I met Dr. Harding at a press conference announcing the expansion of the Give an Hour initiative and really enjoyed our candid conversation about the unmet mental health needs of veterans of the war in Iraq and Afghanistan. It is sobering to know that many hundreds of thousands of soldiers are returning to the U.S. with traumatic brain injuries and post traumatic stress disorder. They volunteered to give up their lives for us, will we volunteer to care for them?
An interview with Richard K. Harding, M.D., professor and chair of the Department of Neuropsychiatry and Behavioral Science and an adjunct professor of pediatrics at the University of South Carolina School of Medicine.
Dr. Val: You mentioned that this quote means a lot to you: “One does not escape war by leaving the war zone.” Can you explain what you mean by that?
Dr. Harding: I was referring to my own experience with children rescued from Vietnam and transported to the U.S. Here, 6000 miles away and in a perfectly safe place with lots of support and food, they were still dealing with the trauma of the war zone. And I’ve seen this all along in my career, especially taking care of the National Guard folks in South Carolina. I’ve seen people become depressed and anxious and use substances to try to deal with the recurring thoughts provoked by combat experiences. They have profound changes in how they see the world. These are healthy people who were doing well in their jobs and family life. And then when they come back, they have a considerable amount of anxiety and worry and a loss of optimism about the future. In a way, the war follows them home.
Dr. Val: How do you help your patients to gain maximal recovery?
Dr. Harding: The best treatment begins with an accurate diagnosis and good access to care. There have been some major road blocks in terms of dependents trying to use TRICARE insurance, so access has been limited for family members who need services.
A good diagnostic workup by someone who knows what he’s doing is really important. Military personnel need to see a therapist who has had experience with PTSD [post-traumatic stress disorder] and other combat-related mental health issues.And they also need to get into a good treatment program that is tailored to their needs. Some people need psychotherapy, and others need psychotherapy plus medications. Some may be so severely depressed that they need to be in the hospital temporarily.
Dr. Val: There have been reports of different rates of mental health disorders in different arms of the military. For example, 50 percent of National Guard personnel report mental health issues, whereas only a third of Marines report the same. What’s that about?
Dr. Harding: Well we don’t know why, but I can speculate. If you are a trained military infantry combat soldier, you’ve been through a lot of training. You are camping out in the woods, you’ve been shot at, you’ve been through all kinds of simulations. You also belong to a tight group of individuals with whom you’ve been working for a long time, and your family has support at the military base in which you live.
That’s a lot different than a National Guard outfit composed of citizen soldiers. They’re suddenly asked to come in — not just one or two weeks out of the year — but to deploy to Afghanistan for 15 months. These people are lawyers, doctors and so forth, but they are often put on frontline assignments as soldiers. Unfortunately, they don’t have the same training and experience as the professional soldiers, so they’re more subject to emotional trauma. In addition, their families back home are scattered all over the state and don’t have the same backup and support that a family on a base would have. Spouses are often isolated when their partner is deployed.
Finally, the stigma associated with mental illness makes the military personnel less likely to get help early on because they’re worried that it will limit their opportunity for promotion.
Dr. Val: I heard that the question about mental health treatment was recently removed from the security clearance questionnaire. Is that evidence of the Army’s attempt to embrace and normalize mental health treatment?
Dr. Harding: It’s a very important symbolic victory. There is still a problem with stigma, but the Army is responding to this concern. There’s a tendency to think of mental health issues as a sign of weakness. Tough Army guys aren’t supposed to have emotional problems. They feel that they’re letting down other people if they admit to problems. You’re supposed to be able to pull yourself up by the proverbial “bootstraps.”
Dr. Val: It strikes me as somewhat adaptive, though, to choose that kind of attitude in a combat situation.
Dr. Harding: Yes, it may be. Seventy-five percent of military personnel make it through without mental health problems. They show amazing resiliency when you think about it. I’d like to think that I’d have that kind of resiliency too, but I don’t know. You don’t know until you’re in the situation. When good people try to do tough things, some will inevitably fall into the injury category. What we have to do is get recovery going and the “physical therapy” in the mental sense started as early as possible to help them get back to full capacity.
Dr. Val: What’s the most important message that you’d like to relay to a general public audience about mental health services and veterans returning from Iraq and Afghanistan?
Dr. Harding: Services are available, but you have to ask for them. You have to raise your hand and admit that you have difficulties and need help. It’s also important to do this early on before you leave military service because you won’t necessarily get the same amount of care once you’re back in the workforce.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.