The current military conflicts in Ukraine and Gaza have left death and destruction in their wake, with more to come in both “theatres of war.” The carnage is mass producing to varying degrees all the signature wounds of organized violence, in any era: burn damage and lost limbs, brain injuries and blindness, and bodies otherwise torn apart by bombs and bullets.

As shocking as it is, the rising toll of civilian and military casualties, on all sides, does not fully reflect the long-term human cost of preparing for and participating in killing, watching others be killed or grievously injured, or becoming a brutalized POW or civilian hostage.

Whenever lasting cease-fires or peace settlements are finally reached, many Ukrainians, Russians, Palestinians, and Israelis will be afflicted with the mental health condition known as Post-Traumatic Stress Disorder (PTSD).  This often-hidden wound of war will be a great personal burden for those who suffer from it and a major treatment challenge for their professional or family care-givers.  

It will also be a costly responsibility of national healthcare systems badly disrupted or even totally demolished by the current conflicts (although that will not be the post-war condition of the Israeli healthcare system, for those most favored within it).

A Legacy of War

To put this future societal problem in perspective, it’s worth noting that nearly 20 percent of returning Afghanistan and Iraq vets have been diagnosed with PTSD and hundreds of thousands have qualified for mental healthcare provided by the Department of Veterans Affairs (VA) and related disability benefits. 

Operating the nation’s largest public healthcare system, with nine million patients, now consumes more than a third of the VA’s $300 billion budget last year. But that enables men and women who served in the U.S. military to get treatment for anger and depression, substance abuse, suicidal ideation, and other problems arising from their past exposure to combat or military sexual trauma. 

Meanwhile, millions of damaged local survivors of U.S. occupations of in the Middle East (and Vietnam before them) were left to fend for themselves, in their respective resource-poor countries, a post-war fate that awaits many victims of on-going military assaults in Palestine and Ukraine.

The importance of specialized, high-quality care for anyone traumatized by war, in any country, is well documented in Jason Kander’s new book, Invisible Storm: A Soldier’s Memoir of Politics and PTSD (Mariner Books) and a related film called Here. Is. Better.  Directed by Emmy Award winner Jack Youngelson, the movie focuses on Kander and three other U.S. military veterans who never expected that their military service would end up adversely affecting their family relationships, career or retirement plans, ability to hold a job or even find housing.

Youngelson and his documentary crew filmed all four PTSD sufferers during their interaction with family members, other participants in group therapy or peer counseling sessions, and their work with staffers of a VA-run residential treatment center in Cincinnati or the Veterans Community Project in Kansas City, which provides transitional housing and support services for homeless vets.

Not Feeling Disabled

While different in age, gender, and ethnicity, all four subjects of Youngelson’s film had a common reluctance to seek professional help. In Kander’s case, he felt that his brief tour of duty in Afghanistan, as an Army intelligence officer, hardly qualified him to be a “disabled” veteran. “I didn’t feel like I did enough to earn it,” he writes. “I was just some jerk who went to meetings. To even consider I had PTSD felt like ‘stolen valor”–the phenomena of veterans or non-veterans claiming military laurels they were not awarded. 

Some soldiers who served in the same combat zone came back with traumatic brain injuries, amputated limbs, or spinal cord injuries that left them paralyzed for life. After he was discharged, Kander’s only problem was “bad dreams,” not even troubling enough to keep him from still reading books or watching movies about war. The other veterans who tell their stories in Here. Is. Better –on a first name basis only— similarly ignored or minimized their symptoms, while experiencing, like Kander, a considerable amount of survivors’ guilt. 

In the film, we meet Teresa and Tabitha, both post-9/11 war veterans, and John, a draftee in 1968 who won a Silver Star for his role in firefight that killed 170 North Vietnamese and Americans. A helicopter door gunner in Vietnam, John returned home with traumatic memories of jungle warfare that he managed to suppress for fifty years, until he couldn’t find a way “to move beyond them.” Teresa was a heavy equipment operator for the Army who never recovered from the impact of an improvised explosive device (IED) that rocked her convoy in Iraq. Recruited at age 18, Tabitha was sexually assaulted during her Marine training, like many other women in the military. She managed to complete tours of duty in Iraq and Afghanistan but the scars of military sexual trauma (MST) made her a troubled single mother of two young children in later civilian life. 

A High Profile Crash

Kander’s mental health crisis is recalled movingly in both the film and Invisible Storm, but with more humor in the latter. When he entered the Kansas City VA Medical Center, as a walk-in patient five years ago, the former Army captain and Georgetown Law School graduate was still a rising star in regional and national politics. He had been a state legislator, served as Missouri’s secretary of state, and, in 2016, ran a highly competitive campaign for the U.S. Senate against a Republican incumbent.

After that narrow defeat, he formed a voting rights group called Let America Vote and went on a speaking tour that took him to forty-six states in a single year, including appearances in Iowa and New Hampshire. That grueling schedule—plus Barack Obama hailing him as the future of the Democratic Party–fueled speculation about an eventual presidential campaign. Kander’s next stepping stone in that direction was supposed to be city hall in Kansas City.  By late 2018, based on polling and fundraising, he was far ahead in a mayoral race there.

