For all of you who were able participate in Visible Honor for Invisible Wounds on 28 June, we wish to say thank you.
For those of you who were not able to join us I would take this opportunity to briefly summarize the progress made at this impressive forum to combat the stigma and misunderstanding of post-traumatic stress.
I believe several new and fresh concepts were brought forth which will, if followed, go far to modernize our view, interpretation and resolution of invisible wounds.
- Joe Geraci and Tim O’ Connor of Battle Buds brought up the notion of posttraumatic growth in which the individual who has been exposed to mental trauma now has the infrastructure and foundation to build a new understanding of life and personal development
- Ty Carter advance the idea of post-traumatic stress is something that we all experience to some extent at some point or points in our lives; and it is, beyond being distasteful and harrowing, an opportunity to learn and adjust.
- Dr. Frank Ochberg emphasized the idea that post-traumatic stress is an injury and for the benefit of the injured it needs to be referred as such.
- JB Moore of NAMI hammered home the absolute need for parity between visible and invisible wounds and called for the establishment and entitlement of the Purple Heart for post-traumatic stress incurred in combat in order to curb the current discrimination against those who have incurred battlefield traumatic stress
- Deputy NYPD Commissioner Susan Herman stressed the need to end the stigma of mental trauma among first responders and victims of crime
In the end the dominant and unmistakable message emerging from this avant-garde forum brought forth the undeniable conclusion that post-traumatic stress is an injury that needs to be accepted and honored as such
If we do not attend to it earnestly and expeditiously;
if will allow it to progress into a disorder;
we have failed in our reciprocal duty to those who protect our freedom and safety as well as those we love;
we have failed as a modern society and free nation.
Once again the words of author Jennifer Worth:
Invisible wounds are the hardest ones to heal
For their closure is dependent upon the love of others
On patience, understanding, and the tender gift of time
The keynote address at this year’s Visible Honor for Invisible Wounds ceremonies will be delivered by Staff Sargent Ty Carter, recipient of the Congressional Medal of Honor in 2013.
He will be joined at the podium by representatives from the offices of: the Chiefs of Staff of the Army and Navy; Iraq Afghanistan Veterans of America; the Wounded Warrior Project; Service Women’s Action Network; the FDNY Commissioner and NYPD Commissioner; individuals from the national healthcare sector, and last, but certainly not least, individuals among us now dealing with the everyday consequences of post-traumatic stress.
Our goal is to reduce suicides among veterans, first responders, victims of abuse and others caused by misunderstanding and prejudice applied to post-traumatic stress injuries, known to most Americans, unfortunately, as a disorder.
Discovery and resolution of a bio-marker will reduce stigma and lead to better understanding of the consequences of modern warfare, occupational trauma and abuse.
In the Executive Summary of the National Research Action Plan, dated August 2013, the Administration has made it clear that it considers the replication and confirmation of biomarkers for PTSD and the identification of the blast pathology for TBI to be preeminent in the research priorities of the National Research Action Plan (NRAP) to aid in the prevention, diagnosis and treatment of mental health issues among service members, veterans and their families. Accomplishment of this directive will lead to greater understanding of mental injury and illness which will in turn, benefit those now suffering in inequitable silence.
Key Themes Specific to PTSD, TBI, and Suicide Prevention Research -
Beyond the research priorities spanning conditions (presented previously) and looking deeper into specific research needs for PTSD, TBI, and or suicide prevention, the themes highlighted here are examples of topics described in greater detail in the full report. Please note that the bullets under each research area are organized along the Interagency Research Continuum Approach, described earlier, and are not placed in order of importance or priority. Also note that all of these research areas are expected to include consideration of co-occurring disorders, including substance use disorders.
PTSD: Biomarkers, Mechanisms, and Treatment Research -
• Replicate and confirm emerging data on promising biomarker candidates and other diagnostic tools for PTSD, including genome-wide associations, plasma molecules, and methylation patterns.
• Optimize risk and resilience screening tools and test new PTSD prevention and treatment interventions that target underlying mechanisms and causal pathways.
• Enhance current PTSD evidence-based treatment delivery to be briefer, more durable, and more efficacious in treating service members, Veterans, and their family members, including individuals with multiple mental and physical health issues, including substance abuse.
TBI: Biomarkers, Diagnosis, Mechanisms, and Treatment Research -
• Determine whether blast-induced TBI is a unique pathobiological entity and, if so, define the neuropathology of blast injury and in a subsequent step evaluate appropriate imaging technologies for their ability to identify the blast pathology in histologically characterized brain tissue. Utilize these imaging tools in service members and Veterans to determine whether blast, or repetitive blast injury, is a risk factor for chronic neurodegeneration or other chronic neurologic disorders.
