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Stigma is biggest hurdle for veterans with PTSD

November 22, 2018

My father was a man to be emulated. He was the typical masculine: a foreman of a big machine shop, respected by those in his charge, a big talker with a good sense of humor. He was a war veteran and an officer of the local VFW. No one would have dared to challenge his “fitness” or called him “weak.”

He also had post-traumatic stress disorder. He would have never said this because of his own perceptions and the feared perception of others, despite his suffering and the repercussions it had for him and for his family. He never received help — partially because he did not seek it because of stigma, but also because at the time, help was not available.

As a psychiatrist, I encounter many frustrations regarding lack of appropriate services, disparities to care and the stigma that surrounds mental health. Some of the ugliest stigma exists around the diagnosis of PTSD, wrongheadedly due to a culture that values “being strong” or “getting over” adversity.

This culture is intensified in the military. Veterans with PTSD are constantly bombarded with dismissal and shaming, in the form of others’ ignorance about their diagnosis but also in the words that we, and more importantly our leaders, use to continue this stigma. Nothing is as disheartening as the vulgar epithets I have heard veterans with PTSD use to describe themselves, to describe “weakness.” Hearing them describe themselves in those ways is heartbreaking. The stigma we perpetuate is a fundamental disrespect to our veterans with PTSD.

More people ought to know PTSD is a medical condition caused by a specific cascade of endocrine and neurotransmitter systems meant to prepare the brain and body for more trauma. Unfortunately, there is no switch that turns off this system. What that means for a veteran with PTSD who is expected to re-engage with society is that he or she is still operating in a mode to cope with imminent danger. It is potentially a 24-hour-a-day torment. PTSD is associated with increased medical illness, development of other mental illnesses, disruption of the family unit, alcohol and drug use, homelessness and suicide.

Depending on the service era, rates of PTSD in American veterans are around 10 to 20 percent. PTSD is complicated by head trauma, which has been more prevalent in the wars in Iraq and Afghanistan, as well as the military sexual trauma sustained by veterans of both genders.

Although federal funding and charitable funding through organizations such as the Wounded Warrior Project exist for research on and treatment for PTSD, veterans with PTSD are woefully underserved by the lack of access to evidenced-based care for PTSD, including psychotherapy, peer support and other social services. This is related to our poor regard for a condition directly caused by the trauma suffered during combat. This is not clinical guesswork; this is obvious when the leaders of our country describe veterans with PTSD as “weak or unfit.”

I believe that we woefully underestimate the cost of war and the cost of sustaining our military. We estimate the financial toll from facilities maintenance, the expensive tools and weapons of war, feeding and clothing our troops. The unseen toll is more insidious. Our veterans voluntarily serve our country and are sometimes exposed to events that the rest of us are fortunate to never see. That predisposes them to a complex syndrome that would potentially affect the outcome of their lives, their happiness and success, and that of their families.

Knowing that cost and funding it appropriately are one thing, but even more important is validating the existence of PTSD, that it is real. Respecting our veterans with PTSD enough to acknowledge their traumatic experiences is necessary for their healing.

We must understand that character and illness are two separate things. We have to acknowledge that PTSD can and does happen to our courageous, our strong, our survivors. By creating a culture receptive to the experience of our combat veterans, we are making it safe for them to receive the care they need.

Kimberly Kjome is an assistant professor of psychiatry in the Dell Medical School at the University of Texas at Austin. She is also a psychiatrist at the Seton Mind Institute.

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