ptsd

[1] Journalistic Source: Mainstream

Alvarez, Lizette and Frosch, Dan. “A Focus on Violence by U.S. Soldiers Back from War.” International Herald Tribune 2 Jan. 2009: A1

Part 1: Source Analysis

The International Herald Tribune was founded in 1887, and is currently owned by The

New York Times Company (www.ulrichsweb.com). It is an international weekly consumer

newspaper, printed in 33 sites around the world, with a circulation of 234,722

(www.ulrichsweb.com). The magazine’s website states that it is the “Global Edition of the New

York Times” and its audience is international (www.iht.com). Lizette Alvarez is a national

correspondent for The Times who covers the home front and other military related stories

(www.iht.com). Dan Frosch is a former staff writer for the Santa Fe Reporter and currently a

New York-based freelance writer for The Nation, and other publications (www.metroactive.com)

Part 2: Main Assertions

Alvarez and Frosch say that violence and crimes committed by returning service

members has risen since the start of the Iraq war. They discuss how the military is finally shifting

attention to what is causing these crimes to be committed by soldiers returning from duty; a

connection to war that has been majorly deflected since the war started. They use specific

occurrences at military bases and assertions by veterans to support their claims and opinions. The

information presented in the article describes how many soldiers knew they had a problem and

tried to seek help, but were not given adequate treatment or support. Major issues such as

multiple deployments, combat trauma, post-traumatic stress disorder, along with combat injuries

have been linked to the cause of the instability of many soldiers.

1

Part 3: Strengths and Weaknesses in Logic

While analyzing what appears to be reliable statistics and assertions, Alvarez and Frosch

present the reader with multiple accounts of violence and crimes occurred by soldiers returning

home and the reasons behind such actions. By using first-hand stories as well as statistical

evidence, they allow the reader to connect with the situations and ultimately strengthen their

claims being made. Alvarez and Frosch clearly define the links between mental health and

combat and assess the reasons for such issues arising. They strengthen their assertions by

referring to veterans and other military officials who have witnessed such links and problems.

When referring to first-hand accounts and current incidents of violence, Alvarez and Frosch fail

to identify the possibility of other factors affecting the actions that were made. This weakness is

made evident when they assert to mental illness as the main reason for the violence and crimes

being committed but never addressed subsequent causes. This article will be useful because it

serves as the basis of my topic and addresses mental stability as a main cause of violence and

crime among soldiers returning from combat.

Part 4: Comparisons and Contrasts

Alvarez and Frosch claim that violence and crimes committed by soldiers are linked to

mental illness and have risen since the start of the war which compares with Bowman [28] and

Alvarez [5] who conclude the same findings and opinions. The article contrasts with Johnson [8]

who claims that mental illness alone is not a leading cause for violence and crime.

Part 5: Uses in Essay

I will use this source in the third sub issue of my essay to explain about violence and

crimes committed by soldiers.

2

[2] Journalistic Source: Alternative

Montgomery, Nancy. “Military Aims to Remove Stigma From Seeking Therapy For Post-Combat Stress.” Stars and Stripes 4 Aug. 2005.


The Stars and Stripes is an independently owned, daily military consumer newspaper

with a circulation of 92,000 (www.ulrichsweb.com). According to the magazine’s website, Stars

and Stripes is authorized by the Department of Defense and is distributed overseas for the U.S.

military community (www.stripes.com). What makes it unique is it operates as a First

Amendment newspaper, free of control and censorship allowing the military community to stay

informed and exercise their citizenship (www.stripes.com). The Stars and Stripes audience is the

military community, specifically during times of war or conflict (www.time.com). Nancy

Montgomery has written several articles for the paper about issues with post traumatic stress

disorder and mental illness in the military (www.stripes.com). She is also a photographer and

takes pictures for her articles as well as other news stories for the publication (www.stripes.com).


Montgomery says that there is a significant barrier to soldiers seeking mental health care.

Several soldiers discussed their belief that seeking mental health care will harm their military

careers and stigmatize the armed forces members as weak. Another issue brought up was many

soldiers felt their commanders would treat them differently, like a weak link, if they saw a

counselor for mental health. Researchers are trying to determine which of the many terrible

things combat soldiers experience are most linked with post-traumatic stress syndrome, the

leading cause of mental instability and whether pre and post deployment mental health

screenings will help limit the barrier soldiers feel for seeking treatment.

3


Montgomery succeeds at providing numerous viewpoints in her article regarding the

stigma attached with mental illness in the military. By using opinions from actual soldiers who

served in combat she gains evidence that there is a stigma attached and supports her assertion

that that there are barriers to treatment. What strengthens her article is her use of researchers

alongside the soldier reports, which provides an alternate viewpoint using statistical evidence

that the stigma associated with mental illness has lessened due to increased outreach, education

and mandatory screenings. Montgomery briefly addresses the certain aspects of the claimed

stigmatization, such as being perceived as weak, but fails to go into depth on the reasoning

behind such believes. By not providing background information on why such believes exist, her

article is weakened and leaves the reader with a lack of knowledge about the issue. This article

will be useful because it analyses in depth the perceived stigmatization attached with mental

illness in the military and what is being done to break down the barriers.


Montgomery’s main assumption that there is a significant stigmatization and barrier for

soldiers seeking mental health care compares with numerous sources but matches up most with

subcommittee hearing [17], Bowman [28] and Britt [21] who claim stigmatization is a significant

problem. The article contrasts with Carolla [22] who makes claims that certain factors such as

insurance or accessibility are not a barrier.


I will use this source in the discussion section of my essay to assert that there is a stigma

associated with mental illness in the military.

4


Chedekel, Lisa and Matthew Kauffman. “Special Report: Mentally Unfit, Forced to Fight”. TheHartford Courant 14 May, 2006.


The Hartford Courant is a daily newspaper with a circulation of 207,000

(www.ulrichsweb.com). The paper was founded in 1764 and is currently the oldest continuous

publication in the country (www.courant.com). The publication is owned by the Tribune

Company and according to its website its mission is to maintain the highest standards

of ethics, accuracy, fairness, service and timeliness (www.courant.com). Lisa Chedekel is a

Courant staff writer who was recently a finalist for the 2007 Pulitzer Prize in investigative

reporting along with fellow staff writer Matthew Kauffman (www.wesleyanargus.com). Their

coverage on the “Mentally Unfit” series won awards including the George Polk Award for

Military Reporting, and the Selden Ring Award for Investigative Reporting and also helped

spark a firestorm among the government and medical community (www.wesleyanargus.com).


Chedekel and Kauffman assert that the U.S. military is keeping soldiers in combat and

sending troops with serious psychological problems back into Iraq even after superiors have been

alerted to suicide warnings and other signs of mental illness. They refer to specific soldier cases

and investigated the military’s increased reliance on anti-depression and anti-anxiety medications

used to treat mentally unstable soldiers in the war zone along with inadequate counseling and

monitoring of those medicated individuals. They concluded that the military has increasingly

kept, sent and recycled troubled troops into combat and those practices have fueled an increase in

the suicide rate among troops serving in Iraq.


Chedekel and Kauffman’s assertions are strong and to the point and are supported by

their conducted investigation in which they found evidence of the military sending troops back to

combat despite mental illness. By conducting their own in depth investigation, and referring to

specific cases of soldiers that had been a part the issue, Chedekel and Kauffman provide the

reader with a well built analysis of the problem with valid viewpoints. This is the greatest

strength of the article. They assert to numerous sources allowing the validity of their claims to

strengthen. Although strong assumptions and evidence are presented to the reader, Chedekel and

Kauffman fail to address other circumstances causing increased mental illness and suicide rates

upon soldiers. By placing the entire blame on the military redeploying troops, they pose an unfair

assumption and disregard any other plausible cause, ultimately weakening their conclusions.

This article will be useful because it provides a strong evaluation on the rise of soldier suicides

and the causes and problems arising from redeployments of soldiers.


Chedekel and Kauffman’s main assumption that the military is re-deploying soldiers who

are suffering from mental illness compares with Merzenich [32], Kennedy [7] and Adam [31],

who claim that suicide rates and PTSD are rising because of this issue. The article contrasts with

the Assistant Secretary of Defense for Health Affairs [18] who listed requirements and policies

on deployment limitations for soldiers suffering from mental illness.


I will use this source in the second sub issue of my essay to support limiting the number

of deployments and length of deployments.


Schaffer, Amanda. “Not a Game: Simulation to Lessen War Trauma.” The New York Times 28 Aug. 2007.


The New York Times was founded in 1851, and is currently owned by The New York

Times Company (www.ulrichsweb.com). It is a daily consumer newspaper, with a circulation of

1,118,565 (www.ulrichsweb.com). The New York Times reports on regional, national, and

international news events and its audience extends worldwide (www.ulrichsweb.com).

According to its website, the newspaper has won 120 Pulitzer Prizes and is the largest

metropolitan newspaper in the United States (www.nyt.com). Amanda Schaffer is a graduate of

Harvard University with a degree in the history of science (www.amandaschaffer.net). She

writes for Slate magazine as a science and medical columnist and frequently contributes to the

New York Times science section (www.amandaschaffer.net).


Schaffer asserts that through Virtual Iraq, a simulation created to treat Iraq war veterans

suffering from post-traumatic stress disorder, veterans can begin to reprocess traumatic events

and become desensitized to them, perhaps suffering fewer side effects. She goes on to discuss

how exposure therapy, in which patients are asked to confront memories of a trauma, has long

been a first-line psychological treatment for PTSD. Psychologists supported that encountering

sights, sounds, and smells that evoke painful memories through new virtual reality may make

exposure therapy more effective and reduce effects such as insomnia, nightmares and flashbacks.

Shaffer concludes with a scientist who believes this therapy may not be enough for veterans with

complicated symptoms but it is better to receive some treatment now, rather than 20 years down

the road.


Schaffer presents unsupported assertions from different scientists and jumps between a

number of conclusions. This is the major weakness of the article. Although she presents the

virtual Vietnam simulation as a new and effective treatment for PTSD, she provides no factual

evidence to support that it is indeed better than other treatments. Failure to compare the new

treatment with another questions its true effectiveness. One of Schaffer’s strengths is providing

numerous opinions from psychologists and scientists throughout the article. Although some

contradict each other, the different opinions strengthen the simulations pros and cons and allow

for the audience to make their own judgment. All the scientists introduced agree that exposure

therapy is one of the best forms of treatment for PTSD and Schaffer does a good job in leaving

no questions that treatment should be administered sooner rather than later to prevent worse

symptoms from occurring. This article will be useful because it presents current technological

steps that are being taken to advance treatment and rehabilitation for soldiers suffering from

PTSD.


Schaffer’s main assumption that through Virtual Iraq and other simulation treatment

technologies, veterans can begin to treat their illness with a new effectiveness, compares with

Marble [19] in regards to new Army policies and also source [10] in regards to treatment

strategies; it contrasts with Coleman [13] who asserts that society is not putting mental illness

treatment as a priority.


I will use this source in the discussion section of my essay to explain new technology and

treatments implemented to treat PTSD.


Alvarez, Lizette. “After the Battle, Fighting the Battle at Home.” The New York Times 8 July. 2008.


The New York Times was founded in 1851, and is currently owned by The New York

Times Company (www.ulrichsweb.com). It is a daily consumer newspaper, with a circulation of

1,118,565 (www.ulrichsweb.com). The New York Times reports on regional, national, and

international news events and its audience extends worldwide (www.ulrichsweb.com).

According to its website, the newspaper has won 120 Pulitzer Prizes and is the largest

metropolitan newspaper in the United States (www.nyt.com). Lizette Alvarez is a national

correspondent for The Times who covers the home front and other military related stories

(www.iht.com). She has written numerous military based articles including a special series

entitled “War Torn” that covered veterans of the wars in Iraq and Afghanistan who have

committed killings, or been charged with them, after coming home (www.nyt.com).


Alvarez asserts that alcohol and illegal drug abuse is rising among veterans of combat in

Afghanistan and Iraq and is in turn increasing domestic violence and suicides. She states that

experts indicate the problem is particularly prevalent among those suffering from post-traumatic

stress disorder, which raises awareness and concern about access to treatment and whether

combat veterans are receiving the help that is available to them. Alvarez uses numerous first-

hand accounts and stories to illustrate the current problem and concludes that the military is

facing a shortage of substance-abuse providers across the country, and its health insurance plan,

Tricare, is making it difficult for many veterans and their families to get treatment.


Although strong assumptions and evidence are presented to the reader regarding the issue

of substance abuse among soldiers, Alvarez fails to address the connection to post traumatic

stress disorder and other mental illnesses in more in depth. By briefly bringing up mental illness

as a factor, Alvarez leads the reader to question more about its role. Her failure of analyzing the

factor after addressing it ultimately weakens her article. Despite her lack of analysis, Alvarez’s

use of numerous first-hand accounts and stories of soldiers suffering from substance abuse is one

of the greatest strengths of the article. It provides the reader with a strong visual and relatable

depiction and helps support the arguments she asserts. Her reference to numerous sources allows

the validity of her claims to strengthen. This article will be useful because it addresses the issue

of substance abuse in soldiers and the lack of treatment being provided to soldiers.


Alvarez’s main assumption that mental illness is causing substance abuse to rise among

veterans, ultimately increasing domestic violence and suicides, compares with assertions made

by Bowman [28], Coleman [13], Page [30] and Arthur, Kenny and Adam [31], who all agree that

mental illness is a cause for violence, substance abuse, depression, and suicide. The article

contrasts with Johnson [8] who claims that mental illness alone is not a factor or cause of

violence or substance abuse but that other risk factors must be associated.


I will use this source in my third sub issue to discuss the rise in alcohol and substance

abuse by veterans suffering from PTSD.


Brook, Tom V. “Mullen: PTSD Screening for all returnees.” Army Times 13 Oct. 2008.


The Army Times is a weekly military newspaper with a circulation of 316,954

(www.ulrichsweb.com). It was established in 1950 and is currently published by the Army Times

Publishing Co. (www.ulrichsweb.com). According to the Army Times’ website, it is the trusted

resource in Army news and information for military personnel, and is packed with exclusive, in-

depth news and analysis about military careers and lifestyle (www.armytimes.com). Tom

Vanden Brook was a freelance reporter for numerous agencies but now serves as a Pentagon

reporter for USA Today (www.kellyaward.com). He has covered numerous articles on the

military and holds a master's degree in journalism and a bachelor's degree in history from the

University of Wisconsin (www.kellyaward.com).


Brook asserts that the Pentagon’s top uniformed officer is requesting all returning combat

troops, from privates to generals, to undergo screening for post-traumatic stress with a mental

health professional. He uses top military officials and current policies to support his argument by

stating that soldiers are examined by medical professionals for physical injuries, but not by

mental health experts for psychological injuries. If this was changed, Brook and the officers

believe screening to everybody will help remove the stigma of not-admitting psychological

problems for fear of showing weakness. Issues with the proposal included budget costs and lack

of mental professional staffing. Brook concluded that a mental health professional can detect

signs of post-traumatic stress very quickly and one on one screening will help remove the stigma

associated with getting mental health care.


Brook’s use of top military officials and current policies as references to his argument

helps strengthen the article by providing the reader with what seems to be reliable sources and

data. Using direct quotes and recommendations from a Pentagon military official emphasizes the

fact that mental health issues are being acknowledged and taken seriously by the government.

Brook also succeeds at addressing the complications surrounding the recommendation of

mandatory mental health screening proposed by the sources. By addressing counter arguments to

the proposed idea, Brook allows the reader to gain knowledge on the positive and negatives of

the issue. Although Brook addresses the complications, he fails to support them with facts or

evidence and merely provides assumptions, which weakens his stance. His failure to address

potential costs or timelines on the recommendations causes the article to lack important

information. This document will be useful because it provides a strong recommendation by top

military officials on changing current policies regarding mental health screenings given to

soldiers and why the changes should be made.


Brook’s main assumption that screening for PTSD with a mental professional should be

mandated to increase diagnosis and reduce stigma, compares with Friedman [9], Rona [12], and

Paulson and Krippner [14]. The article contrasts somewhat with subcommittee hearing [17]

which asserts barriers to implementing new screenings such as financial costs and staffing.


I will use this source in the discussion section of my essay to discuss removing

stigmatization through mandating mandatory exams with a physician.


Kennedy, Kelly. “Mental Health Worsens as Deployment Lengthens.” Army Times 26 Apr.2007.


The Army Times is a weekly military newspaper with a circulation of 316,954

(www.ulrichsweb.com). It was established in 1950 and is currently published by the Army Times

Publishing Co. (www.ulrichsweb.com). According to the Army Times’ website, it is the trusted

resource in Army news and information for military personnel, and is packed with exclusive, in-

depth news and analysis about military careers and lifestyle (www.armytimes.com). Kelly

Kennedy is a medical/health reporter for the Army Times and has also reported for the AP,

Chicago Tribune, the Oregonian, and NASA (www.dartcenter.org). She holds a graduate degree

in journalism from the University of Colorado and is currently at work on her first book: a

fictionalized account of her experience as a soldier in the first Persian Gulf War

(www.dartcenter.org).

