Stigma of mental health disorders in the military remains

Veterans with PTSD falling through the cracks might not be the ones you expect

By Drake Fenton, Ottawa Citizen August 5, 2013 (Link)

OTTAWA ‚ There is a small framed photo of the Canadian War Memorial hanging in an office at the Royal Ottawa‚ Operational Stress Injury clinic. Christine McDowell points to it and begins to cry.

It hurts. Looking at that picture hurts, she says. When I see that and when I see people in uniform, I feel a loss. That was a big part of who I was.

For an hour and a half she talks about her past life in the military, her three tours in Afghanistan and the thousands of casualties she treated as an Intensive Care Unit trauma nurse.

She can remember with striking clarity who she was and what she went through. She says those memories don’t fade. They ever-present.

“I wouldn’t even call them flashbacks. I would call them ghosts,” she says.

It’s a slide show of faces: Canadian, America, Afghan, and even Romanian. At a base in Kandahar, in a hospital constructed of plywood, she looked down at all of them as they laid injured on one of the six ICU beds in the facility.

“We’re seeing hundreds and thousands of casualties,” she says. “I don’t know any civilian environment where one staff member would see as many amputated limbs as anyone who worked with us for six months.”

The slide show plugs into the void, running on a loop. She says it’s the faces of the dead that follow her.

“I came home from Kandahar in 2006 and I was messed up. I was really messed up,” she says. “But I didn’t admit it. You get addicted to that adrenalin and that sense of importance and doing what you’re meant to do.

“I’m an ICU nurse. I couldn’t just be sitting behind a desk.”

Despite showing signs of what would later result in a medical discharge for post-traumatic stress disorder, McDowell says, she
“sucked it up” and returned to Kandahar for another six-month tour in 2008.

It took her some time before she eventually got help, and she wasn’t discharged with an official diagnosis of PTSD until 2010.

In the mental health community, her story isn’t unique. PTSD doesn’t discriminate. It affects men and women and affects combat troops and cooks. As she says, “everybody’s trauma is their own.”

The problem is that outside the confines of places like the Royal’s OSI clinic, there’s still an issue with stigma. In recent years there’s been an exponential growth in publicity about mental health. It’s no longer taboo for a veteran to admit they have PTSD or any other form of operational stress injury.

But according to Dr. Raj Bhatla, the chief psychiatrist at the Royal, while mental health is now better understood, there’s still a long way to go when it comes to stigma.

“There’s a reluctance to come forward and say, “I’m having a problem with an operation stress injury,” he says. “Veterans are thinking they are one of the very few, because everyone they know doesn’t have an issue, or seems to not have an issue.”

It’s the exact experience McDowell says she went through.

She says she felt like a weak link because when she returned from Kandahar none of her colleagues had PTSD.

“Why is it me that can’t handle this?” She would ask. “I’ve always been superwoman.”

McDowell was in denial. She was going through what is often called self-stigmatization. It’s one of the many ways stigma occurs, and it’s part of a larger chronic problem that plagues veterans with PTSD; the stigma they face is loaded with nuance.

Even if a veteran can overcome denial, there is a host of other issues to consider, explains Bruce Philips, a former soldier who’s had PTSD since 1994 and is now a peer support worker for veterans with operational stress injuries.

“It doesn’t matter where you work, you can imagine what would happen if you disclosed you have a mental health issue,” he says. “When they find out, co-workers are going to question, “Is this the best person for the job?”

“It’s going to affect your career, and there is going to be a financial impact.”

He says it’s analogous to the issue of concussions in the NHL.

“If a player admits he has concussion, he might think it will give him a specific label and affect his next contract. So he’ll hide it,” he says. “It’s a similar scenario with PTSD in the military.”

These problems are then compounded by the inner-culture within the military, one that can lead to veterans being accused of “faking” their disorder. Philips explains that during a deployment there is a separation between the front line “outside the wire” combat troops and the support service “inside the wire” personnel like McDowell.

“We feel like we have to prove ourselves because we didn’t go outside the wire,” McDowell says. “By some odd soldier means of measurement, my trauma is less, or not the same.”

But PTSD isn’t always about battle and gunfire, says Bhatla. It’s a common misconception, both within the military’s inner-culture and in war tropes often perpetuated in popular media.

“It doesn’t have to be that one Hollywood type of incident,” he says. “It doesn’t have to be a traumatic life or death situation. Some of the most challenging situations are when people experience or see something they weren’t ready to be exposed to.”

According to stats compiled by the Royal, there are about 11,500 veterans pensioned with PTSD. Bhatla says those numbers aren’t close to the actual number of Canadian veterans suffering from mental illness.

“Of all the veterans in Canada, only 13 per cent are connected with Veterans Affairs Canada,” he says. “So 87 per cent of veterans don’t even know what services are available to them.”

Due to a lack of awareness and stigma, he says it can be years before someone seeks out service. The Royal in Ottawa has clients from the Second World War that are only now getting treatment.

It’s one of the reasons the clinic released a free mobile phone app last month. It provides immediate contact information for the Royal’s 17 OSI clinics spread across the country and comes with multiple self-assessment tools.

It’s a way for the Royal to cut through bureaucratic red tape and open up a line of communication that is anonymous and stigma-free.

It’s deployable and you can carry it anywhere, which was a game-changer for me, says Philips, who helped test the app. “You can pretty much figure out where you stand and decide what you’re going to do about it.”

McDowell is more skeptical. She says she didn’t agree with the interface and had trouble navigating. But she says those complaints are minor as it serves a larger purpose: to provide a route to get treatment for people like her who fell through the cracks, for people who suffered trauma without ever firing a shot.

Bhatla says he’s hopeful the app will help get veterans into treatment quicker. He says the longer someone goes without treatment, the harder it is to help them.

McDowell knows that firsthand. She describes how it’s only now, after years, that she think she’s starting to get better. As she talks, her eyes keep flicking down to her wrist.

On it are three tattoos, two words written in Pashto, a common dialect in Kandahar, and a brilliant red poppy.

She says the words mean harmony and equilibrium. They’re a reminder of her goal to one day get balance back in her life.

McDowell pauses before speaking again. Her head bows down, and when she raises it, her blue eyes are misty with tears again.

“The poppy,” she says, collecting herself. “It’s my permanent remembrance, so I’ll never forget what I did and why I did it.

“And it always reminds me that what I did was important, and it reminds me of the difference I made in a lot of lives, even the ones that didn’t survive.”