Chairman: Psychological Wounds Need Same Attention as Physical Ones

By Jim Garamone
American Forces Press Service

Aug. 19, 2007 - Psychological wounds are just as devastating to servicemembers and families as physical wounds, the chairman of the Joint Chiefs of Staff said after meeting with servicemembers and veterans undergoing treatment for post-traumatic stress disorder at Tripler Army Medical Center here yesterday. When Marine Gen. Peter Pace met with men undergoing treatment at the Department of Veterans Affairs PTSD Residential Recovery Program, he asked them where and when they had been wounded.

Some of the men were on the verge of saying they weren't wounded, but the chairman continued. "I use that term specifically to include you," he said. "Because it doesn't matter if it was psychological or physical, you were wounded in service to your country, and we need to do all we can to make you better."

The VA administers the program at Tripler.

"The program has done a lot for me and my family," said a Marine veteran of the second battle for Fallujah. "I didn't believe there was anything wrong with me when I came back to Kaneohe Bay. By the time I did, I didn't want to do anything because of the stigma attached."

The young man got out of the Marine Corps, but had serious problems adjusting and coping with the memories of Iraq. He first learned about getting help at the Veterans Center at Marine Base Kaneohe Bay.

Reserve component servicemembers also are part of the program. A soldier from Guam received physical and psychological wounds from his service in Iraq. He wants to get healthy, he said, so he can deploy with his unit when it goes again. "We're still warriors, sir," he told Pace.

The program has active duty servicemembers in it as well. One active duty soldier involved in the program went to Camp Zama, Japan, after a very tough tour in Baghdad. He spiraled in pretty fast, he said -- abusing alcohol and "messing up."

"I just didn't care any more," he told the chairman. "I had hit rock bottom, and I don't like to think about what could have happened."

He is still in the service. At Zama, his superiors referred him to the Army's substance abuse program, and that organization got him into the residential program. "I'm sober for eight months now, and I'm learning to handle things here," he said.

The soldier is in the minority. Usually, active duty servicemembers don't get diagnosed in time to remain in the service. Often, they abuse alcohol or drugs, and they have problems relating to family and friends. The trouble mounts, and they find themselves receiving Article 15 nonjudicial punishments or worse, and they often are discharged.

The behaviors that got them in trouble in civilian life after leaving the military often are the ones they relied on to survive combat. "These are skills the soldiers used in Baghdad to keep themselves alive," said Dr. Kenneth A. Hirsch, the director of the traumatic stress disorders program for the VA. "They learned how to turn off these feelings in order to survive. It's a coping mechanism."

Hirsch told Pace that junior leaders and noncommissioned officers – the ones closest to the fight and the troops – must be educated to recognize the signs of PTSD, and to get people help early enough so professionals can intervene.

Hirsch also said there needs to be a better screening process. Servicemembers fill out a questionnaire when their combat tours are over, but they don't want to say anything is wrong.

"No one wants to say that they may have a problem – it might delay the start of block leave," Hirsch said. "It also might affect the way others – superiors – regard them as somehow damaged goods."

After the meeting with the men, Pace said he was impressed with the treatment they're receiving. "I had met with individuals suffering with PTSD before, but this was the first time at a group session – where there was actually a program," he said in an interview.

Pace is concerned about the stigma that has been associated with psychological wounds. "It's important for senior leaders to make sure that folks understand that (PTSD or other psychological wounds are), for some people, a consequence of going to war," he said. "It's very much a wound that needs to heal just as a physical wound. Leaders need to be very comfortable in stepping forward or recommending subordinates to receive care."

Pace said it will take a collective dialogue of all levels in the military to understand that PTSD is a wound and needs care just as a soldier of Marine would need care for a chest wound.

The general is interested in following the work of a joint Defense Department-Veterans Affairs group looking at the "whole life" medical approach. The two agencies would share records of servicemembers from the time they enter service, though discharge and on.

"I want to make sure I get some input into the DoD-VA group that's looking at the situation," he said. "Mental health needs to be part of the full spectrum of medical health care to make sure we develop the necessary screening tools.

"We screen for cancer and all kinds of diseases," he continued. "We need to develop the mechanisms to screen for mental health conditions in a way that becomes routine as an X-ray or a blood test."

The Army and Marine Corps – the services most affected by PTSD – are developing systems to educate the troops and their families about the symptoms of the disorder. They need to know what to watch for in themselves, their buddies or their spouses.

At the end of the meeting, Pace and the men drank a toast with a typical Hawaiin concoction that contained pineapple juice and iced tea. He raised the paper cup to the men and said, "To your health."