Part 2: Main Assertion

Kennedy asserts suicides are rising among combat vets and mental health issues are

greater among those soldiers who deploy multiple times and for longer periods. She refers to a

survey done that released the information of soldiers and Marines and also gave

recommendations on how to fix the rising problems of suicide and mental health and what was

working and not working. Kennedy concludes with recommendations from the study suggesting

extending the time interval between deployments and shortening the length of deployments in

hopes of decreasing mental health issues and allowing adequate time for mental recovery.


Kennedy presents the audience with what seems to be reliable evidence from a survey

concluding that suicides are up among combat vets and mental health issues are worse among

those who deploy often and for longer periods. By focusing his conclusions and opinions on the

survey, Kennedy strengthens his article by allowing concrete research and evidence to back up

his claims. Another major strength of the article comes when Kennedy addresses the

recommendations made in the survey by mental health workers on how to resolve the current rise

in suicide rates and mental illness. This strengthens the article because not only is the evidence

supporting the rise in suicide rates presented, but ways of resolving the issue are acknowledged

as well. Although Kennedy presents different ways of resolving the rise in suicides and mental

illness among soldiers, the weakness of the article becomes apparent when he focuses the bulk of

recommendations on the re deployment factor. It provides the audience with a strong

understanding of how re-deployments play into the issue, but leaves the other factors lacking

information. This article will be useful because it provides statistical evidence of a rise in suicide

and mental illness in soldiers and addresses the issue of multiple deployments as a major factor.


Kennedy’s main assumption that the military should extend the leave time and shorten

the length of deployments compares with Chedekel and Kauffman [3], GAO [15], and

subcommittee hearing [17], who all assert a direct correlation between combat duty and risk

developing of mental illness. The article also contrasts with parts of subcommittee hearing [17]

where extending transition times would put more strain on the soldier to adjust back and forth.


I will use this source in my second sub issue to support shortening deployments.


Johnson, Carla K. “Mental Illness Alone is No Trigger for Violence.” The Associated Press 2Feb, 2009.


The Associated Press (AP) was founded in 1846, and is the largest and most trusted

source of independent news and information (www.ap.org). The AP is a not-for-profit

cooperative and is owned by its 1,500 U.S. daily newspaper members (www.ap.org). According

to its website the AP has received 49 Pulitzer Prizes and on any given day, more than half the

world's population sees news from AP (www.ap.org). Carla Johnson is an AP reporter and desk

supervisor at its Chicago branch (www.healthjournalism.org). She has specifically covered

health and medicine since 2001 and is a graduate of the Medill School of Journalism at

Northwestern University (www.healthjournalism.org).


Johnson asserts that mental illness alone is not a leading cause of violence. She refers to

studies done by researchers that showed people with serious mental illness, without other risk

factors, are no more violent than regular people. Instead, predicting violent behavior was more

relevant in factors such as age, history, gender, and substance abuse. One researcher assured that

the majority of violence in America has “nothing to do with mental illness”. Included in the

research addressed was a compiled list of the top 10 factors leading to the cause of violence.

Johnson acknowledged that severe mental illness and substance abuse were at the end of that list.

She concludes that while mental illness on its own was not a major factor in violence, when

combined with one of the other factors above, the risk of violent behavior increased dramatically.


Johnson’s use of researchers and current studies in her article helps provide statistical

evidence and opinions to back up her claim that mental illness is not a leading cause of violence.

By focusing her assertions on the conclusions of the studies she strengthens her article and gives

the reader reliable data to analyze. Although Johnson asserts that mental illness by itself is not a

leading cause of violence, she briefly acknowledges that when combined with another factor on

the list, violence increases dramatically. This assumption is the greatest weakness of the article

because she fails to continue and address why this is the case. Johnson’s failure at providing

information on why a combination of factors increases violence leaves the article with a gaps and

lack of relevant information. This article will be useful because it provides strong opinions on the

issue of violence and factors causing it, ultimately addressing that mental illness does not play a

large part.


Johnsons’ main assumption that mental illness alone is not a leading cause of violence

contrasts with Bowman [28], Alvarez and Frosch [1], and Arthur [31], who all assert that

psychological problems do in fact associate strongly with violence and substance abuse. The

article compares briefly with Carolla [22] when examining the differences between society and

the military.


I will use this source in the third sub issue of my essay to contradict that mental illness is

not a cause of violence.

[9] Academic Source

Friedman, Matthew J. “PTSD Among Military Returnees From Afghanistan and Iraq.” American Journal of Psychiatry April 2006: VOL 163; NUMB 4; pp. 586-593


The American Journal of Psychiatry is a monthly academic journal with a circulation of

46000 paid subscribers (www.ulrichsweb.com). The publication was founded in 1844 and is

published by the American Psychiatric Publishing, Inc (www.ulrichsweb.com). The AJP’s

purpose is to present clinical research and discussion on current psychiatric issues and its

intended audience is psychiatrists and other mental health professionals (www.ulrichsweb.com).

Dr. Matthew J. Friedman is a Professor of Psychiatry at Dartmouth Medical School and is also

the Executive Director of the U. S. Department of Veterans Affairs National Center for Post-

Traumatic Stress Disorder (www.ncptsd.va.gov). He is listed in The Best Doctors in America and

has researched and studied extensively on stress and PTSD for over thirty years; publishing 93

peer reviewed articles in scientific journals (www.ncptsd.va.gov).


The academic article broadly discusses the different aspects of PTSD including: types of

conditions, diagnosis, risk and protective factors, and treatment. Friedman believes that the

majority of military personnel returning from deployments will readjust successfully to civilized

life but a significant minority will exhibit PTSD or other psychiatric disorders. He refers to

specific soldier cases as well as research evidence to support his claims. Friedman concludes that

military and civilian practitioners should routinely inquire about war-zone trauma and symptoms

when conducting psychiatric assessments and that treatment should be initiated as soon as

possible to forestall later developments of more severe symptoms and medical illness.


While analyzing what appears to be reliable data and assertions, Friedman presents the

reader with an array of stories, facts, and evidence regarding the different aspects surrounding

PTSD. Friedman’s use of first-hand accounts of soldiers suffering from PTSD at the beginning

of the article allows the reader to connect and understand the condition and its effects on a

person. By addressing the issue on a personal level, Friedman strengthens the audiences

understanding for the vast array of information that follows. The greatest weakness of the

academic article is its lack of specifics regarding individual factors of PTSD. Covering so many

aspects and issues leads Friedman to only address the top layer and not dig deep into analysis.

Basic information on multiple aspects of PTSD is useful, but by not providing more in depth

analysis, Friedman forces the reader to look for information elsewhere. This academic article

will be useful because it recognizes many aspects and provides a very broad scale of information

on PTSD.


Friedman’s assumption that the majority of military personnel readjust successfully to

civilian life contrasts with Coleman [13], Paulson and Krippner [14], GAO [15], and Page [30]

who all claim that combat is a major cause of psychological illness and many soldiers come

home changed. Friedman’s claim that mental health assessments and treatment should be

initiated as early as possible compares with Arthur, Kenny and Adam [31], Page [30], and

Huseman [16] and Sullivan [26].


I will use this source in the introduction and first sub issue of my essay to discuss what

PTSD is and how to effectively diagnose the disorder.

[10] Academic Source

Hoge, Charles W., Castro, Carl A., Messer, Stephen C., McGurk, Dennis, Cotting, Dave I.,Koffman, Robert L. Combat Duty in Iraq and Afghanistan, Mental Health Problems,and Barriers to Care. N Engl J Med 2004 351: 13-22


The New England Journal of Medicine (NEJM) is a weekly academic journal with a

circulation of 231,126 (www.ulrichsweb.com). The journal was first founded in 1812 is owned

and published by the Massachusetts Medical Society (www.ulrichsweb.com). According to its

website, the NEJM is the oldest continuously published medical journal in the world

(www.nejm.org). Its target audience is the medical community but beginning in 2007, the

Journal has provided free access to original research articles online with no registration required

making content available to all audiences (www.caul.edu.au).


The researchers asserted that studies were needed to assess the mental health of members

of the armed services who have participated in combat operations and that informing policy of

mental health care for returning veterans was critical. They studied members of U.S. combat

infantry units using an anonymous survey that was administered to the subjects either pre or post

deployment to Iraq or Afghanistan. They compared the results of Iraq soldiers to other

servicemen and found that exposure to combat was significantly greater among those who were

deployed to Iraq; increasing major depression, generalized anxiety, and post-traumatic stress

disorder (PTSD). They concluded that their findings indicated significant risks of mental health

problems and that the subjects reported barriers to receiving mental health services, particularly

regarding the perception of stigma among those suffering from mental illness.


The research conducted demonstrated generalized assumptions of all military personnel

when only specific units were analyzed. This generalization ultimately weakened the conclusions

made and did not specifically target the military as a whole. Their comparisons between combat

exposures and deployment areas was however one of the greatest strengths of the findings

presented. By comparing soldiers in one area to another, the research presented reliable evidence

that combat exposure played a large factor in mental health problems. This conclusion ultimately

led to more specific issues of combat trauma to be addressed and allowed the audience to learn

more about the issue. While the researchers presented and concluded that subjects reported

barriers to receiving mental health services, the report failed to acknowledge what could be done

to fix this issue. By not addressing alternate means of gaining access to mental health services,

the reader was left with a lack of information and knowledge. This report study will be useful

because it analyzes and compares specific combat operations to the risk of contracting mental

illness and also addresses policy of mental health services provided.


The article’s main finding that significant risks of mental health problems occurred when

exposed to combat and that soldiers reported barriers to receiving mental health services

compares with Montgomery [2], GAO [15]. subcommittee hearing [17], and Britt [22], who all

claimed similar findings. The research contrasts with Friedman [9] who believes the majority of

soldiers returning from combat will readjust successfully to civilian life.


I will use this source in the second sub issue of my essay to discuss the risk of multiple

deployments and in my discussion to address the mental health stigma in the military.


Hoge, Charles W., Auchterlonie, Jennifer L., Milliken, Charles S. Mental Health Problems, Useof Mental Health Services, and Attrition From Military Service After Returning FromDeployment to Iraq or Afghanistan. JAMA. 2006; 295(9):1023-1032.


The Journal of the American Medical Association was founded in 1883, and is an

international peer-reviewed general medical journal published 48 times per year (www.

jama.ama-assn.org). It has a current circulation of 332,337 and is published by the American

Medical Association (www.ulrichsweb.com). According to the JAMA’s website, its intended

audience is the medical community and objective is to promote the science and art of medicine

and the betterment of the public health (www. jama.ama-assn.org).


The researchers asserted that there needed to be a systematic analysis and assessment of

the U.S. military’s population-level screening for mental health problems among all service

members returning from deployment. They also analyzed the impact of those deployments on

mental health care utilization. Their goal was to determine the relationship between combat

deployment and mental health care use during the first year following post-deployment. They

also wanted to assess the mental health screening effort, specifically the correlation between the

screening results, actual use of mental health services, and attrition from military service. They

did this by conducting a descriptive study of all Army soldiers and Marines who completed the

routine post-deployment health assessment in a given time period. They concluded that the high

rate of using mental health services among Operation Iraqi Freedom veterans after deployment

highlights challenges in ensuring that there are adequate resources to meet the mental health

needs of returning veterans.


The researchers presented the audience with an in depth assessment and analysis of the

military’s post-deployment mental health screenings and the use of mental health services by

soldiers returning to civilian life. By conducting their study on both the Army and Marines

returning from combat, the researchers strengthened their results by analyzing the different

branches of the military, which ultimately allowed for a well-built conclusion to be made. To

strengthen the study further, the researchers used the current military post-deployment screenings

instead of their own questionnaires, which helped them to analyze the effectiveness of our

militaries current screening policies and to advise changed if needed. The weakness of the study

became apparent when the researchers identified high rates of mental health services being

sought among Operation Iraqi Freedom veterans after deployment and the lack of resources

being provided. They briefly highlighted this issue of providing adequate resources for veterans

but failed to address why such services are lagging behind the demand. This study will be useful

because it researches and assesses the militaries screening for mental health problems among

service members returning from deployment and their ability to seek health care.


The research findings concluded with an assumption that there are not adequate resources

to meet the mental health needs of returning veterans which compares with Miller [23], Paulson

and Krippner [14], and Sullivan [26]. The findings contrast with Kenny [31], Task Force [20]

and Huseman [16], who assert that positive programs are in place for veterans.


I will use this source in the intro and first sub issue of my essay.


Rona, Roberto J. Screening for Psychological Illness in Military Personnel. JAMA. March 2005; 293:1257-1260.


The Journal of the American Medical Association was founded in 1883, and is an

international peer-reviewed general medical journal published 48 times per year

(www.jama.ama-assn.org). It has a current circulation of 332,337 and is published by the

American Medical Association (www.ulrichsweb.com). According to the JAMA’s website, its

intended audience is the medical community and objective is to promote the science and art of

medicine and the betterment of the public health (www. jama.ama-assn.org). Rona is a professor

at King’s College in London, England (www.ajph.org). He also works and researches with the

Department of Public Health Sciences (www.ajph.org).


Rona asserts that although psychological screening efforts have been supported by the

military and mental health professionals, evidence that the programs are effective and that the

benefits of screening outweigh the psychological and financial costs have been lacking. He goes

on to evaluate the different methods of screenings and proposes 6 criteria for implementing an

effective screening program to detect psychological morbidity in the military. His report

highlights issues regarding the barriers to confidentiality, lack of evidence on the effectiveness

and validity of such programs, and the possibility of causing harm rather than providing benefit.

He uses statistics and research from past wars as well as present studies to support his claims.

Rona concludes that a focus on improving support structures for veterans and service personnel

while also improving the recognition and management of health problems in screening for

psychological problems are a better approach for the future.


Rona’s report uses historical facts and clear assumptions supported by evidence to sustain

his claims about the effectiveness of mental health screenings. By introducing a historical

perspective on previous military policy regarding mental health screenings, Rona strengthens the

readers knowledge of the issue and allows for the rest of his assertions to compare to previous

mistakes and tactics attempted by the military. As Rona proposes his 6 criteria for implementing

an effective screening program, strengths and weaknesses of the proposals begin to become

evident. His use of statistics and current research to support his proposals strengthens his

arguments in terms of validity but his recommendations lack an in depth analysis on how the

criteria can be met and what specific changes need to be made. By not providing an alternative

measure to the current screenings being done, Rona ultimately weakens his article. This

document will be useful because it analyzes the effectiveness of mental health screenings

historically and currently, and suggests criteria for establishing a more effective result.


Rona claims a lack of effectiveness in the current mental health screening process and

advises improving support structures for veterans and service personnel, which compares to

Brook [6], Paulson and Krippner [14], subcommittee hearing [17], Miller [23] and Sullivan [26].

The article contrasts with Task Force [20] and Kenny [31] who assert effective programs are in

place.


I will use this source in the history and background and first sub issue of my essay to

discuss the militaries screening efforts and effectiveness.

[13] Book Source

Coleman, Penny. Flashback: Posttraumatic Stress Disorder, Suicide, and the Lessons of War. Boston: Beacon Press, 2006.


Flashback was published by Beacon Press, an independent publisher founded in 1854

(www.beacon.org). According to its website, it focuses on publishing serious non-fiction and

fiction books meant to change the way readers think about fundamental issues

(www.beacon.org). Flashback is a deeply researched chronicle of PTSD and the theoretical and

historical aspects of the illness, aimed towards educating anyone dealing with the issue

(www.flashbackhome.com). Penny Coleman is an award winning author who has written over

18 books (www.blogtalkradio.com). She was introduced to PTSD through Daniel, her husband

she married shortly after he returned from Vietnam in 1969 who later committed suicide

(www.fleshandstone.net).


Coleman’s main argument is that the soldiers who are now in Iraq and Afghanistan will

come home changed and damaged affecting our society with a social cost, both in fiscal and

human terms. Suicide rates she asserts is a rising problem among veterans. She framed the

investigative portions of the book on stories of thirteen women, herself included, whose

husbands, fathers or sons came home from a past war with psychological injuries that ended in

suicide. She uses those stories to gather and analyze some of the personal, historical and

scientific evidence that is needed to evoke awareness of suicide stemming from PTSD. She

asserts that mental health issues have been a problem for years and the issue needs be prioritized

as public conversation.


Coleman presents the audience with two types of information in her book: historical and

theoretical. This gives the audience an informational look at how things have happened in the

past and what to expect in the future. Her main focus historically comes from soldiers who

served in the Vietnam era and are still continuing to battle mental illness to this day. She uses

multiple first-hand accounts of women, including herself, who experienced the struggles and

emotional impacts of men returning from duty with psychological injuries. This is the biggest

strength of her book. By providing first-hand accounts she emphasizes the social costs of war,

even years down the road. Her weakness becomes apparent when she does not give clear

evidence about present day soldiers and their struggles with mental health or suicide but instead

theoretically claims that if past experience is a predictor, society will be forced to deal with Iraq

and Afghanistan veterans, similar to Vietnam. Although a reasonable assumption, she fails to

note what the military is doing differently than that of the Vietnam era in regards to treating and

diagnosing the illness. This book will be useful because it provides multiple first-hand accounts

and focuses on suicide as a specific issue stemming from PTSD and how it affects society.


