U.S. Army Confronts Mental Health Problems

How one daughter survived her veteran father’s PTSD and what research suggests should be done to help others

U.S. Army Confronts Mental Health Problems
U.S. Marines from Task Force Tarawa search for Iraqi troops on March 26, 2003, in southern Iraq. (Getty Images)

On the morning of Sept. 11, 2001, as smoke billowed from the Pentagon in Arlington, Virginia, U.S. Army Maj. David Komar helped evacuate the daycare center that stood on its grounds. As he wheeled cribs out of the building and helped childcare workers grab essential items, Komar, who later became a brigadier general, wondered whether all his colleagues would make it out alive.

But mostly, he was thinking about his wife and two kids, the youngest of whom was the same age as some of the crying children he was helping to corral. Out of harm’s way himself, Komar wondered whether some of the daycare’s charges had just lost one or both parents to the scorching fire burning in the rubble of the building and the Boeing 757 that barreled into it at 530 mph.

For decades, Komar, a veteran of Operation Desert Storm and the Afghanistan War, would be repeatedly asked to recount the experience, often by journalists. People always told him he was a hero and thanked him for his service. They saw my father’s bravery and his admirable service mentality.

What they couldn’t see was the mental anguish, the trauma that was compounding and would continue as 33 years of military service wore down his mind and body. They couldn’t see the nightmare that day helped catalyze not just for him but for our family.

I was too young to remember any change and instead grew up knowing only one, often frightening version of my father. But as my mother tells it, after the stress of his experience on 9/11, my dad became more withdrawn, more depressed, quicker to anger. He started exhibiting classic signs of post-traumatic stress disorder (PTSD), including nightmares and sudden, uncontrollable fits of rage. My brother and I usually bore the brunt of those outbursts. But our family’s story was far from unique.

The U.S. military spent decades misunderstanding the effects of service-related trauma and stress on veterans. When my dad joined the Army in 1987, at age 21, the term PTSD was not used — combat-related mental health struggles were known as “battle fatigue.” Following that, plus 20 years of active conflict in the Middle East, the military has a problem. Service members and veterans are suffering a severe mental health toll, while a long-standing culture of stoicism and stigma has created a challenging environment for those needing help.

Dr. Brian Moore, a research psychiatrist and director of the Center for the Advancement of Military and Emergency Services Research at Kennesaw State University in Georgia, served 13 years in the Army before deciding to study military mental health. One of the biggest reasons for the current crisis, Moore explained, is that improvements in body armor and other equipment have resulted in more soldiers surviving active conflict and bringing its effects home.

The current problem can be difficult to quantify. According to the 2021 Health of the Force report, 15% of Army soldiers had been formally diagnosed with one or more mental health disorders — lower than the 21% rate of the U.S. adult population but still up from 9.4% 15 years earlier. However, in a 2014 study of some 5,500 active-duty, non-deployed Army soldiers, researchers found that nearly 25% met the diagnostic criteria for at least one mental illness. The rate of major depression was found to be five times as high as among civilians, the rate of intermittent explosive disorder — characterized by episodes of extreme anger — six times as high and the rate of PTSD nearly 15 times as high.

Veteran suicides also paint a grim picture. According to a Boston University report, by June 2021, an estimated 30,177 veterans of the post-9/11 wars — excluding reservists and guardsmen — had died by suicide, compared with the 7,057 killed in those wars. Department of Veterans Affairs estimates suggest the veteran suicide rate is rising and is about 1.5 times that of the general population.

The unprecedented nature of warfare during the U.S.’s most recent conflicts was especially detrimental to soldiers’ mental health, Moore said.

“The way the Iraq and Afghanistan conflicts were was sort of asymmetric,” Moore said. “There was no front line. You could be attacked from any side at any point, including from inside your safety environment. That’s very taxing.”

Many soldiers experience terrible things while deployed that stick with them forever, which they often bottle up.

My father still vividly remembers Desert Storm and the months afterward when his unit patrolled the southern bank of the Euphrates and witnessed the gruesome realities of war and Saddam Hussein’s atrocities. Surveying enemy losses after artillery strikes they had unleashed, he and his compatriots sometimes found the festering, seared bodies of Iraqi cooks who’d been chained to their stoves so they couldn’t desert. To this day, the smell of burning flesh, like when someone burns themselves while cooking, makes my dad freeze up.

For Steve Smith of upstate New York, who spent 30 years in the Army, it’s memories of the aftermath of a certain battle when he was a battalion commander during Operation Iraqi Freedom. He and the rest of his brigade were treating the wounded when an Iraqi man brought a young child to them.

