Join Mark and Charles on a journey through time as they trace the roots of military medicine back to Roman legions, navigating the delicate balance between maintaining an effective fighting force and providing essential mental health support. They trace the silhouette of war’s psychological toll that unravels the changing perceptions and legal battles that have shaped how we view and treat our warriors' invisible wounds.
Table of Contents for Discussion
Have questions, thoughts or suggestions on topics? Email Mark at mrussellphd@gmail.com
Tune into our CHW Streaming Radio and the full lineup at cominghomewell.com
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Join Mark and Charles on a journey through time as they trace the roots of military medicine back to Roman legions, navigating the delicate balance between maintaining an effective fighting force and providing essential mental health support. They trace the silhouette of war’s psychological toll that unravels the changing perceptions and legal battles that have shaped how we view and treat our warriors' invisible wounds.
Table of Contents for Discussion
Have questions, thoughts or suggestions on topics? Email Mark at mrussellphd@gmail.com
Tune into our CHW Streaming Radio and the full lineup at cominghomewell.com
Download on Apple Play and Google Play
Online-Therapy.com ~ Life Changing Therapy Click here for a 20% discount on your first month.
Thank you for listening! Be sure to SHARE, LIKE and leave us a REVIEW!
What we got here is failure to communicate, a chronic neglect of military mental health care. This is Psychiatric Casualties, how and why the military ignores the full cost of war.
Speaker 3:Welcome to episode three and welcome again Charles.
Speaker 2:Welcome to you, mark. This is Mark Russell, who just introduced himself. I'm Charles Figley, and we're here with this new show that we think you're going to like.
Speaker 3:So the first two episodes we talked about just kind of an introduction to military mental health care and what are some of the issues that we wrote about and that we wanted to talk about in this podcast, and so it leads us up to the kind of the 1st chapter of a book of Psychiatric Casualties, which is really kind of laying the historical foundations for understanding where we're at today as far as mental health In general, but also specifically in the military, and we provide a kind of a chronological history of Issues around traumatic stress and trauma and pensions and all the debates and controversies around that, from the time those began All the way up until modern times. So that those are kind of the things that we'll be talking about in this episode and the next episode.
Speaker 2:Yeah, we weren't exactly sure how to break things up, because you know, this is a real problem and we have been at this for a long time together and certainly separately. We have been at this for a long time. I'm dating mine as 50 years because I got out of the Marine Corps 1963. No wait, I went in in 1968. 67. And you know, the rest is history from my perspective. But there's a lot, of, a lot of information that we have gathered and we published about.
Speaker 2:We want to give it away, but we can't, really, we don't feel as motivated unless you guys respond and our understanding is you may not even have our email address yet, you may not even seen this, and because we're recording this one on the 7th of what, march, so but anyway, we yeah market.
Speaker 2:I see Mark as the leader, not just as the first author of most of our publications, if not all of them, and he's the one who has been in the grass, in the dirt, in the details of mental health within the military, and you already heard in the last couple of sessions the work they did and he will. My hope is he will go ahead and let you know again if not, but it's challenging to be able to break this up and to be able to, you know, do justice to the knowledge that we've gathered, as well as how we have been blessed by the knowledge, although I wouldn't say blessed by all of the knowledge. I don't know about you, mark. Mark is now doing on a regular basis, reviewing military records, especially medical records, to determine if the person deserves enough. Am I allowed to talk about this? I yeah, sure, okay, yeah, whoo, that's good, stumbled into a major area. But yeah, mark is helping the Navy and the.
Speaker 2:VA to determine who should get PTSD or not, though the people that are attempting believe they have it and they need, you know, compensation for that, which they deserve. So both of us have been working in this area and want you to really enjoy and appreciate what we have learned and, as Mark says, we've selected.
Speaker 2:Well, five for this hour and the next hour to talk about, but my guess is that once we start getting letters that may pull us away from some of this material. So, Mark, do you want me to start? You want to start?
Speaker 3:Let me just start on something, and that is that I wanted to go back to maybe what we I should have mentioned in our last episode, and which is they come to overall purpose. Both you know our work together and and researching and trying to publish and, and through documentary films, the issues about military mental health care specifically, but about mental health care at large, and that is there are three real purposes to our work, and that includes what this podcast is about. And if I, if I can, I'll just go ahead and list those. Read those off, all right.
