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The psychological toll of war is vast, and the social costs of war’s psychiatric casualties extend even further. Yet military mental health care suffers from extensive waiting lists, organizational scandals, spikes in veteran suicide, narcotic overprescription, shortages of mental health professionals, and inadequate treatment. The prevalence of conditions such as post–traumatic stress disorder is often underestimated, and there remains entrenched stigma and fear of being diagnosed. Even more alarming is how the military dismisses or conceals the significance and extent of the mental health crisis. The trauma experts Mark C. Russell and Charles Figley offer an impassioned and meticulous critique of the systemic failures in military mental health care in the United States. They examine the persistent disconnect between war culture, which valorizes an appearance of strength and seeks to purge weakness, and the science and treatment of trauma. Instead of reckoning with the mental health crisis, the military has neglected the needs of service members. It has discharged, prosecuted, and incarcerated a large number of people struggling with the psychological realities of war, and it has inflicted humiliation, ridicule, and shame on many more. Through a far-reaching historical account, Russell and Figley detail how the military has perpetuated a self-inflicted crisis. The book concludes with actionable prescriptions for change and a comprehensive approach to significantly improving military mental health.
The Oklahoma City bombing, intentional crashing of airliners on September 11, 2001, and anthrax attacks in the fall of 2001 have made Americans acutely aware of the impacts of terrorism. These events and continued threats of terrorism have raised questions about the impact on the psychological health of the nation and how well the public health infrastructure is able to meet the psychological needs that will likely result. Preparing for the Psychological Consequences of Terrorism highlights some of the critical issues in responding to the psychological needs that result from terrorism and provides possible options for intervention. The committee offers an example for a public health strategy that may serve as a base from which plans to prevent and respond to the psychological consequences of a variety of terrorism events can be formulated. The report includes recommendations for the training and education of service providers, ensuring appropriate guidelines for the protection of service providers, and developing public health surveillance for preevent, event, and postevent factors related to psychological consequences.
Gender roles are nowhere more prominent than in war. Yet contentious debates, and the scattering of scholarship across academic disciplines, have obscured understanding of how gender affects war and vice versa. In this authoritative and lively review of our state of knowledge, Joshua Goldstein assesses the possible explanations for the near-total exclusion of women from combat forces, through history and across cultures. Topics covered include the history of women who did fight and fought well, the complex role of testosterone in men's social behaviours, and the construction of masculinity and femininity in the shadow of war. Goldstein concludes that killing in war does not come naturally for either gender, and that gender norms often shape men, women, and children to the needs of the war system. lllustrated with photographs, drawings, and graphics, and drawing from scholarship spanning six academic disciplines, this book provides a unique study of a fascinating issue.
Nearly 1.9 million U.S. troops have been deployed to Afghanistan and Iraq since October 2001. Many service members and veterans face serious challenges in readjusting to normal life after returning home. This initial book presents findings on the most critical challenges, and lays out the blueprint for the second phase of the study to determine how best to meet the needs of returning troops and their families.
Looks at the effect of deadly battle on the body and mind and offers new research findings to help prevent lasting adverse effects.
Counting Civilian Casualties aims to promote open scientific dialogue by high lighting the strengths and weaknesses of the most commonly used casualty recording and estimation techniques in an understandable format.
Since October 2001, approximately 1.64 million U.S. troops have been deployed for Operations Enduring Freedom and Iraqi Freedom (OEF/OIF) in Afghanistan and Iraq. Early evidence suggests that the psychological toll of these deployments -- many involving prolonged exposure to combat-related stress over multiple rotations -- may be disproportionately high compared with the physical injuries of combat. In the face of mounting public concern over post-deployment health care issues confronting OEF/OIF veterans, several task forces, independent review groups, and a Presidential Commission have been convened to examine the care of the war wounded and make recommendations. Concerns have been most recently centered on two combat-related injuries in particular: post-traumatic stress disorder and traumatic brain injury. With the increasing incidence of suicide and suicide attempts among returning veterans, concern about depression is also on the rise. The study discussed in this monograph focuses on post-traumatic stress disorder, major depression, and traumatic brain injury, not only because of current high-level policy interest but also because, unlike the physical wounds of war, these conditions are often invisible to the eye, remaining invisible to other servicemembers, family members, and society in general. All three conditions affect mood, thoughts, and behavior; yet these wounds often go unrecognized and unacknowledged. The effect of traumatic brain injury is still poorly understood, leaving a large gap in knowledge related to how extensive the problem is or how to address it. RAND conducted a comprehensive study of the post-deployment health-related needs associated with these three conditions among OEF/OIF veterans, the health care system in place to meet those needs, gaps in the care system, and the costs associated with these conditions and with providing quality health care to all those in need. This monograph presents the results of our study, which should be of interest to mental health treatment providers; health policymakers, particularly those charged with caring for our nation's veterans; and U.S. service men and women, their families, and the concerned public. All the research products from this study are available at http://veterans.rand.org. Data collection for this study began in April 2007and concluded in January 2008. Specific activities included a critical reviewof the extant literature on the prevalence of post-traumatic stress disorder, major depression, and traumatic brain injury and their short- and long-term consequences; a population-based survey of service members and veterans who served in Afghanistan or Iraq to assess health status and symptoms, as well asutilization of and barriers to care; a review of existing programs to treat service members and veterans with the three conditions; focus groups withmilitary service members and their spouses; and the development of a microsimulation model to forecast the economic costs of these conditions overtime. Among our recommendations is that effective treatments documented in the scientific literature -- evidence-based care -- are available for PTSD and major depression. Delivery of such care to all veterans with PTSD or majordepression would pay for itself within two years, or even save money, by improving productivity and reducing medical and mortality costs. Such care may also be a cost-effective way to retain a ready and healthy military force for the future. However, to ensure that this care is delivered requires system-level changes across the Department of Defense, the Department of Veterans Affairs, and the U.S. health care system.
This title provides a comprehensive overview of clinical, epidemiological, psychobiological, psychosocial and service organization aspects of disaster psychiatry. It takes a practical approach and includes a series of reports on significant experiences made in this field in various regions of the world. An Unbiased and reliable reference point, endorsed by the WPA Includes contributions from internationally acclaimed experts
Vietnam still haunts the American conscience. Not only did nearly 58,000 Americans die there, but--by some estimates--1.5 million veterans returned with war-induced Post-Traumatic Stress Disorder (PTSD). This psychological syndrome, responsible for anxiety, depression, and a wide array of social pathologies, has never before been placed in historical context. Eric Dean does just that as he relates the psychological problems of veterans of the Vietnam War to the mental and readjustment problems experienced by veterans of the Civil War. Employing a multidisciplinary approach that merges military, medical, and social history, Dean draws on individual case analyses and quantitative methods to trace the reactions of Civil War veterans to combat and death. He seeks to determine whether exuberant parades in the North and sectional adulation in the South helped to wash away memories of violence for the Civil War veteran. His extensive study reveals that Civil War veterans experienced severe persistent psychological problems such as depression, anxiety, and flashbacks with resulting behaviors such as suicide, alcoholism, and domestic violence. By comparing Civil War and Vietnam veterans, Dean demonstrates that Vietnam vets did not suffer exceptionally in the number and degree of their psychiatric illnesses. The politics and culture of the times, Dean argues, were responsible for the claims of singularity for the suffering Vietnam veterans as well as for the development of the modern concept of PTSD. This remarkable and moving book uncovers a hidden chapter of Civil War history and gives new meaning to the Vietnam War.