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Mental Health and the Military

Despite Renewed Efforts to Address Mental Health Concerns, Many War Veterans Refuse Medical Treatment

Tulips and gravestones at Arlington National Cemetery, photograph by Alyssa Wolice

By Alyssa Wolice for Jane Hall's Advanced Reporting course

Vietnam War veteran, Jack DiCesare, battled with nightmares, flashbacks and involuntary arm movements for years upon his return from serving his country, yet he waited nearly two decades to request medical treatment from the Department of Veterans’ Affairs.

DiCesare, who has since been diagnosed with posttraumatic stress disorder, accepted initial treatment options with the VA, but refused to request an increase in his disability rating because of fears that he would be deemed unemployable, said his wife, Kathie DiCesare, a senior chaplain for the International Fellowship of Chaplains.

“Many veterans currently suffering from PTSD and other mental illnesses think, ‘If we go for help, we’ll get diagnosed and we’ll have to stop working,’” said Kathie DiCesare. “But the truth is, many of them are capable of working, with therapy and medication.”PTSD, which develops when an individual experiences a trauma that leads them to become emotionally vulnerable due to the perception that his or her life or the lives of people they know have been threatened, can lead to the development of other mental illnesses and even contribute to suicide, according to clinical psychologist, Dr. Kenneth Manges.

According to the VA’s National Center for PTSD, more than 90% of suicide victims have a mental illness such as PTSD or depression, most of which were either undiagnosed or untreated.

“For war veterans, treatment of PTSD and other psychological traumas can be difficult, particularly because they are more prone to have had brain injuries,” said Manges. “Brain injuries then cause them to be less psychologically stable and have difficulties thinking and problem-solving as their emotional level is weakened.”

Guard at Arlington National Cemetery

In 2007, Congress passed the Joshua Omvig Suicide Prevention Act in efforts to address the war veteran suicide rates, which remains approximately eight times greater than suicide rates among the general population, according to a recent study conducted by the Veterans’ Health Administration of the VA. However, the act also outlined a series of measures to be taken in order to prevent suicide among veterans, including the need to restrict veterans struggling with psychological illnesses from retaining access to their firearms.

“Veterans fear that if they seek medical help for psychological illnesses, it will ruin their military career or even their abilities to pursue different jobs, particularly if they are looking for jobs in the police force or other similar fields,” said Kerri Childress, Director of Communications for the Department of Veterans’ Affairs National Center of Posttraumatic Stress Disorder. “And the fact is that there is also a stigma that exists within our culture at large, as well as in the military, that says that seeking mental health care makes you less of a person.”

Although the issue remains something that both the Department of Defense and the VA have been working to address, many men and women will continue to deny treatment options until they feel that there is a change within society in regards to how to address the prevalence of psychological illness among war veterans, Childress said.

Flag flies at half-mast over Arlington National Cemetery, photo by Alyssa Wolice

Since the Omvig Suicide Prevention Act, both the VA and the Department of Defense have made several attempts to further ensure that unemployment fears do not prevent war veterans from seeking necessary medical treatment. One such effort involved the elimination of information requests regarding a veteran’s medical health history from the DOD’s questionnaires, according to Dr. Barbara Romberg, founder and executive director of Give An Hour, a nonprofit organization that focuses on the mental health needs of U.S. troops and their families.

“Our goal right now is to get these men and women to seek help, rather than wait until their marriages dissolve, they lose their jobs, they have DWIs, or their lives simply fall apart,” said Childress. “We're trying to get that early outreach to veterans. And of course, it all ties in with suicide as well because when these people don't get the help they need, it can essentially lead to suicide."

The VA, which launched a suicide prevention hotline in 2007 for veterans suffering with mental illnesses, has received over 100,000 calls including approximately 2,600 that were considered to be individuals who were on the verge of committing suicide had they not received the appropriate medical help in time, according to Childress.

The VA has also placed suicide prevention centers in over 150 hospitals across the country and has hired over 3,700 mental health physicians in order to increase the response to the prevalence of mental illnesses among veterans of the wars in both Iraq and Afghanistan. The recent hiring brings the total number of mental health physicians affiliated with the VA to more than 17,000.

“The issue of veteran suicide is a very difficult area to address,” said Romberg. “It's painful to think about not being able to sleep at night and not being able to close your eyes because every time you do, you see the horror you experienced during combat. Our society is challenged when we have to wrap our brains and emotions around what our veterans are experiencing, and we’re still learning to understand what’s happening.”

Arlington Cemetery Cherry tree surrounded by grave stones, photo by Alyssa Wolice

However, despite efforts from the VA and the DOD, as well as from hundreds of veterans’ organizations across the country, the prevalence of mental health issues and suicide rates remain at an all-time high, said Childress.

According to a recent study issued by the Research and Development Center for Military Health Policy Research, 20% of the current veterans of the wars in Iraq and Afghanistan have PTSD or a similar psychological illness.

One of the greatest challenges to treating war veterans who are suffering with mental illnesses and PTSD remains the method of approaching the needs of Iraq and Afghanistan war veterans versus the needs of veterans from previous conflicts, such as Vietnam, said Childress.

“We’re now facing a different type of conflict,” Childress said. “Our veterans leave to serve for two or three terms, and now we’re seeing that there are lots of men and women of the National Guard who are serving, which we’ve never really seen before.”

Recent approaches to the recovery process for veterans of the wars in both Iraq and Afghanistan have ranged from standard medical treatment options to “virtual treatment,” in which veterans view simulations of their war experiences in efforts to make their memories more bearable, said Romberg.

“We see so much violence on television that I feel that we don't really relate to what’s happening in our reality anymore,” Childress said. “You can watch movies about what’s going on in Iraq and Afghanistan, you can read books, you can see the news but, the truth is, you can then turn around and finish your dinner in your secure home and still disconnect yourself from what’s going on. For those men and women who were there, dealing with what they’ve had to face in combat, can put incredible pressures on themselves, especially those who were already struggling with psychological issues before they went to serve.”