Operator Syndrome: Why No One Is Coming to Save Our Warriors

Editor’s Note: This 4-part series was adapted by Chris Frueh, PhD, from his book titled Operator Syndrome (2024; Ballast Books). The pattern of injuries and impairments associated with the Operator Syndrome framework is often seen in soldiers from the combat arms, private defense contractors, intelligence agents, law enforcement officers, and firefighters. Read Parts 1: Operator Syndrome: When the War Comes Home in Silence and 2: Operator Syndrome: Unseen Scars of the Elite Warfighter.

---

There are powerful voices within “The Establishment”—mainstream medicine, health policy makers, health insurance, and military leadership—that have circled the wagons to resist the framework of Operator Syndrome. I’ve heard this from various sources, including individuals inside the VA, the DOD, SOCOM, organized medicine, mental health professional associations, and several large veterans’ foundations. Common arguments against Operator Syndrome—and my rejoinders—are as follows:

• “Operator Syndrome discriminates against those who were not in SOF; social justice requires treating all soldiers and veterans equally.”
  My response: Unique injuries require unique treatments.
• “It will stigmatize operators and harm recruitment and retention.”
  My response: The specter of brain and orthopedic injuries doesn’t seem to reduce the number of athletes competing for roster spots on professional sports teams. Virtually every operator I’ve met has made it clear that even knowing what he knows now, he would still volunteer to do it all over again.
• “It is not a ‘real’ diagnosis anyway.”
  My response: That’s correct—it is a whole-systems framework to guide research, performance optimization, and treatment for the unique injuries and impairments incurred by SOF.
• “It will require us to develop new programs and services.”
  My response: Yes, it will. But that is no excuse to avoid providing quality medical care. Suck it up—it’s the right thing to do and supports our armed forces and national security.

Sadly, in medicine today, differences of opinion are often not settled with data, logic, or critical analysis. Too often, political ideologies in medicine not only trump empiricism but actively censor it.

The VA and DOD are responsible for virtually all healthcare for veterans and service members. They control a vast empire of treatments, facilities, pharmaceutical contracts, and specialized personnel. These two departments represent powerful vested interests and maintain a virtual monopoly on medical research related to veterans and service members. Not only do they dictate what research can be conducted within their systems, but they also control most of the available research funding.

For example, while any medical scientist can apply for NIH grants, only VA employees are eligible to apply for VA research grants. You have to be in the club to play. The result? No competition from outside researchers, leading to groupthink and a herd mentality. Much of this research is carried out by a unionized workforce bound to the political priorities of the VA’s entrenched bureaucracy.

How could meaningful innovation not be stifled?

The PTSD “industry”—which includes Big Pharma and the VA’s psychologists, social workers, and psychiatrists—is a behemoth. The Operator Syndrome framework runs counter to much of its accepted wisdom and standard practices. These vested interests don’t want to see the primacy of psychiatric treatments or branded psychotherapies diminished. Small research empires would be disrupted. Careers threatened. Clinics restructured. The dominance of the entire mental health field would shift in favor of other medical disciplines.

This demonstrates how difficult it is to find thoughtful, specialized healthcare that meets the needs of the SOF community. As one active-duty SOF soldier recently told me, “Nobody’s coming for us.” Many within the community are now turning to nongovernmental solutions rather than waiting on the VA.

---

Modern Healthcare: Fragmentation, Systems, and Insurance

One of the core problems faced by operators, soldiers, and first responders—indeed, by all of us—is the fragmented, overly specialized approach to modern healthcare. Specialists rarely coordinate with one another, leading to poor communication when multiple conditions are present.

To address SOF-specific needs, a uniquely tailored, comprehensive, programmatic approach is essential. Intensive, multidisciplinary outpatient programs lasting two to eight weeks are likely the most effective. Evaluation and treatment should target all conditions and involve a team that may include neurologists, endocrinologists, sleep medicine specialists, physiatrists, psychiatrists, psychologists, orthopedists, gastroenterologists, physical therapists, pain specialists, nutritionists, speech pathologists, vestibular medicine experts, internists, and other rehab professionals.

