Steven Berkowitz, a clinical psychologist at Kimbrough Ambulatory Care Center, once treated a Soldier diagnosed with post-traumatic stress disorder who came to him for treatment for nightmares.
Berkowitz said the Soldier complained that a war buddy, who had died in combat, was visiting him in nightmares.
The Soldier had been tasked with taking care of his buddy's body and was now afraid of the recurring dream.
“I told him, ‘Maybe you, as the only one who took care of him, you were the one who helped keep his body sacred,' ” said Berkowitz, who works at Kimbrough's Behavioral Health Clinic. “He's thanking you. That's why he comes back to you in your dream.”
Berkowitz said that in treating Soldiers with combat-related PTSD, it is often effective to help Soldiers gain a new perception of their experience in battle.
“This was helpful to this service member to think of [the dream] in this way,” Berkowitz said.
Although it is not uncommon for active-duty service members to experience a mental health condition, many avoid seeking treatment because of the stigma and perceived risk to their career.
However, Berkowitz said, both the stigma and fear of losing one's career are not a reality.
“The stigma exists, but it isn't accurate,” Berkowitz said. “ ... The fact that a person has been to [a] mental health [provider] doesn't mean they're going to lose their clearance.”
The mental health team at the Behavioral Health Clinic provides psychotherapy and medication management to active-duty service members of all service branches. Forty-percent of the active-duty service members who receive treatment experience some symptoms of PTSD.
Aftermath of Trauma
In order to bring greater awareness to the issue of post-traumatic stress disorder, the Senate designated June 27 as National PTSD Awareness Day. In addition, June has been designated as PTSD Awareness Month by the National Center for PTSD.
According to the center, which is part of the U.S. Department of Veterans Affairs, PTSD can occur after a traumatic event such as combat exposure, child abuse, sexual abuse or a serious accident.
The Office of the U.S. Army Surgeon General reports that 15 percent of Soldiers who have deployed to either Iraq or Afghanistan meet the diagnostic criteria for PTSD. Another 10-15 percent will experience other behavioral health problems that could benefit from treatment.
In addition to PTSD, anxiety, depression, stress and concentration problems are also treated at the clinic. Patients who suffer from chronic pain receive treatment as well.
In his role as a clinical psychologist, Berkowitz is the embedded behavioral health consultant for Army units on post.
Commanders refer to Berkowitz's expertise when they are concerned that a mental health issue may be interfering with a service member's ability to perform his or her mission.
Berkowitz said he works in consultation with commanders when there is a question of whether service members may be unfit for duty, deployment, a special-duty assignment, carrying weapons or access to classified materials.
He also provides psychological consults for security clearance and safety evaluations.
The mental health team at Kimbrough is composed of psychiatrists, psychologists, clinical social workers, psychiatric technicians and support staff.
You Can Still Function
Another clinic, the Child and Family Behavioral Health Clinic, provides services to family members and retirees.
Berkowitz said that, contrary to popular belief, a mental health diagnosis does not equal dysfunction.
“Essentially, a person can have a diagnosis and be very functional,” he said.
There are times when the debilitating effects of a mental health condition are limited — similar to breaking a leg and not being able to walk for six weeks.
“Most of the people who come in here are doing pretty well. It's kind of like having the common cold,” Berkowitz said of some mental health disorders. “You know anxiety and depression are kind of like the mental health equivalent of a common cold.”
However, there are times when a diagnosis is more serious.
“When someone is imminently dangerous to themselves or someone else, we have to protect them or others,” Berkowitz said.
In regard to high-level security clearances, Berkowitz said if a Soldier's condition “adversely affects their judgment, reliability or stability so much that we think they are a risk to national security, then we are required to make a report. But it's pretty rare.”
If a service member reports being involved in child abuse, spousal abuse, or the abuse of the elderly or the disabled, the mental health team must also make a formal report.
“Lots of people walk around with mental health symptoms and never need help. They may have sufficient support from friends and family and they may be able to resolve things on their own,” Berkowitz said.
“If the problem interferes with your life, if it interferes with your job, school or with your home life, or if you don't feel like you can connect with people like you used to, then it's probably a good idea to come in.”
In most cases of command-directed mental health evaluations, Berkowitz said the commander is simply concerned about the well-being of a service member.
“They just want to make sure that the person gets the right care,” Berkowitz said. “If the person isn't performing very well, the command will want to make sure if there's a mental health condition that's affecting performance, that we get it fixed.”
Berkowitz said if a service member has a mental health condition and doesn't seek treatment, there is more of a likelihood that a problem may arise that will cause his or her leadership to become concerned.
“The reality is, if you have a problem and you don't seek help, that's when people say ‘well that person has poor judgment,' and that can become a problem,” Berkowitz said.
For service members with PTSD, there are three empirically validated forms of treatment used at the clinic:
Cognitive processing therapy
Prolonged exposure therapy
Berkowitz most commonly uses cognitive processing therapy, which helps patients process the thoughts and feelings they have about the traumatic event.
This is the form of therapy that was used to help the Soldier with the nightmares.
Prolonged exposure therapy helps patients by desensitizing them to their traumatic events.
“By avoiding it, you never process it. You never resolve it,” Berkowitz said.
According to the Naval Center for Combat and Operations Stress Center, eye-movement desensitization utilizes a patient's eye movements as he focuses on positive thoughts to deal with any tension or discomfort from the traumatic event.
Berkowitz said service members who feel they need help should not be afraid to reach out.
“Just like physical health, almost everyone will experience some sort of emotional challenge sometime in their lives,” Berkowitz said. “The key becomes when they have the opportunity to seek support to help them resolve whatever that difficulty is.”
The Behavioral Health Clinic is dedicated to serving those in need.
“We are here for that reason,” Berkowitz said. “That's our mission in life.”
Knowing the symptons of PTSD
According to the National Center for PTSD, symptoms can start immediately after the traumatic event, or several months or even years later.
There are four main symptoms of PTSD that mental health professionals recognize to make a possible diagnosis. They are:
Reliving the past event – A person can experience bad memories or nightmares that are called flashbacks.
Avoiding situations that remind the person of the event - A person may avoid a holiday celebration that includes fireworks because the sound reminds him of combat.
Negative changes in beliefs and feelings – A person may develop feelings of guilt, shame or fear.
Feelings of hyperarousal – A person may feel jittery or always be on alert, or is looking out for danger.
If you are experiencing any of these symptoms or feel you need help for another mental health issue, contact the Behavioral Health Clinic at Kimbrough at 301-677-8895.