Tuesday, December 05, 2006


Mental health and the US Army

This one is scary. On Morning Edition yesterday, NPR had an item about soldiers who come back from Iraq and need mental healthcare — and aren't getting it. Some of it comes from an overloaded system, bureaucracy, incompetence. It should be fixed, but we do understand it and know how it could be fixed.

Officially, the US military wants to care for these soldiers, and takes their mental health very seriously. Here's what William Winkenwerder, Assistant Secretary of Defense for Health Affairs told NPR:

I draw no distinction between mental health and physical health. If a soldier or marine, sailor, airman is wounded... we go to help.

But that attitude often doesn't filter down to those who run things from day to day, and that's the scary part:

We have a training schedule, we have things the Army needs to get done. That's what you need to be focused on. You can't train for a day, go to an appointment, come back, train for a day, go to another appointment. You just don't get any training value out of it.
That's Sergeant Travis Platt, who says he has refused to let soldiers keep their mental-health appointments.

Now, I can't imagine that Sergeant Platt would tell a soldier with a broken ankle that he had to take that cast off and get back into the training schedule. And these are appointments that have been approved by military doctors who've diagnosed PTSD or other mental health problems.

But it gets worse as Sergeant Platt continues, saying that, well, he went to Iraq and he doesn't have PTSD:

Stuff happened in Iraq, people died, you know... I understand. But then again, I lost two of my friends, and, uh... I don't have a problem, you know? I mean, I'm sorry they died and all, but... you gotta go on with life.

And so, conclude Sergeant Platt and others, these soldiers are just faking it, to get out of work, or to avoid going back to Iraq:

[Platt] People are trying to say they have problems, who don't, just because people are, you know, getting in trouble and they're just blaming it on PTSD.

[NPR] For instance, Platt says some of the soldiers who keep going to the mental health unit are the same ones who've been doing a bad job since they came back from Iraq. They show up late for formation. Sometimes they don't go to work at all. The officers keep citing them for being dirty, or lying, or taking drugs. I've obtained Army records and they corroborate what Platt says.

On the other hand, military studies show that when soldiers get PTSD or other emotional disorders, they often misbehave in just those kinds of ways, as part of their illness. But Platt says that's no excuse. And he and another Sergeant named Drew Preston say there's another reason why so many soldiers are pretending to have emotional problems:

[Platt] They don't want to go back to Iraq, and they're trying to blame all of their life's problems on PTSD.

[Preston] The order comes down that, you know, we're going back, and then all of a sudden, "Oh, I got PTSD." PTSD is pretty much, like, the back door to get out of the military right now.

And in the continuation of the report, yesterday afternoon on All Things Considered, we hear from Sergeant Nathan Towsley:

[Towsley] I'll be blatantly honest, I think some people are just weak. You know, you just have to buck up and be a man, and face it.

[NPR] So, would we ever find you going to therapy and saying, "I'm depressed, I have nightmares."?

[Towsley] No, absolutely not! Actually, my girlfriend wants me to. She says I have anger problems. She thinks that I have, you know, a severe case of PTSD, but... I don't see it. You know, like I said, I just... I don't like people who are weak-minded. Don't come complaining to me and crying to me about your problems, because everybody has problems.

And that's just it: we have supervisors who think people suffering from mental health problems are just wusses — that real men "buck up [...] and face it." Hell, Sergeant Towsley's girlfriend is telling him he has it bad, and he still doesn't see it.

It's always been this way with mental illness. An injury that isn't visible is harder for people to accept, and it's easy to think that someone's goldbricking. What's worrisome here is the shortage of training for those in authority. The sergeants, and the others who are leading with these attitudes toward mental illness, should be trained to understand PTSD and accept that some need treatment for it. And they should be under orders to allow soldiers with mental-health appointments to keep them, even if it means missing a military exercise. But I suspect that, as it's not really in the Army's best interest to do that, it's easier to state that policy at the top but not enforce it at the lower levels. Indeed, NPR's report tells of a number of soldiers who were diagnosed with PTSD but were discharged for other reasons, presumably to avoid the payment of disability benefits.

One irony of this is that if a soldier comes back from Iraq with a chunk of shrapnel in his arm, he'll get a medal and not have to go back. If he's able to stay in the military, he'll get an assignment that he's able to handle with his injury. But a soldier who comes back with emotional shrapnel gets no medal and may be redeployed, right back to the place that continues to injure him further. Perhaps he'll try to kill himself, perhaps he'll abuse his family, perhaps he'll crawl into an emotional hole, unable to emerge. He might be far more disabled than the soldier with the bad arm, and yet the system might not help him.

Since NPR talked with Sergeant Towsley, the sergeant has accepted that he has a problem and has gone into therapy after all. And it seems to me that Sergeant Platt has more problems than he's willing to think he does, considering how casually he can talk about his buddies' deaths. "I mean, I'm sorry they died and all, but...." I wonder whether it will come out later, in some way that Sergeant Platt will have a hard time understanding. But I don't know: I'm not a psychologist.

What I do know is that we have to take care of these soldiers, and not just send them back or send them out to fend for themselves.

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