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Troops' Mental Health: How Much Is Unknown?

Gen. Peter Chiarelli, former vice chief of staff for the U.S. Army, says the Army lacks reliable diagnostic tools to screen for mental health. (AP)

The killing of 16 Afghan civilians last Sunday is now one of the greatest points of tension between the United States and Afghanistan. U.S. Army Staff Sgt. Robert Bales allegedly killed the civilians in cold blood; those close to him say they were shocked by the news.

According to the Pentagon, Bales had been treated for a traumatic brain injury that he suffered in Iraq in 2010, though the extent of the damage is unclear.

Other information leaked by military officials indicate Bales, who was on his fourth deployment, may have "snapped" under pressure due to possible marital problems or alcohol abuse. Bales' civilian lawyer has cast doubt on those theories.

Screening With Uncertainty

Gen. Peter Chiarelli spent the last couple years of his military career working to help troops returning from combat with invisible wounds of war like post-traumatic stress.

He retired from the military in January, ending a four-decade career as a vice chief of staff of the Army. He is now the CEO of One Mind for Research, a nonprofit organization dedicated to finding cures for brain disorders.

Chiarelli said he could not comment on the specifics of Bales' case, but he tells Weekend Edition host Rachel Martin that the staff sergeant would have been screened before, during and after every deployment.

"I can guarantee you that he was screened, and before he was allowed to redeploy, doctors indicated that he was fit for deployment," Chiarelli says. "Unless the investigation shows something different, this is not uncommon for a force that has been fighting in two separate theaters for over 10 years."

He says what the incident "proves more than anything ... is just how much we don't know." As vice chief, Chiarelli says he was frustrated by not having reliable diagnostic tools to screen for behavioral health issues.

"This was a huge problem for us, and continues to be a problem today," he says.

When it comes to screenings, some are done by a health care provider when a soldier returns home. There are also written surveys.

"I don't trust those as much because soldiers know how to answer those in order to be able to go home to their loved ones and not be caught up in future evaluations," Chiarelli says.

It's also possible, he says, that soldiers know how to game the system in order to be redeployed.

Stamping Out Stigma

But Chiarelli is also careful not to stereotype.

"What worries me when we talk about this, more than anything else, is that there's a tendency to kind of paint a brush across every single soldier, male and female, who has served in Iraq or Afghanistan, and think that they have come back with post-traumatic stress or traumatic brain injury," he says. "That's simply not the case."

Misconceptions can spread into other areas of the veterans' lives, like when they talk to employers. Stigma may make some employers think twice about hiring someone who fought for years in Iraq or Afghanistan.

Balancing between raising awareness and combating stigma can be a tricky task.

"You want to raise awareness, you want people to get the help that they need," Chiarelli says, "but at the same time, you do not want to leave the general public with the idea that everyone is suffering from these traumas."

One tool for cutting the cultural bias is language. Rather than saying "post-traumatic stress disorder," or PTSD, he calls it only "post-traumatic stress."

"I have totally dropped the 'D,' and one of the reasons I've dropped the 'D' is no soldier likes to be told that he has a 'disorder.' The key is to try to get him into treatment," Chiarelli says. "There are very effective treatments available, but if you can't get them inside the doors so they can get that help, they do no good."

The general's position has evolved over his years at war. He says one of his greatest regrets is not putting the name of a soldier who committed suicide on a memorial in his division.

"There was a general belief back then [in 2004, 2005] that individuals that committed suicide did not deserve to be on the same memorials as individuals who had lost their life due to enemy action," he says. "That is a tremendous regret that I have."

While Chiarelli has not reached out to that soldier's family, he hopes "that one day I will do that and right that wrong."

Whose Responsibility?

The commander on the ground, he says, has a responsibility to look out for the mental health of those under his command.

"We all have a responsibility to look for the signs. And the signs are obvious. We know the signs. We've taught the signs. People understand the signs," Chiarelli says.

The signals are high-risk behavior, such as self-medicating with alcohol, anger management, involvement in partner abuse and drug abuse.

"We have a responsibility not just to tell him to get help," he says. "We have a responsibility to ensure that they get the help that they need."

The impact of post-traumatic stress and traumatic brain injury reaches beyond the soldier in need.

"I get upset when people start throwing numbers around about the number of people that are affected. I promise you, all the numbers are far less than the real number," Chiarelli says. "Because for every soldier that's out there that has a family, you multiply that number by the size of their family. That's why we have got to find a way to properly diagnose and treat these diseases."

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Transcript

RACHEL MARTIN, HOST:

General Peter Chiarelli spent the last few years of his military career working to help troops returning from combat with post-traumatic stress. He retired from the military in January as vice chief of staff of the Army, ending a four-decade career. He's now the CEO of One Mind for Research, a nonprofit organization dedicated to finding cures for brain disorders. Gen. Chiarelli said he couldn't comment on the specifics of Staff Sergeant Robert Bales' case, but he told us Bales would have been screened before, during and after every deployment.

