What's Really Ailing Our Veterans? Where We Can Start Looking
Sam Coleman, PhD, MSW
© 2007
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"The invisible wounds [from war] inflicted on survivors are potent. They can destroy lives, long after the conflict has ended, as effectively as artillery shells."
--Chris Hedges, What Every Person Should Know About War
A Growing Problem
The National Association for Social Workers (NASW) is addressing the emotional problems of men and women in today's military.[1] Grim statistics support the Association's concern. Some 28,300 servicepeople have been severely wounded in Iraq,[2] and over 20 percent of those injuries represent head wounds [3] in addition to limb amputations and grossly disfiguring facial wounds. These casualties pose tremendous challenges of emotional adjustment. The figures for PTSD are mounting also: in the first quarter of 2006 alone, the VA treated 20,638 Iraq War vets, well over the VA's projected figure for the whole year. [4] In the same year there were 99 officially recognized cases of suicide among Army personnel on active duty-the highest rate in 26 years [5] --and the actual extent of war-related suicides could be much higher. [6] As social workers, we know all too well the pain-filled consequences of these individual tragedies for family members as well.
Needed: Deep Inquiry and Refocus
If the NASW response to date is any indication, established social work organizations will strive to expedite, streamline, and expand services for veterans. These moves make perfect sense, but we must recognize another task critical to helping returning soldiers heal: comprehending the real nature of their total experience, from recruitment to deployment. Only when we truly know what soldiers have experienced, and grasp the full force of their emotional struggles, can we then devise the most effective interventions.
Recruitment
We should first keep in mind how men and women are brought into today's armed forces. A look at the military's recruitment tactics sheds some light on the process of selection for the world's most perilous jobs. Economic need is one critical factor. Recruiters meet their quotas most easily in depressed regions of the country [7] and among minorities, especially Latinos. [8] A sluggish economy helps meet quotas, too. [9] Besides this "economic draft," the "solidarity draft" offers escape from the alienation of broken homes and atomized communities. [10] Recruitment advertising addresses this emotional need by depicting the uniformed services as a welcoming group united in a single purpose. Qualifications for recruits have softened also. Army officials have acknowledged that for over four years they have increased the number of waivers for recruits with criminal records and medical problems, with over 20 percent of new enlistees lacking a high school diploma. [11] Social work's ‘person-in-environment' paradigm raises a red flag here: before a new soldier even puts on his or her uniform, he or she could represent a vulnerable population, short on those resources that support emotional well-being.
The Pentagon's budget devoted to luring the young into uniform is truly vast, approaching 592 million dollars in 2003 for advertising alone; [12] in 2005 the Department of Defense spent over $16,000 per recruit in inducements. [13] Sales tactics aim at young people's yearnings for prestige, achievement and recognition, adventure, and mastery of powerful technologies. They also manipulate young men's gender identity insecurities by offering symbols of manliness. All the techniques of modern persuasion have gotten a boost from old-fashioned dishonesty and abuse of authority, too: the Government Accountability Office counted 6,600 allegations of military recruiter wrongdoing and 68 clear criminal violations in 2005, with "irregularities" increasing at end of month quota time. [14] Contrary to popular assumption, there are no legally binding job or training guarantees in the military, and the majority of military jobs are in areas which account for only a small percentage of civilian occupations. [15] We must not be surprised if a soldier feels betrayed by the recruitment process.
