Military aims to remove stigma from seeking therapy for post-combat stress
By NANCY MONTGOMERY | STARS AND STRIPES Published: August 4, 2005
When Capt. John Trylch of the 1st Squadron, 4th U.S. Cavalry Regiment made it safely back from Iraq, he expected things would be different, that he would be different.
“I kept waiting — where’s the change? Where’s the change?” he said. “But you find yourself falling into the same routines. I was surprised by that.”
Trylch is among the more than 80 percent of U.S. soldiers who, new studies are finding, served in battle in Iraq and came back home apparently unchanged, without a psychological problem, despite the stress and tragedy of war.
But he’s well aware of the other 15 percent to 20 percent whose combat duty leaves them with psychological wounds — depression, anxiety, post-traumatic stress disorder among them — that the military is showing interest in trying to treat. Two of Trylch’s soldiers had to be evacuated out of Iraq because of mental-health problems, he said, and more returned from battle with symptoms of depression or anxiety that they hadn’t had before.
He said he wanted to make sure they knew seeking help was the way to go.
A landmark 2004 study by researchers from the Walter Reed Army Institute of Research — thought to be one of the first to examine battle-related psychological problems of active-duty soldiers — found that there was a significant barrier to troops seeking mental-health care.
The barrier, according to the study of more than 6,100 soldiers and Marines who’d deployed to Iraq and Afghanistan, was the belief that seeking counseling would harm military careers and stigmatize armed forces members as weak. Fifty percent of troops in that study showing symptoms of mental-health problems said it would be bad for their career to see a counselor; 65 percent said they’d be perceived as weak; and 63 percent said commanders would treat them differently.
“We all read the study,” said Lt. Col. Christopher Kolenda, 1-4 Cav commander. “We said, ‘We’ve got to do better.’”
The 1-4 Cav, then under the command of Lt. Col. Jim Chevallier and deployed near Samarra, Iraq, joined with chaplains and military psychologists to try to remove the stigma of seeking mental-health care and to bring greater attention to the issue.
They invited the U.S. Army Medical Research Unit Europe, based in Heidelberg, to do pre-deployment and post-deployment mental-health screenings to aid in further research into the types of emotional changes soldiers undergo in combat and how to deal with them.
Additionally, services and information for family members in Germany were stepped up.
“If we got the families comfortable with the process, the more likely it was that they would encourage their soldier to get the help they needed,” Kolenda said. “It doesn’t mean you’re weak. It doesn’t mean you’re going to be treated differently. It’s all about assistance to overcome these wounds.”
After the 1-4 Cav and Brigade Reconnaissance Team returned to Schweinfurt, Germany, 732 of them filled out the mental-health screening forms. Of those, 135, or 18.4 percent, were referred for follow-up psychological care.
But those soldiers also reported a much greater acceptance of mental-health care. Just 9 percent of 1-4 Cav soldiers viewed counseling as detrimental to their careers, 14 percent said they’d be perceived as weak and 17 percent said they thought their command would treat them differently.
“We worked really hard to break down these barriers,” Kolenda said.
But some portion of the barrier remains.
No 1-4 Cav soldiers undergoing counseling for post-combat psychological issues were willing to be interviewed about it, Trylch said.
The Heidelberg research unit still is working on its findings from the 1-4 Cav. One of the more intriguing questions being raised is whether it can be determined which of the many terrible things combat soldiers experience are most linked with post-traumatic stress syndrome — “certain exposures that are so intense that they are hard-wired, almost, to produce post-traumatic stress” — as Lt. Col. Paul Bliese, research unit commander, puts it.
According to Trylch and two soldiers under his command, all who saw difficult duty, the absolute worst experience is easy to identify and very hard to forget: the deaths of three soldiers in their unit killed in action — among 10 soldiers and one civilian the squadron lost in its year in Iraq.
Trylch credits his equanimity to the support of family and friends, and time spent thinking.
“Introspection — who I am and what I’ve seen and how I want to deal with that,” Trylch said. “I’ve tried to reconcile them the best that I can so that I can live with it.
“But do I look at the world through a little different set of eyes? Yeah, I do.”