GENERAL PETER CHIARELLI: I can guarantee you that he was screened, and before he was allowed to re-deploy, doctors indicated that he was fit for deployment. Unless the investigation shows something different, this is not uncommon for a force that has been fighting in two separate theaters for over 10 years. I think what this incident proves more than anything to me is just how much we don't know. What frustrated me as the vice chief was that we did not have reliable diagnostic tools that we could use to ensure that soldiers, both new and old - old meaning those who in fact had been on previous deployments - were suffering from post-traumatic stress and traumatic brain injury, or other behavioral health issues. This was a huge problem for us. It continues to be a problem today.

MARTIN: Let's talk about that. You say that there are all these screenings that a soldier like this and others, everyone, is required to go through some kind of mental health screening. What are those like?

CHIARELLI: Well, there are different screenings. There are the screenings when an individual comes home. They are done by a health care provider. There are written surveys. I don't trust those as much because soldiers know how to answer those in order to be able to go home to their loved ones and not be caught up in future evaluations.

MARTIN: Do they also know how to game the system in order to go back to their unit deployed?

CHIARELLI: Well, that's always a possibility. What worries me when we talk about this more than anything else is that there's a tendency to kind of paint a brush across every single soldier, male and female, who has served in Iraq or Afghanistan, and think that they've come back with post-traumatic stress or traumatic brain injury. That's simply not the case. There are many soldiers who have gone on four, five and six deployments and show no signs of post-traumatic stress and traumatic brain injury. When we do that, when we kind of paint everybody with this, it has second- and third-order effects. I worry about the employer who says, well, you know, should I really hire this infantryman who spent six years fighting in Iraq or Afghanistan and bring him onto my company if there's a possibility that they have post-traumatic stress or traumatic brain injury?

MARTIN: So, is it a double-edged sword then?

CHIARELLI: It is a double-edged sword, yes.

MARTIN: 'Cause you want to raise awareness.

CHIARELLI: Exactly right. You want to raise awareness, you want people to get the health that they need, but at the same time you do not want to leave the general public with the idea that everyone is suffering from these traumas.

MARTIN: I want to pursue the idea of the stigma. This is something you acknowledged early on, that there was a cultural bias against this diagnosis, this label, post-traumatic stress disorder. Has that changed?

CHIARELLI: Post-traumatic stress - I totally dropped the D, and one of the reasons I've dropped the D is no soldier likes to be told that he has, quote, "a disorder." The key is to try to get him into treatment - he or she. There are very effective treatments available. But if you can't get them inside the door so they can get that help, they do no good.

MARTIN: I wonder, you talked about your own experience commanding U.S. troops from all branches in Iraq, yet you admit that you weren't able to admit that these injuries could be as severe as they are, these invisible wounds.

CHIARELLI: I've said publicly that one of my greatest things that I regret is the single soldier under my command who committed suicide in 2004, 2005, who I - because others recommended to me, did not put his name on a memorial in the division that I commanded. There was a general belief back then that individuals that committed suicide did not deserve to be on the same memorials as individuals who had lost their life due to enemy action. That is a tremendous regret that I have.

MARTIN: Have you reached out to his or her family?

CHIARELLI: I have not at this time, not yet. And I hope that one day I will do that and right that wrong.

MARTIN: I wonder what you think of the responsibility that the commander on the ground has in measuring someone's mental health. Is it beyond their responsibility by the time that soldier gets there?

CHIARELLI: No, it's not. We all have a responsibility. We all have a responsibility to look for the signs. And the signs are obvious. We know the signs. We've taught the signs. People understand the signs. The signs are high-risk behavior. When you see someone who is self-medicating themselves by drinking too much after a deployment, when you see someone that has anger management problems that didn't have anger management problems before, when you see someone who's involved in partner abuse of some kind or child abuse, when you see someone who's abusing drugs, who's just not quite right, we have a responsibility not just to tell them to get help, we have a responsibility to ensure that they get the help that they need.

MARTIN: But is it fair to say that this issue being thrust into this position as vice chief, having to deal with issues of soldier suicide and post-traumatic stress, that this changed you in some way?

CHIARELLI: Well, it did, it did, it did. I saw a large number of soldiers that I had dedicated my life to who were suffering. And, you know, it's not the same as other diseases. When a soldier comes back with post-traumatic stress or traumatic brain injury, it's not only the soldier that is affected but it's the entire family. I get upset when people start throwing numbers around about the number of people that are affected. I promise you all the numbers are far less than the real number, because for every soldier that's out there that has a family, you multiply that number by the size of their family. That's why we have got to find a way to properly diagnose and treat these diseases.

MARTIN: Gen. Peter Chiarelli, recently retired as the vice chief of staff of the Army. He is now the CEO of One Mind for Research. He joined us in our studios in Washington. General, it's been a pleasure.

CHIARELLI: Thank you very much.

MARTIN: You're listening to NPR News. Transcript provided by NPR, Copyright NPR.

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