Why Are PTSD Rates So High Among Veterans?

kalkriese_mask
One of the many masks of war

W.J. Astore

Post-traumatic stress disorder (PTSD) is a major problem among veterans who fought in Iraq and Afghanistan.  The VA government web site explains that “OEF/OIF service members are at risk for death or injury. They may see others hurt or killed. They may have to kill or wound others. They are on alert around the clock. These and other factors can increase their chances of having PTSD or other mental health problems.”  The site goes on to say that “Research on OEF/OIF Veterans suggests that 10% to 18% of OEF/OIF troops are likely to have PTSD after they return.” (OEF and OIF are acronyms for the wars in Afghanistan and Iraq.)

That’s a lot of veterans.  Hundreds of thousands, potentially.  Why is this number so high?  Is there something uniquely bad or intense about wars in Iraq or Afghanistan?  We can point to several factors, to include constant redeployments – four or five were not uncommon – on high-risk and high-stress missions, only to witness regress instead of progress.  Add to this the everyday shifts between secure bases and insecure field ops (as with air crews in World War II), direct electronic connections to home (which can prove discomforting rather than reassuring), and transitions from battlefront to homefront that are often too rapid for bodies and minds to adjust.  Finally, we’re witnessing better diagnosis (think of the “epidemic” of concussions in the NFL, which is much more about better recognition of the symptoms rather than an explosion in cases).  Small wonder there’s almost a pandemic of PTSD cases among the troops.

Are today’s troops not adequately prepared to handle the stresses of war?  Were warriors of the past somehow different?  A colleague, the classicist Steven Willett, explained that within ancient Greece there’s no direct evidence of warriors suffering from what we today term PTSD (though doubtless men suffered physical and mental anguish in the aftermath of brutal physical combat associated with Greek phalanxes).

In Willett’s words,

The evidence [of PTSD] is nonexistent because their [the Greek’s] emotional attitude to service and death for the state is not ours.  One way to appreciate this is to look carefully at the beautiful funeral sculptures set up in the Kerameikos of Athens after the first years of the Peloponnesian War.  Dead soldiers stand serenely in the confidence of having done their duty, perhaps with a favorite dog or horse by them, and the parents looking on never betray grief.  The emotional ambience is calm, the tears long shed, the family proud in its sorrow.  A lot of these funeral sculptures are available on line, but the best are in National Archaeological Museum of Athens.  The families and relatives of Spartan soldiers who had died [are] nobly celebrated, while those of the survivors almost mourned.  Think of Thermopylae.

It got me thinking anew about America’s current wars, and how these wars – unlike those for the Greeks – are not directly for communal defense.  Nor are America’s wars fought by communities, not when 99% of Americans exempt themselves from military service.  In Greek society, all able-bodied men believed it to be both duty and honor to wield shield and spear to defend their communities.  (Socrates was one of them.)  In America today, “support” for the troops often begins and ends with a bumper sticker.

Shared sacrifice for communal ideals: such common purpose doubtless acted as a cushion for the physical and mental blows inflicted in Greek warfare.  No matter the era, troops in combat see and experience horrible things, but the trauma is arguably easier to process when blows are cushioned by necessity, and softened by sacrifices shared within tightknit communal settings.

And that’s precisely what’s lacking in the USA today: a sense that our overseas wars are for a communal cause, for honored ideals held in common.  (Other than a vague sense of protecting the “homeland” from “terrorists.”)  The lack of a strongly held communal cause/purpose for our wars ultimately contributes, I believe, to PTSD rates among our returning veterans.  A sense of confusion – why did I suffer – what was it for, intensified by bitterness – my suffering wasn’t worth it – I killed people and saw my buddies killed and it was all for nothing, plagues the troops that our government sends to war ostensibly in our name.

The military historian Sir Michael Howard quotes Carl von Clausewitz on the larger meaning of war.  War, Clausewitz wrote, “cannot be divorced from political [communal] life; and whenever this occurs in our thinking about war, the many links that connect the two elements [of political purpose and war] are destroyed and we are left with something pointless and devoid of sense.”

If we want to lower PTSD rates, the easiest way is to stop sending troops to war, full stop.  And the second easiest way is to stop sending troops to pointless wars that are devoid of political or communal sense.  Wars that serve no larger communal purpose lack meaning.  And where meaning is debased, so too is our troops’ ability to deal with wars in all their horrors.

Are Troops Being Evangelized Instead of Being Treated for PTSD?

An older symbol of the Chaplain Corps that includes Christian and Jewish symbols.  There are now Buddhist, Hindu, and Muslim symbols as well
An older symbol of the Chaplain Corps that includes Christian and Jewish symbols. There are now Buddhist, Hindu, and Muslim symbols as well

W.J. Astore

I wrote the following article for Huffington Post back in August of 2010.  Good Friday seems an appropriate day to revive it.

