Question: So, how does a soldier who would like to try these integrative therapies to help minimize their discomfort and anguish without overtly asking and risking being stigmatized, go about receiving them?
Dr. Ritchie: Good question. To be honest, it’s highly variable as to what their access is to those treatments. At a place like the NICoE (National Intrepid Center of Excellence) in Bethesda at the new Walter Reed Military Medical Center, there is a very intense program that includes art therapy, acupuncture, and virtual reality exposure therapy. There are also other facilities, such as one in San Diego, but if a service member doesn’t have access to these facilities it might be difficult to get this kind of treatment.
Question: How does the Veterans Health Administration deal with this?
Dr. Ritchie: I need to separate what I have just been talking about, which is to deal with the military health care system, from the VA. There is a lot of confusion over this. They are not the same health care system; they’re very different. When someone is on active duty, by and large they will be seen in the military health care system. If someone is a veteran, they may or may not be able to be seen in the VA depending on their priority level, their income, whether they had a disability, whether they had a service-related condition, et cetera.
The larger question is, how does the VA deal with PTSD? Well, I think the VA does a really good job providing evidence-based therapies, and in other cases, it’s quite overwhelmed by the number of veterans coming to it for treatment. It’s hard, because many people will say that the VA is 141 different hospitals, and it has centers and clinics, so it’s highly variable.
Question: So, if I am a service member seeking treatment without stigma, would I go to a community-based clinician?
Dr. Ritchie: The military actually has been quite active in trying to provide confidential treatment. Military OneSource has a website and phone number to call to refer troops to resources. Although a military member can go on his or her own to a community doctor for treatment, they’re not really supposed to, although certainly people do it.
On every base, there are chaplains and a mental health clinic, and there are other programs such as resiliency training, like the Comprehensive Soldier Fitness Program, and other programs that try to provide treatment while minimizing stigma, and to reach out to the service member who might not be willing to reach out to the military. So, the military is trying, but it’s not easy. It’s not as simple as hiring 20 more psychologists, because a lot of people are worried about their career and so won’t come into a clinic.
I didn’t talk about this before, but the army also uses therapy dogs, or animal-assisted therapy, because a lot of times the soldier won’t come talk to you as a shrink, but they will come talk to you about their dog. So, there are a lot of bridges that can be made.
Question: Well, then is there really a stigma? Or if it’s there, is it really as impactful as a soldier might fear?
Dr. Ritchie: I wish I could say that there is no reality behind the stigma, but there is a reality there. If someone is known to seek mental health treatment, some people will think less of them. This is true elsewhere in law enforcement and in the civilian world. So the approach taken in many cases in the military is to combine mental health with primary care, because if someone goes into the primary care clinic, that’s a lot less stigmatizing than sitting in the mental health clinic. But simply saying that stigma should end doesn’t work.
This is a downsizing military, and there is lots of talk about troop cuts, especially in the Army, so you don’t want to be the one who has something less than perfect on your record.
Question: Let’s back up to something you said before about the purpose of a soldier being to win wars. If the military is scaling back, are troops worried they won’t have that job to do any more, and maybe are wondering about their purpose, so that there is an existential component to the anguish these service members face? In other words, is the term "posttraumatic stress disorder" wholly appropriate to explain what is happening before some of these people try, and in some cases, succeed, to take their lives?