Coleman’s main assumption that our society is not doing enough to prioritize mental

health issues in returning soldiers and veterans compares with Paulson [14]; it contrasts with

Schaffer [4], who asserts that the issue is being prioritized and modern day technologies are

being used to treat the disorder.


I will use this source in the third sub issue of my essay to discuss the rise in suicide rates

among veterans and the cost associated to society.

[14] Book Source

Paulson, Daryl and Stanley Krippner. Haunted by Combat : Understanding PTSD in War Veterans Including Women, Reservists, and Those Coming Back from Iraq. Westport: Praeger Security International, 2007.

Part 1: Source AnalysisHaunted by Combat was published by Praeger Security International (PSI) in 2007

(www.janus.uoregon.edu). Owned by Greenwood Publishing Group, PSI publishes insightful

material on issues dealing with international security, defense and foreign policy, military

history, and terrorism (www.greenwood.com). Daryl S. Paulson is a Vietnam U.S. Marine

veteran and is also a psychologist (www.bn.com). He is a Fellow of the American Academy of

Traumatic Stress and has worked extensively with veterans affected by PTSD (www.bn.com).

Stanley Krippner is a Professor of Psychology at Saybrook Graduate Institute and Research

Center (www.bn.com). He is also a member of the advisory and editorial board for the Journal of

Humanistic Psychology (www.bn.com).


Paulson and Krippner discuss post-traumatic stress disorder among war veterans and

present debate about diagnoses and strategies. They state the U.S. Department of Defense

instituted a universal questionnaire screening program that must be completed by all returning

service members within two weeks of coming home from duty. However, critic’s fight that such

programs have been tried in the past and soldier to soldier pressure prevents true responses from

being given. They conclude that steps are being taken but there is still a need for increased

mental health monitoring of service members.


Paulson and Krippner take us into the minds of PTSD-affected veterans, but strengthen

the book further by writing about their own struggles against the traumatic events lingering in

their minds from combat experience. They fill gaps by allying their personal experiences with

first-hand accounts of veterans from current war situations, specifically Iraq, giving the reader a

better understanding of the issue at hand. The combination of personal and clinical approaches

makes this book an educational read to both mental health professionals working with soldiers as

well as victims and their families. They clearly state that it “is not an anti-war book” but discuss

the negative impact of war on servicemen. They fail to talk in depth about the majority of

servicemen who are stable after being deployed. Paulson and Krippner conclude with a general

assurance that most veterans get beyond their combat experiences, despite the fact that most

receive no formal intervention. This is a weakness of the book due to its mere assumption that

everything will be ok despite the evidence presented in their book that things are not. This book

will be useful because it shows first-hand accounts of PTSD in veterans and how it is an urgent

issue that must be addressed.


Paulson and Krippner assert that there is an increase need for mental health monitoring

and breaking down the stigma associated with mental health in the military which compares with

Montgomery [2] in regards to the stigma and Brook [6] who addresses ways to reduce stigma

and increase mental health monitoring. The book contrasts with [11] which assessed the

screenings and claimed that there was a high rate of soldiers diagnosed and seeking treatment.


I will use this source in the second sub issue and discussion section of my essay.

[15] Government Source

United States. Government Accountability Office. Post-traumatic Stress Disorder: DOD needs to Identify the Factors its Providers Use to Make Mental Health Evaluation Referrals for Service Members: report to congressional committees. [Washington, D.C.] : U.S. Government Accountability Office, [2006]: GAO-06-397.


The United States Government Accountability Office is an independent, nonpartisan

agency that works for Congress (www.gao.gov). According to the GAO’s website, the agency

advises Congress and the heads of other executive agencies about ways to make government

more efficient, effective, and responsive through investigating, analyzing, and reporting their

findings in documents and reports (www.gao.gov). They provide their audience of congressional

committees or subcommittees with timely information that is objective, fact-based, fair, and

balanced (www.gao.gov). Much of the work by The U.S. Government Accountability Office has

lead to laws and acts that improve government operations (www.gao.com).


The GAO states that many service members participating in Operation Enduring

Freedom (OEF) and Operation Iraqi Freedom (OIF) have engaged in intense and prolonged

combat, which research has shown to be strongly associated with the risk of developing post-

traumatic stress disorder (PTSD). The report recommends that the Department of Defense

(DOD) try to identify factors that its providers use in issuing referrals for further mental health

evaluations to provide reasonable assurance that such issues are being treated appropriately and

consistently. The GAO reported findings that the DOD has not provided reasonable assurance

that service members who need referrals for further mental health evaluations receive them. The

information shows the DOD’s lack of treatment care for service members returning from combat.


While analyzing what appears to be a reliable report, the GAO presents factual

information supported by its own research and findings to reach the conclusions identified. By

conducting their own studies and research, the GAO strengthened their claims made against the

DOD. The GAO clearly defined that the DOD was not providing reasonable assurance of mental

health evaluations and that they needed to identify the factors in doing so. To strengthen the

report further, the GAO advised steps to implement to fix the problem and gave

recommendations that were supported by their findings and statistics. Although a thorough

report, it begins to weaken when recommending suggestions for the DOD. The GAO asserts that

factors need to be identified when making health evaluations, but fails to mention what those

possible factors could be and how the DOD should go about deciding on them. This report will

be useful because it addresses failures in the DOD screening system and provides information on

what needs to be changed to better address testing.


The GAO’s main assumption that combat exposure increases the risk of developing

PTSD and that soldiers have not been receiving adequate treatment for their illness, compares

with Alvarez and Frosch [1], Sullivan [26], and Miller [23]; it contrasts Task Force [20] and

Carolla [22] who assert there are positive treatment programs in place and military policy

encourages soldiers to seek treatment.


I will use this source in numerous areas of my essay but mainly the first and second sub

issue to discuss the militaries effectiveness of screenings and multiple deployment issues.


Huseman, Susan. “‘Battlemind’ Prepares Soldiers for Combat, Returning Home.” AmericanForces Press Services 3 Jan. 2008.


The American Forces Information Service (AFIS) produces news, feature articles, and

TV reports on all aspects of military life within the United States Department of Defense Press

Office (www.defenselink.mil). The American Forces Press Service (AFPS) specifically is the

news service provided by the American Forces Information Service (www.defenselink.mil). The

DOD Press Office and the AFIS are part of the Office of the Assistant Secretary of Defense for

Public Affairs (www.defenselink.mil). Susan Huseman serves in the U.S. Army Garrison

Stuttgart Public Affairs Office as an associate editor (www.imcom.army.mil).


Huseman asserts that post-deployment health briefings didn’t specifically target soldiers

going into combat and coming back with adjustment challenges. To support her article she

interviewed a doctor from Walter Reed Army Institute of Research, who defined their objectives

for a mental health training program and described that the Battlemind system was built from

findings in surveys and interviews given to soldiers and Marines returning from Iraq and

Afghanistan. Huseman claims that pre-deployment Battlemind tells soldiers what they are likely

to see, to hear, to think and to feel while deployed and the post-deployment training addresses

safety concerns and relationship issues, normalizes combat-related mental health reactions and

symptoms, and teaches soldiers when they should seek mental health support for themselves or

for friends. Huseman concludes that the system supports soldiers and families across the phases

of deployment and reemphasizes normal reactions and symptoms in a realistic and relatable way

to true combat service.


Huseman presents the audience with an in depth description and analysis of the

Battlemind system by using professional information from a research facility. By providing the

reader with a look at the training system from a mental health professionals’ analysis, she

strengthens her claims that the Battlemind system addresses issues that previous training did not.

Huseman provides background information to military training education and asserts why the

Battlemind system was put in place to begin with, giving the reader a focus historically and

presently on how the military addressing the issues. The weakness of the article becomes

apparent when she fails to address factual evidence and statistics that the new system is indeed

an improvement from previous training. It leaves the reader questioning the effectiveness of the

new program and whether the significant increase in education does indeed help soldiers. This

article will be useful because it provides an in depth analysis of a new training program

implemented by the military that focuses primarily on addressing mental health education.


Houseman’s main assumption that post-deployment briefings were not effective at

targeting soldier’s mental stability and that the new Battlemind training system is efficient at

doing so compares with Schaffer [4] in regards to new treatments being implemented, and Rona

[12] in regards to ineffectiveness of past screening efforts. The article contrasts somewhat with

subcommittee hearing [17], in regards to the financial toll of the new training.


I will use this source in the discussion section of my essay to discuss new treatment.


U.S. House of Representatives. Committee on Veterans' Affairs. Subcommittee on Health. PTSD Treatment and Research: Moving Ahead Toward Recovery: 110th Congress House Hearing. Washington, D.C. 2008. Hrg. No. 110-78.


The Committee on Veterans' Affairs is the authorizing House Committee for the

Department of Veterans Affairs (DVA) (www.veterans.house.gov). The DVA was established

March 15, 1989, with Cabinet rank, and assumes responsibility for providing federal benefits to

veterans and their dependents (www.veterans.house.gov). The responsibilities of the Committee

are to recommend legislation expanding, curtailing, and fine-tuning of existing laws relating to

veterans' benefits (www.veterans.house.gov). According to its website, the Committee is also

responsible for monitoring and evaluating the current operations of the DVA. They are the voice

of Congress in dealings with the DVA and present their finding and recommendations through a

hearing process and legislation (www.veterans.house.gov).


The hearing presented before the Subcommittee of Health of the Committee on Veterans

Affairs, addressed issues regarding post traumatic stress disorder treatment and research in the

VA and how to positively move ahead in the future. The hearing provided testimony from

several organizations working to provide comprehensive and cutting-edge treatment for PTSD

and also presented numerous facts and research statistics. The Subcommittee recognized that

PTSD is an important issue and the testimonies all addressed some aspect of the illness;

including research, treatment, technology, barriers, policies and finances. The committee

concluded with numerous policy changes and recommendations and ensured that they are

improving research and technology so veterans can receive the best possible treatment.


The Committee addresses two types of information in the hearing: factual research and

recommendations for change. The vast array of information provided is overwhelming to the

reader but gives the audience an in depth look at what the government is doing to address PTSD

and veterans health benefits. By providing numerous organization testimonies the hearing covers

every aspect of issues regarding mental illness. Each organization brings something new to the

hearing and allows more questions and policies to be addressed. This is the greatest strength of

the hearing. It provides numerous viewpoints over issues and allows for counter arguments to be

addressed and strategic recommendations to be made in order to satisfy each party. The hearing

jumped from one issue to another and failed to address timelines for its recommendations which

was its greatest weakness. The recommendations provided were strong but failing to address a

timeline of enactment causes the reader to wonder when such policies will be implemented. This

hearing will be useful because it provides a lengthy in depth analysis of what the government is

currently doing to address PTSD and what plans are being made for the future of veterans’ health

benefits.


The subcommittee hearing addressed numerous issues that compared and contrasted to a

lot of the sources in reference to research, treatment, policies, deployments, and screenings.

However, the hearings main assumptions on the effectiveness of screenings and barriers to

seeking mental health treatment, compared with Paulson and Krippner [14], Britt [21] and Miller

[23]; it contrasts somewhat with Task Force [20] in regards to resources and treatment available.


I will use the source throughout my essay in regards to every sub issue and discussion.


United States. The Assistant Secretary of Defense for Health Affairs. Policy Guidance for Deployment-Limiting Psychiatric Conditions and Medications: memorandum. Washington, D.C.: 7 Nov. 2006.


The Assistant Secretary of Defense for Health Affairs is the principal staff assistant and

advisor to the Office of the Secretary of Defense for all DOD health policies, programs, and

activities (www.mhs.osd.mil). The Office of the Secretary of Defense (OSD) is the principal

staff element used by the Secretary of Defense to exercise authority, direction, and control over

the Department of Defense (www.defenselink.mil). According to its website, the purpose of the

Health Affairs office is to provide our military with strategy, policy and resources to achieve

excellence and care (www.health.mil). Dr. S. Ward Casscells is currently appointed the Assistant

Secretary of Defense for Health Affairs (www. defenselink.mil). He received a B.S. in biology

from Yale in 1974, and his M.D from Harvard Medical School in 1979 (www. defenselink.mil).


The memorandum from the Assistant Secretary of Defense for Health Affairs provides

guidance on deployment and service for military personal experiencing mental illness or trauma.

The guidance addresses new requirements and policies on deployment limitations and military

service associated with psychiatric disorders, psychotropic medication, and assessment and

documentation. The guidance asserts that any condition or treatment must be evaluated to

determine the potential impact on the individual service member and the mission. It explains that

early identification and treatment are key to returning service members to duty. It concludes by

listing multiple new policies as well as defining the need for health affairs to ensure military

personnel are fit to fight while also minimizing the risk of harm.


The guidance asserts multiple new policies to better addresses deployment limitations

and military service associated with mental illness and trauma. By providing these numerous

policy changes and sub points to each, the guidance is strengthened and ensures every aspect of

the new changes are valid and supported. Each sub point specifically addresses an aspect of the

current policy to ensure all viewpoints are covered. While analyzing what appears to be strategic

and reliable policy changes, the lack of facts and evidence weakens the validity of such changes.

Although reasonable assumptions, the weakness of the memorandum becomes more apparent

when it does not provide information regarding the previous policies and why they are being

changed. Analyzing current policies to those suggested would allow for a stronger guidance.

This memorandum will be useful because it provides information regarding policy changes to

deployment limitations associated with mental illness which can be used to assess what currently

is being followed in the military.


The guidance addresses requirements and policies on deployment limitations and military

service associated with having a psychiatric disorder. This compares with subcommittee hearing

[17] in regards to current policies implemented but contrasts with Chedekel and Kauffman [3],

Skelly [24] and Merzenich [32], which all assert that the military is avoiding policies and

sending soldiers suffering from mental illness back into combat.


I will use this source in the second sub issue of my essay to discuss requirements on

multiple deployments and sending mentally unstable troops back into combat.


Marble, Sanders. Rehabilitating the Wounded : Historical Perspective on Army Policy. Falls Church, Va.: Office of Medical History, Office of the Surgeon General, 2008.


The Office of Medical History (OMH) is a part of the Office of the Surgeon General

(OTSG) which is operated by the U.S. Department of Health and Human Services

(www.surgeongeneral.gov). The Surgeon General serves as America's chief health educator by

providing Americans the best scientific information available improving their health and

reducing the risk of illness and injury (www.surgeongeneral.gov). The OMH is specifically

responsible for supporting and educating the men and women of the U.S. Army Medical

Department and Army Medical Command by assembling and publishing medical references

(www.history.amedd.army.mil). Dr. Sanders Marble is currently a historian for the OMH and has

had nine chapters or articles on various military and medical topics published

(www.firstworldwar.bham.ac.uk). He has worked for the US Air Force, the Smithsonian's

National Museum of American History, and currently teaches at Norwich University

(www.firstworldwar.bham.ac.uk).


In Marble’s historical study he asserts that our nation has apportioned responsibility of

rehabilitation of soldiers throughout history. He claims that the Army has tried to handle patients

itself, at times it expected the Veteran’s Affairs (VA) or other organizations to take patients, and

now our current policy is somewhat of a mix. Marble shows why policy decisions have changed

by analyzing advancements of medicine, political climates, and the creation of organizations.

Marble concludes that doing nothing for soldiers is not an option, doing everything for them is

not practical, so clear standards and action plans for rehabilitation need to be created.


While analyzing what appears to be reliable data, Marble presents us with an array of

facts and evidence regarding medical policies in the Army throughout history. By using graphs

and tables to refer to medical statistics and data, Marble strengthens his claim that policy

decisions have changed over time. He clearly defines every course of action that can and has

been taken regarding different medical policies throughout history, as well as the drawbacks and

strengths to each. This is the greatest strength of the document. By not taking a side on one

policy or another, Marble provides both views equally and clearly defines what would occur with

each outcome. Although a historical perspective on Army policy, Marble fails to address current

issues and policies in depth and analyze whether they are working in comparison to past policies.

He briefly touches on what is presently being practiced, but then concludes that throughout

history we have yet to find a balance that works and leaves the reader wondering whether we are

taking the right steps. This document will be useful because it discusses in depth medical Army

policy throughout history and what changes needed to be made to enhance rehabilitation in a

positive direction.


Marble’s main assumption that our nation has apportioned responsibility of rehabilitation

of soldiers throughout history without every achieving a clear standard compares with Coleman

[13] and GAO [15] in regards to policies and actions being taken; it contrasts with source [10]

which supports that treatment and standards are present in medical policy.


I will use this source in the first sub issue of my essay to discuss historical screening

policies and their effectiveness.

[20] Institutional Source

American Psychological Association Presidential Task Force on Military Deployment Services. “The Psychological Needs of U.S. Military Service Members and Their Families: A Preliminary Report.” American Psychological Association 2 Feb 2007.


The American Psychological Association (APA) is the largest association of

psychologists worldwide with a membership base of over 150,000 (www.apa.org). Based in

Washington, DC, the APA is a scientific organization that represents psychology in the United

States (www.apa.org). According to its website, the mission of the APA is to advance the

creation, communication and application of psychological knowledge to benefit and improve

society (www.apa.org). The Task Force was designed in 2006 to develop a strategic plan and

identifying the psychological risks and mental health-related service needs of military members

and their families during and after deployments (www.issuelab.org).


