There are two changes Alexander Paul feels can be made in how the military works with our veterans which would reduce PTSD and also the number of suicides. A common theme running through the accounts of veteran suicides on the memorial website, suicidewall.com is that the veteran refused to seek help. This is understandable, because military personnel are taught that they need to be tough to survive combat and they do a great job of surviving their one year tour of duty. Once they return home it is natural to feel that things are just fine because they are no longer in combat, so if anyone has problems with PTSD, essentially lingering problems brought on my psychological trauma, the veteran feels that they just need to “be tough” because that is how they survived during their combat tour.

The military offers counseling, but in a way that requires the veteran to step forward and say they feel they have problems. The military should make therefore make counseling mandatory with the assumption that everyone in a combat zone has undergone a traumatic experience. We already do this for other public servants, for example it is typical to put a policeman on paid leave and require counseling after the policeman has shot someone in the line of duty. The same often occurs for fire and ambulance personnel who have to deal with life and death trauma.

As of this writing there have been 6300 combat deaths since 9/11/2001. There have been 4,000 plus suicides. According to the psychiatric study “Readjustment Problems of Veterans” found elsewhere on this website, 23% of all combat casualties were due to men being excused from combat for psychological reasons. Since WWII the diagnosis of combat fatigue or shell shock was eliminated, meaning while men could actually still suffer from combat fatigue, they were no longer allowed to be relieved from combat duty, and instead had to remain on duty for a one year tour.

Since the number of combat zone casualties since 9/11/2001 now totals approximately 110,000, it is probably fair to estimate that there could have been another 31,000 men who would have been relieved of duty due to combat trauma by applying the same ratio as that which occurred in WWII when men were still allowed to be diagnosed with combat trauma and considered to be casualties.

So the first step is to make counseling mandatory for all personnel in a combat zone, because this “invisible wound” is not being reported voluntarily, but it is definitely causing problems for veterans once they come home; problems ranging from relationships, to not being able to hold down a job, to substance abuse and in some cases suicide.

The second step, the second change we need to make, is to give all combat zone veterans three years of full military pay and benefits after discharge for each year of combat zone duty, so that these veterans can have a chance to “get their feet back on the ground”, because it is extremely difficult for these veterans to come home and deal with the problems of finding work during a recession on top of dealing with the problems of dealing of PTSD.

While some may argue that these steps are going to be expensive, which is true, we should look at it a different way. Veterans with PTSD have suffered an invisible wound on the battlefield. If they had been physically wounded, we would never leave them on the battlefield to die. Instead we spare no expense to fly them quickly to a hospital and receive the very best of medical treatment. Yet the veterans with PTSD, though harder to identify, have suffered psychological wounds that may well end up killing them. We owe it to these veterans who have risked their lives, given years of their lives, for their country. We owe them the finest of psychiatric counseling as well as financial support to allow them to readjust to civilian life.

A final objection to the above proposals will probably be that we should only provide these benefits for soldiers who actually experienced combat. One of the problems with PTSD is that it can come from trauma associated with the war, not just combat. A stark reminder of that is the case of a Vietnam soldier recorded on the suicidewall.com website. This soldier served in the Philippines in the morgue preparing bodies for shipment back to the United States. This was enough trauma to result in suicide. Another common theme is the phenomenon of survivor guilt. Many of those who survived a military tour in a rear support role are haunted by a sense of survivor guilt, which is common in any trauma as the survivor asks the question, “Why did I survive and others around me die?”

In the end we need to make sure that all those who could have PTSD receive counseling and financial assistance so that we leave no one behind.