Unseen Injuries

After the Vietnam War, the term Post Traumatic Stress Disorder (PTSD) has become a recognised condition affecting individuals who have been involved in an extremely traumatic experience, causing them ongoing distress and anxiety.

Whilst PTSD is a known condition and understood on a very basic level in the general population, there is a risk that it is becoming a catch-all diagnosis to describe a number of mental health issues that are attributed to those individuals who witness or participate in traumatic events. PTSD is one of a number of unseen wounds or injuries that can afflict soldiers and first responders as a direct result of their service.

Our minds and bodies are not designed to deal with continued states of flight or fight that accompanies the exposure to constant trauma, danger and risk which we now see as part of modern warfare. It is reasonable then to expect that as a result of being exposed to these stressors over extended periods of time, there could be a lasting legacy - an unseen wound.

The concept of unseen injuries is not new and not the sole domain of the military, but for the purpose of this forum, our focus is on military personnel.

The understanding of these psychological traumas,  their causes and symptoms,  has developed significantly in recent years. There is a growing expectation and demand within the military and the civilian community to better understand the issues and provide greater support to veterans.  There is a growing impetus to look for ways to not only improve methods of diagnosis and treatment for military personnel, but to also provide avenues for the prevention of the injury, or mitigate its severity, in the first place.

It’s hard enough, when you have an unseen injury such as PTSD, to understand and rationalise the pain you feel when there is nothing to see, no scars and only a label to explain your state of mind.  It’s harder still to deal with the stigma associated with mental Illness.  The perception of weakness is still one of the major factors for military personnel to avoid seeking treatment.

Members with unseen wounds are often described by units as admin problems, they are the subject of welfare boards, command-initiated psychological assessment referrals, restrictions on service and closed-door discussions of which they are not a part.   Others may pass unnoticed or ignored, as they continue on their daily lives, trying not to let the self-doubt, anger and nightmares overtake them, only for them to emerge in other places in their lives or under further stress.  They are stigmatised by the perceptions of others and those that are self-imposed; that they are weak or broken, and afraid to admit to themselves or to others the full extent of what is going on within.

The effect the military organisation has on the individual, and their concomitant willingness to seek treatment, can contribute to the continued suffering of an individual, or it can provide an individual with the support framework he or she needs to seek help and commence the healing process. The Army has recognised this and is taking steps to reduce the stigma attached to mental health issues and unseen wounds such as PTSD.

There must be integrated solutions involving the individual, the unit, the community and health services. There must also be engagement with, and empowerment of, members who require assistance so that they may feel confident to speak up and be heard in a positive, supported, and non-judgmental environment where help can be sought without the threat of negative consequences.

When the current Chief of Army, Major General Rick Burr, issued his Commander’s Statement in July this year he spoke at length about the value of our people, in particular stating that we will continue to “maintain a skilled and resilient workforce” and that “we care for our people, and we continue to assist our wounded, injured and ill. “

Clinging to outdated and ill-informed methods of dealing with members who are suffering from mental illness, will only continue to perpetuate the re-victimization by bureaucratic processes.

Unseen wounds can be complex, and just as there is no single way to predict those who will be affected by these issues, neither is there a single answer on how to fix or prevent these injuries.

In the article, ‘Dealing with the unseen scars of war' author Alex Quade gives three important take-home messages to the community and military alike:

1. There is no “quick fix” solution for unseen injuries
2. Education is the key
3. This is not just a military problem

The 2014 Army research paper on “PTSD and Stigma in the Australian Army”,  the measures which the author John Bale discusses can be used not only to de-stigmatise PTSD, they can also be employed across the wider spectrum of unseen injuries in the military. He highlights the key initiatives from the US, UK and Canada, discussing what has worked and points out weaknesses in current and past strategies which need to be avoided.

Unseen injuries in the military affect a large number of personnel either directly or indirectly, as well as family and community members.  We can reduce the effect by working together to ensure a consistent and enduring message is delivered and commit to actions that continue to educate and support members and their families. We must also continue to participate in and monitor research into unseen wounds.

After 25 years as a Military Police Officer, I have seen first-hand how hard it is for some members to navigate the system and find the scaffolding they need to support their recovery and healing. Far too many times members who still have so much to offer the military end up in the discipline system after failing to get the help and support needed from mates, families and units.

Every one of us enters the military fit and healthy with a huge potential to serve the ADF and the community. It would be a shame for that not to continue past a diagnosis of PTSD.