Treating War's Toll on the Mind
Thousands of soldiers have post-traumatic stress disorder. Will they get the help they need?
In the past few years, in part because of events such as September 11, there have been advances in therapies for PTSD. "Just because you have PTSD, it doesn't mean you can't be successful in daily life," says Harold Wain, chief of the psychiatry consultation and liaison service at Walter Reed Army Medical Center in Washington, D.C., the main Army hospital for amputees. Many of the patients Wain sees have suffered catastrophic injuries and must heal their bodies as well as their minds.
Reimagining the trauma again and again, or what's known as exposure therapy, has long been believed to be the most effective way of conquering PTSD. It is still popular and has been made even more effective by such tools as virtual reality. However, therapists are increasingly relying on cognitive behavior therapy or cognitive reframing, putting a new frame around a thought to shift the way a soldier interprets an event. A soldier who is racked with guilt because he couldn't save an injured buddy, for instance, may be redirected to concentrate on what he did do to help. Other approaches such as eye movement desensitization and reprocessing use hypnosis to help soldiers.
For some soldiers, simply talking about what happened to them can be therapy enough. When Zachary Scott-Singley returned from Iraq in 2005, he was haunted by the image of a 3-year-old boy who had been shot and killed accidentally by a fellow soldier. With a son of his own, Scott-Singley couldn't get the picture of the child and his wailing mother out of his head and became increasingly paranoid about his own child's safety. "I was constantly thinking about how people were going to attack me and take him," he says. Scott-Singley twice sought mental health care from the Army. The first time he says he was told that since he wasn't hurting anybody, he didn't have PTSD. The next counselor suggested he buy some stress-management tapes on the Internet and practice counting to 10 whenever he felt overwhelmed. (The VA is legally precluded from discussing a soldier's medical records.) Ironically, Scott-Singley found his therapy on the Web anyway, with his blog A Soldier's Thoughts (misoldierthoughts.blogspot.com). "It feels so much better to know I am not alone."
Outcry. Many veterans say they would also find it therapeutic to hear Bush acknowledge PTSD and the psychological costs of the war instead of downplaying them. Earlier this year, for instance, the Institute of Medicine was asked by Congress to re-evaluate the diagnostic criteria for PTSD, which was established by the American Psychiatric Association in 1980. Critics claim the review was ordered by the Bush administration in an effort to make it harder to diagnose PTSD, which would in turn reduce the amount of disability payments. The number of veterans from all wars receiving disability payments for PTSD, about 216,000 last year, has grown seven times as fast as the number receiving benefits for disabilities in general, at a cost of $4.6 billion a year. And that figure does not include most of the more than 100,000 Iraq and Afghanistan veterans who have sought mental health services. The IOM report, released in June, supported the current criteria for diagnosing PTSD.
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