Monday, January 7, 2008

Shrinking The News

A column by Peter Sheehy

"But my dear man, reality is only a Rorschach ink-blot, you know" -Alan Watts

A Debt That Haunts...

During his second night in Iraq in October of 2003, Sergeant Andreas Pogany witnessed an Iraqi man cut in half by a machine gun. Pogany vomited, shook for hours, and by his own confession, “couldn’t function.” Despite Pogany’s insistence that he was having panic attacks, he was denied proper therapeutic care and was eventually sent home. Before long, Pogany faced court-martial for cowardice, a charge the military had not pursued since the Vietnam war, and one that carries a maximum sentence of death.

Although the military eventually dropped the charges against Pogany, the government's neglect of combat traumas is a bad flashback to the Vietnam era. Even worse, it's a denial of the therapeutic practices that our armed forces developed during World War II. Turning its back on our soldiers' psychiatric wounds, today's military is also rejecting its own history.

Given the administration’s belief that “shock and awe” was a fitting strategy for the war, its lack of preparation for the “shell shock” and disorientation that followed is not surprising. Just eighteen months after President Bush declared "Mission Accomplished" in Iraq, The New England Journal of Medicine reported that one sixth of all U.S. veterans of the Iraq war were suffering from post-traumatic stress or depression. Even the Army’s own study found that 30% of soldiers currently serving in Iraq display symptoms of anxiety, depression, and post-traumatic stress.

The number of veterans from Iraq and Afghanistan who have struggled with post-traumatic combat stress (a modern variation of “shell shock” that is perhaps the most serious psychological wound for a soldier), will soon reach 45,000. And that number is sure to rise since repeated tours increase the chances of acute combat stress by 50%. The unfolding of the President’s surge plan is thus an appropriate time to contemplate the devastating psychological wounds of this war and adjust our policies by remembering how the “greatest generation” cared for the psychological wounds of its men in uniform.

Many of the psychological wounds from the present war are still as invisible to the public as the caskets of our dead soldiers. The Pentagon's public relations and limited “therapeutic” strategies have marginalized our veterans’ painful memories of a war we would like to forget, but continue to wage. Sadly, recent news reports show that the government and military have been stigmatizing and even punishing psychiatric casualties, undermining treatment plans with bad science, and inadequately funding therapeutic programs.

Present policies have brought us back to a pre -World War II standard of care. During that war, the Roosevelt administration provided therapeutic treatment and preventative care to more than two million soldiers. William and Karl Menninger, the main architects of wartime and post-World War II psychiatry, knew that American GIs needed more than a stiff upper lip to overcome what they called “combat exhaustion” and “war neurosis.”

World War II experts responded by demolishing the stigmas attached to mental illness and helped millions of Americans understand that fear in combat was normal and that seeking help was productive and responsible, not shameful. These actions helped modernize psychiatry by pulling it out of an era of institutionalized care, and establishing that the stress of war could break down even the most well-adjusted individuals.

The "greatest generation" had no tolerance for General Patton’s ignorant rejection of military psychiatry. When Patton slapped a “psychiatric casualty” across the face, officials forced the general to apologize and then stripped him of his command.

Unfortunately, the enlightened standard of therapeutic care established during World War II was ignored during the Vietnam war. The emotional suffering of our veterans from this war has been seared into the public consciousness by films such as The Deer Hunter and Full Metal Jacket. The government finally officially recognized post traumatic stress disorder in 1980, yet many of the commanders treating soldiers in this war do not even support the diagnosis.

Today, Americans worship the "greatest generation" of World War II soldiers. We admire their grit and determination in defeating the fascist enemy. But we forget how much they suffered along the way, and the enormous role that psychiatry played in helping them survive battle and come home with support and dignity. It's time for all of us to remember, before it's too late.

Shrinking the News is a column written by Peter Sheehy, who earned a PhD from the Department of History at the University of Virginia. His dissertation is on the cultural history of psychotherapy. Dr Sheehy teaches history at the Horace Mann School in New York City and is working on a book about the history of psychotherapy.

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