A soldier at Walter Reed Army Medical Center put it simply: “Coming home is the toughest thing I ever did.”
Note that he didn’t say going to war, former U.S. Sen. Max Cleland told an audience at Brown Medical School on Tuesday, recalling the man’s words. As a Vietnam veteran who came home grievously injured and traumatized, he can relate to that.
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“Wars are not over when the shooting stops,” he said. “They go on in the lives of those who fight them.”
Two years into the Iraqi conflict, and with many soldiers, National Guard members and reservists having already served two and even three tours of duty in the Persian Gulf and in Afghanistan, America is starting to feel the impact at home, Cleland said.
Not only has modern technology allowed many grievously wounded soldiers to survive – but then face a grueling recovery, Cleland said. Many have post-traumatic stress disorder and other mental problems that civilian doctors may not even know how to identify.
As the numbers grow, and families nationwide are strained, Cleland predicted, returning veterans’ problems are going to become the nation’s top public health issue.
“This is only the beginning, boys and girls,” he said. “We’re going to be seeing this growing, terrible, terrifying public health problem across the country.”
Cleland, a Georgia Democrat who served in the U.S. Senate from 1997 to 2002 and has been a national leader in veterans’ affairs for three decades, was at Brown to deliver the sixth annual Barnes Lecture as part of Public Health Research Day. But more important, he was here to lend his support for Pathways to Recovery from Combat, a new project at Brown to study returning veterans’ needs and develop national models for ways to meet those needs.
Started by a businessman’s donation two years ago, Pathways has grown, with little publicity, into a major collaboration with the U.S. Departments of Veterans Affairs and Defense, spanning medical issues, mental health, and public-health policy.
The best-known part of the Pathways so far is a project led by Dr. Roy Aaron to develop “biohybrid” limbs for amputees, melding human tissue with a prosthesis controlled by the person’s own brain and muscles. The effort, a collaboration with the Providence VA Medical Center and the Massachusetts Institute of Technology, is backed by a $7.2 million VA grant.
Other projects, all involving the Providence VA as well, are looking at sleep disturbance and war-related adjustment difficulties; genetic and personal experience factors that can worsen vulnerability to war stress; post-traumatic stress disorder and related alcohol abuse; and the need for physical rehabilitation and community services for soldiers and their families.
All that attention to PTSD and other mental-health issues is crucial, Cleland said, because the problems are rampant, and National Guard members and reservists, who make up almost half the troops now in service, are unlikely to get the help they need on their own.
While regular soldiers go back to military bases, where people understand what they’ve experienced, Guard members “come back to the Guard shack, they get debriefed, and then they try to go back to their lives,” Cleland said.
“They come back to Cranston and go back to being a pharmacist,” he said in an interview. “They’ve been to hell and back and they expect to function just like they would normally. And they can’t.”
To make things worse, Cleland said, the length of the wars has forced many of these men and women to go back for second and third deployments. Many of those being sent back, he added, already show symptoms of PTSD from previous service.
PTSD is so widespread, in fact, Cleland said, that just in the three days before he visited the Providence VA last week, about 70 cases had come in. The VA system is doing a great job, he said, but it’s “overwhelmed” and needs more resources. And the private health care system just isn’t equipped to deal with these situations, he said – vets really need to go to the VA.
Terrie Fox Wetle, associate dean of medicine for public health and public policy at Brown Medical School, said that’s why Pathways to Recovery was created: to help the nation deal with the growing crisis.
“The VA and the Department of Defense are working really hard to develop programs, but there’s a general sense that much more needs to be done, and we’re about to be hit by a tsunami of people with special needs and we need to gear up to deal with it,” Wetle said.
