A Well of Courage

[Tom Odom]

Drew

I can only say that in the intel world, one never ever fessed up to such things lest you lose your clearance and thereby lost your career.

Best

Tom

[selil]

My mother in-law is one of the formost experts in PTSD for the VA (well was she is now retired). She used to work at the VA Hospital in Richmond VA. I have argued with her, pleaded with her, and finally cussed her out in front of my wife. She is sure that all soldiers are broken and we must be fixed. Not nearly house broken enough if we've ever worn a uniform we are surely the victims of violence. From her point of view of course it is valid as she only see's military members once they've had a substantial mental break. If the only sample you've see is 100 percent messed up then .... Still the negatives of trying to find help (other than the bottom of a bottle) are far outweighed by any treatment. And that REALLY sucks.

[Ken White]

not even Psy 101, I long ago decided that the ideal Soldier, Marine, Sailor or Airman -- anyone exposed to combat with a potential for blood to be seen -- is what I call a controlled sociopath. One who has strong sociopathic tendencies yet can control them to an extent in order to function moderately normally in society. This is the guy or gal who can scrape someone else's body parts off their face and keep going -- and not fall apart over it months or years later.

There have been a slew of studies, some using MRI and PET scans that show some people have an adverse reaction to violence and others can accept it with equanimity. We probably ought to screen for that in IET...

Lacking that we will continue to send people who have great difficulty coping with the trauma of combat to war and, given our increasing sensitization and softening as a society, garner more psychological problems in the future than we have done or than we now do. I think there's a cost effectiveness issue in there somewhere.

Not to mention a training, performance and capability issue or two...

[wm]

I think a valuable study would be to compare the "shock" associated mental issues among first responders (firefighters, police, ER level 1 trauma personnel, EMTs) with those of the military--both qunatiutavely and qualitatively--that is numbers/percentages/frequncy of folks exhibiting PTSD type symptoms as well as the severity and frequency of occurence of the debilitation caused by those symptoms. My armchair theorizing is that the reports on the two groups might be pretty comparable.

If first reponders have a lower incidence rate and/or do better coping, that might also be worth pursuing. We might discover coping mechanisms that would help veterans both before and after suffering the traumatic events that trigger the PTSD.

Such a study would require accurate data, which I am suspicious about finding. I suspect that the medical community might skew its reporting to look much better than it actually is. I would also not put it past the armed services to downplay their numbers while the VA could "cook" its position upward in order to justify bigger budgets.

[selil]

An interesting item I read a long time ago was that deputies have a lower incidence of chronic stress versus metropolitan police officers. Rural deputies patrol and see incidence of specific incidence violence much like a Marine patrolling off a firebase. Lots of tedium followed by moments of absolute panic (siege mentality?). Metropolitan police officers I'd theorize are more like COIN always in the face of the adversary hooking the bad guys up with one way trips and helping little old ladies out of jams. A more chronic stress I imagine.

[Rob Thornton]

Evening Wayne,

I think you've got a good idea about a place to start - but one thing I'd say to qualify it is that there may be some key differences. I'm thinking out loud here, but the unpredictable nature of sustained operations might make it more one where the the fire fighter awoke in his own house to find it on fire, then rescued his family, then put the fire out, then settled with the Insurance company and so on.

I don't mean to say that EMS and first responder trauma is not applicable - only that perhaps its a least a little different. I remember my Dad coped with the stress of being a Metro Cop by doing allot of hunting and fishing - it got him out in the woods. Over his 25 year career he did have some life troubles that you might could link to the job (a failed marriage for one), but its hard to say that wasn't just the result of getting married at 19. I think its the intensity and cumulative quality we have to be cognizant of.

We also need to consider scale - just the sheer numbers of men and women exposed to wartime conditions in places that even when somewhat stable are different enough from most of America to have you looking over your shoulder. I think when training is as it should be, and entry criteria are held high, we build the foundations for physical and moral strength to see most people through, but as war is sustained we fight the battle of exhaustion in many ways - while units and leaders are doing their very best to uphold standards, there is still a significant strain on the individual, their families, communities, maybe even the national psyche. One of the things that interests me is how cultural values change over a sustained war - one of the best accounts I've read is Thucydides - war, disease, poverty, famine, atrocity, etc. are accounted for.

I don't know for sure, but my gut tells me the VA is probably underfunded (under or inadequately resourced is probably a better way to say it) to deal with the long term human toll of treating the number of veterans we are going to account for in this long war. I think the Army is starting to get a handle on it - only because I know a few docs and nurses who say there is a big interest in it. I hope the politicians stay committed to veteran programs, like many things associated with war, I think consequences resemble the "iceberg" analogy. Just something we have to deal with, and something that should be considered when contemplating the use of military force to achieve a political end. We'll see these injured young men and women for the rest of our lives, I know for all of us here we hope that our government will sustain the best level of care for them possible long after the public gravity of their sacrifice is left to a wing at a museum, a monument on the mall, and reason to have a BBQ on a Monday.

Best, Rob

[wm]

We also need to consider scale - just the sheer numbers of men and women exposed to wartime conditions in places that even when somewhat stable are different enough from most of America to have you looking over your shoulder. I think when training is as it should be, and entry criteria are held high, we build the foundations for physical and moral strength to see most people through, but as war is sustained we fight the battle of exhaustion in many ways - while units and leaders are doing their very best to uphold standards, there is still a significant strain on the individual, their families, communities, maybe even the national psyche.

Rob, Slap, Ken--
Part of my reason for suggesting a look at the first responder community is the issue of scale and continuous contact with tragedy. I sometimes wonder how those folks can continue to go to work day after day, night after night, given the horrific stuff they deal with. I complete agree with folks' points about what I'll summarize as a "shattering of our sense of the normal." This "out of the normal" becomes the normal for those folks who routinely work trauma events. Ever notice how "warped" a sense of humor health care workers have?