The Task Force provides a report about the impact of military deployments on service

members and their families; discusses the number of programs that have been developed to meet

the mental health needs of service members; and describes the significant barriers to receiving

mental health care within the Department of Defense (DOD) and Veterans Affairs (VA) system.

They conclude that the mental health needs of service members and their families are often

misunderstood or ignored due to inadequate resources, poor planning, and lingering stigma

associated with mental health care. They assert however that there are many positive military

mental health programs currently in place, and awareness has increased in the military regarding

the need to improve these services.


While analyzing what appears to be a reliable report, the Task Force presents us with an

array of facts and issues regarding medical programs and mental health resources. They clearly

cover many aspects of mental health including barriers, current programs and causes. This is a

major strength of the report because it is not limited to one aspect but covers different viewpoints

and issues in depth. The Task Force’s recommendations provided throughout the report also

enhance its validity. Instead of just concluding that things are inadequate or not working, they

identify what can possibly be done to improve and change the problem. This strengthens the

report by not only identifying the problems and issues but by also trying to resolve them. It

shows the Task Force’s dedication to the mental health issue. Given the limited research data

available on mental health, the report cites and compares numerous other studies instead. This is

somewhat of a weakness compared to if actual new data was present. The report tries to advocate

for more research needing to be done instead of taking on the research themselves. This

document will be useful because it discusses in depth mental health issues of all kinds including

causes, barriers and current resources and what should be changed to improve the system.


The Task Force’s main assumption that positive military mental health programs are in

place compares with Arthur and Kenny [31], Schaffer [4], and Huseman [16]; it contrasts with

Paulson and Krippner [14], Sullivan [26], and Alvarez and Frosch [1], who assert there is not

adequate treatment or support for veterans.


I will use this source in my first and second sub issue as well as discussion section to

address multiple deployments, effective treatment, and the stigmatization of mental illness.


Britt, Thomas W. “Stigma of Mental Health Problems in the Military.” Military MedicineFeb 2007. Vol 172, 2;157.


Military Medicine is a monthly publication from the Association of Military Surgeons of

the U.S (AMSUS) (www.ulrichsweb.com). It has a circulation of 11000 and was founded in

1891 (www.ulrichsweb.com). According to its website, the mission of the publication is to

increase healthcare education by providing scientific and other information to its readers while

also facilitating communication and offering a prestige publication for members’ writings

(www.amsus.org). Thomas Britt is currently a psychology Professor at Clemson University

(www.britt.socialpsychology.org). He holds a Ph.D. in social psychology from University of

Florida and was the winner of the 1998 Applied Research Award from the Center for Creative

Leadership (www.britt.socialpsychology.org).


Britt asserts that a major factor that leads soldiers experiencing psychological problems to

not seek help from a mental health professional is the perceived stigma associated with admitting

a problem and seeking help for that problem. He draws from civilian and military research to

present a model for how the stigma of admitting a psychological problem can prevent soldiers

from seeking help for these problems. Britt acknowledges the perceived barriers to accessing

mental health care and examines potential interventions to reduce the negative stigmatization for

help-seeking. He concludes that it becomes the responsibility of leaders to help service members

feel comfortable receiving help for a mental health problem and an implementing organizational

policies and programs aimed at mandating soldiers to receive mental health treatment is an

additional way of reducing stigma.


Britt presents the audience with a very one sided view on the perceived stigma associated

with mental health in the military. A major weakness of the article is that he fails to acknowledge

the belief of many people that there is no stigma in the military. Instead, Britt rightfully assumes

there is one and provides in depth information on the subject and barriers associated with it. A

major strength of his document is the research he draws from civilian and military organizations.

The research he uses helps him support his reasoning and claims and provides a first-hand

account of the issue and what soldiers experience through service. Although his documentation

and assumptions are strong, Britt concludes his article with recommendations on reducing

stigmatization. Those recommendations, while reasonable, lack evidence to support that they

would indeed fix the problem and are mere assumptions with no factual base or support. This

article will be useful because it provides an in depth analysis on the perceived stigma and

barriers associated with soldiers admitting a problem and seeking help in regards to mental

health in the military.


Britt’s main assumption that there exists a perceived stigma associated with admitting a

problem and seeking help for that problem and that mandating soldiers to receive mental health

screening is a way of reducing stigma, compares with Brook [6], Montgomery [2], and Bowman

[28]; it contrasts with subcommittee hearing [17] in regards to the financial barriers for

implementing a mandatory screening.


I will use this source in the discussion section of my essay to discuss the perceived stigma

associated with mental illness in the military.


Carolla, Bob. “Mental Health in the Military: A Community Takes Care of its Own.” NationalAlliance on Mental Illness 2003.


The National Alliance on Mental Illness (NAMI) was founded in 1979 and is the nation’s

largest grassroots organization for individuals with mental illness and their families

(www.nami.org). The NAMI is located in every state and has over 1,100 offices in local

communities across the U.S (www.nami.org). According to the NAMI website, its mission is to

advocate for all persons affected by mental illness and ensure they receive the services that they

need and deserve (www.nami.org). NAMI members and friends work to fulfill their mission by

providing support, education, and advocacy through their website, helpline, educational

programs, and support groups (www.nami.org). Bob Carolla serves as the Director of Media

Relations for NAMI (www.nami.org). He also works as a reporter and columnist for a small

chain of weekly newspapers in New York and throughout his career has published numerous

free-lance articles (www.nami.org).


Carolla asserts that the U.S. military faces many of the same challenges as civilian

society in regards to addressing mental illnesses. He examines differences between the military

and society and claims that for military personnel, lack of health insurance is not a barrier to

receiving treatment and the structure of the military services and official policy encourages

soldiers to seek treatment. He addresses suicide as a problem with mental health and uses data

and current research to support his claims. Carolla concludes that by getting mental health care

personnel out of their offices and clinics and making them visible throughout the community,

veterans will be more comfortable seeking help and treatment.


Carolla presents the audience with an in depth analysis on civilian strategies regarding

mental illness compared to military policy and uses specific data and research to back up his

claims. His use of specific data strengthens his arguments and assertions by providing the reader

with current statistics that make his viewpoints relatable. By using current statistics, Carolla

emphasizes the problems of suicide and other issues as a rising issue among veterans. Although

his assumptions and statistics are reasonable and thorough, Carolla fails to address specific

causes for the suicides and contracting mental illness. This weakness in his article becomes

apparent when comparing suicide rates in the military to that of civilian society where the

reasons behind the actions could be totally unrelated. This article will be useful because it

provides a statistical and in depth analysis to suicides in the military and the policies and

structures being taken in both society and the military to address the issues.


Carolla's main assumption that there is not a barrier associated with mental health and

that military official policy encourages soldiers to seek treatment compares with Huseman [16],

Task Force [20] and subcommittee hearing [17]; it contrasts with GAO [15], Brook [6], study

[10], and Miller [23], who assert that the military is failing to provide adequate mental health

care and barriers, such as the perceived stigma, are preventing soldiers from receiving treatment.


I will use this source in the third sub issue of my essay and discussion section to assert

there is not a barrier to receiving treatment in the military.


Miller, Greg. “Mental Health: Widening the Attack on Combat-Related Mental HealthProblems.” Science Magazine 2006;313 : 908–909.


Science Magazine was founded in 1880 and is published by the American Association for

the Advancement of Science (AAAS) (www.ulrichsweb.com). It is a weekly publication with a

circulation of 145,000 (www.ulrichsweb.com). The AAAS is an international non-profit

organization dedicated to advancing science by serving as an educator, leader, spokesperson and

professional association (www.aaas.org). The AAAS was founded in 1848, and serves around

262 affiliated societies and over 10 million individuals (www.aaas.org). Greg Miller is a current

staff writer for the Science Magazine and is stationed out of their San Francisco bureau

(www.sciencemag.org). His focus of research is on neuroscience, mental health, molecular, and

cell biology (www.sciencemag.org).


Miller asserts that the mental health lessons of Vietnam have prompted U.S. military

leaders to do more to protect the mental health of troops in Iraq and Afghanistan. He uses first-

hand accounts and stories of soldiers to support his claims about stigmatization, treatment and

testing, while also addressing comparisons between Vietnam and Iraq in regards to policies and

factors. Miller touches on concerns regarding the reliability of using surveys to detect mental

problems and the effectiveness of the DOD's new post-deployment health assessment program.

He uses research from journals and opinions from mental health professionals and military

officers to address support and concerns regarding issues surrounding mental illness while also

acknowledging other countries’ policies. Miller concludes that the DOD is failing to get veterans

mental health care when they need it and U.S programs are lacking behind current knowledge.


Miller presents the audience with an array of views on mental health and the screening

process currently used in the military. By comparing present day statistics to that of Vietnam, he

strengthens his main assertion that more needs to be done to help our current soldiers. Marble

never fully takes a side on one opinion or another but uses opinions and research from military

and health professionals to guide his assertions, letting the reader make their own opinion. This

is the greatest strength of the document. He briefly touches towards the end of the article what

other countries are doing in regards to mental health screenings which weakens his closing

arguments. Miller never fully compares the U.S process to that of other countries but leaves the

reader questioning the relevance. The article as a whole addresses many key issues of mental

health in soldiers and more specifically the effectiveness of current screenings which is a positive

course of information for the reader. This document will be useful because it discusses the

effectiveness of current military mental health screenings and also touches on comparisons of

Vietnam to our current conflicts and the possible outcome of soldiers’ mental health.


Miller’s main assumption that the current mental health screenings are not effective or

reliable and that the DOD is failing to get veterans health care when they need it compares with

study [10], Rona [12], and Sullivan [26]; it contrasts with subcommittee hearing [17] and Task

Force [20], who assert that the screenings are showing positive results and that positive mental

health programs are in place for veterans.


I will use this source in the history and first sub issue of my essay to address

effectiveness of surveys and relationships to Vietnam.


Skelly, James M. “American Soldiers and War Crimes in Iraq.” Open Democracy 6 Aug. 2006.


The Open Democracy organization is a United Kingdom based educational not-for-profit

supported by a number of Trusts and Foundations as well as individuals since 2001

(www.opendemocracy.org). Open Democracy publishes an online global magazine, Open

Democracy: Free Thinking for the World, which covers politics and culture and specifically

clarifies debates which help people make up their own minds (www.ulrichsweb.com). Dr. James

Skelly is currently a senior fellow at the Baker Institute for Peace & Conflict Studies, Juniata

College, Pennsylvania (www.opendemocracy.org). Skelly served as a young U.S. military officer

and refused to serve in Vietnam, eventually graduating from the University of California, San

Diego, with a PhD (www.ises.hu). His doctoral research explored the historical legitimation of

American military service and he has since written numerous books and articles associated with

the military (www.ises.hu).


Skelly begins his article with discussion of the differences and similarities arising

between Vietnam and Iraq, and the nature of collapse of the armed forces. He claims in Vietnam

this was ultimately because of combat refusals, whereas in Iraq it is profoundly because of

psychological issues. Skelly asserts that a rise in war crimes in Iraq has been due to desperation

for soldiers, even the ones who have previously demonstrated psychological problems. He

discusses wrong doings of the military and responsibilities associated with their actions. Skelly

concludes with suggestions including convening a military court of inquiry to assess the

militaries actions and current policies being administered in Iraq.


Skelly uses numerous historical comparisons to Vietnam to support his claims of war

crimes being committed in the military while in Iraq. Although he asserts that psychological

issues are currently a main trigger for war crimes in combat, he fails to address what other issues

or instances cause such actions to happen. This weakness in the article becomes apparent when

Skelly addresses in depth different situations where mental illness played a factor in wrong

doings but never referred to any other possible reason for the outcomes. By only giving one

reason for the actions committed, he causes the reader to question the validity of his claims.

When addressing specific situations regarding war crimes in Iraq, Skelly succeeds at providing

reasons for the actions and multiple viewpoints on the issue, allowing the reader to analyze for

themselves whether the actions were wrong or right. By staying neutral on his viewpoint and

questioning the responsibility of such actions, he allows the audience to make their own

decisions, ultimately strengthening his article. This document will be useful because it brings up

mental illness as a cause for war crimes and assesses where the responsibility lies when such

actions are committed.


Skelly's main assumption that the militaries desperation for soldiers has lead to the

redeployment of servicemen with psychological problems compares with Merzenich [32],

Kennedy [7] and Chedekel and Kauffman [3]. His assumption contrasts with the Assistant

Secretary of Defense for Health Affairs [18], who listed requirements and policies on

redeployment limitations for soldiers suffering from mental illness.


I will use this source in the history and second sub issue of my essay.


Levin, Aaron. “Army Says Keep Brain Injury, PTSD on Radar Screen.” Psychiatric News 2007. 42:9.


Psychiatric News is the bi-weekly newspaper of the American Psychiatric Association

(APA) (www.pn.psychiatryonline.org). It was founded in 1966 and has a circulation of 37,000

(www.ulrichsweb.com). The newspaper serves as the official means of communication between

the APA and its members providing current information about legislative activities and the latest

developments on policies and issues regarding psychiatry (www.pn.psychiatryonline.org). The

American Psychological Association (APA) is the largest association of psychologists worldwide

with a membership base of over 150,000 (www.apa.org). Aaron Levin holds a B.A in History

from Oberlin College (www.linkedin.com). He is a current staff writer at Psychiatric News and

writes about all aspects of psychiatry and mental health (www.linkedin.com).


Levin asserts road side bombs and explosions have become the most dangerous threat to

soldiers serving in Iraq, which has led to an increase in U.S. Army research on the incidence of

brain damage suffered in soldiers. He uses claims and evidence from military officials and

scientists to acknowledge the current issue and explain what is currently being done to address it.

The scientists claim that brain damage due to explosions has a direct correlation with mental

illness and PTSD. Levin also addresses new technologies and tests associated with assessing

brain trauma as well as barriers attached with the treatments. He concludes that physicians

should question veterans about exposure to head trauma, blasts, or other traumatic events to help

determine need for further screening or monitoring and diagnose PTSD more effectively.


Levin’s use of military officials and scientists provides current data and observations of

the issue for the reader to analyze and interpret. By having scientists address their research and

findings, Levin strengthens his claims with what seems to be reliable data. He clearly defines

new findings and links between brain trauma and PTSD and then provides suggestions on how

the findings can be used to help soldiers. Another strength of Levin’s article is that he addresses

sub-issues concerning mental illness and explains barriers associated with receiving treatment as

well as what physicians should expect as soldiers begin returning home at a higher rate. Levin

claims that new technology is being used to test brain trauma caused by explosions in soldiers

but fails to assert whether the technology is effective at doing so. This is the major weakness of

his article. By not clearly defining whether the testing being done is effective, his other

assertions and suggestions are weakened in the process. This document will be useful because it

provides new information and links between combat exposure and factors causing PTSD.


Levin’s main assumption that combat exposure has a direct correlation with mental

illness in soldiers and that new technologies are being developed to treat the illness compares

with Schaffer [4], Kennedy [7], GAO [15] and subcommittee hearing [17]. The article contrasts

briefly with Sullivan [26] who asserts the military needs a more effective health treatment plan.


I will use this source in the discussion section of my essay to talk about new treatments

and research being conducted regarding PTSD.


Sullivan, Paul. “VCS Announces Our Four PTSD Priorities for 2009 for the Department of Defense.” Veterans for Common Sense 27 Jan. 2009.


Veterans for Common Sense (VCS) are a nonprofit charitable organization formed by

war veterans in August 2002 (www.veteransforcommonsense.org). It is currently based in

Washington, D.C and focuses on issues related to national security, civil liberties, and veterans

benefits (www.veteransforcommonsense.org). According to its website, its main purpose is to let

the voices of veterans be heard so that the military, freedom, and national security can be

protected and enhanced for future generations (www.veteransforcommonsense.org). Paul

Sullivan currently serves as the executive director of VCS (www.veteransforcommonsense.org).

He holds a BA in Political Science, and Master’s in Project Management from George

Washington University (www.veteransforcommonsense.org). Paul also served in Saudi Arabia,

Kuwait, and Iraq as an Army scout during the Gulf War and has since been on boards for the VA

and other veteran organizations (www.veteransforcommonsense.org).


Sullivan asserts a greater focus on problems within the military are needed so mental

health conditions can be identified and treated early, when treatment is more effective and less

expensive. He identifies four priority items developed by the VCS on how the military can

improve its handling of PTSD during 2009. Those four priorities include implementing

mandatory exams by physicians, strong anti-stigma programs, increasing supply of mental health

practitioners, and better transitions between the DOD and VA with medical care records and

disability claims. Sullivan concludes that the priorities are necessary to reduce the rising tide of

PTSD-related violence and suicides among our veterans and need to be implemented.


Sullivan’s report of the VCA recommendations for the DOD is clearly identified and to

the point. To strengthen the list of priorities given, Sullivan defines why current policies are

failing and what the changes would fix in order to improve the mental health care of soldiers. His

reference to reports and research by the VCA provides statistical evidence supporting and

strengthening the recommendations given to the DOD. Sullivan fails to address why such

policies have not been implemented in the past which is a clear weakness in the report. He does

not acknowledge potential costs or barriers to changes in the policies which is something that

should be taken into account when proposing priorities. This weakness causes the reader to

question the effectiveness to financial ratio of the proposed ideas without receiving an actual

conclusion on that basis. This document will be useful because it demonstrates and describes

new proposed ideas to advance mental illness policies and proves that some organizations are

acting on implementing change.


