Bay Area panel on veterans’ health highlights untold stories

By Colleen Paretty
Chair, San Francisco Bay Area AHCJ chapter

A panel of experts gave a compelling presentation about one of the nation's biggest health stories – the medical, mental, and psychosocial challenges faced by returning war veterans and their families – at a May 21 meeting of AHCJ's San Francisco Bay Area chapter.

During "Hitting Home: Reporting on the Health Fallout from the Iraq War," the panelists' insights suggested several story ideas and angles health reporters everywhere can use to cover this important and difficult topic.

Moderator Laurie Udesky, a freelance health reporter whose work has been published in The Lancet and Salon.com, began by emphasizing that as the war in Iraq continues, more troops are returning home with multiple physical and psychological disabilities. "Even so," she pointed out, "not all are receiving help. A recent report by the Rand Corporation says that one in five of returning troops reports symptoms of PTSD or depression, but only half are seeking help. This raises the questions: What sort of health care is available to returning veterans? What obstacles do they face in receiving care or compensation?"

DoD photo/Master Sgt. Andy Dunaway, U.S. Air Force

A U.S. airman scans for surface to air weapons from a C-130 Hercules aircraft during a cargo mission from Bagram Air Base, Afghanistan, on April 16, 2008.

Panelist Tia Christopher, program associate for the Iraq Veteran Project of Swords to Ploughshares in San Francisco, began by describing her often harrowing experience as a Navy veteran who survived military sexual trauma and has PTSD. She has had difficulty getting the support she needed (and sometimes even getting others to believe she was a vet at all).

"It became clear to me that even the basics – how to get a VA card, where to get medical help, getting prepared for a possible PTSD diagnosis, even what to say, what not to say to a vet – needed to be spelled out." She wrote a transition manual for vets, and is particularly concerned about female vets, whose experiences and health issues are different from those of male soldiers and are largely underreported. For example, in a paper she compiled, she cites a VA survey of Iraq female vets: 29 percent returned with genital or urinary system problems, 33 percent had digestive illnesses, and 42 percent had back troubles, arthritis, and other muscular ailments.

Another little-known aspect of the war is the sheer number of troops who may return needing care, said Keith Armstrong, L.C.S.W., a clinical professor of psychiatry and director of the San Francisco Veterans Administration's Family Therapy Program. "I hear local psychiatrists guess 40,000, maybe 100,000 vets we're talking about with possible mental health issues. But in both the Afghanistan and Iraq wars, we're talking 1.6 million troops as of November 2007. And more than 571,000 are on more than one tour. So, these vets are at an even higher risk for mental health issues like PTSD when they get home. These are huge numbers."

Armstrong pointed to other potential stories yet to be told, such as the marital status of troops. Nearly 52 percent on active duty and 53 percent in the reserves are married. The impact of war is enormous for spouses, children, and families – not just the single young soldier on his or her own. Another untold story concerns parents. "What do you do with a kid who's old enough to go to war," Armstrong said, "but who won't get help?"

Yet another factor is pre-war trauma; that is, the military has no idea about traumas or abuse that may have happened to a soldier before he or she enlists. "Then they get to war, and these issues emerge. How do we handle that?" Armstrong pointed out that mental problems tend to appear in clusters as well. "You may have PTSD, but then you abuse alcohol to handle the symptoms, and so on."

To address these and other issues, panelist Joe Bobrow, Ph.D., said that he founded the Coming Home Project specifically to figure out how and which services returning veterans would respond to. "One challenge was to get groups who normally don't talk to one another – the DOD, the VA, the clergy, the medical profession, and so on – to begin talking," he explained, "to build the safety net vets need to help them create the inner connectivity that war ruptures."

Bobrow, a clinical psychologist and psychoanalyst, emphasized that "trauma involves everyone, even the ones bearing witness," which means families. So integrating family is a cornerstone of his project's methods, what he calls the "healing power of the group," to help combat the stigma of mental illness – especially for those coming out of a military culture.

Follow-up questions from the audience addressed specific examples of care for vets suffering from PTSD; various misconceptions about who returning vets are (Christopher pointed out that stereotypes abound.); how to keep vets in treatment programs (attrition is high); and vets' challenges finding and holding onto jobs.