Preventing And Treating The Invisible Wounds Of War

This volume provides several perspectives that help practitioners, advocates, and policymakers understand the impact of historical and recent wars on U.S. Military veterans. The chapters address newly recognized psychological conditions as risk factors for more serious diagnosable mental health disorders.

The number of cases of post traumatic stress disorder (PTSD) affecting both combat veterans and survivors of armed conflict has increased in recent years. Exposure to traumatic events can cause PTSD, and the serious consequences of this disorder can often lead to impulsive and destructive behaviors such as drug abuse and uncontrollable anger. Combat related PTSD is also one of the strongest contributing factors to the high suicide risk in returning troops. This book presents the collected papers from the 2012 NATO Advanced Study Institute (ASI): Invisible Wounds – New Tools to Enhance PTSD Diagnosis and Treatment (IW2012), held in Ankara, Turkey, in June 2012. This ASI was attended by 56 scientists and representatives from NATO and Partner countries, and expert contributors from nine different countries were invited to take part in the workshop. The aim of the ASI was to equip participants with an in-depth knowledge of the latest theoretical advances in neuroscience, psychotherapy and pharmacology, and thereby to assist them in the task of assessment, diagnosis, prevention and treatment of PTSD and related co-morbid disorders. The book is divided into four sections: a review of the latest science related to theoretical constructs and associated neurosciences; screening; stress inoculation training; and co-morbid issues: considering the whole person in treatment. This book will provide a valuable resource for all those whose work involves dealing with post traumatic stress disorder.

The surprising story of the Army’s efforts to combat PTSD and traumatic brain injury The wars in Iraq and Afghanistan have taken a tremendous toll on the mental health of our troops. In 2005, then-Senator Barack Obama took to the Senate floor to tell his colleagues that “many of our injured soldiers are returning from Iraq with traumatic brain injury,” which doctors were calling the “signature wound” of the Iraq War. Alarming stories of veterans taking their own lives raised a host of vital questions: Why hadn’t the military been better prepared to treat post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI)? Why were troops being denied care and sent back to Iraq? Why weren’t the Army and the VA doing more to address these issues? Drawing on previously unreleased documents and oral histories, David Kieran tells the broad and nuanced story of the Army’s efforts to understand and address these issues, challenging the popular media view that the Iraq War was mismanaged by a callous military unwilling to address the human toll of the wars. The story of mental health during this war is the story of how different groups—soldiers, veterans and their families, anti-war politicians, researchers and clinicians, and military leaders—approached these issues from different perspectives and with different agendas. It is the story of how the advancement of medical knowledge moves at a different pace than the needs of an Army at war, and it is the story of how medical conditions intersect with larger political questions about militarism and foreign policy. This book shows how PTSD, TBI, and suicide became the signature wounds of the wars in Iraq and Afghanistan, how they prompted change within the Army itself, and how mental health became a factor in the debates about the impact of these conflicts on US culture.

Summarizes key findings and recommendations from Invisible Wounds of War: Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery (Tanielian and Jaycox [Eds.], MG-720-CCF, 2008), a comprehensive study of the post-deployment health-related needs associated with post-traumatic stress disorder, major depression, and traumatic brain injury among veterans of Operations Enduring Freedom/Iraqi Freedom.

There’s no real homecoming for many of our veterans returning from the wars in Iraq and Afghanistan. They may go through the motions of daily life in their hometowns, but the terrible sights and sounds of war are still fresh in their minds. This empathic, inside look into the lives of our combat veterans reveals the lingering impact that the longest wars in our nation’s history continue to have on far too many of our finest young people. Basing her account on numerous interviews with veterans and their families, the author examines the factors that have made these recent conflicts especially trying. A major focus of the book is the extreme duress that is a daily part of a soldier’s life in combat zones with no clear frontlines or perimeters. Having to cope with unrecognizable enemies in the midst of civilian populations and attacks from hidden weapons like improvised explosive devices exacts a heavy toll. Compounding the problem is the all-volunteer nature of our armed forces, which often demands multiple deployments of enlistees. This results in frequent cases of post-traumatic stress disorder and families disrupted by the long absence of one and sometimes both parents. The author also discusses the lack of connectedness between civilian society and military personnel, leading to inadequate healthcare for many veterans. This deficiency has been highlighted by the urgent need to treat traumatic brain injuries in survivors of explosions and the high veteran suicide rate. Bouvard concludes on a positive note by discussing some of the surprising and encouraging ways that the chasm between civilian and military life is being bridged to help reintegrate our returning soldiers. For veterans, their families, and especially for civilians unaware of how much our soldiers have endured, The Invisible Wounds of War is important reading.

