The Wages of War: The Unpaid Debt Owed to Our Veterans

This Memorial Day in particular has me feeling some kind of way; not just because I am keenly aware of those lives lost to ensure my freedom, but also because I am acutely aware of those lives indelibly changed as a result of their service to this great country.  My own service in Afghanistan as a civilian has given me an entirely different perspective on the combat experience. On what it means to be prepared for war; and what it means to go to war unprepared (like so many of our young men during Vietnam). I understand just a bit more about their sacrifice. I know what it is to go to bed with one eye open, with your weapons and ammo and boots near you. To be ever vigilant, never at ease, and always on the ready.  To have your heart pound almost out of your chest and fight to keep your wits about you the very first time you feel the impact of an IED blast. To be separated from your loved ones for a really long time.  But I don’t know what it’s like to have to fight for your life. Or to kill to protect your life.  Or to see the gory horrors of war.

And so because of my experience, I have a newfound respect for all combat veterans; but especially those who continue to fight the silent war.  The silent war is the war inside their minds. It is a war waged largely against their own thoughts, memories, feelings.  It is a war against habits and behaviors that many implement to numb the pain. It is the isolation that they enact because they feel that no one understands, or that they cannot be totally open and honest and trusting of anyone, and because they just don’t want anyone to know the depths of their pain. They don’t want to deal with the stigma. The stigma is real. For a soldier even more so.

As much as we say we honor them, we dishonor them and their sacrifices. We turn our heads when we see a homeless guy with a nappy hat, and a tattered jacket, and a dirty sign saying, “Hungry veteran. Please help me eat.”  We cross to the other side of the street when we see the woman mumbling to herself.  We forget that it was war that contributed to this social problem. And we forget that our brothers and sisters who were prepared to lay down their lives, they are our problem.

No veteran should struggle with mental illness, addiction, unemployment, homelessness, or hunger following his or her service. So many of them have been adversely impacted by their combat experiences. We still don’t really know how many Vietnam-era vets struggle with PTSD, but certainly our best guess pales in comparison to the true numbers. Four decades later, we now know that a large majority (THE vast majority) of Vietnam vets struggle(d) with chronic PTSD symptoms. Four out of five Vietnam veterans reported active PTSD symptoms when interviewed 20 to 25 years after that war. Indeed, I recently interviewed a Vietnam-era vet who sobbed as he recounted story after story of his war experience in vivid detail just like it was yesterday. He had never spoken of his experiences in theatre. They rarely if ever do.

Why do I do what I do? Why is it so important to shed light on the issues facing our veterans? Because the rates of suicide amongst veterans are astounding; in one year it was 2 times the number of suicides in the US population writ large.  In 2014, 20 veterans per day committed suicide. I do what I do because:

  • 50% of those with PTSD do not seek treatment.
  • Rates of post-traumatic stress are greater for the Iraq and Afghanistan wars than for prior conflicts
  • 19% of veterans may have a traumatic brain injury (TBI); and 7% may have PTSD and TBI
  • More active duty personnel die by their own hand than from combat.
  • It is estimated that 20% of Iraq and Afghanistan combat veterans have PTSD and/or depression.

There is a consequence to waging war, and it is a costly one. You cannot place a price on mental health, or psychological wholeness. Nevertheless, we owe this debt and it must be paid in full. How can we ensure that we do right by the men and women who have valiantly served?  We must demand that Congress allocate the funds to providing state of the art services, to hiring the best and brightest clinicians and researchers, and to creating the infrastructure to properly and adequately care for our wounded warriors.

To do your part — to truly thank them for their sacrifice, and to honor those lives lost for your freedom and mine, contact your state representatives to Congress via letter or phone, and demand that this be a priority.

We owe it to those who laid their lives down for us — to take care of their brothers and sisters-in-arms who are still fighting a war alone.

Be well,

The Good Dr. Nik


Dr. Nicole Alford is a DMV-based clinical psychologist, writer and prolific blogger, teacher, media commentator and compassionate activist working to raise mental health awareness and end stigma. For more information on her professional services, view her website at, and follow her @TheGoodDrNik on all social media platforms.



