Wednesday, August 26, 2009

"Broken Soldiers:" Depression and the Military

Many are the stories we hear about the bravery of our soldiers in the battlefield. Amongst these stories, the most remarkable ones are usually those that describe how one of our finest, selflessly laying his life on the line, manages to save one of his own. The ties binding our fighting men within the ranks of our military, need to be experienced in order to be understood. No amount of words; no Hollywood movie, patriotic song or beautiful poem, could ever come close to accurately describing this bond. So powerful a bond is this, that makes it common for a junior or senior enlisted man, as well as a higher ranking officer, all in the prime of their lives, to courageously launch their bodies on top of a grenade, or walk straight into the line of fire - their hopes and dreams vanishing in the blink of an eye - to ensure the safe return home of someone they probably didn't even know a year before.

But what happens to the injured who have yet to see combat? What happens to those who are left behind in garrison, in direct support of our fighting men, and whom are queued to follow? The treatment and care extended to those wounded in the battlefield, by those who actually send them there, is one full of compassion, empathy, and support. Sadly, somehow, somewhere, something is lost, and, the same displays of courage, affection, and understanding; extended by senior enlisted men and officers to those wounded in the battlefield, are seldom experienced by those who suffer wounds other than those caused by enemy fire. This is particularly true in the case of those suffering from the injuries inflicted by a silent, yet deadly enemy: mental illness.

Mental disorders are common in the United States and internationally. An estimated 26.2 percent of Americans ages 18 and older — about one in four adults — suffer from a diagnosable mental disorder in a given year. If we only concentrate on depression (perhaps the most common mental illness), the numbers are equally astounding! 14.8 million American adults, or about 6.7 percent of the U.S. population age 18 and older, suffer from Major Depressive Disorder within a given year*. Is the military exempt from this reality? Where do our soldiers come from, if not from within the hearts of our cities and farms; from our slums, and up market, ritzy neighborhoods? Our military is, after all, a mere reflection of our society; therefore it should be no surprise to see it's members being plagued by the same evils that affect our nation as a whole.

Being diagnosed with Severe Major Depression while "in uniform," is definitely one of the most difficult challenges faced by any military member, especially if the individual knows he can keep up with his duties and still wants to remain in the service of our nation. The extent of ignorance surrounding this illness, and the resistance by so many of our military leaders to understand it and acknowledge it as a treatable but debilitating illness that affects every aspect of the individual's life (rather than a mere reflection of weakness), is completely negligent, unjustified and downright scandalous! More should be demanded and expected from our senior enlisted members and officers in general. The men and women in charge of our young soldiers; those whom they look up to for advice, leadership and guidance, should be held to higher levels of professionalism and intellectuality. Someone who is trusted with our children's lives; someone who has the authority to control and even run their lives in ways unimaginable for those who have never served in the military, should step up to their responsibilities and learn that the battlefield is not the only place where they are expected to be heroes. Saving a life shouldn't be exclusive to the theatre of war, especially when we consider that in 2008, approximately 169 soldiers and marines ended their own lives. Where were those in charge when this was happening? Were they doing all they could, to keep these young men and women safe? My best and only guess is no!

"With every single chevron obtained, there comes more responsibility and authority." Anybody who has served, knows that this might be especially true in the case of administrative tasks, but in reality, in practice, what every chevron means is usually more "delegation" of authority: the authority of holding others responsible, thus creating a chain of usually well versed people (in military matters), but usually ill-knowledgeable in the realities of life. There is always a weak (ignorant) link to be found somewhere in this chain of command that, when confronted with the mental illness diagnosis of one of his underlings, decides to think that his own insignias actually mean something in the real world. Mistaking his level of intellect with the amount of chevrons on his sleeves, this ever so commonly found "know-it-all," decides to label the affected soldier as lazy, a weakling, or a plain out malingerer. The boot camp mentality rises to the occasion, and "off" he goes to pressure, force and exorcize out, what he considers to be rubbish; blatantly disregarding the professional opinions of those who (in most cases) made it out of high school by actually attending, and hold degrees and high levels of expertise in what he willfully knows nothing about; usually for lacking the humility of realizing that his rank and years of service within the protective confinement of the military, do not bestow upon him the ability to know everything.

