Sunday, November 08, 2009

Mental health issues, in war and in peace

I am not a military veteran, and only know about war second-hand.

But I do know depression first-hand. I know how DNA and bad juju can combine to make a potent cocktail of melancholia. It can lead to extensive funks or something worse. Suicide, even murderous rampages.

Vietnam veteran and former Georgia congressman Max Cleland wrote a stirring op-ed Saturday in the New York Times. He was severely wounded in Vietnam in 1968, and treated at Walter Reed Medical center for his injuries. His post-traumatic stress disorder (PTSD) didn't rear its ugly head until the breakout of the Iraq War caused him to relive his own experiences. He sought help by returning to Walter Reed.

I never saw it coming. Forty years after I had left the battlefield, my memories of death and wounding were suddenly as fresh and present as they had been in 1968. I thought I was past that. I learned that none of us are ever past it. Were it not for the surgeons and nurses at Walter Reed, I never would have survived those first months back from Vietnam. Were it not for the counselors there today, I do not think I would have survived what I’ve come to call my second Vietnam, the one that played out entirely in my mind.

When I was wounded, post-traumatic stress disorder did not officially exist. It was recognized as a legitimate illness only in 1978, during my tenure as head of the Veterans Administration under President Jimmy Carter. Today, it is not only recognized, but the Army and the V.A. know how to treat it. I can offer no better testament than my own recovery.

Cleland documents all of this in his new book (co-authored with Ben Raines), "Heart of a Patriot: How I Found the Courage to Survive Vietnam, Walter Reed and Karl Rove." I plan to read it. It will make a good companion piece to a book I read last summer, "A War of Nerves: Soldiers and psychiatrists 1914-1994" by Ben Shephard. In it, the author documents "shell shock," "battle fatigue," "neurasthenia," "gas poisoning" and all of the terms used in other 20th century wars to describe PTSD. A fascinating look at the inner workings of the machinery of war, especially the ongoing conflict between the needs of the soldiers for psychiatric treatment and the needs of the generals to wage war.

In the early wars of the century, the generals usually got their way. Mental health professionals on all sides struggled to address soldiers with shell shock from their time in the trenches. British doctors sent soldiers home at an alarming rate. The generals objected and the soldiers spent time in recovery near the front. It was discovered that proximity to the war zone actually worked better than sending them home to fester in a hospital or to be looked upon with pity by people with absolutely no idea of what really happened at Ypres and Paschendale and the Somme. Newspapers operated under wartime restrictions. The people at home could only guess at the scope of the horror.

Some writers and poets documented the slaughter. Wilfred Owen said it best in the preface he wrote for the book that he'd never see:

Cleland continues in his op-ed:

There are estimates that 35 percent of the soldiers who fought in Iraq will suffer post-traumatic stress disorder. I’m sure the numbers for Afghanistan are similar. Researchers have found that nearly half of those returning with the disorder have suicidal thoughts. Suicide among active-duty soldiers is on pace to hit a record total this year. More than 1.7 million soldiers have served in Iraq and Afghanistan. Imagine that some 600,000 of them will have crippling memories, trapped in a vivid and horrible past from which they can’t seem to escape.

We need to make sure that returning soldiers and sailors and marines get the mental health care they need. It's crucial for them. Very important for the rest of us. Don't let those stereotypes get cranked up again. During the 1970s and 1980s, we heard a lot about "crazed Vietnam vets." An exaggeration, to be sure, as most Viet vets were working and having families and buying houses. Maybe they got help for PSTD or never experienced its effects. But there were some who went off the deep end and got all the attention.

Let's not let this bad image get started. Take care of our veterans NOW. And do it right.

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