It Takes a Community
Therapy-as-usual can’t serve the needs of our returning troops
By Laurie Leitch and Elaine Miller-Karas
The debate about our involvement in Iraq and Afghanistan has raged for a decade, but no one disputes one fact: as a result of those conflicts, thousands and thousands of young men and women have been profoundly wounded—physically, emotionally, and spiritually. The statistics measuring the effects of wartime service on our troops reveal high rates of drug and alcohol abuse, homelessness, homicide, suicide, divorce, depression, traumatic brain injury, and post-traumatic stress disorder. Yet, unless we’re closely related to someone in the military, many of us still feel insulated from the impact of these wars, detached from the sacrifices of those fighting them, and removed from the problems they experience once they return to civilian life.
Our detachment and complacency about the consequences of these wars are profoundly miscalculated. Although combat missions have ended in Iraq and the countdown to the withdrawal of troops from Afghanistan has begun, the long-term impact of these engagements will be far more pervasive and widespread than many of us realize. In addition, it’s becoming increasingly clear that our mental healthcare establishment, both civilian and military, isn’t capable of handling this public healthcare crisis. Those in the trenches of service delivery already know that our standard psychotherapeutic paradigm—one mental health professional with one client, applying one or several standard interventions—fails to meet the needs of this population, both because of the number of potential clients and the complexities of war trauma. As professional psychotherapists, we need to rethink our ideas about how to reach out to the troops and their families struggling to return to ordinary life. It’s time to move outside the limited conceptual box that now defines how we provide care to our homeward-bound warriors.
The Scale of the Problem
About 2.1 million troops have served in Operation Enduring Freedom in Afghanistan or Operation Iraqi Freedom. Assuming that each returning veteran has five or more close family members (spouse or significant other, mother, father, two siblings), these wars directly affect at least 10 million people. If we include children, other relatives, coworkers, and friends, the number of Americans affected could be 40 million or more.
Beyond the growing numbers of people whose lives have been touched by the war, our troops disproportionately experience a range of mental health problems, some related to traumatic brain injury—which, along with PTSD and depression, is one of the signature injuries of these wars. A report developed by the RAND Corporation in 2008 estimated that 300,000 veterans suffer from significant PTSD, anxiety, or major depressive symptoms; an additional 320,000 may have experienced a traumatic brain injury. The number of soldiers forced to leave the Army solely because of a mental disorder increased by 64 percent between 2005 and 2009. The actual numbers of veterans suffering from these problems is probably much higher than these figures indicate, because of the latent onset of PSTD in some individuals and the widespread misdiagnosis, or lack of diagnosis, of traumatic brain injury.
Meanwhile, divorce rates among returning troops are at record levels, particularly for women. According to the Army’s Mental Health Advisory Team’s 2007 survey, as many as 30 percent of soldiers and marines consider divorce by the midpoint of their deployment. Given the stressors that deployment imposes on entire family systems, it isn’t surprising that cases of intimate partner violence and child maltreatment are up 30 percent in military couples and families. In one study of 250,626 wives of active-duty U.S. Army soldiers receiving medical care between 2003 and 2006, those whose husbands were deployed for up to 11 months exhibited more than a six-percent increase in diagnoses of depression, anxiety, sleep disorders, acute stress reaction, and other problems over those whose husbands stayed home.
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