Sullivan’s main assumption that mental health conditions need to be identified early and

priorities need to be made to increase the effectiveness of screenings compares with Brook [6],

Friedman [9], Rona [12] and Page [30]. His article contrasts somewhat with parts of

subcommittee hearing [17] which asserted that programs and screenings currently are effective.


I will use this source in the first sub issue of my essay to address increasing the

effectiveness of diagnosing PTSD.

[27] Interview Source

Burns, John. Personal interview. 11 February 2009.


John Burns is a cadet in the Army Reserve Officers' Training Corps (ROTC). Although

graduated from the University of Oregon, John is finishing up his final year in the Reserve

Officers’ Training Corps. Upon graduation from the Army ROTC program, he will earn the bar

of a Second Lieutenant and be commissioned into the Active Army as an engineer. Throughout

ROTC his responsibilities have included communicating and leading, educating new members,

and operating military equipment. I would expect him to be in favor of increased mental health

treatment and screening to improve the overall stability of the Army.


Burns provided insights into issues regarding mental health in the Army from the

perspective of an active duty service member. He explained that the Army takes mental health

very seriously in regards to commissioning new soldiers and that from day one he was told to

talk to someone if he was not feeling emotionally stable. He stated that one of the biggest

challenges in this area is that many men feel like they can handle their own emotions and refuse

or ignore help when it should be administered. He asserts that something needs to be done to

make mental health testing and diagnosis an accepted part of being in the military and not

something that kept quiet. “The diagnosis and treatment of PTSD has skyrocketed a lot in the

past few years and I think it’s because the Military has made it a main focus needing

improvement,” he stated. He concludes that if the Army focuses more on the issue, soldiers will

become more comfortable admitting they have a problem.


Burns said that he is very passionate about being in the Army despite the possible

negative outcomes. He had many ideas on how to strengthen the mental health of soldiers and

was assured that the Army is taking positive strides in making the issue known. The details he

expressed supporting mental health as an accepted part of being a soldier show his dedication

and support for the positive actions of the military. He relayed details that PTSD is a known

problem in the military, but had a hard time accepting that studies show there still isn’t

inadequate rehabilitation or testing being done for service members or veterans with mental

health problems.


Burns sees a need for improvement between the testing administered and the

responsibility of soldiers admitting they have a problem. This compares with Montgomery [2]

who also believes that admitting problems should be more accepted. It also compares with

Coleman [13] and Marble [19] in regards to needing improvement in policies and standards. It

contrasts somewhat with Schaffer [4] which discusses new treatments and improvements being

made to treatments and rehabilitation of PTSD.


I will use this source in the discussion part of my essay to address the increased need for

family and friend support.

INTERVIEW SUMMARY SHEET

Interview #__1__ Conducted x in person ____by telephone ___via e-mail

SECTION A: (Pre-interview)

Name of interviewee: John Burns

Job Title: Cadet – U.S. Army ROTC

Occupation: Enlisted Military

Telephone number: 503-780-0755 E-mail address: [email protected]

Location and time of interview (in-person interviews only):

University of Oregon ROTC Building, 11 Feb. 2009.

What do you want to get or expect to learn from this interview?

I expect to get personal info on the process of joining the Army and what tests or screening is done when enlisting. I hope to learn more about how the Army portrays mental health to their service members and what a soldiers’ view on those issues are.

SECTION B: (Post-interview) How long did the interview take? Did you contact the interviewee again with follow-up questions?

The interview was conducted in about an hour, but could have been completed faster if ROTC stories irrelevant to mental health were not discussed. There was no need to contact the interviewee again as I gained all the necessary info I expected and wanted to get from him the first time around.

How did the actual interview differ from your expectations? The interview was more laid back and went smoother than expected. I went into the

interviewing thinking that the negatives of the military were a sore subject to talk about and that John was going to be very defensive when answering questions. However, he was more than willing to discuss the issue of mental health to the best of his knowledge and regarded it as an issue many people should be open about in the military.

What other interview sources were recommended by this source?

None

55

SECTION C:a. Summarize and paraphrase your questions and the interviewee’s answers:

Q: How did you first become interested in the military?A. Grew up in a military family. My grandpa served as well as my dad and an uncle.Q: Have any of your family members suffered from PTSD?A: None of them have. Or at least none of them admitted or talked about it openly.Q: Do you believe PTSD is occurring more today than it was in previous wars?A: No but I think it seems that way because PTSD wasn’t an actual disorder until recent years. I think more people are admitting they have a problem because it has become a more accepted and common occurring disorder.Q: Were you given tests or screenings before enlisting into the Army? A: Yes, everyone is required to take a written questionnaire and is given background checks.Q: Do you think that written examinations are accurate in determining someone’s mental health?A: No. No one can tell if someone is answering the questions truthfully.Person to person interaction seems like a more accurate way of determining someone’s mental health.Q: Since joining the Army has mental health been brought to your attention at all?A: Yes, once I became more involved I was told that if at any time I was feeling emotionally unstable I should talk to someone right away.Q: Would you feel comfortable talking to someone about your mental health? Would most soldiers?A: Mental health has became a more accepted problem in the military recently andsoldiers including myself feel more confident about being open towards it since we know we would not be alone. Q: What is one thing you would do to make soldiers feel more comfortable getting help?A: Support from other soldiers and the Military as a whole is required in making sure someone who needs help feels comfortable doing so.Q: Studies show that mental health testing and rehabilitation of veterans is not being fully utilized, what are your thoughts?A: It’s hard to believe that someone who has a problem and has dedicated their life for this Nation cannot receive the help they need after serving. It seems there is something that needs to be done to improve our standards of health care.

b. Write out completely two (or more) direct quotes from your interview that will be useful in the main assertions section of this annotation:

“The diagnosis and treatment of PTSD has skyrocketed a lot in the past few years and I think it’s because the Military has made it a main focus needing improvement.”

“There is no way to tell if someone is answering the questions truthfully. I think direct person to person testing with a psychiatrist or qualified doctor is the only way to really tell if someone is mentally stable. Written tests or questionnaires leave too much room for error.”

56

[28] Interview

Bowman, Jeff. Personal interview. 15 February 2009.


Jeff Bowman is the Chief of Police in Gearhart, Oregon. His responsibilities include

monitoring the conduct of his force, including complaints or disciplinary actions in relation to

police officers, as well as serving as an on-duty officer himself. He enforces all state and county

laws throughout his district and works closely with the National Guard and Coast Guard forces

in the area. Jeff has been working in law enforcement for over 20 years. I would expect him to be

in favor of increased military pre and post deployment mental health testing to help reduce the

number of violent crimes committed by soldiers returning to civilian life.


Bowman provided insights into issues regarding mental health from the perspective of a

law enforcement officer. He explained that throughout history no military man admitted to

"mental issues" unless he wanted out of the military and believes the rise in mental health

issues is due to sending tens of thousands of Reserve Military personnel into combat zones.

He said that reserve members live civilian lives and then pressures of suddenly being

deployed into combat zones and leaving family causes trauma. Bowman believes there is a

direct correlation between mental illness and substance abuse and violence and uses law

enforcement experience to back up his claim. He asserts that in law enforcement today, any

officer involved in a shooting incident is required by law to have at least one sit-down with

a Mental Health Professional before returning to work. He concludes that the same

requirement should be present in the military.

“I think there should be pre-screening (for recruits) and post for returning combat troops.

This process should be face to face and written to fully assess mental stability,” he said.


Bowman said that he believes mental illness is taken seriously in the military and was

assured that steps are being done to improve testing. He had ideas on how to break down the

stigma associated with mental health but ultimately felt that it was up to the soldier to take on

responsibility. His strengths came in comparing law enforcement experience with the military.

His idea of implementing face to face sit downs pre and post deployment was something that has

been argued by many others and had positive results in law enforcement. His other strength was

using first-hand experience with a crime committed by a soldier to assure that mental health does

affect substance abuse and violence. Jeff did not recognize any other points of view in his

assertions, which was a weakness, and he was assured that what the law enforcement was doing

would be successful in the military.


Bowman’s main assumption that there is a direct correlation between mental illness and

substance abuse and that the military should require sit down screenings with a health

professional for every soldier, compares with Brook [6] in regards to new screening policies and

Alvarez [5], Page [30], and Arthur, Kenny, and Adam [31] regarding substance abuse. Bowman

contrasts with Johnson [8] who asserts mental illness alone is not a leading factor for violence or

substance abuse.


I will use this source in my second sub issue of my essay to discuss the impact of

multiple deployments on Reserve soldiers.


Interview #__2__ Conducted __x__in person ____by telephone ___via e-mail


Name of interviewee: Jeff Bowman

Job Title: Chief of Police, Gearhart OR

Occupation: Law Enforcement


Location and time of interview (in-person interviews only):

Starbucks in Beaverton, OR - 2/27/2009

What do you want to get or expect to learn from this interview? (2-3 sentences)

I expect to gain a law enforcement perspective on issues regarding violence and crimes of returning service members. Also as a non-stakeholder Jeff can provide insight on his thoughts of mental health in the military and express his opinion regarding the issues of my paper. As a police officer in Gearhart, Jeff works closely with the coast guard and National Guard bases located at the beach and can provide information to what he has seen and noticed with mental health and service members in the coast area.


The interview lasted for about forty five minutes. There was no need to contact the interviewee for follow-up questions because a lot of my questions and his responses were opinion and thought based. He thoroughly answered my questions and explained his thoughts during the interview.

How did the actual interview differ from your expectations? (2-3 sentences)I went into the interview not realizing that Jeff had any connection to the military or the

service but found out that he occasionally is in contact with the Coast Guard and National Guard, both of which are located near Gearhart on the coast. This made him much more knowledgeable on the subject and military as a whole and led to a much more in depth conversation.

What other interview sources were recommended by this source? No

60


Q: What are your personal experiences with mental health? A: I have had professional dealings Clatsop Behavioral Health Department Section for persons that have been taken into custody for crimes and have mental issues or just civil holds for mental issues.Q: Do you believe there is a “stigmatization” (afraid of admitting mental illness for fear of losing rank, looking weak, etc.) about mental health in the military? A: Throughout history no military man admitted to "mental issues" unless he wanted out of the military, the so-called "section 8". Today's military personnel are a different breed and there are more personnel actively wanting health services for behavioral health

Q: Do you feel there is a correlation between PTSD and alcohol/drug abuse or violence among soldiers trying to adapt back to normal life?A: Yes. Drug/Alcohol abuse among non-combat citizens increases violence. Having PTSD and substance abuse combines for an explosive behavioral change.

Q: Do you feel the military takes mental illness seriously and is doing all it can? A: They take it seriously but will down play it for years to come. It is bad for business to admit that mental health issues are a concern. The military can pre-screen and allow shorter deployments to help fix the problem which will start happening in the future.

Q: Is it more up to the soldier to help himself if he has a problem? A: Post treatment is always up to the soldier. Q: What are your thoughts on mandating mental health examinations with a health professional upon returning from combat vs. just a post deployment questionnaire? A: I think there should be pre-screening (for recruits) and post for returning combat troops. This process should be face to face and written. In Law Enforcement today, any officer that is involved in a shooting incident is required by law to have at least one sit-down with a Mental Health Professional before returning to work. He is allowed to have as many as he needs and it will be paid for by the agency. The same should be in the military.

Q: Any personal experience with law enforcement and soldiers?A: We have only had one incident with a returning soldier (back less than one year). he came back to his family and started drinking heavily. This created problems within the family and he was arrested for domestic assault against his wife. He was jailed and restrained from returning to his home. Some jail time, alcohol treatment programs and mental counseling were ordered by the court.


”I believe PTSD has increased due to sending tens of thousands of Reserve Military personnel into combat zones. These servicemen had lived normal lives, with only once a month weekend service and two weeks in the summer. The pressures of suddenly being deployed for a year or more into combat zones and leaving your family behind takes a toll.”

61

“I think there should be pre-screening (for recruits) and post for returning combat troops. This process should be face to face and written to fully assess mental stability.”

62

[29] Interview Source

Bankston, Dave. Telephone interview. 2 March 2009.


Dave Bankston holds the rank of Major in the United States Army. The rank of Major is a

field grade military officer rank just above the captain and just below lieutenant colonel. Dave

currently is serving in the Army Reserve units and has been deployed twice to Iraq since the start

of Operation Iraqi Freedom in 2003. When not actively serving in the Army, Dave is an

instructor for the University of Portland’s Reserve Officers’ Training Corps (ROTC). Dave was

raised in Louisiana and is currently married with a 2 year old daughter and lives in Portland, OR.

As a Major in the Army, Dave serves as a battalion executive officer with duties that can include

being a primary staff officer for a brigade or task force in the areas concerning personnel, I

would expect Dave to be in support of increased mental health screenings.


Bankston provided insights on mental health in the Army from the perspective of an

active duty soldier who has served in Iraq. He asserted that this past year suicide rates within the

army increased at a level that has never been seen before and stated, “The Army has just recently

launched a massive campaign to try and prevent suicides, ranging from what to look for in a

buddy who may be having problems, to what to do if you are having problems. They really

pressed talking it out with a professional.” He concluded that the military has in most recent

years begun to recognize the growing importance of PTSD, and he has been made aware of the

many resources available to him.


Bankston said that he has loved being a part of the Armed Forces despite some of the

negative connotations. He was assured that the Army is taking positive strides in making the

issue of PTSD and more recently, suicide, be known and addressed to soldiers. The details he

expressed about his experiences serving in Iraq, and his current knowledge and teaching of the

issues to fellow soldiers demonstrates his dedication and support for the positive actions of the

military. He asserted that suicides in the Armed Forces have risen greatly, but had a hard time

accepting that studies show the Military is continually re-deploying soldiers who are suffering

from PTSD or depression, ultimately causing the rise in suicides.


Bankston's main assumption that the military has begun to address suicide as an

important issue compares with Kennedy [7], who gave recommendations on fixing the rise in

suicide rates. He contrasts with Coleman [13] and Chedekel and Kauffman [3], who both

claimed that the Military is repeatedly sending soldiers back to combat who are suffering from

psychological problems.


I will use this source in the second sub issue of my essay to address the militaries

acknowledgement of suicide as a rising problem.


Interview #__3__ Conducted ____in person __x__by telephone ___via e-mail


Name of interviewee: Dave Bankston

Job Title: Major – U.S. Army

Occupation: Army Reserve, ROTC Instructor


Location and time of interview (in-person interviews only): n/a

What do you want to get or expect to learn from this interview? (2-3 sentences)I expect to learn more about a soldier’s personal experience and thoughts regarding

mental illness in the military from this source. Being an active member of the military, and having been deployed, I expect Dave to have many strong opinions and assertions associated with current testing and the effectiveness of the programs.


The interview lasted for only 30 minutes and no follow up interview was needed.

How did the actual interview differ from your expectations? (2-3 sentences)

It didn’t really. At first Dave seemed reluctant to discuss the issue very in depth but towards the end of the interview he opened up more about his personal experiences. As with many soldiers who have been deployed, talking about their experiences is sometimes hard and I went into the interview knowing that.

What other interview sources were recommended by this source?

None

65


Q: Do you believe there is a “stigmatization” (afraid of admitting mental illness for fear of losing rank, looking weak, etc.) about mental health in the Army? How can this be broken down? A: Without a doubt, there is a 'stigma' in the army when it comes to seeing someone about mental health problems. When someone sees a mental health professional, especially when they are deployed, it is not a secret to their leadership, and so keeping it one would pose danger to that individual as well as others. Q: Do you feel most soldiers are truthful on their post deployment questionnaires? A: I was, but my initial hunch would be no. People just want to return to normalcy, and bringing attention to any issues they may have could hinder that. Furthermore, many soldiers do not feel the effects of PTSD until they settle into 'normal' life again.Q: What are your thoughts on mandated mental health examinations with a health professional upon returning from combat vs. just a questionnaire? A: I think it is good idea in theory. Logistically it would be a nightmare to effectively evaluate hundreds of thousands of troops returning home at various times. Q: What is one thing that you think the Army does a good job at regarding mental health? What needs improvement? A: The army is always in a state of improvement. This past year suicide rates within the army increased at a level that has never been seen before. They have just recently launched a massive campaign to try and prevent suicides, ranging from what to look for in a buddy who may be having problems, to what to do if you are having problems. They really pressed talking it out with a professional. Q: What are your personal experiences with mental health screenings and testing? A: I took the PDHA and PDHRA. Was diagnosed as ok. As mentioned previously the army has added a massive campaign to prevent suicides. I had to sit in a 2 hour brief on suicide prevention, which included a guest lecture from a mental health professional. Furthermore, at my summer training I attended this summer we also talked about symptoms of PTSD and what we can do to help out fellow soldiers. Q: Anything else?A: The Military has in recent years begun to recognize the growing importance of PTSD, and I have been made aware of the many resources available to me. The Army pays a lot of attention to mental health issues, and I believe it is a constantly growing focus within the military.


