The Foreign Service Journal, January 2008

Based on an initial review of the survey, the State Department acknowledges that PTSD is probably pre- sent in at least 2 percent of the respondents. An addi- tional 15 percent may possibly have this disorder, for a total of 17 percent. While it is important to bear in mind that a thorough examination by a medical practitioner is required to make a definitive diagnosis, the fact that one in six of the survey respondents are potentially at risk for developing PTSD is worrisome. MED has contracted with a data analysis firm to conduct a more detailed analysis to see if responses differ depending on the post where the unaccompanied tour was served, the length of the tour and the amount of time since departing the post, among other factors. This will allow for a focused assessment of the stress impact in Iraq and Afghanistan, and possible further dis- tinctions among places within those countries. We will report on those findings as they become available. Our Coverage Dr. Raymond M. De Castro, director of MED’s men- tal health services division, begins our coverage with an overview full of useful advice (“Post-Traumatic Stress Disorder: A Guide,” p. 28). While many readers may already be generally familiar with the condition, we hope that the checklists of background factors, symptoms, treatment options and Internet resources will prove help- ful. I would particularly call attention to the section in which he discusses the impact of PTSD on family mem- bers of the patient. Next, FSO Rachel Schneller shares her own struggle with Post-Traumatic Stress Disorder. As she explains in “Recovery: When Surviving Isn’t Enough” (p. 35), impor- tant as the decision to seek treatment is, it is just the first step of what can be a long, arduous journey. Note: This is a searingly frank and detailed account of what she has endured, which some readers may find disturbing. While the incidence of PTSD within the Foreign Service (and the military) appears to be increasing, it is definitely not a new phenomenon. Though I know of no official surveys concerning the psychological health of the thousands of Foreign Service personnel who served in Vietnam during the war, several Foreign Service retirees responded to the AFSAnet solicitation we sent out this fall seeking contributions for this issue with stories of how their time there and in other war zones, or experiences with massive natural disasters, still haunt them today, decades later. (Our thanks to all members who contact- ed us in response to that request.) Retired USAID FSO Kristin Loken served in two countries undergoing civil wars in the early 1980s: El Salvador and Lebanon. Those traumatic experiences, along with the lack of institutional support as she attempted to cope with their psychological effects, taught her the hard truth that PTSD is “Not Only for Combat Veterans” (p. 42). Our longstanding policy is to publish the names of all contribu- tors. However, for reasons that will be obvious when you read it, we are printing a commentary from an anonymous officer who questions the credibility of State’s public commit- ment not to penalize employees who disclose the use of antidepressants or therapy when they seek a security or medical clearance (“Encouraging Employees to Seek Help,” p. 46). While not suffering from PTSD, this contributor sought professional care for depression, only to receive a downgraded medical clearance as a result. (The individ- ual’s security clearance was given additional scrutiny but eventually renewed.) Such experiences, coupled with the grossly inadequate coverage of mental health treatment by many health insurance policies, lead the author to rue- fully conclude that “State seems to prefer that I go off my meds and become the unhappy, less productive, less col- legial employee I was a year ago.” Today’s Foreign Service reality is that more and more personnel have to serve in dangerous environments, including combat zones. And because such places tend to be unaccompanied posts, they have the additional bur- den of being away from their families and other support networks just when they most need them. We believe that the open discussion of PTSD that follows is need- ed to help ensure that proper support is given to those who may face this debilitating illness as a direct result of their dedicated service, and hope that it will con- tribute to updating State’s approach to mental health issues generally. F O C U S J A N U A R Y 2 0 0 8 / F O R E I G N S E R V I C E J O U R N A L 27 We hope that our coverage will raise consciousness about this growing problem.