No Comment — June 17, 2007, 10:56 am

The War Inside: The Meltdown in the Military’s Mental Healthcare System

A few weeks ago, Secretary of Defense Robert Gates addressed the graduating class of Naval midshipmen at Annapolis. He offered an extraordinary message:

As officers, you will have a responsibility to communicate to those below you that the American military must be non-political and recognize the obligation we owe the Congress to be honest and true in our reporting to them. Especially when it involves admitting mistakes or problems.

The same is true with the press, in my view a critically important guarantor of our freedom. When it identifies a problem, as at Walter Reed, the response of senior leaders should be to find out if the allegations are true – as they were at Walter Reed – and if so, say so, and then act to remedy the problem. If untrue, then be able to document that fact. The press is not the enemy, and to treat it as such is self-defeating.

The journalists he was singling out for this high praise – though not by name – were Dana Priest and Anne Hull of the Washington Post, whose path-breaking series of reports on the quality of military health care, starting with an exposé of conditions at the Army’s flagship Walter Reed Hospital, brought the magnitude of the problem to the public’s attention for the first time. Priest received a 2006 Pulitzer Prize for her reporting on the CIA’s operation of “blacksite” interrogation and torture centers, among other things. As a result, she became the target of an intense campaign of vilification which was steered by the Bush Administration and entailed the mobilization of its rightwing media assets. She was also the subject of threats, intimidation and harassment by the U.S. Government which ultimately became so intense that she and her editors decided it was time for her to take a break from the national security beat. It is no mean feat for a journalist to move to an entirely different desk and, within only months, take the lead in reporting from it. But then, Dana Priest is no ordinary journalist, and neither is Anne Hull. These are among the best practitioners of their craft in the United States today.

This morning, Priest and Hull continue their work with an important exposé of the operation of the mental healthcare provided by the Army for its personnel who have suffered a battering in a long, psychologically straining occupation and war. They face an enemy which is unclear and are operating in a largely urban environment in Iraq particularly. This is a high risk environment for military operations, but it also produces extraordinary mental stress-related problems. Priest and Hull start their account with the story of Jeans Cruz, a soldier who was part of the group who captured Saddam Hussein. Like hundreds of other soldiers, Cruz developed post-traumatic stress disorder (PTSD), but when he applied to the Veterans Administration for disability, he was turned down flat.

Jeans Cruz and his contemporaries in the military were never supposed to suffer in the shadows the way veterans of the last long, controversial war did. One of the bitter legacies of Vietnam was the inadequate treatment of troops when they came back. Tens of thousands endured psychological disorders in silence, and too many ended up homeless, alcoholic, drug-addicted, imprisoned or dead before the government acknowledged their conditions and in 1980 officially recognized PTSD as a medical diagnosis.

Yet nearly three decades later, the government still has not mastered the basics: how best to detect the disorder, the most effective ways to treat it, and the fairest means of compensating young men and women who served their country and returned unable to lead normal lives. Cruz’s case illustrates these broader problems at a time when the number of suffering veterans is the largest and fastest-growing in decades, and when many of them are back at home with no monitoring or care. Between 1999 and 2004, VA disability pay for PTSD among veterans jumped 150 percent, to $4.2 billion. By this spring, the number of vets from Afghanistan and Iraq who had sought help for post-traumatic stress would fill four Army divisions, some 45,000 in all.

They occupy every rank, uniform and corner of the country. People such as Army Lt. Sylvia Blackwood, who was admitted to a locked-down psychiatric ward in Washington after trying to hide her distress for a year and a half [story, A13]; and Army Pfc. Joshua Calloway, who spent eight months at Walter Reed Army Medical Center and left barely changed from when he arrived from Iraq in handcuffs; and retired Marine Lance Cpl. Jim Roberts, who struggles to keep his sanity in suburban New York with the help of once-a-week therapy and a medicine cabinet full of prescription drugs; and the scores of Marines in California who were denied treatment for PTSD because the head psychiatrist on their base thought the diagnosis was overused. They represent the first wave in what experts say is a coming deluge.

In the last week I have spent more than a half dozen hours with senior officers in the Army’s mental healthcare area. They portray a truly horrific situation. Resources are insufficient to cope with the rising problem and conditions in hospitals are disgraceful. One described to me the case of a suicide patient who was referred from Camp Doha in Kuwait to Walter Reed to be placed under constant monitoring. Walter Reed screeners overrode the referring physician’s analysis, taking the view that the soldier was just a shirker trying to avoid military service – they put him in normal transient billeting. When he failed to appear for three sessions of outpatient counseling, a soldier dispatched to look for him found his rotting corpse dangling from a light fixture in his billet. This is but one of many such stories which are likely to be further developed in the coming weeks.

But the most striking thing that emerged from my own interviews with medical officers was the attitude of the Army Surgeon General and his senior staff. When concerns were raised, they say, the reaction from the Army’s chief medical officer was always the same and always very swift: it was immediately to retaliate against the physicians expressing concern. Fingers were pointed at Lieutenant General Kevin C. Kiley, described by one as “probably the most vindictive SOB I ever encountered.” Kiley was fired when the Walter Reed scandal first broke, but his successor was described as working to flag the problems, but lacking the resources to really address them.

With Priest’s and Hull’s firm spotlight planted on the problem, however, there will be hope for some change and for more worthy treatment of the combat veterans of the Bush Administration’s war on terror.

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