What Happened to Mental Health Care for Vets?

[babylonsister]

What Happened to Mental Health Care for Vets?
The debate over the subject of suicide, and the treatment of soldiers and veterans, continues in Washington. Meanwhile, veterans of the wars in Iraq and Afghanistan are killing themselves at an alarming rate.
by Tara McKelvey


Andreas-Georg (”Andrew”) Pogany was trained at the U.S. Army Intelligence Center in Fort Huachuca, Arizona, to interrogate high-level terrorism suspects in Iraq. But one evening in September 2003 in Samarra, he fell apart. That night, he saw the corpse of an Iraqi man cut in half by a Bradley cannon during a battle. Afterward, Pogany began shaking, barely able to catch his breath. He sat for hours in a dark room in a military compound with his hand on a weapon. If someone opened the door, he was prepared to shoot.

The following day, he told a team sergeant he did not feel strong enough to work. “He took me outside, and he told me I was a fucking coward, and if it was up to him he would shoot me in the head,” says Pogany, 36, on a December evening at a restaurant called Racine’s in downtown Denver, four years after the incident. Pogany has broad shoulders and grey hair at the temples, and he wears heavy silver rings on both hands. He does not look like someone who is easily thrown off balance. When he talks about his conversation with the military officer, though, he stares into the distance. “He was like General Patton. Short of slapping me with his glove, he did it all,” he says.

Pogany was soon facing charges of cowardice, a crime punishable by death in a military court. He told his less-than-supportive military attorney: “Go pound sand.” Then he hired a Colorado Springs-based civilian lawyer and showed that he had been suffering from side effects of a military-issued, anti-malarial drug called Lariam while he was in Iraq.

On Nov. 6, 2003, less than six weeks after he experienced his “drug-induced, psychiatric breakdown,” as he says, a CNN segment titled “Heroes and Cowards in War” appeared on television. Army Private Jessica Lynch was held up as a hero; Pogany was described as a coward. Yet things have changed over time. In April 2007, Lynch testified before the House Oversight and Government Reform Committee that the Army exaggerated her role in fighting off Iraqi insurgents, turning her into “little girl Rambo” in order to pump up enthusiasm for the war. Meanwhile, Pogany, though he’s far from the battlefield in Iraq, has emerged as a hero. At Army posts and in military communities across the country, he is trying to help save people who have returned from the war with mental and emotional problems.

On July 15, 2004, the Army dropped the cowardice charges. At that point, Pogany became Exhibit A in the case against the military’s treatment of mental illness among soldiers. He was featured in GQ (”The Coward,” July 2004) and on PBS’ Frontline (”The Soldier’s Heart,” March 2005), as well as in dozens of newspaper articles. “He was like a canary in a coal mine,” explains Paul Rieckhoff, executive director of Iraq and Afghanistan Veterans of America. “Now, years later, we see more cases of the stress of war — acute stress — and the Army’s inability to deal with it.”

Over the past several years, Pogany has visited military installations, set up meetings between congressional leaders and soldiers, and examined ways the Army can improve its mental-health care. On Jan. 1, 2008, he was hired as an investigator for the National Veterans Legal Services Program, a Washington, D.C.-based nonprofit organization. Experts in the field of veterans’ care say he is one of the most effective advocates in the country. “Congress tends to hear about the military from higher-ups, and there’s an institutional response. They’re making things look the best they can,” says Charles Sheehan-Miles, former executive director of Veterans for Common Sense. Pogany has worked hard to ensure that people in Washington meet directly with individuals who have been through the military’s mental-heath-care system — “the folks on the ground,” as Sheehan-Miles explains.

more...

http://www.commondreams.org/archive/2008/02/18/7258/

[yellerpup]

1. Kick! n/t

And recommend. Important to keep this issue alive.

[Karenina]

2. What for whom? Pass me the TV Guide.

[babylonsister]

4. Yup. This is heartbreaking, and most Americans don't even know

about it.