Military Training
Understanding the experience of today's veterans also requires familiarity with their training. Marching and drill have been a staple of training since the days of matchlock firearms, to instill automatic, unthinking responses and discourage flight in the face of a lethal hail of lead. Sleep deprivation and abusive behavior from drill instructors elicit obedience by wearing down individual identity, [16] and generate pent-up subordination stress ready for channeling at the next human target through redirected aggression. [17] Graduates of such training recount having to chant cadences about blood and indiscriminate murder. [18]
Battlefield Conduct And Conditions That Breed Cruelty
Although military specialists debate the extent to which humans resist killing other humans, inducing murderous behavior without rage-building provocation is a difficult proposition. [19] As part of the recruitment and training process, video war games lend an unreality that reduces resistance. [20] An ex-Marine Iraq War veteran warned about the actual experience: "It's not a video game. There's no resetting the button. Once you kill, that's it. And the horrors of killing stay with you forever." [21] Pentagon planners also rely, ultimately, on the instinct of self-preservation. Military specialist Philip Gold related the old saying: "The Army never forces you to fight. They just put you down in the middle of a war and let you make up your own mind." [22] About two percent of any population, however, are "natural killers" who enjoy killing, and they can account for up to half of the killing committed by a military unit. [23]
In Iraq and Afghanistan, our soldiers are exposed to the potentially devastating psychological trauma of having to fight counterinsurgencies in the midst of civilian populations, often in urban neighborhoods. Both countries have been plunged into civil war, in a crescendo of violence that traps the innocent. Civilian war-related deaths, particularly in Iraq, are staggering in number-one reliable estimate published in 2006 calculated 655,000 [24] Our soldiers are witness to this daily carnage, and some have been involved in attacks on civilians as well. [25] Any therapist treating returning soldiers must take an honest, unflinching look at such incidents. We must recognize two key factors in the brutalization process: an alienated and traumatized local population experiencing civil war; and, the tremendous lethality of present-day weapons. As one Iraq vet said, "Weapons aren't prejudiced. ... When they go off they go everywhere." [26]
Conditioned Solidarity
Returning soldiers typically express strong feelings of loyalty to members of their unit, and readers of war stories are familiar with the strong bonds forged by the "comrades in arms" experience. Peer pressure among troops encourages cooperation and acts of bravery, but this dynamic doesn't reflect enduring traditions of honor: the later years of the Vietnam War, for example, saw near-chaos as men defied orders or, in some cases, even killed their officers. [27] The American military learned from that. Since then, the Pentagon has carefully nurtured soldiers' mutual dependence to achieve "unit cohesion." Battalions train, deploy, and return together, in whole-unit rotations as opposed to individual transfers. [28] This experience amplifies the sense of guilt typically expressed by returning soldiers, who say they feel they've abandoned their comrades.
What's Different This Time?
Discussions of soldiers' experiences of PTSD and other disorders from their tours of duty in Iraq and Afghanistan invariably raise the question of whether their experience differs from those of American soldiers in past wars. Certain features of insurgents' explosive devices and soldiers' protective gear have resulted in higher rates of traumatic brain injury than in past wars. [29] Some specialists believe that fighting in an unpopular and "unwinnable" war makes a difference. [30] The proposition deserves further study, but it should not overlook the fundamental trauma-inducing aspects of all modern industrialized warfare. Although clinicians did not work out the formal diagnosis of PTSD until after the end of the Vietnam War, soldiers' psychological suffering from wartime trauma was evident even in World War II, the "good war." [31] Filmmaker John Huston's 1946 documentary about the war's "neuropsychiatric casualties," which it claimed accounted for about one out of five total casualties, contained scenes of soldiers with severe psychosomatic disorders. The Army suppressed the film for over three decades. [32] The aftermath of combat experience in the Civil War, arguably the world's first mechanized war, evidenced its own toll in subsequent physical and mental harm. A carefully executed epidemiological study found that veterans who had been subjected to war trauma suffered from more post-war cardiac, gastrointestinal and nervous disease than those not exposed, and younger soldiers showed the highest post-war mortality risk. [33]
What We Can Do
Many of us are directly involved in helping veterans already: the Veterans Administration employs more than 4,400 social workers. [34] Those of us outside the VA who know the politics of social services and the abuses of large bureaucracies must work with colleagues within, raising our voices to make sure our vets get the treatment they deserve. We must also sharpen our knowledge of what goes on inside military life. Some call the armed forces a "family." Unlike most real families, however, the military exercises a stark hierarchy beyond questioning. About 15 percent of our people in uniform are women, [35] and they are now assigned the most dangerous jobs. [36] We must look for dysfunction and for abuse of women and every other "family" member who may have less power, just as we diagnose and intervene among actual families.
The good therapist listens first, and we have some painful listening to do. The task is complicated by our exposure as everyday citizens to the mass media's sanitized and romanticized treatment of war. [37] Our challenge is to move beyond these images for an authentic grasp of the war experience. In addition, those of us who deal with the tragic fallout of war in our clinical work will need the emotional support and understanding of other social workers and allied therapists, too. My fellow members of the Social Action Social Justice Council join me in asking all concerned social workers to educate themselves about the issues. I suggest viewing the documentary, The Ground Truth http://thegroundtruth.net/ and reading Purple Hearts www.purpleheartsbook.com, along with Christopher Hedges' What Every Person Should Know About War (Free Press, 2003). We can also acquaint ourselves with the volunteer organizations that are now springing up to alleviate the suffering that veterans and their families are experiencing. [Please read the accompanying interview with Dr. Judith Broder.]
