Silent Treatment

Between 2001 and 2009, about 5,000 American military men and women who served during Operation Enduring Freedom or Operation Iraqi Freedom committed suicide. According to clinical psychologist Chris Howells (MA ’08, PsyD ’12), about 60 percent of military members who have either contemplated or attempted suicide were never actually deployed, negating the popular misconception that suicidality is directly related to serving overseas and experiencing wartime trauma.

“That opens the door to the idea that maybe there are more people on active duty that are dealing with anxiety and depression,” he says, a discovery that has increased his desire to learn about new opportunities to administer effective treatments for those suffering from post- traumatic stress disorder (PTSD).

Now a civilian working for the Department of the Army in a special program focusing on PTSD, Howells harnesses the unique insight he gained while serving as an active-duty air force officer after completing his doctoral degree from the Graduate School of Education and Psychology.

During those fast-paced years as the director of psychological health at the Kadena Air Base in Okinawa, Japan, Howells realized the difficulties that clients experience when attempting to unload years of depression and anxiety in 50-minute therapy sessions occuring, on average, every few weeks. For these clients, overcoming the apprehension to open up was particularly difficult while attempting to juggle the job-related duties that include simulated deployments and attacks, maintaining mission readiness, and physical training.

Howells quickly discovered that the primary challenges military psychologists and clients encounter are issues of allotted session times and self-censorship. On-site treatments further hinder honest communication from clients for fear that the discovery or diagnosis of certain disorders will prevent them from continuing their military service—and earning an income.

“Therapy works when you can speak freely about your issues, but these clients are operating in a culture where they may fear doing that because the person who is providing the therapy is also the person who is rendering the decision of whether they are deployable or fit to stay on active duty,” Howells explains.

Breaking this cycle proves to be a challenge, as military mental health providers navigate the difficult balance between giving people the level of care that they require and deserve in a system in which care resources may be thinly spread while simultaneously maintaining a roster of fully deployable service members. This is especially concerning for those already suffering from mental health illnesses, as their potential deployment might result in a worsening of depression, PTSD, familial strains, or other psychological issues.

While that puts pressure on the providers developing and administering the trauma treatments to be more thoughtful and think less traditionally, it also pushes growth in a positive direction. “Traditional talk therapy is not enough for PTSD,” insists Howells, who now, in his current role as a clinical psychologist for the US Army at Joint Base San Antonio and Fort Sam Houston in Texas, customizes his treatment plans to encourage his patients to explore the mind-body connection through body work, yoga, interventions, and meditation. Howells exclusively treats active-duty military service members battling PTSD and the comorbid (coexisting) conditions that often accompany that diagnosis, such as alcohol dependency, marital discord, and chronic pain.

His clients, referred from all branches of the military, are able to express their personal pain without concern of judgment or disciplinary action by their command. Therapy provides a place where they can feel free to disclose otherwise hidden emotions tied to their trauma—perhaps about their superiors and colleagues— without fearing that these details will be exposed through the proverbial grapevine.

“I tailor how I interact with people,” he shares about his unique program. “I’m very open to giving people the opportunity to speak freely, be , and have a place where they can take the military bearing out of the equation and just be people in therapy.”

“Having worn the uniform and been on the other side of that, I understand the frustrations that come from prolonged courses of treatment where the system doesn’t always line up for the individual,” Howells continues. “That’s something I keep in mind when working with these folks—that understanding where they’re coming from really legitimizes some of their experiences.”

In closely examining what is not working for clients, which accounts for 30 percent of those in therapy, Howells asserts that treatments must expand in complexity and be tailored to the needs of the specific patient in order to adequately confront the most complicated of issues.

“Treating PTSD is not like treating blood pressure or an infection,” he says, commenting on the frequently idiosyncratic network of symptoms seen in the disorder. “PTSD therapies can be very effective for many, however there is a lot of room for growth and improvement, and the mental health field is starting to own that and shine a spotlight on recognizing the limitations of treatment.”

Note: Howells’ comments represent his personal opinions. They do not represent the opinions of the United States Air Force or the United States Army.