PTSD: The Invisible Wounds of Our Returning Veterans

On February 2, 2013, Chris Kyle and an associate were shot dead by former US Marine Eddie Ray Routh at a gun range in Central Texas. Kyle, a former Navy Seal famous for being the deadliest American sniper was allegedly at the gun range to help Routh with his post-traumatic stress disorder (PTSD) [1]. A few days later, the news media was in an uproar over a tweet posted by three-time Republican presidential candidate, medical doctor and US veteran Ron Paul regarding the death of Kyle: “…Treating PTSD at a firing range doesn’t make sense [2].” Along with questions of the appropriateness and efficacy of treating PTSD this way, this story highlights the low quality of the national discourse on the mental health of our soldiers returning home from war and the dangers that come with it.

President Obama in his 2013 State of the Union Address announced the return of half of the American soldiers currently deployed in Afghanistan. With the war in Iraq already at an end, the country is expected to receive thousands of military personnel, most of whom have been actively involved in combat.  The difficulties these veterans of war will face in their effort to reintegrate themselves into civilian life are varied and most notably include post-traumatic stress disorder. Unfortunately for these veterans, the negative stigma attached to PTSD by the American public means that, more often than not, soldiers who have been most severely traumatized will be returning from one battlefield to another

A recent report released by the Veterans’ Affairs (VA) office shows that in 2010, 22 veterans committed suicide each day in the US [3]; an alarming statistic which highlights the fact that a growing number of veterans suffering mental health disorders such as PTSD are not getting the required help they need. Around 14% of veterans are reported to suffer from PTSD [4], but many more mental health disorders among veterans likely go undetected [5] and presumably unreported. It comes as little surprise then that only few of them get the requisite treatments since no soldier wants to be perceived as “crazy” or “dangerous” by his friends and neighbors.

PTSD is listed as a mental disorder in the Diagnostic and Statistical Manual of Mental Disorders by the American Psychiatric Association with symptoms ranging from withdrawal, flashback of traumatic events and hyperarousal [6]. The VA office states that “the majority of individuals with PTSD have no history of aggression, violence, or criminal behavior, although irritability and anger are symptoms. Among individuals who do, minor aggression is more common than severe violence, and episodes of extreme violence are rare [6].”

A recent spate of murders that have received national attention shines a spotlight on violence committed by people with mental disorders trained in firing guns; a profile that easily fits veterans with PTSD. James Holmes opened fire on unsuspecting moviegoers in Aurora, Colorado killing 12 people and injuring 58 others. His lawyers declared him to be mentally ill. A couple of weeks later, a US army veteran Wade Michael Page, went on a shooting spree at a Sikh temple that left 6 people dead and 4 wounded. Most recently, Adam Lanza shot and killed 26 people at Sandy Hook Elementary school. Adam had been diagnosed with sensory integration disorder (SID) as a child and his mother had taught him how to shoot at gun ranges. The tragedy is that the national debate arising from this unfortunate series of events has been focused more on gun control and less on the treatment of mental health disorders.

There is also the risk that public perception of people suffering from PTSD, especially veterans, could change for the worse due to these killings. This has forced experts on PTSD and even veterans suffering from it to rush out to speak on the issue hoping to dispel any misconceptions about the disorder. An open letter to America posted on the Wounded Warrior Project website by Ryan Kules, a veteran who also suffers from PTSD, admonishes the public not to view veterans battling with PTSD as crazy but as survivors of war trying to reintegrate themselves back into society [7].

“Public concern about the mental health problems of soldiers has prompted political action, with President Barack Obama announcing a plan to increase the ease with which veterans diagnosed with post-traumatic stress disorder can receive federal health benefits [8].” This and other similar actions such as efforts by the VA to increase the number of veterans they treat are admirable but fall short of addressing the critical issue of public perception. While there has been a steady increase in the number of veterans seeking mental health care in recent years, there are still many more who are not getting the care they need. At a recent symposium in Washington, DC to discuss the struggles of the Department of Veterans’ Affairs, Rep. Jeff Miller, the chair of the House Veterans Affairs Committee, rightly stated that “The true measure of success with respect to mental health care is not how many people are hired but how many people are helped [9].” Hiring more workers and providing more money serves no purpose if veterans suffering from mental health disorders do not show up for treatment.

The reluctance to seek help by veterans suffering from PTSD is closely tied with how the public views people with mental health disorders and this is where most of the efforts should be focused. Instead of maintaining the status quo, what recent events show us is the need to open up a public discussion on mental health in order to destigmatize mental health disorders and help get the necessary treatment to those in need of care, especially our veterans of war.

References
1. Botelho, Greg and Josh Levs. 2013. “Ex-Navy sniper, another military vet killed at Texas gun range.” CNN, February 4. Accessed February 7, 2013. http://www.cnn.com/2013/02/03/justice/texas-sniper-killed/index.html
2. Weber, Peter. 2013. “Ron Paul’s puzzling critique of murdered SEAL Chris Kyle.” The Week, February 5. Accessed February 7, 2013. http://theweek.com/article/index/239674/ron-pauls-puzzling-critique-of-murdered-seal-chris-kyle
3. Veterans Affairs. 2013. “Suicide Data Report, 2012.” Accessed February 7. http://www.va.gov/opa/docs/Suicide-Data-Report-2012-final.pdf
4. Schnurr, Paula P; Lunney, Carole A; Bovin, Michelle J. and Brian P Marx. 2009. “Posttraumatic stress disorder and quality of life: Extension of findings to veterans of the wars in Iraq and Afghanistan.” Clinical Psychology Review 29:727–735. Accessed February 7, 2013. doi:10.1016/j.cpr.2009.08.006
5. Boyd, Mary Ann; Bradshaw, Wanda and Marceline Robinson. 2013. “Mental Health Issues of Women Deployed to Iraq and Afghanistan.” Archives of Psychiatric Nursing 27:10–22. Accessed February 7, 2013. doi: 10.1016/j.apnu.2012.10.005
6. Express-News Editorial Board. 2013. “PTSD victims aren’t ticking time bombs.” MySanAntonio, February 14. Accessed February 28, 2013. http://www.mysanantonio.com/opinion/editorials/article/PTSD-victims-aren-t-ticking-time-bombs-4279878.php
7. Wounded Warrior Project. 2013. “A Letter to America on Behalf of This Generation’s Wounded Warriors.” Accessed February 7. http://www.woundedwarriorproject.org/media-room/a-letter-to-america-on-behalf-of-this-generation’s-wounded-warriors.aspx
8. Cesura, Resul; Sabiab, Joseph J. and Tekinc, Erdal. 2013. “The psychological costs of war: Military combat and mental health.” Journal of Health Economics 32:51– 6. Accessed February 7, 2013. http://dx.doi.org/10.1016/j.jhealeco.2012.09.001
9. Leo Shane III. 2013. “VA questioned on mental health care progress despite hiring, funding.” Stars and Stripes, February 13. Accessed February 28, 2013.  http://www.stripes.com/news/veterans/va-questioned-on-mental-health-care-progress-despite-hiring-funding-1.207815
10. Image credit (Creative Commons): Truthout.org. 2010. “The Intensity of PTSD.” Flickr, June 2010. http://www.flickr.com/photos/truthout/4688523825/sizes/l/in/photostream/

Emmanuel Aryee is a recent graduate of the University of Chicago with a major in Biology and a specialization in Cell and Molecular Biology.

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