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Healing the Invisible Wounds of War

Shrinking the Stigma

WASHINGTON, Nov. 25, 2008 — A chorus of voices in the Defense Department has underscored the need to remove the stigma attached to military people seeking mental health care.

With as many as one-fifth of the more than 1.7 million servicemembers who have served in Iraq and Afghanistan reporting symptoms of post-traumatic stress disorder, or PTSD, countering troops' aversion to treatment is a chief concern.

Dr. Robert M. Gates"We have no higher priority in the Department of Defense, apart from the war itself, than taking care of our men and women in uniform who have been wounded, who have both visible and unseen wounds," Defense Secretary Robert M. Gates said in May.

But as one Army survey presented to Gates last month reveals, nearly half the soldiers polled believed they would be seen as weak if they sought treatment for their invisible injuries. While the overall Army attitude has become more accepting of mental health care recently, the Defense Department's effort to remove the stigma is an attempt at remolding a deeply entrenched aspect of military culture.

In an interview last month, Gates described a common perception that rank-and-file troops have of PTSD, an anxiety condition that manifests itself in a range of emotional and behavioral changes that persist for more than six weeks after experiencing a life-threatening, traumatic event.

"People basically say, 'Suck it up and get on with the job,' without realizing that people who have PTSD have suffered a wound, just like they've been shot, and need to be treated," Gates told the
Pentagon Channel.

During his two-year tenure, Gates has overseen several department programs aimed at shedding light on PTSD and moderating troops' attitudes about treatment. He has praised the Army for taking the initiative among the service branches.

In July 2007, the Department of the Army instituted a "chain-teaching" program that required every soldier in the force -- from the most seasoned commander down to the most junior enlisted soldier -- to learn about the symptoms associated with PTSD and mild traumatic brain injury, and the need to seek treatment if afflicted.

At the time of the launch, Army Chief of Staff Gen. George W. Casey Jr. highlighted the importance of researching and preventing PTSD and mild traumatic brain injuries, which have been described as the "signature injuries" of the wars in Iraq and Afghanistan.

Army Gen. George W. Casey Jr."Combat is inherently brutal and difficult, and it impacts humans in different ways," Casey said. "We have made significant improvements in the identification and treatment for PTSD and mild TBI, but we must aggressively work research, prevention and treatment of these injuries and encourage soldiers and their families to seek treatment."

Army Secretary Pete Geren, speaking at a Pentagon roundtable on troop care this month, said that educating the 900,000-strong force has helped to start conversations about mental health within units.

"That's done a great deal to get soldiers comfortable talking about those kinds of issues with each other, and to enable them to spot the symptoms in themselves, spot the symptoms in others and name them, and not just deal with this generalized sense of anxiety," he said.

"Stigma is a challenge," Geren added. "It's a challenge in society in general. It's certainly a challenge in the culture of the Army, where we have a premium on strength -- physically, mentally, emotionally."

The Army has made strides over the past two years in creating a climate that is more amenable to mental health services, according to a report showing the change in soldiers' attitudes toward treatment in 2006 and 2007. The survey showed soldiers in Iraq had become more open to seeking mental health care, though the stigma clearly still is intact.

The results revealed the following:

  • About 53 percent of soldiers polled in 2006 thought they would be seen as weak if they sought mental health care, compared to 50 percent the next year.
  • Of soldiers surveyed in 2006, 37 percent agreed or strongly agreed that it would be too embarrassing to seek mental health services. In 2007, the figure decreased to 32 percent.
  • Nearly 34 percent in 2006 said it would harm their career to seek treatment, compared to about 29 percent in 2007.
  • More than half surveyed in 2006 said members of their unit might have less confidence in them if they sought mental health treatment. That figure dropped to about 45 percent the next year.
  • About 58 percent in 2006 said their unit membership might treat them differently if they sought treatment, compared to 52 percent in 2007.
  • Asked if their leaders would blame them for their mental health problem, 43 percent agreed in 2006, compared to 39 percent in 2007.

Army Brig. Gen. Gary H. Cheek, director of the Warrior Care and Transition Program that presented the findings to Gates, said the military embraces tenacity and toughness.

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