Then, he suddenly dropped out. He informed supporters and the media that he had called a Department of Veterans Affairs (VA) hot line, tearfully confessed to having “suicidal thoughts,” and checked himself into a VA hospital. As a new patient, Kander pulled a baseball cap down to hide his face because “the one place where you don’t want to be famous is in a psych ward.”  Dressed in hospital scrubs, sitting in a bare room, with the psychiatric resident assigned to take his medical history, Kander confessed everything he’d spent years hiding from the world: “My night terrors, my consuming fear of someone hurting me or my family, my ever-present anger, my unrelenting guilt and punishing shame, my inability to feel joy, and my increasing dislike of myself.”

Not recognizing or knowing about him, the young doctor asked Kander if his post-military career was particularly stressful? “I’m in politics,” he explained, referencing both his Kansas City mayoral campaign and his eventual plan to run for the White House with Obama’s blessing. The puzzled doctor sat back in his chair, tapped his notebook a few times with his pen, and then pursed his lips. “Barack Obama told you that you could run for president? “he asked. “How often would you say you hear voices?” 

Blue-Collar Backgrounds

The personal struggles of the other veterans profiled in Here. Is. Better are more representative of what service members, from blue-collar backgrounds, experience in civilian life. After much prodding from her husband, Teresa joined an all-female cohort of veterans enrolled in a “last chance program,” as one participant calls it. They begin their seven-week stay at a VA residential treatment center beset with dark thoughts and doubts about its effectiveness. “I sat in my fucking shit for a lot of years, making it hard to be a wife and mother,” Teresa tells the group.  Tabitha reveals that she’s in the program because “I’m a horrible person and a horrible mother,” who just “wanted to die.” In the course of the film, we learn that, after her sexual assault, she was “yelled at for being a whore” and transferred to another Marine unit, while her attackers, per usual, went unpunished.

As the story of John, the Vietnam vet, unfolds, we learn that he first tried to get help from the VA, in the early 1970s. At the time, it was under-funded, under-staffed, and unprepared for a huge influx of new patients, thanks to the Nixon and Ford Administrations.  “There was nothing there then,” he says. John was able to find stability in his job and marriage but rarely discussed his combat experience with anyone, even his wife of 36 years. “What I saw, what I did, the loss….it all still plays on my head,” he confesses in the film. 

After John retired and was nearing age 70, he attended a retreat for older veterans, facilitated by a clinical social worker from the VA. This time, he found that he was not “alone in this search for a little more peace in our lives.” At the retreat and follow-up peer counseling sessions, he reconnects with one aspect of his long-ago military service that was more positive—namely, the mutual aid and strong sense of camaraderie that was essential to individual survival in Vietnam.

A Culture of Solidarity

Among those shown caring for John, Teresa and Tabitha, and Jason Kander are clinical social workers, psychologists, psychiatrists, and peer support specialists. In that last job category—but others as well –are fellow veterans, since about one-third of all VA healthcare staff served in the military themselves. This helps foster a unique institutional culture of empathy and solidarity between patients and provider that has no counter-part anywhere else in the U.S. healthcare system. In addition, every VA employee is trained on how to better recognize and assist patients who are suicidal. Thousands of its mental health providers learn to use and then employ the latest evidence-based treatments for PTSD, while outside the VA, studies show, only 30 percent of private-sector providers employ such treatments.

In Here. Is. Better, one in-house VA care-giver says her biggest treatment challenge is “how to create hope?’ The film-makers report that participants in the residential program that Teresa and Tabitha completed have a 70% success rate, leading them to suggest that the model of “trauma-informed care,” used by the VA, could also help the millions of other Americans with a PTSD diagnosis. Nevertheless, the VA’s  medical research functions, major teaching hospital role, and provision of direct care have all been jeopardized by incremental privatization of its services under Presidents Obama, Trump, and now Biden. As a result, an exemplary system of integrated and coordinated care is in danger of being de-funded and dismantled, with much on-going loss of highly trained and dedicated staff like the suicide prevention specialists and group therapists we meet in Here. Is. Better and Invisible Storm.

Pitfalls of Privatization

Out-sourcing advocates often point to the work of groups like Kander’s own community-based program for homeless vets as examples of how VA patients—in need of housing, healthcare, or emergency assistance– are better served by private sector initiatives than a big government agency. Yet, the thousands of non-profit and for-profit entities now vying for an ever-larger share of the VA budget invariably lack the institutional scale, resources, and experience necessary to meet the complex needs of veterans like those profiled in Here. Is. Better or Invisible Storm.

In the latter, Kander confesses that he never dreamed, during his political career, of becoming a “posterchild” for what he calls “post-traumatic growth.”  Let’s hope that this former  advocate for single payer healthcare in the Missouri legislature, will use his continuing “platform and influence” to help save our best working model of socialized medicine. Because it was that healthcare system that changed his life for the better, along with the lives of many others who left the military never expecting to have personal problems or career challenges due to the “invisible storm” that eventually overtook them.

---