Whether viewed in person or on TV, it was a thrilling, unforgettable sight--the 116th Combat Brigade returning to Idaho after more than a year of service in war-torn Iraq. But with the flags, signs, crowds and cameras now cleared from the tarmacs, a sizeable number of returning soldiers face physical and mental health issues that may just now be surfacing.
According to a May 17, 2005, report by the Department of Veterans Affairs, almost 28 percent of combat veterans who have returned from operations Enduring Freedom and Iraqi Freedom (nearly 24,000 troops) have already been diagnosed with mental disorders, a number on par with the number diseases of the musculosketal/connective system (36.9), digestive system (28.3) and diseases of the sense organs and nervous system (25.1). Concerning the most common mental disorders among Iraqi and Afghan veterans, the report lists "adjustment reaction" first, followed by nondependent abuse of drugs, depressive disorders, neurotic disorders and affective psychoses.
A total of 1,389 of all returning vets have been categorized with alcohol dependence, and 601 with drug dependence problems since returning. The report notes that "a higher percentage of separated active duty troops (29 percent) have sought VA health care than separated Reservist/National Guard troops (20 percent)," although the statistical differences appear minimal. Yet these figures do not account for any possible overlaps between illnesses, and only represent those vets who have actually contacted the VA for treatment.
High on the list of disorders is Post-Traumatic Stress Disorder (PTSD), a complex condition with emotional and mental manifestations. In 1989, Congress established the National Center for Post-Traumatic Stress Disorder within the VA. According to its Web site, "People who suffer from PTSD often relive the experience through nightmares and flashbacks, have difficulty sleeping, and feel detached or estranged, and these symptoms can be severe enough and last long enough to significantly impair the person's daily life." Problems associated with the disorder include "impairment of the person's ability to function in social or family life, including occupational instability, marital problems and divorces, family discord, and difficulties in parenting." Against, symptoms of PTSD may not manifest for months or even years after exposure to combat.
Costs of treating PTSD are currently higher and rising faster than any other combat-related mental condition. A December 27 article by Shankar Vedantam in the Washington Post noted that in the past five years, "the number of veterans receiving compensation for the disorder commonly called PTSD has grown nearly seven times as fast as the number receiving benefits for disabilities in general," citing a recent report by the inspector general of the Department of Veterans Affairs. The article also reported that 215,871 veterans received benefit payments for PTSD last year, at a cost to the government of $4.3 billion, an increase of more than 150 percent from the 1999 levels of $1.7 billion. These numbers do not even include veterans who served in Afghanistan and Iraq.
David E. Autry, deputy national director of communications for Disabled American Veterans, tells BW he believes that although "9,688 vets have been provisionally diagnosed with PTSD, the numbers are masked. We're having real difficulty getting the Department of Veterans Affairs to pin down real PTSD numbers. There's a real reluctance to even admitting to this as a problem." Autry, a Vietnam veteran himself, also thinks that new Pentagon policies make readjustment to stateside life more difficult. "Nowadays we're in-country one day, and the next day we're home. It makes for culture shock, big time," he said. As opposed to Vietnam and Korea, "the military knew that decompression time was needed, but now they have gotten away from that. The Department of Defense knows they need to take another look at rapid reintegration."
Autry's views are seconded by Lt. Col. Art Moore, who serves as Joint Force Chaplain for the Idaho National Guard. While Moore says "there's not a lot of PTSD right now" among the returning troops, he adds, "It depends on how much (combat action) they've seen. The 116th and the 189th and some Marine reserves were hammered the hardest in combat, because they were the tip of the spear, but all of them will have readjustment issues." In such a potentially sensitive state, he says, personal circumstances also affect veterans' mental stability. "They may return and have divorce papers handed to them, there may be some significant events after they get home, like family members dying." He also anticipates that if plans move forward to move Idaho-based combat units to Oregon, it may also upset some vets.
From Moore's perspective as chaplain, age can also make a difference in the level of mental trauma from combat, especially given that National Guard soldiers tend to be older than their active duty counterparts. "The older ones adjust easier because they already have the skill sets to do that," he says. But he admits that even for older soldiers, "'Normal' is a big term, and they're facing a 'new normal' in terms of their relationship to the law, to their community and even to their faith."
As a chaplain, Moore says he gets called in "more for mediation than interdiction" when behavioral problems get out of hand. "It takes at least 90 days for returning troops to even reach an equilibrium. In 90 to 270 days after returning, we only catch the initial phrases of adjusting to the 'new normal.'" He says service members are often reluctant to ask for counseling or psychiatric help for fear that breaches of confidentiality could affect their service records. As such, he often has to assure vets that "short of the threat against a life or abuse," pastors and psychologists in Idaho are supposed to maintain the privacy of "privileged communication." But he cautions that "You have to be careful. For example, people talking to each other in a store, that may not be privileged. Each state has its own laws regarding privileged communication, so you better know what you're doing" when confiding in others.
Moore travels throughout the state giving advice to returning soldiers, their friends and families. He advises the public to help returning soldiers to reintegrate by "making sure to welcome the troops back, to honor their service, and to help them help themselves, sometimes by nudging them towards help." In military terms, "Be someone's battle buddy, someone's wing man. Tell them, 'welcome home, job well done, if you need help, get it, because it's out there. Take one day at a time.'"
For more information about PTSD, visit the National Center for Post-Tramautic Stress Disorder Web site at www.ncptsd.va.gov.