PHYSICIANS ON THE FRONT LINE
assessment, including the tracking of concussions. There were a large
number of Improvised Explosive Devices (IEDs) used against us in
that time frame. We were implementing new systems of testing and
measuring impairments in individuals exposed to blasts. soldiers across the board.
This focus on concussions came about in part because IEDs were
a change in how those we were fighting were attacking us. As we
gained more experience with soldiers and Marines being exposed
to blasts, we got smarter. We started investing money in this study
in 2008 in a significant way. How could we assess concussions and
what does it take to recover? In addition, we’ve really worked hard to combat stigma. Having
a mental health condition does not have to mean lasting and per-
sisting impairment if you get effective treatment. The more we can
demonstrate that, the better off we’ll be.
TELL ME ABOUT THE COMBAT STRESS CONTROL PROGRAM.
The program has an interesting history. Most of it emerged after
World War I. That’s when the Army first came up with the principles:
proximity, immediacy, expectancy and simplicity (PIES). These were
a set of principles built around the idea of treating stress reactions
as close to the front lines as possible, in a safe environment. Doing
that treatment very quickly with the expectation that these are
transient reactions that frequently resolve with a few days of rest
and supportive care.
These were not in-depth analytic interviews. It was rest, re-
storative food, and possibly opportunities to talk about or process
experiences that led to the reaction.
Those principles have been rearticulated in various ways in the
decades since. But that’s really at the core of what we do. Recognize
a sense of safety, lower the level of arousal, start to process cogni-
tively, and then make a determination of whether the soldier can
go back to their unit.
THE DEPLOYMENT HEALTH CLINICAL CENTER (IN 2017
CHANGED NAME TO PSYCHOLOGICAL HEALTH CENTER OF
EXCELLENCE) FOUND THAT, AMONG ALL SERVICE MEMBERS,
MENTAL HEALTH DISORDER PREVALENCE ROSE FROM AP-
PROXIMATELY 12% IN 2005 TO MORE THAN 23 PERCENT BY
2013. THEIR FINDINGS SHOWED THAT THE CATEGORIES OF
ANXIETY DISORDERS, DEPRESSION, INSOMNIA AND PTSD
REPORTED THE LARGEST INCREASE.
DID YOU SEE A SIMILAR INCREASE DURING YOUR TIME IN
SERVICE THAT WOULD SUPPORT THEIR FINDINGS?
Its hard to say from a personal perspective, but I remained busy
during that time. (laughs) I wouldn’t dispute the data though.
We’re able to say, “This is stress,” or “This is going beyond stress.
This is possibly illness or something that may benefit from treat-
ment.” And, we made that type of treatment much more available.
IN WHAT WAYS DO YOU FEEL PSYCHIATRIC CARE OF ACTIVE
SERVICE MEMBERS AND VETERANS HAS IMPROVED OVER
THE LAST TWO DECADES? IN WHAT WAYS ARE IMPROVE-
MENTS STILL NEEDED?
We know a lot more about the disorders and the changes that oc-
cur from concussions, traumatic brain injuries (TBI) and PTSD.
However, we’re still working to find reliable and robustly effective
treatments. We’re using many of the same medications today that
we were using 20 years ago.
For example, anti-depressants are helpful and effective in PTSD,
but they don’t have the most robust effect. We’re continuing to
build our knowledge and can hopefully forge new pathways in the
years ahead.
WHAT SHOULD LOUISVILLE PHYSICIANS KNOW TO BETTER
CARE FOR THIS POPULATION?
The first thing I would say is that many physicians out in the com-
munity may be caring for veterans and not know. The majority
of service members served for their four or eight years, then they
entered the work force. They get private health care. The reality is
that most of these people are being cared for out in the community.
As a community, its incumbent on us to be sure we’re asking our
new patients about their military service.
Ask questions like: “Did you serve in the military? Tell me
about what you did. Tell me about your experiences. What do they
mean to you?”
That understanding can go a long way for many of us. It helps
build a better bond in our patients because there is often a very
strong identity built by serving in the military.
Aaron Burch is the former communications specialist for the Greater Louisville
Medical Society.
One factor to consider is that this has been a very long conflict.
It’s the longest conflict in the history of the US military. That places
a significant wear and tear on the organizational structure of the
Armed Forces: to be deploying in those numbers, in that frequency
and with that intensity of combat for more than a decade.
Another contributor is that there are many more resources
available for soldiers experiencing stress. There are more ways they
can seek help. I believe we’ve done a much better job of educating
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