The Foreign Service Journal, September 2010

24 F O R E I G N S E R V I C E J O U R N A L / S E P T E M B E R 2 0 1 0 ployees have received marital or grief counseling, regard- less of where they’ve served. How Prevalent Is PTSD? MED officials say they believe new screening and treatment protocols for Post-Traumatic Stress Disorder have contained what was once thought to be a growing problem. (See the January 2008 Foreign Service Journal for in-depth coverage of the issue.) A survey three years ago found that about 15 percent of Foreign Service em- ployees reported some symptoms of PTSD, but only 2 percent seemed to have had serious cases. In the last year, just seven officers have gone through a specialized, six- to seven-week program in Washington for PTSD that the department has established. All have returned to duty. Another two officers were enrolled in the program at press time. MED officials say they’ve seen no greater prevalence of the condition among returnees from Iraq and Afghanistan. Nonetheless, the department has expanded medical serv- ices at high-stress posts, as well as before and after such assignments. The pre-departure training now familiarizes officers with the security issues they will encounter in war zones, and alerts them to the signs of stress-related condi- tions. In response to a Government Accountability Office re- port that criticized the lack of a mandatory post-deploy- ment evaluation, State has begun to require one, which aims to help employees recognize the symptoms of PTSD. AFSA has long argued for such a mandatory post-assign- ment screening, saying that a voluntary assessment stig- matizes those who agree to it. Even among the general population, cases of PTSD are not all that uncommon. As many as 10 percent of people will suffer from it over the course of a lifetime, and the numbers are higher for soldiers who have served in war zones. The Defense Department says that about 17 per- cent of soldiers and Marines who served in Iraq and Afghanistan suffered from symptoms of PTSD, which can range from insomnia and irritability to persistent re-expe- riencing of a traumatic event, as well as depression. More- over, in some patients the symptoms may appear soon after the traumatic event, then disappear just as quickly. For others, they may take years to surface and require years of treatment to manage. Congress has been looking at the issue, holding hear- ings in 2007, last year and earlier this year to examine MED’s protocols for dealing with mental health problems, particularly Post-Traumatic Stress Disorder stemming from long-term assignments in dangerous places. At the 2007 hearing, Rep. Gary Ackerman, D-N.Y., put into words what many FS members feel. “There seems to be widespread fear among affected employees that seek- ing treatment will have a seriously detrimental impact on their careers. Employees are afraid that they may lose their security clearances or medical clearances, or simply be perceived by superiors and colleagues as damaged goods.” Ackerman said the department should “make crystal clear that no stigma attaches to those employees who seek support and treatment.” A Cautionary Tale Some officers who responded to AFSA’s inquiry con- tend that MED was slow to realize the dangers of PTSD and other mental health conditions as the State Depart- ment ramped up the number of hardship and unaccom- panied posts, and say that they are paying for MED’s lack of vigilance. One officer, who asked to remain anonymous, said poor treatment he received might have permanently af- fected his career. A military officer who joined the For- eign Service eight years ago, he considers himself highly ambitious. He is a tsunami survivor and works as a human rights officer, where he’s seen the most horrify- ing aspects of war. He took a slot at one of the most dangerous hardship posts in 2008 because he wanted to bring those skills to where they were needed most. And he didn’t complain when he found himself working 12 to 14 hours a day while mortars and small-arms fire rained down outside. But after he was injured in a roadside bomb attack, he sought help for the stress he was feeling. After a 10-ques- tion survey revealed that he was probably suffering from PTSD, he was referred to the regional psychiatrist sta- tioned in a nearby country. After a phone consultation, he started to take the powerful antidepressant Lexipro. The officer asked the psychiatrist whether there might be side effects and was told he might feel drowsy. But he soon found that he could not sleep, his blood pressure went up and he lost his appetite. He researched the drug on his own and found that all were potential side effects. (Drowsiness was not, in fact, typical.) But after consult- ing with a local doctor recommended by MED, he con- tinued to take the medicine. F O C U S