Military Mental Health : The Battle Within
Publish Date: November 11, 2025
Author: Dr. Jeffrey A. Lieberman
Source: Shrink Speak substack
The Cost of Ignoring Military Mental Health – And What We Must Do About It
I have a good friend who is an amateur historian and an avid collector of American flags. Each year, he celebrates Flag Day by acquiring another banner for his collection and hosting a presentation on the flag’s provenance and, more importantly, the historical events of its era.
Last year, he showcased a flag that flew on one of the Landing Craft Vehicles (Higgins Boats) that landed on Omaha Beach on D-Day. His presentation on the Normandy invasion was told from the perspectives of four embedded journalists: Robert Capa, Martha Gelhorn, Ernest Hemingway, and J.D. Salinger. All were indelibly affected psychologically by the harrowing experience of the landing and the events that followed as the allied troops made their way through France to Germany. My small role in his elaborate production was, as a psychiatrist, to provide input on the syndrome now called PTSD.
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To bone up on my history, I decided to view some war movies that realistically depicted these events (i.e., the feature film Saving Private Ryan and the television series Band of Brothers). Rather than feeling emotionally spent after a weekend binge-watching those films, however, I felt an irresistible desire to see more. I suppose a part of me wanted to vicariously experience what my draft lottery number and acceptance to medical school in 1969 had enabled me to avoid: military service and the experience of live combat.
So I spent the following weekend immersed in twentieth-century war movies, beginning with The Longest Day, The Thin Red Line, Mrs. Miniver, The Best Years of Our Lives, and Patton. As though that weren’t enough, I then proceeded to screen some of the most horrific prisoner of war films ever made, including Stalag 17, The Bridge on the River Kwai, The Great Escape, Seven Beauties, The Deer Hunter, and Unbroken. After gorging on World War II movies, I broadened my cinematic experience by screening All Quiet on the Western Front, Coming Home, Platoon, Rescue Dawn, and Full Metal Jacket.
The collective experience was profound. It drove home not only the fundamental horrors of war but also the enormous mental toll it takes on its combatants. This mental burden is exacerbated by the resistance of the military establishment to acknowledge and provide treatments for its psychological casualties. A scene in Patton captures the utter cruelty and injustice of this undeniable fact when George C. Scott slaps a soldier with post-traumatic stress disorder (PTSD) and calls him a “yellow-bellied coward.”
Relentless Stigma – On Steroids
The military’s historic ambivalence toward the psychological wounds of war is a reflection of civilian society’s pervasive stigma of mental illness – stigma that breeds our indifference toward and neglect of our country’s mental health crisis. But in the case of the military, it is a stigma on steroids. Not only does it hinder active-duty and veteran military personnel from receiving mental health care, but this disgraceful stigma has also impeded the development of effective treatments, and thus we have seen only limited progress in understanding the pathophysiology of psychological trauma.
The consequences for our men and women in uniform are dire. Roughly one in ten active-duty service members were diagnosed with a mental health condition in 2021, and the frequency of mental disorders has nearly doubled over the last five years. Given the stigma-driven reluctance of military personnel to seek mental health care, the actual number of those suffering from mental health conditions is likely far higher. The poster child for these conditions is PTSD, which carries with it a laundry list of complications including violence, addiction, and suicide. Between 2014-2019, U.S. active-duty service members were shown to be nine times more likely to die by suicide than in enemy combat. Veterans are more than 1.5 times as likely to commit suicide as their civilian peers.
The Shortfalls of Military Mental Health Care
Military medicine has made extraordinary advances in the care of soldiers wounded in combat over the 20th and 21st centuries. Upon entering the theater of war, soldiers are girded with body armor to prevent injury. If they are injured, medics embedded with the soldiers immediately stabilize them until they can be evacuated to field-hospitals. For more serious cases, soldiers are air-vac’d to military hospitals in Weisbaden, Germany, or Walter Reed Hospital in Washington, D.C.
There are no parallel protocols for the treatment of psychological injuries, however, despite the fact that we have long known that military service and combat can produce distressing, disabling, and persistent conditions. Before the term “PTSD” was coined and codified in the Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-3) after the Vietnam War, it was recognized by other names, beginning with “soldier’s heart” in the Civil War, “shell shock” in World War I, and “battle fatigue” and “combat neurosis” in World War II and the Korean War. Yet despite their desperate need, only limited efforts to develop effective treatments for this notable malady have been made.
This lack of progress is all the more frustrating given that of the 265 disorders described in the DSM-5, PTSD is one of only two disorders (the other being substance abuse) that have a known etiology (cause) and can be readily studied in animal models. Scientists should be able to examine the biology of PTSD through all of its stages in the laboratory and develop therapeutic approaches to prevent, mitigate, and alleviate its symptoms. For military personnel, the consequences of such therapies would be immense. Preventive treatment could potentially immunize those who go into harm’s way. Acute treatment could be administered in the field as soon as possible after trauma exposure, helping to minimize the extent of the psychological damage. For those who do not receive timely prophylactic or acute treatment to prevent or mitigate the trauma, better treatments must be developed to resolve the enduring effects of PTSD. Future research should focus on addressing these stages so that a soldier is cared for psychologically in the same way that he or she is protected physically on and after the field of battle.