Speaker 3:The first, the first purpose, is to generate public awareness about the nature and causes of preventable wartime crises in the military's attempts to resolve its mental health dilemma. We'll talk more about that dilemma In just a few minutes. The second goal or purpose is to identify constructive solutions to improve the quality of mental health care both inside and outside of the military. And then, lastly, our third goal is to end the generational cycle of neglect and self-incorrected, self inflicted harm that is caused by, specifically, the military's willful negligence in remembering and trying to learn from their lessons, to learn through the Chronicles of War and what's been documented about.
Speaker 2:It's really remarkable, mark, as I look to prepare for today and the two coming podcasts, the bumbling, repeated stupidity and error and just avoiding the obvious and trying to hide even though it's right in front of us, all of us. It's really remarkable and you know, I'm sure that the military has some degree of defensiveness, but it's not like they themselves any one person has done this. With regard to ignoring mental health or essentially using it as a way of beating someone over the head, it's probably very, very frustrating, for I have a good friend and colleague who cut out the military, just retired a couple years ago, but he's very proud of his service. He was in Iraq and he had the full tour of the whole retired, as it has a colonel. And Jeff talks glowingly about what our thesis is, what you just said, these three ill issues in particular and wrote a glowing comment he said.
Speaker 2:Jeffrey Jarvis wrote Russell and Figley provide a bloodstirring and much needed examination of the many reasons that behavioral health concerns continue to affect the ranks of the military. This book should be a mandatory reading for everyone concerned with the care and well-being of America's forces, from indoctrination to discharge and beyond. I mean it seems like that's as good a review, as you would want, and I'm not saying to vote our book necessarily, but I am, though, promoting what we are studying and what we are learning and what we wanna share with all of our fellow veterans or anyone else who's interested.
Speaker 2:And let me just say, with regard to these three issues, they're very very important and we are gonna cover them a little bit later If I have a role in this hour-long session on this week, thank you.
Speaker 2:I'm going to be talking about military families and children, but also the wives and husbands of those who are in the military or have been in the military, and particularly after they came home, and how best to handle their issues and challenges. I want to start a dialogue with that and hoping that eventually wives and children will send us notes or emails or call in. We haven't set that up yet, but they're the ones who are the legacy of the errors that the military has made with regard to mental health. They're the ones that have to pay the price for the absence of this veterans mind. In effect, they're not all there frequently from time to time and certainly it was the case for my father from time to time. I can talk about that sometime along the way. But yeah, I'm looking forward to hearing from everybody and learning what you all are interested in, mark.
Speaker 3:Yeah, so at the end of the show and at the end of every show I'll provide the listeners my email address so that we can start to get some of that feedback from people, either their own lived experiences or questions or things they want us to talk about, things that they might not agree with, you know. So we'll hopefully start to get some feedback from people. Until that time we're kind of speaking and hopefully we have people listening, and then we'll again try to reach out and have a little more dialogue.
Speaker 2:Well, let me just jump in, mark, if you don't mind, and just so. The first thing we really want to talk about is the military and medical dilemmas that were discussed in chapter one. We certainly talk about it more throughout than the book, yeah, but that in particular is what we're focusing on here, but it's page 2324 in particular focus on it. But it's really the marriage as we have talked about. Let me just a little bit larger here. Yeah, it's the marriage between medicine and the military.
Speaker 2:And that's no easy thing, and we talk about what it has been like throughout the ages with regard to needing to link those to the military, apparently, as always had some form of medical assistance, et cetera.
Speaker 2:But we hope to discuss, and we hope to discuss with you someday we can discuss the challenges and suspicion of the military, medical and it's essentially the uncomfortable working together, those that are focused on an objective and all the things that are involved in that, and then those that are responsible for taking care of hatching up our own people. There is in this underlying military morale issue, and when military and healers are combined, it's a challenge because one may be operating in a very different space. It certainly does more than now and may not be able to do that I wanna talk about table one, but, mark, do you wanna talk more about that?
Speaker 3:Well, yeah, just a couple of thoughts, and this is the idea of the mental health dilemma that the military faces in such as the military, our government, as well as just society chases.
