Since October 2001, approximately 1.64 million U.S. troops have been deployed for Operations Enduring Freedom and Iraqi Freedom (OEF/OIF) in Afghanistan and Iraq. Early evidence suggests that the psychological toll of these deployments -- many involving prolonged exposure to combat-related stress over multiple rotations -- may be disproportionately high compared with the physical injuries of combat. In the face of mounting public concern over post-deployment health care issues confronting OEF/OIF veterans, several task forces, independent review groups, and a Presidential Commission have been convened to examine the care of the war wounded and make recommendations. Concerns have been most recently centered on two combat-related injuries in particular: post-traumatic stress disorder and traumatic brain injury. With the increasing incidence of suicide and suicide attempts among returning veterans, concern about depression is also on the rise. The study discussed in this monograph focuses on post-traumatic stress disorder, major depression, and traumatic brain injury, not only because of current high-level policy interest but also because, unlike the physical wounds of war, these conditions are often invisible to the eye, remaining invisible to other servicemembers, family members, and society in general. All three conditions affect mood, thoughts, and behavior; yet these wounds often go unrecognized and unacknowledged. The effect of traumatic brain injury is still poorly understood, leaving a large gap in knowledge related to how extensive the problem is or how to address it. RAND conducted a comprehensive study of the post-deployment health-related needs associated with these three conditions among OEF/OIF veterans, the health care system in place to meet those needs, gaps in the care system, and the costs associated with these conditions and with providing quality health care to all those in need. This monograph presents the results of our study, which should be of interest to mental health treatment providers; health policymakers, particularly those charged with caring for our nation's veterans; and U.S. service men and women, their families, and the concerned public. All the research products from this study are available at http://veterans.rand.org. Data collection for this study began in April 2007and concluded in January 2008. Specific activities included a critical reviewof the extant literature on the prevalence of post-traumatic stress disorder, major depression, and traumatic brain injury and their short- and long-term consequences; a population-based survey of service members and veterans who served in Afghanistan or Iraq to assess health status and symptoms, as well asutilization of and barriers to care; a review of existing programs to treat service members and veterans with the three conditions; focus groups withmilitary service members and their spouses; and the development of a microsimulation model to forecast the economic costs of these conditions overtime. Among our recommendations is that effective treatments documented in the scientific literature -- evidence-based care -- are available for PTSD and major depression. Delivery of such care to all veterans with PTSD or majordepression would pay for itself within two years, or even save money, by improving productivity and reducing medical and mortality costs. Such care may also be a cost-effective way to retain a ready and healthy military force for the future. However, to ensure that this care is delivered requires system-level changes across the Department of Defense, the Department of Veterans Affairs, and the U.S. health care system.

This volume provides several perspectives that help practitioners, advocates, and policymakers understand the impact of historical and recent wars on U.S. Military veterans. The chapters address newly recognized psychological conditions as risk factors for more serious diagnosable mental health disorders.

An urgent, wide-ranging account of racial trauma and its psychological impact. Racial trauma is an inescapable byproduct of persistent exposure to repressive circumstances that emotionally, psychologically, and physically devastates one’s sense of self while simultaneously depleting one’s strategies for coping. It is a life-altering and debilitating experience that affects countless numbers of people of color over multiple generations. Unfortunately, the failure to consider the interrelationship between racial oppression and trauma limits clinicians’ ability to work effectively with many people of color who live amid sociocultural conditions that are injurious to their psyches and souls. Even when therapy is trauma-informed, it rarely devotes adequate attention to racial oppression and the pervasive trauma associated with it. This groundbreaking book provides a comprehensive overview of the anatomy of racial trauma and the debilitating hidden wounds associated with it. Racially sensitive trauma-informed interventions and strategies that centralize race and racial oppression in every facet of the therapeutic process and relationship are meticulously highlighted, making this a must-read resource for all practicing and aspiring clinicians.

The authors identified ten standards for the delivery of high-quality care for veterans with posttraumatic stress disorder, depression, substance use disorders, and mild traumatic brain injury. They also provide considerations for implementing and disseminating these standards as a first step to improve access to high-quality care for veterans with invisible wounds.

