Combat’s Toll on Caregivers

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The tragic case of former Army psychologist Captain Peter Linnerooth reveals that wars don’t spare those there to help their comrades.

There have been numerous reports on suicides in active duty troops. Another report is hitting the streets Tuesday about the highest (again) suicide rate in U.S. military history — 349 suicides in 2012.

Less has been written about the effects of the suicides on their caretakers. When a patient suicides, as happens too often, it is devastating for their caretaker. Lots of investigations, reviews of records, self-recrimination: should I have done something differently?

“When my patient shot his wife and then himself, it made me feel how hard it is to predict, in a population chronically at high risk, who will ultimately lose control and who won’t,” says Dr. Chris Nelson, a civilian psychiatrist at Camp Lejeune, N.C. “You go into the clinic thinking, `Is he next?’”

Military mental health workers—Army, Navy and Air Force psychiatrists, psychologists, social workers and others—also face combat situations. When they return home, instead of returning to a lighter garrison schedule, they find themselves back in the clinic again. There they listen and treat the Soldiers and Marines, re-living the tales of war and gore. Caregivers are clearly not immune to the strain on their marriages, and the tension of not knowing then they will deploy again. Quietly they joke about their own Post-Traumatic Stress Disorder.

Leadership knows about these stressors and strains and tries to do something about them. Back in 2008, the Army surveyed its own workers for compassion fatigue. Overall, the medical force was doing well. A notable exception was for mental health clinicians, especially those who had deployed. While Dr. Linnerooth deployed and ended up with PTSD, he never lost a patient to suicide. “He was often called to the aftermaths of suicides, to provide counsel, etc.,” says Brock McNabb, who served alongside him in Iraq as a combat medic. “But never lost one of his own guys.”

Unlike Dr. Linnerooth, who repeatedly sought help, most clinicians are resistant to going into therapy themselves. They fear, as do all Soldiers, the effects on their careers. They know about the electronic health record, which allows other people with the right credentials to access all health records.

After 11 years of war, it is a very tough world for military mental health clinicians, many with PTSD themselves. They are a tough lot. They weep quietly, or not. But how long can they keep it up?