Colonel Terry Walters, a doctor and commander of the Wounded Warrior program at one of the largest U.S. military bases, recently sent a message to her bosses at the Army medical command. "We're going to be short of psychiatrists. But we need even more than our normal complement of psychiatrists to deal with this surge of need," she says.
Colonel Walters' "surge of need" at Fort Bragg, North Carolina is coming because of the end of the surge in Iraq, as thousands of troops deployed to support the new counterinsurgency strategy last year return to their home base.
"One of the lessons we've learned from Iraq is that there are no front lines, that everybody is exposed to stress. What we're doing is we're sending perfectly normal individuals into combat, which is, by definition, an abnormal situation," says Walters, adding that the Army is sending her some extra psychiatrists and psychologists, but sometimes it is difficult to get soldiers to admit they need counseling.
"There is a belief out there in our society and especially in the military that, 'Oh, just pull yourself together, pull your socks up, and rock on [i.e., get on with your life].' I think there are significant numbers of soldiers who are not seeking care because of this perceived stigma, which we're trying to do a lot to combat," says Walters.
U.S. Defense Secretary Robert Gates is among those trying to spread the word. "You're tough and you go into the hospital when you receive a physical wound," says Gates. "That doesn't mean you're weak in some way. And so why wouldn't you when you've received a psychological wound? It's the same difference. They're all wounded."
Secretary Gates has described a proposal to award Purple Heart medals to troops diagnosed with Post-Traumatic Stress Disorder, or PTSD, as "an interesting idea". A Pentagon committee has rejected that proposal in the past, but it is taking another look at the issue. The Purple Heart is awarded to troops wounded in combat, and several senior officers have been quoted as opposing the expansion of the criteria to include PTSD.
But the Pentagon is fighting the idea that psychological wounds are less significant than physical ones. It has established a Center of Excellence to spread understanding of the impact of combat stress and information on what commanders and doctors can do to help.
"We work very hard to help our leaders as well as our service members understand that treatment really works, and it's a sign of strength," says Colonel Loree Sutton, the Director of the Center of Excellence. "Part of our challenge is to help families, help individuals, warriors, help communities understand what are the normal, what are the normal reactions, the human responses to stress. If we don't understand what's happening, it's scary. You know, the flashbacks, perhaps the nightmares, the jumpiness," says Sutton. "And so what we have to communicate to folks is to help them understand these are normal signs of healing from trauma. No, you're not going crazy."
The experts also want the troops to understand that post-traumatic stress is not necessarily Post-Traumatic Stress Disorder. They say it is only a "disorder" if symptoms persist after treatment, and it is only a disability if it prevents the sufferer from returning to work or resuming other aspects of their lives.
But the Defense Department has come under criticism for not providing enough high-quality treatment to the troops who need it. A recent study by the RAND Corporation says that 300-thousand of the one-and-a-half million U.S. troops who have served in Iraq or Afghanistan have symptoms of Post-Traumatic Stress Disorder or major depression. The study also says that only about half of the Iraq and Afghanistan war veterans who have PTSD symptoms, depression or traumatic brain injury have sought treatment, and that only half of those veterans received adequate treatment.
Terri Tanielian, the co-leader of the study says, "Service members will report a number of barriers to getting care. We found that of the top five barriers, three of those were associated with concerns about the career repercussions of seeking mental health care."