Psychiatric Casualties
EP:2 The Unseen Battle Scars of the Mind
War wounds are not always visible, and the battle scars of the mind can be as debilitating as any physical injury. Mark and Charles open up a long-overdue discussion on the unseen struggles of military mental health, tracing the historical neglect and systemic shortcomings in armed forces' approaches. The conversation is both a history lesson and a current affairs class, as we uncover declassified documents and share from-the-front anecdotes that reveal the stark contrast between lessons learned from physical warfare and the often-ignored psychological aftereffects. Mark and Charles shed light on the depth of these issues, from the repeated cycle of learning and forgetting to the pervasive stigma that keeps our service members from seeking the help they so desperately need.
This conversation is not just about the failures of the past but also about the potential for reform—ensuring that every soldier's sacrifice is honored, not just in medals and commendations, but in the care they receive for all their wounds, seen and unseen.
Table of Contents for Discussion
Have questions, thoughts or suggestions on topics? Email Mark at mrussellphd@gmail.com
Tune into our CHW Streaming Radio and the full lineup at cominghomewell.com
Download on Apple Play and Google Play
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War wounds are not always visible, and the battle scars of the mind can be as debilitating as any physical injury. Mark and Charles open up a long-overdue discussion on the unseen struggles of military mental health, tracing the historical neglect and systemic shortcomings in armed forces' approaches. The conversation is both a history lesson and a current affairs class, as we uncover declassified documents and share from-the-front anecdotes that reveal the stark contrast between lessons learned from physical warfare and the often-ignored psychological aftereffects. Mark and Charles shed light on the depth of these issues, from the repeated cycle of learning and forgetting to the pervasive stigma that keeps our service members from seeking the help they so desperately need.
This conversation is not just about the failures of the past but also about the potential for reform—ensuring that every soldier's sacrifice is honored, not just in medals and commendations, but in the care they receive for all their wounds, seen and unseen.
Table of Contents for Discussion
Have questions, thoughts or suggestions on topics? Email Mark at mrussellphd@gmail.com
Tune into our CHW Streaming Radio and the full lineup at cominghomewell.com
Download on Apple Play and Google Play
Online-Therapy.com ~ Life Changing Therapy Click here for a 20% discount on your first month.
Thank you for listening! Be sure to SHARE, LIKE and leave us a REVIEW!
What we got here is failure to communicate, a chronic neglect of military mental health care. This is Psychiatric Casualties, how and why the military ignores the full cost of war.
Speaker 2:Welcome to Episode 2, and this is Mark Russell. We're here to talk a little bit about military mental health care and how we can introduce that topic in our book, psychiatric Casualties. We'll be covering some things like that as well as anything else that comes up. One of the things that we start with is a quote. I love this quote because it's something I came across when I was doing my doctoral dissertation in the 1990 timeframe or something like that. It's from the Second World War.
Speaker 2:Two Army colonels, apple and Beebe, and they quote each moment of combat imposes a strain so great that men will break down in direct relation to the intensity and duration of their exposure. Thus psychiatric casualties are as inevitable as gunshot and shrapnel wounds in warfare. And they made that quote because they were tasked by the War Department, as it was called back then, to investigate an epidemic in psychiatric casualties during the Second World War that they had not anticipated, in fact, that everything they can to prevent and failed, and we're trying to go back and understand why that policy failed, which we'll be talking about. You know today this episode and future episodes too, but that phrase always stuck with me about the inevitability that you know you could be killed in war, that you could be wounded in war and, yes, you could have psychiatric wounds, and those things are all predictable outcomes Anytime we go to war.
Speaker 3:And this was the best kept secret. I mean, the military has done their best to stay on course.
Speaker 2:Absolutely. In fact, if I'm not mistaken, I believe at the time that they published their investigation it was classified, so it wasn't meant to be publicly disclosing. But it's the same thing when we uncovered in our 10 years of researching the topic of military mental health care and war stress that a number of documents that were classified at that time became declassified. So we'll be pulling out from that again that most general public doesn't know.
Speaker 3:Most people in the military are not aware of yeah, and actually the book is full of those. And thanks to you, I mean, you basically forced the military to give you documents, right?
Speaker 2:But there's been some freedom of information act gain, but also just a lot of research and you're trying to find articles and as obscuring, you know, going back to the American Revolution, you know the Spanish American War, the Atlantic Wars, so I mean. So it was really kind of broad stretch of how long have we as human beings had to deal with war, stress, and you know, we're sure that what we use it for, stress, injuries, the effects of war, and you know we can.
Speaker 2:And so this, trying to understand the historical precedents that existed and why were we struggling in the 21st century to do you know a modicum of what we should be doing? And I have a learning the lessons of war, a famous quote by the Spanish philosopher George Santana, which is often. People probably have heard of that. This quote is those who cannot remember the past are condemned to repeat it. It really gets to the heart of what militant mental health care and in the journey that has taken full over generations, is that we constantly don't learn. Our historical lessons are doing the repeated.