Our country was founded on the idea of religious freedom, and several of our nation’s founders were deists (Thomas Jefferson) or skeptical to the point of atheism (Thomas Paine).  Religious plurality and diversity characterized America from our earliest days, and so too was that true of our citizen-military.

Private religious belief should remain that: private.  Evangelism in military settings is inappropriate.  It is especially insidious when practiced by supervisors.  Militaries are rigidly stratified, and certain positions (drill sergeants, first sergeants, commanders, and so on) carry with them great authority.  It is totally inappropriate for NCOs and officers in supervisory positions to promote religion in any way, especially among their subordinates.  

That said, you cannot banish religion from the military since our military will always be a reflection of American society.  In national polls, Americans routinely say they believe in God, with the percentage affirming this belief exceeding 90%. Our military today is more rural than urban, more small town than big city, more Southern and Midwestern than Coastal. In short, our military recruits from areas of the country that are often powerfully infused with evangelical Christian beliefs. Such beliefs are not going to disappear when troops don their uniforms.

God and country are united in the minds of many of our troops.  And a person’s mind is his or her own private affair.  What we must guard against is the intrusion of religion in policy areas and public arenas where it doesn’t belong.  The article below highlights one such case.

Yesterday [8/9/2010], the Military Religious Freedom Foundation (MRFF) and Veterans for Common Sense sent a startling letter to Secretary of Defense Robert Gates. It alleged that the military has sent some psychological casualties to chaplains for counseling, rather than to mental health care professionals for diagnosis and treatment. In a few cases, the letter alleges, chaplains sought to provide comfort through evangelism. In essence, it seems wounded and disturbed troops were encouraged to put their trust in Jesus: that He would provide for them if only they accepted Him.

General George S. Patton Jr. was fired during World War II for slapping soldiers with PTSD. Assuming the MRFF letter is correct, are we prepared to fire chaplains for seeking to alleviate PTSD and other disorders with a healthy dose of scripture and heartfelt appeals to Jesus?

I would advise against this.

I can well imagine that a few chaplains, perhaps of an evangelical bent, in their zeal to provide help, may have conflated their own personal conversion experiences and the resultant comfort they gained from them with the kind of professional care and treatment provided by mental health care experts. If one’s own doubts and problems were resolved through heartfelt conversion, it’s quite possible one would believe that evangelism in the name of Jesus could cure all ills — a belief they may then have tried to transfer to hurting, even desperate, troops.

Such misguided ministering, if it exists, must stop.

But at the same time let’s not forget that chaplains are invaluable as counselors. The equivalent at times to a “big brother” or “big sister,” they are both part of a unit but also in a (moral) sense stand above it and the entire military system. It’s a demanding job — indeed, it’s more than a job, it’s a calling — and the vast majority of chaplains perform it well.

Chaplains, of course, are not mental health care providers. Psychological trauma and other serious mental health issues clearly go beyond their abilities and training to treat and meliorate. The letter from the MRFF and Veterans for Common Sense reminds us of this fact, as well as of the burdens of war on our troops and of the dire shortages of qualified mental health care. It’s the latter that requires the lion’s share of our attention and resources.

That said, allow me a moment to praise military chaplains. The several I’ve known have been dedicated, decent, godly souls as well as good troops. They share in the burdens of their units even as they provide selfless counsel, spiritual or otherwise. One older chaplain I knew eagerly went through jump training prior to joining the 101st Airborne. If he was going to serve alongside airborne troops, he wanted to know what jumping out of airplanes was like.

National prayer breakfasts I’ve attended, run by military chaplains of multiple faiths, were always open to troops of any faith (or no faith at all). There were no distinctions between Protestants or Catholics, or for that matter between Muslims or Jews. As celebrations of non-denominational and undifferentiated spirituality, they were irenic, life-affirming, even moving.

Let’s be careful, then, not to let instances of Christian evangelism in the ranks distract us from a healthy exercise of spirituality and religious feeling. Let’s applaud our military chaplains even as we recognize that they too have limitations. But most of all, let’s be sure to get our troops the professional mental health care they both need and deserve.

The Temptations of Drone Warfare

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A recent article at NBC News is unusual in that it highlights the awfulness of war even when the killing is “surgical” and done by drones.  Brandon Bryant, a former drone operator for the Air Force, suffers from PTSD and feels that killing by drone caused him to lose respect for life, that he became like a sociopath.  Especially upsetting to Bryant was when his commander gave him a “diploma” (most likely an award citation) that stated he had contributed to the deaths of 1,626 people.

