Army's No. 2 officer worries about war's toll on mental health

Four-star general has become an advocate for soldiers suffering from invisible wounds.

Gen. Peter Chiarelli, the Army's No. 2 officer, hardly goes anywhere without his brain chart. It has three images: a normal brain, the brain of a comatose person, and the brain of a conscious person who has just suffered a traumatic brain injury. It doesn't take a neurologist to see that there is very little difference between the brain of the person in a coma and that of the person with the traumatic brain injury. And that is precisely Chiarelli's point.

The four-star general has become an advocate for soldiers suffering from the invisible wounds of war. He's candid about the toll that a decade of fighting has taken on the mental health of many of his troops. But Chiarelli is hopeful that the Army is making the necessary cultural changes-and that the military is taking the lead on innovative solutions-to deal with traumatic brain injury and post-traumatic stress. Edited excerpts of his interview with National Journal follow.

NJ: Statistics show that more members of the military kill themselves than die in combat. Has the Army made progress in this area?

CHIARELLI: I definitely think that we have made progress, but we're fighting an uphill battle. The underlying cause, the stress on the force, the things that are causing the stress on the force, still remain when you have operational-tempo levels that are at what they are right now, especially after 10 years
of conflict.

NJ: Will the suicide rates turn around only when the Army reaches its goal of one year deployed for every two years at home?

CHIARELLI: It's not when you get to 1:2. No one is at 1:2 until they've spent 24 months at home. So it will probably be two years after we reach that point that you will start to see that. But 1:2, frankly, is not sustainable. So this is a huge issue here. It affects not only suicides; it affects the high-risk behavior that you see.

NJ: By high-risk behavior, do you mean alcohol abuse?

CHIARELLI: Overuse of alcohol, prescription-drug abuse. There are folks who have anger-management issues, some that are caused by post-traumatic stress. Post-traumatic stress is something that concerns me because we know-at least, the [National Institute of Mental Health] claims-that an individual who suffers from post-traumatic stress is six times more likely to attempt to commit suicide.

NJ: You are trying to drop the D from PTSD. Why?

CHIARELLI: Words mean something, and if you leave that D, there are some people who think it's a preexisting condition that someone had. I submit to you, it's not. It's caused by an event or a series of events that causes a person to literally have the frontal cortex of the brain not operate the way it's supposed to operate.

NJ: The Army has long had a stigma about mental health.

CHIARELLI: Not the Army, not the military. It's everybody. I believe that the stigma associated with behavioral health issues is something that is shared by the general public. We're just admitting it. And what the Army's trying to do internal to itself is to change that culture. We have a lot of folks who are very focused on the mission who don't want to let their buddies down. Sometimes that gets in the way of seeking the help that they want and need.

NJ: You have expressed concern about the level of research into post-traumatic stress and traumatic brain injury. What worries you?

CHIARELLI: We do not know how to treat post-traumatic stress and traumatic brain injury with the same kind of assurance that we know how to treat what I call the mechanical injuries of this war. The science is just not there. There is a lot of wonderful, very important research going on. The problem is if you're an operator like me who likes to fix things quickly. It takes a long time.

NJ: Is technology the answer?

CHIARELLI: It's a mix of leadership; it's a mix of technology. I can look at a kid who has lost his leg below his knee or a kid who has lost both of his legs, and I can at least tell him or her that you are going to be in a better place than you are today six months from now. With the cognitive issues, I can't say that with certainty.

NJ: Is the military's medical culture changing to address these problems?

CHIARELLI: There's no doubt that we've changed. We've totally done a 180. But have we done enough? No. I want to do more, quicker. I want to have more of these secrets unlocked faster. I want to understand what drugs we should use to treat these symptoms, if we should use any drugs at all. I want to look into alternative pain management. We are finding there are other ways to handle pain that are more effective and allow a person to feel a lot better than throwing a bagful of drugs at them.