Healing Unseen Wounds

In the Army, some officers said they preferred to take a given job after a poor performer because it made it easier for them to stand out. I always disagreed, preferring to take over winning units, because it's much easier to build on excellence. But I understood the preference, and saw it work to a few friends' advantage when they took company command from a less-than-stellar officer.

I'm reminded of this dynamic whenever I read stories like this one involving Defense Secretary Robert M. Gates -- a good leader and manager who took over from a terrible one. Gates is pushing the services hard to do a better job at taking care of mental-health issues, what he calls the "unseen" wounds of war. In remarks this week at Fort Bliss, Gates exhorted Army leaders to lead by example:

...Gates announced at Fort Bliss, Texas, that uniformed and civilian Pentagon employees would no longer be forced to reveal all previous mental health treatment when applying for national security clearances.

Visiting a recovery center for PTSD, Gates called the illness one of the "unseen wounds" of war. He said there are two issues in dealing with it, the first is the task of developing care and treatment.

"The second, and in some ways perhaps equally challenging, is to remove the stigma that is associated with PTSD and to encourage soldiers, sailors, Marines and airmen who encounter these problems to seek help," he said.

Gates later told a gathering of nearly 900 command sergeants major and instructors at Fort Bliss that they have a special role in encouraging soldiers to seek help.

"Let them know that doing so is a sign of strength and maturity," Gates said, shortly after he toured the base's mental health treatment facility. "I urge all of you to talk with those below you to find out where we can continue to improve."

Leadership matters in this area. The stigma associated with pursuing treatment for combat stress will never go away unless leaders push it away. Removing institutional barriers like "Question 21" on the security clearance form is important, because that effectively punished troops and their careers for seeking treatment, and gave them a powerful incentive to either lie or avoid treatment altogether.

Having senior leaders like colonels and sergeants major step forward to say, "Yes, I went to counseling after I came home," is another important step, too. And, the services (as well as the VA) must provide the resources so that soldiers, sailors, airmen and Marines coming home from war can find the right people to talk to when they decide to seek treatment, without having to be triaged or shunted into a month-long queue.

We cannot ask our magnificent military to fight wars in Iraq and Afghanistan, with no end in sight, and fail to take care of them. This is like running a machine with no oil and no maintenance; eventually, it will seize up and stop. But, of course, men are not machines. Our servicemembers are human beings, and the formula for their maintenance is far more complex than "add rest time, add mental health treatment, add R&R, then redeploy."

We have to keep our finger on the pulse of military morale and health, and take rapid action when we find problems. With Gates at the helm, I'm reasonably confident this is being done now. It's a shame we had to wait six years for a leader like him.

By Phillip Carter |  May 4, 2008; 9:30 AM ET  | Category:  Veterans
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"We cannot ask our magnificent military to fight wars in Iraq and Afghanistan, with no end in sight, and fail to take care of them."

Agreed, and in addition to helping to heal any PTSD, this means protecting them from being accidently electrocuted by money-grubbing contractor friends of deadeye-dick Cheney.

http://www.nytimes.com/2008/05/04/world/middleeast/04electrocute.html?_r=1&hp&oref=slogin

Mr Gates should spend some time cleaning up some this lethal contractor mess.

Posted by: Anonymous | May 4, 2008 10:54 AM

The May issue of the American Legion magazine has five articles on TBI that cover a 17-page spread. I normally throw my copy away before reading, as in the last four or five years they have usually had some NeoCon wingnut praising Bush as a glorious Commander as their lead piece. But this months cover called TBI the signature wound of the war and had some striking cover art so I gave it a try. It is worth a read.

http://www.legion.org/national/divisions/magazine

Maybe the national Legion is changing their spots. Hopefully so. The local posts have always been about helping vets and their families. I think the national group sold out and may now be realizing that they made a mistake.

IRRSoldier - In the May issue, they also interviewed the new VA Director LtGen Peake (retired), a Vietnam era 101st Airborne combat vet long before he went to med school. Do you have any inside scoop on this guy when he was Surgeon General?? He sounds good but I take that with a grain of salt as he preceded Kiley of Walter Reed notoriety in the Surgeon General's spot. I don't think that the conditions at building 18 there happened overnight.

mike

Posted by: mike | May 4, 2008 12:30 PM

Mike,

Thanks for the link. I am heartened by LTG Peake's selection to head the VA. While he had a reputation for riding his staff hard as Army Surgeon General, he was a great Surgeon General compared to Kiley and Schoomaker. Rightly or wrongly, he was a very steadying hand for the AMEDD/MEDCOM as they struggled during the start of OIF to manage a growiing patient load and declining resources.

Building 18 was a tragedy, but I chalk this up to a few prime factors: Declining available personnel to assign to command Medical hold, accelerating military-civilian conversions taking the "green-suiters" out of many hospital positions; and the A-76 process that contracted out WRAMC's Federal maintenance workforce with a contractor.

