The Historic Origins of Military and Veteran Mental Health Stigma and the Stress Injury Model as a Means to Reduce It

By William P. Nash, MD; Caroline Silva, BA; Brett Litz, PhD

One of the greatest obstacles to the early and effective treatment of mental disorders arising from the stress of military operations is the heavy burden of social stigma associated with them. Military service members avoid seeking care for mental health problems because they are afraid they will be branded as weak or lose the respect and trust of their peers and leaders. Additionally, mental health stigma causes individuals suffering from mental disorders to lose respect for themselves, whether or not they receive treatment. Shame arising from stigma worsens depressive symptoms and social alienation and increases rates of treatment non-compliance and drop-out.

ABOUT THE AUTHORS

William P. Nash, MD, is with the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury, Arlington, Virginia. Caroline Silva, BA, is with Boston Veterans Healthcare System. Brett Litz, PhD, is with the National Center for PTSD, Boston.

Address correspondence to: William P. Nash, MD, 9259 Old Keene Mill Road, Suite 100, Burke, VA 22015; fax 703-543-4684; or e-mail william.nash@cox.net.

Dr. Nash; Ms. Silva; and Dr. Litz have disclosed no relevant financial relationships.

The opinions and assertions contained in this paper are the private views of the authors and do not necessarily reflect the official policies or positions of the Department of Defense or the Department of Veterans Affairs.

doi: 10.3928/00485713-20090728-05

EDUCATIONAL OBJECTIVES

1. Restate the historic origins of mental health stigma in the military.

2. List the causes of glutamate neuron apoptosis or necrosis that have been documented in preclinical studies, which also may be relevant to clinical mental disorders in service members and veterans.

3. Explain how stigma may be reduced by conceiving of severe, persistent distress, or functional impairment as literal injuries to the brain and mind.