Speaker 2:So just read a little bit about the Department of the Army has a doctrine on lessons to learn and this is the. This is coming from what they describe as the importance of that and what, what they systematically, how they go about learning the lessons of war, and they say it's a doctor for organization, research, development, acquisition, training, planning and other appropriate activities. It's lessons learned programs. It creates a system to serve in both peace and wartime as the focal point for the collection, analysis, dissemination and implementation of combat. Relevant lessons learned which will enhance the army's ability to perform its missions Right, and each service the army, air Force, navy, marine Corps, now Space Force, has their own policies and dedicated centers for lessons learned, and each medical department has its own dedicated programs, policies and personnel to learn the medical lessons of war. So there's one for the army, the Air Force, the Navy, marine Corps. So the big emphasis on the importance of learning lessons, which we think is kind of important to right.
Speaker 3:Yeah, I was waiting for the conjunction. However, or on the other hand, or the other is shared the big.
Speaker 2:However, when it comes to mental health, the mental health lessons are kind of fall in medicine. So military medicine is responsible than surgeon generals are. The heads of military medicine are responsible for including mental health lessons learned as well. We don't do so well with that, yeah.
Speaker 3:So when we hire nurses or pay nurses or help nurses dress up and what was it that you were talking about? Dressing up as superheroes? Goodness yeah how in the hell can you make it seriously if commanders are enabling making fun of it? I mean, laughter is always therapeutic, but not necessarily when you don't pay attention to the major symptoms that's affecting your troops. Yeah, yeah, they thinking what they thinking.
Speaker 2:Well, let me just clue what you're referring to and it's comical, but it was. It was the beginning of my fuse being lit is where we're at Navy hospital Bremerton, about to deploy a field hospital and provision to serve the evasion of Iraq in 2003. So we go to Camp Pendleton right, my old stomping grounds where I used to live, and as a kid as a kid.
Speaker 2:Now I'm going back as a Navy I think at that time I was a lieutenant commander and head of the Neural Psychiatry Department. So I was head of mental health for the field hospital and we had a psychiatrist and social workers and psychiatric nurse and enlisted for men who are psychiatric technicians All all part of this department is we're ready to deploy it in the invasion Iraq. And if you remember back in when they're talking about going into Iraq, a lot of concern about nuclear, biological and chemical weapons and we're invading a sovereign country is not like the first goal, for we're liberating Kuwait, which was pretty much a snap generally, but here we're going to go invade a homeland and with a very large and well armed military, the Iraqis, who we supplied a lot of their arms to. So we were expecting mass casualties in his invasion. Yeah, similar to when we invaded, you know, the islands with Japan occupied in World War two or D day, when we're invading France, we were expecting a large number of casualties, especially a violent chemical nuclear weapons were employed. So along with that should have been this recognition from Apple and BB's quote that we should expect large numbers of psychiatric casualties to in this mass invasion. Right.
Speaker 2:Well, we're at this field hospital and a tent hospital and you know there are simulating the sounds of war and the sounds, the sites, you know, there's gunfire, there's artillery blasts, they're bringing in a helicopter in casualties like a mass unit, right, and they were very realistic. It was Hollywood at its best. I was really impressed on the realism of some of the injuries, the physical injuries that people were being brought in to our tent hospital with, and you know the docs and nurses, the corpsman, everybody's responding, you know, in the sense of urgency and realism, because we know in a couple months we're going to be deployed and we were going to probably be doing this for real, right, and so I'm waiting, with my team at the triad center, for the first psychiatric casualties to emerge. This is where you were talking about the comic book character.
Speaker 2:Well, it took hours, hours into this exercise and I started getting impatient and I went up to the, our commanding officer of the hospital and said Sir, where's psychiatric casualties all of our people are waiting to so we can start to practice, because we've been doing some training and we want to do some of this preparation Before we actually go into Iraq. And he said Well, hang on tight, russell, they're coming. We were told they're coming. Okay, so about an hour later, in three hours into this exercise, we get our first call to come to the the triad center and that is a distress marine, lance Corporal, a female Lance Corporal, who was wearing a cape and a mask and had his little label attached to her uniform that said that girl. And that was our one and only psychiatric casualty that we were to practice on in preparation to go to war. And yeah, that was eye opening.
Speaker 3:Very sad, very frustrated. No, yeah, incredibly disrespectful and yeah, I think people that are listening to this are wondering is that going along? Is that? Is that the level of sophistication of the military? These days, in which they're laughing at these things are not providing the opportunity to train and to be prepared for these kinds of psychiatric care.
