Future therapy/treatment for veterans of near future/ further future mass casualty conflicts

Question

The setting I am working on is near future in a sense and involves veterans dealing with the aftereffects and trauma of war. However, in this setting war is extremely deadly even if not always fatal. More so than our current battlefields. For example, the use of loitering munitions is so prevalent that most infantry units operate from armored APCs with heavy active protection systems and dismount only if the situation calls for it. There is some light shielding so tanks, APCs etc. can take a few hits. Short of nuclear weapons (non-factor in the setting), the soldiers from all sides practically threw everything at each other over a protracted conflict that spanned years. Death is either very fast and unexpected via the use of PGMs or large explosives/artillery. Or slow and painful i.e., when armor piercing shots damage vehicles and maim the crew but don't outright kill them immediately because of shielding.

The result of this is that there are a lot of injured and physically disabled veterans. By the end of the war, which ended in a stalemate with all sides hanging on by a thread, the majority of active-duty soldiers are heavily injured and or have major war related trauma. While not a majority, a decent percentage of each countries' population was recruited or conscripted during the war. The casualties were horrific regardless. Essentially to the point that the militaries of countries have to wipe away the majority of their armed forces and recruit or conscript from scratch due to the prevalence of severely injured soldiers (think Volksstrum levels of bad, but instead of the old and extremely young its mainly the heavily injured.).

With all these returning veterans coming back home there is obviously a major reintegration problem. Especially with how violent the war was. One of the issues is that the fighting didn't really affect civilian areas. Civilians no doubt had their own stressors and issues, but the fighting largely took place off planet. As a result, civilians including the academic/medical community back home have a different and less popular view of the war and the soldiers (think Vietnam).

Given the extra level of violence one could expect from close to far future conflicts between peer forces what would therapy/treatment look like on a systemic level. With the sudden influx of mass casualties returning from an entirely different planet at the end of the war, what medical and psychological advancements could one expect to be used to treat such a large group of returning veterans.

Edit: Focused question based on feedback to focus on future treatments instead of "upper limit" on treatments.

Answer 1

Near Future Medicine:

For purposes of this site, I am interpreting this as a request to know what cognitive and injury therapy and recovery will look like in the near future. At the upper limits, you can reprogram brains and memories, regrow entire bodies, or clone bodies and download new copies of the dead into new bodies, so there really is no "upper limit" except whatever tech level you allow.

Things don't look as bleak as you make them out. If your civilian areas are virtually undamaged, then research facilities, hospitals, and rehabilitative equipment is at your new, artificial fingertips.

Look to current tech, and extrapolate. We are currently dealing with a lot of PTSD, and still botching it enough to be a bit embarrassing. But with drugs and possibly small implants, we are likely going to be able to selectively dull people's memories of trauma so they forget things they don't want to remember. Trauma memories are vivid, but memories are plastic. We are already doing this by having people relive trauma and giving them therapy and drugs to inhibit memory formation so the memories become dull. In this case, wide adoption of more advanced versions of this tech is likely.

• Story-wise, this is a great opportunity to dream up odd side effects for this therapy, like it interfering with people remembering their past.

There ARE going to be significant numbers of people operating with various cognitive deficits. There are interesting programs today working with apps that inform police about people's mental illnesses so the police can know more about people they encounter and how to deal with them safely. Your vets may all be required to carry some kind of device that notifies those around them about their deficiencies, authorizes the use of handicap facilities, and the like.

• This could be extended to include implants that either directly stimulate the brain or remotely administer drugs to calm or sedate vets with violent outbursts, So a police officer might have a phone-like device that brings up a description of the person, their behaviors, and allows to calm or disable the vet remotely.
• This could result in discrimination, legal challenges over freedoms, or people misusing this tech to fake disabilities or fake health to avoid embarrassment or discrimination.

For paralysis, they are working on neural stimulation equipment that lets limbs respond to brain signals even if there isn't feedback. So people with damaged spinal cords can walk with minor assistance. This will get better, so a lot of people may experience a lot of numbness and lack of sensation, but still be able to (somewhat clumsily, and with like the need of some kind of feedback system) use legs and crippled arms.

Scientists can already 3D print bone, and if they can lay down extracellular matrix with the appropriate markers (which they are already doing in animals) they may be able to regrow approximated limbs. Near-perfect, cell-matched ones can also be obtained by dissolving out all the cells from an existing donor limb and allowing the recipient's cells to colonize the resulting matrix. I've seen this done with mouse organs, and it's super-cool (okay, yeah, I'm a biology geek).

