Wars are not over when the shooting stops. They live on in the lives, memories, bodies, and brains of those who fight them.
We want to share a story of a former patient Max Cleland. Forty-eight years ago in Vietnam, he lost two legs and then his right arm in a grenade explosion. The physical injuries healed first; the rehabilitation took much longer, and the emotional anguish has never completely healed for him.
Max’s experience as a patient with post-traumatic stress disorder (PTSD), former head of the Veterans Administration, founder of the Vet Center Program that provides counseling, outreach and referral services to combat veterans and their families, and as a United States Senator, gives him a unique viewpoint that we are excited to share with you.
There is Room for Improvement in Mental Health
First, we must also acknowledge there is significant room for improvement in mental health care as there remains an unacceptably high number of suicides among veterans, and the success rates for PTSD, depression, and anxiety disorders have not improved in years.
In addition, the fallout from the recent wars will impact veterans, families and our society for at least 70 more years. PTSD, depression, and traumatic brain injuries (TBI), common among our veterans, all increase the risk of Alzheimer’s disease and other forms of dementia.
These problems will not be solved without intense, long-term focus and commitment. Anything this country can do to improve mental health care to our war-injured, we should do. It is more than extending a helping hand.
Max shared with us how slow his treatment path was. It was also, frustrating, and sometimes terrifying. For years he told physicians about his symptoms, then based on those symptoms he was prescribed a variety of psychotropic medications (anti-depressants, anxiolytics, and sleep medications), which were mostly ineffective or made him feel worse.
How SPECT Brain Imaging Changed Max’s Life
On the advice of a colleague, Max had a functional nuclear brain imaging study called SPECT (single photon emission computed tomography) that measures regional cerebral blood flow.
PTSD and TBI can have overlapping symptoms (e.g., insomnia, anxiety, depression, and concentration problems — Max had all of them), but the treatments are very different; and the ones that may be helpful for PTSD, such as selective serotonin reuptake inhibitors or benzodiazepines, can impede function or even be harmful to those with TBI.
Max’s SPECT scan showed evidence of both PTSD and TBI. The TBI was never addressed because he did not lose consciousness in the explosion. The functional study gave his physicians important direction for treatment that significantly improved how he felt over time and provided insights into adverse responses to prior medications.
A New Perspective of Mental Health for Max
In truth, the results gave Max a new perspective of himself and the mental health care system.
Fewer than half of those who suffer from mental health problems ever seek help. Why? Let’s be honest…
Many active duty personnel, veterans, and people in general, hesitate to seek mental health care. No one wants to be labeled mentally ill, defective or abnormal.
In addition, the value of knowing that the structure of Max’s brain was normal, but the function was abnormal, gave him hope that his brain could get better.
What if We Reimagined Mental Health as Brain Health?
At Amen Clinics, we believe this one simple idea could shift the negative attitudes many people have about mental illness, decrease stigma, and increase the willingness to get help among those who most need it.
We envision a time in the not-too-distant future when mental health problems will be evaluated and treated like other medical issues, and physicians will use functional imaging tools, genetics, and other markers to guide treatment — just as cardiologists, oncologists or orthopedists do to help their patients today.
Max Cleland is a disabled U.S. Army veteran of the Vietnam War, a recipient of the Silver Star for valor, former head of the Veterans Administration, and U.S. Senator from Georgia. He is a strong advocate for veterans and all of those who struggle with mental health issues.