Treating War's Toll on the Mind
Thousands of soldiers have post-traumatic stress disorder. Will they get the help they need?
The problem is as old as war itself. But this time, American soldiers have been assured by the government and the military that the solution will be different: Iraq will be nothing like Vietnam, with its legacy of psychologically scarred veterans whose problems went unrecognized, undiagnosed, and untreated. "The hallmark of this war is going to be psychological injury," says Stephen Robinson, a Gulf War vet and director of government relations for Veterans for America in Washington, D.C. "We have learned the lessons of Vietnam, but now they have to be implemented."
Since the war began, the departments of Defense and Veterans Affairs have stepped up efforts to address the mental health needs of soldiers before, during, and after they are deployed. And more effective treatments for PTSD have been developed. But as the war drags on, the psychological costs are mounting and so is the tab for mental health care. Troop shortages are driving already traumatized soldiers back into combat for three and sometimes four tours of duty. Those who make it home often feel too stigmatized to ask for treatment lest they jeopardize their military careers. And if they do ask, they often can't get the care they need when they need it.
In addition, there are concerns among veterans groups that the Bush administration is trying to reduce the runaway cost of the war by holding down the number of PTSD cases diagnosed (and benefits paid), and that the promise to protect the mental health of nearly 1.5 million troops is not being kept. "Throughout this war, everything has been underestimated-the insurgency, the body armor, the cost, and the number of troops," says Paul Rieckhoff, an Iraq war vet and founder of Iraq and Afghanistan Veterans of America in New York. "Now, the psychological problems and the needs of these soldiers are being underestimated, too."
Just how many troops will bring the war home with them is impossible to know at this point. But the numbers could be substantial. In a study published in 2004 in the New England Journal of Medicine, researchers at the Walter Reed Army Institute of Research found that nearly 17 percent of soldiers who have returned from Iraq, or nearly 1 in 6, showed signs of major depression, generalized anxiety, or PTSD. A report in the Journal of the American Medical Association earlier this year found that 1 in 5 soldiers met the risk for concern. And those numbers are virtually certain to grow as the war enters its fourth year. "I do think we're going to see a whole lot more PTSD as time goes on," says Platoni.
The VA, short of doctors, therapists, and staff in some areas, is straining to meet the mental health needs of the troops who have already returned from Iraq and Afghanistan. Soldiers often wait weeks or even months to see a psychiatrist or psychologist. A 2004 study by the Government Accountability Office found that six of the seven VA medical facilities it visited "may not be able to meet" increased demand for PTSD. "I don't think anybody can say with certainty whether we are prepared to meet the problem because we don't know what the scope is yet," says Matthew Friedman, a psychiatrist and executive director of the VA's National Center for PTSD in White River Junction, Vt. "What we do know is that the greater the exposure to trauma, the greater the chance that someone will have PTSD."
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