Here's a couple of other semi-related items--not about PTSD issues, but about "Staying the Distance" and morale in trying circumstances:

A sidebar related to health care workers (credibility claim: my wife's a nurse): Acute care workers usually get to see their patients recover and go home. Long term care (nursing homes) workers aren't so lucky--their charges just get worse and worse intil the day they day. This is not a trauma issue, but a different form of job-related stress that may be the reason why we hear about the cases of elder abuse in nursing homes (relates to the lashing out against "civilians" done by troops in the COIN world).

And one other on customer service employees:
The turnover/churn rate in customer service related jobs (particulalrly call center folks) is probably one of the highest of any occupation. I think this has to do with the attitude displayed by those that call and complain--when your clientele doesn't value you, you tend not to value yourself and look for work elsewhere to boost your self esteem. Think about this in the context of folks at home judging the job being done by our deployed forces as a reason associated with our reported declining enlistment/re-enlistment/officer retention crises.

[Ken White]

...
. . .
Such a study would require accurate data, which I am suspicious about finding. I suspect that the medical community might skew its reporting to look much better than it actually is. I would also not put it past the armed services to downplay their numbers while the VA could "cook" its position upward in order to justify bigger budgets.

and so right, I'll bet...

[slapout9]

Believe it or not Traffic Accident Investigators often have problems not because of the danger they are in but from the never ending amount of blood and gore that they can see over a 20 year period.

[Rob Thornton]

Hey Slap,
We had some Washington State Troopers come in and do one of our quarterly safety briefs back in 2002 - they brought in some serious photos - it was very sobering. I think it goes beyond just the actual gore, often its the type of casualties. Seeing a child dead has a more emotional impact then seeing a grown man. I guess that could be because you reflect upon the own things you value most as a parent, and the the idea that those things could be torn away from you in that way is hard to swallow - it tends to stay with you longer.
Best, Rob

[Ken White]

Believe it or not Traffic Accident Investigators often have problems not because of the danger they are in but from the never ending amount of blood and gore that they can see over a 20 year period.

Seeing war casualties doesn't bother me. Guess it's a sort of "goes with the territory" syndrome. However, I can recall vivid details of two traffic accidents I saw up close. Maybe it's the incongruity; you expect people to be hurt and killed in war but a traffic accident in a peaceful area seems to be worse somehow.

[Tom Odom]

Believe it or not Traffic Accident Investigators often have problems not because of the danger they are in but from the never ending amount of blood and gore that they can see over a 20 year period.

Slap,

My post-Rwanda issues--severe depression which I came to call "the Beast"--all dealt with sense saturation with violent death on a scale that cannot be fully described. In contrast, when I had the opportunity to follow up on ops which resulted in lots of dead bad guys, I was quite happy. For me it was very much a case of who was getting killed, not that killing was happening.

Best

Tom

[Penta]

Drew

I can only say that in the intel world, one never ever fessed up to such things lest you lose your clearance and thereby lost your career.

Best

Tom

I pray that changes.

I'll be blunt: Hell yes, I've considered suicide. Been hospitalized for it. I was 15 at the time; teenage stuff plus disability stuff equals one screwed up mind.

I have depression. It helped make college hell for me, but though I will admit there are days it feels otherwise, generally speaking, I'm stable (I could never call myself normal), if vigilant. I take my meds religiously, see the usual professionals like clockwork.

But I'm open about all this. Nobody could ever coerce me with it - and my usual habit when I have depressive episodes is to shut up about anything and everything, not talk.

So why should my mental health issues, so long as they remain treated and stable, be any bar to a clearance? Something happens, I'd give up any clearance temporarily.

And moving aside from me...How the hell does that idea make any sense?

You say "You have a mental illness, you lose your clearance" is the worst idea. 1 in 5 Americans have depression. Shouldn't we be encouraging people to get help?

We don't pull clearances from alcoholics or those with drug problems instantly - we condition their clearance eligibility on getting help, I'm given to understand.

If you say "If you've had suicidal ideations or depression or any other mental illness, no clearance for you", what does that do except give people lots of motivation to leave their issues untreated, hide them from everyone (usually badly), and lie to you?

(Actually...Does anybody know the current policy? I remember hearing they were taking out the mental health questions to encourage people to get treatment, but then I never heard anything more about that.)

[wierdbeard]

My two cents worth or actually more of observations really, As Tom says you'll lose your career (apologies for paraphrasing), while in theater thay hound us to take meds or go to talk to someone because as they put it, we're outside the wire all the time and it has to be stressful, DUH! I had a pretty good idea of what to expect when i signed up, I felt that we were adequately trained to deal with whatever was thrown our way if I felt it were an issue I would go see someone. Upon return I was required to take a quiz based on time outside the wire, actions seen and levels of personal danger, based on the results I was told by the individual that administered it that I had PTSD and needed to go to counseling, not something that i felt was necessary nor warranted. While using the VA medical system for other reasons I continually heard from just about every doc that i should enroll in the PTSD study, after speaking to a VA case manager I was told that, (paraphrased) The VA has recieved a grant for the study of PTSD/MTBI, but in order to continue funding they have to have over 90% of returning vets enter into the program, whether or not they stay in the program was not of consequence. Personally I find that if the VA wants to study this and they have funds great! but not at the cost to my career. While we are being continually told that mental health issues are no longer the death knoll for Intel personnel, the reality is service members that do take part or admit to problems, find themselves in a not so favorable light. Regardless of what the rules say the mindset does not change overnight. Well i may have rambled on a bit there so I apologize now.