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Observations Atlantic crossing

The trouble with US military medicine

BMJ 2007; 334 doi: (Published 15 March 2007) Cite this as: BMJ 2007;334:565

Memorializing our Mental Health Commitment

Uwe Reinhardt’s remarks, in a piece titled the “The trouble with US
military medicine’ was published in 17 March 2006 BMJ. (1) In it, he
says that America’s high-ranking political commitment to our soldiers is
more in word and pageantry than deed and resolve. He highlights the
deplorable conditions of Walter Reed Army Hospital. He asserts the failure
of America’s top military officials to recognize and accept the negative
consequences of their decisions to send troops into Harm’s Way. I agree
with both the substance and spirit of his comments.

Reinhardt, however, does not go far enough in his criticism---at
least as it fails to illuminate the psychological problems and the
inadequate supportive mental health treatment of war veterans. Those
problems include:

1. Inability of the American mental health system, primarily through
lack of funding and failure to (generally) attract sufficient numbers of
highly qualified personnel, including clinical psychologists and
psychiatrists, to understand the differential diagnostic nuances of
returning veterans.

• That lack of a resource includes the inability of many clinicians
to discriminate the psychological elements of posttraumatic stress
disorder from the neuropsychiatric sequelae of toxic exposure, closed (or
open) head injury, response to physical trauma, and adverse effects of
post-war illicit drug and polypharmaceutical treatments. (2)

2. The failure of American mental health systems, including the
poorly-funded Veterans Administration and any other system designed to
treat war-affected individuals, to plan for not only the acute
manifestations of serious mental problems that confront returning vets,
but also those that will plague them, and their families and loved ones,
for years.

• This obligation goes far beyond preventing suicides. (2, 3, 4)

3. To anticipate the negative psychological responses, including the
likelihood of significantly delayed onset, of veterans and veterans’
families who become increasingly aware as years pass that they and their
loved ones may have been sent to war for reasons other than they once

• Physical and mental disabilities can explode when an individual
suddenly recognizes that he or she has been misled, misused, or, as
Reinhardt states, becomes aware that he was exploitable ‘human capital.’
What happens to a fighting man or woman who realizes he or she has
fought not for honor and glory(as in World War II) or the realization of
the American dream(the Revolutionary War), but perhaps for some less
honorable cause?

4. The gamut of emotional reactions and behaviors that result from
dishonesty, deception, misrepresentation, torture, drug addiction,
joblessness, social alienation, family dysfunction, cognitive impairments,
helplessness, loneliness, rage, disenfranchisement, disease, dismemberment
and death.

• The resources needed to effectively deal with these issues do not
come from a medicine bottle, so treatment cannot be hastened by
psychiatric drug prescriptions provided in the context of ten-minute
sessions every month [even if the personnel were available to exercise
that solution.] The solutions must come from a willingness to put forth
an enormous multi-focused effort that include the finances and personnel
available to address long-term mental, emotional, addictive, cognitive and
physical health demands, as well as occupational, financial, family,
social, spiritual, and interpersonal needs.

America’s Memorial Day 2007 is upon us. We can do better for those
who serve on behalf of our Republic in these trying times.

Stefan P. Kruszewski, MD
Harrisburg, Pennsylvania USA 17112

(1) Reinhardt, U. (17 March 2007). The trouble with US military
BMJ; 334:565
(2) Tomlinson, K. (Accessed 5.19.2007). Treating Veterans with Serious
Mental Illness—The VA’s Ability to Deliver Quality Care. Accessed at

(3) (Accessed 5.19.2007). Report: Vets Mental Health
Treatment Poor. Lack of 24-hour care Options Concerning. Accessed at:

(4) Veteran Administration Office of Inspector General, Washington,
DC 20420. 10 May 2007. Healthcare Inspection. Implementing VHA’s Mental
Health Strategic Plan Initiatives for Suicide Prevention. Report No.
06-03706-126 Accessed on May 18, 2007 at:

Competing interests:
None declared

Competing interests: No competing interests

21 May 2007
Stefan P. Kruszewski, M.D.
Psychiatrist, addictionologist
Harrisburg, Pennsylvania 17112 USA