I had a couple of flights yesterday so I caught up on my reading of military magazines -- Proceedings, Marine Corps Gazette, Air Force, and Army. Brig. Gen. Loree Sutton, the Army's highest-ranking psychiatrist, tells her service's magazine what sort of homecoming soldier worries her most:

As a psychiatrist, I must say that an individual who comes back from 12 to 15 months, moreover a series of repeat tours over the last nine years, and says, 'It hasn't affected me at all' -- that's the person I'm most concerned about.

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TOM RICKS

4:30 PM ET

May 27, 2010

Maybe

It's the guy who is tightly wrapped, kicking the dog, barking at his wife, and grabbing a bottle, yet insists that he has no problem, who often has a real problem.
Best,
Tom

 

F

11:17 PM ET

May 27, 2010

You're right, but that's not

You're right, but that's not quite what she says. A lot of guys come back and really aren't all that affected. Or they have some minor issues (sleep-related, wariness . . .) that they expect or have experienced before, know that the issues will go away fairly quickly, and so say 'I'm not affected.' I worry that we may get young guys so worked up that there's an expectation to come home with psychological trauma that it becomes a self-fulfilling prophecy. That diverts resources away from the troops who really do need help. This gets compounded by well-meaning financial compensation for wounds, which is fine if you've lost a leg, but can be a problem for a psych issue. If the payment is based on you continuing to be unwell (which, in the case of a lost leg is pretty much a given), then there's no incentive to even try to get over the psych wound.

I'm not sure our knowledge of these psychological issues (not to be mixed up with head trauma and the effects of concussion on the brain - that's a related but separate field with a lot of potential) has really progressed much beyond what Lord Moran figured out. We throw a lot more resources at the problem and have lots of good intentions. We've almost erased the stigma of this kind of injury, but possibly at the expense of considering it acceptable to not be affected. Most soldiers come back without getting shot and we don't consider that odd. We shouldn't think it odd that soldiers come back without psych either.

 

6OGUREZ

11:36 AM ET

May 28, 2010

comment on F's comment

>>but can be a problem for a psych issue. If the payment is based on you continuing to be unwell (which, in the case of a lost leg is pretty much a given), then there's no incentive to even try to get over the psych wound.

this is the conscious effort to benefit. in psychological parlance there is the 'gain through illness' phenomemon where subconsciously seeks treatment in order to get out of bad situation and then gets financial award.

 

CMEYERGO

4:38 PM ET

May 27, 2010

Cruise Ships are the Answer

Studies show that one problem in the modern world is that a GI can go from combat to his living room in the USA within 48 hours. This is mentally tough, especially when suddenly confronted with family surprises, like big credit card bills, children with tattoos, and new pink furniture. He shows up with jet lag and starts drinking to celebrate and then bad stuff happens. During World War II, GIs came home by ship, so at least a month passed since combat.

One solution is to send pleasure cruise ships to take GIs home from wars, with a few port stops. This provides ample time to sleep, eat well, unwind, exercise, attend numerous counseling sessions, and exchange e-mail and phone calls about what's new. It shouldn't cost much more since flying airplanes is several times more costly than shipping.

 

TYRTAIOS

5:42 PM ET

May 27, 2010

A Few Days to Decompress?

During Vietnam (yea I know - ancient history) too little attention was paid to PTSD. Now it is becoming a cottage industry. However, that is not to say it isn't a problem or a concern

But more to your point CMEYERGO, again during Vietnam, the Corps sent the majority of Marines returning to CONUS from down "south" via a couple of days on Okinawa.

There they administratively processed, were put on mindless working parties (except mine) to let them blow off steam by bitching, and at night go to the on base, and supervised clubs - drink some suds and trade been to hell and back stories with each other - decompressing so to speak. I think it helped? : |

 

SOLDIERSDIARY

7:06 AM ET

May 28, 2010

for the group

A point of debate always comes up on whether the Purple Heart is appropriate for PTSD and other physch related issues that come out of combat. These are problems that must be treated by doctors and so forth. Then there is TBI, which can take a while to diagnose. Any thougts on this one? Huner, RD, JP, Starbuck, Tom?

 

HUNTER

12:12 PM ET

May 28, 2010

Purple Heart

My Dad (COL (ret.) Vietnam Vet, R.I.P.) said it best. It's a stupid award. Why give some an award for getting shot. I say, Get rid of it.

Any award that causes so much concern or requires so much documentation short of our highest awards for valor...should be done away with. (This includes CIB, CAB, CFMB).

Commands spend too much time threading camels through the eyes of needles, with 80 page packets, to justify stupid awards. Then there is the subjective extrapolation of what justifies it (TBI, PTSD, how about John Kerry's supposed band-aid award?). It's a distraction, and it causes animosity in the rest of the bunch. Anytime one guy gets something and another wonders "wait a minute, I got a boo boo too" it just causes problems.

It doesn't take a purple ribbon to illustrate that someone is injured in a war. There are usually, sadly many other outward signs. Get rid of it.

