As Operation Enduring Freedom, the war on terror in Afghanistan, winds down and some 33,000 U.S. servicemen and servicewomen return from overseas in the next year, a plan announced by President Obama on June 22, the psychological issues that veterans face back home are likely to increase.

Some of the key psychological issues affecting the approximately two million American troops deployed to Iraq and Afghanistan since 2001 have been traumatic brain injury (TBI), depression and post-traumatic stress disorder (PTSD)—and the diagnoses often overlap. A 2008 report by the RAND Corp. think tank estimated that more than 26 percent of troops may return from the wars on terror with mental health issues.

It is reasonable to expect a continuation of these brain and mental health trends, only multiplied by the anticipated dramatic uptick in returning troops. On top of that, such issues also tend to crop up several months or even years after service members settle in, rather than directly after homecoming, as researchers learned following America's wars in the late 20th century. A false honeymoon can deceive health care workers and family into a perception that all is well among members of the military reentering society stateside.

After the withdrawal of U.S. soldiers from Vietnam in 1973 "the only thing that happened is that rates of problems went up," says George Mason University assistant professor of clinical psychology Keith Renshaw. "The longer people are back, the more people come forward as potentially struggling." A study in the April issue of the Journal of Affective Disorders showed that among service members injured in Iraq or Afghanistan, health care usage—and psychiatric problems—increased over time.

The influx of veterans from Iraq and Afghanistan into the military mental health system has yet to peak, but it is already well underway. There is some concern, however, that the health care system is unprepared to handle the care of returning troops. A 2010 report from the Institute of Medicine identified a "critical shortage of health care professionals—especially those specializing in mental health—to meet the demands of those returning from theater in Iraq and Afghanistan and their family members."

TBI is especially common: roughly 30,000 service members were diagnosed annually in 2008, 2009 and 2010, according to U.S. Department of Defense (DoD) figures. Most of those diagnoses were for concussions or other relatively mild forms of brain injury. PTSD is also worryingly prevalent—in a RAND survey, 13.8 percent of veterans and returning soldiers from Iraq and Afghanistan met the criteria for PTSD, meaning that some 275,000 U.S. service members may be affected in total.

The RAND report predicted that the mental health needs of returning Iraq and Afghanistan veterans will increase over time. "There are a lot of concerns that what we see now are underestimates, if anything," Renshaw says.

Many of the afflicted veterans will not seek help, and others will not do so for some time. "There's a lag time between when people serve and when they actually come in," says Shira Maguen, an assistant professor at the University of California, San Francisco, School of Medicine and a psychologist at the San Francisco Veterans Affairs (VA) Medical Center. "For many of those people there are a lot of barriers at this point, the biggest of which is probably stigma." Renshaw notes that some soldiers who remain active in the armed forces resist seeking help because they do not want to endanger their military careers by acknowledging psychological issues. Others seek help in civilian practice rather than in the military health system.

The DoD and the VA have taken steps to prepare for the forecast rise in PTSD cases, highlighting two approaches to treatment—cognitive processing therapy and prolonged exposure therapy—that studies have shown to be effective. And June 27 has been designated National PTSD Awareness Day. "They're rolling out a massive dissemination effort," Renshaw says. "But I don't think we're at the point that we're ready yet."

New veterans suffering from PTSD may well fare better than their predecessors who served in Vietnam, as the disorder was only recognized by the American Psychiatric Association in 1980. "I think we've learned a tremendous amount from Vietnam and from prior conflicts," Maguen says. "I think we're in a unique position now to deal with it."

Even with lessons learned from Vietnam and the Persian Gulf wars, however, veterans of Operation Enduring Freedom and Operation Iraqi Freedom present a special treatment challenge. In some ways the new crop of veterans have had similar combat experiences to Vietnam veterans. Both groups fought in wars without clearly delineated front lines, where ambush and insurgency are a constant threat. But the types of combat exposure have changed, as have the potential triggers for negative psychological reactions later in life. For instance, Renshaw says, the urban component of the wars on terror and the threat of improvised explosive devices have made driving and traffic jams problematic triggers for some veterans. "Our methodology is still evolving to catch up with the nature of these conflicts," he says. "I think this is something we're going to be working on and dealing with for a long time."

