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Terrorism & War: Surgeon General Issues Mental Illness Alert

April 10, 2003 --"Today there’s no greater mental health issue facing us as a nation than the effects of terrorism and war," Vice Admiral Richard Carmona, U.S. Surgeon General, said Friday, citing illnesses including post traumatic stress disorder (PTSD) and depression, as well as, national concern over suicide rates.

"The stress is as real as the level orange alert that we are waking up to these days,"Carmona warned California Psychological Association members Friday. Acknowledging intense human reactions related to the terrorist and war events, he stated that immediate shock, anxiety, depression and sleep disturbances are common.

"Depression is a major public health problem in America," said Carmona in his speech. "The good news is that help is available for people who have persistent depression. In any given trial over a year, 80% of people with depression respond to treatment. Depression is an illness that we can treat, but unfortunately, we don’t treat. You can change that."

Carmona introduced the department of Health and Human Services (HHS) "Real Men. Real Depression." campaign, to get the message out that there’s absolutely no reason for anyone to suffer in silence.

"It (depression) affects an estimated 6 million men annually," he stated. "As someone who is ex-army Special Forces, an ex-cop, ex-paramedic, and a former trauma surgeon, I can tell you that for generations, men like me have been told that we have to ‘act tough.’ This campaign, which you’ll start seeing all over the airwaves, says to men, ‘It’s okay to talk to someone about what you’re thinking, or how you’re feeling, or if you’re hurting.’

"We are attacking the stigma that tough guys can’t seek help. They can, and they should."

There is help in the form of reliable information about how to cope with mental illness concerns, according to Carmona. The HHS department has launched a new section on its web site focused on mental health and traumatic events.  The site offers a wealth of materials and tips on ways to deal with exposure to traumatic events including violence, terrorism and war.  It includes citizen-centered information for a variety of audiences, including first responders, children, parents and teachers. The information can be found at

"When people are constantly exposed to war’s images and there’s no respite, fear builds up until it becomes an individual’s primary emotion," the Surgeon General stated. "We know that fear is critical to survival because it readies the body for danger. Physiologic responses include the activation of the sympathetic nervous system, which increases heart rate, blood pressure and blood flow to muscles, and the release of stress hormones such as cortisol, which make energy available. While this physiologic response is highly adaptive in response to a short-term emergency, it has harmful effects on the body if it becomes chronic.

"Psychologic responses are also powerful in facilitating memory formation. Trauma is effective at promoting ‘one-time learning.’ The survival benefits of this are clear. One will not put oneself in harm’s way again. But this powerful memory system is also what makes the human brain vulnerable to post-traumatic stress disorder, in which an excessive trauma usurps this powerful memory system to produce chronic psychiatric symptoms," he explained.

"The value of fear is to permit rapid adaptive responses to transient threats. Terrorism acts to create a sense that the world is not safe and to make people chronically afraid. Terrorism is aimed at undercutting coping abilities," Carmona stated. "Terrorists exploit our negative response to uncontrolled situations. What we need to do in the wake of terrorist incidents is to develop coping strategies that will allow us as a nation to reassert control over circumstances."

Coping strategies of the Surgeon General’s office include:

  • Achieving progress in shoring up the professions, like psychology, and all other aspects of the public health infrastructure so that our nation can respond to future attacks effectively, and
  • Communicating with the public to make sure that people are aware of this progress.

Carmona shared the following data on PTSD and suicide:

  • An estimated 5.2 million American adults ages 18 to 54 have PTSD.
  • About 30% of Vietnam veterans developed PTSD at some point after the war. The disorder also has been detected among veterans of the Persian Gulf War, with some estimates running as high as 80%.
  • More than twice as many women as men experience PTSD following exposure to trauma.
  • In 2002, there were 30,000 suicides in the United States. That’s twice the number of homicides.