Invisible Wounds of War: Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery (2008) | 
 enlarge | Author: Terri Tanielian
Publisher: RAND Corporation
Category: Book
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Avg. Customer Rating:  1 reviews
Sales Rank: 265383
Media: Paperback
Number Of Items: 1
Pages: 424
Shipping Weight (lbs): 2.4
Dimensions (in): 9.9 x 6.9 x 1.5
ISBN: 0833044540
Dewey Decimal Number: 362.19685212
EAN: 9780833044549
ASIN: 0833044540
Publication Date: May 25, 2008
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Product Description
A comprehensive study of the post-deployment health-related needs associated with post-traumatic stress disorder, major depression, and traumatic brain injury among servicemembers returning from Operations Enduring Freedom and Iraqi Freedom, the health care system in place to meet those needs, gaps in the care system, and the costs associated with these conditions and with providing quality health care to all those in need.
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| Customer Reviews:
Important, but not comforting.... August 17, 2008
1 out of 1 found this review helpful
This book, based on a recent (2007-08) RAND study is, so far, the best look we have into what we, as a nation, and what we as mental health providers are likely to be facing over the next half century.
The study lays out three "signature injuries" of the Iraq/Afghanistan war -- PTSD, depression, and TBI or traumatic brain injury (formerly known as closed head injury). Yes, the study has severe limitations, which to their credit, they acknowledge. As a mental health provider working regularly with soldiers from this war and working a lot with the families of soliders from this war, it's my strong guess that their phone interviews grossly underestimate the prevalance of all three injuries. And their prevalence rates -- 14% for PTSD; 14% for major depression, and scariest of all, 19% for TBI -- are truly sobering. This alone totals to over a third of a million young men & women.
The reasons I believe for underestimates are not only my work with "supposedly" non-PTSD, TBI & major depression soliders. It's also 1. knowing how difficult it is for soldiers to admit to these problems, because it so goes against the grain of their own self-perceptiions & hopes and of the necessary military culture, 2. because of the tragically lingering & sometimes horrendous prejudices still against soliders admitting to PTSD (I know, for example, of a solider who was shamed, this within the last few months (2008), by his commanding officer and in front of his fellow soliders), 3. lingering misperceptions on what PTSD, depression and TBI are & what they mean, 4. I have never seen a TBI that didn't go toward major depression & PTSD once it became clear to the person what the on-going deficits & limitations were, and 5. how common major depression becomes once PTSD has settled in for a longer run. Co-morbidity rates -- how common it is to find major depression with PTSD -- run, I believe, at about 60% -- many of us believe that depression is a common part of PTSD. Just as frightening, the comordity rates of PTSD & addictions or alcoholism with males run, as I recall, about 65%, around 2/3's, among vets about 75%. And addictions, while discussed in this study, wasn't given a prominent place. You have to read quite a bit to find it.
The Army & Air Force (I haven't worked with the Navy & Marines) are making genuine & on-going efforts & good progress in changing their culture & systems around assessing, respecting & treating these combat injuries. They're also doing much better in educating soliders & their families, and in setting up programs and promoting access to those programs for treating these illnesses. Only those of us who've worked in the too-recent "bad old days" know how much improvement has been made. And there are now ways, once we know what's happening, to provide for official support & healing.
But: this study, the breadth of these injuries is enormously scary. As the Rand study points out, this will be very, very costly for a long time. (The study provides preliminary cost estimates.) It's also likely to overwhelm the VA, which is, I'm told, powering up in response.
We have, as a field, good techniques for treating PTSD & depression, with more appearing all the time. But our ignorance in assesing & treating TBI is truly vast. We have 60 years, since WWII, of clear evidence on what happens with combat PTSD over the lifetime. Our knowledge of TBI, especially in its less severe forms, over the lifespan is poor. I've worked with TBI's regularly for over a decade and my wife in the last few years sustained a serious TBI. (I've worked 20 years with PTSD & major depression.) At this stage with TBI, we don't even know what we don't know.
Again, this book has important information for all citizens. We're going to be voting monies to support our wounded vets, this in a time of severely limited budgets. We're going to be designing programs to meet these needs, needs which can have even greater costs if we don't treat these injuries. (This study makes clear and, generally, solid recommendations here, too.) Whatever we may think of this war, we must join together to support the men & women we, as a country, have asked to fight. Anything less is dishonorable. This book prepares us, in many ways, for our responsibilities: what that means, what we're facing, what it's going to cost.
The problem with this book is its not only its incompleteness, but just as much its completeness. Most of us, including mental health professionals, don't need this detail and can't even productively wade through it. I can only hope that a book half or a quarter of its 450 pages will ultimately be produced. Because not only mental health providers & policy planners need to know the scope and the recommendations on services. So do ordinary citizens. And unless you're willing to wade through a lot of words -- mercifully not as many technical words as could be -- you'll likely be overwhelmed. Note, too: this book is not about how to assess or treat any of these disorders.
But as a country, and as voters, we need to know what's here.
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