 

SOLDIERSDIARY

2:15 PM ET

May 28, 2010

PH

@Hunter...you can use that argument with just about any award "why give someone a medal/ribbon for doing their job." I don't agree with either argument.
I found that the PH was actually easier to document than CAB/CIB, couple of sworn statements, and proof of the injury. There was really no room for discussion on approval, as either the troop was injured or not (BTW awarding of the PH meant automatic CIB/CAB award).
Are there degrees of injury, sure, losing a limb, going blind is certainly more than a scratch on the arm, but the PH is authorized for both; as in if you are injured, you are entitled to the award. In additon, awarding of the PH leads to benefits after you leave the service, so it is worthwhile to give to Soldiers when they are injured, no matter the sevarity.

 

HUNTER

5:43 PM ET

May 28, 2010

SoldiersDiary

I suppose you are right. But I think (IMHO) that we lend to much creedance to these funny bits of ribbon. And some of them like the combat badges seem to lead our soldiers the wrong way. I have commented on this before.

Badge seekers in the COIN environment are particularly counter to what is required by the mission. My unit had fewer than 20 CIB/CAB earners because they were doing their job properly (and I used the widest net possible on their behalf despite my personal misgivings). Our sister unit had 6-7 times that number doing the same mission, largely (again IMHO) because they were seeking out or creating conflict. Meanwhile they were also undermining their (and my) mission.

Earned badges and tabs seem to me to be reflective of learned skills (Airborne, AASLT, Ranger etc). CIBs/CABs even PHs and whatnot are reflective more of luck/bad luck or being in the wrong place at the wrong time. It is incongruent to me to give awards for that, esp. when so subjective and such wide ranging incidents - scratch on the arm from shrapnel on the FOB vs EFP IED strike eliminating a few of your brothers and maybe a few limbs. Thankfully no PHs in my unit, not because I didn't choose to award them but because my soldiers did their job well,a nd made their own luck and thus were not injured (with all due credit to them - esp the SGTs and SSGs - for their professionalism and discipline)

I know of no special dispensation for PH award winners beyond what a normal vet gets? Feel free to enlighten me.

 

RUBBER DUCKY

10:31 AM ET

May 28, 2010

PTSD etc.

I'll be strangely conservative on this one. Two problems with moving psychiatric illnesses into eligibility for Purple Heart.

One is diagnostic difficulty: does this individual have a diagnosed and diagnosable illness? Am not challenging legitimacy of PTSD as a diagnosis, but it has subjective elements, as does the broader matter of the definitions and categories of psychiatric ailments themselves (witness the ongoing struggle to get published the fifth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5)). Blood is blood. Problems with the human mind are not as easy or sure to detect.

Second problem is the causal question: was this mental ailment the result of combat or of something else in the person's life (or maybe both)? Bullet wounds show what caused them. Mental illness? Not always and not clearly; problems at home, long-standing mental trauma, etc. could be the trigger of what might appear as combat-related PTSD. Correlation is not causation.

The Purple Heart bears special meaning in the military and in the full society. Would go slow with changes in eligibility for this award. Instinctively I say yes on including PTSD, but only with the clearest set of criteria that fully address my two concerns above and only with solid guidelines on who can make an award recommendation and how it gets a solid chop from someone expert in both combat matters and psychiatry.

 

AWR

2:12 PM ET

May 28, 2010

Get your Purple Heart if possible

Long ago in Vietnam I got a totally minor wound (with blood) and did not even think about getting a Purple Heart. Friends would have laughed had I even mentioned it.

Now, Veterans Administration puts Purple Heart veterans right after POWs in the line waiting for service connected problems.

Your either wait for 1000 people in front of you to get served or pay for your own treatment.

 

WHATNOW

6:22 PM ET

May 31, 2010

Many returned

I have heard many family members say their husband or father never spoke about WWII or Vietnam. Don't know if that is good or bad. Each person handles their past in different ways. I have had friends that lost a a parent from just old age act totally different after the fact. Some talked about it and others you would never know it happened except they were off out of the blue for a day or two.

My suggestion is to make it easy to access and make sure their family or close circle at home have the contact info.

The delayed slow return would work wonders for the transition. .

 

MARKUS64

1:45 PM ET

June 26, 2010

Am not challenging legitimacy

Am not challenging legitimacy of PTSD as a diagnosis, but it has subjective elements, as does the broader matter of the definitions and categories of psychiatric ailments themselves (witness the ongoing struggle to get published the fifth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5)). Blood is blood. Problems with the human mind are not as easy or sure to detect.Bet365 Second problem is the causal question: was this mental ailment the result of combat or of something else in the person's life (or maybe both)? Bullet wounds show what caused them. Mental illness? Not always and not clearly; problems at home, long-standing mental trauma, etc. could be the trigger of what might appear as combat-related PTSD. Correlation is not causation.

 

Thomas E. Ricks covered the U.S. military for the Washington Post from 2000 through 2008.

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