Given the fact that military leaders have so much control over our children's lives, shouldn't they be expected to know a little bit more about life as well? The least an NCO (non commissioned officer) or officer should do when one of his subordinates is diagnosed with a mental illness, is to inform themselves on the issue. Consult the very physicians taking care of such soldier and ask what they can do to assist, or at least how can they avoid making the situation any worse. Instead, the individual suffering from this illness is oftentimes subjected to unnecessary pressure, embarrassment, ridicule and public humiliation. The emotional blows received by many service members suffering from mental illness, at the hands of those who supposedly there to support, guide and protect them, end up undermining them, deepening their wounds and lowering their self esteem; scarring the patient to the point that the illness becomes more lasting or perhaps permanent in nature. Many perfectly brilliant and productive military careers are unnecessarily ended early. Valuable personnel is carelessly lost to the lack of dignity and respect with which they are treated, in direct contrast to the care and nurturing extended to those wounded while patrolling through hostile territory. Ironically, the very same person who under other circumstances, in an act of selflessness and heroism, would thoughtlessly risk enemy fire to save a young soldier's life, is now the very same person pushing him to the edge of madness; perhaps with catastrophic results! This wrongful approach and eagerness of military leaders to alienate and get rid of the "problematic" soldier suffering from depression, is not only detrimental to the patient, but to the military as well.

Anyone who knows anything about it, would never argue that depression can become such a debilitating illness, that it can render an individual unfit for a number of tasks. In some cases, mental illness of any kind, can become completely incapacitating. It is obvious that a person suffering from this level of depression, cannot be allowed to remain in service. But that isn't always the norm, and whether that is the case or not, should be left to the professionals, not to the platoon sergeant, squad leader or even the company commander to decide. Many people who have suffered from this illness can function within their environment. Furthermore, just because you suffer an episode of depression, doesn't necessarily mean that you will remain depressed forever. Depression can be endogenous or exogenous in nature. The former being much more difficult to combat and eradicate, than the latter. Endogenous depression is caused by genetic factors residing within the individual and that make him prone to breaking down easier when facing an external stressor; or simply to face a depressive episode without any apparent reason. On the other hand, exogenous depression is caused by an external situation, which the individual finds it difficult to cope with, on his own. Once you identify the main life problem causing the situation, you can isolate it and begin working towards achieving a successful solution. Regrettably, the lack of knowledge in the military, and flat out lack of desire to recognize and learn about something that is reaching epidemic levels within our nation, makes it impossible for those in charge to spot these cases, and even more difficult for those afflicted, to even realize something is going on with them and feel safe to reach out and seek help.

In the times we live, when there seems to be war, or the possibility of war breaking out everywhere. When we hear about the casualties of what sometimes seems to appear as a never-ending war. Today, when so many of our young men and women are in harm's way serving their country proudly; it's appalling that we must also hear how a young soldier has felt so overwhelmed by life, that his only way out has been to end his life prematurely! Many, if not all of these young men and women had suffered from depression, either diagnosed or not. All the signals must have been there in each and every one of these 169 cases, but ignorance is usually the greatest blinding force! They "fell" through! We have all failed them! How many of these precious lives could have been spared, if their leaders had possessed the knowledge and the tools to distinguish and care for these wounded warriors? How many could still be with us if their leaders would have lived up to the word (leader), honoring each and every single one of the 23 leadership traits which they learn, brag and talk so much about, but few actually seem to possess? Tact, empathy, compassion, and humility are usually the leadership traits that begin fading away as the chevrons and awards keep piling up. We are still looking for those true, yet "few good men." Now more than ever! There are still plenty of them! Let the real leaders step forward and take charge!

*Kessler RC, Chiu WT, Demler O, Walters EE. Prevalence, severity, and comorbidity of twelve-month DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R). Archives of General Psychiatry, 2005 Jun;62(6):617-27.

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