Though the suicide rate now is significantly higher than it was in pervious conflicts, and the deaths from combat, lower, it is not clear that the overall
incidence of conditions we now call PTSD and major depression is actually greater. While the situation is indeed grave now, it appears to have been equally
serious, if less widely acknowledged and publicized, in earlier conflicts. It is time for thoughtful attention to contribute to improved outcomes.
The primary answers recently proposed by experts at the Department of Defense and the Institute of Medicine -- better screening for depression,
suicidality, and PTSD, better integration of clinical services, and more mental health professionals and preventive programs -- are reasonable.
Unfortunately, they are likely to make little difference in the numbers of men and women who die from suicide and are disabled by psychological distress,
and equally important, to the numbers who actually use the services offered. In fact, the focus on diagnosis and treatment may continue to alienate those
it is supposed to serve and perpetuate the problem rather than offer a viable solution.
My 15 years of experience creating programs of population-wide psychological healing in war, post-war, and post-disaster situations (in Kosovo,
Israel, Gaza, Haiti, and southern Louisiana) and seven years with the U.S. military and the VA strongly suggest to me the need for fundamental change.
Non-stigmatizing educational approaches grounded in self-care and mutual help, which are being piloted in programs in the military and the VA, including
the one we at the Center for Mind-Body Medicine, use, are more appealing to troops and their families, and more
likely to provide the relief they need, as well as the renewed sense of hope and meaning they crave. They need to be moved from the periphery of services
offered to the very center of our approach to the problems the military faces.
What follows are principles that are critical to our work with the military -- principles that, in various combinations, are beginning to shape a variety of
other programs which are significantly more appealing to and beneficial for our military and their families.
Medical providers, local communities, and the public wellness movement.
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Make psychological services universally available -- and compulsory.
"Going to the shrink" is, for most military, personally embarrassing, socially stigmatizing, and potentially lethal to career advancement. If, like basic
training, a program of self-care were required of everyone, unease at self-disclosure would become a rite of passage and stigma and career damage would
cease. Previous efforts to provide pre-deployment resiliency training, though well intentioned, have not lived up to their promise, largely because they
have not been guided by the principles below.