Speaker 3:And that you can trace back since the Roman legions, that they had medicine healers brought with their legionnaires, and the reason of that is to heal and bind the wounds so that people can go back to fight, and that was the idea, is the first mission of the military, of course is to fight and win wars. That's the whole purpose of the military, that's in their mission statement, right. That's why militaries have existed since human beings started to organize into societies, and so military medicines emergence into that difficult relationship you talked about had to do with preserving the force to fight, and so you have the primary mission, the militaries, to fight and win wars. And the primary mission of military medicine is to preserve the fighting force so they can fight and win those wars. The second mission that has evolved with military medicine and the military at large is one of force protection, and that is preventing illness, restoring people to fitness for duty and basically protecting people's health as a means to support the war fighting mission. So those are two distinct but overlapping missions that create the dilemma, and what military medicine faced was the people in the fighting.
Speaker 3:Military would sometimes look at medicine as skeptically as giving people a way out of combat by sending them to the back lines to recover or to allow them to get out of the army altogether. And so there's always been this skepticism about medicine. But that has magnified a thousandfold when it comes to mental health in the military, and that mental health didn't really have a footing until the first world war. And bringing in the military mental health and we'll talk more about this later was to preserve the fighting force, and but the skepticism ran rampant and the distrust about mental health professionals in the military has never wavered. To be quite honest, in my years as a military psychologist, it was routine. We were valued as a force multiplier, but if we started to diagnose or to remove people from the front lines, we would be viewed as literally the enemy or being conspiratory towards the enemy.
Speaker 2:Mark, tell our friends listening your experience with training and the use of clowns, maybe, and the use of people. And yeah, you know what I'm talking about. You know what I'm talking about.
Speaker 3:Well, okay, so I don't know if I shared this in the first few episodes, but we're training to ramp up for a field hospital that was gonna deploy in support of the Iraq invasion in 2003. And we went to Camp Pendleton and had a kind of a field hospital set up and they had all the mock Hollywood scenes of casualties being a helicoptered in or transported in and all the battle, sounds and sights, explosions, et cetera, and very realistic battlefield injuries, right. And so I'm in this exercise and I'm the head of Neural Psychiatry for our field hospital and I'm sitting there with my team and we're about two or three hours into the exercise and all the medical casualties and people were busy triaging and people busy working and trying to simulate healing those folks. We never got anything and I asked about what about mental health? What about behavioral health? And I said, oh Russell, sit tight, they're coming.
Speaker 3:And so we did get. About an hour later we did get our first psychiatric casualty in order to prepare for this invasion in Iraq and it was a young Marine lands corporal, female, who was dressed in a cape, a black cape and a hood and had a Batgirl kind of taped to her utilities. So we're our first realistic scenario of treating the war stress injuries was Batgirl, and that was just the very beginning of a whole series of events that basically led to my becoming a military whistleblower and trying to get the country to focus on seriously about the issues of mental health and the epidemic that we were seeing.
Speaker 2:The rest is history for sure. Yeah, yeah, it's shocking and amazing. We had, when I was in the record in Vietnam we had a number I can't recall how many, but at least four or five simulations in which we were expected to do what we're supposed to do and no one really took it. Well, some of the officers took it seriously, but none of us did really, and it seemed like it showed.
Speaker 2:With regard to the non-commissioned officers, definitely they weren't in it that much but it's interesting though that right up into when you were preparing for war, that this kind of lack of seriousness still wasn't there, when all of them were so many people died. I'm following when the in the actual war. Yeah, pretty heavy, but you know, I wanted to Also move on and talk about table 1.1. Oh, yeah 1.1.
Speaker 2:Suggest the price of war and the absolute necessity of military health and mental health, absolutely without a doubt, the range of mortality rates, if you look at the, the grand scheme of things, the scale of things, right, were associated with a particular wars. And Let me just mention here it is the battle, mortality from antiquity to the 21st century, yep, and they first talked about the particular era than the war, the medic, total, medically wounded and then mortality. And, and it's when you look at this table that starts with 1194 to 1184 BCE, the Trojan War, and then, following the Punic war, the mortality and the Trojan War was 90%.
Speaker 3:If you were wounded, essentially you would die. Yeah, and this is before antibiotics, before anything about sanitary, you know, hospitalized treatment, medical treatment.
Speaker 2:So yeah, you were there's not much they could do it was baked in by that time. Yeah, but you know it's interesting that the American Revolution 1777, 1775 and gone, had 42% mortality, which is very, very hot. Yeah it went down subsequently over the years, but um War two had 30%, yeah, but interestingly. World War one had 21%.