The Big Picture: Where to Find Genuine Empowerment
We shall help returning veterans with all our skill and dedication, just as trained paramedics and trauma surgeons would treat the victims of a horrific auto accident after a traffic light malfunctions. While helping to the best of our abilities, though, we only attain genuine empowerment for both veterans and ourselves by organizing to fix our nation's geopolitical traffic light: it turns green for war far, far too easily.
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[1] Pace, Paul R., "Reforming Care for Afflicted Soldiers." NASW News 52 (9): 4 (October) 2007. See also Anonymous, "Oprah Ad Highlights Help for Veterans." NASW News 51 (10): 1 (November 2006).
[2] CNN "U.S. And Coalition Casualties: Iraq." Accessed October 22, 2007 at
http://www.cnn.com/SPECIALS/2003/iraq/forces/casualties/
[3] Okie, Susan. "Traumatic Brain Injury in the War Zone." New England Journal of Medicine, 352 (20): 2043-2047. May 25, 2005. Accessed at
http://content.nejm.org/cgi/content/full/352/20/2043
See also Zoroya, Gregg. "Combat Brain Injuries Multiply: 20,000 Not Listed in Pentagon Tally." USA Today, November 23-25, 2007, p. A-1.
[4] Bilmes, Linda and Joseph Stiglitz,. "Encore." Milken Institute Review, Fourth Quarter 2006, p 78. Accessed November 29, 2006, at
http://www.milkeninstitute.org/publications/review/2006_12/76_83mr32.pdf
[5] Jelinek, Pauline. "Army Suicides Highest in Twenty-six Years." AP / Washington Post, August 16, 2007. Accessed October 22, 2007 at
http://www.washingtonpost.com/wp-dyn/content/article/2007/08/15/AR2007081502027.html?tid=informbox
[6] CBS Interactive. "Suicide Epidemic among Veterans." November 13, 2007. Accessed November 16, 2007, at
http://www.cbsnews.com/stories/2007/11/13/cbsnews_investigates/main3496471.shtml
Smith, Wayne. "Suicides among Soldiers Who Served in Iraq." Editor and Publisher, February 24, 2004. Accessed November 29, 2006, at
http://www.commondreams.org/views04/0224-07.htm
[7] Sappenfield, Mark. "Where Recruiting Runs Strongest." Christian Science Monitor, July 19, 2005. Accessed November 29, 2006 at http://www.csmonitor.com/2005/0719/p01s03-usmi.html
[8] Bilmes, Linda. "Uncle Sam Really Wants Usted." Los Angeles Times, August 21, 2005. See also Eunice Moscoso, "Eligibility Bar for Military Too High for Youths." Atlanta Journal Constitution, September 23, 2005.
[9] Schmitt, Eric. "Soft Economy Aids Recruiting Effort." New York Times, September 22, 2003. Accessed November 29, 2006 at
http://www.nytimes.com/2003/09/22/national/22RECR.html?pagewanted=1&ei=5070&en=680ca748c67165dd&ex=1164949200
[10] Parenti, Michael. "When GI Joe Says No." The Nation, pp.18-22. May 8, 2006.
[11] Madhani, Aamer (Chicago Tribune). "$45,000 Is Latest Army Sweetener for Recruits." Los Angeles Times, October 21, 2007, p. A23.
[12] Government Accounting Office Report: GAO-03-1005, September, 2003. Accessed November 8, 2007, at http://www.gao.gov/new.items/d031005.pdf
[13] Lubold, Gordon. "To Keep Recruiting Up, US Military Spends More. Christian Science Monitor, April 12, 2007. Accesssed November 8, 2007, at
http://globalpolicy.igc.org/empire/challenges/overstretch/2007/0412recruitspending.htm
[14] White, Josh. "Violations by Military Recruiters up Sharply." Washington Post, August 16, 2006. Accessed November 29, 2006, at:
http://www.washingtonpost.com/wp-dyn/content/article/2006/08/14/AR2006081401002_pf.html
See also CBS/AP, "Amid Scandal, Recruitment Halts." May 20, 2005. Accessed August 30, 2006 at:
http://www.cbsnews.com/stories/2005/05/20/national/main696991.shtml
[15] American Friends Service Committee Project on Youth and Militarism. accessed October 23, 2007 at:
http://www.afsc.org/youthmil/thinking-of-enlisting/10-points.htm#9
[16] Foulkrod, Patricia, Director. The Ground Truth: When the Killing Ends (documentary). Focus Features, 2006.