Speaker 2:Yeah, and I can't speak for all the different trainings like what the Army might have done in the Air Force in their field hospitals, but for a Navy field hospital if Batgirl is only a one-off, okay, but the idea is that what other level of training that we're getting across the board? And, as I mentioned to you in our first episode, that first training survey we did when we trained our surveyed 111 uniform mental health providers and we found 97% had admitted they were not properly training in how to administer or deliver the top evidence-based treatments for PTSD. Where are we at with that now? And I haven't done a survey, I'm not in the uniform anymore, but I would hazard a guess it might be improved but it's still not anything close to 90% trained, as it was 97% untrained back in 2004, 2005, 2006.
Speaker 3:I can't get my hands around and my arms around you. Think about a commander who would do that and maybe hoping that a little humor would help in the row and people would, it would take the minds off of some of the challenges in front of them, etc. I don't think that's the deal, understand.
Speaker 2:Yeah, yeah, I really honestly don't think it was a purposeful attempt to bring in humor. I think it was a very naive view of mental health in psychiatric casualties. Now I'll share with you why. Because then when we actually deployed the field hospital and we're preparing for that invasion I think it's, you know, in February or whatever it was we were there and we set up our field hospital, all the tents and everything was geared up, and then we had to go and all the functional leaders, all that department heads, all met in the field with our senior medical officer to be assigned. To which tent do we set up shop? Right, and we're in a grassy field or a dirt field, whatever grass that was, and the senior medical officer standing on a box with a clipboard and he's reading off okay, surgery, tent one, nursing ward, two, tent two, icu, or you know, 10, three, er triage room 10, four, you know, etc. Etc. Each department was being called and you know they called the pastoral care and they were. They were set up right next to the morgue and Father Trapani, or Chaplin, was not well happy having his chapel being it, you know, right adjacent to the morgue. So he stood behind with me because I was the last person standing. Literally everybody else went off with their teams to fill up their tents and get ready, because we're about to receive casualties any day.
Speaker 2:And there is neuro psychiatry standing alone. I'm saying, sir, what about mental health? And he looks at his clipboard and he says Well, russell, I don't see anything here for mental health and, to be honest with you, I don't know why you're here. So I think that speaks more to what happened. Yeah, it's just that ignorance and that lesson that Apple BV spoke of. And in the Second World War, by the inevitability of psychiatric causes, large number of second, a second as predictable, as you know, shrapnel and other wounds of war.
Speaker 3:We have a, we have a graph of that pretty early on. Yeah right, this one.
Speaker 2:Yeah, let's talk a little about. That's what that graph is that Charles is referring to. As we went back to all the statistical records kept by the War Department, now known as Department of Defense, about psychiatric cows with ease and war, and this is the trend that we uncover Is that in the Second World War, we started having more psychiatric casualties than the total wounded in action and killed in action combined. And I'm going to be a nerd it out. I'll give you some numbers here, right? So, for example, in the Second World War, a total of 1,076,245 US personnel, rather, killed in action or wounded in action In regards to psychiatric casualties, and this is primarily through the army only because the Navy Marine Corps kept very lousy stats, they didn't publish it and the army 1,253,000. Service members were admitted to psychiatric hospitals or receive psychiatric care, but so that number Eclipse the total number of wounded in action, killed in action combined, right? What makes it more striking in the Second World War was an unprecedented large scale social experiment when they tried to eradicate mental health problems, war stress, injury from the military by screening out 1.6 million Volunteers who had any type of predisposition To mental health issues or trauma related stuff. So everything known if you were from a divorce family, if you were adopted, if you stuttered, if your ears were yeah, I mean any any known vulnerability? Yeah, we screen them out. So, basically, we went to the Second World War with a bunch of Captain Americas, the most psychiatrically and physically hardy and most screened Military ever put on this earth, and yet there were more psychiatric casualties than there were Physical casualties of war. And that's what prompted that War department study that Apple and BB led to go investigate why and they said well, the reason why it's because history has shown us that psychiatric casualties are inevitable in war and they had to reverse that policy at that time. We'll talk more about that in a future episodes, about what that policy exactly was and how that unfolded.
Speaker 2:Let's go to the 21st century, right when I was sharing with you about my preparation to go in a Phil hospital and the evasion of Iraq. What do we do there? Well, that trend has lasted. That trend started in World War 2. Has persisted after every war since World War 2. Where second psychiatric casualties outnumber the physical wounds of war. And in this 21st century there were a total, and this is going back to maybe 2000.
Speaker 2:6, no, 2018, 2019. So these aren't current stats, but you'll get the general idea Right and around 2018, there were a total of 58,586 US Personnel who were killed in action or wounded in action 58,586. In 2018, there was 936,283 military personnel that were identified having some type of a psychiatric issue, 685,540 veterans diagnosed and treated in the VA for a psychiatric issue. Coming out of those wars FAR eclipsed the physical wounds of war. So that idea of George Santana about learning the lessons of war and being prepared, or, if not learning it, we're going to be doing to repeat it. Let's see how does the military respond? Right, I think you can probably get the idea. Not, well, yeah, Right, so let's see. In our earlier articles, charles, we talked about something of a generational cycle, what we call preventable wartime crisis, wartime mental health crisis, and I don't know what your thoughts about the idea of it being preventable.