Speaker 3:Yeah, it's kind of hard to wrap around how that, why that wouldn't be reversed in some way.
Speaker 2:And yeah, you'd think would you? Yeah, but it's interesting, could you talk a little bit mark about the later years, the 2001 to 2012? Because that mortality rate is 10%.
Speaker 3:Yeah, you look at the, you know from the Vietnam, korean War and the first go, for it's basically about 24, 25% mortality rate, meaning that if you got serious, you know wounded, physically wounded, that you would have that's the percent that would die from their wounds, often due to infections or disease and things of that sort.
Speaker 3:And but then you get into the 21st century wars in Afghanistan and Iraq, the, and you're you're looking at a 10% mortality rate, meaning that you have a 90% survivability, which is completely, you know, 180 degrees from the Trojan floor that you said you, we used to die, 90% of us would die from a wound in antiquity, but now Only 10% of us would die from those same wounds.
Speaker 3:Because and I think this is the lesson that is trying to draw on here is that it's because we learn our medical lessons of war. We've applied combat medicine not just in the military but outside the military, and learning the lessons of the hard fought lessons is the crucial Anecdote to what's you know. It tells us today as far as mental health care, and that we, you know we have a repeated failure to learn Psychiatric lessons, but on the medical lesson front, we're doing Military medicine leads the way out Then, and is often cutting edge in terms of new medical technology and life-saving tactics and prevention of disease and illness, etc. Yeah, and going on to the next one, do you want to say any more about I don't?
Speaker 2:yeah as far as lessons learned, we're going to talk.
Speaker 3:More about that later on in other episodes. But I just want to kind of if I can, just provide a brief overview about, you know, the first ask, part of understanding when are we at with Traumatic stress injuries or PTSD? You know, that is understand that there's been an ongoing Debate around trauma and pensions for trauma and then as well as PTSD. So these are referred to as trauma pension wars by a lot of authors and we're going to talk about that later on. So if you go back into what we talked last week about, nostalgia, which is the first War stress syndrome that was identified in Europe, and and kind of looking forward from that, there's been a lot of stress in the past and I think that's the first one that we've seen in the past, and I think that's the first one that we've seen in the past and and kind of looking forward from that, uh, there were other wars where people were starting to develop these unexplained physical health symptoms and psychiatric symptoms combined. That would be depression, anxiety or some type of conversion reactions. Uh, you know pts, all these things rolled up. All these symptoms were available in records from you know, the 17th century and earlier in some cases. But it really hit the head in the industrial age, in the industrial age in europe, in north america. Uh, you know, you had the advent of machines, you had the advent of locomotives and and other forms of motorized transportation and as well as more mechanized industrial basis for warfare. So you had the advent of machine guns and high blast artillery, repeating small arms fires and grenades and mines and all these other Technologies that grew out of the industrial age.
Speaker 3:But the first part of trauma pension Controversy really has to do with industrial accidents or transportation accidents, railroad accidents, and in 1864 a british physician named john erickson Uh, coined the term of these kind of post traumatic accidents from railroads. He called it railway spine, it was called railway brain in in the united states and basically these would be people who were involved in train accidents and, uh, we're jostled around very violently and it then had these lingering symptoms that today would be a mix of tbi, you know, traumatic brain injury, and PTSD, and you know a range of other psychiatric symptoms or diagnosis. So in 1864, after this railway spine and railway brain became part of the medical legal vernacular, in 1864 the british legislation adopted a tort act that allowed individuals to sue the industrial base, including railway companies, but also in factories, to sue for these traumatic stress injuries. And in Germany they the term they used was traumatic neurosis, which is a direct precursor to what we call PTSD today. And in Germany, in 18, I think, 80 something, they had uh german revised their legislation uh toward acts and so that you could sue in germany uh, the same people that you could sue now in uh british and in north america. And what this set up was a real debate about one. Should trauma? Is trauma a legitimate injury, is a legitimate form of suffering, and is it Compensable? Then? Are you allowed to get some type of uh compensation for that injury? And is it the same as if you were to crack your skull or lose an arm in those accidents? Uh, would it? Should it be regarded in the same breath? And so, uh, back in 1864, in the early on the later 1800s, the law of the land in europe and north america was that traumatic neuroses, or what later be called accident neuroses, were compensable, that they were legitimate types of suffering, no different than any physical injury, and that became the medical legal paradigm about traumatic stress. And, um, that leads up to the first world war. And, uh, you know, first world war started 1914, ran through 1918 and there you had unprecedented numbers of psychiatric casualties. That hadn't you'd seen some aspects of that in earlier wars because of the industrialization of warfare, but never to the levels we saw in the first world war. And this is you know.
