PTSD: New War on An Old Foe

They are the invisible wounds of war, the battered minds and bruised spirits we have come to recognize as posttraumatic stress disorder, or PTSD. By one estimate, more than 300,000 of the nearly 2 million U.S. servicemen and -women deployed since 9/11 suffer from the often-debilitating condition, with symptoms that include flashbacks and nightmares, emotional numbness, relationship problems, trouble sleeping, sudden anger, and drug and alcohol abuse. The number of cases is expected to climb as the war in Afghanistan continues, and could ultimately exceed 500,000, according to a new study by researchers at Stanford University. Mental-health experts say PTSD is the primary reason suicides in the military are at an all-time high; 256 soldiers took their own lives in 2008, the highest number since that data was first tracked, in 1980.

As NEWSWEEK and others have reported, the Department of Veterans Affairs has struggled to address this mental-health crisis, and thousands of veterans have suffered as a result. Now, thanks to new leadership and a new openness to collaboration, things appear to be changing at the VA, if slowly. Veterans still often face insufferably long waits for treatment and steep bureaucratic hurdles when filing disability claims. But there is a new sense of urgency under Eric Shinseki, the retired four-star Army general appointed to head the agency by President Obama, to change the culture within the 77-year-old VA. Shinseki has made PTSD a priority, with efforts underway to address concerns from the way claims are processed to the development of new, more effective treatments. "Brain injuries and the psychological consequences of battle are not new to combat," Shinseki tells NEWSWEEK. "We know from past wars that with early diagnosis and treatment, people can get better."

The agency has already trained more than 2,000 mental-health clinicians to administer PTSD treatment using new, evidence-based treatments. Among the most surprising steps the VA has taken is to reach out to mental-health professionals in the private sector, something that never happened under past regimes. Just last month the agency launched a joint venture with the Boston Red Sox Foundation and Massachusetts General Hospital to treat potentially tens of thousands of PTSD sufferers and their families in the Boston area. The VA also recently began what press secretary Katie Roberts called a "collaborative relationship" with Give an Hour, a national nonprofit network of some 4,500 therapists that provides free counseling to returning troops and their families. Barbara Van Dahlen, a psychologist who founded Give an Hour four years ago, says that when she contacted the VA in the past she was turned away. "The VA finally gets that PTSD is a public-health crisis," Van Dahlen says. "They still haven't taken full advantage of the fact that we have 4,500 therapists eager to help, there isn't really a collaborative relationship yet, but the new leadership is showing sincere interest. That's a start."

Shinseki, a wounded vet (he lost part of a foot in Vietnam) who clashed with former defense secretary Donald Rumsfeld in the run-up to the war in Iraq, spelled out the VA's new approach in a July speech to a medical symposium. "We have looked at ourselves closely and have decided to make advocacy—yes, advocacy—on behalf of veterans both our culture and overarching philosophy ... It will involve a long-term process in reorienting our workforce and our work habits toward this philosophy. Culture change will take longer."

One practical application of the new philosophy: the VA has launched its first-ever nationwide search for veterans in rural areas who suffer from PTSD but are unable or unwilling to travel long distances to a VA office. Given the fact that 38 percent of veterans live outside big cities, which the VA acknowledges, this rural outreach seems especially overdue. Dr. Harold Kudler, a VA psychiatrist since 1984 and associate director of the agency's Mental Illness Research, Education and Clinical Centers, heads a program in North Carolina that will partner with rural health centers and National Guard armories to find and treat veterans in outlying areas, using specially equipped vans for house calls. "We should be up and running in three months," says Kudler, adding that similar programs are being developed around the country. "The VA is no longer going to wait for veterans to come to us—we have to go to them."

Finding veterans with PTSD is one problem; persuading them to be treated is another. As many as seven in 10 veterans refuse mental-health treatment even when it is offered, according to a 2008 study by the RAND Corporation. Further complicating matters is the fact that there is no universally accepted ideal treatment for PTSD. But Dr. Matthew Friedman, who runs the VA's National Center for PTSD, says extensive research by the agency has concluded that two approaches appear to be the most effective. One, called cognitive-processing therapy, seeks to help the sufferer by identifying and changing dysfunctional thinking, behavior, and emotional responses. The other, prolonged-exposure therapy, consists of reliving and confronting the trauma and learning to think differently about it. In an innovative effort to reach the younger generation of veterans, the VA is studying a variation of prolonged-exposure therapy that uses technology similar to a videogame to re-create as realistically as possible the original traumatic events. "Younger, tech-savvy veterans have shown a real willingness to participate in this 3-D approach to PTSD treatment," explains Dr. Anne Sadler, an associate director at the Iowa City VA who is heading the study. "Virtual-reality therapy is a way for a generation comfortable with joysticks and videogames to deal with their horrific experiences."