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Sunday, October 14, 2007

As Combat PTSD Stigma Ebbs, Funding Fight and Political Disillusionment Flow

Today's New York Daily News quotes two highly-decorated veterans appointed to the House Veterans Disability Benefits Commission.

They've spent over two years studying the problems of the Veterans Administration health care system. In discussing their 113 recommendations (released earlier in the month), comments by one of its distinguished members, retired Marine Maj. Gen. James Livingston, brought to focus how far we've come in our work to destigmatize combat PTSD:

They were an unlikely bunch of soldiers to be making the case for the "talking cure" before Congress last week. They once dismissed it as a copout for shirkers and wimps.

"Absolutely, we've gone through a transition" over the years, said retired Marine Maj. Gen. James Livingston, who wears the Medal of Honor from Vietnam. "Now I'm a believer in early intervention" by therapists in the treatment of post-traumatic stress disorder, the diagnosis for what was called battle fatigue or shell shock in wars gone by, Livingston said.

While we've made great inroads (especially considering that a rough, tough guy like Livingston has come full-circle in his attitude towards the psychological wounds of war), the truth is that our changed attitudes are worthless if we don't follow up with the proper response.

In educational interest, article(s) quoted from extensively.

Proper response means we make sure that we not only learn from all of these time- and resource-consuming studies, but also that we act on what we've learned. That means putting informed recommendations into action. That means funding these valuable recommendations fully and not being insincere about how we as a nation say we support our military families.

But as we move forward in destigmatizing the way many of us think about combat PTSD, we haven't even begun the work of dealing with another very real stigma against those vets who dare to say that part of their combat PTSD is related to disillusionment with the war that they participated in.

From the Department of Veterans Affairs Iraq War Clinician Guide:

Over time, soldiers develop a belief system about themselves, their role in the military, the military culture, etc. War can be traumatizing not only because of the specific terrorizing or grotesque war-zone experiences but also due to dashed or painfully shattered expectations and beliefs about perceived coping capabilities, military identity, and so forth."

'So forth' can include becoming disillusioned with the war itself.

And that 'so forth' can include disillusionment with the way they're treated once they get back home.

If we learned nothing else from the experience of Viet Nam veterans, it is this: Disillusionment with the reality of war and its aftermath and the role individual soldiers play in it is as much a part of combat PTSD for some as are flashbacks or nightmares of blood and gore, or grief and guilt over the loss of battle buddies and admired leaders.

Let's take a look at these two issues, 1) putting our money where are mouths are when it comes to funding and acting on what we've learned and 2) allowing returning troops the nonjudgmental space to process their experience candidly without stigmatizing those who have returned disillusioned and perhaps even bitter about the war they fought in.

Continuing from the Daily News:

The VA system is overloaded. Waiting periods for appointments at VA regional centers now average 177 days. At Veterans Benefits Administration offices, which assign disability ratings, the waits stretch to more than two years.

But they were told that money was tight for what they proposed. "We must deal with funding issues," insisted Rep. Stephen Buyer (R-Ind.).

Livingston said the money must be found, the PTSD programs must be funded, or the nation will risk decimating the all-volunteer force.

"People have to know they're going to be taken care of," Livingston said, or "moms and pops are not going to allow their kids to join the military."

He reflects on lessons learned:

"Well, you remember what it was like" for Vietnam veterans, Livingston said to this reporter, who served with him in the 2nd Battalion, Fourth Marines, before the battle of Dai Do on May 2, 1968, where he earned the Medal of Honor.

Leading Echo Company, then-Capt. Livingston attacked the fortified village with 180 Marines. He was wounded three times and there were 35 Marines standing after Echo took the village and fought off a ferocious counterattack.

"I always thought after Dai Do it would've been good if we could've sat down and talked about it," Livingston said. "But in those days it was all macho," he said. "You didn't want to admit anything. If you did, you were a battlefield wimp. Well, been there, done that.

"I'd like to think we're a lot more mature in our thinking. Bottom line, somebody's got to give a damn."

Showing our military families that we care about them means that we have to deliver on the promises made to them.

So far, that response has been a hollow, underfunded one.

In addition, society can often place added burdens on its returning troops by expecting them to think and act a certain way. Pro-war soldiers are given the spotlight while anti-war soldiers are often stigmatized and shunned. They make us uncomfortable.

But here's the question: Do returning veterans who have uncomfortable-to-some political arguments against the war deserve the space to share their feelings with us without our condemnation? Or should they be expected to go away or even shut up so that the rest of us don't have to grapple with their issues and concerns?

So far, we have had a relentless two-faced approach towards matters concerning our troops. We say we support them, yet we've allowed them to serve in combat zones without proper equipment. And we've stood by and watched as they return home with insufficient periods of rest between deployments and to underfunded programs they and their families need.

Might any of this further anger or disillusion them?

The fact is that combat PTSD is not merely a reaction to the sight of blood or the grief of losing a comrade.

What they've witnessed and seen and experienced when they were away plays a starring role, of course. But their inner turmoil can't help but be exacerbated by frustration with a system that makes them wait years to get a claim heard or months to get an appointment for care when they come home.

Let's give our veterans the funding they deserve.

And let's give them the freedom they need to express themselves, no matter what direction their views take. They're the ones with real skin -- and heart and soul -- in the game.

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