It seems when it comes to the lingering and troubling health issues faced by many of today's combat veterans, it often takes extreme measures to remind us of our need to do more. Like summiting Mount Everest, a mission recently completed by a group of active-duty and combat-wounded service members to draw our attention to veterans struggling with PTSD and the unyieldingly high rate of military suicides in this country. Or a 2,700 mile, 155 days walkabout from Milwaukee to Los Angeles undertaken by two veterans in a public quest to heal from the debilitating effects of their combat experiences.
There is an important dimension to these extraordinary feats that also needs to be honored. It's the commitment made by these veterans to join together and share their private suffering in full public view in order to help themselves and to help others.
Tom Voss and Anthony Anderson, who made the trek to Los Angeles, each had served extensive tours of duty overseas. Like a lot of returning vets, their attempts to settle back into civilian life did not go well. Their post-military lives soon became defined by bouts of depression, anxiety, with difficulty with interpersonal relationships, and a dependence on alcohol and prescription drugs.
Their journey, which is the subject of a new feature documentary, "Almost Sunrise," introduces viewers to a previously unidentified form of suffering common to many returning veterans; what is now being referred to as "moral injury." Moral injury is a condition that the therapeutic community is only now starting to confront.
Moral Injury is differentiated from PTSD in that it directly relates to guilt and shame veterans experience as a result of committing actions that go against their moral codes. Therapists who study and treat moral injury have found that no amount of medication can relieve the pain of trying to live with these moral burdens. Many experts believe those suffering from moral injury contribute significantly to the shocking toll of suicides among returning vets, which is estimated as high as 18 to 22 a day in the United States.
Through their shared journey, Voss and Anderson are helped by a number of counselors and treatments, including a Native American spiritual healer and a meditative technique called power breathing. Just the act of joining together on this mission and communing with nature was found to have restorative effects on these two veterans.
Their commitment to take this journey addresses the first major challenge faced by veterans trying to cope with what is often suppressed and hidden. Veterans are generally reluctant to seek mental health care. According to an April report from the Government Accountability Office, the persistent stigma linked to mental health counseling has resulted in little progress in addressing issues such as moral injury.
Many clinicians believe that simply having PTSD designated as an injury rather than a disorder could go a long way in helping alleviate the stigma of seeking treatment. It is a designation now thought to be more in line with the reality of the situation. A new study has found concrete evidence of what some military neurologists, physicians and senior officers have suspected for decades — PTSD may in fact be more physical than psychological.
In 2012, neuropathologist Daniel Perl was examining a slide of human brain tissue when he discovered a distinctive pattern of tiny scars unlike anything he had ever seen before. The tissue came from an American combat soldier who had been five feet away from a blast released by a suicide bomber. As recounted in a recent story in the New York Times Magazine, the soldier survived the blast thanks to his body armor, but died two years later of an apparent drug overdose after suffering symptoms that have become all too familiar with our returning warriors — memory loss, cognitive problems, inability to sleep and profound depression. Perl went on to further study more tissue samples of military veterans, eventually publishing his findings. The results may well change the way both science and the military look at the effects of blast exposure in combat.
In 2005, the Department of Defense reported 15,530 cases of traumatic brain injury among service members primarily caused by blast exposure. By 2011, that number had increased to 32,907. Nearly 350,000 service members have been given a diagnosis of traumatic brain injury over the past 15 years. It now seems clear that the actual number is likely to be much higher given the reluctance of soldiers with few visible wounds to report something they have been told is purely psychological. Based on recent findings, what has been traditionally diagnosed as a psychic condition rather than a physical injury — from shell shock, to combat fatigue, to PTSD — is now being subjected to reinterpretation.
Kit Parker is a combat veteran, active reservist and a biophysicist on the faculty at Harvard University. He has been researching this problem of blast-induced traumatic brain injury since 2006. As he told NPR, the military has long been working under the assumption that most concussions weren't causing physical damage to the brain. As a result, troops who'd been near a blast but had no obvious injury were routinely returning to combat, where many were exposed yet again to blast waves.
Partly based on findings published by Parker and his associates in 2011 which demonstrated how a blast wave could disrupt the connections among brain cells, protocols were changed and injured troops are now less likely to be sent back into combat immediately after an incident. But treatment options for these injuries remain extremely limited.
For those combat veterans exposed to these injuries and now living with the aftermath, several former Special Operations soldiers told the New York Times that just being told they have a physical wound rather than a mental one makes a big difference, even if the injury is, at present, incurable.
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