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Fort Hood: Abnormal Minds in Normal Times, or Normal Minds in Abnormal Times

Posted on | April 4, 2014 | 2 Comments

Mike Magee

When Spc. Ivan Lopez, a soldier at Fort Hood, Texas opened fire on his fellow soldiers, killing three this week, he once again focused a light on the chronic, lasting and largely hidden burden of war – mental illness in soldiers who serve our country. But what escaped notice in the broad coverage of the event was our limited understanding of the root causes and  the long term potential impact on those professionals charged with caring for these mentally wounded veterans over the many years ahead.

More on that in a moment. But here are a few facts. The VA estimates that nearly 1000 veterans a week are receiving a diagnosis of post-traumatic stress disorder. Add to that an additional 800 who are tagged for depression. That adds up to about 100,000 a year for just those two diagnoses. And that only includes soldiers who actually come forward.

Of the 155,000 that the Pentagon currently agrees have PTSD, about 3/4 were in combat. That means 1/4 were not. This is not a new revelation. We learned from our experience in World War II that a fairly large percentage of soldiers who received discharges for “battle fatigue” were not actually in battle. Rather a combination of loneliness, deprivation, change and occasional hostility in an environment not fully under the individual’s control was enough to trip mental illness.

Currently, veterans age 18 to 24 are committing suicide at a rate 4 times that of non-veterans of the same age. That amounts to 80 deaths in every 100,000 veterans  per year. The VA has attempted to respond. Over the past 4 years they have increased the number of therapists by nearly 50% to just under 10,000. These therapists and the IOM have taken a critical look at a wide range of instigators including behavioral modifiers in the field or in training, drug and alcohol abuse, and a range of injuries including traumatic brain injury.

The problem has been building. Since the beginning of the wars in Iraq and Afganistan, nearly a million soldiers have reported in with mental health issues. And in spite of the attention and resources thrown at the issue, our understandings of the various complex factors that cause an active soldier or veteran to descend into despair remains remarkably obscure.

This combination of high disease burden in those who have honorably chosen to put themselves at risk for our security combined with a rather remarkable inability to make them all reliably well again has created an auxiliary disease burden that doesn’t receive much publicity.

Back in 2007, I wrote about the toll on health professionals with direct responsibility for veterans with mental illness. In the week of March 19th, seven years ago, both Newsweek and the Wall Street Journal had drawn attention to some disturbing facts -that high or very high degrees of burnout were found in 45% of doctors and nurses, 33% of psychiatrists and counselors, and 27% of chaplains caring for these patients. The message was clear even then – our military caregivers were struggling.

Matt Friedman of the VA’s National Center for PTSD acknowledged as much at the time when he said, “If the therapist finds they cannot listen to another awful war story or that they can’t shut down once they’re at home with their kids, that should be a warning sign.” Chad Peterson of the San Francisco VA Medical Center added,  “I’ll hear about the things they’ve seen or done, the close calls, and my pulse quickens. I’ll get agitated or feel hopeless, because I can’t take this person’s pain away.”

During World War II, William Menninger and his colleagues attempted to better understand what was really happening. During the war, one study commented that, “it would seem to be a more rational question to ask why the soldier does not succumb to anxiety, rather than why he does.”(1)  This observation was reinforced in an article in the American Journal of Psychiatry in 1944 which reflected on the need “to shift attention from problems of the abnormal mind in normal times to problems of the normal mind in abnormal times”.(2)

That last comment deserves some modern reflection.

For Health Commentary, I’m Mike Magee

References:

1. Grinker Roy R. and John P. Spiegel, War Neurosis in North Africa: The Tunisian Campaign, January–May 1943 (Washington, DC: Josiah Macy Foundation, 1943). This manual was later printed, with a number of changes, as Grinker and Spiegel, War Neurosis.

2. Farrell Malcolm J and John W. Appel, “Current Trends in Military Neuropsychiatry,” American Journal of Psychiatry 101, no. 1 (1944): 19.

Comments

2 Responses to “Fort Hood: Abnormal Minds in Normal Times, or Normal Minds in Abnormal Times”

  1. rita
    April 4th, 2014 @ 12:11 pm

    These are things these men need to bring out in the open and discuss, possibly between peers, and even cry about it if needed. too many do not want to talk about what they have seen and done in those abnormal times. And they should be encouraged to leave the burden to God, yes, to Jesus who carried all this on His shoulder on Calvary. We are sick ourselves, live in a sick world, with sick ideas because we have all gone astray, and we all deserve the death punishment. But He has understood us and has procured our pardon. May Easter celebration bring some healing to our souls knowing we may not be able to forgive, and forget, but what really counts is that God has forgiven and forgotten and we can go on to a newness of life, a little wiser perhaps, and more inclined to understand and support rather than criticize and condemn.

  2. Mike Magee
    April 5th, 2014 @ 8:23 am

    Thanks for your thoughtful comment, Rita.

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