The afflictions our veterans bear after returning to civilian life attest to the distressing truth of their psychological wounds. From reconnecting with loved ones after repeated exposure to combat stress, to coping with physical injuries sustained during combat, to renegotiating their lives and finding employment – veterans and their families all too often find the transition to civilian life emotionally overwhelming. The consequences vary from significant social impairment, marital discord, and job instability to violent behavior, substance abuse, and suicide. Research indicates that post-9/11, nearly 50% of veterans discharged from active duty have experienced significant difficulty of a psychological nature associated with acclimating to civilian life. One third of these individuals have gone on to develop mental health problems that meet the DSM criteria for PTSD, anxiety disorders, or depression.
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To make matters worse, there’s an acute shortage of mental health services available to veterans. Trained clinicians are scarce and lack expertise in the evidence-based treatments that are currently available, and our federal government has devoted only limited funding to improving the efficacy of treatments. To add insult to injury, family members of military personnel are not eligible for mental health care under the Department of Veteran Affairs (VA). Ignoring the needs of this population is both unjust and, given their great sacrifices, unwise, because family support is critical for veterans’ optimal adjustment after returning from active duty.
Given the gravity of the mental health crisis among military personnel, it is imperative that better and more mental health services are developed. To do so, however, we must first address the following barriers to success:
1. The idea of psychological weakness is antithetical to military culture and its ethos of strength and invulnerability.
Military leaders are disinclined to accept the possibility of, much less recognize, psychiatric injury. As a result, many soldiers throughout history have been accused of cowardice and punished or even executed for their infirmity.
2. Mental disorders are considered less consequential because they are not tangible.
There are no physical signs or diagnostic tests to confirm them; hence they are minimized. A soldier does not receive a Purple Heart for PTSD.
3. PTSD is largely considered the problem and responsibility of the military.
Thus the development of treatments is primarily left to the Department of Defense (DoD) and the VA. The investment of the National Institute of Health (NIH), in terms of both funding and engagement of the best and brightest biomedical researchers available, does not match the public health burden of PTSD in service members and veterans. Consequently, talented investigators who might have pursued this line of research cannot obtain funding. I personally know of two National Academy of Science-level researchers who submitted innovative and relevant applications to the DoD for funding. Their applications were scored highly, yet they received no funding.
There are clear logical flaws embedded in these barriers. Simply because there is no physical lesion associated with the psychiatric injuries of war does not mean there is no pathologic consequence that is distressing and disabling to the victim. Nor does psychological trauma occur only in the military. It may be more common and more concentrated there due to the nature of military activities, but it is also found in the civilian world. First responders of law enforcement are frequent victims, as are ordinary people who suffer muggings, natural disasters, fires, and automobile accidents. The United States should therefore consider trauma-related health care a medical problem of significance, extending from the military to the civilian population.
Rebuilding Military Mental Health Care: Our Course of Action
What is needed is a “Manhattan Project” to elucidate the pathophysiology of and develop effective treatments for psychiatric injuries of military experience and combat. Although it poses a formidable scientific challenge, this goal is eminently achievable if the following steps are taken.
- Special efforts must be made to deter the particular shame and stigma attached to military mental health care by at least ensuring that all personnel – first in active duty, then after discharge – are encouraged to obtain mental health services if needed.
- The federal government must empanel a task force of leading scientists to develop a strategic plan for research on the pathologic basis of PTSD and the development of effective, evidence-based treatments that target various settings (including basic training, on the battlefield, in theater, following injury, and upon and after discharge).
- Congress must allocate funding to support this research so that it does not subtract from research being performed in other disease areas. This should be done in partnership with the VA and the DoD. The NIH director’s office should be charged with the responsibility of monitoring progress and reporting to the President and Congress.
- We must establish a network of medical centers that work with VA hospitals to provide specialized mental health services for veterans. We must further have mechanisms to reimburse care at non-VA institutions.
A Veterans Day Plea
Perhaps the most dramatic symbol of our government’s failure to care for the mental wounds of war is this sobering historical fact. The National Institute of Mental Health, the nation’s publicly supported premier research institution charged with reducing the burden of mental illness on society, was established by a congressional committee convened in 1949, following World War II. The impetus behind this congressional action was the enormous number of psychological casualties from the war. The sheer quantity of victims overwhelmed the country’s mental health care system and demonstrated with graphic detail a vulnerability of humans to experiential trauma that could no longer be ignored. Seventy-six years later, however, the rates of mental disturbances (including their complications of substance use and suicide) in the military (both active-duty and veteran) are at all-time highs, and the number of mentally ill veterans who are not receiving treatment remains unacceptable.
It is time for us to ask our government to right this historic wrong. Amidst the political gridlock in Washington and polarized opinions of the electorate, we remain nearly united around respect and concern for our veterans and military personnel. Let us pledge that not another Veterans Day shall pass without our government and our biomedical research and medical communities committing to solve the mystery of psychological trauma and remove this scourge from those who placed themselves in harm’s way to defend ourselves and our freedoms.