War is hell, said General William Tecumseh Sherman.
Fortunately, very few of us have to find out. We trust in highly trained professional soldiers, who bear everyone's burden. Not all of them are able to leave these burdens behind, when the battle call falls silent. The Veteran's Health Administration is coping with a record number of physically, emotionally, and mentally scarred warriors returning home.
Some of the damage cuts across the artificial boundary we in the West have drawn between the physiological and the psychological.
The care we have developed for seared skin, torn limbs, broken bones and damaged eyes is the best medicine any warrior has had in the history. A traumatic wound that would have meant certain death in previous generations can often be mended by the medical arts of our healers.
The psychic wounds of those who have seen what no person should have seen is not addressed in as straightforward and confident a manner.
Soldiers return, having witnessed terrible events and atrocities. Even the bravest and sturdiest of our troops confront sights and sounds that can push a person to the limit of what can be endured.
We know more about the psychological, existential, even spiritual damage endured by soldiers than did previous generations. The need to maintain morale among the enlisted, and support from the civilians, kept difficult stories from being too widely told.
Filmmakers such as James Gandolfini and Francis Ford Coppola have explored these themes deeply, breaking a taboo. Families and veterans have formed advocacy groups, told their stories and gone public with their struggles to access adequate mental health resources in times of strained budgets.
Soldiers who are deployed may return with persistent dwelling on negative and traumatic experiences. They can ruminate and brood about terrible memories, and fixate on very disturbing images and memories. Some may find themselves unable to go about their daily lives because of recurrent thoughts that haunt them.
Nightmares and anxiety might compromise their sleep, while they spend much of their waking time obsessing over violent themes, including suicidal imagery and ideas.
Pushed to or beyond the boundaries of what a human can withstand psychologically and emotionally, far too many have taken their own lives in recent years.
It is the duty of medical science to probe such intimate matters, and from this to glean data to guide clinicians about how best to provide care for these psychically shattered men and women.
Exploring these issues is necessary for the medical system, however difficult it can be for those being surveyed. Veterans access limited resources in the best of times, and we are in a different era. There are tough choices to be made about how much medical funding can be allocated to which categories of veterans.
It is a delicate matter for researchers to try to look at different populations of veterans, and to attempt to analyze their suffering. Very personal, painful themes come up, and while talking about these may be a relief for some, for better or worse, others prefer to keep such volatile psychological material hidden.
Researchers are delving into the dark world of post traumatic stress disorder and military suicides. By collecting and analyzing this data, this research can help veterans, their families and their doctors to better understand the very serious nature of these problems.
Do reservists and active duty military experience different mental health issues?
Medical researchers study the ways that different groups of military respond to mental health challenges that are associated with deployment into hostile situations. There are similarities and differences between what some active duty soldiers will experience compared to reservists who are sent into combat.
Active duty soldiers can expect that there is a very real chance of being deployed into violent areas. The last decade has seen many thousands sent into situations they knew would quite likely involve intensely violence and disturbing experiences.
Reservists also must be prepared to be deployed overseas and face violence. While their training addresses this, many reservists historically have performed their duties stationed at home, without having to face the violence in overseas deployments. Depending on the particular challenges the military is tasked with, military reservists may very well be honorably discharged without going abroad or "seeing action".
Non-military can probably only speculate about what expectations and thoughts a person joining the Army Reserve might have about being transported to the other side of the planet and then, after cursory language and culture lessons, being expected to engage in tactical operations with people possessing a very different understanding of the world, in 110 degree heat, while bullets fly.
There are issues about how much what the two groups experience is fundamentally the same, or is actually distinct. There can be some sensitivity about the differences and similarities between the burdens borne by reservists compared to active duty military. Researchers who generate data representing the average of many soldier's experiences must take into account how individuals process their experiences and cope with the aftermath.
Soldiers may return from combat experiences with traumatic brain injuries, post traumatic stress disorder, depression, manic-depression or bipolar disorder, schizoaffective disorder or psychosis. Collecting detailed data reflecting the mental, emotional and behavioral health of combat veterans is a priority for the American health system. There has been a problem with increased substance abuse, depression, suicide and violence among veterans returning from active duty.
In a recent article in the American Journal of Public Health, Marian Lane, Ph.D, and colleagues analyzed similarities and differences between large numbers of military reservists compared to similarly large contingent of active duty military. They examined data from the Department of Defense Health-Related Behaviors surveys, where 18 ,342 reservists and 16, 146 active-duty personnel reported on their psychological, emotional and behavioral states.
The researchers did find that reservists who had been deployed "reported higher rates of suicidal ideation and attempts than did active-duty personnel who had been deployed and higher rates of post-traumatic stress disorder symptomatology" compared to active-duty personnel.
Furthermore, results indicated that the rates of suicidal ideation and PTSD for reservists who had been deployed were higher compared to reservists that had not been deployed.
While all soldiers returning from deployment need careful attention, this evidence is consistent with an interpretation that reservists who are deployed may need to be very carefully monitored upon their return.
Family members should note whether they are integrating back into daily life, or are withdrawn, anxious, depressed or obsessing about their experiences. Low-quality sleep, substance abuse, extreme emotionality, unusual temper, lack of situation-appropriate behavior and violent outbursts are all potential signs of PTSD.
The efforts of Dr. Lane and colleagues can assist returning veterans, families and their doctors in becoming better informed about PTSD. By identifying which groups show the most serious symptoms in reactions to their deployment, caregivers can better anticipate the type of problems that may arise for particular individuals.
Reservists and active duty soldiers who are deployed can return from combat experiences with traumatic brain injuries, post traumatic stress disorder, depression, manic-depression or bipolar disorder, schizoaffective disorder or psychosis. Research indicates that reservists who had been deployed may have higher rates of suicidal ideation and suicide attempts, relative to active-duty personnel who had been deployed.
Reservists who are deployed may also have higher rates of post-traumatic stress disorder, compared to active-duty personnel. All soldiers returning from deployment should be monitored. It is quite possible that reservists who are deployed may need to be even more carefully checked for symptoms of PTSD and/or suicidal thoughts when they come back.
Caregivers should pay attention to whether the returnee is integrating into daily life, if they show symptoms of being withdrawn, anxious, depressed or are obsessing about violent experiences.
Research into the effects of deployment can help veterans, their families and their doctors become better informed about the risks for PTSD and the potential consequences.