Navy Surgeon General Discusses Signature Wounds of War

By Terri Moon Cronk
DoD News, Defense Media Activity

WASHINGTON, Sept. 19, 2014 - Of the signature wounds of the past 13 years of war, limb amputations affect the service member most directly, while psychological health issues can have altogether different challenges, Navy Surgeon General Vice Adm. (Dr.) Matthew Nathan said yesterday.

Speaking to medical personnel at the Defense Centers of Excellence for Psychological Health and Resilience summit in Falls Church, Virginia, Nathan said that since the start of the Iraq and Afghanistan wars, some 1,500 to 1,600 service members across the services suffered amputations -- the visible wounds of war. But 10,000 sailors and Marines alone suffered the invisible wounds of post-traumatic stress or traumatic brain injury, he said.

And "the whole family is consumed by significant psychological health issues," he added.

Nathan, a former commander of Walter Reed National Military Medical Center, said it takes about a year for amputees to get their lives back through the use of prosthetics and other support. "But I could not make that promise to somebody suffering from moderate to severe TBI or post-traumatic stress," he added.

PTSD, TBI treatment can be longer lasting

Nathan said in about 80 percent of limb-loss cases, even service members who lose both legs could run in races using prosthetics a year after injury. Yet the outcomes for those with severe PTSD or TBI can be quite different, he told the audience.

"I bet we know 10 percent to 15 percent of what we need to know," Nathan said of treatment for the invisible psychological wounds of war. "It is much more of an art than a science."

What military medical practitioners do know, he said, is that embedding mental health care specialists where service members begin to develop issues is a concept that works, and it's been proven through evidence and statistics.

"We know that when we put a psychologist on aircraft carriers, all of a sudden the medical evacuation rate for emotional health issues drops like a rock," he said, adding that the same is true for embedding mental health professionals in combat zones and primary care environments. And when embedding mental health professionals in remote locations isn't possible, he said, the services are bringing psychological support to troops via video cameras in a practice now called telemedicine and telebehavioral health.

"We know this is critical," Nathan said of reaching the service member in distress as quickly as possible.

Yet one element of getting mental health care that remains an issue in the military is the stigma of seeking care, he noted. "We know stigma is a huge thing," he said. "Even though we've reduced it to some degree, we still have [problems]."

The need for leadership

The stigma of seeking mental health care can be particularly evident in certain high-demand duty assignments, Nathan said. "If you say, 'I think I am going to kill myself, I want to kill myself, or I'm worried about killing myself, you are done,'" he said of such environments. "So, we have to take another look. It takes a village to approach somebody with these maladies."

And in the battle against the stigma of seeking mental health care, leadership by example can carry a powerful message, Nathan told the audience.

When he commanded Walter Reed National Military Medical Center, in Bethesda, Maryland, in his previous assignment, Nathan said, he once noticed a Marine Corps major general sitting alone in the mental health clinic waiting room for about 45 minutes. Nathan approached him and offered to ask the clinic staff why it was taking so long to see him.

"He said, 'I'm not waiting to see the psychiatrist. I'm waiting for my wife in cardiology,'" Nathan said. He pointed out to the general that cardiology was across the campus and asked him why he was waiting for her in the mental health clinic.

The general's answer was simple, Nathan said.

"He said, 'I sit here to wait for her because I want any Marine that walks by to think I'm here to get help. If any Marine sees a two-star general waiting to see a psychiatrist, half the Corps will know. That's what I am hoping for. I hope that the word gets out that if a general is waiting to see somebody for emotional health issues, a corporal and a gunner will,'" Nathan said.

"That is leadership by example," he said. "That is what we need to do."