INVISIBLE WOUNDS OF WAR by Saralyn Mark, MD

Saralyn Mark photo

UPDATE:  Last Friday, after the hearing Sara talks about below, The U.S. Senate Armed Services Committee voted unanimously to adopt the Montana model for assessing returning combat vets for post-traumatic stress disorder.  Check out the story here

Last Wednesday, I had an opportunity to present to Congress my thoughts on the “invisible wounds” of war. According to a 2008 RAND report, nearly 20% of veterans who have returned from Iraq and Afghanistan suffer from post traumatic stress disorder (PTSD) or major depression. I think that these numbers are actually low, since the report was based on extrapolated data from a survey of less than 2,000 troops. We now know that the number of Army suicides has increased every year since the Iraq War began, and this is the first time since the Vietnam War that the Army suicide rate has surpassed the civilian suicide rate.

The briefing was in the Dirksen Senate Office Building and was sponsored by Senators Max Baucus (D-Montana), Mike Johanns (R-Nebraska), and Jon Tester (D-Montana). The Senate hearing room, with its elegant wood paneling and high ceilings, was filled to the brim and every seat was taken. People were even standing near the windows and out in the doorway. I was seated in the middle of a very long table and was flanked by two colonels: Colonel Jeff Ireland, Director of the Montana National Guard, and Colonel Peter Duffy (retired), Deputy Director of the National Guard Association. We were joined by three others including two psychologists and Mr. Patrick Campbell, Chief Legislative Counsel for Iraq and Afghanistan Veterans of America. Mr. Campbell shared his experiences of how difficult it was to get mental healthcare while on active duty and how he was inappropriately questioned about his symptoms and needs when he returned home to the U.S.

During the briefing, staffers took copious notes and the audience remained completely silent. I don’t think I’ve ever spoken to a more attentive group of people. I usually don’t like to use prepared remarks, but we had tight time limits and I wanted to be sure I conveyed all my points. I’ve included my remarks here in this blog; many passages were actually taken from my prior BeWell blogs (“A Nation of Ghosts” and “Shock and AWE”), which focused on these issues. Congress is considering legislation to help veterans suffering from PTSD and other mental health issues. This was a chance to raise the level of awareness for other Senate offices to support this legislation. (I’ve since learned that other Senators signed on to support S.711-The Post Deployment Health Assessment Act of 2009 after hearing the briefing).

I must admit that it was cathartic to be able to formally share my viewpoints. I was having my own flashbacks to March of this year when I was on Capitol Hill to speak to congressional offices about pancreatic cancer. In some ways, talking about the mental health needs of the military was harder. Both touch my life very closely and I feel a need and a responsibility to make a difference and help others, as well as my own family. But talking about PTSD — or as I would like to call it “AWE” (Adaptation to the Extreme Environment of War) — was a more delicate topic for me.

Perhaps because I think that there is an understanding that military wives are not to speak out, especially to tell Congress that “it is not ethically or morally acceptable to send our loved ones off to war without the resources that they need to protect themselves.” I can only guess that other spouses might feel that they cannot talk about the painful changes they are seeing in their partners. It is a taboo topic filled with stigma, as if our loved ones are weak and not made of the “right stuff” for the military. I wonder if this silence is like a cancer that eats away at our loved ones and our families.

After the briefing, I stayed in the room for an extra 45 minutes taking questions from the audience, including Senate staffers who were officers in the military. Their stories were so poignant and courageous. I felt like we were their voices and I hope that we did them justice.

My three points that I wanted to make in that briefing room were the following: 1) War changes everyone and people adapt. Those changes (AWE) are a normal reaction to an abnormal situation with PTSD at the other end of the continuum, where the adaptation process has progressed to a dysfunctional state; 2) We should offer mandatory surveillance and rehabilitation before, during and post-deployment; 3) Family members need to be involved. Currently we have no where to go to confidentially report changes that we see in our loved ones without causing potential damage to their careers.

After the briefing I left the hearing room with Colonel Ireland we walked together to the train station. I felt a sense of sadness and exhaustion as I entered the Metro. It was an honor to have had the opportunity to speak and share ideas, but the weight of what we still need to accomplish is huge. I know that I am but one voice representing many. I hope that my message encourages others to speak out, as well, and to demand action. We are blessed to have a First Lady who is committed to the well-being of military families and her advocacy can make a big difference.

If we can afford to go to war, we have to afford to take care of the mental health of our troops. We must stop viewing mental health care as a luxury. It is a necessity to ensure that our troops, our loved ones, can defend our nation and come back and be productive members of our society and our families.

Saralyn Mark, MD

http://www.bewell.com Medical Editor

President, SolaMed Solutions, LLC

Associate Professor adjunct of Medicine

Yale and Georgetown University Schools of Medicine

Affiliate Professor

George Mason University School of Public Policy

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One Response

  1. A place to go- where reporting that our partner is having problems will NOT mean the end of their career. A place to go – for parents who are seeing their child changed, and will be taken SERIOUSLY (not just as “mommy pampering her baby boy”) When the military establishes THAT, I’ll start believing they really care. As the mom of a veteran with PTSD problems – and the wife of long time soldier who is on yet another deployment – I’m waiting for it with less and less patience.

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