War Neuroses on the Twenty-First-Century College Campus

by Michael McAndrew

The United States has been engaged in the “Long War” of post-9/11 conflicts for eighteen years. If that war were a person, it might be getting ready to go to college. Indeed, many of the almost three million veterans who have served in the post-9/11 conflicts are also returning to college—though many may be significantly older than eighteen, as they now begin or continue their college educations.

Despite steeply rising tuition, many veterans are able to make use of the generous Post-9/11 GI Bill to begin or return to school. Often, these student-veterans enter as undergraduates, with much, if not all of their tuition covered by the bill (and in many cases supplemented by the colleges and universities they attend). These students are older (perhaps much older, if they had longer terms of service) and have had very different life experiences, to put it mildly, than their fellow non-veteran students. There’s an awfully great difference between an incoming student fresh out of high school and an incoming student-veteran, who may have been deployed multiple times before the first day of, say, their Introduction to Psychology class.

Sigmund Freud spoke of education as being one of the three impossible professions (the other two being governance and psychoanalysis):

Here let us pause for a moment to assure the analyst, that he has our sincere sympathy in the very exacting demands he has to fulfill in carrying out his activities. It almost looks as if analysis were the third of those ‘impossible’ professions in which one can be sure beforehand of achieving unsatisfying results. The other two, which have been known much longer, are education and government. (248)

With all due respect to Freud, I would add a fourth impossible profession: war. In contemporary discourses of mental health, we often hear the word “crisis.” Two such crises are “the student mental health crisis,” unfolding chiefly on college campuses, and “the veterans’ mental health crisis,” which permeates civil society. What follows is my perspective on how these two crises intersect and how psychoanalysis might further illuminate and address that intersection.

Unfortunately, one of the best-known statistics about post-9/11 veterans is that an average of 22 veterans commit suicide every day. And that number is rising among younger veterans, including those who’ve returned to college. According to data released by the Department of Veterans Affairs, the suicide rate of veterans aged 18-34 increased by 10% from 2015 to 2016, which translates into 45 deaths per 100,000 veterans—the highest of any age group of veterans today (Shane). This already urgent problem is further exacerbated by its intersection with the current campus mental health crisis: the American Psychological Association, via a National Survey of College Counselors, estimates that 52.7% of college students experience “hopelessness” and that 39.1% of students are “severely depressed” (2017). Overall, 94% of university counseling centers report that the number of students with “severe psychological problems” is increasing, and that 58.9% of students who visit their schools’ counseling centers are reporting anxiety-related disorders, according to the Association for University and College Counseling Center Directors (Solomon). And, while the reported incidence of Post-Traumatic Stress Disorder (PTSD) among veterans varies from one service era to another, 11-20% of veterans who served in Operation Iraqi Freedom or Operation Enduring Freedom have, according to the VA, reported symptoms of PTSD in a given year (Gradus).

Within the military (as in much of civil society), there is a pervasive culture of silence when it comes to mental health. Many service people, sadly accustomed to combat and sexual trauma, the violent deaths of close friends, suicidality, addiction, and profound alienation after their return from deployment, tend not to speak about such matters. Soldiers, sailors, marines, and airmen are, in fact, taught not to speak of these things—not to each other and not to the “psych,” or psychologist or psychiatrist—because the wrong word could end one’s career and lead to a discharge under unfavorable terms. Given this culture of silence and mistrust, how might already overwhelmed college counseling centers better serve returning veterans?

Contemporary standards of care, including very-short-term behavioral counseling and over-reliance on medications, are in many cases inadequate. Indeed, the efficacy of Cognitive-Behavioral Therapy (CBT) and other “evidence-based” therapies has been questioned for years. According to Dr. Jonathan Shedler: “Research shows that ‘evidence-based’ therapies are weak treatments. Their benefits are trivial. Most patients do not get well. Even the trivial benefits do not last” (319). Shedler concludes that the data published by the National Institute of Mental Health (NIMH) Treatment of Depression Collaborative Research Program (the first large-scale study of “evidence based” therapies, including manualized CBT and antidepressants) was misleading and that “the primary outcome measure in the NIMH study was [that] the difference between the CBT treatment group and the placebo control group was 1.2 points. The 1.2-point difference between the CBT and control group is trivial and clinically meaningless….[H]ow could there be such a mismatch between what we have been told versus what the study actually found?” (321).

Despite mounting evidence that psychodynamic psychotherapies are often far more effective than either CBT or antidepressants, their time- and cost-intensiveness are often regarded as prohibitive—even elitist. Yet, from Freud’s time to the present, psychoanalysts have made comprehensive efforts to overcome these barriers (both real and imagined) to effective treatment for all. These efforts need to be redoubled, including on college campuses.