[stillcool]

3. You would think they would know by now...

SHELL SHOCK AND ITS LESSONS
Manchester University Medical School
Published Manchester University Press, England
First edition 1917
January 15th, 1916, the British Medical Journal was responsible for the statement "The only hope that
our present knowledge of insanity permits us to entertain of appreciably diminishing the number of 'first attacks' lies in diminishing habitual and long enduring drunkenness and in diminishing the incidence of syphilis." This statement would have been sufficiently amazing if it had been made three years ago; but when the hospitals of Europe contain thousands of "first attacks" of insanity, which are definitely not due either to alcohol or syphilis, the only conclusion to be drawn is that its author must have been asleep since July, 1914, or have become so obsessed by a fixed idea as to be unable to see the plain lessons of the war.
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Excuses for inertia, brought forward before August, 1914, can be accepted no longer. The thousands of cases of shell-shock which have been seen in our hospitals since that time have proved, beyond any possibility of doubt, that the early treatment of mental disorder is successful from the humanitarian, medical and financial standpoints. It is for us, not for our children, to act in the light of this great lesson.

Reevaluating Society's Perception of Shell Shock:
A Comparative Study Between Great Britain and the United States
By Annessa Cathleen Stagner
West Texas State University
The combination of traditional fighting techniques and new technology in World War I forced both soldiers and officers to face devastating situations that tested not only their courage, but also their mental strength as well. While society had taught men to be tough and brave at all times, many broke upon enduring the horrifying environment of the trenches. It is obvious that men's ability to hold on to such an extreme ideal of manhood was unrealistic; however, many men tried.
------The devastating impact of war on soldiers, however, quickly forced society to confront the inability of soldiers to maintain society's idealistic courage. Some returning soldiers suffered through nightmares, while others suffered physically, exhibiting nervous twitches, blindness, or limb dysfunction. In 1915, physician C. S. Myers unknowingly acknowledged the result of soldier's mental conflict between idealistic courage and survival leading to a form of nervous disorder, which he termed shell shock.
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Shell-shocked soldiers made an impression on society not only because of their sheer numbers, but also because they called into question masculine ideals of the era.
-----------------
During World War I, the British government's primary focus was to keep as many men available for service and in the field as possible. Shell-shocked soldiers directly hindered the army's ability to successfully wage war because their inability to fight decreased the army's number of active troops. Myra Schock pointed out the conflict doctors experienced when trying to balance their governmental obligations with their own sympathy for the mentally strained soldiers. The doctors knew firsthand what shell shock felt like and realized it as a genuine sickness among the troops. However, the British government viewed shell shock as a form of malingering, deserving court martial, and many soldiers "were shot for cowardice, even when doctors argued that the accused was suffering from a medical condition caused by trauma and/ or shell shock." Schock stated British "doctors attempted to draw firm distinctions between their service as doctors and their role as members of the armed services at war." The British government clearly put pressure on doctors and officials to treat shell shock harshly, not as a disease, but as a form of malingering.
---------------------------------
Instead of acknowledging the disease's legitimacy among the troops, however, the government still discredited many of its victims. Attempts were made to "protect" officers of high status by classifying them as victims of "anxiety neurosis" or "neurasthenia," while common soldiers were classified as victims of "hysteria neurosis," a purely feminine disease. The differing titles reflected the British government's willingness to make a clear distinction between the legitimate illness of its officers and the unfounded appeals of its psychologically weak common soldiers.
While the government did not intend to allow shell shock to hold any legitimacy among its troops, experienced soldiers' and officers' traumatic experiences convinced to advocate for proper treatment of the shell-shocked soldiers. Virtually ignoring the existence of shell shock within common soldiers initially, Peter Leese suggested the government proceeded to improve treatment only as a result of strong public opinion.
http://www.wfa-usa.org/new/shellshock.htm

http://www.vlib.us//medical/shshock/index.htm
----------------------
THE AMERICAN EXPERIENCE
POSTWAR CONCERNS
-----------------------
The kinds of symptoms and reactions classified under the rubric of "hysteria" were considered the result of profound tendencies in the individual, both constitutional and developed as part of an aberrant psychological history. Issues of cost and pensionability came to the fore. The individual who continued to exhibit symptoms tended to be described as an inadequate personality or as constitutionally inferior. Many of those who testified before the British War Office Committee on Shell Shock in 1922, including a number of medical officers, still viewed it as an expression of cowardice or of manipulation to obtain discharge from the danger zone (see Leed, 1981). In the United States, the eugenics movement and racially motivated concepts strongly influenced thinking. It was accepted that some ethnic groups were predisposed to developing war neuroses.

