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The War Inside

But there is another obstacle that those steps could not overcome. "One of my great concerns is the stigma" of mental illness, Pollock said. "That, to me, is an even bigger challenge. I think that in the Army, and in the nation, we have a long way to go." The task force found that stigma in the military remains "pervasive" and is a "significant barrier to care."

Surveys underline the problem. Only 40 percent of the troops who screened positive for serious emotional problems sought help, a recent Army survey found. Nearly 60 percent of soldiers said they would not seek help for mental-health problems because they felt their unit leaders would treat them differently; 55 percent thought they would be seen as weak, and the same percentage believed that soldiers in their units would have less confidence in them.

Lt. Gen. John Vines, who led the 18th Airborne Corps in Iraq and Afghanistan, said countless officers keep quiet out of fear of being mislabeled. "All of us who were in command of soldiers killed or wounded in combat have emotional scars from it," said Vines, who recently retired. "No one I know has sought out care from mental-health specialists, and part of that is a lack of confidence that the system would recognize it as 'normal' in a time of war. This is a systemic problem."

Officers and senior enlisted troops, Vines added, were concerned that they would have trouble getting security clearances if they sought psychological help. They did not trust, he said, that "a faceless, nameless agency or process, that doesn't know them personally, won't penalize them for a perceived lack of mental or emotional toughness."

Overdiagnosed or Overlooked?

For the past 2 1/2 years, the counseling center at the Marine Corps Air Ground Combat Center in Twentynine Palms, Calif., was a difficult place for Marines seeking help for post-traumatic stress. Navy Cmdr. Louis Valbracht, head of mental health at the center's outpatient hospital, often refused to accept counselors' views that some Marines who were drinking heavily or using drugs had PTSD, according to three counselors and another staff member who worked with him.

"Valbracht didn't believe in it. He'd say there's no such thing as PTSD," said David Roman, who was a substance abuse counselor at Twentynine Palms until he quit six months ago.

"We were all appalled," said Mary Jo Thornton, another counselor who left last year.

A third counselor estimated that perhaps half of the 3,000 Marines he has counseled in the past five years showed symptoms of post-traumatic stress. "They would change the diagnosis right in front of you, put a line through it," said the counselor, who spoke on the condition of anonymity because he still works there.

"I want to see my Marines being taken care of," said Roman, who is now a substance-abuse counselor at the Marine Corps Air Station in Cherry Point, N.C.

In an interview, Valbracht denied he ever told counselors that PTSD does not exist. But he did say "it is overused" as a diagnosis these days, just as "everyone on the East Coast now has a bipolar disorder." He said this "devalues the severity of someone who actually has PTSD," adding: "Nowadays it's like you have a hangnail. Someone comes in and says 'I have PTSD,' " and counselors want to give them that diagnosis without specific symptoms.

Valbracht, an aerospace medicine specialist, reviewed and signed off on cases at the counseling center. He said some counselors diagnosed Marines with PTSD before determining whether the symptoms persisted for 30 days, the military recommendation. Valbracht often talked to the counselors about his father, a Marine on Iwo Jima who overcame the stress of that battle and wrote an article called "They Even Laughed on Iwo." Counselors found it outdated and offensive. Valbracht said it showed the resilience of the mind.

Valbracht retired recently because, he said, he "was burned out" after working seven days a week as the only psychiatrist available to about 10,000 Marines in his 180-mile territory. "We could have used two or three more psychiatrists," he said, to ease the caseload and ensure that people were not being overlooked.


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