The Invisible Wounds of War

General Peter W. Chiarelli, On Patrol
The Invisible Wounds of War

Helping Troops Put the Pieces Back Together

Today, our military members are doing an outstanding job in the crowded cities and outposts of Iraq, and across the rugged, mountainous terrain of Afghanistan. They have made remarkable progress over the past nine-plus years, and many of the most important achievements have been toward improving the lives of the people living and working in both theaters.

However, the truth is they are tired. Our nation has been at war for nearly a decade. Most have deployed multiple times. The collective months spent in high-stress combat environments, away from loved ones, has taken a definite toll on them and on their families.

Unfortunately, many are struggling with behavioral health issues, to include post traumatic stress, traumatic brain injury, depression, anxiety, and other debilitating conditions.

These “invisible” injuries — in my opinion — represent the “signature wounds” of this war. And, we must ensure leaders, soldiers, family members — everyone — understands they are real, ‘no-kidding’ injuries. Individuals struggling with them should never be allowed to suffer in silence.

Unfortunately, eliminating the long-standing stigma associated with seeking and receiving help for these kinds of injuries isn’t easy.

One of my favorite movies is “Patton” with George C. Scott. In one of the scenes, Patton is visiting wounded soldiers at a field hospital. He comes up to a young man sitting on a stool, suffering from symptoms of “battle fatigue,” or what is now known as post traumatic stress.

The soldier tells Patton, “I guess I just can’t take it, sir. I just can’t stand the shelling anymore.” Patton looked down at him incredulously... “Shut up! I won’t have a yellow bastard crying in front of these brave, wounded men. I won’t have cowards in my Army!”

As great as General [George S.] Patton was, and he was undoubtedly one of the greatest ever to serve in our Army, this was the mindset for many — if not most — in the military. And, unfortunately, the same negative mindset and stigma associated with behavioral health issues and “invisible injuries” like post traumatic stress and traumatic brain injury persists still today.

We all immediately recognize a soldier who is shot or loses a limb as needing medical treatment. No one begrudges him or her the time needed to rest, heal, and recover.

But, too often the young man or woman who experiences a traumatic event and walks away with no visible injuries [finds] their ‘real-no-kidding’ injuries, such as post traumatic stress, are overlooked and in many cases left untreated. Meanwhile, the potential for long-term or permanent damage can be quite significant.

The Army is working very, very hard to raise awareness among leaders and soldiers about these injuries and the risks involved. And, we’ve been extremely fortunate to have help from some of our nation’s greatest heroes — Medal of Honor recipients like my good friend, Buddy Bucha.

I often tell the story [that] about a year ago, we were looking for a way to get the message out to soldiers about the realities of behavioral health issues and the importance of eliminating the stigma associated with seeking and receiving help.

We were toying with the idea of lobbying players from the National Football League, given all the NFL is doing to raise awareness and better protect players from the long-term effects of concussions.

Then Buddy came up to me at an event and offered his support. In fact, he said there were several Medal of Honor recipients willing to lend a hand. And, the end result was a series of public service announcements. We are deeply grateful to Buddy and the other Medal of Honor recipients, for not only taking the time to put [the public service announcements] together, but for being willing to come out publicly and talk about the very real and personal challenges of post traumatic stress and other behavioral health conditions.

A big part of eliminating the stigma is getting people to talk about these injuries and understand them better.

Back in November, HBO debuted a new documentary about the challenge of post-traumatic stress and its impact on soldiers and families through most of America’s wars.

Wartorn 1861-2010, includes interviews with veterans of World War II, the Vietnam War, and the current wars in Iraq and Afghanistan.

It is an amazing, amazing film. If you’ve not yet seen it, I would highly encourage all of you to do so. It really puts into context the legitimacy and complexity of these types of injuries.

The fact is they can be particularly difficult to diagnose correctly due to the co-morbidity of symptoms. And, again, because the individual can appear and behave “perfectly fine,” his buddies — and in some cases, superiors — are often much less accepting and attentive.

This presents a significant challenge, especially considering the high incidence of these types of injuries on today’s battlefield.

When I took the job as Vice in August 2008, the number of soldiers in our Wounded Warrior program with a service-disqualifying injury of 30 percent or greater suffering from post-traumatic stress or traumatic brain injury was 38 percent. In just two years, that number has grown to 63 percent — 47 percent for PTS and 16 percent for TBI.

The only issue I had with the HBO documentary was that it didn’t cover what we’re doing as an army and as a nation to address these injuries and conditions. And, I think that’s very important.

The reality is there’s a great deal of promising research currently underway, to include the five-year, $50 million partnership between the Army and the National Institute of Mental Health.

The Army Study to Assess Risk and Resilience in Service members (Army STARRS) is the largest study of mental health risk and resilience ever conducted among military personnel.

Within the Army we’ve also taken significant steps to expand our mental fitness and resiliency training through the Army chief of staff’s Comprehensive Soldier Fitness program, the Global Assessment Tool, and Master Resiliency Trainers.

We are making progress. However, the truth is there is much work still to be done. And, we owe it to our men and women in uniform to ensure the very best care, treatment and support is provided to them while they’re serving on active duty, as a member of our reserve component, and also after they’ve separated or retired from military service.

By working together, the military, DoD, the Department of Veterans Affairs, and organizations … with caring individuals who want and are willing to do what it takes to make a difference, I am confident we will continue to accomplish great things in the days ahead.

Posted on BrainLine August 15, 2011.

General Peter W. Chiarelli's address to the Philadelphia Union League's Armed Services Committee and the Philadelphia Chapter of the Blue Star Mothers, 2011, as it appeared in the Summer/Fall 2011 issue of On Patrol, the magazine of the USO. Used with permission.