Speaker 3:Preventable.
Speaker 2:Yeah.
Speaker 3:Within. I think it's definitely an absolutely preventable.
Speaker 2:So if gunshot wounds and shrapnel, psychiatric casualties are inevitable outcomes of war, what makes this? How do we even think about preventing something? And I think what we're talking about is that you can't prevent psychiatric casualties, just like you can't prevent shrapnel wounds and people being killed in war. That is the tragic outcome of war, but we use this sentence here that did we do our very best to implement what we knew we should be and should not be doing in order to avoid unnecessary harm? And the kind of idea of preventability is that are we learning the lessons of war trauma and are we doing it in a way that we did our very best to minimize? You know the predictable outcome and we are going to be psychiatric casualties, but are we really doing our best to mitigate that, to reduce that? If we haven't, then we fell those lessons again right.
Speaker 2:So I want to just walk through a little bit the idea of what each generation we talk about generational crisis is what we uncovered, and I won't go through every one of these, but you know the first lesson learned and that what happens after the war is the military will investigate and all aspects of warfare the technology, the strategies, the different battles In the case of medicine, you know how we dealt with the wounds of war and then the mental health. How we dealt with the mental health wounds of war will be referred to as war stress injuries. So after each war, each generation has looked at how they did with the mental health side of war, and it's they document this in lessons learned volumes, right? So I'll start. They had one in World War One. I'll skip that and go to the Second World War, because they references the First World War.
Speaker 3:So as a result of that, then we every lesson learned should not be repeated.
Speaker 2:That's the idea, right? Yeah, well, that's the whole policy. Is I read the Army doctrine on lessons learned? Is that we analyze, we accumulate these lessons and then we disseminate it and then we implement it so that we have that as part of our DNA and in military medicine? You know we referred to a little bit earlier that you know some of the innovations that have come from learning the battlefield. Battlefield lessons of war, the medical lessons, have been instrumental in transforming civilian care.
Speaker 3:Yes.
Speaker 2:So I did. About transfusions, ambulances and triads. All that started in the Civil War. You had treatments for malaria, all the things with planliness and sterilization, preventing medical disease. All that was borne out.
Speaker 2:Different military conflicts, you know. Blood transfusions, treating burns, traumatic amputations, all those lessons from battlefield medicine translated to you know the kind of amazing emerging care we get in the civilian sector. Right, those are clear benefits from learning the lessons. Now, statistically, there's a medical historian named Gabriel who wrote about this and looked at the survival rates today from people severely wounded, multiple tram amputations, severe burns and today's battlefield in Iraq and Afghanistan 97% survivability rate and amongst the most severely wounded. And Gabriel looks back at different eras and he goes all the way back to the estimate in the era of Alexander the Great. That's going back to show you you're estimating, but based on medical lessons that they revealed from the Greeks then that about 3% survive and now then died from diseases and infections, then the actual, you know, being stabbed or shot or whatever Happening on the direct wounds of war. So we have a 97% survivability rate, which really speaks to the benefit and the wisdom why we have medical lessons learned programs, policies and personnel dedicated to learn those lessons.
Speaker 3:And so where's that same impeccable Finding with regard to mental health?
Speaker 2:Let's see. Let's see what happened in the second world war. All right, what's everybody? You know we have a very fun recollection of, you know, the heroes.
Speaker 2:It was a just war. It was a war where we're heroes and you know that most people think of the second world war generation is being psychologically hardy and resilient and that's, you know, coming back not pretty well unaffected by the war's drama, unlike today's generational war, is that's the myth? Because, as we just talked about, there were more psychiatric casualties in the second world war. Then there were, you know, those who were killed and wounded combined right. So, anyways, they did their analysis, the post war analysis, of the mental health lessons learned. This was the conclusions reached by these army generals and leaders of military medicine the concepts and practices as developed by combat psychiatry and World War two, generally rediscovered, confirmed and further elaborated upon the largely forgotten or ignored lessons learned, and by the allied armies, including the American expeditionary forces in World War one. So they admit it out front we had to relearn everything, just like that Admiral told us in that field hospital right in 2003. Very impressive folks, but unfortunately will be forgotten and will need to be rediscovered almost word for word. They go on to say quote thus, the lessons of World War two, combat psychiatry, should be regarded as relearned and consolidated insights. Further, and most important, there was the documented history of World War one, as well as accounts from other previous wars, and in our book we go again a lot of lessons learned from the American Civil War and other wars before the first world war, which provided abundant evidence that combat would produce large numbers of psychiatric casualties. You can see Apple and BB playing a role in that right. Like what they concluded. They go on, say, just quote despite the foregoing data that were available to responsible authorities, there was no effective plan or real preparation for the utilization of psychiatry by the army in the World War two, and the same could be said about the Navy and Marine Corps as well. Quote facilities for the care and treatment of psychiatric cases were only barely sufficient for the small peacetime army. What a condemnation. Yes, right where we were at and forgetting those lessons learned. Right, we repeated Santa Ana's warning did not heat it and we fell. So let's jump forward and we could go through each generation, which we do in our book. I mean they have similar conclusions, right. But let's jump forward to the 21st century and the recent war on terrorism and specifically around that canister in Iraq.
