Remember the Survivors

It is important to remember that soldiers operate in an environment beyond our comprehension. Our current mission in Iraq is ill defined and the enemy unseen. Daily existence under such circumstances can’t help but grind away at one’s humanity. Furthermore, immoral leadership from the top condoning torture (Bush’s so-called “regrets” notwithstanding) has filtered down to the ranks.

The recent allegations of cold-blooded murder perpetrated upon Iraqi civilians by American soldiers are the direct result of the Bush Administration’s moral bankruptcy. Atrocities happen in all wars on all sides but this may be the tip of the iceberg and only what has been exposed to date. Yet while their actions should not be excused, the real blame for their crimes truly resides with the political leadership that launched an illegitimate war. Both Iraqi civilians and American soldiers are victims of George Bush’s foolish imperialism.

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When otherwise morally upstanding people are compelled to behave immorally their souls is damaged. The stress of combat is horrific enough. Supplementing that trauma with the lingering despair of guilt is irreparable.

The mental anguish resulting from combat is well chronicled. After the Civil War, it was known as “soldier's heart.” In World War One it was labeled” shellshock.” Veterans of World War Two and Korea were described as suffering from “battle fatigue.” After Vietnam it became Post Traumatic Stress Disorder (PTSD).

The American Psychiatric Association officially acknowledged PTSD in 1980. Symptoms include emotional numbing, quick tempers and re-experiencing traumatic situations through flashbacks. Such Symptoms may not surface for years but emerge with a disruptive vengeance.

People with acute PTSD typically recover in three to six months, but chronic PTSD can remain for decades. Combat situations in Afghanistan and Iraq are already generating psychological casualties at an alarming rate.

A study by the Walter Reed Army Institute of Research conducted in 2003 and
published in the New England Journal of Medicine in July 2004, found that 15% to 17% of returning Iraq veterans showed symptoms of PTSD, anxiety or depression. Another 11% of Afghanistan vets showed the same symptoms. Since that study was published the situation on the ground in both Iraq and Afghanistan has worsened and one may surmise the PTSD rate will increase over time.

One tragic victim of PTSD was Jeffrey Lacey. His highly publicized suicide was hauntingly described by the January 2006 edition of the Physchiatric Times:

“When he returned home to Belchertown, Mass., he began drinking heavily and suffering from insomnia, night sweats, hallucinations and panic attacks. He received treatment at a Veterans Affairs facility, where he was described by one physician as having PTSD, depression with psychotic features, suicidal ideation and acute alcohol intoxication. One day, Lucey's father came home to find his son had hung himself in the cellar. On Lucey's bed were the dog tags of two unarmed Iraqi prisoners he said he had been forced to shoot.”

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Sadly, the improved performance of our military’s medical personnel in saving lives from physical injuries has served to increase the percentage of veterans victimized by PTSD. It is imperative to recognize that any soldier returning from war is forever changed and may need support to reintegrate with civilian life again.

That requires funding to provide the Department of Veterans Affairs (VA) infrastructure and trained personnel equipped at treating this disorder. In September 2004, the Government Accounting Office reported that,

“The VA does not have a count of the total number of veterans currently receiving PTSD services at its medical facilities and Vet Centers — community-based VA facilities that offer trauma and readjustment counseling. Without this information, VA cannot estimate the number of new veterans its medical facilities and Vet Centers could treat for PTSD.”

As the aforementioned January 2006 article in the Psychiatric Times reported, in August 2005 the VA, acting on its Inspector General (IG)'s report, said it would audit files of 72,000 veterans who were receiving full disability benefits for PTSD. Veterans groups protested that the review of PTSD cases was simply a pre-text to cut benefits for older veterans and raise the bar for future ones. Thankfully, the VA dropped its audit plans in November 2005 stating that most of the problems did not result from fraud.

However, the VA's auditing controversy illustrates that Republican fiscal mismanagement is forcing older and younger veterans to compete for a shrinking pie. On March 1st, American Association for Geriatric Psychiatry (AAGP) President Christopher Colenda testified before the House of Representatives Appropriations Subcommittee on Military Quality of Life and Veterans Affairs, and described the challenges confronting the VA:

“Of the nation’s 25.5 million veterans, nine million—approximately 35 percent—are seniors who served in World War II or the Korean War. Another eight million Vietnam era veterans are will soon join the population of older adults, a phenomenon of the Baby Boom generation that begins turning 60 this year and will have a massive effect throughout our society. In this context, it is important to note actions relating to late life mental health addressed by the White House Conference on Aging, which was convened by President Bush in December 2005. Recognizing the current health and mental health needs of older Americans and the challenges awaiting as the Baby Boom generation ages, delegates placed mental health and geriatric health professional training issues at the forefront by voting them among their top 10 resolutions. The VA must be able to provide the specialized care in geriatric mental health that this generation of aging veterans will need and deserve.

More than half a million veterans are 85 years of age or older, and the VA predicts that this oldest group will grow to 1.2 million by 2010. Historically, as many as one-third of all veterans seeking care at the VA have received mental health treatment, and research indicates that serious mental illnesses affect at least one-fifth of the veterans who use the VA health care system. In addition, those who are older often suffer from co-existing medical conditions such as heart disease, hypertension, diabetes, lung disease, debilitating arthritis, or other conditions. For these patients, treatment of their medical illnesses is often complicated by psychiatric disorders. Conversely, their psychiatric care is more complex because of the co-occurrence of medical illness, which commonly requires treatment with multiple medications. Thus, for older veterans with mental health problems, psychiatric treatment must be integrated and coordinated with their general medical care needs.

Between the years 1990 and 2000, the number of veterans in the 45-54 year-old age group who received mental health services from the VA more than tripled. The Vietnam era veterans are entering late life and are a cohort bringing new challenges to the VA, such as Post-Traumatic Stress Disorder (PTSD) in the elderly and perhaps a higher burden of substance abuse. Not only does the VA need to prepare for services for these challenges, it needs to allocate funds for research as well.

As the nation pursues the war in Iraq, thousands of younger veterans may soon turn to the VA for the special care and services only it can provide. All of these individuals will swell the ranks of those who will ultimately require geriatric care. However, the most rapid growth in demand during the last decade was among the oldest veterans. During that time, there was a four-fold increase in the number of veterans aged 75-84 who received VA mental health services.

This substantial increase in utilization is even more striking when one considers that research has revealed an ongoing problem with under diagnosis of mental disorders in older age groups. Despite the increasing need for coordinated mental health and general health care services for rapidly growing numbers of older veterans, funding for VA mental health services, training, and research remains disproportionately low and is inadequate to meet the needs of the aging veteran population.”

Early in 2005, President Bush opted to expend his "political capital" on hyping a generational crisis with Social Security that did not exist. Thanks to his misguided foreign and domestic policies a real generational crisis is manifesting itself among those Americans who have sacrificed the most for our freedom. Meanwhile, the rest of us exist in a sea of relative tranquility and Memorial Day is simply a warm weather respite. Just one of many sins committed during America’s current reign of indecency.
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SIDEBAR: Special thanks to cyperspace compadre Bob Higgins who kindly displays my posts on his blog, Worldwide Sawdust. Bob's prose is both irreverent and poignant. My favorite example of Bob's work was his April 30th post entitled "Guernica."