Speaker 3:People refer to shell shock and as kind of one of the first examples of PTSD precursor and that's not true. There were a lot of other examples of conditions before shell shock, but shell shock itself was viewed as changes in the brain that happened as a result of trauma. So basically it took traumatic neurosis, which also talked about functional changes to the brain, to expose to trauma and it and it made it militarized and referred to as shell shock instead. And a lot of people were being sent from the back lines of shell shock, leaving the front lines and the fighting force was being a treat it with being reduced and and we're talking 10s of thousands, hundreds of thousands of people being evacuated for shell shock. That initially was treated like as legitimate physical wound or war, and people in the British army were actually given the red stripe with foreshadow shock, which is the equivalent of a purple heart in the American military. And then it reached a crisis in 1916.
Speaker 3:And the German, in every armed force, was dealing with these epidemics of psychiatric casualties and not understanding why they're existing and what we can do to remove this threat is the.
Speaker 3:It was a threat for them to prosecute the war and what we can do that.
Speaker 3:It was that level of attrition.
Speaker 3:And and I in September of 1916, it's another day of infamy that again, almost no one would be aware of, and this year a nerdy historian like myself and it was a Congress in Munich, germany, and this is again during the war, where they brought together all the all the experts in trauma at that time psychological trauma and medicine and they voted to basically uproot the accepted paradigm, paradigm which was that traumatic stress injuries are real, they were genuine and deserve to be compensated for.
Speaker 3:And they up, they upended that and said that they outlawed the use of traumatic neurosis and shell shock In some cases, like in the German armies. It was for the threat of death for any physician who would diagnose anybody with a traumatic neurosis or shell shock injury, and instead adopted the new paradigm which exists primarily today, and that is of traumatic hysteria, which is this notion that Sigmund Freud and Jean Charcot and others had promulgated, which is that people who develop traumatic stress injuries were really predispose, and they did do some weakness in their moral character, to personality defects, to greed, because they wanted a pension or disability. We're trying to gain compensation for it. So that became the new paradigm halfway through the First World War and that became the American military's policy, to basically saying we're not going to diagnose traumatic neurosis or shell shock or give any legitimacy to psychiatric conditions because of the fear of those evacuation syndromes or the attrition, mass attrition, of psychiatric casualties.
Speaker 2:And that's what we're going to say some, but it seems like also they saved a lot of money.
Speaker 3:Yeah, I let that part out, so thank you. So I have to go back to that 1864, when Europe and the North America changed their medical legal paradigm to accept traumatic stress injury as a legitimate form of suffering. The industrial base fought back and business owners fought back, and he hired a whole slew of neural neurological visit. You know, medical experts to argue the opposite, that these traumatic neuroses were not real and genuine and they were all the more of a hysterical variety and that the traumatic neurosis had won the day. There was more evidence and there was more. The legal system thought that was a more appropriate conclusion.
Speaker 3:Up until September 1916, as I said, when the World War really kind of brought home the whole idea that we have to do something about the epidemic of psychiatric casualties.
Speaker 3:That were being sent back home to France, to Britain, to Germany, etc. And they were getting compensation, they were getting pensions and the military was afraid at the same time they're not going to be able to fight this warning longer due to the rate of evacuation Of these individuals and that it would bankrupt society. By giving all these people a pension on top of it, not only are you going to erode the wheel to fight, but you're reinforcing it and what they call pension neurosis, which is you're feeding this frenzy of people seeking pensions and escape from combat by accepting this paradigm. So that's why they opted to change the paradigm in a military conference. That said, now it's all viewed as hysteria, as a pseudo illness, and it's not compensable and it's not to be rewarded. In fact, treatment is very harsh and people who feigned supposedly psychiatric illness and that became the medical legal paradigm was changed in society to what the military had adopted in order to fight its war.