• Develop a more precise system for classifying and staging TBI to enhance diagnosis and prognosis and enable targeted therapies and personalized medicine.
• Support validation studies of proteomic, imaging, neurophysiolo
research to rapidly translate what is learned into new effective prevention strategies and clinical innovations: biomarkers to detect disorders early and accurately; and efficacious and safe treatments”
To attain these goals, the Order urged research agencies to improve data sharing as appropriate and with appropriate privacy and confidentiality protections, and harness new tools and technologies
The Order also calls for the establishment of a comprehensive longitudinal study of 100,000 service members focused on PTSD, TBI, and related injuries
February 12, 2013
Members of the Federal Interagency Task Force on Improving the Mental Health of Veteran Service Members and Military Families:
As we strive as a nation to better understand, accept and treat the systemic mental illness and injury brought upon by 10 plus years of combat; dedicated research, educational development, and elimination of stigma are all areas equally in need of betterment. Therefore, we ask that you consider the following recommendations for inclusion of your report to the President:
1) Expand and coordinate research;
In the past two decades multiple public and private organizations partnered to concentrate research and develop treatments for AIDS. A similarly collaborative effort can and should be applied to invisible wounds and their complications. Incentives resulting in increased funding and participation can expedite needed advancement in this area.
- We ask that the Task Force and the Administration adopt policy providing incentives for new and extensive research into brain function, illness and injury.
- We ask that the Task Force and the Administration adopt policy providing incentives to encourage academic, commercial and governmental collaboration on research and development of new treatments for invisible wounds.
2) Embrace and educate the public sector;
The Veterans Administration has the Make the Connection campaign and of the Department of Defense has the Real Warrior campaign. These are good and important anti-stigma campaigns, but still targeted principally toward the military and veterans. It is essential that we include the remaining 90-plus percent of the population in this messaging and outreach.
- We ask that the Task Force and the Administration establish, or otherwise procure through a professional public relations firm, a campaign designed to parallel that of the American Cancer Society and the Breast Cancer Awareness Foundation in their successful effort to conquer the stigma of breast cancer using such programs as local and national awareness functions; volunteer walk/run events; benefit concerts; participation of professional sports; and celebrity public service announcements.
3) Invest in education of our youth;
In order to someday realize the permanent elimination of the stigma, we must provide our youth with the facts relating to invisible wounds. Such education would be most beneficial during their formative years, before prejudices develop.
- We ask that the Task Force and the Administration direct the Department of Education to develop accredited syllabuses for the formal instruction of our youth on the subject of invisible wounds and illnesses. Social stigma, self-stigma, bullying, revenge and obliteration are all topics which need to be included in such instruction.
4) Invest in continued education of primary care providers;
Many veterans and families at risk first look to their primary care providers for help with invisible wounds. We should insure that these providers are equipped with the best possible knowledge available
- We ask that the Task Force and the Administration direct the appropriate agency to develop an accredited syllabus for the continued education of primary care providers on the symptoms of mental health issues, and the eligibility and availability of mental health resources in their area.
5) Enable education of interstate health care administration;
SAMHSA needs to be provided funding in order to complete its State Policy Academy initiative. This will give it the ability to educate those who are charged with distributing such information in all fifty states and territories about the unique needs of the military, veterans, and their families and provide them the opportunity to develop and implement an effective strategy.
- We ask that SAMSHA be provided the necessary funding in order to complete their State Policy Academy initiative.
6) Recognize the award of the Purple Heart as an immediate antidote to stigma and a valuable healing aid;
Originally conceived by George Washington, then called the Badge of Military Merit, The Purple Heart is now a sacred award meant to distinguish and help mend those who have been wounded in defense of our freedom. We ask, should the presentation of this award be solely based on blood spilled or, more encompassing, about sacrifices made by our warriors who have suffered wounds whether visible or invisible? To continue to deny the Purple Heart for invisible wounds is to continue to deny the reality of these wounds. We are in fact excluding those who most disparately need inclusion. Bestowal of the Purple Heart can provide affirmation and acceptance where all else only descends. It is the singularly most effective means we now have at hand to immediately carve away at the social stigma, and more importantly, the self-stigma of invisible wounds.
- We ask that the Task Force and the Administration direct the Department of Defense to reopen the discussions on the award of the Purple Heart to for posttraumatic stress and traumatic brain injuries, left unfinished by the Department of Defense in 2009.
- We ask that the Task Force endorse the changing of the name, in the American Psychiatric association’s Diagnostic and Statistics Manual, fifth Edition (DSM V), of the diagnosis Post-traumatic Stress Disorder to Post-traumatic Stress Injury.