Waging the Postwar Battle for Mental Health

Photo by Patrick Ladapo Joseph Ladapo

Our sustained military campaigns in Iraq and Afghanistan have caused repercussions extending well beyond matters of international politics and national security. From a medical perspective, military-related mental health problems are receiving increasing attention from policymakers and health care workers. It is clear that as our soldiers return from overseas, the war against posttraumatic stress disorder (PTSD), major depression, and other mental health problems will be waged within our borders.

The consequences of service-related mental health problems are serious: soldiers experiencing PTSD suffer from flashbacks, difficulty sleeping, and anxiety attacks; major depression and other mental conditions can be crippling. Taken together, these illnesses amplify the challenges associated with returning to former lives, former jobs, and former roles as fathers and husbands and as mothers and wives.

The Impact of Iraq
A recent study published in the March issue of The Journal of the American Medical Association provides some insight into the magnitude of the problem. Using survey results from more than 300,000 American soldiers returning from Iraq, Afghanistan, and other countries, Dr. Charles Hoge, a physician at the Walter Reed Army Institute of Research, and his colleagues found that PTSD, major depression, and other major mental health problems afflicted an astonishing one in five soldiers returning from Iraq. In contrast, about one in 10 soldiers returning from Afghanistan and one in 12 returning from other locations were similarly affected. (A government study released this month found that one in 20 veterans returning from Iraq and Afghanistan appeared to be at risk for PTSD, and of those, about 22 percent were referred for care.)

Fortunately, the Department of Defense and the Department of Veterans Affairs have stepped up efforts to manage the challenge. Their initiatives include both a requirement that every service member be briefed on mental health issues before and after their tours of duty and the establishment of a record number of clinical treatment programs, including teams specializing in PTSD and some programs that specifically target the health of female veterans.

Locally, the VA Boston Healthcare System treats 3,500 male and female veterans a year for military-related mental health problems. According to Dr. Terence Keane, the VA Boston’s associate chief of staff for research and development and an HMS lecturer on psychiatry, the system provides the latest in “diagnostics and assessment as well as individual and group therapies.” He said that the VA is “committed to providing the necessary resources for addressing the psychological casualties” of war, and VA’s research into PTSD assists soldiers in their “recovery and readjustment to civilian life.”

Therapy at War
The initiatives of the Defense Department and the VA are not confined to U.S. borders, however. Mental health care begins in the theater of war, said Colonel John Looper, HMS instructor in psychiatry.

An Army reservist and psychiatrist at McLean Hospital, Colonel Looper is a member of the 883rd Medical Company, a team that served in Iraq in 2003 and returned in October 2005 for a second tour. His team specializes in combat stress control and counsels soldiers whose function has been hampered by severe stress reactions.

Much of their work involves training commanders on how to keep a watchful eye on the health of their soldiers and to catch early warning signs. According to Colonel Looper, their mission is to make these leaders “more broadly psychologically informed … so that they’re doing everything they can to support the troops under them.”

With its placement in the field, the team has become integral to the treatment of soldiers’ postdeployment mental health problems. Colonel Looper believes that by initiating interventions in the war zone, his team helps to “minimize the amount of long-term psychological dysfunction” and to prevent acute stress reactions from becoming full-blown PTSD.

The mental health challenges we face as a nation because of the military campaigns in Iraq and Afghanistan are serious, but still surmountable. With hundreds of thousands of U.S. troops serving overseas, PTSD, major depression, and anxiety are disorders that today’s physicians will likely encounter and treat more frequently and more effectively than many of their predecessors did. Addressing the policy perspective, we, as doctors, should ensure that the Department of Defense and the VA maintain their commitment to assisting soldiers as they readjust to civilian life. Taking a professional and personal perspective, we should maintain our awareness of the issues these soldiers are facing to help them smooth their critical transitions.

—Joseph Ladapo is a Harvard medical student
and a PhD student in health policy.

The opinions expressed in this column are not necessarily those of Harvard Medical School, its affiliated institutions, or Harvard University.

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