“They (the Army) have just recently launched a massive campaign to try and prevent suicides, ranging from what to look for in a buddy who may be having problems, to what to do if you are having problems. They really pressed talking it out with a professional.”

“The Military has in recent years begun to recognize the growing importance of the PTSD, and I have been made aware of the many resources available to me. The Army pays a lot of attention to mental health issues, and I believe it is a constantly growing focus within the military.”

66

[30] Other Source

Page, Bob. “Iraq Never Leaves Us.” U.S. Dept of VA. Personal Account. PowerPoint Presentation.


Bob Page’s presentation is used by the National Center for PTSD as an educational

resource and teaching tool for other veterans suffering from PTSD (www.ncptsd.va.gov). Bob

Page is a husband, father, and Marine veteran who served in Kuwait, Operation Desert Storm

and the liberation of Baghdad, Iraq (www.ncptsd.va.gov). Since 2004, Bob has been receiving

counseling at a Vet Center for PTSD and associated symptoms (www.ncptsd.va.gov). He is very

involved in veteran’s affairs organizations, and serves as a board member on the Iraq War

Veterans Organization (www.ncptsd.va.gov). In his civilian career in the television and

broadcasting industry, Bob has won four Emmy Awards and an AP award (www.ncptsd.va.gov).


In his presentation, Bob Page shares his personal story from the military to provide the

viewer with an up-close and personal view of what life is actually like in Iraq and combat zones.

Page uses personal photos and intense audio and visual content to demonstrate his experience

and life in combat. Page asserts that those images and experiences never left him when he

returned home and addresses how posttraumatic stress has impacted his life. He addresses

personal dilemmas such as suicide and substance abuse as well as his struggles admitting he had

a problem and barriers to receiving help. Page asserts that young kids are at a greater risk for

mental illness because they have no idea about death and combat and are thrown into these

intense situations realizing it isn’t Playstation 2. He concludes that his personal experiences and

problems are why he feels it is important for the military and society to reach out and encourage

soldiers to get help and seek treatment.

Part 3: Strengths and Weaknesses on Logic

Page offers a first-hand account of his experiences in Iraq using distressing audio/visual

content which creates an up-close and personal understanding for the viewer. This is the greatest

strength of his presentation. By using personal and disturbing images to demonstrate his

experiences, Page asserts that these problems are not just discussions but are real life issues and

are currently happening. Page’s impactful life story and his personal struggles with suicide and

admitting he had a problem strengthened his assertion that the military and society need to reach

out more to veterans. His opinion and facts on current processes and policies was factual but

weakened his presentation when he failed to claim how the military can reach out to veterans

better or what steps should be taken to improve mental health diagnosis. This presentation will

be useful because it provides an in depth personal account of a soldiers experience with combat

and suffering from PTSD and his struggles conquering the illness.


Page claims that suicidal thoughts and substance abuse directly correlated with his PTSD

which compared with Arthur, Kenny and Adam [31] as well as Alvarez [5] who noted that

substance abuse is rising among veterans. Page contrasts briefly with Friedman [9] who asserted

that the majority of military personal returning from deployments will readjust successfully and

without problems.


I will use this source in the third sub issue of my essay to discuss the VA’s treatment of

soldiers suffering from PTSD.

[31] Other Source

“True Life: I have PTSD.” MTV Networks. 6 Dec. 2008

Parts 1-3: Source, Audience, Content, and Context

True Life is a documentary/reality series that has aired on MTV since 1998 and reports

real-life stories of young people and the unusual subcultures they inhabit (www.mtv.com). The

show has covered over 140 topics from drug use, money issues and sex, to simple social

behaviors (ww.mtv.com). True Life: I have PTSD was produced by Craig D’Entrone and

featured three veterans by the name of Arthur, Kenny, and Adam who currently suffer from

PTSD (www.remotecontrol.mtv.com).

Arthur served one tour in Iraq and was involved in the battle of Fallujah where his squad

leader died in his arms. After his first tour ended, Arthur was medically discharged and received

$13k and pills as treatment. Upon returning home he suffered from severe depression and had

numerous run-ins with the law. He asserts that PTSD changed his personality but nothing was

done to help him other than pills and medication from the VA. He specifically stated that “My

job was killing people, now I have to learn to be regular again.” Arthur sought medical therapy

on his own and concluded by advising others to not be in denial and to seek help. He claimed

that if he would not have received help he would be dead or would have killed someone else.

Kenny joined the Army out of high school and served one tour in Iraq. He claimed that

while in combat every soldier comes to terms with dying and a person’s mind is changed. Upon

returning home Kenny was medically discharged and suffered major depression and suicidal

thoughts. He claimed to have attempted suicide multiple times in Iraq but the support of his

fellow soldiers kept him alive. He asserts that support from friends, family, and other soldiers is

necessary for acknowledging a mental problem and getting treatment. Kenny took full advantage

of VA treatment and therapy and claimed that “I will be going through therapy for the rest of my

life.” He concluded that therapy works and is available and advised anyone who has PTSD to

seek help as soon as possible by calling a VA Hospital.

Adam served as a Marine and was deployed three times to Iraq. He claimed that every

deployment he became a worse person and by the third deployment he was not himself. Upon

returning home Adam could not sleep and became an alcoholic. He claimed that every time he

went to the VA for treatment all he was given was more and more pills. He asserted that the VA

was doing nothing other than prescribing medicine that did not fix the problem. Adam decided to

help himself and other vets by starting his own organization called Save-A-Vet. Adam concluded

that focusing his efforts on something other than substances and past memories helped him to

treat his illness, and advises other veterans to focus their energy on something important to them.

This television show will be useful because all three of the specific stories covered in

True Life: I have PTSD address successes, barriers, and recommendations regarding mental

illness in soldiers. Personal accounts are the most useful in receiving opinions and

recommendations on the issue.


Arthur, Kenny and Adam all had similar problems with depression/suicidal thoughts or

substance abuse and were given only medication as treatment which compares with Page [30]

and Chedekel and Kauffman [3] who addressed the military’s increased reliance on anti-

depression medicine as treatment. Their assertions contrasted with parts of the subcommittee

hearing [17] which addressed numerous treatments available other than medication.


I will use this source in my third sub issue to discuss alcohol abuse in soldiers.

[32] Other Source

Merzenich, Dr. Michael. “How to Get PTSD. Twice. Worse.” 18 May 2007.<http://merzenich.positscience.com/?p=68>


Dr. Merzenich earned his BS degree at the University of Portland and his PhD at Johns

Hopkins (www.merzenich.positscience.com). He is a retired Professor from the University of

California, San Francisco where he also served as the Chief Scientific Officer of Posit Science

(www.merzenich.positscience.com). Dr. Merzenich has been covered in the New York Times,

the Wall Street Journal, Time, Forbes, and Newsweek, and has also appeared extensively on PBS

(www.merzenich.positscience.com). He known as a pioneer in brain plasticity research and has

received numerous awards and prizes, had more than 50 patents for his work, and published

more than 200 articles in leading peer-reviewed journals (www.merzenich.positscience.com). Dr.

Merzenich posts a blog on his own website entitled “On the Brain” where he discusses and

brings up current issues regarding brain functionality (www.merzenich.positscience.com).


Merzenich asserts that service members with a psychiatric disorder are being sent back to

Iraq or Afghanistan for multiple deployments despite their conditions. Using research and data

conducted by others, he claims that current military policy allows redeployment decisions to be

made by military commanders based on their opinion that the soldier’s symptoms do not impair

duty performance. Merzenich also mentions that some soldiers are not forced, but instead want to

redeploy because of the normality of combat to their current mental state. He concludes with a

strong opinion that sending mentally ill soldiers back to a place where further trauma occurs is

ethically, morally and medically wrong and that as citizens we have an obligation to help the

young men and women who serve our country by not letting this occur.


Merzenich provides the reader with a strong viewpoint on the issue of redeployments and

allows his opinion to be known right from the start. While analyzing what appears to be reliable

data used to support his claims, Merzenich makes it known that the military is inadvertently

supporting the rise in PTSD and mental illness in soldiers by allowing unstable soldiers to return

to duty. By using those facts and current policies, he strengthens his opinion into a

knowledgeable assertion that has evidence to back it up. He clearly defines the course of actions

that have been taken and the effects of such policies on the soldiers. Merzenich also asserts that

some soldiers are not forced, but instead want to redeploy, ultimately acknowledging that the

problem is not in the military alone. This assertion is an attempt at a counter argument but the

main weakness of the article is the lack of other viewpoints presented. Merzenich has a strong

opinion on the issue but fails to mention positives or suggestions on how to fix the current

problem. This blog will be useful because it provides a strong opinion regarding the issue of

redeployment and the militaries lack of care of its soldiers.


Merzenich asserts service members are being sent back by the military for multiple

deployments despite suffering from psychiatric conditions. This claim compares with Adam

[31], Chedekel and Kauffman [3], and Skelly [24] who all address the same issue occurring.

Merzenich contrasts with the Assistant Secretary of Defense for Health Affairs [18] who listed

requirements and policies on deployment limitations for soldiers suffering from mental illness.


I will use this source in the second sub issue of my essay to discuss the effect of multiple

deployments on soldiers.

The OutlineI. Introduction

A. Should the United States Military increase pre and post deployment mental health screenings to identify mental illness in soldiers?

B. Nearly one in five combat veterans suffers from PTSD and the disorder is currently the most common diagnoses made by the Veterans Health Administration (VHA) Mental health screenings help detect clear physical and psychological symptoms in soldiers suffering from mental illness. Conducting pre and post deployment tests on soldiers allows health professionals to compare, identify and treat mental illness at its earliest stages; allowing the soldier to reintegrate back into the military or society in a timely manner. [2, 4, 6, 9, 11, 12, 13, 17, 20, 25]

C. Many people question the effectiveness of the mental health tests currently conducted and their ability to identify mental illness in soldiers due validity and stigmatization. Other issues involve the mental impact of re-deployments and crimes committed by service-members suffering from mental illness. [1, 2, 4, 6, 7, 9, 24, 25]

D. I believe the U.S. Military should increase pre and post deployment mental health education and screenings and require every soldier to undergo examinations with a mental health professional to ensure valid diagnosis. The U.S. Military should also limit re-deployments and deployment lengths to better ensure a lower risk of contracting PTSD or other mental illness. Such limits can ultimately reduce suicides, substance abuse, and domestic violence committed by mentally ill soldiers returning to society.

II. History and background information

A. What events, if any, sparked the need for this legislation, policy or regulation?

1. Research has shown that the likelihood of mental health problems rises with combat exposure. Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) are the deadliest American military conflicts since the Vietnam War, and mental illness of returning veterans is already comparable. [1, 4, 6, 7, 9, 13, 17, 25]

2. Decades of studies on the problems of Vietnam veterans have established links between combat trauma induced mental illness and child abuse, domestic violence, substance abuse and criminality. [4, 17, 19]

3. The National Vietnam Veterans Readjustment Study found that 15 percent of veterans still suffered from full-blown post-traumatic stress disorder more than a decade after the war ended. This raises awareness that OIF and OEF veterans need to be treated early to prevent prolonged illness. [9, 17, 23]

B. How has government addressed the issue, or comparable issues, in the past?

1. VA established a national Center for PTSD in 1989. This center was created to advance the well-being of veterans through research, education and training, and the diagnosis and treatment of PTSD. [14, 17]

2. The military has rolled out a number of programs to deal with excessive drinking and substance abuse including call-a-cab cards and portable breathalyzers. The Army has also increased its substance-abuse budget from $38 million in 2004 to $51 in 2008. [4, 17]

3. In 1998, the US Department of Defense introduced short pre-deployment and post-deployment questionnaires, which included limited screening for physical and psychological illnesses. [12, 17]

C. The U.S. Department of Defense currently mandates that all service members be required to complete a brief Post-Deployment Health Assessment (PDHA) within two weeks of returning from any deployment and then another Post-Deployment Health Re-Assessment

(PDHRA) six months later. [6, 9, 11, 17, 24, 25, 26]

III. Issues

A. Are current PDHA and PDHRA mental health questionnaires effective at determining mental illness?

1. Mental health questionnaires are effective.

a. The multiple post-deployment questionnaires have construct validity and offer professional’s documentation of symptoms for referral needs to resolve post-deployment issues. It is proven the second assessment has increased rates of reported mental health problems demonstrating it catches and identifies illness missed in the first screening. [4, 14, 17, 20]

b. The mental health portion of the screening provides a valid indicator of soldier’s deployment-related experiences and those immediately needing assistance on return

from deployment. [11, 12]

c. Twenty percent of active service-members and about forty percent of Reserve members were referred for mental health treatment or evaluation from the questionnaire process. Providing a second re-assessment 3-6 months down the road catches soldiers who may have slipped through diagnosis earlier, or who may not have experienced symptoms of PTSD until late. [11, 17]

2. Opponents argue that the self reported questionnaires are an overly general assessment of PTSD and question the validity of the written psychological tests under-identifying psychological problems.

a. The screening only identifies a small percentage of individuals who will then go on to develop problems. [1, 11, 12, 13, 14, 17]

b. By self reporting, soldiers may be uninterested in seeking professional help or, more likely, they may have mixed feelings about the perceived stigma that military personnel associate with having a mental disorder; ultimately affecting their answers. [1, 2, 6, 11, 12, 17, 27]

c. Written tests can provide widely varying overestimates and underestimates of any given disorder and referrals. The timing, how the questions are framed, and the setting of the assessment can also affect the responses to a questionnaire. [6, 12, 15, 17]

3. Mental health questionnaires provide a general assessment on soldiers with possible symptoms but fail to diagnose mental disorders in individual soldiers, causing them to further seek testing and treatment on their own.

a. The screening processes themselves are inaccurate. There is no way to 100 percent identify individuals diagnosis through universal screening. [6, 12, 17]

b. Experts and veterans, as well as some military and government officials, agree that treatment continues to lag behind failure of awareness and diagnosis. [4]

B. Should the U.S. Military limit deployment length and the number of re-deployments to reduce the risk of soldiers contracting or worsening symptoms of PTSD?

1. Minimizing the number of deployments a soldier can serve would help decrease PTSD rates in veterans.

a. There is a direct relationship between the number of deployments and the psychological well-being of service-members. [1, 3, 7, 17, 20, 24, 31]

b. The military is fueling the increase of suicide and psychological problems in soldiers by continually sending and recycling troubled soldiers back into combat. [1, 3, 24, 32]

c. A large portion of troops on current tours are members of the National Guard or Reserve, meaning they are civilians who are normally not accustomed to a full-time military lifestyle or combat experience. [9, 28]

2. Extending leave, and shortening deployment numbers and lengths would put more strain on military numbers and force an even more unrealistic mental adaptation on soldiers and their families

a. Many soldiers admit the only cure for psychological problems is to go back into combat, not sit at home between deployments. [1, 3, 14, 32]

b. Rates of PTSD rise as soldiers come home. [17]

c. Soldiers resetting and transitioning back to normal life struggle when adapting back into society and need to maintain the mechanical skills needed for combat if they are to be re-deployed. It is unrealistic to ask a soldier to turn on and off skills and lifestyles between duties. [1, 17, 32]

3. The time interval between re-deployments should be extended and deployment lengths should be shortened to allow soldiers mental recovery and the chance to get help if issues arise.

a. Although there have been numerous soldiers sent back to combat despite suffering from PTSD, extending leave time would allow soldiers to be properly diagnosed and access treatment before having to return to combat. [1, 7, 17, 32]

b. By reducing deployments, the military will also help reduce the number of soldiers diagnosed with PTSD as well those suffering from depression, thoughts of suicide and substance abuse [3, 4, 13].

C. Should suicides, substance abuse, and domestic violence be associated and treated with PTSD?

1. Substance abuse must be acknowledged first because it is hard to treat someone for PTSD who is heavily drinking and using drugs.

a. Evidence shows that suicide, substance abuse, domestic violence and rape have risen since the start of the war and are correlated with PTSD. [1, 3, 4, 8, 22]

b. The House and Senate passed bills requiring veteran agencies to expand substance abuse screening and treatment for all veterans [17].

c. Of 88,235 soldiers surveyed in 2005 and 2006, 15% acknowledged having serious problems with alcohol [5].

2. PTSD is not correlated or addressed with substance abuse, crimes and suicides committed by soldiers.

a. Mental illness alone is not a factor in violent behavior among returning service members. [1,8]

b. The VHA cut back alcohol and drug abuse services in the 1990’s as veterans declined, but with the new influx of veterans from Iraq and Afghanistan, there exists a lack of the proper amount of support programs [5].

c. The military has begun focusing attention on soldiers charged with homicides and domestic violence after returning from a tour of duty, which since the start of the war they largely claimed was not related [1].

