Shameful failure to help American war fighters - a psychiatrist echo opinion

Brain injuries from Iran air strike highlight military's failure to care for its own

Hundreds of thousands suffer the invisible injuries of war. The medical campaign to treat psychological problems and brain injury has fallen short. There are mounting needs but little research, writes

Dr. Stephen N. Xenakis, echo opinion published in The Spectrum, a Utah newspaper. 

First the Pentagon said no U.S. troops were injured in Iran's missile strike last month on an Iraqi air base hosting Americans. Then it rose to 11 with brain injuries, then 34, then 50, and by Thursday the number was up to 64. That's upsetting, as was Donald Trump's (stupid!) recent comment that "it's not very serious."

This is consistent with a decades long tradition of downplaying the significance of traumatic brain injury. Senior government leadership and the departments of Defense and Veterans Affairs have failed utterly in caring for the mental health of war fighters. Later labeled the signature injury of the wars in Afghanistan and Iraq, the U.S. military was not prepared in the early days of 2003-4 to either defend against improvised explosive devices (IEDs) or treat the injuries they caused. 

Although the CIA operated a station in Afghanistan in the 1980s supporting the mujahedeen in fighting against the Soviets, it failed to learn that IEDs had been a weapon of choice. If the fighters and medics had paid attention, there should have been no surprises about the seriousness of the injuries and impact on brain health.

It wasn’t until 2010 that the Army took the minimal step of giving 24 hours rest to soldiers who had been hit by IED blasts before sending them back out on patrol.

Historically, mental health services get shortchanged in funding and support across the country, but the failure to care for the war fighters has been notably shameful. 

Looking back 18 years, we find that the medical campaign to treat psychological problems and brain injury has largely failed. Hundreds of thousands of veterans and service members suffer with the invisible injuries of war.

These men and women carry the burden of intractable emotional problems, traumatic brain injury, sleep disturbances, chronic pain and moral injury. Up to 20% of combat veterans develop significant post-traumatic stress disorder, and another 10% to 15% develop post-concussion symptoms, much like the professional football players. On top of that, many incurred injuries that cause chronic pain and exposed them to opioid addiction.

Tragically, suicide by serving military members and veterans has been the most devastating phenomenon. According to a Defense Department report last fall, 541 active military committed suicide in 2018. The Veterans Administration reported in September that more than 6,000 veterans committed suicide each year from 2008 to 2017. The Army set up a major research study in 2010 and awarded $50 million to an academic consortium, but there are no findings that have significantly changed the treatments or programs. The suicide rates have continued unabated.

The medical establishment across the Department of Defense failed from the beginning to acknowledge and respond to the mental health impacts of combat even as the fighting in Iraq intensified horrifically. There have been no significant developments in assessing and caring for the brain injuries from IEDs nor the mental health consequences following combat. DoD Health dragged its feet in gearing up until the problems became glaringly apparent.

It took the media to spotlight the shortcomings in mental health care to the soldiers and the epidemic in suicide and invisible wounds that increasingly burdened them. An Army secretary was forced out for failing to notice and act on inadequate support to outpatients at Walter Reed.

When Mike Mullen was chairman of the Joint Chiefs of Staff and I was a senior adviser to him, senior medical leadership repeatedly blocked proposals and initiatives to better diagnose and treat blast concussions and profound emotional problems. Few if any new medications or diagnostic tests have been studied and put into practice.

As the injuries and debilitation mounted, the military needed programs and initiatives that fast-tracked potential diagnostic tests and treatments for PTSD, brain injury, sleep and suicide. To do that, the leadership needed to shift gears, exercise initiative, and challenge medical researchers tied to tradition, legacy processes and time-honored procedures. Fielding treatments to soldiers and veterans expeditiously requires transformation and thoughtful risk-taking. That never happened, and there have been few improvements in day-to-day care. And, judging by a lack of published reports about better treatments, any serious criticism has been discouraged.

Our inadequate medical care for combat veterans is particularly poignant at this time when both the DoD and VA are working to outsource more treatment to insurers and the private sector. That will further weaken military medicine and set it up for failure in the future. Military medicine has unique features and requirements. Supporting and caring for our war fighters requires that the help they need come from dedicated doctors and medical teams, in uniform. The shortfalls in treating the invisible wounds of war should be another lesson learned from the wars in Iraq and Afghanistan.

Stephen N. Xenakis, a psychiatrist and retired Army Brigadier General, serves on the executive boards of The Center for Ethics & the Rule of Law at the University of Pennsylvania and is an Adjunct Professor at the Uniformed Services University of Health Sciences. Follow him on Twitter: @SteveXen