Speaker 2:Well, let me go back, Mark, you don't mind to. You talked about a phenomenon that very few people have referenced, at least, but it definitely existed and was a justification for the military developing, and I think that's a great. Well, let me just tell you evacuation syndrome, what that means.
Speaker 3:Yeah, so the evacuation syndrome, and this is what they saw.
Speaker 3:It was only the 1st World War.
Speaker 3:They saw some concerned about that in earlier wars as well the mass attrition of frontline armed forces that had developed psychiatric symptoms that were being diagnosed as, again, shell shock or traumatic neurosis at the time, and and it led to the fear it wasn't actually a real list of fear, but it was a fear of the military that this could expand to a mass hysteria, a mass evacuation where everybody dropped their weapons and would go run to the back lines and that the war would be over, that the allies are, in the case of the access powers, would lose the war.
Speaker 3:So that fear of the leadership and was a fear of the government of having to pay all these people pensions, and so that's a big line to what they've referred to as evacuation syndromes, which is that once you open the back door, a floodgate will prevail and then the military will lose its capacity to To achieve its primary mission and so you have recall any particular examples or instances of evacuation syndrome, because we're going into the back was is there an event in which a plane landed and they loaded up all the patients, and what sort of?
Speaker 2:what was the example? I know what you're talking about in this. It's a fear of those that are planning the wars and executing an, afraid of that. I'm not sure how I feel about that, but just the general examples of when this would happen.
Speaker 3:Well, I think again, you can trace it to 1916. Before they changed the medical legal paradigm and adopted traumatic hysteria as the primary basis for psychiatric casualties. The Battle of Somme was raging in Europe and that battle was one of the most intense ever fought and again high industrialized warfare at its absolute worst. And I think in the first minute I'm sorry, the first hour the British Army suffered something like 62,000 casualties just in the opening salvos of the Battle of Somme and overall I think the British Army had 500,000 casualties in that one battle. And that doesn't speak to the French and to the British. This is before the Americans entered in 1918.
Speaker 3:And at the time that they were having that many casualties.
Speaker 3:You had a huge amount and it's never there's not a firm number on it, but it's tens of thousands of enlisted in officers from all different armed forces were being diagnosed with shell shot or traumatic neurosis and sent off the front lines to hospitals.
Speaker 3:And so that combination of the psychiatric casualties on top of the physical casualties, that kind of fed into this hysteria of the military's leadership that psychiatric casualties are going to be that mass evacuation that will end the war for us, our ability to execute the war, and they did everything in their power to stop that out and that led to that conference in Germany in September of 1916. But then all the, all the allied and the Axis powers all agreed to it. That was one thing they agreed while they were fighting this war is they're going to prevent psychiatric casualties by outlawing the use of those diagnosis and and doing battlefield executions for cowardice and incarcerating people and making examples of people really weaponizing stigma to a whole degree and bringing in psychiatrists for the first time in the military in order to stem the tide of these epidemics of evacuations coming up for psychiatric casualties?
Speaker 2:Mark, have you talked to psychiatrists about this?
Speaker 3:Oh sure, what did they say? Well, some of them not agrees that. That's my understanding, it's my experience and what I've lived. And others would say they totally disagree. They believe that this whole problem of PTSD, for example, is manufactured and it's a societal issue of society's weakness. And psychiatry has played a role in corroding that toughness in in men to be able to withstand the stresses of war. And these are even psychiatrists that are openly hostile towards the construct of PTSD and labeling people with PTSD or PTSD in the military so that they would be removed from the front lines.
Speaker 2:And that's still happening today.
Speaker 3:Oh, absolutely yeah.
Speaker 3:You know, the whole advent of what we call frontline or forward psychiatry, where you bring mental health professionals to the military and at the frontline, grew out of that World War I experience, in fear of evacuation symptoms, and they basically weaponized psychiatry to say we're going to have you help people who are having some type of nervous breakdown on the front lines.
Speaker 3:They're going to withdraw them from the brief respites of three days of meals, three days of sleep and then with the expectation that they are absolutely going back to those front lines and there is no escape for them and that frontline policy exists today. It's been a hundred years since that has been enacted and nowadays in the American policy for frontline psychiatry it's explicit. It says that they expect that 90 percent I think 90 or 95 percent will be returned to duty. And the only way that people will be evacuated from the front lines is if they are grossly impaired, meaning that they have some psychotic break, and or that they are clear danger to themselves, meaning that they've actually attempted suicide. Just thinking of it would often not be enough to warrant a evacuation from the front lines, but you'd have to actually have made attempts to kill yourself or kill your fellow soldiers, Marines, whatnot.