Speaker 2:In 2007, the Department of Task Force on mental health reported their findings after a year long investigation into mental health care in the military. That 2007 investigation was mandated by Congress. It wasn't the army deciding to do that proactively what's his typical and it was prompted in part by my Department of Defense I G complaint against military medicine which I forwarded to members of Congress and it helped inform the. We need to really take a serious look at what's going on in the military. We have an epidemic of suicides, untreated veterans and kind of a lot of problems when they leave the military. And so they went and did a year long investigation. Try service, or a multi service, let's say investigation.
Speaker 2:Here's their conclusions the task force arrived at a single finding underpinning all others the military health system lacks the fiscal resources in the fully trained personnel to fulfill its mission to support psychological health in peacetime or fulfill the enhanced requirements imposed during times of conflict. Almost identical verbiage is the second world war right. We couldn't even provide adequate mental health during peacetime, yet alone war. They go on. The task force does go on and state quote the time for action is now. The human financial costs of unaddressed problems will rise dramatically over time, which it has. Our nation learned this lesson at a tragic cost in the years following the Vietnam War, fully investing in prevention, early intervention and effective treatment are responsibilities incumbent upon us as we endeavor to fulfill our obligation to our military service members.
Speaker 2:There were 99 separate recommendations in that Task Force report. Most of them mirrored what I was recommending in the IG complaint that I filed in 2005. Here we are in 2007. This is 180 degrees different than what military leaders were testifying to Congress in the different variety of armed services committee meetings, hearings about how we were doing groundbreaking work in mental health and we had unprecedented level of access to the top military or top mental health treatments and well-trained providers, et cetera. All that was completely debunked by the Task Force's findings made public. And what do you think happened in response?
Speaker 3:Oh, I'm not sure.
Speaker 2:Well, what do you think Congress did in direct just in 2007, one month before the revealing of this report, that military leaders were still holding that line, and then, one month later, they completely contradicted like no, we can't even provide adequate care in peacetime. What was the response, you think, from the media, from Congress or the government? How would you think they would respond?
Speaker 3:Well, I would think that they would respond this is a tragedy. This is horrific. Let's do something about it as soon as possible.
Speaker 2:Yeah, it's outrageous. How dare you come up here one month early and tell us everything's fine and now you come back and say it's just the opposite. Right, but no one asked that, right? No, nobody asked. The media didn't ask. In fact, the people who did, the leaders, the certain generals who were on that Task Force, who were responsible themselves because that Task Force was led by the service generals I'm sorry, the Surgeon Generals for the head military medicine and they were all awarded for it after this task. They got awarded, they were applauded as providing a groundbreaking, being so transparent, etc. Etc. And the press didn't follow up on it. No hard questions were asked. Well, why now? We started the invasion in 2001. This is 2007. Why didn't we do something earlier?
Speaker 3:How did?
Speaker 2:this happen.
Speaker 3:Did anything like that come out of this? No, sir.
Speaker 2:Not a single negative thing. It was all heralded as groundbreaking and positive and people were applauded and they applauded themselves in the back. No outrage from the public, no outrage from the media, no outrage from Congress, certainly not from the government, not from the military. The military they thought they did something really great by admitting the problem. Yeah, by admitting that we failed to adhere to the lessons learned from all those previous reports from every generation.
Speaker 3:Without doing anything about it. That's fine and dandy.
Speaker 2:Without doing anything. It was meant to say okay, now we're going to do something about it. Now we're going to put these 99 recommendations into effect.
Speaker 3:Good, that's great. Where is that?
Speaker 2:It's still waiting to happen. Some things did change and we'll talk a little bit about that in future episodes, and also this is our talking about. This is not at all to be smirged. The providers of healthcare, mental health providers, many of which and most of which, I would say, do a Herculean job and doing the best they can, but, like in my situation, we're not the only mental health uniform mental health provider on a base where Marines are coming right out of the sandbox and landing the next day into this rural base in Japan. It was a nightmare, and that was repeated throughout the DLD, at home and as well as abroad.
Speaker 3:I wonder, wouldn't it be nice to get one or two of those generals that were on that panel and who made that report and were bathed in the joy of Congress and doing such a great job? Interesting yeah.
Speaker 2:How could they live with themselves?