“This little boy, maybe 4 years old, 5 years old, had been hit by some explosive, had an open wound in his stomach and he was not going to live. I saw this little boy and I got up and went over … and I asked the major who had escorted this guy, ‘What happened?’ And he just looked at me and said, ‘Oh, you guys did this.’ Meaning our artillery guys. And it just affected me personally,” Smith said, choking back tears.

In addition to damaging individual well-being, unmanaged mental illness can hurt the military’s ability to carry out missions. In a 2017 article, Peter Holstein of the Air Force surgeon general’s public affairs office wrote that sound mental health was “critical to readiness” and that “complications from mental health issues are one of the most common reasons for medical evacuation of service members” from combat.

Soldiers with “behavioral health conditions” accounted for about 80,000 hospital admissions and a million medical encounters in 2014, equivalent to nearly an entire battalion spending three months in the hospital each year, according to an Army report.

Ask veterans how mental health was discussed when they were in the military, particularly in their earlier years, and most will tell you it simply wasn’t. They’ll describe a culture of fear and stigma in which those suffering from mental illness were viewed as feeble, crazy and dangerous. Soldiers were ashamed to talk openly about their struggles and afraid of what might happen should they seek help. After all, getting treatment for even minor mental health issues — treatment that, until a 2014 rule change, counselors were almost always allowed to report to commanders — could mean losing a security clearance, being reassigned to menial tasks or being discharged.

“Particularly when I was a lieutenant, and a captain as well, I had no doubt in my mind if I let my chain of command know [I was struggling], or if I went to go get counseling, that my security clearance would be at risk,” my father told me.

Cam Wesson of Leavenworth, Kansas, who spent 22 years in the Army before retiring in 2005, saw those kinds of scenarios play out too many times to count, he said. In one instance, one of Wesson’s colleagues was traumatized after returning from Desert Storm and losing his wife to a massive brain aneurysm, along with an unborn baby. He spiraled downward and his commanders fired him without trying to rehabilitate him, Wesson said.

“We were all dumb … our commanders were dumb,” Wesson said. “I remember our battalion commander — and I won’t use his name — but him and a sergeant major were just like, ‘Get rid of him.’ No help, no nothing else. ‘Get rid of him.’”

In a 2010 survey of enlisted Army soldiers who had been in combat for nine months and screened positive for mental health disorders, 28.6% said they did not seek treatment because “it would be too embarrassing” and 48.9% said they didn’t because “I would be seen as weak.” About 60% to 70% of military personnel who experience mental health problems do not seek treatment, according to the Defense Health Agency.

Even soldiers who manage to get past the wall of stigma or are lucky enough to have open-minded commanders must often contend with staff shortages at their local military and civilian medical facilities, Moore said. “Sometimes … you can ask for help and it’s just not there,” he said.

Until I was about 16, I was terrified of my father. He could go from exhausted but calm to furious and screaming in the blink of an eye. He would back me and my older brother, Stephen, up against walls and shove his finger into our chests while berating us at the top of his lungs for infractions as small as bickering or talking back.

When he deployed to Kabul for a year as part of a NATO training mission in Afghanistan in 2011, I was worried for his safety but secretly relieved that we would get a break. But when he returned, further traumatized by his experience, things became worse than ever.

He had lost friends to roadside bomb attacks there and the experience had brought back bad memories of Desert Storm. The deployment also opened his eyes to just how deeply the military had deceived Americans about the “progress” being made in Afghanistan. He witnessed rampant corruption and abject poverty and returned home alone, demoralized and angry. It had been several years since he had last seen — in secret, of course — a psychologist for his depression and he received no mandatory post-deployment counseling or evaluation. As he had previously done in times of extreme stress, he took it out on us.

But we were far from alone. After 20 years of war, the military faces a twin crisis of domestic abuse, heavily linked to unchecked mental illness. The true extent of the problem — especially in relation to child abuse — is hard to pin down because of data gaps and reporting failures, according to government auditors. Still, the Government Accountability Office found more than 40,000 incidents of domestic abuse involving service members, spouses or intimate partners were recorded in fiscal years 2015-2019.

“[A military spouse] can’t possibly do it all while the husband is deployed,” said Rohini Hughes, a military domestic abuse survivor and vice president of the National Military Family Advocacy Organization. “And then, when he returns, mental health evaluation or treatment is not even mandated. So he’s coming home, possibly bringing PTSD or complex PTSD. And there’s erratic behavior that’s taking place — escalation and aggression.”

The link between untreated mental illness and family abuse is clear and strong, said Moore, whose center’s research scope includes military family and community dynamics.

“One thing … that military people don’t necessarily even think is bad is anger and aggression … that’s part of it,” Moore said. “Like, I was an infantry officer, and if you’re not angry about something you’re probably not doing your job. If you’re not aggressive you’re definitely not doing your job. And so a lot of times … adults have difficulty separating our work and home life.”