Speaker 2:So it's not that you were diagnosed with PTSD. That wouldn't do it.
Speaker 3:with regard to sending people with the RTDs, Well, there's a real robust effort in today's military and this has started in the First World War again to avoid labeling people with a diagnosis, especially like PTSD. They might be given a diagnosis like an adjustment reaction or usually it's going to be an acute stress reaction or something like that that would be considered to be non pathological and wouldn't affect their fitness for duty. So all efforts are made to avoid things like PTSD, especially anything near the front lines, and that's today's doctrine for combat operational stress, as they call it now.
Speaker 2:Even though it happens all the time. I mean those women who are suffering from PTSD, irrespective of those elements that stand out and definitely qualify them.
Speaker 3:But you know, Charlie, important point to highlight is that that that policy that was adopted in the First World War is that essentially boils down to this that you are not to leave the front lines If you're experiencing a nervous breakdown or psychiatric break, unless you are so impaired that you're psychotic or that you actually have tried to kill yourself or kill a fellow soldier or something.
Speaker 3:So, and the idea is that you will go back to the front lines every time you need a respite, you come and get a three day respite or a short respite, but your expectation is again 90, 95% are going to go back to the front lines and keep going back to the front lines. So they keep getting more doses of combat stress or stress. They still have developing more and more symptoms and they keep going back to these respite centers and then back to the front lines until the point you break. And when you fully break, then you know the idea of restoration it becomes much more difficult and it becomes more permanent. Yeah, Amazing. Yeah, we're going to talk a lot more about that whole policy, more in the weeds of that, but you know again, that's just a short kind of trying to provide a brief overview of it.
Speaker 2:But it, just as you say, it's a constant challenge. It's in the mix all the time. Yeah, the combat experiences, the combat stressors, whether it's diagnosis or not. Men are very good at hiding their symptoms, and that is just encouraging them to do that.
Speaker 3:Well, it is.
Speaker 2:The beginning takes care of it.
Speaker 3:Yeah, and again you can see again, for the primary mission of the military is to fight and win wars. And so you know, soldiers from, you know, from the very beginning of human warfare, had had fear and, you know, had anxiety and you know, had a lot of emotional issues. But the argument is that they still, they sucked it up, they had to stiff up her lip and they, you know they, they did their manly duties and fought the wars. And you need that if you're going to have a military, to have a fighting force. So that's the real dilemma is that on one hand, you need the military to fulfill its primary mission, but then you also need that force help protection too. At what point do we are looking out for the individual and their health and their family's health and and and when do our policies become harmful to that individual and their families in order for that primary mission to be? That overrides the force protection mission.
Speaker 2:Yes, families. Much of my work really has been involved with families, at least early on, and the people that suffer are those that are not ashamed of admitting that they have symptoms. They have spouses, the wives, the kids and, excuse me, the struggles that they've had. Has the military in any way realized that this policy has a negative impact on families?
Speaker 3:Absolutely not. The US military has never researched the efficacy and the potential harm or the potential benefits of their forward psychiatry, frontline psychiatry, combat operational Stress. I think there's been a couple studies done but most of it's been done by the Israeli army and our reviewing that. You know that.
Speaker 3:Israelis found from their studies of combat stress and implementing the forward psychiatry is that there's a lot more conflict at home when people get home, and that family members are suffering, suffering along with the service members, as they have been exposed to excessive amounts of combat stress so they kept being returned back to the front lines until they break, or or that you know they Are no longer able to fight, and then they go back home and then there's these problems just manifest and multiply when they get all, and their spouses and their children, all, all affected as a consequence as well.
Speaker 2:I'm wondering has there been any efforts to Serve as a listening post or some way of accessing the experiences of spouses? Is it that the those that are serving are concerned about promotion and rank etc and not want to bring any attention whatsoever, so they would discourage their spouse from speaking up?
Speaker 3:Yeah, I think there's that it was.
Speaker 3:There was a study done by the US Army a Walter Reed, Charles Hodge and his group In 2004,.
Speaker 3:Right, and this was published in New England Journal of Medicine.
