Mental Illness: Suffering, solitude and stigma.

Mental illness:
Suffering, solitude and stigma

Romeo Dallaire

Despair, self-doubt, helplessness, humiliation and anger are just some of the feelings I've grappled with continuously since the hellish 1994 Rwandan genocide. But in my daily struggle to improve my mental health, there have been positive experiences and significant personal victories as well.

Being in the public eye, I have seen and heard much about the suffering, solitude and stigma that surround mental illness in our society.

Though 13 years have passed since the genocide, the sights, smells and sounds of death continue to haunt me, and they likely always will. The barbarity of the massacre of 800,000 people in 100 days was unspeakable, and remains one of the darkest periods of the 20th century. I stood helplessly amidst the genocide in command of the meagre United Nations force during that country's doomed attempt to establish peace. All UN peacekeepers who were there, many still haunted like me, also witnessed the horror.

Looking back, time ground to a halt during my months in Rwanda, and I gradually became numbed to the sight of rape victims, atrocities against children, piles of bodies along the roads, and pools of blood from murder victims who had been hacked to death with machetes and clubs. My mission required me to bring warring factions together according to a peace plan that existed only on paper, so I was obliged to deal regularly with the very leaders who had planned and launched this butchery. I could get no help from the international community, and the United Nations refused to listen or act.

Although I functioned as well as I could in that anarchy and relied on my training and professionalism as a soldier to fulfill my leadership responsibilities, I knew as I neared my departure that I had suffered an incredible psychological injury. My mission had failed, some of my soldiers had been massacred, and my leadership was starting to fail me as I had lost my sense of humour and my sense of balance in my decision making. The stress became overwhelming.

Like many who suffer from psychological distress, I fought to ignore and deny symptoms and danger signals when I returned home to Canada. I tried to deal with the flashbacks, anxiety attacks, mood swings and nightmares by burying myself in my work, but I could not stop the memories and the mental anguish they fed.

So many soldiers returning from UN missions in Bosnia and Croatia were physically wounded, but I was not. My wounds, though crippling, were invisible. Like the vast majority of soldiers in the Canadian Forces, I had long subscribed to an organizational ethos that demanded we "suck up the pain" and show no signs of weakness or suffering-especially psychological suffering.

But it was no good. My symptoms inexorably overtook my ability to function, and I could no longer mask my anguish from others. I was diagnosed with posttraumatic stress disorder (PTSD), a psychological disorder unknown in the late 1990s to many people, both within and outside the military. I began treatment, quietly, haltingly and almost furtively, to avoid the stigma I knew surrounded mental health problems-a stigma I had subscribed to for so long myself.

As my treatment progressed, I came to understand that I needed to stop hiding my psychological illness, and that speaking out about my experience to soldiers throughout the Canadian Forces seemed to resonate with them and their families. Using my high rank and visibility, I believed I could make a dent in the stigma that caused so many other soldiers to suffer silently. I knew they were out there, their careers on the rocks and their families in crisis. I knew that even those who understood they were ill were too afraid and ashamed to seek help.

Don't think my decision to go public about my PTSD meant I had conquered my own PTSD demons, but at least for the Canadian Forces, I helped coax the genie out of the bottle. I still occasionally hit rock bottom myself, but whenever I could I spoke out to soldiers, former soldiers, families, veterans-to anyone who would listen-about the need to treat the illness and break the stigma so ingrained in the military's tradition-driven, insular, self-perpetuating and rigorous hierarchical structure.

For so long, mental illness was viewed as weakness, laziness, malingering and just plain unmanliness. Those afflicted were expected to suffer in silence, get over their symptoms by willpower, extra effort and "pulling up their bootstraps." They just could not fathom that it was an operational injury.

Then in 1999, I crashed and became mentally incompetent for more than six months. I was in a perpetual state of incoherence, fatigue, mental lapses, nervousness, sleeplessness, and extremes of overeating and food deprivation. I could not read one line of the newspaper. In April 2000 I was medically released from the military after a period of reasonable accommodation. I then went into an isolationist state and attempted suicide four times while abusing alcohol.

I was greatly relieved and encouraged when in 2001, the Department of National Defence Ombudsman announced he was beginning an in-depth investigation into the systemic treatment of soldiers with PTSD. Other mental illnesses whose symptoms were similar and equally disabling naturally came under scrutiny. The Ombudsman's February 2002 report, and his detailed follow-up report that December, exposed for all to see the long-defended barriers to treatment of mental illness. His reports, blunt and wide-ranging, found major problems within the military surrounding the diagnosis of, treatment of, and support for stress-related illnesses. The negative attitudes of the rank and file, some senior leaders and even some medical professionals toward PTSD and other mental illnesses were unflinchingly exposed.

In many circles, the Ombudsman's investigators found those who felt that "Roméo Dallaire was the worst thing that happened to the Forces," referring to my decision to speak out about this "new" invisible injury. Other negative comments pertaining to soldiers similarly injured were documented, such as "every one of them is a below-average soldier" and "they are just faking it. It is a good way to get a pension." In one prescient observation, the Ombudsman noted that "those who deny that PTSD exists may themselves have problems they are reluctant to admit to.... Investigators heard anecdotal evidence... that some of those most vociferous in denying that PTSD is a genuine illness were subsequently diagnosed with PTSD themselves."

For those who wish to battle stigma within an organization, the DND Ombudsman's reports are a must-read. They have facilitated an impressive overhaul of the care and support available in the military today to those suffering from operational stress injuries.

I encourage advocates for PTSD and mental health, family members of patients, and individuals who are sufficiently recovered from their injury to fight hard against stigma wherever it is manifested. Those diagnosed with PTSD, or those who think they might suffer from it, must resolutely seek out the care they need and realize they are not alone.

We who continue to fight the stigma of mental illness in our society should be guided by the words of Gandhi, a man who believed deeply in the need for compassion, understanding and perseverance: "First they ignore you, then they laugh at you, then they fight you, then you win."

Peux ce que veux. ("Where there's a will, there's a way.")