Male combat veterans suffering from PTSD were two to three times more likely to abuse their female partners, clinical psychiatrist Dr. Richard Frierson determined in a 2013 literature review. In one study, about 33% of combat veterans with PTSD in an intimate relationship reported perpetrating physical aggression against their partners in the previous year, while 91% reported perpetrating psychological aggression.

Nor do women in the military only suffer at the hands of disturbed partners. Female veterans are also disproportionately impacted by mental illness. Almost 20% of female veterans of the Iraq and Afghanistan wars have been diagnosed with PTSD — the highest rates compared with male veterans and civilians, according to Department of Veterans Affairs (VA) data.

Women tend to experience PTSD differently and are more likely than men to feel emotionally numb, be jumpy, avoid reminders of their trauma and suffer depression and anxiety. Meanwhile, men are more likely to feel angry, have trouble controlling anger and develop alcohol or drug problems. Regardless, the disease can be just as detrimental to military women’s health. With the female percentage of the veteran population projected to grow from 9.4% in 2015 to 16% in 2040, the military could be staring down another ticking time bomb.

There are some signs of a slow culture shift surrounding mental health in the military. High-ranking veterans — including my own father, now a retired general — are starting to speak out about their personal experiences with mental illness.

My dad has been regularly seeing a VA therapist for years. Being retired and getting distance from the Army’s most toxic aspects has helped his recovery immensely. “I’d been so indoctrinated into the Army culture,” he said. The person he is today seems miles from the erratic, furious man in crisis I spent my childhood fearing. My family is healing together through time, therapy and tough emotional work.

Once afraid to admit his struggles, my dad is now vocal about his story. He thinks it is important for young soldiers to see their superiors openly discuss mental health, the importance of proactivity and the services available.

“Most people don’t know … there’s different kinds of counseling, these are some of the different things you can accomplish by doing counseling,” he said. “I had no idea, and I went to college. I have a couple of master’s degrees and I didn’t know that stuff. How do you expect some 17-, 18-year-old, 20-year-old to know?”

In January, active-duty Air Force Gen. Mike Minihan made headlines for tweeting a photo of his daily schedule with all his appointments blurred except one: a mental health check-in at his installation’s clinic. “Warrior heart. No stigma,” Minihan wrote.

In July, Jason Kander, a veteran of the Afghanistan War, a former Missouri secretary of state and the current president of national expansion for the Veterans Community Project, published an autobiography detailing his journey into PTSD recovery. The rising political star had made national waves in 2018 when he abruptly and very publicly left politics to seek treatment at the VA.

“I didn’t want to want to kill myself,” Kander said. “So I decided to get help. And the reason I decided to be public is because I realized that maybe if somebody like me in a public role had done that years ago, maybe I would have gotten help a lot sooner.”

Although increasing openness may be creating slow cultural change, most veterans agree more is needed to build a brighter future.

David Preston of Williamsburg, Virginia, a 27-year Army veteran who retired in 2017, recognizes the importance of mental health to soldier well-being and unit readiness. He implemented a nearly unheard-of policy during his fourth deployment to Iraq, in 2010, when he served as a battalion commander. Preston made it a standing order that if any of his soldiers experienced a traumatic event, they were required to meet with an embedded psychologist. At the time of his battalion’s post-deployment survey, no soldier in it had diagnosed PTSD.

Preston thinks service members would benefit from such policies becoming universal. Those changes could come from new rules implemented by military branches, the Department of Defense, or, at the most decisive level, Congress or the president.

Some such moves have been made recently, as in the 2022 National Defense Authorization Act, which includes language that permits soldiers to refer themselves for mental health evaluation and requires commanders to make it happen promptly. Dubbed the “Brandon Act” after Navy Petty Officer Brandon Caserta, who died by suicide, the provision will also help service members seek confidential treatment outside the chain of command. However, multiple other bipartisan bills aimed at tackling the mental health crisis died in committee last year.

Moore thinks much of the focus needs to be on developing better early intervention strategies.

“The problem with rehab is you never quite get back to normal,” Moore said. “So what I’m interested in looking at is not a rehabilitative approach but a ‘prehabilitative’ approach.”

One factor that veterans and experts seem to consistently think will be critical is time.

“Trust is not something that’s gained overnight,” Wesson said. “And it’s not one thing specifically, it’s a whole bunch of little things that are put together that show the people who are in now that it’s OK. Then it becomes a teaching and it becomes something that’s handed down to the next generation.”

My father also thinks that, despite signs of progress, the military has a long, winding road ahead. I tend to agree. Just as it has taken and will continue to take time for my family — and so many others — to heal from what we have experienced, it will take time for the military to mend its deep, self-inflicted wounds. Perhaps, one day, it will be an unrecognizable system to me, fostering an environment that saddles fewer families with something to heal from in the first place.

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