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Library

More than 30 centuries ago, long before even the written word Homer talked about combat stress in his epic poems on the Trojan War. 

During the Civil War soldiers were removed from the front and considered for disability and pensions for Soldiers Heart or “nostalgia”, but in reality combat stress during that time was considered a form of insanity.

By 1914, at the outbreak of World War I, combat stress and its civilian counterpart, “railway spine” had actually risen to the position of being considered physical ailments that deserved medical treatment. 

By the summer of 1916, the brutal trench warfare on the Western Front had produced an epidemic of shell shock among French and British troops, and “nervenshock” among Germans troops which was draining the treasuries and manpower pools on both sides. To address this crisis, Kaiser Wilhelm directed the German Association of Psychiatry to convene a special War Congress.

 After briefly discussing the evidence, these leading psychiatrists of their day settled the debate by declaring –“Persistent distress or functional impairment following exposure to a traumatic stressor could only occur in individuals already afflicted with the pre-existing personality weakness that they termed hysteria”.

Subsequently, the German government was relieved of its responsibility to pay disability pensions to veterans sufferingfrom combat stress, while commanders in the field were no longer obligated to evacuate stress casualties from the front.

The term “hysteria” was never intended to be a neutral label. It was chosen to be intentionally stigmatizing, especially when applied to male service members who understood it to be a feminizing term. 

The French and English and later the Americans also adopted the doctrine. The term shell shock was dropped and there was a drastic reduction in the evacuation of stress casualties along with the responsibilities of paying compensation fees.  

As a result of these new tenets the rates of wartime psychiatric evacuations during the 20th century fell to approximately 10% in WWII, 3.7% in the Korean War and barely 1.2% in Vietnam.

Tom Mahany and others talk about suicides among Vietnam Veterans

 February 12, 2013
 

To the Members of the Federal Interagency Task Force on Improving the Mental Health of Veteran Service Members and Military Families:

 

Jonathan Woodson, Department of Defense

Robert Pretzel, Department of Veterans Administration

Pamela Hyde, Department of Health and Human Services

Cate Miller, Department of Education

Rosye Cloud, Director of Policy for Veterans, Wounded Warriors and Military Families

and all Members of the Federal Interagency Task Force on Improving the Mental Health of Veteran Service Members and Military Families:

We respectfully ask that you consider the following recommendations for inclusion in 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.