5 Comments

1. 1. notslic 08:27 PM 6/27/11

   As a draftee (most of these volunteer freshies don't even know what that is), I was, and continue to be, simply happy to have survived to come home. The military is now a jobs program. Military contracts are corporate welfare. The American political ego is responsible for the fine mess we're in. I can't understand why anyone with any intelligence believes their "patriotic" and "national interests" crap anymore.
   
   I shot people in the back and dropped men out of helicopters. Just doing my job. "I swear there ain't no heaven and I pray there ain't no hell. Can't know by livin', only my dyin' will tell." (Blood, Sweat & Tears)
   
   Vote for Ron Paul if you want no more wars for a couple years. Everyone else is a big fat liar.

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2. 2. RedRoseAndy 01:55 AM 6/28/11

   Why brain wash? The simple fact is that the ability to remove unwanted character traits, whether voluntary ones that lead to a life of crime, or due to illness such as Alzheimer's, or due to brain injury such as being wounded in wars is a good thing. Removing bad memories that lead to such things as depression, manic depression and psychopathy can also be treated in the same way.
   
   The Kadir-Buxton Method is done by making a fist of both hands, and striking both ears of the patient at exactly the same time and pressure with the soft part of the inner hand which is where the thumb joins the hand. Please see the diagram on page 1 of my website.
   
   The procedure is painless and the patient regains consciousness faster the less hard the double blow is struck. With practice, I am able to render the patients unconscious for only thirty seconds. Other individuals have faired even better.
   
   Removing unwanted character traits is the same as removing bad memories. For example, if the patient is one of the 80% of battle casualties that have brain damage, then the new character traits have to be found by interviewing family and friends. If the patient is more violent they should be asked to remember their reasons and emotions for violence as vividly as possible, and the stun technique is then used. The procedure of remembering the reasons for violence must be remembered again twice more and the stun technique used on each occasion. Once the memory is eradicated, the patient is cured of the personality change, and the other changes witnessed can be worked upon. Whilst there is not much hope of getting the patient's personality back exactly how it was it is a great improvement on doing nothing.

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3. 3. Diesel67 06:04 PM 6/28/11

   Red Rose - What is that website? Is anything about your technique published in peer-reviewed journals?

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4. 4. KIMWEST 08:14 AM 6/29/11

   As a health care provider, I've had the honor to work with individuals that served in hostile lands. Unfortunately, my consumers were drafted and served in Vietnam but did not step forward to seek treatment for their metal health problems. As a result these individuals spent 20-25 years struggling on their own and often self medicating to numb the effects of the war they carried home. It horrified me to witness this loss of their youths and struggles they faced on their own. I am hoping for individuals serving today in Iraq or Afghanistan that will take advantage of resources and treatment options available today. If the VA cannot meet your needs, please turn to community resources and available mental health services (often free or reduced) because it is not a journey you need to take on your own. This too is a battle and you should not expect that on your own it has to be handled solo.
   
   Please know I am forever humbled by your sacrifices and service and do all I can to honor and thank you for same. America is fortunate to have such incredible individuals willing to step up and serve in a most difficult situations. It does not mean that if when returning home that war you left behind now followed you to US soil that it is one to be fought on your own. Rather, allow others to guide and help you at this time.
   
   With upmost appreciation and respect,
   
   Kim (Nurse)
   
   

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5. 5. Raghuvanshi1 10:55 PM 6/29/11

   This is misadventure of Bush and his errand boy Tony Blair American solders suffered.You are not went there for humanitarian purpose.You removed white man burden from your head long long ago .Your attacked only selfish purpose.Real wonder American people never learned any lesson from Vietnam war.If there is not oil and precious minerals you did not attacked on both counties.I think warmonger tendency is wholeheartedly fix up in your psyche so you do again and again misadventure.Now you are attacking Libya.what purpose?. Can anybody give honest answer?

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