One will not be able to celebrate Veterans Day this week without considering the tragic killing of 13 and wounding over 30 at the Army base at Fort Hood, Texas last Friday. The shootings by U.S. Army Maj. Nidal Malik Hasan rightfully strike people as particularly horrific. There is something about soldiers who are about to be deployed to war zones being shot at by one of their own that is particularly obscene; especially when that man is a psychiatrist, a medical professional who operates under the code of do no harm.
Yet whatever the ensuing investigation uncovers about the motivations of Maj. Hasan we must also face up to the fact that the American military has a significant mental health issue.
When I last wrote about this in September I noted that the psychic casualties are staggering. The situation has not gotten better.
The Los Angeles Times reported yesterday that military leaders acknowledge rampant psychiatric problems in their midst. According to the Army, the suicide rate among soldiers in Iraq is five times that seen in the Persian Gulf War and 11% higher than during Vietnam. The Army reported 133 suicides in 2008, the most ever. In January of this year, the 24 suicides reported by the Army outnumbered U.S. combat-related deaths in Iraq and Afghanistan.
The Marine Corps also reported an increase in suicides in 2008, to 41. The Army and Marine Corps have provided most of the troops in the two wars.
Ironically, Hasan had been chosen to be part of an ambitious plan to treat U.S. troops in Afghanistan who need psychological counseling where counselors are often not available. As a result, the Pentagon is flying record numbers of therapists and other mental health workers into combat areas.
USA Today reported yesterday that where psychologically damaged troops in far-flung places cannot reach a therapist, the military now flies therapists to them in numbers not seen before.
Col. Carl Castro, a psychologist and director of Army Military Operational Medicine, says “flying mental health care providers exclusively to service members who need help is unprecedented. It’s almost like the EMTs (emergency medical technicians) that you see on the interstate when they block the road and land the helicopter. It’s just never been done.
And now we must face up to the fact that many of those in the military mental health community charged with provided treatment to the afflicted are suffering their own mental stresses and traumas. Even if one does not accept that mental health professionals can experience their own post traumatic stress disorder (PTSD) by treating those who do, it is certainly the case that good counseling and support for those mental health providers is critically important. And already we are seeing reporting that the military has failed in this regard, just as it has often failed to help veterans suffering physical and mental wounds.
Salon reported Sunday that with the U.S. fighting two wars, an acute shortage of trained personnel has left therapists emotional drained and overworked, with limited time to prepare for their own war deployments.
A military mental health task force in 2007 expressed concerned about the stress on nondeployed mental health personnel because of the shortage, which it said was leading to high attrition rates. “A vicious cycle has formed that will probably continue to worsen before it improves,” the report said.
Bob Herbert put it quite eloquently in his New York Times column on Sunday when he wrote:
The rest of us need to look very closely at the stress beyond belief that is being endured by so many other men and women in the armed forces — men and women who are serving gallantly and with dignity, who have not taken out their frustrations on one another, and who deserve better from the broader society.
Simply stated, we cannot continue sending service members into combat for three tours, four tours, five tours and more without paying a horrendous price in terms of the psychological well-being of the troops and their families, and the overall readiness of the armed forces to protect the nation.
The breakdowns are already occurring and will only get worse as the months and years pass and we remain engaged in the conflicts in Afghanistan and Iraq. None of this is the military’s fault. There have not been nearly enough people willing to serve in the all-volunteer armed forces to properly staff two wars that have already gone on for the better part of a decade.
I spent some time on the West Coast recently interviewing doctors and researchers studying the enormous problem of troops returning from Afghanistan and Iraq with some form of mental health disorder, most commonly depression and post-traumatic stress disorder, or P.T.S.D. The caseloads are off the charts, and very often the P.T.S.D. or depression (or both) are accompanied by substance abuse, problems with anger management, domestic violence and family breakdown.
These are not weak men and women we are talking about. This is the toll that the horror of combat, especially repeated doses of it, takes on people — even those who are young, physically fit and mentally sound.
The same day former U.S. senator and Vietnam veteran Max Cleland, who lost both legs and an arm in that war, had an op-ed in the New York Times. He wrote:
When we are at war, America spends billions on missiles, tanks, attack helicopters and such. But the wounded warriors who will never fight again tend to be put on the back burner.
This is inexcusable, and it comes with frightening moral costs. There are estimates that 35 percent of the soldiers who fought in Iraq will suffer post-traumatic stress disorder. I’m sure the numbers for Afghanistan are similar. Researchers have found that nearly half of those returning with the disorder have suicidal thoughts. Suicide among active-duty soldiers is on pace to hit a record total this year. More than 1.7 million soldiers have served in Iraq and Afghanistan. Imagine that some 600,000 of them will have crippling memories, trapped in a vivid and horrible past from which they can’t seem to escape.
It is time for America to put up or shut up. Either it cares about its military men and women who are making unbelievable sacrifices or it doesn’t. If it does it will start putting its money where its mental health mouth is. And if not, then it can continue doing just what it is doing now.