Prosthetics will likely get better, lighter, and cheaper. While not likely mounted in the flesh like a cyborg, they will have directly signaled systems reading the user's brainwaves and providing some basic feedback for things like touch and temperature. Given the sheer number of people in your world with experience using such systems, other equipment (think cars, military vehicles, forklifts) may have feedback systems, so people are likely to be thought-controlling in increasing number of things in your society.

Answer 2

Your setting seems to be a reasonable extrapolation of warfare trends. There is a lot of medical literature about the differences between Vietnam and Iraq/Afghanistan in terms of survivability and conflict. With better training of the use of combat tourniquets, better medical evacuation times (at least in Iraq) and better body armor survivability went way up, but that meant a lot more Traumatic Brain Injury and loss of limbs. So a lot more people with severe injuries made it home. There has been some amazing progress made with prosthetics, research in interpreting nerve impulses and integrating them with prosthetics. Rehabilitation therapy has gotten much better. The variety of prosthetics for different purposes has also greatly increased and it is a reasonable extrapolation that some prosthetics might be more complicated machines that are controlled with the brain, or manipulated via the prosthetic interface.

There is a lot of current concern about the next peer to peer conflict. Being able to handle mass casualties day in the 10's of thousands is very very different than something like an Iraq/Afghanistan where forward deploying a few surgeons, or training up medics to a very high level can make a big difference. Instead there is a big logistics problem, concerning how you extend someones life on the battlefield long enough such that they can be transported to an appropriate level of care. Some of that can be helped a lot with technology, stopping hemorrhaging in creative ways and preventing infection can go a long way. Artificial blood that can be stored at room temperature, or dehydrated blood you can store and have available for transfusions. Pain management, smart bandages for burn and wound care could help a lot. But as you mention there will be a lot of casualties where there may not be a lot that can be done, but and there will likely be a lot of very damaged people.

All the physical stuff ties into the mental health aspects. With mental health it is a lot more complicated.... there is PTSD, but then there is a lot of stuff that doesn't rise to the level of PTSD and in my opinion that is a big gray area. There are a lot of people who make it day to day, contribute to society but struggle. Is it is due to their military experience, or other life circumstances? In just the normal civilian population there are a lot of traumatic experiences, PTSD and people who struggle as well.

A huge portion of the PTSD and related mental health tied to how society views people who struggle and how those people feel integrated into society or not. Your story could go from any extreme between veterans being despised to them being viewed as very important to society.

On the technology side though it seems that we now better understand that the brain is very plastic and can be trained to overcome some pretty severe deficits. There is some discussion about if some PTSD could be reduced if the brain was reset using psychotropic drugs. We also seem to know that things stress and trauma can impact things like impulse control, executive functioning. Like mentioned in the other answer, on the research side, there is interest if different parts of the brain be selectively stimulated, is that through an implanted device, or by applying strong magnetic field, or though light being shone though the skull and activating a drug in a certain region. A lot of this type of research has been funded or stimulated by military interests, but there should hopefully be much wider benefits to society.

Things like cosmetic surgery are also important. It really helps in reintegrating, but it also hides the injury. If someone looks normal... how do you know that they were injured or are struggling.

If you look at crime statistics, I think veterans as a group are less likely to commit crimes than the general population. However, veterans are clearly identified as a group and violence and domestic abuse are perceived as a problem and generally get blamed on military service. I think the professionals that look into these kinds of things have a more nuanced view and seem to think other factors beyond military service are also at fault. They also point out that only a very small number of veterans get diagnosed as having PTSD.

The issue of violence and PTSD is particularly complicated. Self medication - in particular alcohol abuse seems to be a aggravating factor, but I think most people also understand that the overall social system is important. The conclusion of one study

Co-occurring PTSD and alcohol misuse was associated with a marked increase in violence and aggression in veterans. Compared with veterans with neither PTSD nor alcohol misuse, veterans with PTSD and no alcohol misuse were not significantly more likely to be severely violent and were only marginally more likely to engage in other physical aggression. Attention to cumulative effects of multiple risk factors beyond diagnosis - including demographics, violence history, combat exposure, and veterans’ having money to cover basic needs like food, shelter, transportation, and medical care - is crucial for optimising violence risk management.

I think from a world building perspective - there is a lot that you can do projecting from future trends in technology, but the heart of your story probably ends up being about the human condition and how individuals interact with the society that they are in.

Answer 3

This is a Frame Challenge

Our modern understanding of the effects of war on the individual soldier has, in my opinion, led us to erroneously believe that war today is somehow worse than it was in yesteryear. And that has led you to believe that it can be made ever so much worse, leading to asking just how much psychological damage can be fixed. You've included a description of weaponry that's designed to, theoretically, maximize psychological stress and you have created a condition (not hitting population centers) to maximize the separation between soldier and civilian.

It's an entirely false premise.

