“Thank you for your service” — a phrase heard frequently on television commercials, in airports, and across city streets. But as our nation begins to reflect on the end of nearly 20 years of continuous war, we must also come to terms with the reality that while public gestures of appreciation are nice, our veterans and service members need action for the conditions that are taking their lives at record numbers — traumatic brain injury (TBI), post-traumatic stress disorder (PTSD), as well as “moral injury” of the psyche, most commonly referred to in aggregate as “invisible wounds.”
As a nation, we are still massively failing to diagnose and treat these conditions adequately. This is most salient among the 1.64 million Americans deployed as part of Operation Enduring Freedom (OEF; Afghanistan) and Operation Iraqi Freedom (OIF; Iraq) who have borne the brunt of nearly two decades of combat and suffered historic levels of brain injury.
The toll of these invisible wounds extends far beyond the initial injury. Suicide among the veteran community is a rampant and stubborn tragedy, captured in public awareness campaigns such as “22 Veteran Suicides per Day.” Our failure as a nation to address the invisible wounds directly contributes to further lost lives. Studies by the Department of Veterans Affairs find that a history of TBI or PTSD is associated with a substantially increased likelihood of suicide attempts compared to those without the diagnosis — 1.5 and 2.8, respectively. For those with both TBI and PTSD, the likelihood of a suicide attempt is 3.3 times greater than for those with a TBI alone.
Perhaps the most telling data point tied to the failure to address the impact of TBI and PTSD is depicted in a recent study by the Watson Institute of Brown University. The study shows that the suicidality rate for post-9/11 veterans and service members ages 18-34 has exploded to 2.5 times that of the general population — an increase of 76 percent since 2005. As the study quotes: ‘An estimated 30,177 active duty service members and war veterans of the post 9/11 wars have died by suicide, significantly more (4.28x) than the 7,057 killed in “Global War on Terror” military operations.’ The true number of active duty and veterans dying by suicide is most likely greater; there is no national database for tracking suicides and many suicides are often improperly attributed to other causes. One thing we can all agree on is despite years of appreciation for their service and sacrifice, the suicide rate among veterans and service members remains unacceptably high.
The record number of OEF and OIF personnel seeking care for and ultimately, losing their battle to, the invisible wounds of war has grabbed the public’s awareness, sparking the creation of numerous task forces and commissions. The Department of Defense and VA have invested millions to address these injuries and lower the suicide rate, but these investments have proved inadequate to advance prevention, diagnostics, and treatments. We still have no cures. We diagnose both diseases based on symptoms — not biology — and we lack consistently reliable, evidence-based treatments.
Invisible wounds are not invisible to those that struggle with them every day or their families. They are invisible to the rest of us and to the system that is blind to them and has failed to aggressively pursue the answers.
The United States spends a lot of time, money and effort readying our service members for war, only to leave them ill equipped after they return home. After 20 years of war, remembrance, appreciation, and well-intentioned research, we have few returns on our investments. Veterans feel resigned to take their mental health care into their own hands, turning to alternative treatments with little clinical guidance because traditional treatments are not effective and often seeking care outside the walls of the VA. We have an opportunity to correct this. It is time to narrow the gap between “thank you for your service” and the reality that we are falling short when it comes to those who have sacrificed so much for this nation.
The VA and DoD have an ethical obligation to mobilize a national call to arms for research into the invisible wounds of war. They must focus on increasing the body of scientific knowledge that can bring faster diagnoses and new treatments that work. By leveraging existing large-scale collaborative research road mapping efforts, the VA and DoD can build on the suggested solutions of leaders in the nonprofit, academic, and industry spaces as well as their own leadership to more quickly and collaboratively evaluate and put to trial new solutions, including emerging treatments such as psychedelics, stellate ganglion block, and hyperbaric oxygen therapy that are embraced by the veteran community but require further clinical evaluation. The VA and DoD must demonstrate conclusively whether these treatments work, and if so, for which populations. For treatments shown to work, the VA should promptly deploy them throughout the VA system. Finally, Congress should ensure that groundbreaking legislation aimed at creating an environment for research innovation, including the Commander John Scott Hannon Mental Health Improvement Act, is implemented to the fullest extent intended.
As we reflect on the end of 20 years of war and countless men and women lost to suicide, in addition to saying thank you, let us also take necessary steps to support those whose service to their country has forever changed their lives by urgently and greatly expanding the body of science that will once and for all make it easier for veterans and service members to get the care they need. Veterans and service members need definitive answers that only impartial and thorough clinical research can provide. Without swift action, members of the military will continue to suffer needlessly waiting on definitive diagnoses. They will continue to seek care outside of the VA and lowering the suicide rate will remain elusive. We stand ready to be part of the solution and collaboratively help the VA and DoD build towards solutions. Our brave men and women are counting on us to take our “thank you” one step further to meaningful action that truly honors their sacrifice.
Members of the Cohen Veterans Bioscience Veterans Advisory Council:
Hon. Frank Larkin, 40th U.S. Senate Sergeant at Arms (Ret.), Chair
RADM Brian Losey, USN (Ret.) SEAL, Executive Director
VADM Bob Harward, USN (Ret.), SEAL
Robin King, CEO, Navy Seal Foundation
LTG John F. Mulholland, U.S. Army (Ret.), Special Forces
Gayle Tzemach-Lemmon, Author
Cohen Veterans Bioscience is a non-profit 501(c)(3) biomedical research and technology organization dedicated to advancing brain health by fast-tracking precision diagnostics and tailored therapeutics. The Veterans Advisory Council represents, advocates, and supports veterans’ interests to CVB, to partners, and to the broader community engaged in the support, research, prevention, and treatment of brain health conditions.
Editor’s note: This is an Op-Ed and as such, the opinions expressed are those of the author. If you would like to respond, or have an editorial of your own you would like to submit, please contact Military Times senior managing editor Howard Altman, haltman@militarytimes.com.