Speaker 3:If they walk in ignorance of how ignorant that was. I don't understand. Yeah, I mean you can almost say some people have blood on their hands?
Speaker 2:Yes, absolutely. With the rash of suicides and all the things that happened, a lot of the harm that was caused by their failing to adhere to their own policies, their own lessons to learn. We didn't do that for battlefield medicine. You didn't hear about medical crisis or dental crisis, right?
Speaker 3:Yeah, we're not even focusing on the veterans Right. An active duty military is getting it in the neck and not being attended to, but the veterans we get out of here, we're not even starting on that.
Speaker 2:Well, I think we rightly point out that and this is something that Roosevelt FDR at the time that he really emphasizes that the military itself is responsible and obligated to provide the optimal level of psychiatric care before people are discharged from the military, because that's a definite show in the future it will be doing about that executive order from FDR, but he puts the responsibilities on the military and that say, well, we're going to discharge these people who are struggling and send them all to the VA, which has been the policy Right.
Speaker 2:Unfortunately, we won't. Yeah, so I wonder if you might? In each generation, as we did this research, we uncover the same lessons to learn that kept propping up almost verbatim. Some of us were very explicit, like as far as preparation and training and resources. Others were more inferred about what are the things that they're saying that need to be changed, and we identified 10 foundational lessons of war trauma that go across each generation, that apply back in 1918, in the First World War, and the current conflicts and future conflicts. So I'm wondering if you would you please just go with those.
Speaker 3:War is inevitable, inevitably causes a legitimate spectrum of war stress, injuries. Okay, if they're inevitable, then we need to prepare for that, right? I just want to speak on that.
Speaker 2:A legitimate spectrum of war stress injury. That means that it's more than just PTSD. We often kind of look at, well, what is the psychological effects of war or terrorist act or COVID or something? And we look at, well, people have PTSD, People have PTSD or not. But war stress or traumatic stress injuries involve a whole range of conditions and PTSD is just one part of that spectrum.
Speaker 3:What are some examples then? What are in addition to PTSD?
Speaker 2:Well, you got depression. It could be some type of anxiety disorder, it could be some type of a physical complication, or what they call medically unexplained medical conditions, such as fibromyalgia, irritable bowel, GERD, headaches, seizures. So all these a range of hosts. I think one study that identified 300-some-odd physical conditions that are related to exposure to chronic and extreme and traumatic stress. These are physical health conditions that, might you know, don't reach the criteria for PTSD, but they are manifested in the body in a sense. So there is this, as I said, a spectrum, including psychosis, which is a spectrum and you may not know this one of the top diagnoses coming out of Vietnam. The reason why individuals were medivac out of Vietnam was they were diagnosing as schizophrenia. Now, how many of those people actually had schizophrenia? I think is probably a small fraction.
Speaker 2:I mean, we wanted symptoms, they essentially symptoms, but they had symptoms of psychosis, and psychosis was actually part of the symptomatology of the first war syndrome. It was called nostalgia and this is going back into the 1500s and 1600s and the European armies, and psychosis was a symptom of this Syndrome and what we call soldiers heart and all these other labels. Sometimes you'll see excerpts of psychosis. So again, we don't think of psychosis is usually something that is related to traumatic exposure, but it has always been, and so there's this. I'm sorry to deliver that, but that spectrum is important to get to. Yeah, yeah, so yeah.
Speaker 3:So the second adequate research, planning and preparation are indispensable during war and peace. Good to know it's appropriate. Certainly doesn't happen. No, a large cadre of well trained mental health specialist is compulsory. We don't have that. We still are not fully.
Speaker 2:No, and by the way they use there's an excuse that's often uses that whereas a shortage of mental professionals in the country and that's true, but the military has ways to they could develop that. We have a uniform health services college in the military and it's used to train I can listed people and officers into medical professionals. So then being discharged in military to go in, you go to medical school or dental school or nursing school and then they come out and they they're a commission and they serve Obligated, you know, 4 years or 6 years and in military medicine they started doing that a trickle with mental health. How many of these enlisted soldiers and Sailors, airmen, would maybe jump at the opportunity to get Free graduate school, paid for, and then come out as a commission officer and provide that service and with their background is being in the military, that would be invaluable resource. So we don't use the resources we have available and, as we said, we'll talk more about these Concrete solutions going forward. But yeah, we don't have a well trained. We know that the training certainly is.
Speaker 3:Yes, but for a holistic public health approach to war, stress injuries necessitates close collaboration with the private sector. Conferences, private sector, along with full parody between medical and mental health services. Yeah, I mean, do you have anything to add to that? I mean, it's pretty obvious that this is needed, important, but it's not happening. Is there any process of making sure it does happen? I haven't heard any holistic public health approach.
