Fort Hood Has Experienced Other Kinds of Violence

Although the investigation of the shooting at Fort Hood last week is still underway, it seems clear that it wasn't the result of post-traumatic stress disorder (PTSD). But in the New York Times today, Michael Moss and Ray Rivera report on a different kind of violence that has been happening, quietly, in the town of Killeen, Tx, the town surrounding Ft. Hood.

Reports of domestic abuse have grown by 75 percent since 2001. At the same time, violent crime in Killeen has risen 22 percent while declining 7 percent in towns of similar size in other parts of the country. [...]

Since 2003, there have been 76 suicides by personnel assigned to Fort Hood, with 10 this year, according to military officials.

The shooting last week earned national attention, but in many ways, it is a freak occurrence. Domestic violence, violent crime, and suicide is far more typical in this Army base town.

Estimates vary, but the National Alliance on Mental Illness says some experts predict about 15 percent of veterans who served in Iraq and Afghanistan will develop some form of PTSD. But the policy on how to treat PTSD is a bit underdeveloped. So far, the only way to treat PTSD is through therapy with a psychiatrist or psychologist, but the Veterans Administration doesn't employ nearly enough of them to effectively treat all of the cases of PTSD that can develop in veterans (and the DOD has a similar problem with active-duty soldiers). Furthermore, mental health professionals are a really expensive kind of employee that requires a lot of specialized training. How to effectively (and cheaply) treat the soldiers and veterans of Iraq and Afghanistan for PTSD is somewhat of a quagmire that lawmakers, the military, and activists continue to grapple with. It becomes complicated by some individuals who are reluctant to seek help because of the stigma that can sometimes be associated with seeking help from a mental health professional.

It's true that the majority of veterans from Iraq and Afghanistan will return from duty, well adjusted and quickly readapt to civilian life. But for a minority of soldiers, the problems of PTSD extend to their families and their surrounding communities.

Cross posted.

Veterans Day: Looking at Veterans' Needs

This election season, the moniker of “Support the Troops” warring with “Support the Troops: Bring Them Home” fell off the national scene. Instead, veterans of Iraq and Afghanistan are quietly getting shipped home. As reporting in the Washington Post after the election showed, troops don’t necessarily have a ton of time to ponder election returns. On seeing the election results, one soldier even quipped, “We're all going home! … What time does the plane leave?”

In other words, solving some of the problems we have is nowhere near that simple, especially as we address the needs of our largest war veteran population since Vietnam. Following is an examination of the upcoming battles in veterans’ issues.

The Montgomery G.I. Bill

This year Congress passed an expanded version of the Montgomery G.I. Bill this summer, initially proposed by Sen. Jim Webb, addresses some of the key problems that a highly mobilized military presented. The bill expanded benefits to those that served on or after September 11, 2001 and increased funding of the G.I. Bill to total up to the cost of in-state tuition at a public university (including some housing benefits).

But the problem here isn't with the legislation; it's with the execution. The changes to the G.I. Bill are supposed to go into effect on August 1, 2009. But the Veterans Administration may not be ready by then to handle the high volume of paperwork that they are expecting to receive. Another problem is that many veterans may already be finishing school (or nearly finished) by the time the benefits go into effect, and the benefits aren't retroactive.

Veterans’ Health Care

Believe it or not, veterans tend to enjoy some of the best, most "socialized" medical care in this country today. Veterans receive free care at any VA facility, and the government picks up the bill. VA hospitals also tend to have the most advanced prosthetic technology available. There has also been a push to convert to electronic medical records to increase speed and accuracy of treatment. It's something that many have called for to be replicated in the private health care sector.

But the VA system isn't perfect. With an increased population of war veterans and only marginal increases in the VA budgets until 2006, the VA hospitals often don't have enough doctors or appointment times, with waits of up to 18 months for some patients, to meet the demand of patients. An audit [pdf ] conducted last year by the VA's inspector general found that only three-fourths of patients had wait times of less than 30 days , far fewer than the 95 percent the VA had originally claimed. Additionally about 1.8 million veterans are "uninsured" because they don't live near enough to a VA facility for that treatment to be accessible.

Post-Traumatic Stress Disorder

Of the roughly 1.7 million soldiers serving in Iraq and Afghanistan, about 300,000 of them -- 1 in 5 -- are estimated to be suffering from some form of PTSD or severe depression, according to a RAND report released earlier this year. The costs for treating these veterans can cost upwards of $6.2 billion. As recently as this May, a PTSD program director in Texas urged her facility to cut back on the number of PTSD diagnoses so that

Since there's no one way to treat a person for PTSD, the problem of treating all of these veterans becomes a very difficult one. Some propose interviewing all soldiers upon their return from a war deployment to get a baseline and flag those who may be susceptible to PTSD. More recently, the Army is trying a program where soldiers are treated in the field almost immediately after a traumatic event. There needs to be more research into the best and most effective ways to treat soldiers and veterans with PTSD.