[17] See Barash, David. "When Moe Hits Larry..." Los Angeles Times, July 24, 2005.
[18] Foulkrod.
[19] Grossman, David. "Trained to Kill." Posted August 8, 2000, at Freerepublic.com. Accessed December 6, 2006 at: http://www.freerepublic.com/forum/a39a377326dd5.htm
[20] Turse, Nick. "The Pentagon Invades Your Xbox." Los Angeles Times, pp. M1, M6. December 14, 2003.
[21] Former Marine Staff Sergeant James Massey. Statement in Before You Enlist (documentary). Princeton, NJ: Telequest 2006.
[22] "The Coming Draft." Interview with Philip Gold by Larry Mantle. KPCC 89.3 FM, November 16, 2006. Accessed at:
http://www.scpr.org/programs/airtalk/listings/2006/11/airtalk_20061113.shtml
[23] Hedges, Chris. What Every Person Should Know About War. p.75.
2003. NY: Free Press / Simon & Schuster.
[24] Burnham, Gilbert, Lafta, Riyadh, Doocy, Shannon, and Roberts, Les. "Mortality after the 2003 Invasion of Iraq: A Cross-sectional Cluster Sample Survey." The Lancet (October 11). See also Iraq Body Count, http://www.iraqbodycount.org/database/.
[25] Human Rights Watch. Hearts and Minds: Post-war Civilian Deaths in Baghdad Caused by U.S. Forces. 2003. Accessed at http://www.hrw.org/reports/2003/iraq1003/
See also Hedges, Chris and Al Arian, Lila, "The Other War: Iraq Vets Bear Witness." The Nation, July 30, 2007. For one soldier's account of the brutalization process in Iraq and the firestorm of reaction to such testimony, see Thomas, Scott, "Shock Troops," The New Republic on line, original post July 13, 2007. Accessed at http://www.tnr.com/politics/story.html?id=860c9bec-a77a-4786-a869-cc893a43c8b2 along with an update by the editors of The New Republic, "A Scott Beauchamp Update," August 10, 2007. Accessed at
http://www.tnr.com/politics/story.html?id=860c9bec-a77a-4786-a869-cc893a43c8b2
[26] Jason Gunn, US Army Iraq veteran. Statement in Before You Enlist (documentary). Princeton, NJ: Telequest 2006.
[27] Delano, Skip, editor. "GI Mutiny in Vietnam," GI Resistance: Soldiers and Veterans Against the Viet Nam War. A Bibliography. Charlottesville, VA: University of Virginia Institute of Advanced Technology in the Humanities. Accessed at
http://www3.iath.virginia.edu/sixties/HTML_docs/Resources/Bibliographies/GI_Mvmt_bib.html
[28] Parenti.
[29] Okie.
[30] Benjamin, Mark. "Post-traumatic Futility Disorder." Salon.com, December 21, 2006. Accessed May 14, 2007 at: http://www.salon.com/news/feature/2006/12/21/ptsd/index_np.html
[31] Weddle, David, "Secrets at the Bottom of the Drawer," Los Angeles Times Magazine, July 22, 2001.
[32] Canby, Vincent. "'Let There Be Light,' John Huston versus the Army."
New York Times, January 16, 1981.
[33] Pizarro, Judith, Roxane Cohen Silver, and JoAnn Prause. "Physical and Mental Health Costs of Traumatic War Experiences Among Civil War Veterans." Archives of General Psychiatry, 63(2): 193-200 (February) 2006.
[34] de Silva, Elvira Craig. "Honoring and Helping Veterans." NASW News, p.3. November, 2006.
[35] U.S. Census Bureau "Facts for Features" page, accessed November 30, 2006 at:
http://www.census.gov/Press-Release/www/releases/archives/facts_for_features_special_editions/006232.html
[36] Cohen, Sharon. "Women Take on Major Battlefield Roles." December 2, 2006. Associated Press. Accessed in Washingtonpost.com, http://www.washingtonpost.com/wp-dyn/content/article/2006/12/02/AR2006120200476.html
November 28, 2007. See also Chin, Richard. "Female Soldiers in Equal Danger: Women Serving in Convoys See as Much Combat as Infantrymen." Knight Ridder News Service, September 9, 2005.
[37] Samstag, Michael and Debbie Etchison. War and Truth (documentary). Canoga Park, CA: Cinema Libre Studio, 2007. See also Turse.
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