The War After the War

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Staff Sergeant Joe Biel with his Buffalo route-clearing vehicle in Iraq.

The Capitol was shining it its full glory Wednesday, under a beautiful sunny sky, as a crowd gathered in Senate Park to grapple with the vexing problem of PTSD and suicide among the nation’s troops.

The Army, Navy and Air Force surgeon generals were there for the kickoff, amid the television cameras. But by the time I spoke later in the day, they had moved on. But my message bears repeating here.

With the hot sun and no TV cameras I could take off my jacket, and donned my straw boater. I reminded the attendees that the Capitol was only a few blocks away from Union Station, where the homeless, some of who are veterans, live under the First Street, Northeast, bridge.

I recommended that:

— The American Psychiatric Association, and the larger mental-health community, consider anew changing the name of PTSD (post-traumatic stress disorder) to PTSI (post-traumatic stress-injury).

— The Department of Defense: conduct a careful review of all the policies that promote stigma (no anti-depressants allowed in submariners or aviators, the deployment limiting psychiatric conditions policy, security clearance procedures, etc). and decide, on a scientific basis, whether they are warranted.

— That military medicine avoid the humiliation that often accompanies treatment for behavioral health issues in the military. For example, avoid separate buildings with their Army Substance Abuse Program or Division Mental Health signs.

— The VA make it less difficult to get an appointment and  implement its the peer-specialist programs.

— The scientific community continue its research into treatments on the often over-lapping conditions of PTSD, traumatic brain injury, pain and disability.

— That the states do an analysis of the various programs offered by the military, the VA, the public mental health system, non-profits, and the academic institutions. Identify resources and gaps, and collaborate to fill the gaps revealed. The federal government’s Substance Abuse and Mental Health Services Administration is tacking a crack at this, but local efforts can speed it up.

— Finally, I am continually reminded of a statement made by a General’s wife: “I would not want someone driving a tank on Prozac.”

To which the doctor in me responds: “Would that be better than having Soldiers with untreated depression driving a tank?”

Defense Secretary Leon Panetta says we are making progress. “At the Department of Defense, we believe the unseen wounds of war are every bit as pressing – and every bit as treatable – as the visible wounds that have left a permanent physical mark on thousands of our heroes,” he wrote in a column published Wednesday in the Hearst newspapers around the country. “While we have made great strides in treating wounds from IED blasts and bullets, we still struggle with the scale of unseen injuries caused by combat stress and their manifestation in substance abuse, depression, relationship issues, and suicide. But steadily, we are developing a strategy to confront this challenge.”

Congress created Wednesday’s PTSD Awareness Day in 2010, in honor of Army National Guard Staff Sergeant Joe Biel. He killed himself on April 26, 2007, six months after returning from his second Iraq tour. Wednesday was his birthday.