In these personal reflections on his thirty years of clinical work with victims of genocide, torture, and abuse in the United States, Cambodia, Bosnia, and other parts of the world, Richard Mollica describes the surprising capacity of traumatized people to heal themselves. Here is how Neil Boothby, Director of the Program on Forced Migration and Health at the Mailman School of Public Health, Columbia University, describes the book: "Mollica provides a wealth of ethnographic and clinical evidence that suggests the human capacity to heal is innate--that the 'survival instinct' extends beyond the physical to include the psychological as well. He enables us to see how recovery from 'traumatic life events' needs to be viewed primarily as a 'mystery' to be listened to and explored, rather than solely as a 'problem' to be identified and solved. Healing involves a quest for meaning--with all of its emotional, cultural, religious, spiritual and existential attendants--even when bio-chemical reactions are also operative." Healing Invisible Wounds reveals how trauma survivors, through the telling of their stories, teach all of us how to deal with the tragic events of everyday life. Mollica's important discovery that humiliation--an instrument of violence that also leads to anger and despair--can be transformed through his therapeutic project into solace and redemption is a remarkable new contribution to survivors and clinicians. This book reveals how in every society we have to move away from viewing trauma survivors as "broken people" and "outcasts" to seeing them as courageous people actively contributing to larger social goals. When violence occurs, there is damage not only to individuals but to entire societies, and to the world. Through the journey of self-healing that survivors make, they enable the rest of us not only as individuals but as entire communities to recover from injury in a violent world.

Invisible Wounds: Guilt is the first installment of the new Freedom Series from James Maloney. Using James notably simplistic and concise manner of writing, this booklet presents a life-changing lesson on the necessity of being free from guilt and the ways in which the enemy of your soul would like nothing better than to trap you in the wounding of self-condemnation. The material inside outlines three ways we deal with guilt: having our consciences seared with repeated sinning; passing the blame off on others; and rationalizing our guilt away as something that doesnt really matter. But the truth is the blood of Jesus was shed to cleanse our condemnation, awaken our conscience, and overcome the invisible wound of guilt. This booklet can help make that real in your life.

There’s no real homecoming for many of our veterans returning from the wars in Iraq and Afghanistan. They may go through the motions of daily life in their hometowns, but the terrible sights and sounds of war are still fresh in their minds. This empathic, inside look into the lives of our combat veterans reveals the lingering impact that the longest wars in our nation’s history continue to have on far too many of our finest young people. Basing her account on numerous interviews with veterans and their families, the author examines the factors that have made these recent conflicts especially trying. A major focus of the book is the extreme duress that is a daily part of a soldier’s life in combat zones with no clear frontlines or perimeters. Having to cope with unrecognizable enemies in the midst of civilian populations and attacks from hidden weapons like improvised explosive devices exacts a heavy toll. Compounding the problem is the all-volunteer nature of our armed forces, which often demands multiple deployments of enlistees. This results in frequent cases of post-traumatic stress disorder and families disrupted by the long absence of one and sometimes both parents. The author also discusses the lack of connectedness between civilian society and military personnel, leading to inadequate healthcare for many veterans. This deficiency has been highlighted by the urgent need to treat traumatic brain injuries in survivors of explosions and the high veteran suicide rate. Bouvard concludes on a positive note by discussing some of the surprising and encouraging ways that the chasm between civilian and military life is being bridged to help reintegrate our returning soldiers. For veterans, their families, and especially for civilians unaware of how much our soldiers have endured, The Invisible Wounds of War is important reading.

Are you fully healed from your invisible wounds? As Christians we have all faced moments of feeling pressed or oppressed by life situations. However, there is a way that one can live healed and as a body of Christ we are charged to help others as well to heal from invisible wounds. This begins with love and transforming our minds to the mind of Christ (see Romans 12:2). Most importantly, to not continue the Life Cycle of Complacency in dealing with any mental health, substance abuse, sexual addictions, or any other invisible wounds that try to overwhelm us. In these pages are insightful educational tools and resources to help not only yourself but others, and especially church leaders to assist others to not only get strong in their healing but also to remain strong in their healing from invisible wounds.

The Invisible Wounds of Stress: Inside and Out is from the physical, emotional, and spiritual wounds that affected me while I was serving in the military. Understanding and managing stress is crucial for the overall healing process. Anxiety, depression, fear, and other psychological issues play important roles in the invisible wounds. The invisible wounds can easily be misinterpreted when they are not seen with the naked eye. Stress is real, and it can affect anyone’s mind, body, and soul at any time. By learning about the invisible wounds and how they can be managed, the effects of stress can be limited and a peaceful, and more stress-free life can be possible. Peace and blessings!