What The Wild Things Are

Understandings of Self, Awareness, and Mental Health in an Ever-Changing World

Tending to the hidden wounds of war

The wounds of war may not always be visible.

Compared with other wars in our history, the numbers of deaths so far for the Iraq and Afghanistan wars do not amount to anything close to the major conflicts in our past. The Civil War, for example, saw approximately 625,000 dead. We lost 405,399 in World War II and 58,209 in Vietnam. In comparison, there have been 4,404 reported deaths in the Iraq war and 1,135 in Afghanistan.

On the surface, it looks like the war has caused significantly less devastation to the United States. But what do these numbers truly mean? And what do we not see in these numbers? Certainly, part of the difference in numbers is related to advances in medical technology. Thanks to modern medicine, many more lives can be saved and bodies rehabilitated from what would have certainly caused death in the past.

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But these numbers also are a disguise - they don't account for the injuries that go unseen, both the physical and the psychological/emotional devastation that the veterans experience. For example, as many as 300,000, or 20 percent, of combat veterans who regularly worked away from bases have suffered at least one concussion. About half of them get better within hours, days, or months but tens of thousands of others have longer-term problems that may not surface for weeks or months after their return and are often debilitating enough to hobble lives and livelihoods. In truth, we know little about what happens to a brain as the result of a powerful bomb blast; these are the first wars in which soldiers protected by strong armor and rapid medical care routinely survive explosions at close range and then return to combat. Some of these mild concussions don't even lead to a loss of consciousness or obvious signs of trauma but the negative results due to loss of brain functioning can be far-reaching.

As for the psychological damage due to combat, these injuries may not prevent veterans from walking across the street or remembering things, but may prevent them from living a happy, fulfilling life or being able to function well in relationship with others. The emotional cost of war can have as devastating consequences as the physical, and for those on repeat tours of duties the toll increases exponentially.

Yesterday, the Department of Veterans Affairs announced new rules that may be released as early as Monday that will make it substantially easier for veterans who have been found to have post-traumatic stress disorder (an illness precipitated by exposure to a traumatic event and characterized by flashbacks, emotional numbness, and hyperarousal) to receive disability benefits. In order to qualify for disability claims and treatment for their disorder, they will no longer have to document specific traumatic events, such as firefights or mortar attacks as the specific source of their disorder.

There has been some debate about these new rules, some saying that it will foster a dependency on disability for those veterans who could go back to work. Others are saying it could lead to false claims and abuse of the system. There is already a huge backlog of disability claims.  But Veterans Affairs has stated that there will still be a review to ensure that claims are filed fairly, and that more importantly the new rules will give help to more veterans who need it. "This nation has a solemn obligation to the men and women who have honorably served this country and suffer from the emotional and often devastating hidden wounds of war," the secretary of veterans affairs, Eric K. Shinseki, said in a statement to The New York Times. "This final regulation goes a long way to ensure that veterans receive the benefits and services they need."


US soldier looks through his rife scope in Afghanistan.  He may have wounds that aren't visible. (AP Photo/Kevin Frayer)

 



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Samantha Smithstein, Psy.D., is a clinical and forensic psychologist and co-founder of the Pathways Institute for Impulse Control in San Francisco.

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