Drone strikes are basically extra-judicial death sentences from the sky.  For Americans, they seem unproblematic because we’re not exposed to them and because our government tells us only “militants” and evil-doers are being killed.

But the temptations of drone warfare are considerable, as I wrote in an article for Truthout in August 2012.  Here’s what I said back then:

What happens when we decouple war’s terrible nature from its intoxicating force? What happens when one side can kill with impunity in complete safety? General Robert E. Lee’s words suggest that a nation that decouples war from its terrors will likely grow too fond of it. The temptation to use deadly force will no longer be restrained by knowledge of the horrors unleashed by the same.

Such thoughts darken the reality of America’s growing fondness for drone warfare. Our land-based drone pilots patrol the skies of foreign lands like Afghanistan in complete safety. They unleash appropriately named Hellfire missiles to smite our enemies. The pilots see a video feed of the carnage they inflict; the American people see and experience nothing. In rare cases when ordinary Americans see drone footage on television, what they witness is something akin to a “Call of Duty” video game combined with a snuff film. War porn, if you will.

Many Americans seem happy that we can smite foreign “militants” at no risk to ourselves. They trust that our military (and the CIA) rarely misidentifies a terrorist, and that “collateral damage,” that mind-numbing euphemism that obscures the reality of innocent men, women, and children obliterated by missiles, is the regrettable price of keeping America safe.

But the reality is that sloppy intelligence and the fog and friction of war combine to make seemingly antiseptic drone warfare much like all other forms of war: bloody, wasteful, and terrible. Terrible, that is, for those on the receiving end of American firepower. Not terrible for us.

There is a real danger that today’s drone warfare has become the equivalent to the Dark Side of the Force as described by Yoda in The Empire Strikes Back: a quicker, easier, more seductive form of terror. It is indeed seductive to deploy the technological equivalent of Darth Vader’s throat-constricting powers at a safe distance. We may even applaud ourselves for our prowess while doing so. We tell ourselves that we are killing only the bad people, and that the few innocents caught in the crosshairs constitute an accidental but nonetheless unavoidable price of keeping America safe.

In light of America’s growing affection for drone warfare combined with a disassociation from its terrible results, I submit to you a modified version of General Lee’s sentiment:

It is not well that war grows less terrible for us – for we are growing much too fond of it.

W. J. Astore

War is a Racket

The business of wars and weapons sales is booming, with the United States leading the pack as the world’s foremost “merchant of death,” as Michael Klare notes in this article on the global arms trade for TomDispatch.com.

But why should we be surprised?  War has always been a racket.  And if you don’t believe me that forever war is forever profitable – for some, I recommend that you read War Is A Racket (1935), a classic polemic written by U.S. Marine Corps General Smedley D. Butler.  Twice awarded the Medal of Honor, Major General Butler turned against military adventurism in the 1930s as he saw how his efforts and those of his men were exploited by elites to expand corporate wealth and power, even as they exempted themselves from the hardships and dangers of combat.

Plaque in Philly in Honor of Smedley Butler.  Photo by author.
Plaque in Philly in Honor of Smedley Butler. Photo by author.

As Butler put it in War Is A Racket:

“How many of the war millionaires shouldered a rifle [during World War I]?  How many of them dug a trench?  How many of them knew what it meant to go hungry in a rat-infested dug-out?  How many of them spent sleepless, frightened nights, ducking shells and shrapnel and machine gun bullets?  How many of them parried a bayonet thrust of an enemy?  How many of them were wounded or killed in battle?”

Not many.  Butler knew who really paid war’s high bills:

“Yes, the soldier pays the greater part of the bill.  His family pays too.  They pay it in the same heart-break that he does.  As he suffers, they suffer.  At nights, as he lay in the trenches and watched shrapnel burst about him, they lay home in their beds and tossed sleeplessly … And even now the families of the wounded men and of the mentally broken and those who never were able to readjust themselves are still suffering and still paying.”

And Butler knew how best to put an end to the racket of war.  He was blunt – and right:

“We must take the profit out of war.”

“We must permit the youth of the land who would bear arms to decide whether or not there should be war.”

“We must limit our military forces to home defense purposes.”

Tragically, since the end of World War II Butler’s sage advice has been completely ignored.  War is more profitable now than ever.  We permit our youth to have no say in whether there should be a war.  (Congress hasn’t issued a formal declaration of war since 1941.)  And today as a country we equate “home defense” with the world’s strongest military, configured for global reach, global power, boasting of “full-spectrum dominance.”

Unless we heed Butler’s advice, debilitating wars will continue.  They will continue because perpetual war is simply too profitable.  In the racket of war, the chief racketeers are easy to identify.  As Butler knew, just follow the money.

W. J. Astore