Many of the victims of mental illness who teeter totter between prisons and the streets are war veterans.The U.S. Army has recognized the price of psychopathaology. (see link) In 2008, The U.S. Department of Defense invested 125-million dollars in a resiliency training component to Comprehensive Soldier Fitness, a program to prevent war-related mental illness in soldiers and their family members.
Comprehensive Soldier Fitness might appear to be "macromedicine" at its best since it "likely represents the largest deliberate psychological intervention in history" (Scientific American).
The program follows a cognitive-behavioral approach based on the Penn Resiliency Program that was successful in preventing depression and anxiety in children ages eight to 15.
However, this program has faced significant criticism in academic circles because it was lunched "in a hurry" with no pilot studies to assess its effectiveness or uncover potential risks involved (source). Is Wiliam Casey, Army Chief of Staff, realistic to expect interventions that worked in developing children, whose minds and habits are inherently more flexible than those of adults, to be equally effective in adult armed forces? Is it really possible to prevent soldiers from suffering the debilitating effects of war trauma? What are the long-term effects of resiliency training at the neurochemical level and at the behavioral level? What about civilians and war victims? What is the U.S. military's responsibility to the non-soldier lives that war uproots and shatters?
Time will answer many of these questions as the Army has essentially embarked on a massive prospective study (http://www.army.mil/csf/). However, the ethical consequences that result from training and equipping human beings to intentionally kill other human beings will undoubtedly persist.
I like this post; I think that this article is a fine portrayal of one of the main characteristics of public health - that public health focuses on widespread disease prevention rather than individual diagnosis and treatment. However, in this case, I think the efforts are incomplete.
ReplyDeleteAs you mentioned in the article, there will always be ethical consequences for those who are trained and equipped to kill another human being. There is no doubt that teaching these individuals how to cope with that responsibility will help prevent post-war mental disorders. However, in this case, I believe that no amount of training or schooling will be able to completely prevent such disorders. Therefore, shouldn't another important aspect include the establishment of programs to help deal with the cases that are unpreventable?
I read an article one time that followed 4 US marines suffering from post-war stress syndrome. The article portrayed that a marine with anything that makes them weak, including mental disorders caused by war, automatically warrants a dishonorable discharge from the Army - a fate that takes away all of their benefits.
Therefore, I believe that the US government, the US Army, and our society as a whole owe our veterans suffering from mental illness the support they deserve, something that would not only focus on the preventative measures, but focus on the diagnostic measures as well.
I would agree with you that this program has a long way to go before being fully developed and I think in this case they are taking steps in the wrong direction.
ReplyDeleteI do not see resiliency training having the same effect on adults as it does on children whose as you mentioned minds are still developing. Foremost though, I do not even know resiliency training is a step in the right direction in and of itself. Resiliency refers to the ability to return to the original form--but if you experience trauma or powerful events, is it even healthy to return to the original form? I personally think it's a negative sign if there is not a sign of change/growth/development. My worst fears for this program albeit it being unsuccessful, would be that it could also potentially lead to increased suppression which may result in higher frequencies of depression or violent outbursts as we have seen in recent times. I agree with AHayden that no training is really sufficient to assuage the experience of taking away another human being's life, nor should it.
This being said though, clearly better support for mental health is needed. The military has been taking steps in the right direction, but I do not think it is enough yet.
Good article. How is this resiliency training being funded? Tax-payers? If so, I wonder if we would be too keen on funding a yet-untested program? Makes me think of the counter-successful application of the DOTS program in Peru I just read about in Kidder's Mountains Beyond Mountains.
This is such an interesting article, Sara!
ReplyDeleteI honestly think that the program and it's flaws show the overall lack of concern the country has towards a soldier's mental state during and after the war. You would think that if a man or woman is willing to give his or her life for their country, the government would do it's best to train soldiers how to cope with and avoid the mental traumas associated with war. It seems that the sheer number of those suffering from it, and the fact that it leaves many soldiers homeless or incarcerated, shows how much more needs to be done by the government to address the problem of mental trauma.