Issue Report

Invisible Wounds: Psychological, Neurological Injuries Confront our Newest Veterans

As early as 1919, doctors began to track a psychological condition among combat veterans of World War I known as “shell shock.” Veterans were suffering from symptoms such as fatigue and anxiety, but science could offer little in the way of effective treatment.

Although there remains much more to learn, our understanding of war’s invisible wounds has dramatically improved. Thanks to modern screening and treatment, we have an unprecedented opportunity to respond immediately and effectively to the veterans’ mental health crisis.

Among Iraq and Afghanistan veterans, rates of psychological and neurological injuries are high and rising. According to a landmark 2008 RAND study, nearly 20 percent of Iraq and Afghanistan veterans screen positive for Post Traumatic Stress Disorder or depression. Troops in Iraq and Afghanistan are also facing neurological damage. Traumatic Brain Injury, or TBI, has become the signature wound of the Iraq War. The Department of Defense is tracking about 5,500 troops who have suffered TBIs, but many veterans with TBIs are not being diagnosed. According to the RAND study, about 19 percent of troops surveyed report a probable TBI during deployment. These milder injuries are difficult to identify and are often not easily distinguished from Post Traumatic Stress Disorder or depression. In fact, tens of thousands of troops are suffering from either two or all three of these conditions.

Although these statistics are troubling, we have yet to see the full extent of troops’ psychological and neurological injuries. Servicemembers are still deploying on long and repeated combat tours, which increase the risk of blast injuries and combat stress. Rates of marital stress, substance abuse, and suicide are all increasing. The annual divorce rate among female Marines is 9.2%, almost three times the national average. During the Iraq War, the Army suicide rate has increased every year, and the rate for 2008 is likely to hit a 27-year high. Untreated psychological injuries are also a risk factor for homelessness; almost 2,000 Iraq and Afghanistan veterans have already been seen in the Department of Veterans Affairs’ homeless outreach program. Because of these long-term effects, the economic cost of the new veterans’ mental health crisis has been estimated in the billions of dollars.

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