TOPICS > Health

Troops’ ‘Avalanche of Needs’ in Treating Traumatic Stress

November 11, 2009 at 12:00 AM EDT
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Judy Woodruff speaks with a pair of experts about how the military helps treat soldiers dealing with post-traumatic stress disorder.

JUDY WOODRUFF: With me are two with extensive experience counseling troops for traumatic stress. Doctor Jeffrey Johns was an Air Force psychiatrist from 2001 to 2008. He’s now in private practice, and he works at a community health clinic. Heidi Kraft was a clinical psychologist in the Navy. She directed a combat stress unit in Iraq and later wrote a book titled “Rule Number Two: Lessons I Learned in a Combat Hospital.” She continues to treat soldiers. Thank you both for talking with us. We just saw that compelling profile of the former Marine. We heard how prevalent it is. Heidi Kraft, does that square with what you have seen?

HEIDI KRAFT: Absolutely. Sgt. Workman’s story sounds very, very similar to what I hear from many of my patients who are also Marines and experience so much of the same types of symptoms that he described. It’s — it really sounds incredibly familiar to me.

JUDY WOODRUFF: And, Dr. Johns, does that sound like what you’re — what you have witnessed?

DR. JEFFREY JOHNS: Oh, yes, very much so. There are many cases very similar to Jeremiah’s all across this nation

JUDY WOODRUFF: And Dr. Johns, what about how prevalent it is? We heard Betty Ann cite just the skyrocketing — skyrocketing number of suicides, the number of service members seeking treatment. What — what’s your sense of that?

DR. JEFFREY JOHNS: Well, my sense is that it’s a tremendous problem, an un — often unrecognized and undiagnosed while members are still in the active-duty services. While the president talks that we will take care of our own, we’re really shortchanging our troops and not providing them the care that they need. So, this problem is pervasive. It is extensive. And we need to be doing a lot better job to take care of these troops.

JUDY WOODRUFF: Heidi Kraft, give us a sense of — of — of what you saw, what you — what you’re working with now, and the challenges that these veterans face when they come back and they try to get help.

Treating PTSD

HEIDI KRAFT: I was in Iraq during a tough time, during 2004, during the battle for Fallujah, before Sergeant Workman was there. And it was a difficult time, I think, for all the Marines that were in our care and for us, as medical providers, not knowing what was next for the conflict, and how it was going to affect all of us.

In the desert, we dealt with very acute traumatic situations, and treated them in that acute sense, sort of trying to keep people functional and get them back to their units as soon as possible. Since then, after the book, and doing a fair amount of public speaking and still seeing patients part-time, it's interesting that many of my patients have deployed three and four times. But these more recent deployments have actually served as triggers for earlier traumas, such as during the battle for Fallujah, which continues to be a time that a lot of Marines kind of revisit in these symptoms.

So, it is -- it is a challenge. The continuing deployments continue to provide challenges across the board for both the warriors and the docs that take care of them.

JUDY WOODRUFF: How does -- how does that affect them, the fact that they are being sent back, as you say, three and four times?

HEIDI KRAFT: Most of my patients are very willing and -- and able to go back. They're Marines. It's what they do. They feel like that's their duty. It's what they're well-trained to do, and they want to stay with their units. They don't want to let anybody down. It's a big deal in the Marine Corps, as I think you heard from Sergeant Workman's story. I think where this becomes a little bit challenging is when something in a later deployment triggers some of the very traumatic memories from an earlier deployment that have been very effectively denied along the way, because they still had a job to do. We're very, very good, as human beings, at avoiding traumatic memories when we have to continue to function. It is what causes PTSD.

Not enough support

JUDY WOODRUFF: Dr. Johns, you left the military. How good a job is the military doing taking care of these -- of these veterans who come back with these kinds of issues?

DR. JEFFREY JOHNS: Not a very good one. We simply do not have the numbers of trained professionals that we need to take care of these individuals. There's an avalanche of needs of individuals suffering with depression, PTSD, traumatic brain injury, and other mental illnesses. And they're not getting the care that they need. Try as it might, the military is not able to retain and recruit the talented mental health professionals that it needs. And there are several reasons for this, but the stresses of daily military life are primary. Also, with the current deployment cycles as they are, it does not allow for the good, quality treatment to take place, with both therapists, as well as soldiers, going in and out of deployments.

JUDY WOODRUFF: You told -- Dr. Johns, you told one of my colleagues this is one of the reasons you decided to leave the military.

DR. JEFFREY JOHNS: Yes. I grew up as a military brat. My father was a career military physician. And I thought I would be, too. But, when I realized that my primary job as a doctor in the military was not to provide the standard-of-care treatment to the troops, but to use my skills to prepare them to fight a war in which I happened not to believe, I decided that that was not the place for me.

I would also say that I knew full well that our troops would inflict traumas and have traumas inflicted upon them, and would not be receiving the definitive care that they need. We're letting them down. We're not providing them the care that they bargained for when they signed up. And we should be doing a lot better job.

JUDY WOODRUFF: Heidi Kraft, how would you assess the job the military is doing taking care of these returning veterans?

HEIDI KRAFT: It's interesting, because, since the book's come out, I have had the opportunity to consult with a lot of our line leaders, sort of spent more time with them lately. And it's -- it's this real push on the side of the warriors, the actual soldiers, the actual Marines that actually do the fighting in these situations. And they are -- they are trying so hard finally to understand and make changes to the longstanding stigma to which Sergeant Workman referred. It is very, very tough for these guys, these warriors, to admit that they're suffering, and to try to conceptualize the trauma that they might have experienced as an injury, something that can, in fact, be healed and get better and can return them to duty.

This is not the way the stigma has -- has led them to believe. And, so, it has not just been a medical fight, but also a line fight, to try to change that stigma. I think it's a slow, slow process. This culture has had an intolerance for emotional imperfection for a very long time. So, the -- the attempts are being made. I see a lot of changes happening as I go and speak to different groups and meet with different folks. It's starting to change. It's just -- it's just incredibly slow to change.

'The military comes first'

JUDY WOODRUFF: And -- and, Dr. Johns, I think both of you mentioned to us the pressures from commanders to keep these units at full strength, and -- and -- and how that fights the desire of mental health professionals to identify veterans -- or troops, rather, as -- as having a problem.

DR. JEFFREY JOHNS: Exactly. The needs of the military come first. That is something that is repeated over and over again, even in mental health clinics. Our job is to prepare folks for war. And that is incompatible with taking care of troops and providing them the definitive treatment that's needed for PTSD. While there have been some efforts to decrease the level of stigma against mental illness in the military, that's really not what the military does. It needs bodies on the ground. It needs to fight wars by sending troops overseas. And, you know, that's not what good therapy does.

JUDY WOODRUFF: Heidi Kraft, what, finally, would you say most needs to be done to -- to make this -- to improve this situation?

HEIDI KRAFT: For me, it continues to be the stigma. So, I think, probably, the line needs to continue to buy into this and have every level of the chain of command buy into it, that these injuries are just that, injuries, and not disorders, not mental illness, but something that can in fact be treated and get better.

The other thing is that all of our therapists, anyone who provides mental health care, need to be trained in the evidence-based treatments that actually help these symptoms get better and help people process trauma. There's a real push to make that happen right now. It is starting to be rolled out. And it's a -- it's a big and important -- an important push, because I think we all need to be very -- very ready to treat these difficult disorders and difficult injuries.

JUDY WOODRUFF: Well, on this Veterans Day, we especially want to thank both of you, Heidi Kraft and Dr. Jeffrey Johns, for talking with us. Thank you.


HEIDI KRAFT: My pleasure.