Record numbers of veterans from the Afghanistan and Iraqi wars are suffering from post-traumatic stress disorder because the conflicts are the longest combat operations in America's history and they contain elements that provide fertile ground for fermenting the condition.
There are no front lines of battle, making no place safe -- not even the so-called Green Zones. Troops are being redeployed for two, three or more tours of duty, causing soldiers to be exposed over and over to these intense situations. And unlike in prior wars, women are being exposed to combat situations in which they are attacked and must fight back.
"A wealth of research has shown convincingly that the frequency and intensity of exposure to combat experiences is strongly associated with the risk of chronic post-traumatic stress disorder and related impairment," according to the National Center for PTSD.
The government and military services are responding to the growing problem.
In February, President Barack Obama proposed a 2011 budget of $125 billion for the Veterans Affairs Department, including $5.2 billion for mental health, an 8.5 percent increase over current spending. VA Secretary Eric K. Shinseki said that 20 percent of the patients seen last year in VA health care facilities had a mental health diagnosis. He noted the department had added more than 6,000 mental health professionals since 2005, bringing to 19,000 the number of employees dedicated to mental health care.
The increased budget will allow the department to continue its expansion of programs dealing with PTSD, which Mr. Shinseki called "central to VA's mission."
In the department's strategic plan for fiscal years 2010-14, Mr. Shinseki said the "psychological wounds of war" have affected every generation of veterans, and an increased response is necessary now.
"We must aggressively diagnose and treat these unseen wounds to address other portions of the downward spiral that often result in severe personal isolation, dysfunctional behaviors, losses of identity, confidence, and personal direction, shattered relationships, depression and substance abuse," he said.
"We know this cycle. We've watched it for years. We are not going to let this happen to this generation."
The additional requested funds also will be used to expand VA programs for traumatic brain injury, depression, substance abuse and other mental health problems and to continue the department's suicide prevention program, which the VA credited with saving the lives of nearly 7,000 veterans, active duty personnel and family members since July 2007 through its suicide prevention hot line.
In July, Mr. Obama announced the government will make it easier for thousands of U.S. veterans with PTSD to obtain benefits. Veterans no longer will have to produce evidence proving a specific event caused their PTSD, a process that sometimes took years. And soldiers in non-combat roles, such as those in military convoys affected by fear of roadside bombs, will now be eligible.
On another front, the military services have begun resiliency training programs to build up soldiers' emotional strength before deployment to combat zones in hopes they will be better equipped to deal with what they experience.
Upon return from deployment, soldiers are screened for PTSD at varying intervals, although it is suspected many of those suffering symptoms are not reporting for fear of being stigmatized, a barrier the armed services are working to break down.
A 2008 Rand Corp. study found that nearly 20 percent of military service members who have returned from Iraq and Afghanistan -- 300,000 in all -- reported symptoms of post-traumatic stress disorder or major depression, yet only slightly more than half had sought treatment.
That compares with 3 percent to 4 percent reported in the general adult population in the United States, according to a 2004 study in the New England Journal of Medicine.
Many service members said they did not seek treatment for psychological illnesses because they fear the stigma will harm their careers.
"These are hardened, tough individuals," said Daniel C. Ziff, coordinator of the PTSD Clinical Team at the VA Pittsburgh Healthcare System. "Admitting they have a problem is seen as a weakness. But the opposite is true -- admitting you have a problem takes tremendous courage."
In the first analysis of its kind, Rand researchers estimated PTSD and depression among returning service members will cost the nation as much as $6.2 billion in the two years following deployment -- an amount that includes direct medical care and costs for lost productivity and suicide.
"There is a major health crisis facing those men and women who have served our nation in Iraq and Afghanistan," Terri Tanielian, the project's co-leader and a RAND researcher, said upon release of the study.
"Unless they receive appropriate and effective care for these mental health conditions, there will be long-term consequences for them and for the nation."
In honor of Veterans Day, the Post-Gazette begins a four-part series today on the invisible wounds warriors bring home from combat.
Michael A. Fuoco: firstname.lastname@example.org or 412-263-1968.