3. PTSD is a major factor in domestic violence, substance abuse, and suicides committed by soldiers. Screening and treating the problems along with PTSD would help reduce the number of soldiers experiencing behavioral problems.

a. Service members with mental illness problems more often report heavy drinking or illicit drug use. [1, 3, 4, 22]

IV. Discussion

A. Requiring pre and post deployment mental health screening with a mental health professional reduces the mental health stigmatization in the military. [6, 9, 21]

1. Top military officials as well as the Department of Defense do not like to acknowledge that there is a ‘stigma’ in the military for receiving mental health care. They want to believe that soldiers feel comfortable asking for help when they need it and that soldiers will be truthful when filling out the PDHA and PDHRA. [6, 9, 21]

2. Soldiers and Marines in Iraq who may test positive for a psychological problem are concerned that they will be seen as weak by their fellow service-members as well as the effect of mental health diagnosis on their career and security clearance. This creates a barrier between soldiers and their acknowledgement to seek mental help through questionnaires. By requiring mandated screenings with a face to face mental health professional, soldiers are unable to hide their psychological problems. [2, 6, 9, 10, 21, 27, 28, 29]

B. Technology plays a positive impact on treatment of mental illness. [4, 25]1. This issue may have been overlooked because it is still in a very developmental stage in regards to treatment of mental illness. Little research has been done to identify the effectiveness of virtual reality and brain scan treatments on soldiers with PTSD. [5, 17, 25]

2. Results to date show that the virtual reality protocol is successful in decreasing symptoms of PTSD, depression, and anxiety and a panel of academic and government experts have published a consensus opinion that exposure therapy is the most appropriate therapy for PTSD. [4, 17]

V. Stakeholders’ suggestions for how best to resolve the issue

A. The stakeholders propose that the United States Military should focus on reducing the stigma and self help attitude associated with seeking mental help. By adequately funding treatment and screenings with mental professionals, they will ensure the programs provide a more proactive approach mandating treatment for unstable veterans upon their return from combat. [27, 28, 29]

1. The strength of this solution is that mandated screenings and treatment with a health professional reduces the number of soldiers who previously ignored seeking mental help.

By treating mental illness in more soldiers, substance abuse, violence, and crimes will also be positively affected. [1, 3, 13, 24]

2. The weakness of this solution is it is difficult to implement such a large personal screening process due to lack of funding and staffing. [1, 12, 17, 24]

B. The nonstakeholder says the United States Military should concentrate its mental health effort on pre combat training and education to increase awareness of the issue and potential warning signs and outcomes. Soldiers need to be aware of what causes PTSD and what steps they can take to avoid the illness. [28]

1. The strength of this solution is that educating soldiers on symptoms and signs before deployment will help them know when they need to access treatment upon returning home. This puts less pressure on the Military to screen for symptoms and more responsibility on the soldier to get help when needed. [16, 30]

2. The weakness of this solution is that it is sometimes impossible to avoid contracting a mental condition. It also puts too much responsibility on the soldiers to help themselves when many soldiers do not want to admit they have a problem for fear of stigmatization. [2]

VI. Recommendations

I believe the United States Military should increase and improve the mental health screening process before and after deployment by mandating universal screenings with a health care professional. The process should begin with pre deployment education courses and continue following return from combat. Requiring multiple mental screenings upon return helps identify illness in soldiers who develop symptoms later on. A soldier’s successful transition back into society relies on their mental stability and it is the Militaries job to provide adequate screening and health care services for all soldiers.

A. The strength of this solution is that it clearly identifies what needs to be done in order to validly diagnose and treat soldiers suffering from mental illness. Multiple post deployment screenings and education courses are necessary in preparing a soldier for reintegration to society.

B. The weakness of the recommendation is the idea of forcing soldiers to seek mental treatment against their will as well as the implementation of multiple programs. Funding for resources and staffing are limited and mental health is just one or many issues concerning veterans returning from combat.

C. Although mandated mental health screenings force soldiers to admit they have a problem, the programs fully benefit and improve mental health problems in soldiers and society. Multiple screenings and treatments alleviate misdiagnosis in previous tests and further help identify mental illness in soldiers.

VII. Conclusions

A. Many soldiers are not prepared to re enter society after deployment because they lack the mental stability to be successful. Mental health screenings help detect clear physical and psychological symptoms in soldiers suffering from mental illness. Conducting pre and post deployment tests on soldiers allows health professionals to compare, identify and treat mental illness at its earliest stages; allowing the soldier to reintegrate back into the military or society in a timely manner.

B. I analyzed the issue by focusing on sources that explained what is currently being done and the problems that are still arising with the current system in regards to effectiveness, soldiers actions, and the barriers to seeking treatment.

C. I believe the U.S. Military should increase pre and post deployment mental health education and screenings and require every soldier to undergo examinations with a mental health professional to ensure valid diagnosis. The U.S. Military should also limit re-deployments and deployment lengths to better ensure a lower risk of contracting PTSD or other mental illness. Such limits can ultimately reduce suicides, substance abuse, and domestic violence committed by mentally ill soldiers returning to society.

The Essay

I. Introduction

Mr. K worked successfully as an automobile salesman. He was happily married with two

children ages 10 and 12 years, and was socially outgoing. Mr. K had an active and involved

lifestyle and a large circle of friends. He was also a member of the Army National Guard, where

in 10 years of service he had never experienced live combat or death. That was before he was

sent on a 12-month deployment to the Sunni Triangle in Iraq. While deployed, Mr. K was

involved in extensive combat exposure. He witnessed death and injury of fellow soldiers, was

heavily shelled and ambushed on numerous occasions, and was a passenger in a convoy attacked

by a roadside bomb. He recalled the worst moment of his deployment occurred when he was

unable to intervene, and instead had to watch helplessly while a group of Iraqi women and

children were slaughtered in the crossfire of a bloody assault [9].

Upon his return to the States, Mr. K experienced irritability, depression and anxiety. He

could not sleep or perform at work, and was unable to return the love and warmth of friends and

family. Life had become a terrible burden. The man that left for Iraq was not the same man that

returned home. Mr. K felt as though he would have been better off dying in Iraq [9]. His

thoughts and experiences are not unusual; Mr. K is one of nearly 20% of veterans returning from

Operation Enduring Freedom (OEF) in Afghanistan and Operation Iraqi Freedom (OIF)

suffering from Post Traumatic Stress Disorder (PTSD) [9, 17].

In March 2003, the United States and its coalition partners launched OIF, the largest

sustained ground operation since the Vietnam War [11]. To this day, the U.S Department of

Veterans Affairs (VA) is treating veterans from Vietnam suffering from mental illness [9, 17,

19]. The current military operations in Iraq and Afghanistan, and knowledge of the effects

caused by past wars, have raised important questions regarding mental health screenings and

policies in the military and the current mental state of our soldiers who have been deployed to

combat zones [10, 17, 19]. Whether or not the U.S. Military should increase pre and post

deployment mental health screenings to better identify PTSD in soldiers is an important question

needing to be addressed.

Nearly one in five combat veterans suffers from PTSD and the disorder is currently the

most common diagnoses made by the Veterans Health Administration (VHA) [6, 17]. Of the

nearly 300,000 veterans from OEF and OIF who have accessed VA healthcare, over 60,000 of

those veterans have received a preliminary diagnosis of PTSD [6, 17]. A study conducted by the

Rand Corp. estimated that treating these veterans could cost our nation more than $6.2 billion

and even more in social costs [6]. Research conducted identified a strong correlation between

PTSD and depression, substance abuse, impairment in social functioning, domestic violence, and

suicide [4, 10]. These issues bring to the forefront the need to identify and treat our veterans

suffering from PTSD.

Although rates of veterans diagnosed with the disorder are high, many people question

the effectiveness of current military mental health policies and their ability to identify and treat

PTSD in soldiers [11, 12, 17]. Issues regarding the validity of current screenings administered,

the mental impact of re-deployments on soldiers, and a connection to a rise in crime and

substance abuse have all been questioned [1, 3, 5, 6, 7, 9, 11, 12, 17, 26]. The stigmatization

surrounding mental illness in the military and its impact on soldiers seeking treatment is also an

important factor which requires attention [2, 6, 9, 10, 12, 14, 17, 20, 21, 22, 26, 27, 28, 30, 32].

The U.S. Military should increase pre and post deployment mental health screenings and

require every soldier to undergo testing with a mental health professional. They should also limit

re-deployments, a major factor in developing PTSD, which may ultimately help to reduce crimes

and substance abuse among psychologically unstable service-members.

II. History and Background Information

Psychological screening was first put into practice on a massive scale by the U.S. during

World War II. By the time the screening was stopped in 1944, it had been recognized as a major

failure; over 2 million men had been rejected as psychologically inadequate, and thus unable to

serve in the military. Learning from past mistakes, the military’s current emphasis has been less

about predicting mental vulnerability and more on detecting and managing psychological illness

before and after deployment. This new outlook was inspired by the aftermath of the Vietnam

War, and more recently by the health problems reported by veterans of the 1991 Gulf War [12,

19].

Veterans face several psychological challenges when returning from combat, including

the shift away from an adaptive, combat-ready, hyper-vigilant state of mind. After many months

of deployment to a war zone where the threat to life is continually heightened by surprise attacks,

direct assaults, deaths of fellow soldiers, and inadvertent civilian casualties, it can be difficult to

mentally readjust and properly settle back into society [9]. After the Vietnam War, the

difficulties suffered by many returning troops – including flashbacks, nightmares, and feelings of

detachment – inspired a new psychiatric diagnosis, PTSD [23]. At the time, it was known more

commonly as Post-Vietnam Stress Syndrome [17, 19]. The term officially entered the psychiatric

lexicon as PTSD in 1980 as an entry in the Diagnostic and Statistical Manual of Mental

Disorders, third edition [23]. PTSD is defined as a common anxiety disorder developed after

exposure to a terrifying event or ordeal and has symptoms including: flashbacks, guilt, insomnia,

depression, anxiety, irritability and even suicidal thoughts [9].

A study of Vietnam vets by the National Vietnam Veterans Readjustment Study

(NVVRS), commissioned by Congress, concluded that 31% of Vietnam vets have suffered from

PTSD at some point in their lives [23]. Deployment stressors and exposure to combat have been

linked as the main factor for contracting PTSD [10, 17]. However, gauging the prevalence and

diagnosis of PTSD in combat veterans has been difficult and controversial and experts say it's

impossible to know how many of the troops serving in Iraq or Afghanistan will develop PTSD or

other combat-related mental problems [23].

Under a Congressional mandate, the VA established a National Center for PTSD in 1989

to advance the mental health of veterans through research, education, diagnosis and treatment

[14, 17]. The lessons witnessed and learned from the Vietnam War have prompted the U.S.

Department of Defense (DOD) and U.S. Military to do even more to protect the mental health of

troops in Iraq and Afghanistan [12, 23]. In 1998, the DOD introduced optional short pre and post

deployment questionnaires, which included limited screening for physical and psychological

illnesses and failed to target PTSD directly [11, 12]. Most recently in 2003, the DOD mandated

that all service members complete a Post-Deployment Health Assessment (PDHA) upon return

from any deployment and a Post-Deployment Health Reassessment (PDHRA) 3 to 6 months

following the PDHA. The purpose of the questionnaires are to review each service member's

current health, including mental health or psychosocial issues, possible deployment-related

exposures, and to raise discussion on deployment-related health concerns, allowing the soldier to

reintegrate back into the military or society in a timely manner [11, 12]. Congress also

appropriated $300 million for PTSD research in 2007 and addressed excessive drinking and

substance abuse, common problems associated with PTSD, by increasing the Army’s substance

abuse prevention budget from $38 million in 2004 to $51 million in 2008 [4, 17]. The VA also

currently has over 17,000 employed mental health staff and 232 Vet Center programs to assist

veterans [17].

III. Issues

Are current PDHA and PDHRA mental health questionnaires effective?

Although psychological screenings and questionnaires have been supported by the

military and mental health professionals as a way to detect PTSD, evidence that the current

PDHA and PDHRA are effective at diagnosing the disorder have been debated [11, 12, 17, 26].

The PDHA and PDRHA consist of 3 pages of self-administered questions pertaining to

deployment location, general health, physical symptoms, mental health concerns, and exposure

distress. About half of a page is devoted to questions related to mental health concerns, including

PTSD symptoms, depression, suicidal ideation, aggression, and interest in receiving mental

health services. The questionnaires present information to help professionals diagnose and

document referral needs and discuss resources to resolve mental health issues if they are present.

Those who screen positive for a mental health problem schedule or receive an interview with a

physician [11, 14, 20].

Many supporters of the PDHA and PDHRA assert that the questionnaires have construct

validity and are effective at documenting referral needs and diagnosing mental illness in soldiers

[4, 14, 17, 20]. Specifically, the mental health portion of the screening has been noted as a valid

indicator of soldiers’ deployment related experiences and recognizes those immediately needing

assistance on return from deployment [11]. Two thirds of service members who accessed mental

health care did so within 2 months of returning home strengthening the need for the PDHA [12].

The goal of the military has been to catch soldiers who need help early on and get them treatment

before their symptoms develop into a full-blown disorder or become compounded by alcohol, or

drug problems, as happened to many soldiers after Vietnam [23]. Statistics show that the military

is achieving its goal to increase earlier identification and treatment of mental health problems

[12].

According to Colonel Charles W. Hoge from the Walter Reed Army Institute of

Research, 20% of active service members and about 40% of Reserve members are referred for

mental health treatment or evaluation through the PDHA and PDHRA process. The bulk of those

referred come through the PDHRA which signifies the importance of a second screening.

Providing a second re-assessment 3-6 months down the road catches soldiers who may have

slipped through diagnosis earlier, or who may not have experienced symptoms of PTSD until

late [11]. Research has shown symptoms of PTSD tend to be more prevalent in the following

months of returning to society emphasizing the effectiveness of the current program [17].

Although there is adequate evidence supporting the effectiveness of the PDHA and

PDRHA, several findings highlight the problems with mass population screening [11]. The good

intentions of the military alone cannot sustain a screening program of such complexity [12, 29].

Opponents to the PDHA and PDHRA argue that the self reported questionnaires are an overly

general assessment and under-diagnose psychological problems in specific soldiers. They argue

that the screening only identifies a small percentage of individuals who will then go on to

develop problems [1, 11, 12, 13, 14, 17]. Soldier to soldier warning, as well as the threat of

ramification for their careers is seen as a major setback to the self administered questionnaires

[14, 21, 27].

By using a self reporting system, the military runs the risk of not being able to accurately

estimate the number of military personnel who need mental care. Soldiers may be uninterested in

seeking professional help or be fearful of the negative stigma associated with having a mental

disorder; ultimately affecting their responses [1, 2, 6, 11, 12, 17, 27]. Matthew Denton, a Marine

deployed to Iraq for six months, claimed he suffered from PTSD but managed to stay below the

initial mental health radar, stating he felt as if there was barely any radar to avoid. He reported

that it was easy to keep secret because the health screenings were self reported and commanders

or practitioners never specifically probed his mental state [3]. Soldiers who take the survey

before returning stateside are often tempted to hide symptoms to avoid delaying their return, and

worries about confidentiality are also widespread. Many soldiers may not check the box because

they fear negative ramifications for their careers [21, 23]. Most surveys in the armed forces show

a response rate of less than 75%, and often much lower [12].

Written tests can provide widely varying overestimates and underestimates of any given

disorder and referral. Overestimation of illness may sometimes occur because of over reporting

symptoms when soldiers return home, perhaps influenced by the desire to access health care after

leaving the service [12]. The timing, how the questions are phrased, and the factors a psychiatrist

uses to determine a referral can also affect the effectiveness [6, 12, 15, 17]. Critics are troubled

by the inconsistency and small amount of referrals given for those who take the survey; fewer

than 8% of veterans seeking help a year after returning were referred by the questionnaires [14].

Inconsistencies have also been found when referrals are in fact made. The Government

Accountability Office (GAO) found that DOD health care providers varied in the frequency with

which they issued referrals to OEF and OIF service members; the Army referred 23 percent, the

Marines 15 percent, the Navy 18 percent, and the Air Force 23 percent. Critics say the DOD

needs to identify the factors its providers used in determining which OEF/OIF service members

need referrals in order to increase the effectiveness of current programs [15, 26].

Mental health questionnaires provide a general assessment on soldiers with possible

symptoms but fail to diagnose mental disorders in individual soldiers, causing them to further

seek testing and treatment on their own. The screening processes themselves can never guarantee

100% accuracy or diagnosis of every soldiers suffering from PTSD and universal self reported

screening allows too many soldiers to slip through the cracks [6, 12, 17]. Experts and veterans, as

well as some military and government officials agree that diagnosis and treatment continues to

lag behind awareness [4].

Should deployment length and the number of re-deployments be limited?

The Cycle of Deployment is divided into four distinct phases including: Pre-Deployment,

Deployment, Post-Deployment and in some cases Re-Deployment [20]. According to the DOD,

more than 378,000 active duty and Reserve troops have served more than one tour in Iraq or

Afghanistan, representing almost one third of the 1.3 million troops who have been deployed [3].

Experts say that the repeat exposure to combat could dramatically increase the percentage of

soldiers who experience PTSD, major depression, or other disorders [1, 3, 31]. This raises the

question of whether the U.S. Military should shorten deployment lengths and limit the number of

re-deployments for soldiers to decrease the risk of service members contracting or worsening

PTSD.

