Veterans from combat operations in Iraq, Afghanistan and countless other one-off endeavors around the globe face a crisis of empathy once they return to the United States. While this crisis is not without historical precedent, current factors in the composition and operations faced by our armed forces make the transition back to civilian life all the more difficult. Post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI) run rampant and although medical research has leapt forward since previous major combat operations, proper diagnosis and treatment leaves much to be desired. The solution lies as much with society as it does with the individual and his or her medical team. In order to properly support the veteran community, the Department of Veterans Affairs (VA), the Department of Defense and outside organizations must take an integrated approach that looks outside the box and treads into issues sometimes less palatable to government agencies.
Approximately one in five veterans deployed to Afghanistan or Iraq suffers from TBI and/or PTSD. While PTSD has been described in a variety of ways throughout combat history, the underlying condition remains the same. On the other hand, TBI has evolved with the course of battlefield medicine. Both are threats to the veteran community. Even in the face of mild TBI and PTSD, veterans are likely to report poor general health, missed work, cognitive issues, depression and chronic pain. An exceedingly high number (up to 78 percent in some instances) of injuries sustained in Iraq and Afghanistan are related to explosives. When considering the fact that 60 percent of injuries caused by an explosive result in TBI, it is not difficult to see this as an overwhelming issue. The lingering effects of these sorts of illnesses are even more dire, with suicide rates numbering 22 per day in the veterans community. In fact, the Medical Surveillance Monthly Report, a journal produced by the U.S. armed forces, recently reported that suicide has surpassed war as the primary cause of death among active service members. It is clear that the status quo can no longer remain in place.
In order to properly deal with the complexity of TBI and PTSD, integrated, high levels of specialized skills and training must exist inside and outside of the armed forces community. In addition to cognitive and memory issues, changes in vision and weakness resulting from TBI often exist. Most importantly, patients with PTSD frequently face psychological issues requiring social support and mental healthcare. It is in this realm that treatment falls short. While the medical community has pushed for greater levels of integrated care, including behavioral therapy for veterans (a far cry from the entirely drug-based approach of early years), the subtleties and wide-ranging nature of both disorders inherently limit the efficacy of a common therapeutic regimen. In addition, the brief nature of most screening techniques fails to capture the individual essence of the injuries. As such, many veterans are not referred for thorough evaluation and appropriate treatment — effectively falling through the cracks of the system. Without properly addressing the physical and psychosocial subtleties of TBI including the cognitive, psychiatric and emotional problems, these veterans will not receive the care required for proper rehabilitation and integration back into society. Treatment must work toward individualized solutions that do not end until a subject is fully reintegrated into the civilian community.
In order to definitively ensure that veterans are not left to the wayside, care must transcend hospitals and even the VA system and take into account larger societal factors at play in the United States. The fact of the matter is that while a volunteer-based military has created an unmatched, highly trained force, it has also become one that is obviously self-segregated. No longer does a national culture surrounding military service exist. An appreciation for service helps to ensure that realistic cultural empathy exists between the veterans community and the larger U.S. one. For disorders such as PTSD, this empathy plays a key role in working towards eventual reintegration. It is perhaps the single-most important factor towards long-term recovery, yet also the one most difficult to cultivate. It must be brought about largely without the help of the government, but by outside organizations and individuals that seek not to victimize or apotheosize veterans but ensure broad understanding of their experiences.
A comprehensive and integrated approach toward veterans care requires individualized treatment that also takes into account societal factors. This collaborative approach is a difficult one for many in a government system to accept. It requires a broad base of knowledge, a multitude of personalities and expertise and outside-the-box thinking. It is not unlikely that those inside the system may reject the opinions of outsiders, and vice versa. However, it is this very dialogue, between those inside the veterans community and those outside, that must be created in order to render lasting progress in the field. At its core, many of the issues faced by the veterans community are crises of communications. Taking the first step by stimulating this conversation and promoting the subsequent programs that utilize the experience of all parties is critical towards ensuring lasting change.
Dobkin is a national security and defense technology analyst currently serving as the CEO of the Kant Institute, a bipartisan 501(c)(3) organization dedicated toward fostering national learning and the creation of public discussion surrounding key policy issues. The Kant Institute recently launched its 2015 Veterans Initiative to bring about substantive discussions in the field of veterans affairs. The author can be found on Twitter @AdinDobkin.