Those in the front lines of war have to reconcile their ultimate power—to kill and destroy—with their helplessness to influence the ends and means for which they fight. In a relatively short time they are taught to kill and destroy, endure unspeakable conditions, then return to civil society and resume their pre-war psychosocial status. No wonder we have an unprecedented rate of mental health visits by U.S. Iraq war veterans. One-third of veterans (mostly young) are seeking help for psychiatric reasons, while our military authorities refer only five percent for such evaluation. [Mar. 1, A 16.]

Simultaneously we find that 72 percent of US troops in Iraq favor a pullout in a year or less, while only 23 percent support the policy of President Bush, their commander in chief. [N. Kristof op-ed., Feb. 28; Lemoyne-Zogby poll] This highlights another paradox: while our goal is to protect and extend democracy in the world, the military instrument is quintessentially undemocratic. Those in service obey superior officers, who do not take polls. It should be no surprise that post-traumatic stress disorder, suicide, alcoholism, and antisocial behaviors will occur among veterans, all the more in a war clouded by doubt. In our everyday work, mental health professionals address human conflicts resulting from paradoxes like these, including the legendary “catch-22.” The folly of war, this one in particular, is coming home to roost on the couch.

E. James Lieberman, M.D

Clinical Professor of psychiatry, George Washington University School of Medicine.