'Just World News' with Helena Cobban

US Army & Marines: mental health alert

Well, we knew it would happen, and it has. Now, a study supported by the Military Operational Medicine Research Program, U.S. Army Medical Research and Materiel Command of Ft. Detrick, Md., has discovered that war is hazardous to the mental health of the soldiers who fight in it.

The study, titled "Combat Duty in Iraq and Afghanistan, Mental Health Problems, and Barriers to Care" was published in the New England Journal of Medicine this week. In addition to revealing some interesting facts about the breadth of the mental-health problems caused by the Iraq and Afghan wars to US service members, it also gives one little window into the shockingly high number of service members who feel responsible for the deaths of nonconbatants--see below.

The principal author of the study was Charles W. Hoge, MD. His five collaborators include a numch of clinical psychologiosts and one other MD. Promising anonymity to respondents, they gave a self-administered questionnaire to a large number of service-people before they were deployed, and then to others subsequent to deployments in either Afghanistan or Iraq. Their principal finding was that:

The percentage of study subjects whose responses met the screening criteria for major depression, generalized anxiety, or PTSD was significantly higher after duty in Iraq (15.6 to 17.1 percent) than after duty in Afghanistan (11.2 percent) or before deployment to Iraq (9.3 percent); the largest difference was in the rate of PTSD.

So if you calculate that the increase in these conditions has been on the order of 6.3 to 7.8 percent among the soldiers (and Marines) who went to Iraq, and that probably 250,000 US service members have now served in Iraq--maybe a lot more?-- you could calculate that somewhere between 15,750 and 19,500 Americans have been given serious mental disorders as a result of Bush's quite optional decision to launch that war.

And we can all imagine what that means for those individuals, their families, and the communities they return to, I'm sure.

That is in addition, of course, to the thousands of service-members with longterm physical disabilities (and a high proportion of them will also be battling mental-health probs; but they probably weren't counted in the Hoge survey.)

And then, of course, there are the bereaved families of the US dead--plus, in each of the forgeoing categories, the far, far larger number of Iraqi individuals and families affected.

PTSD as a category has an interesting history. Of course, as long as people having been waging wars, the wise elders in their society have realized that the people who wage war nearly always bring some form of violence or other social sickness back into their home communities afterwards. (In the book I'm currently writing, I have some sections on how traditional healers in Mozambique have viewed and dealt with this phenomenon.)

In more modern times, the British made a particular study during WW1 of what they called "shell shock", or "neurasthenia". One of the prime places for those studies was Craiglockhart Hospital in Scotland, and one of the principal treatment gurus there was W. H. Rivers. Here is a link to one of his seminal works on the subject. Among his patients were the (anti-)war poets Wilfred Owen and Siegfried Sassoon.

Well, trust the Americans to try to invent something all over from scratch, eh?

US psychiatry "discovered" PTSD during the Vietnam War. As in any public consideration of mental-health issues, there was a huge amount of politics involved.

Many people have said that PTSD is ways too limited a category, and often hard to use, since its definition, for example in DSM-IV, states that "The person has been exposed to a traumatic event in which... " But many people who live in situations of repeated and/or continuous trauma seem to be left out of that. In the 1980s, mental health workers in South Africa suggested the creation of a category of continuous traumatic stress syndrome that would cover, for example, the situation of non-White South African people living under the continuous stress inflicted on them by the apartheid system.

Ah well, the DSM-IV definition is what we have. (Unless it's been updated?)

So here are a few of the numbers for what the Hoge study discovered about the experiences of the post-deployment soldiers. The question must have been something like, "Did you experience this?"

And among the answers were the following, in percents:

(Army in Afghanistan/Army in Iraq/ Marines in Iraq)

Being attacked or ambushed...58/89/95
Receiving incoming (large-wepon) fire...84/86/92
Being shot at or receiving small-arms fire...66/93/97
Being responsible for the death of an enemy combatant...12/48/65
Being responsible for the death of a noncombatant...1/14/28*
Seeing dead bodies or human remains...39/95/94
Seeing dead or seriously injured Americans...30/65/75
Seeing ill or injured women or children whom you were unable to help...46/69/83
Being wounded or injured...5/14/9
Had a buddy shot or hit who was near you... n.a./22/26

*The numbers for those feeling responsible for the death of a noncombatant are significantly high. If we stick with the estimate of 250,000 service members having gone through Iraq; and the samples are representative--which the researchers strived for; and we recognized that the total force deployed in Iraq is a mixture of Army and Marines...then that would mean that between 35,000 and 70,000 service members feel responsible for the death of a noncombatant.

Okay, some may have claimed to feel responsible when they either knew they had no reason to (bravado), or when they were wrong to feel they had reason to (excessive sensibility). That still leaves a bunch of incidents in which service members were right to feel some responsibility for the death of one or more noncombatants.

So I wonder how many noncombatants we're talking about there? Not a small number, that's for sure.

(By the way, I want to thank Marine's Girl of Across the River for sending me to the NEJM study. Her blog is always worth reading. Thanks, MG!)