Thursday, April 24, 2008


There was an interesting "exposé" in the news the other day, which I'm sure will receive a lot of attention by the lefty blogs--intent as they are in always bruiting the evil of the US military.

It never occurs to them that they themselves represent at least one of the reasons why military personnel are sometimes unable to come to terms with the actions they are called upon to do in war.

Such self-reflection on the part of the plitical left would require insight, honesty, and integrity--none of which are in abundance on that side of the political spectrum these days.

Throughout history war has always resulted in a significant psychological cost to the men (and now women) who are members of the military. The Iraq war is no different.

A few years ago, there was a fairly balanced article in the LA Times which looked at some of the psychiatric problems being seen in Iraqi war veterans:
A study by the Walter Reed Army Institute of Research found that 15.6% of Marines and 17.1% of soldiers surveyed after they returned from Iraq suffered major depression, generalized anxiety or post-traumatic stress disorder — a debilitating, sometimes lifelong change in the brain's chemistry that can include flashbacks, sleep disorders, panic attacks, violent outbursts, acute anxiety and emotional numbness....

When you think of psychiatric disorders along a spectrum from "biological" to "psychosocial", there are some people who are biologically resiliant and not subject to psychiatric illness under most "normally" stressful situations.

But war is not "normally" stressful.

It is stressful like no other situation for a living being. And that is why even the biologically resiliant may develop problems; not to mention those who might be more physiologically prone to depression or anxiety or psychosis.

Combat stress disorders — named and renamed but strikingly alike — have ruined lives following every war in history. Homer's Achilles may have suffered from some form of it. Combat stress was documented in the late 19th century after the Franco-Prussian War. After the Civil War, doctors called the condition "nostalgia," or "soldiers heart." In World War I, soldiers were said to suffer 'shell shock'; in World War II and Korea, combat fatigue or battle fatigue. But it wasn't until 1985 that the American Psychiatric Assn. finally gave a name to the condition that had sent tens of thousands of Vietnam veterans into lives of homelessness, crime or despair

After WWI, the military got the idea of placing psychiatrists and mental health professionals near to the front line to deal immediately with some of these stress disorders. It seemed to work better and prevent some of the longer-term problems. After the immediate intervention, they were either returned to the front, or sent back for longer treatment. You might remember the 1963 movie "Captain Newman, M.D.", starring Gregory Peck, which was about a military psychiatrist who ran a mental ward during WWII.

During the Korean War, the M.A.S.H. units and military facilities near the front also had psychiatrists attached to them. Nowadays, of course, the pharmacological and psychotherapeutic interventions are considerably better than they were in the middle of last century. The faster one can intervene with those soldiers at risk, the better--before they can injure themselves or others. Reportedly there have been a number of suicides by soldiers while in Iraq, and this is an indication that there is not sufficient mental health support at the front lines; especially since even one suicide is too many. The problem reported in the article above relates to mental health support after a soldier returns home.

Vietnam popularized the term "Post-Traumatic Stress Disorder" (PTSD), which was originally used to describe the stress syndrome noted in its veterans when they returned home (but which described symptoms that every veteran of every war in history was likely aware of). It was estimated that maybe 30% of Vietnam vets had some symptoms of this disorder, which is now well-described in the literature and also applicable to people in traumatic situations other than war.

Whether one volunteers for military service or is drafted, there is no doubt that war is hell, and that it dramatically, intensely, and sometimes irrevocably impacts body, mind, and soul.

I have always suspected that PTSD is more likely common in wars like Vietnam, where many of the soldiers were not there voluntarily; and where they returned to the U.S.--not to acclaim and pride--but to rather frequent displays of disgust and even hate from the very people they believed they were serving.

I would not underestimate this latter reality as a major reason why many veterans of Iraq are unable to fully come to terms with their service. Even if you believe you are doing and have done the right thing, being constantly belittled and demonized for it by a large percentage of the population is at best daunting, at worse, depressing; and the stigma they place upon you (spitting on you in airports, is one small example; accusing you of 'crimes against humanity' is a larger one) can shake you to your soul.

The political left has transformed their hate and disgust of all things military into a true art form--along the lines of Alicia Shvart's performance art, to be sure, but nevertheless an art form. Even more so today than during Vietnam, the heroes serving voluntarily in Iraq are aware of the daily insults and denigration that is made of their service. They may believe in what they are doing, but as a psychiatrist, I can attest to the damaging effects of the left's righteous "support" of the troops, as well as the "patriotism" of people like Michael Moore, Cindy Sheehan, Code Pink and so on, ad nauseum.

[images from Zombie]

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