Supporters of a limit believe that minimizing the number of deployments a soldier can

serve would help decrease PTSD rates in veterans. Their main argument is that research has

proven a direct relationship between the number of deployments and the psychological well

being of service members [1, 3, 7, 17, 20, 24, 31]. A study presented in the subcommittee

hearing over PTSD asserted soldiers on their third deployment to Iraq had a 30% diagnosis rate

of significant combat stress or depression symptoms, compared to about 20% of those on their

second deployment and 12% on their first deployment [17]. This statistic alone is enough to

prove a rise in psychological problems as deployments increase. Critics even claim that military

leaders acknowledge multiple deployments strain soldiers and families, and can increase the

likelihood of PTSD but yet they are doing little to denounce it [1].

Another reason in support of limiting deployments is the claim that the military is fueling

the increase of suicide and psychological problems in soldiers by continually sending and

recycling troubled soldiers back into combat [1, 3, 24, 32]. Studies show that the Armed Forces

are stretched so thin that some soldiers are being called back to duty in far shorter time than the

12 month recommendation. Some are only receiving a 90 day leave and then are sent back to

combat. Psychologists assert that even the recommended 12 months between deployments is not

sufficient time for soldiers to “reset” and be ready to go back for another deployment, let alone

one-quarter of the recommended period [17]. This has led to the military sending troops who

have not diagnosed or treated their serious psychological problems back into combat [3, 24].

Henthorn, an Army soldier, was sent back to Iraq for a second tour despite the military’s

knowledge of his unstable mental state. Upon returning to Iraq, he became more suicidal and

succeeded in killing himself with the work of his M -16 rifle [3]. He was just one of many cases

of soldiers forced back into deployment despite suffering from mental instability. In 2005,

suicides in Iraq reached an all time high of twenty five [3, 13]. Dave acknowledged suicide as a

current problem addressed by the Army. He asserted a massive campaign to try and prevent

suicides, ranging from what to look for in a buddy who may be having problems, to what to do if

you are having problems, has been implemented in the last year [29]. Recommendations from

mental health workers are to extend the interval between deployments to 18 or 38 months or

decrease deployment length to allow time for soldiers to mentally reset before re-deploying [7].

Limiting deployments has also been supported because a large portion of troops on

current tours are members of the National Guard or Reserve, meaning they are civilians who are

normally not accustomed to a full-time military lifestyle or combat experience [9, 28]. Bowman

believes the rise in mental health issues recently is due to sending tens of thousands of our

Reserve Military personnel into combat zones. He said that reserve members lead civilian

lives and then all at once are suddenly being deployed into combat zones and leaving

family. These circumstances cause extreme trauma [28]. Evidence to support the higher

rate of mental illness in Reserve soldiers was made at the Congressional subcommittee

hearing where 40% were diagnosed with PTSD compared to 20% of active members [17].

Critics of the long deployments argue that asking soldiers to mentally transition between

home and combat in such short periods of time is both unfair and unrealistic [17, 32].

Many military experts point to recruiting shortfalls and intense wartime pressure to

maintain troop levels as reasons more service members are being deployed and kept longer [3].

A therapist in Colorado Springs who treats PTSD in soldiers, asserted that she reached the point

where she stopped asking if soldiers have been deployed and started asking how many times [1].

Critics opposing limiting deployments believe that extending leave, and shortening deployment

numbers and lengths would put more strain on military numbers and force an even more

unrealistic mental adaptation on soldiers and their families [17].

According to the subcommittee hearing, PTSD has actually been identified to rise as

soldiers are home longer, creating speculation about the idea of increasing leave time between

deployments [17]. Critics assert this is due to the military’s attempt to create a contradiction; a

perfect warrior one moment and a perfect gentleman the next [5]. According to scientific

evidence, there are a host of changes that happen within the nervous system of a soldier upon

deployment. Normal biological processes that are adaptive and necessary in combat such as

being hyper-alert, are not perceived as normal when returning to society and is a symptom of

PTSD. However, the main issue arises when soldiers need to maintain those mechanical skills

necessary for survival in a wartime atmosphere because they know they are going to be re-

deployed [1, 17, 32]. Both supporters and proposers of limiting time and frequency of

deployment agree that it is unrealistic to ask a soldier to turn on and off their social and mental

adaptations but proposers differ by believing the only way to limit this is to keep soldiers on

deployment tours more frequently [1, 3, 14, 32]. Many soldiers admit the only cure for

psychological problems is to go back into combat, not sit at home between deployments [1, 32].

In my opinion the time interval between re-deployments should be extended and

deployment lengths and number of deployments should be limited to allow soldiers a chance to

mentally recover and seek treatment if issues arise. According to official policy guidance,

restricting deployment and service for military personnel experiencing mental illness or trauma is

put into action when any health or psychological condition limits the service member to plan,

train, or execute the mission or represents a risk to the individual, the unit and mission success

[18]. Although there have been numerous soldiers sent back to combat despite suffering from

PTSD, extending leave time would allow soldiers to be properly diagnosed and access treatment

before having to return to combat [1, 7, 17, 32]. By reducing deployments, the military will also

help reduce the number of soldiers diagnosed with PTSD as well those suffering from

depression, thoughts of suicide and substance abuse [3, 4, 13].

Should suicides, substance abuse, and domestic violence be given more attention?

Evidence of a positive correlation between PTSD and suicides, substance abuse, and

domestic violence has been asserted by numerous studies [1, 3, 7, 9, 10, 22]. There is a growing

body of evidence that alcohol abuse is rising among veterans of combat in Afghanistan and Iraq

[5, 10]. Indications have suggested that illegal drug use, much less common than heavy drinking

in the military, is up too. Increasingly, troubled veterans have continually been spilling into the

criminal justice system and committing suicide [7]. With the rising awareness of problems,

mounting concern about the association of these behaviors, and their link to PTSD, the

treatments the military is currently offering for veterans are being questioned [5, 10].

Experts say substance abuse must be acknowledged first because it is hard to treat

someone for PTSD who is heavily drinking and using drugs. In recent years the military has

worked to transform a culture that once indulged heavy drinking as a warrior ego, into one that

discourages it and encourages soldiers to seek help. This ego, however, is hard to break in a

soldier’s mind. Service men and women are trained to be tough and ignore their fear and

physical as well as psychological wounds, ultimately resorting to drugs or liquor to compensate

for their instability. Of 88,235 soldiers surveyed in 2005 and 2006, 15% acknowledged having

serious problems with alcohol [5]. Adam, who was documented on MTV’s True Life reality

show, also asserted that upon returning home he spent his entire savings on his alcohol addiction

and had a hard time accessing treatment [31]. For users of harder drugs, treatment within the

military is said to be rare. The military usually discharges them, arguing that they can no longer

successfully perform service [5].

The VHA cut back alcohol and drug abuse services in the 1990’s as veterans declined,

but with the new influx of veterans from Iraq and Afghanistan, there exists a lack of the proper

amount of support programs [5]. The issue has been recognized and the House and Senate passed

bills requiring veteran agencies to expand substance abuse screening and treatment for all

veterans [17]. Critics support the military’s serious stance on drug and alcohol abuse and the

military says it plans to tackle the problem with education, prevention, and treatment programs.

In recent years the military has rolled out a number of programs to deal with substance abuse.

Call-a-cab cards, portable breathalyzers, and online anti substance abuse campaigns are just a

few ideas that have been implemented to reduce alcohol related issues [5].

Opponents argue that the military’s current treatments rely too heavily on anti-

depressants and other pills to treat depression and PTSD, which add dangerous side effects and

the potential for more problems. Some service members who experienced depression or stress

before, during, or after deployment to Iraq described being placed on Zoloft, Wellbutrun and

other medications, with little or no mental health counseling or monitoring [3, 10, 13, 30, 31].

Many of the drugs used by the military as treatment carry warnings of an increased risk of

suicide. Giving soldiers access to pills on top of access to a weapon is asking for a tragic end [3,

31].

Lance Corporal Justin Bailey is one of those cases. Upon developing major depression

and a substance abuse disorder, he sought treatment at a VA center near his home. Instead of

being properly diagnosed and treated, he was given five different medications by the VA. Bailey

would later use these pills to overdose and kill himself. Assessment of suicidal risk is most

important during diagnosis and treatments [7]. There is evidence of a link between the number of

traumatic events and the likelihood of a suicide attempt which highlights the need to diagnose

and treat soldiers effectively, not just prescribe pills [9, 10, 31].

Supporters assert the military has begun focusing attention on soldiers charged with

homicides and domestic violence after returning from a tour of duty, which since the start of the

war they largely claimed was not related [1]. Officials suggest that the rise in number of

domestic violence cases is due largely to the military’s increased practice of holding soldiers

accountable and encouraging victims to come forward so the issues can be addressed more

effectively [1]. A small but increased number of authorities are trying to help to bridge the gap

between PTSD and domestic violence. Robert T. Russel, a city court judge, helped create the

nation’s first Veterans Court, where, instead of jail, veterans arrested for low-level crimes are

enrolled in treatment and counseling [5].

Critics of a perceived link between PTSD and behavioral factors claim that a large new

study suggests mental illness alone is not a leading cause of domestic violence. Instead, a

combination of factors must be present, the study says, claiming that people with mental illness

are no more violent than people without mental illness. The study also pointed out that U.S.

systems to treat mental illness and substance abuse are separate. It was mentioned, however, that

when mental illness was combined with previous exposure to violence that the risk of domestic

issues increased by a factor of 10 [8].

In my opinion, PTSD is a major factor in domestic violence, substance abuse, and

suicides committed by soldiers. Screening and treating the problems along with PTSD would

help reduce the number of soldiers experiencing behavioral problems. Statistical evidence

supports that service members with mental illness problems are heavier drinkers and drug users

than those without [1, 3, 4, 22].

IV. Discussion

Is there a stigmatization surrounding mental health in the military?

Top military officials as well as the DOD do not like to acknowledge that there is a

“stigma” in the military that seeking treatment for mental health issues. They want to believe that

soldiers feel comfortable asking and admitting the need for help when they need it and will be

truthful when filling out the PDHA and PDHRA [6, 9, 21]. Some argue that the perceived

‘stigma’ is a way for the Military to retain troop numbers [2].

A landmark study in 2004 by the Walter Reed Army Institute of Research however,

found that there was a significant barrier to troops seeking mental health care. The barrier,

according to the study, was the belief that seeking counseling or admitting mental health

problems would harm a soldiers’ military career and security clearance and stigmatize

themselves or the Armed Forces as weak. Statistical numbers show that 50% of troops showing

symptoms of PTSD believed it would be bad for their career to seek help; 65% said they would

be perceived as weak; and 63% said commanders or other soldiers would treat them differently

[2, 10, 21].

Many troops returning from war acknowledge that their own fear of being stigmatized

kept them from seeking psychological help during deployments. Soldiers admit they are trained

to be tough, and not talk about their problems let alone express emotion [5]. Despite efforts by

the military to improve mental health care, the negative views associated with admitting

problems has lead to a decrease in effectiveness of the PDHA and PDHRA [3, 21].

Suggestions on how to break down the stigma include requiring mandated screenings

face to face with a mental health professional which reduces the ability of soldiers to hide their

true psychological state. Getting families and friends comfortable in the education of PTSD will

also help to encourage a soldier to get help if needed [2, 6, 21, 27, 28, 29].

To de-stigmatize the psychological injuries of war, the DOD and Ad Council have

partnered to conduct a 3-year public service announcement campaign to try and ensure that

troops who need mental health care access it. The goal is to inform service members and society

that veterans are not damaged goods and there is treatment available and it does work [17].

Is technology and research positively affecting treatment of PTSD?

Technology has had a positive impact on the treatment of mental illness in recent years

[4, 25]. New treatment has been unaddressed in the past because until recently, studies have not

been able to assess the effectiveness of various programs because many were in developmental

stages. Even currently, research has not been fully analyzed to identify the full effectiveness of

the treatments. It will take years to analyze the positive and negative effects of new training,

virtual reality treatment and brain scans on soldiers suffering from PTSD [5, 17, 25].

Exposure therapy, in which a patient is asked to confront memories of trauma by

imagining and recounting details, has long been a psychological treatment for PTSD. Recently, a

simulation called Virtual Iraq was created to treat Iraq war veterans suffering from PTSD. The

realness of virtual exposure has helped to increase the effectiveness of exposure therapy [4].

Consider a soldier who experienced a road side bomb attack while driving in Iraq and upon

return to society he or she suffers flashbacks and nightmares from that experience simply by

driving. A therapist might use virtual reality to simulate an actual driving experience to help a

veteran extinguish the negative stress and de-stigmatize that reaction [17]. According to the

Congressional subcommittee hearing, academic and government experts claimed that exposure

therapy is the most effective and appropriate therapy for PTSD. It has been asserted that even

though not all patients will benefit from this type of treatment, an overall success rate of 92% has

been found among soldiers using Virtual Reality technology as treatment [4, 17].

New research indicates that the PDHA and PDHRA alone did not specifically target or

educate soldiers going into combat and coming back without adjustment challenges. The newest

treatment and education tool available to soldiers is the Battlemind program. The pre deployment

part of the program addresses what soldiers are likely to see, hear, think, and feel while

deployed, while the post deployment training addresses safety concerns, normalizes combat

mental health reactions, and teaches soldiers when they should access mental health support for

themselves or friends [16]. The Battlemind system is the newest program implemented by the

military and has yet to be fully tested. However the system addresses issues past research has

described as problems and supports soldiers and families across all phases of deployment in a

realistic and relatable way [16, 17]. The program is assurance that the military is addressing

current research and advocating better mental health in soldiers [16].

V. Stakeholders’ suggestions for how best to resolve the issue

The stakeholders propose that the U.S. Military focus on reducing the stigma and self

reliant attitude associated with seeking mental treatment. By adequately funding and providing

resources for sit down screenings with mental health professionals, they will ensure a more

proactive approach to helping veterans suffering from PTSD [27, 28, 29]. The strengths of this

solution are that mandated screenings and treatment with a health professional reduce the

number of soldiers who previously ignored seeking mental health due to stigma or ineffective

referral reasons. By treating and diagnosing PTSD more effectively in soldiers, substance abuse,

domestic violence, and suicides will also be positively affected [1, 3, 13, 24]. The weakness of

this solution is the difficulty in implementing such a large personal screening process due to lack

of resources and funding [1, 12, 17, 24].

The non stakeholder believes the U.S. should concentrate its mental health effort on pre

combat training and education to increase awareness, warning signs, and symptoms of the issue,

especially in Reserve service members who are not regularly involved in military life [28]. The

strength of this solution is that educating soldiers before deployment will help them know what

to expect and when they should access treatment upon returning home [16, 30]. It also puts less

pressure on the military and allows the soldier to actively get help when needed [16, 24, 30]. The

weakness of the solution is that it is impossible to avoid experiencing intense trauma no matter

how much education or knowledge about a situation, contracting a mental condition can be

unavoidable. It also puts more responsibility on the soldiers to help themselves which has proven

to be an issue with the perceived stigma associated with mental health, notably affecting a

soldiers’ admittance to problems [2].

VI. Recommendations

The U.S. Military should increase and improve the mental health screening process

before and after deployments by mandating universal examinations with a health care

professional. The process should begin with pre-deployment education courses and continue

following return from combat. Requiring multiple mental health examinations upon deployment

and the return helps identify psychological illness in soldiers more effectively. It also addresses

the soldiers who should not be re-deployed and are at risk of worsening their mental state. A

soldier’s successful transition back into society relies on their mental stability, which forces the

military to provide adequate diagnosis and health care services to the soldier, as well as the

soldier to access what is available.

The strength of this solution is that it clearly identifies what needs to be done in order to

validly diagnosis and treat soldiers suffering from mental illness. Multiple post-deployment

screenings and education courses are necessary in preventing other issues from arising and

preparing a soldier for reintegration into the general public. The weakness of the

recommendation is the idea of forcing soldiers to be examined and possibly seek mental

treatment against their will. Funding for the implementation of multiple programs and finding the

resources and staffing are also issues concerning the military and veterans wanting to seek

treatment. Although mandated mental health screenings are more effective at determining a

soldiers psychological well being, they also benefit and improve a soldiers’ rehabilitation to

society and the social costs. Multiple screenings alleviate misdiagnosis and further help to

effectively identify PTSD and other psychological problems in soldiers.

VII. Conclusions

Many soldiers are not prepared for the mental impact of combat or re-entering society

after experiencing traumatic events. Conducting pre deployment education courses and

mandatory mental health examinations with a professional help acknowledge and detect clear

physical and psychological symptoms in soldiers suffering from PTSD. Conducting pre and post

deployment screenings on soldiers allows health professionals to compare, identify, and treat the

illness at its earliest stages, allowing the soldier to assimilate back into the military or society in a

timely and safe manner.

I analyzed the issue by focusing on sources that explained what is currently being done

and the problems that are still arising with the current system in regards to effectiveness,

soldiers’ actions, and the barriers to seeking treatment.

I believe the U.S. Military should increase pre and post deployment mental health

education and screenings and require every soldier to undergo examinations with a mental health

professional to ensure valid diagnosis. The U.S. Military should also limit re-deployments and

deployment lengths to better ensure a lower risk of contracting PTSD or other mental illness.

Such limits can ultimately reduce suicides, substance abuse, and domestic violence committed by

mentally ill soldiers returning to society.

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