Speaker 3:It was really the first real time study done about the psychiatric effects of war in the 21st century and you'll need to look at PTSD, depression and anxiety Rates that are going exponentially higher is the longer you're exposed to War, stress and when they got back.
Speaker 3:But then they looked at stigma and they looked at stigma not only from the individual warfighters perspective, which was like 70, 80%, whatever people would not disclose for fear of being perceived as weak or being a force out of the military, but they looked at family members views of mental health and I want to say it's 2004, 2006, when they did a follow on study with family. But the family members had just about the same level of fear of stigma and the effects that's going to have on their spouses Career, you know, the income for the family to the extent that they did not want their family member to go get mental health help because they're going to lose you know their job and they'll and that's going to have a real negative effect on the family. So that was a, I think, a 1st, Really good look at a real time stresses and the factors that family have to deal with to when it comes to Trying to help their loved one deal with more stress.
Speaker 2:So there's really no movement that you're aware of to Connect the family, to make sure that they're protected, to, to reduce the Rehesidence of speaking up and talking about what it what it's like being in a family with a vet active duty either way.
Speaker 3:Yeah, I'm certainly not aware of any kind of nationwide or a do d wide Program to that effect.
Speaker 3:I think no experimental studies it may be some things out there that are being done. I think a lot of it's probably done through nonprofits and Reaching out for veterans and family members of veterans. But Again, the family members is is. We both know I've always kind of had the short end of the stick when it comes to mental health care for themselves. But also, you know they're you know support programs for these spouses and children who Are supporting the war fighters. And we always give lip service to the value of military spouses and military families but we don't often, we don't typically back it up with any real resources that have been proven to be, you know, even modestly meeting the needs of military families.
Speaker 2:It seems like it will happen anytime in the near future.
Speaker 3:No well, in the same reason why the military struggles with its mental health dilemma is that the fear is that, if you treat mental health on par as physical health, psychological wounds are not any different, as far as legitimacy, than physical wounds, which was the pre 1960. 1916 medical legal doctrine and a paradigm at the time. The fear is, though, if you treat it on par with physical wounds, it's going to open the floodgates, and it will. It will cause mass attrition, those evacuation syndrome, and it will lead to bankruptcy because you're going to be paying more and more disability compensation, and there's some truth to that. These last wars, I think it was like 700, 100% increase in the disability claims for PTSD or something along those lines. It's skyrocketed.
Speaker 3:And people will point to a lot of different reasons. Again, it's because of the negative influence of psychiatry. It's due to our society being weaker. You know everything except the war itself and that technological advances, that that have helped militaries fight and win wars, has also led to more and more psychiatric casualties, far exceeding any of the physical wounds of war now, since the Second World War.
Speaker 2:Okay, we're close to the end of this hour. I want to thank everyone for listening what we're going to talk about the next time from the program. Let's see. We're going to talk about World War two and relearning the realities of modern war yeah, and that's going to be interesting. And including the in March 1943, us Army Captain Frederick Hansen utilize the quote brief period of sedation and rest, along with techniques of suggestion and ventilation. This demonstrated 30% of acute psychiatric casualties could be returned to duty. So among the things that we're going to talk about was the return to duty and the challenges that Hansen, of course, faced in terms of the study, but there's a lot of challenges there, so I'm going to talk about next time.
Speaker 2:Yes, I also talked about the Vietnam War, one that I fought in. Well, I didn't Okay, among it 8.5 million who served in Vietnam. So we'll talk about that and, mark, I'm hoping you're going to remark about no military research has been conducted that compared the outcomes of frontline psychiatry RTD, with psychiatric evacuation and treatment.
Speaker 3:Right, yeah, we could talk more about that as well.
Speaker 2:So I mean, talk about one other thing that we're going to be doing and then hope you'll talk about the sixth point. We're going to be focusing on post war mental health analysis. So the Congress mandated that the national Vietnam veterans readjustment study. So we're going to be talking about that and what are the implications of it at the time, but mostly just talking about the experiences of Vietnam combat veterans.
Speaker 3:Right, we got a lot to cover A lot to try to jam in and just going to leave my email address. If any listeners want to contact us and you'll provide us some feedback or any questions that you have that we can entertain. We would be very much appreciative of that and that email address is M. And we'll look forward to picking this up again on the next episode.
Speaker 2:Right, bye, bye Music playing.