Fighting the Stigma

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Financed by the Pentagon and produced by the Institute of Medicine, (that influential member of the National Academy of Sciences with particular political and legislative sway), a 400-page report published Friday recommended a broad range of PTSD-related initiatives. They include annual PTSD screenings for troops returning from combat, and a more coordinated approach to supporting those with PTSD between the Department of Defense and the Veterans Administration.

Two factors addressed in the study are cause for concern:  first off, while 20% of our returning veterans are diagnosed with PTSD, barely half of them actually receive treatment; secondly, for those that do receive treatment, the DoD and the VA aren’t adequately tracking the success of their respective treatment programs. Why is it that so few of our men and women who return home suffering from PTSD actually seek treatment?  One word:  stigma.

Despite the efforts by leaders up and down the hierarchy within the DoD and the VA to reduce the stigma of seeking mental health counseling, there remains a stark perception amongst much of our veteran and non-veteran population that seeking mental health services is a sign of weakness and dishonor.  Many active duty personnel refrain from seeking help out of an acute fear of potential repercussions from their command, and a strong desire not to become labeled as a “head case” by their peers.

Initiatives such as annual PTSD screenings sound great on paper, but until the mindset changes and the stigma of mental health counseling fades away, these annual screenings will follow what’s referred to in the finance realm as “Garbage In, Garbage Out.”  In other words, if stigma prevents service members from being honest on their PTSD screening questionnaires, then any conclusions drawn from those surveys will be fundamentally flawed, at best.

What’s also troubling is the fact that between the DoD and the VA, there are a wide array of programs that have been developed for treating PTSD. But there is a lack of consistency with how these programs are implemented by the organizations.  There is also, according to the report, surprisingly little information regarding the newer, so-called innovative treatments such as yoga and acupuncture, and whether any of these treatments are actually effective in the long run.

On a positive note, the cornerstone treatment programs developed by the VA and supported by robust data, Cognitive Processing Therapy (CPT) and Prolonged Exposure Therapy (PE), are cited as successful treatments for PTSD.  In order to effectively lesson PTSD symptoms, each program requires months of weekly appointments (and a great deal of sometimes excruciating homework for the veteran to complete between appointments). In other words, the treatments that have been proven effective require a significant commitment of time, energy, and fortitude on the part of the veteran and the VA alike.

Recovering from (and treating) PTSD is hard work, period.

 Let’s hope that the VA is able to marshal the money and the psychologists necessary to treat the flood of veterans seeking shelter from PTSD.  In the meantime, let us work to remove the barriers to getting help, namely stigma, so more veterans suffering with PTSD will actually seek the help they so desperately need — and deserve.

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 The VA has only 1/3 of the mental health personal needed to deal with the 1M estimated vets with PTSD and PTSD symptoms according to the House Armed Services Committee and the National Center for PTSD. What is needed is a new approach to PTSD treatment that is inexpensive, confidential, effective and can reach these large numbers. Web interventions, like PTSDSTRESS.COM and others are now being used by vets with very positive results. The first session is free.


i wish their could be discussion on comparisons of LEO,MEDIC AND FIRE as related to PTSD. NOT WANTING TO "MEASURE SHOE SIZES", BECAUSE FULL BLOWN BATTLE IS SLIGHTLY DIFFERENT THAN OTHER  EMERGENCY FIELDS. I put 21 years in as FIRE,BODY RECOVERY,RESCUE,MEDIC AND 12years LEO. MY DEPT FOUND OUT I WAS DOING WHAT I THOUGHT WAS RIGHT IN SEEKING CBT AND MEDS ON MY OWN. THEY GAVE ME THE OPTION PLAN OF RESIGNING OR GETTING FIRED. I LOST ALL BENEFITS AS I WAS CAPABLE  OF WORKING ON A NON FULL TIME BASIS ELSEWHERE. I WAS CRUSHED,EMBARRASSED, BROKE, AND DENIED BENEFITS.I was swept under the rug. All I wanted was fair,human benefits to pay for complete loss of retirement due to medical bills. Instead, I was treated like a diseased liability. I wonder if the new affordable care act will help??Hmm..i think i know the answer.All I wanted was to help and now my hand is out streched, and no one will help. I was punished for trying to help myself because of the stigma.I'm 42 and short of the lottery,I gave all i could for nothing 


Why is PTSD a " stigma " ? Is it because the army doesn't want to pay for therapy , and therefore it doesn't exist ?


A few thoughts. 

First about Stigma.  Mr. Jamison ... given that you are a Marine and a former active duty Intelligence Officer - would you, if depressed or had experienced a traumatic event that significantly impacted you such that you were struggling at work, in your relationships and with your overall functioning, - seek counseling inside the system?  And if so - I'd be interested in how you might have dealt with the security form/clearance issue.  Would you lie on your clearance form (and risk being caught lying on a security clearance form) OR would you answer that you had, in fact, sought counseling and risk that impacting your clearance?  Your response could serve as some good concrete advice for service members struggling with this issue.   Folks feel between a rock and a hard place.

Second – PLEASE know- that Cognitive Processing Therapy and Prolonged Exposure Therapy are not for everyone ... it truly depends on the 'type' and meaning of the trauma experienced.  In my experience - to rely on these methods applied 100% of the time as intact protocols and not nuanced and flexed to meet individual need, can cause greater injury.  Aspects of “so-called innovative treatments” (as you state)  such as learning to modulate breath in YOGA can actually serve a very practical and concrete skill that can be integrated into a treatment like CPT or PE, as it is very important that the processing and exposure is done in an optimum state of arousal.  Learning breath technique can help with arousal modulation, which can create an environment such that processing and exposure are more effective, leading to better treatment outcomes.  Read about it.

Third, as bobdebarb points out,   not everyone’s PTS (D) or “Depression” is combat related.  Combat PTS (D) is very real, of course, AND so is Major Depressive Disorder or PTS (D) that is a result of something other than combat.  Whenever I’ve offered up to a service member … “Do you think that maybe you are depressed?  It sounds to me like you are,” then go on to articulate why I’ve formed this opinion – the look on that service member’s face is sadness – but mostly resonance, and relief. 


What about PTSD from sexual assault? An estimated 1 in 5 female veterans have been assaulted during their service. And yet there is absolutely no support for people who have PTSD from sources other than combat. If servicemembers were provided the support and, just as importantly, the PRIVACY they needed to heal more of them would step forward for help. The same is true for depression. Not everyone can link their sadness or troubles to combat, and yet the only acceptable way to reach out for help is if you have combat related PTSD. I will continue to bang the drum: if the DoD truly wants those who *need* help to get help, they need to broaden their outreach beyond combat related PTSD to those issues such as PTSD from sexual assault and ordinary depression. But they are too busy congratulating themselves on how awesome they are doing with combat related PTSD. Meanwhile the suicide rates continue to climb while they ignore the bigger issue.

Destigmatize depression as well as sexual assault related PTSD. Allow those servicemembers to get the help they need without having to report it on their security clearance (i.e. stop treating people as suspect if they seek treatment. All you are doing is convincing people that if they get counseling they are potentially ending their career. No many how many times you say "counseling, in and of itself, is not a reason for clearance denial" as long as you ask the question you are implying there is something suspect about them if they seek help).


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