War is individually more brutal the further back you go in history

Modern warfare is certainly more instantaneously destructive than wars in the past. But destructiveness alone doesn't create deeper scars on the individual soldier. The U.S. Civil War meets all of your criteria and yet I'd bet you think it's "less violent" than wars today or in your near future. Some states had to devote a third (a third!) of their annual budget to prosthetic limbs. Some towns lost all of their military-age men. Photographs of the battles are sickening and depict, in my opinion, as much or more violence as you're trying to consider.

And it gets worse the further back you go. People a thousand years ago waded through blood, too often had to kill face-to-face, and had the pleasure of seeing bodies trampled by horses and chariots. Theirs was a day when all too often it took a long time to die.

I believe it's false to believe that war today is more onerous than it was in the past. I believe it was, for the individual soldier, much more onerous in the past. Humanity simply didn't have the psychology skills to understand the problem. If you have any technology at all in your near future, that technology will be used to strike from a distance and remove the expensive-to-train and expensive-to-fix soldier from the field.

Not surprisingly, "statistically" it appears that there was less cancer 200 years ago than today. That premise is false, too. People 200 years ago simply didn't understand cancer as well as we do today and so its consequences were recorded as something else, skewing the historical data. I believe you're affected by the same problem with the psychology of war.

No modern war would ignore population centers

Humanity has long since left behind the idea that civilians are not part of the military machine—that they should be left alone or protected because they're not a threat. They are, in fact, the greatest threat. Civilians make the bullets and the bandages. Civilians make policy. Civilians make war. Humanity learned a long time ago that if you want to win a war, you need to beat the capacity for war out of the civilian population.

To make a point, nuclear weapons don't exist to fight armies. They exist to destroy population centers. Oh, we may try to be more surgical than in years past with so-called smart weapons that target and destroy specific factories, power generation plants and dams, government centers... but you're still attacking civilians.

I'm not going to ask, but it wouldn't surprise me that you (like I) are a U.S. citizen. It's been 150 years since we experienced a war on our own soil—excluding the BLM riots, Capitol incursion, gangs, school bombings, and serial killers. I'm not being facetious, those are terrible things, but they're not a real war because they can't bring the "big guns" to bear. We Americans have a bit of a skewed idea about the tragedy of war because it's been a very, very long time since we experienced it first-hand. Unlike a great many other nations on our fair planet that have experienced it first hand and whose citizens likely have a very specific opinion about our average citizen's ability to know what real war is.

Psychology is part of all wars, but it's not the driving purpose of any war

No war would be fought for the purpose of hurting the surviving soldiers in a way that makes their continued presence in society a problem. Some wars are fought to humiliate the enemy. Some wars are fought to capture a resource. Some wars are fought to promote religion. Some wars are fought to "finalize a divorce." No war is fought to intentionally keep the enemy alive but in mental pain.

I once had a discussion with a friend in the Finnish military. He made an interesting point. As part of his training, he was taught that, when possible, shoot to wound-and-disable, not to kill. The goal was two-fold: (a) to stop the other guy from shooting at you and (b) to force one or two other people to be engaged getting the wounded soldier off the field. The goal wasn't to cause the target soldier mental trauma. To quote U.S. Civil War general Tecumseh Sherman, "all war is hell." The goal was to cause as many people to stop shooting bullets as possible.

But that's also a reflection of modern efforts to "civilize" warfare. During WWI we used gas and machine guns. During the US/USSR Cold War it was nuclear weapons. Today we worry about the use of biological weapons (to the point of a great many people thinking COVID-19 was a biological weapon run amok). Despite efforts to "civilize" war, I suspect that when you're in the proverbial trenches, the goal is reflected in a statement by U.S. general George Patton, “No dumb bastard ever won a war by going out and dying for his country. He won it by making some other dumb bastard die for his country.”

But the central problem is that your question is the proverbial blind being led by the blind

But here's the biggest problem: you don't know what you're doing. Unlike authors like Arthur C. Clark and Larry Niven who had advanced degrees before they wrote their works, you don't have an advanced degree in psychology (or you wouldn't be asking this question here). And you're asking people who don't have advanced degrees in psychology what the upper limit is—if there's any factual reduction in PTSD and other psychological trauma at all. The veterans I've spoken to all explain that the therapy/medicine helps them cope. It doesn't solve anything, because the memories remain and the cultural conditioning that makes those memories unacceptable/traumatic also remains.

Unless you think that removing said conditioning or removing memories is a legitimate answer to your question. Oh, the consequences that technology would have on society! It's also been explored by SciFi before.

Frankly, the only user I can think of who could possibly answer this question with authority is @Otkin, who hasn't posted a question or answer on the Stack since last March.