The DOD’s National Intrepid Center of Excellence (NICoE) and Intrepid Spirit Centers offer TBI-focused programs for active-duty personnel. However, these have long waiting lists, are not specifically SOF-tailored, and are unavailable to retirees. A few civilian and veteran programs exist, but they also have long waits. Insurance may cover individual treatments, but none that I’m aware of covers a full-spectrum multidisciplinary program tailored for former operators.

---

Healthcare Needs That Are Unique, Not “Special”

Over the last decade, I’ve frequently heard objections—usually from neurologists, psychiatrists, psychologists, and military officers—against developing SOF-specific treatment programs. These objections often reference “social justice” (equal treatment for all) or assert that PTSD is the main issue and should be treated similarly for all veterans. Often, there’s an unspoken suggestion that SOF members are seeking special entitlement.

To this I say: everyone who served deserves effective care for their injuries and impairments. But the PTSD and TBI treatment models offered by the DHA and VA address only parts of the puzzle. SOF healthcare demands a comprehensive, multidisciplinary approach—delivered with deep understanding of SOF culture.

---

A Few Thoughts on PTSD

Most are familiar with PTSD, a common psychiatric diagnosis among military veterans. It’s a go-to label for the VA system. But what is it? PTSD is essentially a combination of depression and anxiety, plus symptoms of trauma-specific fear reactivity.

“Fear reactivity” includes intrusive memories, nightmares, flashbacks, anxiety at reminders, and avoidance behaviors. Fortunately, PTSD is highly treatable with behavioral therapies, particularly in civilian and non-VA populations.

However, beware the PTSD disability trap. More than half of all service members from Iraq or Afghanistan have been diagnosed and are receiving lifetime PTSD disability benefits. Yet the best research shows only about 8% of warzone veterans meet true diagnostic criteria. Most deployed veterans weren’t even combatants. This discrepancy raises questions about how the diagnosis is used within bureaucratic systems.

And here’s another issue: despite spending $5 billion annually on mental healthcare, the VA can’t—or won’t—release system-level data showing the effectiveness of their PTSD treatments. I’ve asked. Others have asked. No answers. What I often hear from SOF veterans is that the VA’s motto is “medicate and isolate,” suggesting more focus on quieting veterans than treating them.

The PTSD disability trap promotes becoming—and staying—a psychiatric invalid. If you’ve experienced this pressure, I urge you: don’t succumb. Don’t let it define you. PTSD is treatable with the right therapy. Also, consider that the diagnosis may be inaccurate. Most operators lack the intense fear reactivity that PTSD requires.

---

Limitations of Medical Science

There are indeed scientific limitations to what’s presented in this series. Our paper on Operator Syndrome is a descriptive account, based on lived and clinical experience, not a prospective or longitudinal research study. There are gaps in our understanding of causes, effects, and treatments—not just for Operator Syndrome but for TBI and related conditions.

With today’s overreliance on a narrow “mental health” lens, we may not be asking the right research questions or exploring the right biological mechanisms. But even with these uncertainties, inaction is not an option.

---

1. Wounding Warriors: How Bad Policy is Making Veterans Sicker and Poorer by Daniel Gade and Daniel Huang (Ballast Books, 2021)

Christopher Frueh, Ph.D. is a novelist, clinical psychologist, and professor of psychology at the University of Hawaii. With over thirty years of experience working with military and first responder communities, he has led clinical trials and epidemiological studies, conducted neuroscientific research, and co-authored over 325 scientific publications. This 4-part series was adapted from his book Operator Syndrome (2024; Ballast Books).

As the Voice of the Veteran Community, The Havok Journal seeks to publish a variety of perspectives on a number of sensitive subjects. Unless specifically noted otherwise, nothing we publish is an official point of view of The Havok Journal or any part of the U.S. government.