Military marches toward mental health

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By Ann Geracimos

The military finally is getting ahead in the head business -- tackling the psychological health and traumatic brain injuries of soldiers and their families in a comprehensive way.

It's happening at the moment under the leadership of an energetic, Shakespeare-quoting Army psychiatrist, Brig. Gen. Loree K. Sutton. Gen. Sutton holds a medical degree from Loma Linda University in Loma Linda, Calif. She completed her internship and residency in psychiatry at Letterman Army Medical Center in San Francisco.

Gen. Sutton, 49, is director of the year-old Defense Centers of Excellence (DCoE), an arm of the Department of Defense dealing with health matters. The concept is to find the means of caring for troops and their leaders before, as well as after, service members and their relations suffer the debilitating effects of trauma.

The game plan focuses on building up what is being called "resilience" among the military's many warrior volunteers as well as providing more and better treatment options for visible and invisible injuries of this type in a totally integrated program for recovery and reintegration. Gen. Sutton describes it as a network "like the Internet -- a collaborative global network" functioning in a partnership, which is expected to take four years to put fully in place.

The plan, and its three R's -- resilience, recovery, reintegration -- had a big workout at a recent three-day DCoE symposium, "Warrior Resilience Conference: Partnering With the Line," and attended mainly by service members involved in health matters. Billed as the first of its kind, the event at the Fairfax Marriott at Fair Oaks typified what the organization sees as its mandate: promoting a shift of emphasis in the military away from what is known, in jargon terms, as an "illness-based medical model" toward a "wellness-centric resilience continuum."

The latter phrase is a mouthful, with good reason, covering as it does a range of approaches that almost directly counter traditional military culture and practices.

"It's ironic how the military trains us to overcome discomfort but not how to deal with invisible injuries," Gen. Sutton notes. "As soldiers, we keep a lid on our feelings while we do our job. But nobody tells us when to take the lid off or how to deal with it when we do."

At some point, too, she feels compelled to quote Hamlet on his deathbed, addressing his friend Horatio: "If thou didst ever hold me in thy heart, absent thee from felicity awhile and enter my harsh world and draw my breath in pain to tell my story." This is Gen. Sutton's way of emphasizing the necessity of bringing soldier-warriors' stories to light.

Such a shift acknowledges what has been lamentable neglect and often superficial understanding of the wounds of war that have proved to be different in different eras. Some degree of post-traumatic stress disorder (PTSD) is known to affect hundreds of thousands of today's military serving overseas, along with the mental and physical impacts felt by the prevalence of improvised explosive devices (IEDs).

To this end, audience members at the conference were treated to a lecture on neuroscience titled "Factors of Resilience" by Dr. Steven Southwick of the Yale University School of Medicine, detailing the latest clinical studies concerning brain function and plasticity. He pointed out the complexities of various physical and emotional survival mechanisms and how "stress inoculation is key." Yet "the moral compass proves to be extremely important," he noted, as is the value of social support and role models in learning "coping strategies" -- strategies that are central to successful recovery and reintegration into society after combat.

Another r-word -- resistance -- also has been an enemy, whereby the very act of seeking psychological help is equated with weakness. However, showing vulnerability can have a positive outcome, as mental health experts and dramatists of distinction know well -- none better than Greek playwright Sophocles, who wrote more than 2,000 years ago in the tragedies "Ajax" and "Philoctetes" about the afflictions of characters in war and how suffering has an impact on warriors' close relationships.

Selections from these classics were interpreted at the conference in a panel called "Theater of War" by top-ranked actors from the 2-year-old New York-based Philoctetes Project. This is an ad hoc group -- different actors are recruited at different times, depending on availability -- under the direction of Bryan Doerries. The group does staged readings on the theme of warriors' suffering to connect the emotions of actors with the experiences of audiences in medical and military communities. Excerpts from the plays are delivered with fiery intensity by actors seated on a platform in everyday dress as a way of promoting audience discussion and possibly even -- as the Greek model would have it -- catharsis.

For actor Paul Giamatti, seen recently as John Adams in the HBO series of that name, it was his first time appearing in such a setting. Reaction was "more visceral" than usual, he said, looking visibly moved after his explosive turn as Sophocles' Greek warrior Philoctetes, who was abandoned by his troops after contracting a debilitating illness.

Afterward, Army Maj. Gen. David Blackledge quietly slipped Mr. Giamatti a red-starred gold coin as a show of thanks and appreciation -- a happenstance moment and perhaps a telling one, given DCoE's strategy of having leaders communicate and stay in touch with their troops. Gen. Blackledge, who defied the Army's code of silence in seeking psychiatric counseling for PTSD first acquired in Iraq and then telling about it, was following a military tradition in which a supervisor congratulates a soldier on special occasions by giving him a coin marked by the former's rank.

Now assigned to the Pentagon, the two-star Army Reserve general, 54, has finished treatment for the most part, he said in an interview, but still has periodic sleep problems.

He was injured during two tours, in 2004 and 2005. The ideal, he says, is to implement open attitudes in both the Reserves and the National Guard "to reduce the stigma associated with soldiers coming forward. We want them to come forward early, before problems are even greater."

Once he had done so, he recalls, "it was an epiphany for me. When I explained what I went through, I suddenly had soldiers of all ranks stick up their hands and tell their own story. It made me realize how sharing my own experience helped them. [Gen. Sutton] said that is exactly what we are looking for on a grander scale."