Healing Hidden Wounds of War

HMS joining forces to better serve returning veterans

Nearly 30 per cent of the hundreds of thousands of troops who have served in the wars in Afghanistan and Iraq suffer from some kind of post-deployment illness, according to recent studies. Their chronic disorders, including post-traumatic stress disorder (PTSD), traumatic brain injury, and other invisible wounds of war, also affect the returning veteran’s families. This national health crisis will likely have a profound effect on our communities for many years, according to Michael Charness, HMS professor of neurology and chief of staff of the VA Boston Healthcare System.

Harvard Medical School has joined the Association of American Medical Colleges, along with more than 100 other medical schools, in a national initiative entitled Joining Forces. Formed under the leadership of first lady Michelle Obama and Vice President Joe Biden’s wife, Jill, the goal of the program is to improve care for veterans and their families, and to better understand and treat post-deployment disorders by enhancing medical education, clinical treatment techniques and research. VA Boston will be collaborating in the initiative with HMS and with Boston University School of Medicine.

“Veterans have risked their lives to serve their country and many have suffered terribly as a consequence of their service. We owe it to them to provide the best care that they can have,” said Charness, who is chair of the HMS committee that is coordinating and developing Harvard’s part of the initiative.

High rates of PTSD

Post-deployment disorders are more common in veterans of contemporary wars for several reasons, Charness said. Unlike previous wars, the conflicts in Iraq and Afghanistan have never been divided into dangerous front lines and safe rear zones.

Instead, troops live in near-constant fear for their lives.

U.S. Navy photo by Lt. j.g. Matthew Stroup

In addition, many servicemen and women have repeatedly witnessed deadly explosions and seen their colleagues killed, even in their own bases. The all-volunteer U.S. armed forces have also required troops to make longer and oft-repeated deployments.

Also, because the returning veterans are largely within a population that has been confined to bases and deployed overseas, their presence in local communities at home has not been felt as much as it would be if they were integrated in the population at large. As a result, the problems that veterans are experiencing are not sufficiently understood or appreciated by the public, said Charness.

While many veterans interact directly with VA healthcare workers, Charness said it is critical for all medical students and health care professionals to be aware of the issues that veterans may face to ensure that they are able to guide the veterans they treat toward appropriate treatment.

Living with veterans who are suffering from disorders such as PTSD may also be particularly challenging for family members, who may need treatment and services of their own, Charness said.  Since many of the post-combat disorders are chronic, this is likely to remain a concern throughout the working careers of current medical students, he said.

Enhancing medical education

Since HMS signed on to Joining Forces, the committee has been working with faculty members to find ways to integrate related materials into the HMS curriculum. The second year neuroanatomy class, for example, will now include a case study of a military amputee.

Terry Keane, associate chief of staff for research and development for VA Boston Healthcare System and director of the Behavioral Science Division of the National Center for Posttraumatic Stress Disorder, will lead the lecture, emphasizing the interplay between PTSD and substance abuse problems.

Col. John Bradley, lecturer on psychiatry at VA Boston Healthcare and former chief of psychiatry at Walter Reed, is developing an advanced clinical elective in Post-Deployment Psychiatry. In this course, students will be trained to assess and diagnose veterans’ post-deployment mental illnesses. They will also learn about psychosocial and psychopharmacological treatment approaches for these conditions.

Focused research

“Not everyone who is deployed has these problems; our investigators are trying to understand the factors associated with risk and resilience,” Charness said.

Researchers are also trying to develop new treatments for these disorders.

The committee has identified more than 100 potential research opportunities for students participating in the Scholars in Medicine program, including clinical, translational and basic science and epidemiological studies.

HMS Edward Wigglesworth Professor of Dermatology, Emeritus, John Parish, is also leading an initiative through CIMIT, with assistance from Terry Keane and others. The goal is to promote interdisciplinary, collaborative research—bringing together engineers with basic, translational and clinical scientists—that might lead to new technologies and improvements in the treatment of post-deployment disorders.

Integrated resources

In addition to the many research and clinical resources available through the VA Boston, which provides a comprehensive and integrated model of neurobehavioral and mental health treatment that may serve as a national model for the Joining Forces initiative, the HMS community has developed and collaborated on many programs that combine research and clinical care in integrated programs.

Among them, the Home Base program at Mass General, which combines clinical care and support services to Iraq and Afghanistan service members, veterans and their families throughout New England. Its aim is to help those affected by deployment– or combat–related stress or traumatic brain injury (TBI) and it offers clinical and community education about the “invisible wounds of war,” and the challenges faced by military families. It is also conducting research to improve the treatment and understanding of PTSD and TBI.

“HMS is proud to be contributing to this crucial effort at this critical time,” said Nancy Tarbell, HMS C.C. Wang Professor of Radiation Oncology at Mass General and dean for academic and clinical affairs. “As the wars in Iraq and Afghanistan wind down and disappear from the news, the invisible wounds of those wars continue to need healing.”

Contact Stacy McGrath for more information about these research opportunities, as well as opportunities for funding for summer research projects.