Posted by: IRR Soldier... | May 4, 2008 1:07 PM

It will take a whole lot more than Secretary Gates removing a single question from a security clearance questionnaire to change the Army's, (and the rest of the services) ingrained approach to service connected mental illness. As far back as George Patton slapping soldiers showing possible mental stress (although one of them had just arrived, wasn't yet diagnosed, and was actually in the early phases and stages of malaria) through the Armiy's failure to discover a way to deal with the high incidence of depression and more serious mental problems suffered by certain signal intelligence MOS's. For those of us in those MOS's, where possible the Army found a way to discharge the soldier for actions (like drig use) that violated the UCMJ, but some of us failed to react that way, and just developed blatantly obvious symptoms of the stress that weren't in violation of the regs. In that case, given that they couldn't discharge us for medical cause without giving us medical retirements, the Army moved us out of intelligence jobs, and into dead end MOS's with no where to go and long waits for promotion, to drive us out of the Army so they wouldn't have to pay for our mental problems.

Until the real powers (civilian and Congressional) that find service related mental disabilities to be a form of malingering (as at least one member of Congress has gone on record as saying) the Army will continue to be lousy at dealing with the mental damage its current deployment and training pace is causing.

Basically, the Army acts, toward mental injuries in a standard way that is the equivalent of demanding that a soldier who had a leg amputated after being blown up in an IED incident prove that he really had two good legs when he came into the service, and that now that he isn't whole and entire, that he will really have problems without that leg when he exits the service.

Of course, physical injuries can be blatantly obvious, whereas PTSD can't be physically measured, and so a multiple deployment fuel tanker driver who has had several IEDs detonated on him, and is a mental mess because of the deployments and the IEDs can be easily stigmatized, by his own chain of command, and the Army as a whole, and maneuvered out of the service, and the civilian world, not having obvious injuries to judge by, will go along with the Military in marginalizing the veteran.

It will take the approach that the Army was forced to take when it began really dealing with a non segregated Army, taking the position that looking to see if the problem exists won't be effective, but declaring that it is obvious THAT THE PROBLEM MUST EXIST, and the Army must find ways to deal with it.

The current system, finding ways to transition PTSD and TBI casualties out of the service is dead wrong. The Military, over all, and the Army, especially, must decide that NO GI showing signs of mental disability, may be discharged UNTIL he has demonstratedly made a full recovery from the disability. Wherer it becomes apparent that such recovery is not likely for a significant period of time, then the serrviceman gets a 100% retirement, and direct access to specially designed Military Hospitals for further treatment. To provide the hospitals we don't have, take back Presidio of San Francisco, and reconstitute Letterman General Hospital, Take back Fitzsimmons General Hospital and reconstitute the Army amputee center that used to be there, Reopen Fort Sheridan and Valley Forge Hospital, and dedicate those hospitals to studying and treating PTSD and TBI. Then call back every serviceman who was ever discharged with a record of mental problems, reevaluate him, and reconsider his discharge.

That would only be just.

Posted by: ceflynline@msn.com | May 4, 2008 4:24 PM

IRR soldier's comment "Building 18 was a tragedy, but I chalk this up to a few prime factors: Declining available personnel to assign to command Medical hold, accelerating military-civilian conversions taking the "green-suiters" out of many hospital positions; and the A-76 process that contracted out WRAMC's Federal maintenance workforce with a contractor."

succinctly describes the problem. The contracting out process, where dedicated Federal civilian and military care providers had to bid for their own jobs against outside contractors out for the bucks, who had high level help inside the administration in their bidding for the work, could only come about because the Administration sees military disabilities as government costs to be eliminated by whatever means necessary. The underlying principle of the BRAC process was that the DOD was too expensive and had to be made less costly wherever possible. That it simply made Defense less in general didn't bother those dedicated cost cutters one bit.

Perhaps we need to go back to the size and shape of the Army. Navy, Marines, Air Force, and Coast Guard as on 19 Jan 1969, until we can really decide what we need as our nation's defense in the modern era.

Posted by: ceflynline@msn.com | May 4, 2008 4:36 PM

I am one to believe that it is the follow on to a deteriorated situation that brings the better results for the person and the origanization. Success has too often been the one who places the best shine upon the past. A battleship sailor or an T-capping admiral who believes showing the broadside of his ship to a torpedo carrying boat at the start of the War in the Pacific come to mind as an example.

Holding to:
a focus on the only military national security asset being the moveable brigade combat team of warfighters (i.e. killers with ethos);
old bases with poorly managed facilities and patronage and family related support personnel;
an entrenched entitlement civil service;
biases against brain injuries that are trauma, stress, biologically or chemically induced;
preferences for continuing corrupted contracting methods yielding personal services to civil and military commands and employment for their family;
a list of too, too many senior officers on the payroll before and after retirement;
a blindly incompetent IG structure;
a plethora of isolated military commands and laboratories for research, development, requirements and equipment standards;
backhands to officers and enlisted who point to failure in character or leadership;
and, most importantly;
testimony and submissions to the Secretary and Congress without certification and integrity accountability (SarbanesOxley)that publically traded companies produce.

All are items of apparent past shine that need promptly to be cast, with heavy weights, over the stern of this ship of state that already is carrying far too much ballast for its own survival.

The only truly successful unit to have a need for continued commitment unchanged to excellence is the guard force at Arlington.

I am sure Secretary Gates would agree.

Posted by: Bill Keller | May 4, 2008 6:59 PM

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