What is especially problematic is that women who are sexually assaulted while deployed in a war zone can get a "double wammy" of PTSD. The VA has opened a few treatment facilities exclusively for women that can allow them to address their PTSD in an environment they perceive to be more safe.

Image by Flickr user eggman, used with a Creative Commons license.

Cross posted at Pushback.

Treating PTSD in the Field

The Army is trying a new approach to treating PTSD, according to a story today by McClatchy. After soldiers witness a traumatizing incident they speak with a doctor one to three days after the incident, something called Critical Incident Debrief (CID). They're basically asked to relate what happened during the incident -- right down to their feelings. The Army is starting to treat PTSD as a normal response to an abnormal experience, and they recognize the value in treating PTSD. Apparently it's cheaper to treat it than to recruit and train a new soldier. I'd also argue there's something of a moral imperative to help the person you put in a fucked up situation.

Death on the Home Front

The NYTimes this weekend had a long report on soldiers who have returned to the United States and committed a killing:

The New York Times found 121 cases in which veterans of Iraq and Afghanistan committed a killing in this country, or were charged with one, after their return from war. In many of those cases, combat trauma and the stress of deployment — along with alcohol abuse, family discord and other attendant problems — appear to have set the stage for a tragedy that was part destruction, part self-destruction.

Three-quarters of these veterans were still in the military at the time of the killing. More than half the killings involved guns, and the rest were stabbings, beatings, strangulations and bathtub drownings. Twenty-five offenders faced murder, manslaughter or homicide charges for fatal car crashes resulting from drunken, reckless or suicidal driving.

About a third of the victims were spouses, girlfriends, children or other relatives, among them 2-year-old Krisiauna Calaira Lewis, whose 20-year-old father slammed her against a wall when he was recuperating in Texas from a bombing near Falluja that blew off his foot and shook up his brain.

A quarter of the victims were fellow service members, including Specialist Richard Davis of the Army, who was stabbed repeatedly and then set ablaze, his body hidden in the woods by fellow soldiers a day after they all returned from Iraq.

And the rest were acquaintances or strangers, among them Noah P. Gamez, 21, who was breaking into a car at a Tucson motel when an Iraq combat veteran, also 21, caught him, shot him dead and then killed himself outside San Diego with one of several guns found in his car.

The thing about this is that the DoD isn't inclined to take ownership of the killings, especially since a good chunk of them were committed after the soldiers become veterans and therefore beyond the DoD's jurisdiction. Unfortunately, the DoD's "no comment" stance on this issue is worse than if they addressed it head on.

The bad news is that when we train people to kill people sometimes it's really hard to turn that switch off, especially given the extreme and prolonged stress that these soldiers undergo in combat situations. We can't say that in every instance these killings can be chalked up to PTSD, but it's hard to ignore that combat stress has lasting effects. What I found saddest and most disturbing was that in a third of the circumstances, the victim was a family member. These wives, children, or close relatives are happy to see their soldiers return home, but they aren't the same. In many cases, these former soldiers also took their own lives.

It's becoming a more common story as troops return from the combat arena. The thing is, PTSD is treatable, and we should be pushing to make sure these kinds of incidents don't happen because the veteran gets treatment before he or she causes destruction. As the death toll is starting to subside in Iraq, it's important that we monitor it here as well.

Cross-posted on campusprogress.org/blog.

Reviewing In the Valley of Elah

My review of In the Valley of Elah is up on The American Prospect's site today:

What’s peaking though the fairly transparent plot is the costs of sending soldiers to war -- encouraging them to torture and kill terrorists (or suspected terrorists) -- and returning them home unable to continue with normal lives. A side plot of the film has a woman ahead of Deerfield at the police station there to report her husband's (another recently returned Iraq vet) violent drowning of the family's Doberman Pincher in the bathtub in front of their son. Later in the film he is arrested for drowning his wife, who Theron's character had sent home without helping.

The movie clearly depicts post traumatic stress disorder. But what makes In the Valley of Elah portrayal valuable is that it depicts the strain of PTSD on families and communities as well.

Official estimates of how many Iraq war veterans might be affected by PTSD vary, mainly because it’s something that affects patients in a matter of degrees, many of which are not necessarily violent. It’s a cost of war that’s little talked about estimated to cost billions of dollars. Many psychologists, including the American Psychological Association's Education Directorate, advocate a public education campaign that would not only teach soldiers and their families what the symptoms of PTSD are (often sleeplessness, flashbacks, problems with aggression, and relationship stress) but also instruct the public that PTSD can be a normal reaction to abnormal levels of stress or violence, especially when encountered for long periods of time. Some soldiers are serving tours as long as 15 months.

Read the whole thing.