This note comes from one of our readers - he's a leader of men and veteran of deployments with the Australian Army in Iraq and Afghanistan. It's hard to believe that the scuba-diver Dr Robyn Walker belongs to the same organisation.
Thanks for your interest in the appalling ignorance of RADM Walker when it comes to PTSD. Clearly she has never been to war. She has obviously never seen the anguish of so many people involved in dealing with a fatal battle casualty. It’s not just the soldiers on the ground who are part of the team, although of course they are the most immediately and heavily impacted.
There are the stores personnel cleaning bits of body of the controlled items that have to be accounted for – weapons, body armour, night vision etc. The clerks who send out the fatalcas message. Those watching the scene from the UAV footage – totally unable to help. The military police who secure the body, the padre and the Commanding Officer and Regimental Sergeant Major who positively ID the body. Then there are the troops on the ground who have to keep on going and their leaders who have to keep them disciplined and focused on the task at hand.
I would have thought that the Surgeon General of the ADF would be well aware of the incredible work done by the RAND Corporation on ‘invisible wounds’.
Their landmark study – “Invisible Wounds of War” won two major awards for research excellence in the USA:
2008 PROSE Award — Clinical Medicine The American Publishers Award for Professional and Scholarly Excellence
WINNER — 2011 HSR Impact Awardee The Academy Health Board of Directors Health Services Research (HSR) Impact Award
This is on the RAND corps website (my boldings):
Early evidence suggests that the psychological toll of these deployments — many involving prolonged exposure to combat-related stress over multiple rotations — may be disproportionately high compared with the physical injuries of combat. In the face of mounting public concern over post-deployment health care issues confronting OEF/OIF veterans, several task forces, independent review groups, and a Presidential Commission have been convened to examine the care of the war wounded and make recommendations. Concerns have been most recently centered on two combat-related injuries in particular: post-traumatic stress disorder and traumatic brain injury. With the increasing incidence of suicide and suicide attempts among returning veterans, concern about depression is also on the rise.
The study discussed in this monograph focuses on post-traumatic stress disorder, major depression, and traumatic brain injury, not only because of current high-level policy interest but also because, unlike the physical wounds of war, these conditions are often invisible to the eye, remaining invisible to other servicemembers, family members, and society in general. All three conditions affect mood, thoughts, and behavior; yet these wounds often go unrecognized and unacknowledged. The effect of traumatic brain injury is still poorly understood, leaving a large gap in knowledge related to how extensive the problem is or how to address it.
This monograph presents the results of our study, which should be of interest to mental health treatment providers; health policymakers, particularly those charged with caring for our nation’s veterans; and U.S. service men and women, their families, and the concerned public. All the research products from this study are available at http://veterans.rand.org.
Data collection for this study began in April 2007 and concluded in January 2008. Specific activities included a critical review of the extant literature on the prevalence of post-traumatic stress disorder, major depression, and traumatic brain injury and their short- and long-term consequences; a population-based survey of service members and veterans who served in Afghanistan or Iraq to assess health status and symptoms, as well as utilization of and barriers to care; a review of existing programs to treat service members and veterans with the three conditions; focus groups with military service members and their spouses; and the development of a microsimulation model to forecast the economic costs of these conditions over time.
Among our recommendations is that effective treatments documented in the scientific literature — evidence-based care — are available for PTSD and major depression. Delivery of such care to all veterans with PTSD or major depression would pay for itself within two years, or even save money, by improving productivity and reducing medical and mortality costs. Such care may also be a cost-effective way to retain a ready and healthy military force for the future. However, to ensure that this care is delivered requires system-level changes across the Department of Defense, the Department of Veterans Affairs, and the U.S. health care system.
In a press release the Invisible Wounds research team had this to say about PTSD:
Service members reported exposure to a wide range of traumatic events while deployed, with half saying they had a friend who was seriously wounded or killed, 45 percent reporting they saw dead or seriously injured non-combatants, and over 10 percent saying they were injured themselves and required hospitalization.
Rates of PTSD and major depression were highest among Army soldiers and Marines, and among service members who were no longer on active duty (people in the reserves and those who had been discharged or retired from the military). Women, Hispanics and enlisted personnel all were more likely to report symptoms of PTSD and major depressions, but the single best predictor of PTSD and depression was exposure to combat trauma while deployed.
I read invisible wounds whilst deployed in Afghanistan as a part of some work I was doing. I was disgusted that the Defence Psychology unit Commanding Officer and many in theatre psychs were unfamiliar with this study.
Please have a read through the executive summary or scan the early chapters which clearly lay out the relationship between exposure to combat operations and PTSD. Also note that Traumatic Brain Injury (TBI) is also little known about yet, although suicide and major depressive disorder appear to be common side effects.
TBI occurs when you are ‘blown up’ but appear to suffer no damage apart from seeing stars or ringing ears etc. I recall reading in the report that penetrative brain injuries had something like a 50% incidence of suicide.
I did a quick survey of the unit I was with in theatre and found that most soldiers who routinely deployed beyond the wire had most likely suffered TBI many having been blown up on multiple occasions in Iraq and or Afghanistan.
Please don’t mention my name – I have had a number of run ins with the people at Joint Health Command some of whom are truly terrible people. Of course there are also many fantastic dedicated and committed people working in or for Joint Health Command.