Speaker 2:No, there there isn't. And this really speaks to the transition, to when you transition out of the military, and why we've had such problems with that Is that there isn't this collaboration between the military and the private sector and the VA to make sure people aren't falling to the cracks, particularly those who are reserves or National Guard, who go back to their private lives after they deploy, and their family members and I do a full parody, full parody between medical mental health. Wouldn't that be nice If mental health was treated just like medical conditions, then there would be no stigma.
Speaker 3:Yes, Number five effective mental health services demand empowered leadership of an independent, unified organizational structure. For example, behavioral health core would be a nice idea, providing integrated, well coordinated continuity of care equal to medical services. Yeah, you were just talking about the lack of continuity of care when you have a medical diagnosis and you go to the air Nowhere.
Speaker 2:Yeah, Well, and the idea of a behavioral health core. We're going to talk more about that in future episodes. But there's a core. The military uses cores as a organization to Provide for recruiting and for training and policies Amongst different core and it signals the priorities the military places on this group of professionals that belong to a core. So we have, for example, a medical core, a dental core, a nursing core, a chaplain core, a legal core, a supply core. We even have a veterinary core, but there is no behavioral or mental health core.
Speaker 2:And if you want to know, I gave you a quick example why that's important. When I was on that base in Japan, that marine base in rural Japan, as a sole mental provider for 6,000. I was actually there were a marine core community counseling center that employed 7 different mental health providers who were licensed we're civilian but yet they were forbade by instruction To provide care for anything other than Some kind of adjustment reaction or a relationship problem. But they could not treat, it could not work for people at PTSD or depression or that suicidal ideation. They all had to be referred to me, the uniform mental health provider, yeah. So that's the idea.
Speaker 2:Yeah, so I belong to military medicine and these community counseling people belong to the base commander or the fleet or the force, right? So there are 2 different, separate chain of commands, 2 different pipelines, 2 different sets of policies, and that's what we talk about needing an integrated organization. We need a core that brings all these people together, because we're creating staffing shortages, often because of our policies. Right, we forbade these counselors licensed counselors to provide their full level of training. Right, as a licensed mental health provider, their full scope of practice. We say you can't see these people, you can only see these people, and that creates a staffing shortage.
Speaker 3:So this is my own five, six. That's good. Elimination of mental health stigma, barriers of care and the disparity is a priority leadership issue at all levels directly impacting individuals, families and military radiators. Absolutely, the issues of stigma and related barriers are just. You could have a kid who is interested in seeking what's going on with him or her, but it's just him.
Speaker 2:Yes.
Speaker 3:And you share that information with other people and you would, I'm sure, be perceived as there would be stigma, without a doubt. But you know, I'm not sure of today's military. I my hope is, but it doesn't seem from your skeptical. All right Well.
Speaker 2:I'll tell you, well, I yeah, I told you I've been doing the VA disability exams. Yes, I mean now the military. So I can tell you, speak to current day, less than 70% ever breached stigma and most of them don't talk about disclosure mental health issues on active duty for fear of stigma and the reprisal against their careers. So we haven't done it really much of a thing at all with that.
Speaker 3:You know, I was hoping, because the current students that we have, including graduate students, actually are far more I think I mentioned this earlier far more liberal with regard to mental health issues.
Speaker 2:Yeah, and I, I see that too, but the it's an issue where there may be more accepting of it personally, individually. But then when you have to go to an organization and tell your NCO or your, your commander that I have, I think I'm having emotional problems. What's that going to mean? One, how people are going to perceive you. Two, you're not going to be in your career. Potentially, you're going to lose your security clearance. You won't be able to be deployed. Potentially you will be on the exit route. And that's the fear. Even if it's not a reality, that is the ongoing fear that people have, that this is going to come back and buy them. So the issues of being much more progressive about mental health and not have a carrier stigma, but they're still affected by the organizational stigma that exists.
Speaker 3:Yeah, I think that's still the case. I have a very, very good friend of mine who just got out of the Marine Corps as a colonel. He passed over, yeah, and he admits he has issues with regard to combat, to these experience and it's not real impressed with mental health services and confident that it would be held in confidence and all of that knows that, the various tracks of going on the outside and getting the services potentially that they need. But he calls me. That's the time, yeah, and it's. It's very frustrating seeing that after all we have learned, after all we've published, absolutely.
Speaker 3:And these are among our biggest fans, but also think of it.
Speaker 2:Now. That's a full bird kernel in the Marine Corps. What do you think on the enlisted end of that? Well, how that? Or the junior officer folks, you know, if that level of stigma and fear exists at that high ranking, which it does. I've talked to generals and admirals confidentiality who had the same struggles but didn't want to have anybody know about it for obvious reasons. So you can imagine the intense pressure that people feel at lower ranks. Yes, yeah.
Speaker 3:Yeah, I've talked with them actually. Yeah, we said let's see which number are we on now Seven.
Speaker 2:Number seven Okay.
