Concern about unacceptable shortfalls in the VA system’s ability to respond to the medical and psychiatric needs of veterans is not new. The Associated Press reminds us the issue was unearthed by a task force appointed by former president George W. Bush eleven years ago and was reported again two years ago in a Senate hearing. Of course, the problem will only grow as large numbers of active duty soldiers leave the military and enter the VA medical system. One major reason the problem persists is because it was ignored when previously noticed. This is a story about stigma—not simply or even principally the stigma of mental illness, but the stigma of having faced adversity and war trauma on our behalf and now being chronically in need.
Nearly a decade ago I visited the Walter Reed Medical Center department of psychiatry. Much earlier I, like many physicians, did some of my training at a VA hospital. My experience was of radically different perceptions of active duty soldiers treated at Walter Reed compared to veterans treated under the VA system. While a grateful nation and government perceived injured active duty soldiers at Walter Reed as courageous wounded warriors, and the medicine practiced with them as exciting, high tech acute and post-acute care, once these war heroes left active duty their care, often for chronic conditions, moved to the VA medical system, where many in the nation and in government perceived them as moochers and malingerers who expected to be taken care of forever at public expense. These veterans were often viewed the way presidential candidate Mitt Romney described a good chunk of the nation in his secretly recorded remarks at a Florida fundraiser during the 2012 election campaign, as part of “47 percent who are . . . dependent upon government, who believe that they are victims, who believe that government has a responsibility to care for them, who believe that they are entitled to health care . . . . ”
Are we ready to turn away from stigma and face up to the reality that injured heroes don’t fade away, but continue to struggle from the physical and psychological consequences of war trauma even after they leave active duty? Providing them care is our solemn obligation.