War Trauma Is an Admission of Weakness in 'Macho' Army Culture

The seven qualities of leadership itemized in Army Field Manual (FM) 22-100 are loyalty, duty, respect, selfless service, honor, integrity and personal courage. Nowhere in that list is there any reference to heartlessness, lack of compassion and a cavalier disregard for the wellbeing of one's troops. And there is certainly no reference to posturing, denial or dissembling. Leading by example trumps mindless stoicism every time.

Back in 1974, when Betty Ford was diagnosed with breast cancer, mastectomy was still considered a taboo topic, too shameful and frightening to be openly discussed. "Too many women are so afraid of breast cancer," she told a gathering of the American Cancer Society, "that they endanger their lives. These fears of being 'less' of a woman are very real, and it is very important to talk about the emotional side effects honestly. They must come out into the open."

Ford's courageous decision to use her position as First Lady to set a visible example for other women made a significant impact on public attitudes. According to the New York Times, "Within weeks, thousands of women who had been reluctant to examine their breasts inundated cancer screening centers. One of those following Mrs. Ford's example was Happy Rockefeller, the wife of the Vice President, Nelson A. Rockefeller. She, too, had breast cancer and underwent a mastectomy. Mrs. Rockefeller and many others said Mrs. Ford's example gave them the courage to discuss their experiences openly."

Researchers have since dubbed that phenomenon the "Katie Couric Effect" in honor of the co-anchor of NBC's "Today Show" who, in March 2000, underwent a colonoscopy on live TV. Couric, who lost her husband to colorectal cancer in 1998, decided to undergo the procedure on-air to "further the science being done on all aspects of colon cancer and increas(e) awareness about the critical role screening plays in combating the nation's number two cancer killer." According to Mark Fendrick, one of a team of University of Michigan doctors who studied the public response to the Couric demonstration, in the days and months following, the number of Americans who signed up for the exam rose by more than 20 percent. "This test," said Fredrick, "which requires healthy people to undergo an invasive, uncomfortable and often embarrassing exam, especially needed a celebrity advocate to reduce the stigma and fear, and thereby increase participation."

Interesting. A celebrity advocate to reduce stigma and fear.

In our military today, the stigma and fear that attach to post-traumatic stress injuries is a contributing factor to the current epidemic of suicides among American soldiers and veterans, 120 a week according to the recent study by CBS news. The stigma attaches to any admission of weakness, especially weakness of mind. The fear is of being shunned, shamed, punished or encumbered by a health record that might compromise future employment options. That stigma and fear might be profoundly challenged by an officer willing to go public with his -- and I use the male pronoun intentionally -- post-traumatic stress.

The need for service members to forego notions of manliness intrinsic to traditional military culture, to "come out of the closet" as it were, was raised poignantly by Mike Bowman, the father of Tim Bowman, when he testified before the House Committee on Veterans' Affairs in December. Tim, a Specialist in the Illinois National Guard, suffered from post-traumatic stress and took his own life after returning from Iraq.

Bowman made the point that, like most of the rest of the guys in his unit, Tim refused to go to the VA for help when his symptoms became invasive. Instead, they seek "counseling of some form or another -- privately - away from the military, away from the V.A., some as far as 100 miles away from home, to make sure that that information does not get back to their unit." In his statement, Bowman emphasized the courage and clarity evidenced by a soldier admitting a psychic injury. Instead of punishing or decrying such a soldier, Bowman insisted, "Grab that soldier and thank him for saying, 'I'm not OK,' and promote him. A soldier that admits a mental injury should be the first guy you want to have in your unit because he may be the only one that really has a grasp on reality."

Unfortunately, a soldier who has such a grasp on reality, a soldier who has the insight and education to understand that his or her ability to function reliably in a combat situation is compromised, currently faces a very different scenario, in which the convenience and judgment of commanding officers are prioritized. As of December 2006, new Pentagon guidelines give commanders the right to decide whether or not a soldier with a "psychiatric disorder in remission, or whose residual symptoms do not impair duty performance" may be sent back to Iraq or Afghanistan.

Aside from the obvious question of commanders' qualifications to make decisions about the mental health of the soldiers in their charge, there is something truly insidious lurking behind the new guidelines. According to Dr. Katherine Scheirman, a retired Air Force colonel who served as chief of medical operations in the Air Force's European headquarters from July 2004 to September 2006, a medical discharge can take months, sometimes longer, and all the while the commander is stuck with an undeployable soldier. An administrative separation usually takes a few weeks, at most. So commanders have a choice. They "can send him to the hospital and say, 'Hey, this guy isn't able to do his work. Would you look at him for PTSD?' Or they can just kick the guy out. If you kick the guy out, you'll get somebody to replace him. So that's the incentive for the commanders."

That incentive conveniently merges with beliefs of the many "traditional" officers who continue to insist that PTSD is just an excuse for cowardice, weakness, or the old stand-by, malingering. "I've never had a guy in my unit develop PTSD," one senior general from Iraq recently told CBS News correspondent Kimberly Dozier. "It's nonsense." Such Neanderthal attitudes are encouraged by a cabal of conservative culture warriors in Congress who believe that PTSD is faux science, touted only by a bunch of anti-war activists to justify their liberal politics. And they are using that reasoning to justify this administration's astonishingly callous health care policies for active and veteran service members.

According to the Army's own studies, one in three soldiers will return from Iraq with significant mental health problems. Like Tim Bowman, far too many are still ashamed to ask for the help they need and, if the CBS report is read as a cautionary tale, far too many will end up as suicides. The lives and futures of every soldier who might be moved by example, who might be saved by the "Couric Effect," should be reason enough for senior officers to finally and definitively disown the stubborn machismo that sustains the stigma, and visibly demonstrate their belief that post-traumatic injuries are not a sign of weakness or cowardice. Such injuries cannot and should not be sucked up. Even by the manliest. Where are they?

I call on our generals and other senior officers to lead by example. And lest your mottos take on a hollow tone: "Leave no man behind." "Be all you can be." "Do Something Amazing. Aim High." "Honor. Courage. Commitment." And "Semper Fi."


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