Since October 2001, approximately 1.64 million U.S. troops have been deployed for Operations Enduring Freedom and Iraqi Freedom (OEF/OIF) in Afghanistan and Iraq. Early evidence suggests that the psychological toll of these deployments -- many involving prolonged exposure to combat-related stress over multiple rotations -- may be disproportionately high compared with the physical injuries of combat. In the face of mounting public concern over post-deployment health care issues confronting OEF/OIF veterans, several task forces, independent review groups, and a Presidential Commission have been convened to examine the care of the war wounded and make recommendations. Concerns have been most recently centered on two combat-related injuries in particular: post-traumatic stress disorder and traumatic brain injury. With the increasing incidence of suicide and suicide attempts among returning veterans, concern about depression is also on the rise. The study discussed in this monograph focuses on post-traumatic stress disorder, major depression, and traumatic brain injury, not only because of current high-level policy interest but also because, unlike the physical wounds of war, these conditions are often invisible to the eye, remaining invisible to other servicemembers, family members, and society in general. All three conditions affect mood, thoughts, and behavior; yet these wounds often go unrecognized and unacknowledged. The effect of traumatic brain injury is still poorly understood, leaving a large gap in knowledge related to how extensive the problem is or how to address it. RAND conducted a comprehensive study of the post-deployment health-related needs associated with these three conditions among OEF/OIF veterans, the health care system in place to meet those needs, gaps in the care system, and the costs associated with these conditions and with providing quality health care to all those in need. This monograph presents the results of our study, which should be of interest to mental health treatment providers; health policymakers, particularly those charged with caring for our nation's veterans; and U.S. service men and women, their families, and the concerned public. All the research products from this study are available at http://veterans.rand.org. Data collection for this study began in April 2007and concluded in January 2008. Specific activities included a critical reviewof the extant literature on the prevalence of post-traumatic stress disorder, major depression, and traumatic brain injury and their short- and long-term consequences; a population-based survey of service members and veterans who served in Afghanistan or Iraq to assess health status and symptoms, as well asutilization of and barriers to care; a review of existing programs to treat service members and veterans with the three conditions; focus groups withmilitary service members and their spouses; and the development of a microsimulation model to forecast the economic costs of these conditions overtime. Among our recommendations is that effective treatments documented in the scientific literature -- evidence-based care -- are available for PTSD and major depression. Delivery of such care to all veterans with PTSD or majordepression would pay for itself within two years, or even save money, by improving productivity and reducing medical and mortality costs. Such care may also be a cost-effective way to retain a ready and healthy military force for the future. However, to ensure that this care is delivered requires system-level changes across the Department of Defense, the Department of Veterans Affairs, and the U.S. health care system.

In these personal reflections on his thirty years of clinical work with victims of genocide, torture, and abuse in the United States, Cambodia, Bosnia, and other parts of the world, Richard Mollica describes the surprising capacity of traumatized people to heal themselves. Here is how Neil Boothby, Director of the Program on Forced Migration and Health at the Mailman School of Public Health, Columbia University, describes the book: "Mollica provides a wealth of ethnographic and clinical evidence that suggests the human capacity to heal is innate--that the 'survival instinct' extends beyond the physical to include the psychological as well. He enables us to see how recovery from 'traumatic life events' needs to be viewed primarily as a 'mystery' to be listened to and explored, rather than solely as a 'problem' to be identified and solved. Healing involves a quest for meaning--with all of its emotional, cultural, religious, spiritual and existential attendants--even when bio-chemical reactions are also operative." Healing Invisible Wounds reveals how trauma survivors, through the telling of their stories, teach all of us how to deal with the tragic events of everyday life. Mollica's important discovery that humiliation--an instrument of violence that also leads to anger and despair--can be transformed through his therapeutic project into solace and redemption is a remarkable new contribution to survivors and clinicians. This book reveals how in every society we have to move away from viewing trauma survivors as "broken people" and "outcasts" to seeing them as courageous people actively contributing to larger social goals. When violence occurs, there is damage not only to individuals but to entire societies, and to the world. Through the journey of self-healing that survivors make, they enable the rest of us not only as individuals but as entire communities to recover from injury in a violent world.

The first book to explore the idea and effect of moral injury on veterans, their families, and their communities Although veterans make up only 7 percent of the U.S. population, they account for an alarming 20 percent of all suicides. And though treatment of post-traumatic stress disorder has undoubtedly alleviated suffering and allowed many service members returning from combat to transition to civilian life, the suicide rate for veterans under thirty has been increasing. Research by Veterans Administration health professionals and veterans’ own experiences now suggest an ancient but unaddressed wound of war may be a factor: moral injury. This deep-seated sense of transgression includes feelings of shame, grief, meaninglessness, and remorse from having violated core moral beliefs. Rita Nakashima Brock and Gabriella Lettini, who both grew up in families deeply affected by war, have been working closely with vets on what moral injury looks like, how vets cope with it, and what can be done to heal the damage inflicted on soldiers’ consciences. In Soul Repair, the authors tell the stories of four veterans of wars from Vietnam to our current conflicts in Iraq and Afghanistan—Camillo “Mac” Bica, Herman Keizer Jr., Pamela Lightsey, and Camilo Mejía—who reveal their experiences of moral injury from war and how they have learned to live with it. Brock and Lettini also explore its effect on families and communities, and the community processes that have gradually helped soldiers with their moral injuries. Soul Repair will help veterans, their families, members of their communities, and clergy understand the impact of war on the consciences of healthy people, support the recovery of moral conscience in society, and restore veterans to civilian life. When a society sends people off to war, it must accept responsibility for returning them home to peace.