Treating War's Toll on the Mind
Thousands of soldiers have post-traumatic stress disorder. Will they get the help they need?
Last November, Sedotal was redeployed. "They told me I had to go back because my problem wasn't serious enough," Sedotal said in an interview from Baghdad in mid-September. Sedotal says he started "seeing things and having flashbacks." Twice a combat stress unit referred him to a hospital for mental health care. Twice he was returned to his unit, each time with more medication and the second time without his weapon. "I stopped running missions, and I was shunned by my immediate chain of command and my unit," says Sedotal, who returned to Fort Polk last week.
Cases like Sedotal's prompted Congress earlier this year to instruct the Department of Defense to create a Task Force on Mental Health to examine the state of mental health care for the military. It is expected to deliver a report to Secretary of Defense Donald Rumsfeld in May 2007 and make recommendations for everything from reducing the stigma surrounding disorders to helping families and children deal with the traumatized soldier.
Sending military members who suffer from PTSD back into combat goes straight to one of the toughest issues of the war: how to protect soldiers' mental health and still keep them fighting. It is well-established that repeated and prolonged exposure to combat stress is the single greatest risk factor in developing PTSD.
At the same time, there is tremendous resistance to sending home soldiers who are suffering from psychological wounds, in all but the most severe cases. "If a soldier has some PTSD symptoms," says Kiley, "we'll watch him and see how he does." The expectation "is that we're all in this boat together and we need to drive on to complete the mission," he says, adding that if the situation gets worse, the soldier would most likely be given a couple days of rest to see if he recovers. Once soldiers are evacuated, "they are much less likely to come back."
With that in mind, the DOD has designed a program to manage combat stress and identify mental health problems when they occur. It will include so-called battle-mind training for recruits, which focuses on the emotional fallout of seeing and contributing to the carnage of war and how to deal with it. Once they are in Iraq, there are psychologists and combat stress-control teams, such as Platoni's, who work side by side with troops to help them deal with their emotions and decompress immediately after battle. "Soldiers suffering from combat stress do better if they are treated early, efficiently, and as close to the battlefield as possible," says Col. Charles Hoge, chief of the Department of Psychiatry and Behavioral Sciences at Walter Reed Army Institute of Research.
Currently, there are more than 200 psychiatrists, therapists, social workers, and other mental health experts working with soldiers "in theater." They lend an ear, encourage soldiers to talk about their experiences with each other, and administer whatever short-term remedies they can, including stress-reduction techniques, anger-management strategies, or medications. However, their mission, first and foremost, is to be "force multipliers" who maintain troop strength. Their success is judged by their ability to keep soldiers from going home for psychological reasons. Soldiers are often their allies in this effort, as they feel such guilt and shame over abandoning their units they'll most likely say anything to keep from leaving. "It's a very sticky wicket," says Platoni. "We don't know if our interventions are enough to help them stay mentally healthy, or if they'll suffer more in the long term."
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