Army Officials Work to Treat Invisible Wounds of War

By Fred W. Baker III

American Forces Press Service

WASHINGTON, Dec. 26, 2010 – Military leaders and troops alike need more time at home between deployments to help diagnose and receive treatment for the "invisible" wounds of war such as posttraumatic stress, a senior Army officer said today.

"It affects everything. It affects the divorce rate. It affects substance abuse. It affects everything. And we've kind of taken our focus and shifted it to ensure that we're getting at that," Army Gen. Peter W. Chiarelli, the vice chief of staff of the Army, said on ABC's "This Week" with Christiane Amanpour.

"You want to get at these issues. We need more time at home before deployment," Chiarelli said.

Complicating matters, the symptoms of posttraumatic stress take sometimes months or years to show. More research is needed to understand the brain and the effects of stress, Chiarelli said.

"I think we're doing everything we possibly can to learn as much as we can about the brain. And that's really the issue. It's trying to understand the brain as well as we do the other organs in the body," he said.

"We just don't know that much about the brain. We automatically assume so many times that a person that's in a blast has a concussion. Many times, they don't have a concussion. Instead, they have posttraumatic stress," Chiarelli said.

The Army has implemented new programs both in theater and here at home to identify and treat those who show signs of suffering from posttraumatic stress, but there is still much to learn about the brain and how it responds stress and treatment.

In Afghanistan, soldiers are now sent to resiliency centers after suffering a bomb blast.

If a soldier is in a vehicle that is damaged, within 15 meters of a blast, in a building with a blast or if they lose consciousness, they are given an initial medical evaluation and pulled from the fight for 24 hours.

"Sometimes the symptoms of concussion don't display themselves for 24 hours. We give them a second evaluation, and if they pass that, they in fact go back to duty. If they fail either one of those in that 24-hour period, they go to a resilience center where we rest them until the brain has had an opportunity to heal from that concussion," Chiarelli said.

Before, the soldiers would have likely simply continued on duty.

"We had soldiers who knew that they'd had a concussion, knew that they had had their, quote, 'bell rung,' and they did nothing about it," the general said.

Chiarelli said that treating the stress on the battlefield is more effective than waiting until the soldier returns from deployment for medical help.

"We know in treating PTS the closer you treat PTS to the event that occurs, the more likely you are to help that individual," he said. "So much so that ... if the event occurs in the morning, it's very important that you bring the individual's anxiety level down before they go to sleep that night, because in [rapid eye movement] sleep, something happens in the brain that causes an individual to remember that and make the PTS harder to treat."

Once the soldier returns from combat, military leaders at Army installations work to identify those troops who engage in high-risk behaviors.

"What we see is a soldier who's down range for 12 months in a very high adrenaline environment, where every single day, he or she finds themselves facing an enemy. And they come home, and many times, want to replicate that," he said.

"We're looking at programs that, first of all, ensure that we are identifying early on those who are going to have a rough time reintegrating. And then taking soldiers and putting them in high-stress kind of events that are safe for them, such as water rafting and out doing those kind of sports to burn off that adrenaline, rather than getting on a motorcycle and traveling down the road at 100 miles an hour without a helmet on," he said.

Chiarelli said he briefs the leadership of every brigade combat team before deployment on the effects of traumatic brain injury and posttraumatic stress and needed treatment.

Also, Chiarelli added, the Army works closely with Veterans Affairs to ensure soldiers leaving the service understand their ongoing treatment options.

"You know, the problem with posttraumatic stress is that in the United States, the National Institute of Mental Health will tell you, for regular civilians, it is 12 years between the initiating event and when someone first seeks help. Now the issue there isn't that they finally seek help. It's all the things that happen in between," he said.