To read the story behind the Globe's unprecedented, far-reaching investigation into soldier suicides, please click here.
War changes men (and women). It leaves wounds, physical and mental.
We have developed countless weapons to kill and maim and, as a counterpoint, sophisticated body armour to minimize injuries, and amazing medical treatments to piece wounded warriors together again.
While we can prevent and treat many visible physical injuries, what about the oft-invisible mental harms?
Where is the bulletproof vest for the mind? How do you heal the mind of a soldier haunted by what she/he has seen and felt?
In recent days, Globe and Mail reporter Renata D'Aliesio has catalogued the devastating toll of suicide among veterans of the Afghanistan war: 158 soldiers died in the mission, while at least 54 more took their own lives.
Soldiers suffering from posttraumatic stress disorder often face dismissive, penny-pinching treatment when they reach out for care, and their families fare even worse. In contrast to the combat deaths, the suicide deaths have been hushed-up, compounding the pain.
That discriminatory response will, hopefully, be corrected by the new federal government.
But, in addition to helping soldiers and veterans currently suffering from PTSD, there are much larger questions to be addressed: Can we prevent PTSD or, at the very least, minimize its impacts?
In recent years, a lot of research has been conducted and much has been learned about PTSD, in large part due to the massive deployment of U.S. troops in Iraq and Afghanistan, and the retrospective analysis of the experiences of Vietnam War veterans.
Posttraumatic stress is an anxiety disorder that some people get after witnessing a traumatic event. "Fight or flight" is a healthy reaction to danger and serves us well. But people with PTSD remain stressed or frightened even when they are no longer in danger, a process called "fear conditioning."
While most people will suffer at least one traumatic event in their lifetime, most do not suffer long-term effects. Humans tend to be resilient. But a significant minority will suffer from chronic, unremitting stress and anxiety.
Almost one in five Vietnam War veterans suffered from PTSD. Researchers found that three factors predisposed soldiers to the illness:
• Severity of exposure: Meaning the more horrific the things soldiers witnessed, the greater the risk;
• History of childhood abuse: Soldiers who were physically or sexually assaulted – meaning they had already suffered trauma;
• A history of substance abuse in the family, another form of trauma;
Other research hints that some people's brains are anatomically better able to recover from trauma.
Understanding the roots of resilience suggests that screening could reveal which soldiers are predisposed to PTSD – not with the goal of excluding them, but of ensuring they are monitored and get follow-up care.
The U.S. Armed Forces have tried a number of methods to prevent PTSD, but most have proven ineffective, according to a report from the Institute of Medicine.
The clear message that emerges from research is that swift response to trauma is important. PTSD symptoms usually arise within three months and, if untreated, tend to grow worse with time.
The U.S. National Center for Biotechnology Information, in a comprehensive analysis of PTSD treatments, found that drugs are largely ineffective, except to treat specific symptoms. What works best are psychological interventions like cognitive behaviour therapy (CBT), cognitive processing therapy (CPT) and prolonged exposure (PE), all of which help the patient understand the impact of trauma and restructure their beliefs.
While these approaches are effective, they take time (about a dozen sessions for most) and money (psychological care is not generally covered under medicare).
Those with the most severe forms of PTSD also suffer from persistent suicidal thoughts, which can require institutional care. The suicide rate among military personnel is more than twice that in the general population, and PTSD can be a precipitating factor.
In exchange for their service, members of the military should be provided with the care they need. Not care that is cursory, but the care that is necessary for their recovery.
That is the social contract that the Canadian Armed Forces and, by extension, the federal government, are failing to honour.
If we are going to spend on war, we need to also invest in peace of mind.
Thanks to a few brave veterans and advocates, the invisible disability of PTSD (and the related tragedy of suicide), is now visible. What remains is for Canada to cast off its willful blindness.
Are you a military family with a similar story? E-mail reporter Renata D'Aliesio at RDaliesio@globeandmail.com as she continues to bring attention to this important issue.