Behavioral Health Articles
Invisible Wounds
by Fred Bush and Erick Roat
When we think of a wounded Serviceperson, many will think of the Soldier with an amputation or other outward visible injury. We take for granted that people with such injuries might have a difficult emotional time re-integrating into civilian life. We understand if they feel withdrawn or depressed, or if they are hesitant to go into certain social places such as the mall. We aren't surprised if these soldiers jump at loud noises, have nightmares or trouble sleeping, or have a "short fuse." But what about the Serviceperson who has inward, invisible wounds? Do we recognize that their experiences are "worthy" of respect, understanding, and support?
The reality is that, like veterans of other eras and conflicts, many of the 1.6 million Service Men and Women who have served in Iraq, Afghanistan, or in support of those operations, will experience either a mental illness or isolated symptoms such as those described above. All will have a period of transition, but not all will need help. For some, these difficulties will be manageable without the help of mental health services, although they may be unpleasant and stressful. Others may develop an actual disorder such as major depressive disorder, Post-Traumatic Stress Disorder or other syndrome, and may experience serious difficulties returning to and functioning normally in old roles and relationships.
Unfortunately, it is not uncommon for those who do not access care to turn to other ways of dealing with their symptoms. Some choose to use alcohol or illicit drugs to self-medicate. Others may find themselves socially isolating themselves, or having a brush with law enforcement. Accessing care can help these warriors draw upon their strengths to learn healthy ways to manage their symptoms and achieve personal growth from the experience; however, the stigma of mental illness, and that of receiving mental health services, remains a formidable obstacle. Early data suggests that only about 1/3 of returning Servicepersons will seek mental health intervention. Some may be unwilling or unable to access these services, even though they could benefit from them. Two prominent obstacles are fear of stigmatization by others and self-stigma: stereotypes and prejudices turned against oneself. Both are prevalent in military culture.
Servicepersons often feel that while a physical injury is "respectable," cognitive or emotional symptoms connote "weakness." Military training emphasizes working through fatigue, injury, and emotions to accomplish the mission. Admitting that there is a problem may feel like admitting an inability to accomplish the mission. Some fear an early end to their military career, or being passed over for promotion, because they access mental health care. Others report that they are afraid that they will be "locked up” or "doped up." Most have no experience speaking with a mental health professional and do not understand that they will work with the provider as part of a team. Finally, the tradition of stoicism and toughness prevalent in military culture can prevent people from getting help or even recognizing that there is a problem: "I didn't die in combat, so this won't kill me either." Misperception, stigma and fear can lead to silent suffering rather than treatment that can help Servicepersons live a full life.
Fortunately, typical Servicepersons of this generation are being asked about their mental health more frequently than any other generation. Screening for mental health issues upon returning from a combat mission, after deployment, and at regular intervals after serving in combat can help detect problems early. Accumulating data about the experiences of returning service persons is helping us to understand what our soldiers and veterans face. We know that many people will experience a "honeymoon" period after returning home and may not experience difficulties and negative emotions until months later. Often, the emotional challenges of coming home will subside with time and require only the natural support of one's friends and family. When they don't, or when these emotions interfere with a person's ability to lead a normal healthy life, it is time to seek professional help.
Educating families, community leaders, and others about the rigors of readjustment, techniques for supporting veterans' needs, and ways to recognize signs of stress and mental illness, is key. People around the Serviceperson are able to help them understand that they shouldn't feel pressured to hide symptoms or problems or to "tough it out"; that it is a brave act to ask for help when it is needed and a greater sign of honor to face the challenge of these emotions than to avoid them.
Fred Bush, LMSW, is the Returning Veterans Mental Health Coordinator at Syracuse VA Medical Center.
Erick Roat, Ph.D., is the Syracuse VA Recovery Coordinator at Syracuse VA Medical Center.