The PTSD stigma shuffle

Since 2007, the Defense Department has worked to eliminate the stigma associated with seeking help for Post-Traumatic Stress Disorder and other mental health conditions, including a public education campaign and training for senior leaders.

In May 2008, then-Defense Secretary Robert Gates eliminated what troops considered a major roadblock to seeking help for PTSD -- a requirement that service members acknowledge on security clearance forms whether or not they had consulted with a health-care professional during the previous seven years regarding an emotional or mental health condition.

Anyone who answered yes had to provide dates of treatment and the provider's name and address.

"For far too long and for far too many, this question has been an obstacle to care," Gates said when he ordered a key change in that form. A new policy said service members could answer "no" to that question, he said, "if the care was strictly related to adjustments from service in a military combat environment."

Despite this policy change, soldiers seeking care for PTSD still bear the stigma burden, the Army Surgeon General's office reported in an new PTSD diagnosis and policy memo released April 10.

When career soldiers seek help from mental health professionals, that memo said, they do not want a PTSD diagnosis documented in their health record, viewing it as an impediment to advancement. To accommodate these troops, the policy memo said clinicians record PTSD consultations as "Anxiety Disorder Not Otherwise Specified."

The Surgeon General memo said clinicians contacted in a survey went along with this diagnosis side-step to help reduce stigma and protect future career prospects Changing a PTSD diagnosis to less career-threatening condition "reflects a current standard of practice within military treatment settings," [emphasis added] the policy memo said.

Or it drives troops wanting to protect their careers to seek help outside the system. An active duty buddy of mine definitely needed help after his second Iraq tour but did not want to jeopardize his career and asked if I could refer him to a mental health professional outside the military health care system, which I did.

This buddy also has access to a network of vets who he can talk to outside a clinical setting -- old-fashioned peer therapy -- a treatment approach, as far as I know, ignored by all four services.