Win the Mind, Win the Day: Better Mental Health Care is Needed!

The murderous rampage of an Army office in Afghanistan highlights the dearth of necessary mental health treatment in our military.

In the third season of Star Trek: The Next Generation there is an episode called “The Hunted.” While it was not the best show they ever did (the fights in it are particularly cheesy), the plot is quite interesting. In the episode, chemically and genetically enhanced soldiers of an alien world live in exile from general society, because they are deemed too dangerous to live there in peace. Both their physical enhancements and their experiences in war make these soldiers unsafe. The citizens of the planet are scared so, rather than give them treatment and/or try to reverse their enhancements (because they might need them again for future wars), they vote to relocate the soldiers to a penal colony. Thus, these soldiers were created for war but, when they are no longer needed, they are forgotten.

“The Hunted” has been haunting me because I believe that we treat our soldiers here in the U.S. just as badly. One of the things that strikes me as similar relates to the knowledge of risks. In the episode, the soldiers are not told of the risks of the enhancements prior to receiving them. As such, they do not realize until too late that serving their country means that they can never go home again. They also weren’t told that their improved memory means that they will be able to remember the faces of every one of the people they killed. In short, they didn’t receive true informed consent, something that we in the healthcare profession tend to be adamant about. Unfortunately, I don’t think we give our military personnel true informed consent either. While most of them surely understand the general nature of what they will be trained to do, how many of them comprehend what combat service will mean for their psyches and for their future?

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Do we inform people of the damage that extended periods of deployment does to romantic relationships and family dynamics? Are they told about the difficulty of balancing long periods of boredom with times of intense fear? Do they understand how it feels to watch friends get injured and/or killed? Are they aware of the toll long periods of stress takes on physical and emotional health? Do they realize what depersonalization — the taking away of human characteristics from people deemed the enemy — does to someone? Do they receive training on PTSD (Post-Traumatic Stress Disorder) so that they know what it is, what symptoms to watch for and how to possibly avoid it? Are they told how the constant threat and/or presence of violence will change them?

No, of course they are not told these things, because if they were, very few would choose to participate willingly. Given that we currently have an all-volunteer service, our military would be forever changed if informed consent was required before people could join. That wouldn’t be a bad thing.

I am very aware that the military does much more than just engage in war. I have friends in Special Forces, on active duty and in the Reserve. I’ve taught and counseled many active duty personnel and veterans. I even served as a research analyst on a Presidential Commission looking at the role of women in the Armed Forces. So, I get that the military serves a vital purpose. I know that military personnel build things like roads and schools, help out after disasters, provide protection, train others and even serve as unofficial ambassadors to people in foreign places. I also know that many members of the military are intelligent, outstanding, noble, loyal and accomplished people who just want to help make the world a better place. We need to treat them better.

There are a lot of ways in which our society could assist our military personnel. We could increase funding for VA hospitals, improve pay and housing, help veterans find employment, and enhance support for military families. All of those things are both well-deserved and desperately needed, but what I want to discuss is helping our soldiers deal with all those risks they were never told to expect. Just like it was for the soldiers in “The Hunted,” the state of mental healthcare for our military personnel is pretty poor.

While there are many dedicated and talented mental healthcare professionals working diligently to help current and returning service members, there aren’t nearly enough. Moreover, the military culture is one that doesn’t generally encourage mental health treatment. Mental healthcare professionals are difficult to find (especially on the front lines where they’re the most needed), evaluations are rare even for those taking medication for mental health conditions, confidentiality is a big problem, and many military service members are not educated on the need for and effectiveness of mental health treatment. Quite a number of active duty personnel develop PTSD while serving, yet are sent back to the war zone instead of receiving help, even though it is well known that this exacerbates the problem. According to media reports, this is what happened to Staff Sergeant Robert Bales who is accused of the slaughter of 16 Afghani civilians. From what I have read, of the 13 symptoms that have been shown to exacerbate PTSD, SSG Bales met at least six of them.

Given all of this, it appears that the military doesn’t see mental health as a priority for its members. I find this very puzzling as the research is pretty clear on both the problems and the solutions for mental health issues. Moreover, when we choose to ignore these issues instead of confronting them, we get what we’ve already seen: in addition to the high rate of divorce in military families, an increase in domestic violence, and a rise in mental health issues, we inevitably see some military personnel turning violent, either toward themselves or others. The suicide rate is unacceptably high (in 2005, these deaths accounted for nearly one in five of all Army non-combat deaths) and then there are those who turn the violence elsewhere. Some of the more high-profile cases involve the four separate wife-killings at Fort Bragg in 2002; the killing of his wife and baby daughter by Kip Lynch in 2010; the 17 soldiers from a Colorado military base, who have been linked to killings and attempted killings since their return to the United States; and, of course, the most recent murderous rampage by SSG Bales. (For more information about PTSD in the military, see the U.S. Department of Veterans Affairs’ National Center for PTSD.)

In “The Hunted,” the soldiers force the issue by staging a coup, and demanding to receive treatment and return to their homes. As we do not live in a television show, I doubt that a small coup by a handful of veterans will be the solution to our problems. However, we really cannot and should not ignore the lack of mental health treatment for the military any longer. Our military personnel, the very people who defend our liberty and allow us to live in freedom, are suffering and we can do something about it. We have the knowledge and the means, we just need the will. How many more lives have to be ruined before we find it?

• abuse and trauma
• ethics
• public health
• society
• violence