May Aint Just About Flowers: Why Mental Health Awareness Month Is So Important

May is Mental Health Awareness Month. This is the month that we mental health professionals, survivors, families, and those otherwise dedicated to the cause take to raising awareness and dollars to advance our agenda. For us, May aint just about the flowers! The Good Dr. is here to tell you that for some, April showers are a 12-month occurrence. For others, the flowers are but an illusion. So here is why I do what I do, and why this month is so incredibly important:

To Educate: Knowledge truly is power. You can’t address what you don’t admit, and you won’t heal what you don’t acknowledge. Not only must we become a more educated society with respect to mental illness, but we must seek truth.  A wise Bishop once stated, “It is not the truth that will set you free, it’s the knowledge of the truth.” So here is a small sampling of the truth about mental illness and its impact:

  • Approx. 63M Americans (26.2%) suffer from a diagnosable mental illness each year — whether or not they are ever diagnosed (NIMH)
  • Anxiety Disorders comprise the most frequently occurring diagnosis; with 18.1% of Americans and women more likely to suffer this type of disorder than men (NAMI)
  • 16M adults live with major depression
  • African-Americans and Hispanics utilize mental health services at half the rate of Caucasian Americans (NAMI)
  • Each day an estimated 18-22 veterans die by suicide
  • Suicide is the 10th leading cause of death in the US; the 3rd leading cause in people aged 10-24 and the 2nd leading cause in people aged 15-24
  • Among the 20.2M Americans in the US living with a substance use disorder, 50.5% of them have another co-occurring mental illness
  • Gay, lesbian, transgendered or Q youth are twice as likely to attempt suicide than their heterosexual counterparts

The truth of the matter is that minority communities are predisposed and significantly more vulnerable to mental health issues due to the stress of living in a society that discriminates, marginalizes and moves against them aggressively on the regular, the stress of a life of poverty, urban violence, and lack of access to affordable quality healthcare. The truth of the matter is that even when we do have the means to afford mental health care or the access to it, we don’t use it. The sad truth is that there are historical and cultural myths, traditions, and beliefs that keep us stuck in dysfunction and suffering in silence. The truth of the matter is that we are a prideful people who are trained not to ask for help, to take it on the chin, to be the superwoman and Mandingo warrior labels that have been ascribed to us.

To Advocate:  Those of we regular people who have voices and concerns that often go unheard need to not only learn to advocate for ourselves, but we must also empower those in the position to advocate for our interests. Grassroots organizations and activists like the National Alliance for the Mentally Ill (NAMI) regularly lobby Congress and state legislatures to enact laws that ensure the ease of accessibility, quality, and affordability of mental health care in addition to taking stances, (even unpopular ones), on issues that have a mental health nexus. For example, it was lobbyists that were instrumental in getting the gun laws strengthened following the Virginia Tech massacre in 2007, and lobbyists that led to the tightening of the mental health data reporting laws from states to federal databases for background checks. Related to empowering advocates, one way is to donate money and/or volunteer your time in assistance to these organizations.

To Eradicate:  In the early 1960’s, psychiatrist Thomas Szasz wrote a well publicized (and criticized) book entitled The Myth of Mental Illness; eschewing mental illness as nothing more than a stigmatizing label placed on people with problems in living. While I understand his argument, and agree that mental illness has historically been a destructive label used to isolate and separate those with real problems, it has also been a way that behavioral scientists and researchers have come to understand, study, categorize and treat classes of symptoms. There is still great stigma attached to having, admitting to, or seeking treatment for any type of mental illness — no matter the context. Even when, by right, symptoms should be expected (i.e. veterans returning from the horrors of battle, or someone going through a difficult divorce), we tout only the strength and seeming resilience shown as if it is a badge of honor to not break down during such tragedies. If history teaches us anything, it is that silence kills. We must work together to end stigma. We must admit and acknowledge when we are struggling. We must make it OK to say, “I am not OK.”

One thing the Millennial generation understands and gets my total admiration for is their openness and proud ownership of their issues and ‘isms.’ They wear their issues like a crown for all to see, and true to their generational nature highlight their battles and make a platform of them to help others. From Prince Harry’s admission of his early struggles with depression, to Chance the Rapper’s acknowledging his PTSD from urban violence, to Kid Cudi very openly admitting his battles with depression and suicidality — these youngins are launching a very public campaign to destigmatize help seeking. As the Good Book says, ‘…A little child shall lead them’ and the Bible aint never lie! Say what you want to about Generation Z but right now, they lead the fight to end stigma. And I stand boldly and courageously with them.

Do your part in May. Educate someone. Admit that there have been times when you were not OK. Check on your people. Donate some dollars to the cause, or join the annual NAMI walk that every major city has on May 20th. For more information on how you can advance this cause, especially during this seminal month, go to

Be well,

The Good Dr. Nik


Dr. Nicole Alford is a DMV-based clinical psychologist, writer and prolific blogger, teacher, media commentator and compassionate activist working to raise mental health awareness and end stigma. For more information on her professional services, view her website at, and follow her @TheGoodDrNik on all social media platforms.