Speaker 3:Ensure ready access to high quality mental health services, including definitive care prior to military separation or discharge. Yeah, it was a joke when I was getting out of the Marine Corps in 1967. I guess I actually wasn't because I knew automatically go into the reserves. But the notion of you know, yes, no sort of thing, you don't have these things, right. Right, it wasn't that obvious, obviously, and I don't think that I did. I mean, I had the great last year at Cherry Point, but it was a vacation compared to what I've been before.
Speaker 2:Oh sure.
Speaker 3:But yeah, it wasn't done as well as I hoped at that time. How about you?
Speaker 2:Oh, I didn't know. Heck, no, I'm not. You know, I'm that ilk of. I'm not going to identify myself as having a problem because I'm a mental health provider. I got this facade of.
Speaker 3:And you did that when you were an enlisted jet mechanic.
Speaker 2:Yeah, when I was enlisted I definitely would not. I would not feel free at all to disclose it because I knew in my heart that if I did one people would start joking on me and that stigma amongst my peers. But then also, you know, I could be kicked out of the Marine Corps for, you know, not be fully fit for duty, or something like that.
Speaker 3:Which would have been horrible, given your family and your father and all that yeah.
Speaker 2:Yeah, young, yeah, in that case, I had two young boys at home and a wife, and you know one was I going to do next? I didn't have a plan, so being kicked out prematurely would have been disastrous. So, yeah, there was no incentive whatsoever to come forward in the mid I was having mental health struggles or seeking mental health care, right, okay, eight out of the 10. Okay.
Speaker 3:Families must receive adequate mental health and social support during and after military service and you know it, rarely when I'm reading veteran literature do we ever mention families. So it's absolutely important. Is there anything that, as an illustration that you've experienced from family that's supportive, that illustrates how important families are and they have to receive adequate mental health and mental services?
Speaker 2:Yeah, well, one of my jobs in the military and I had that same function here as a private therapist is I work with children, adolescents and families. So in addition to adults, you know active duty, that's all the stuff. And, boy, I mean there was really no resources. Where you can? You know we would tell them what your son or daughter need counseling but if you're overseas base you know that's not going to be available as it is maybe in the state side. But there is such pressure for the families. I have wives and some husbands expressed the same concern about stigma that they didn't want to be identified as having problems or they were very concerned about their spouse who was struggling getting help because they were fearful for that they might lose their job, their position, their source of support for the family.
Speaker 3:So there's this pervasive fear and uneasiness throughout the military populations about Well, it's not only in the military, it's in our team as well. Absolutely it's gotten much better than the 50 years since I've been in. So number nine accurate, regular monitoring and reporting are critical for timely, effective management of mental health needs.
Speaker 2:Yeah, yeah, it's like you don't. If you don't know what the problems are, you're not going to be able to respond to it. So let's monitor. You know how many people are needing care, how? What's the access to care like? And there have been some 114, I think different government sponsored studies into military and mental health care during the wars in Afghanistan and Iraq, many of which overlap, of course, in the recommendations in terms of what problems they identified. So there's a lot of monitoring goes, but there's not a lot of implementation after that too. So that kind of goes through that idea. We need somebody accountable for mental health care. Who is responsible for implementing some of these reports? Yeah, the health court.
Speaker 3:Yeah, number 10, robust dedicated mental health lessons, learn policy and programs integral to meeting present and future needs and prevent crisis. Yeah, how about that? It seems so obvious.
Speaker 2:It does and it's a nice, I think, kind of a book into what we were talking about. The beginning of the show today is, you know how, what? How important the lessons learned to the military and how we have these programs throughout the military, dedicated policies and personnel whose sole mission is to capture these lessons and disseminate it and implement these lessons learned, but not so for mental health. We need that, oh right. Well, so that's just a bit of an overview. That's our introduction and then we didn't cover a scratch, but hopefully it gives the listeners at least a general view of the landscape, of why we took on this task of identifying what are the reasons why the military is neglecting their trauma lessons and, more importantly, what can we do about it. So that will be the discussions in our future shows, but hopefully that was helpful at least to frame the issues that why, how we have seen it and how we got started into this.
Speaker 3:Yeah, I hope so. Well, hopefully this has been helpful and useful to everybody, and we are, you know, dedicating our own time to doing this because we think it's really important, and we hope that you will tune in, know what the schedule is, be able to listen to it again if you want. We're happy to be with you and look forward to many more.
Speaker 2:Yeah, I agree Everything you said and also that if people have questions or comments or reactions or anything we said, you can email me and I'll show that with Charles, of course, at mrusselrusselphd at gmailcom, and again, we're not going to talk about clinical issues at that. You're going to I recommend you talk to your primary care, you talk to your therapist, but we're going to stick to kind of answering questions and reactions to some of the issues around policies and people's experiences with military mental health care. So until then, until the next episode, we wish you all a very good day, see you guys later. Bye.