May is Mental Health Awareness month, and, fittingly, The New York Times addressed the U.S. Court of Appeals’ strong support of veterans’ complaints about mental health services on its At War blog yesterday. In her new book, When Johnny and Jane Come Marching Home, Paula Caplan explains why war trauma shouldn’t be called a mental illness, questions the effectiveness of therapy for veterans, and provides alternatives for how we can help veterans returning from wars in Afghanistan and Iraq.
What are some of the risks associated with sending veterans to therapy?
First, veterans will tell you that they worry that having a psychiatric diagnosis and a record of treatment for a mental disorder will impair their career progress in or out of the military, and they are right in believing that that is a substantial risk. Second, since mental illness is generally thought to imply trouble that comes from within, to call the devastating effects of war a mental illness is a serious error that leads veterans to consider themselves sick for having understandable, human reactions to the horrors they have experienced. It adds to their burdens, and it leads us in wrong directions—such as using psychiatric medications that may help some people but often cause severe harm and certainly get in the way of our trying to find out what really will help. Some therapists can help, of course, but statistics show that after decades of using therapy as one of the two primary courses, we still have millions of veterans from all wars who are homeless, jobless, addicted to drugs or alcohol, imprisoned for acts of violence, attempting or committing suicide, and plagued by insomnia, fear and anxiety, guilt, shame, a sense of betrayal, moral conflicts, spiritual crises, and more. So something more is needed.
How did the labels for the emotional effects of war change over the twentieth century?
In the Civil War, it was called “soldier’s heart”; in World War I, “shell shock”; in World War II, “combat fatigue”; then after the Vietnam War, “Post-traumatic Stress Disorder.” Use of the term “PTSD” masks the emotional carnage wrought by war, making it impossible for us as a society to see its full horror and thus increasing the ease with which we will allow our government to go to war next time, before seeking other routes.
How do such labels impact society’s view of veterans?
Because no term directly referring to war is part of the term "Post-traumatic Stress Disorder," it becomes a euphemism when applied to war veterans (and to others, such as rape victims, for similar reasons). There is something unseemly about using a euphemism to apply to an experience of intense horror or sorrow. To use these psychiatric euphemisms distances therapists and the loved ones of those who are traumatized from the traumatized person's experience. It isolates the latter as we move that much farther away from sharing their experience with them and from having the chance to show that we respect the fact that they have been through hell (quoted from my Psychology Today blog).
How does the term “PTSD” hide the source of suffering for servicepeople?
The term “stress” is used freely these days to apply to such things as being caught in traffic when you are late for a meeting. Thus, as noted above, use of the term “PTSD” masks the emotional carnage wrought by war. The images that come to mind when one thinks of “PTSD” do not, for the civilian, come close to the horror of the images that come to mind when one thinks of “war trauma.”
What drives people to believe that therapists can fix the emotional damage done by war?
The lobby groups such as the American Psychiatric Association and the American Psychological Association spend vast fortunes persuading the public that if you are experiencing emotional pain, it’s a therapist you need and that the therapist uses scientifically-developed and -proven techniques to alleviate that pain. They have gone far to persuade people that just about any emotional upset is a mental illness and thus requires treatment by professionals and that laypeople cannot do much to help. This is simply wrong. The drug companies have massive budgets aimed solely at persuading both the public and professionals that psychiatric drugs can alleviate emotional pain, despite the millions of war veterans who have been treated with therapy and/or psychotropic drugs and are still homeless, jobless, addicted to drugs or alcohol, unable to readjust to non-military culture and life with family and friends, imprisoned for violent conduct...or dead from suicide related to war.
What are the top three ways society can help veterans returning from wars in Afghanistan and Iraq?
The top three?! So many needed, and it's hard to prioritize, but here are some that are extremely important and certainly low-risk, compared to much of what happens in the mental health system:
(1) Listen to a veteran's story about what they have been through, how it was for them in the military, and how it has been since returning home. As part of that, try to put yourself in their position, and see if you can honestly tell them you do not think that they are crazy, that you can well imagine feeling as they do if you had experienced what they have.
(2) Look for ways to help them reconnect with the wider community. Listening to their story is a good beginning but only a beginning.
(3) See if you can help them orient toward creativity, productivity, and care (through the arts, paid work, volunteer work for others in need) as part of an explicit discussion that can take place between individuals and also in the wider society about the enormous and clashing differences between the two cultures — military/war and home — where they have lived. Moving toward creativity, productivity, and care means moving away from military hierarchies and the aims of war.