Eric-
This development hopefully means a start to changing attitudes in the military. If over 20% of Iraq and Afghanistan exhibit treatment for PTSD or depression, and only half even seek treatment. The culture in the military is very much a suck it up and tough it out culture.
Over 60% in the Rand study said that even SEEKING OUT help for mental problems would adversely effect their military career. 53% thought others would think less of them!
The stigma problem has dogged mental health care for centuries and it will take an enlightened bunch of leaders to help alleviate it.
As someone who has dealt with depression in my own life, toughing it out only works so far and it deprives the soul of much deserved happiness. I cannot even imagine what some of these brave soldiers have seen and heard, and I pray that they get the help that they need to truly deal with it.

I agree, Dude. From what I’ve read, the stigma problem is one of several major barriers to addressing the problem. It was mentioned repeatedly in the Senate committee hearing last week.

How deeply ingrained is it? When NPR returned to Fort Carson in May 2007, five months after its initial investigative reports — and after the involvement of the U.S. Senate, the DoD Task Force on Mental Health and condemnation by the top military and civilian leadership — here’s one thing it found:

The post’s chief psychiatrist had a memo posted to his bulletin board. It essentially advised officers that they can’t “fix” very soldier who’s broken — i.e., who has mental illness — so it’s better for the Army to get them out of the service as quickly as possible. Here’s a link to a page where you can click to the audio:

http://www.npr.org/templates/story/story.php?storyId=10395101

Finally, the military has known for a very long time what combat does — to varying degrees from individual to individual and from specific experience to specific experience — to the human psyche. I’m reading “An Army at Dawn,” Rick Atkinson’s Pulitzer-Prize-winning history of the North Africa campaign in WWII, in which my late father served, and he includes significant discussion of the mental effects of combat — as noted by Army psychiatrists at the time.

Eric- Good book. Just finished it myself. Atkinson’s second book of the trilogy is out now also.

Yeah, it’s exceptional. I’m nearly done, but I think I’ll need to take a break before taking on the Sicily/Italy volume.

I also want to dig out my dad’s wartime letters to his parents (my grandparents) and to a girlfriend and try to match the dates to some of the operations described by Atkinson.

No doubt that “war is hell” and that some soldiers return with PTSD. I have the highest regard for these men and women, and want to see them treated right.

I wouldn’t hazard a guess as to what percentage of them have mental problems as the result of war, but the “over 20%” estimate sounds way over the mark. At age 73, I have known my share of veterans, and only once was aware of one with a problem. He had been a young medical orderly in a field hospital in Korea, and probably “saw too much”. He now lives a normal life.

Depression leading to suicide occurs frequently in civilian life, often involving persons with no military background whatever. I have known a number of them. Probably many of us have. I have also known Auschwitz and Dachau survivors with no evident mental problems.

One difficult part of this for medical practitioners is determining AND BEING ALLOWED TO STATE who is really affected, who is looking for extra attention and benefits, and who thinks he/she ought to be treated “just to be sure”.

We all remember (those of us who are willing to admit it) the furor over asbestosis. It was a terrible desease. Entire corporations, beginning with Johns-Manville and also affecting a firm that I worked for and invested in, were driven into bankruptcy over asbestos. Anyone who could spell “asbestos” was a plaintiff in a class action suit. Nearly all were found to be suffering, if at all, from cigarette smoke, not asbestos, but they collected anyway. It was virtually unheard of for a non-smoker to have an asbestos problem.

Some problems even result from extenal factors like bargaining unit agenda. I once walked into a new assignment in a small UAW plant and found every production employee wearing not one but two carpal tunnel cuffs, which of course they had all demanded.. Nobody was injured; it was just the order of the day in seeking softer jobs.

Unfortunately many alleged medical problems like back strain, carpal tunnel syndrome and PTSD are tough to diagnose accurately, so many more people claim them than actually suffer from them.

My dad was in WWII and a POW, and he had to be treated for depression after the war. He never talked about it much with me, but I don’t think that the treatments then were near as good as they are now. The frustrating things is that now we could help so many of these young men and women today if they just felt comfortable coming forward and seeking help.

I understand the impulse to doubt, Bob.

Still, I think it’s our obligation to give active-duty military people and veterans the benefit of the doubt until proved otherwise:

1. As “Dude” noted above, there is a negative stigma, especially within the military, to having mental illness. That tends to REDUCE the number of people willing to admit they need help, not inflate the numbers.

2. We KNOW that the experience of combat is traumatic, psychologically as well as physically. So the idea that someone who has been serving in combat conditions might be having mental problems is not just plausible; it’s probable. That doesn’t mean they’re suffering to the point of being disabled by it; as some of the things you mention indicate, everybody’s different, so there’s always a range of reactions to the horrific experiences they encounter.

3. These are people who have put themselves in mortal danger in the name of the people of the United States — us. Whether we think that it’s important for them to be there or think that they shouldn’t be there and should come home as soon as possible, we need to listen to them, watch for indications of problems they might be afraid to admit openly, believe them if they ask for help and make sure they get it.

Dear Mr. Mink: I believe that I have both the experience and judgement to seriously doubt the “over 20%” figure given above, for some of the reasons that I offered above, and much more that I don’t care to go into. My “doubt” is not an impulse. It is a serious belief based on life experience.

I do agree generally but not entirely with your thoughts, and refer you back to the first sentence of my initial comment.

People certainly do react differently to trauma and hazard, actual or perceived. A worthwhile read on the subject is “Hazardous Duty, an American Soldier in the Twentieth Century” by Major General John K. Singlaub (OSS in WW2, SOG in Vietnam, as well as hazardous and usually covert duty in Korea, Manchuria, and Nicaragua). You can order it at the county library, but they only have one copy and I haven’t finished with it. It does show that people can, with the right attitude, come through not one hell but half a dozen.

My apologies, Bob. I certainly didn’t intend to imply that you advocated denying care to anyone who truly needs it.

The rates of PTSD and other mental problems in the reports to which I’ve referred are not drawn from individual observation or anecdotal accounts but from studies that at least attempt to apply a degree of rigorous inquiry to quantify things with some specificity. A couple of things that might be interesting:

This summary release on the latest RAND study sets forth the methodology they used to arrive at the 20-percent estimate:
http://rand.org/news/press/2008/04/17/

This piece from Foreign Policy in Focus from about a year ago offers a decent summary of various findings, including reports by the DoD and VA. It also offers some interesting possible explanations, if rates for Iraq/Afghanistan troops/vets are higher than expected, as to why that might be the case.

http://www.fpif.org/fpiftxt/4056

Finally, here’s a sidebar to a 2005 story in the San Francisco Chronicle that reviews sources of data on the issue stretching back to WWII.

http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2005/06/22/MNGJ7DCKR71.DTL&type=health

I have also seen the 15-20% figure for “combat fatigue” for the North African campaign. The preferred treatment being the infamous “blue 88s” which essentially knocked you out for 24 hrs. and they sent them back to the front…unless you were an officer of course, in which case the treatment was a bit more enjoyable. Hopefully, we’ve come a long way since then.