Before I became a Lacanian psychoanalyst in formation, or attended a graduate counseling program, or had even heard of Freud, I myself was in the military. I spent four years in the U.S. Navy on the flight deck of the USS Abraham Lincoln. After I was honorably discharged, I became a student-veteran and began to learn about the efforts that Freud and many other early analysts (Sándor Ferenczi in particular) made to open the doors of their consulting rooms to veterans of the First World War. It was, in fact, under Ferenczi that the psychoanalytic “hour” was reduced to 50 minutes, in order to accommodate larger numbers of those veterans suffering from “war neuroses.” Today, in campus-based mental health centers, there is a pervasive need to treat more complex cases of “civilian” students and student-veterans alike, and analytically informed approaches could and should be made more readily available. Larger numbers of seasoned analysts need to volunteer more of their time, and space and time need to be made for honest, inclusive conversations about mental health.

I also learned that, in many campus mental health clinics today, students are often forced to wait weeks, even months, for an initial consultation and that providers themselves are often overwhelmed by complex cases they’re not adequately trained or resourced to treat:

Between 2010 and 2016, the number of students seeking on-campus counseling shot up by 30 percent—more than five times the growth of overall college enrollment. The result: By 2018, 34 percent of school health centers reported wait times of up to three weeks or more—and these long wait times often lead to “no shows” or discourage students from scheduling an appointment in the first place per the Association for University and College Counseling Center Directors (AUCCCD). For students on those lists, the average wait time was 17 business days. But at some schools, it stretched to 34.7 days. (Bullock)

U.S. campuses are facing a major student mental health crisis; and many of the nearly 900,000 student-veterans on these campuses may require an even greater level of care. This care could be provided, if some basic steps were taken and some strategic partners enlisted. Throughout the U.S., there are many local psychoanalytic institutes, societies, reading groups, associations, and forums, many of which could, in partnership with university counseling centers, handle larger caseloads and more complex cases—including combat-related disorders that university counseling centers aren’t generally equipped to handle. During the COVID-19 outbreak, the Colorado Analytic Forum and the Lacanian Forum of London both offered pro-bono services oriented toward essential employees and front-line professionals, including other mental health professionals. Similar initiatives could help address the mental health crisis of student-veterans, by making such partners stakeholders in sustained, comprehensive, campus-based mental health services.

Other institutional players could also pitch in. For example, Psychoanalytic Studies programs (such as those at Emory University, Hampshire College, NYU/Gallatin, and the University of Pennsylvania, among others) might be able to help facilitate campus-wide education and partnerships as well as to support university counselors in their efforts to meet the unique challenges of working with student-veterans. Student-veterans themselves could be instrumental in educating their peers, counsellors, and instructors about service- and combat-related disorders, while, in the process, helping each other—finally, healthily—to find their own way home.

 

Works cited

American Psychological Association. 2017. “Campus Mental Health.” https://www.apa.org/advocacy/higher-education/mental-health/

Bullock, Maggie. 2019. “It Can Take Weeks for College Students to Get the Mental Health Help They Ask For. That’s a Seriously Dangerous Delay.” Cosmopolitan, 15 October 2019. https://www.cosmopolitan.com/health-fitness/a29211906/college-mental-health-clinic-long-wait-times/

Gradus, Jaimie L. 2007. “Epidemiology of PTSD.”

https://www.mentalhealth.va.gov/coe/cih-visn2/Documents/Provider_Education_Handouts/Epidemiology_of_PTSD_Version_3.pdf

Department of Veterans Affairs. “How Common is PTSD in Veterans?” https://www.ptsd.va.gov/understand/common/common_veterans.asp

Freud, Sigmund. 1964. “Analysis Terminable and Interminable,” in The Standard Edition of the Complete Psychological Works of Sigmund Freud, vol. 23. Tr. James Strachey. London: Hogarth Press, 209-53. Originally published as “Die Endliche und die Unendliche Analyse,” Internationale Zeitschrift für Psychoanalyse 23.2: 209-40.

Shane, Leo, III. 2018. “VA: Suicide rate for younger veterans increased by more than 10 percent.” Military Times, 26 September 2018. https://www.militarytimes.com/news/pentagon-congress/2018/09/26/suicide-rate-spikes-among-younger-veterans/

Shedler, Jonathan. 2018. “Where Is the Evidence for Evidenced-Based Therapy?” Psychiatric Clinics of North America 41: 319-29. https://jonathanshedler.com/wp-content/uploads/2018/05/Shedler-2018-Where-is-the-evidence-for-evidence-based-therapy.pdf

Solomon, Samantha. 2019. “Facing the College Mental Health Crisis: The Need for More Faculty Training.” BestColleges, 12 July 2019. https://www.bestcolleges.com/blog/facing-the-college-mental-health-crisis/