This mode of thought–defining aspects of such symptomatic responses in racist terms as inherently predispositional–was stated baldly (and quite acceptably to an audience of distinguished psychiatrists in the section on nervous and mental diseases) at the annual meeting of the American Medical Association in 1921. After focusing on "pension neurosis," Benton (1921, p. 362) continues:

In addition to the recently growing pension neurosis group another group has been present and prominent continuously since the opening of this hospital. The particular condition occurs among foreigners, especially, Italians, Greeks, Austrians and Poles. It is most pronounced in Italians . . . . One of the fundamentals of the condition seems to arise from the general belief that the United States is a very wealthy country and that its government is due and destined to provide for them for the rest of their lives.
http://www.gulflink.osd.mil/library/randrep/marlowe_paper/mr1018_11_ch5.html

WORLD WAR II
Guadalcanal produced extraordinary levels of psychiatric casualties in the First Marine division and the Army units sent in to reinforce it. Rosner (1944) reported that 40 percent of the casualties evacuated from Guadalcanal "suffered from disabling neuro-mental disease" <(compared with only 5 percent following the attack on Pearl Harbor). He describes the psychiatric casualties as[br />
reduced to a pitiable state of military ineffectiveness after prolonged exposure under severest tropical conditions to exhaustion, fear, malaria, and sudden violent death at the hands of an insidious and ruthless enemy (Rosner, 1944, p. 770).
--------------------------------------------------------
BATTLE FATIGUE/COMBAT FATIGUE
The overwhelming focus of military psychiatry on the problem of combat fatigue operated throughout the war and for decades into the future, diminishing concern about other psychologically relevant phenomena affecting troops during deployment. The reason was quite simple–strategy and tactics focused military concern upon those who actually carried the war to the enemy, and these soldiers had rapidly demonstrated that they were the group most vulnerable to breakdown during or following combat. Well over 90 percent of all combat fatigue cases came from infantry maneuver regiments, followed by more modest numbers from armor and even fewer from artillery (see Mullins and Glass, 1973).

In the mid-century period of mass armies engaged in extensive and intensive ground war, large drafts of manpower were critical to maintaining the war effort. Due to selection processes, combat losses, and demands of competing theaters, as well as the forces required to maintain a massive logistics effort, troops were in short supply. By the later part of 1944, the European Theater of Operations was scraping the "bottom of barrel" for replacements. This fact led to the termination of the Army Specialized Training Program, designed to continue the university education of those in "vital" specialties and their subsequent rapid movement to Europe as infantry replacements. Some infantry regiments were suffering casualty rates of 1,600 per thousand per year. The only nonland forces that suffered equivalent levels of behavioral and psychophysiological breakdown were the heavy bomber forces, particularly the 8th Air Force. Their air war, with casualty rates extending from 15 to 40 percent of those involved in deep penetration raids, shared the traumatic intensity of ground warfare (see Mullins and Glass, 1973). In this situation, combat fatigue losses represented a major problem. Yet, it is important in looking at the war-related problems of the second half of the 20th century, and in particular those of the Gulf War, to realize the extent that other elements contributed to, and in a number of cases drove, psychological, psychosocial, and stress-based illnesses
--------
http://www.gulflink.osd.mil/library/randrep/marlowe_paper/mr1018_11_ch7.html

[cbayer]

5. There is not been adequate mental health care for Americans who are not vets

Why would we expect it to be any different for vets?

And if I may hijack for a moment, I have heard the following terms applied to one of our democratic candidates today:

Bipolar, crazy, schizoid, insane, manic-depressive.

The prejudice against anyone suffering from a psychiatric disorder is unspeakable and it is exemplified by the acceptably of throwing around terms referring to their illnesses.


Sorry. Appreciate your piece.

[Kitty Herder]

6. Istarted to respond to this, but I can't even respond to this right now, without getting emotional.

Maybe I'll try later.