts. But the proposal entails comprehensive fitness assessments for all force members, over their entire careers.
At the senior enlisted level and within the officer corps, emphasis will be placed on training programs to help these personnel instruct and instill these values in their younger subordinates.
"This is going to be a culture change for the Army," Cornum said. "But I think it's really important, because these are life skills and capabilities that you can train."
Editor's Note: Gerry J. Gilmore of American Forces Press Service contributed to this report.