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Healing the Invisible Wounds of War

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"But it can work against you," Cheek said. "I don't know that we'll get to where a guy that was shot and a guy who has PTSD will ever be viewed in the
same stature.

"Over time, I think you're going to see a lot of positive change, a lot of emphasis by leaders, a lot more soldiers seeking care and a lot more successful treatments," he continued. "But I don't know how far we'll get in terms of [changing] overall culture.

Leaders are trying to reduce the stigma and are encouraging soldiers to take the step and seek help, because it's likely to be more effective that way,
he said.

Navy Adm. Mike Mullen, chairman of the Joint Chiefs of Staff, suggested that the perception of mental health could be softened if the services institute mandatory emotional screening to complement physical evaluations.

"I believe we can alleviate (this problem) by making everyone undergo screenings so no one has to raise his or her hand," he said last month at the annual Association of the U.S. Army conference here.

Mullen, speaking on the heels of a visit with dozens of PTSD-afflicted troops at the Veterans Affairs hospital in Palo Alto, Calif., said the disorder can be difficult to diagnose and that many servicemembers are wary of seeking treatment that is sometimes seen as taboo.

Mullen said some of the roughly 30 troops with whom he met had sought help, only to find they were forced to go to unreasonable lengths to prove their cases before being referred for treatment of their
invisible wounds.

"It really bothered me to see what they had to go through just to get into the program -- essentially bottoming out, like they were in an alcoholic or drug rehab regimen," he said. "We shouldn't be letting
that happen."

Mullen said his wife, Deborah, has found in talking to spouses that they, too, are sometimes affected by PTSD-like symptoms. Many of these military spouses claim that they, too, are hesitant to volunteer for assistance because they worry about its impact on their family member's career.

Admiral Michael MullenThe chairman emphasized that the military needs to lead the charge in stamping out negative associations that society has tied to the pursuit of mental
health treatment.

"We simply must press ahead to remove this stigma," Mullen said. "That is best led by battalion commanders and command sergeant majors and general officers who knock on the door -- having been in combat - saying, 'I need help.' Because if those who we lead see us do that, they, in fact, will follow."

Even though deployed servicemembers and their families have been "exceptionally strong" for more than seven years of war, their resilience masks an underlying brittleness, Mullen said.

"It is a grim reality of war that people die or come home forever changed," he said. "Who is making sure

they get the support - emotional, financial, medical, spiritual - that they need to move on with their lives? "They need people in charge, and also accountability, to make sure they are responsive to real needs -- needs that are changing."

In perhaps its most direct attempt to deal a blow to the stigma, the Defense Department changed a controversial question on its security clearance form that required applicants to divulge their mental health history. The rationale for revising the language in the form's Question 21 was that officials believed it was preventing some people from seeking counseling for fear that it might affect their careers in the future.

Defense Department security officials said at the time of the May announcement that no one had been denied a security clearance based solely on the fact they received mental health counseling. But the perception that receiving care would jeopardize a security clearance, combined with the stigma of having to acknowledge the care on the form, may have been preventing some from receiving needed care, officials said.

We simply must press ahead to remove this stigma.

"Our people see it as a major blemish on their record," David S.C. Chu, undersecretary of defense for personnel and readiness, said at a Pentagon news conference. "It is one of the highest reasons given on these surveys for why people don't seek mental health care."

Gates hailed changing Question 21 as an important step, but characterized it as one tactic in an overall strategy that must also include military leaders acting as role models.

"Fundamentally, it's a leadership issue in terms of setting an example of senior officers -- even acknowledging that they may have had to seek help and so on, and kind of set the example that way," Gates said in his recent Pentagon Channel interview.

"I think the role of really everyone in the chain of command is important here, but particularly for our more junior enlisted, the role model of their [non-commissioned officers] is really critical here," he said. "They're going to be the most likely to spot somebody who's got a problem and be willing to encourage them to seek help for it."

The department is making headway, the secretary said. "But this is a very strong culture, and it's going to take time," he added.

In an effort to showcase testimonies of troops who have benefitted from treatment, the Defense Department recently launched a DVD series titled, "A Different Kind of Courage." The video series is part of a concerted push to investigate new treatments in a campaign designed to assist wounded warriors suffering from PTSD and traumatic brain injury.

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