Leadership not Lexicon Will Break the Stigma of PTSD.

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My colleague Mark Thompson has mounted three posts mentioning Post-Traumatic Stress Disorder today. I’m not shooting for the superfecta, but I do want to comment on a point Mark made

As I noted in one of my earliest posts here on Battleland, I have struggled with mental health problems.  My PTSD diagnosis came in 2002 while I was serving in Afghanistan. I was a mobilized Army reservist, a field-grade officer and subject-matter expert ordered to join a regular Army unit fighting in Afghanistan. In Army culture, especially in the elite unit filled with rangers and paratroopers in which I served, asking for help was showing weakness. My previous tours in Airborne and Special Operations units, all my qualifications and awards, my skill and knowledge—none of these would matter. To ask for help would be seen as breaking.

I  staggered around the base for weeks, operating on a couple hours sleep a night, my head filled with visions of the dead, avoiding interaction with my comrades. Sometimes, when my entire body would be trembling and the images crashing into my consciousness, I would have to hide, shaking and crying, in the concrete bunkers between our tents. All the while I was making decisions that put peoples’ lives in danger.

When I finally sought help, one of the first questions I got was, “Are you a danger to yourself or anyone else?”  I didn’t think I was a danger to myself. But even after several cycles of treatment and long periods on medication, four years later I sat alone in another desert thousands of miles away with a pistol in my hand ready to put it in my mouth and pull the trigger.

So what? Well, all of this throat clearing is as way of saying that I have skin in the game. So I’m interested when I hear Admiral Mullen drop the “D” off of PTSD and use the term Post-Traumatic Stress because he wants to lower the stigma of asking for help.

I get it. I understand their desire to reduce the stigma of PTSD. But the way to do this isn’t by changing the medical lexicon. Leave that to the developers of DSM-5. The stigma attached to asking for help isn’t a medical problem. It’s a leadership problem. From the fire-team leader to the four-star combatant commander, leaders have to change the way the military thinks about PTSD.

A friend who is a Special Forces warrant officer told me how his detachment commander debriefed his team on their arrival in the U.S. The captain stood at the front of the bus carrying the men to their unit from the airfield and said something to the effect of “I’m required to inform you all that if you need mental health counseling it is available at any time. Speak up if you think you need help. OK, no takers, right? Good.” This type of mockery is not unusual.

Soldiers who ask for help risk their careers. Soldiers who approach their chain of command risk ridicule, accusations of malingering, or worse. At Fort Carson a soldier was accused of cowardice when he asked for help with PTSD. Soldiers who approach the medic know that their conversation is only partially protected. A doctor has a responsibility to the military and to the patient.

Sometimes, soldiers who are known to be instable deploy with their units but find their weapon rendered inoperable so they can’t harm themselves or others. Of course, they won’t be much help in a firefight either.

This is a leadership problem. The military needs to disabuse its troops of the idea that mental health problems are any less real or grave than any other health concern.

The services have made progress. Many soldiers feared asking for help because they worried they would lose their security clearance – a real worry. The Department of Defense changed Question 21 on the security clearance questionnaire. This helped, but only a little. Security screeners still routinely ask improper questions about mental health issues. In the past couple years, two Army generals have come out about their own struggles with PTSD. This might make it easier for others to come out, too.

Around the services today, service members are learning the rules on how to work alongside openly gay comrades. Senior leaders can break the stigma of mental health disorders the same way: through a program of education, by setting standards and enforcing them, and through leadership at all levels.