A soldier in Baghdad sits in shock following an IED explosion. IED blasts are one of many reasons service members suffer from PTSD. (Photo: David Furst / AFP)
Neglect, mistreatment and abuse are the norm for active-duty soldiers suffering from post-traumatic stress disorder (PTSD).
The wars in Iraq and Afghanistan have thrown post-traumatic stress disorder into stark public light. As of the end of March, 346,393 US veterans were being treated for PTSD; 115,000 of those served in Iraq or Afghanistan. That number continues to grow rapidly.
However, PTSD symptoms don't always wait to emerge until soldiers return home. For active-duty soldiers like Airman Steven Flowers, stationed in Aviano, Italy, it can take years to receive even minimal care. And once treatment begins, the soldiers are often punished for revealing their problems.
Diagnosed with PTSD in 2007, Flowers receives only a 15-minute monthly session with a military psychiatrist - mostly to prescribe medications - and a brief monthly or bimonthly session with a psychologist. Since his diagnosis, Flowers has endured "constant harassment" within his unit, and incurs harsh punishment from his commanders for even the "slightest perceived inadequacies."
"Though I have had suicidal ideations, I am not considered a risk," Flowers told Truthout.
Flowers's case is not unique. Active-duty PTSD sufferers are subject to neglect and ridicule, according to Tim Huber, director of the Military Counseling Network.
"PTSD is a great scapegoat for the military to trot out when veterans face discrimination or have a difficult time securing jobs and making a new life in the civilian world, but while those troops are on active duty, they're supposed to simply 'soldier on' and get over it," Huber told Truthout.
This mentality leads many soldiers to conceal their symptoms for years. It also means that military leaders are resistant to signs of PTSD in the ranks. In fact, Huber considers Flowers's case lucky.
"I am actually impressed Flowers was able to receive a PTSD diagnosis," Huber said. "We work with many service members who can't even get that much recognition, and are instead simply criticized for being soft, and/or trying to get out."
The trend toward disregarding or silencing PTSD sufferers even extends to military psychiatrists, according to Chris Capps-Schubert, the Europe coordinator for Iraq Veterans Against the War, who is following Flowers's situation closely.
"In the summary of Flowers's case, his military psychologist said it's a difficult position for him as a doctor, because he has conflicting interests in his role as a medical provider and his role as a soldier," Capps-Schubert told Truthout.
Flowers was experiencing PTSD symptoms well before 2007, but says he was afraid of the consequences of seeking help.
Many soldiers suffer for long periods before coming forward with their symptoms; others speak out about their condition but are denied treatment.
Army Sgt. Selena Coppa was recently diagnosed with military sexual trauma, a form of PTSD resulting from sexual harassment, assault or rape, years after her symptoms began.
"I think that the lack of initial treatment has severely impacted my life," Coppa, who served in Iraq and is now stationed in Germany, told Truthout. "I was told by my therapist that my PTSD had gone from simple to complex as a result of the military environment and lack of real treatment. Military practitioners tend to be extremely unwilling to diagnose PTSD in active-duty soldiers, and thus make it more difficult for individuals to have access to treatment and care."
Retention at All Costs
Both Flowers and Coppa protested the military's neglect of their problems, but found little recourse for their grievances.
"I complained about what I felt was inadequate treatment, but was told there was simply no better treatment to offer me outside of the States, and they would not consider transferring me to the better treatment until I had already 'run the full course' with the less-effective treatment," Coppa said.
The military's reluctance to diagnose or treat PTSD is linked to its primary goal: retaining soldiers on the ground. Even if a soldier is only marginally able to perform, military authorities may make a strategic decision to delay diagnosis and treatment, which could lead to a discharge.
"For Flowers to be discharge-worthy, the military must feel it is better off without him," Huber said. "But there's a wrinkle. The military has to cultivate a culture of commitment. If it were easy to skip the enlistment contract and get out early, retention would plummet and America's ability to maintain the military status quo would vanish. That's why so many squeaky wheels don't get greased, and eventually crack and crumble.... I guess one could say brute retention is more important than mission readiness."
Soldiers diagnosed with psychological disorders may be reassigned to alternate duties, in place of receiving adequate treatment or a discharge. Flowers, for example, is now relegated to "meter maid" duty. He walks the Air Force base looking for parking violations, though he suffers from serious knee and back problems.
By the end of his daily nine-hour shift, he is in excruciating pain.
Coppa, who is now stationed in Germany, notes that her treatment - or lack thereof - was determined almost solely based on the "wishes of the command," not on her medical needs. Even after her diagnosis was recognized, she repeatedly met with resistance and indifference.
She also discovered that the military has startlingly few resources to deal with military sexual trauma.
"There are no domestic violence groups here in Germany, and no military sexual trauma groups," Coppa said. "They are ill-equipped to treat this form of PTSD in anything but a solo setting, which is not as helpful. Though they acknowledged I would benefit medically from a transfer to the States, one was refused."
Coppa's experience is widespread: support groups and alternative treatments are very rare. Typically, PTSD-diagnosed soldiers are prescribed medication at the outset, often with little explanation or accompanying talk therapy.
Drugs are seen as the quickest, most efficient route to retaining a soldier on duty, regardless of the consequences, according to Huber.
"The main strategy is to prescribe the problems away with pills, and as long as someone can remain upright under their own power and perform the base elements of their MOS [military occupation specialty], the military is adequately 'treating' the problem," Huber said. "If someone refuses to medicate, for fear of what they might do with live ammunition under the influence of three, four, five or more mind-altering drugs, they are simply written off as refusing the military's 'help' and not wanting to get better."
Recently, after a long fight, Steven Flowers was able to form a support group for PTSD sufferers in his unit. The group was created against the wishes of the military mental health staff, and Flowers's psychiatrist initially refused to consider the idea. Such groups are almost unheard of for soldiers on active duty.
For many service members with PTSD, the best they can hope for is the strength and luck to hold out until they return home.
"The help can be a little better after people get out and start seeing civilian psychologists, who care more about the individual then retaining a soldier who fills a slot in a unit," Capps-Schubert said.