Invisible Casualties

On a day like today, when 19 American soldiers were killed in a single blast at a military base near Mosul, “the deadliest single strike against US troops since the start of the Iraq war,” we tend to forget that there are casualties in this war that are not as easily quantified. We’ve heard, for example, that there have been in excess of 1,300 US service members killed, and well over 8,000 wounded. But there have been a reported 30,000+ “medical evacuations” from Iraq, and some of these relate to wounds that are not apparent to the naked eye.

On three successive nights last week, Nightline, hosted by Ted Koppel, featured a series entitled “Coming Home: Invisible Casualties.” These are the kinds of casualties that were once characterized as “combat stress” or “battle fatigue” or “shell shock.” But while there is no “shame” in returning to the states with one less limb, the emotional scars are all too often hidden by a military culture that deplores “weakness.” As one soldier puts it: “You don’t want ... the people who work under you to think that you’re weak.” ABC News reporter John McQuethy points out that it is never “easy to confess doubt, let alone depression. ... Even the women soldiers are discouraged from showing emotion.”

Koppel summarizes the startling facts:

It’s still a macho culture. ... And talking about it is not the best way to advance your career. But [according to the New England Journal of Medicine] an estimated 1 out of 6 combat troops returns with Post-Traumatic Stress Disorder (PTSD). 1 out of 6. Here’s the problem. The army takes perfectly ordinary men and women, mostly men, and teaches them how to kill. In peacetime, that’s a purely theoretical exercise. Soldiers are trained how to use their weapons but they never actually have to go out and kill anyone. And except for the occasional accident during a training exercise, none of their buddies is ever killed. ... But in wartime, things are different. ... Two recent medical surveys estimate that of the roughly 140,000 troops now in Iraq, about 23,000 will come home with some sort of depression or generalized anxiety.

This is not the typical portrait that is being painted by an embedded media. As NY Times journalist Chris Hedges argues, the media is too busy peddling “the myth of war ... the myth of heroism, the myth of glory, the myth of honor. The reality of war is so revolting and horrifying that if we actually saw it, we would be disgusted.” Hedges’s book, War is a Force That Gives Us Meaning, is taught regularly at West Point. In it, Hedges discusses the “intoxicating powers of violence and war.” He explains that when he covered his first war, it had all the excitement of a “first sexual experience,” something that could never be duplicated. It had a narcotic effect on him. For Hedges, “war is the most powerful narcotic invented by humankind,” and in many respects, it has a “direct correlation” to the experience of taking drugs. On the battlefield, one feels a “pumped-up” rush of adrenaline, a “combat high,” a sense of being

present in a way that you never were before, when even colors are brighter. You have these grotesque hallucinogenic landscapes where you see things that were unimaginable to you, in terms of ... what happens to human bodies, entire villages in flames. ... The concussions of explosive devices. You never sleep very well. And you can fall into these sort of zombie-like trances, and all of this can happen within a 24-hour period.

But Hedges maintains that none of the battle footage that is broadcast today truly captures the reality of war. Journalists may seek to impose a sense of order and logic on that which they report, but the situations on the battlefield are usually characterized by chaos and destruction:

You never watch somebody with their legs blown off ... bleeding to death for twenty minutes in the sand. ... When we wage war too easily, when—as a nation—we think war is a form of entertainment, that war is somehow like a video game, then perhaps we need a dose of that to understand what war actually is.

Alas, the soldiers returning from Iraq understand it. McQuethy interviewed many of these men and women, who tell us how they are suffering from assorted mental and emotional stresses, where even “loud noises like thunderstorms in the night become a crippling trigger.” Many of the more than 300,000 US troops that have served in Iraq are returning to a very unstable emotional life. Robert Ursano, who is the Director of the Center for Traumatic Stress and Chief Psychiatrist at the military’s “own medical school says Iraq today—with suicide bombers, roadside mines, and the constant threat of attack—poses a unique challenge to the mental health of American troops.” These troops are suffering under the threat of “extreme uncertainty [which] is likely to cause even deeper psychological scars.”

The soldiers operate in an environment where everything is performed under fire or threat of fire. As one soldier puts it: “Everyday, it never changes. Everyday, you’re scared.” That fear of “not really knowing if you’re going to come home. ... It’s just not knowing. That’s the worst part about it.” That, and the fact that soldiers are seeing all forms of unspeakable horror, inspiring intense feelings of fear, disbelief, agitation, and irritability, leading to decreased sleep, changes in appetite, depression, and isolation.

In essence, many of these soldiers have been reduced to a state of metaphysical uncertainty and inefficacy, which is profoundly disabling.

There is a basic human need for efficacy, a need to know that one’s actions will bring about a desired effect. In his book, The Power of Self-Esteem, psychologist Nathaniel Branden stresses that this need for cognitive efficacy

is not the product of a particular cultural “value bias.” There is no society on earth, no society even conceivable, whose members do not face the challenge of fulfilling their needs—who do not face the challenges of appropriate adaptation to nature and to the world of human beings. The idea of efficacy in this fundamental sense ... is not a “Western artifact.” ... We delude ourselves if we imagine there is any culture or society in which we will not have to face the challenge of making ourselves appropriate to life.

In the atmosphere that is Iraq, terrorism is used as a weapon to undermine certainty and efficacy as such. Its aim is to strike in unpredictable and violent ways.

Some soldiers have attempted to deal with these realities by keeping a journal. One man

described seeing an enemy fighter after he had been shot."The left side of his skull had been blown off and all that was visible was his brain. Yes, that’s right. His brain. I do not know what to do. I have seen so much blood and death. It is enough for a lifetime." He also wrote dark poetry to calm his nerves. As death comes like the shadows creep/ We watch children suffer as parents weep/We came to give a better life/ We leave in the midst of turmoil and strife.

Journal-keeping is not the only method of calming a soldier’s nerves. The military has become proactive in assisting soldiers while they are in Iraq, and in offering additional assistance upon their return home. But there is still “the stigma of getting help for psychological problems,” which is “an enormous barrier.” True, the military has come a long way from that episode immortalized in the film “Patton” when the General, played by George C. Scott, slapped a soldier across the face, calling him a coward for manifesting “battle fatigue.” Today’s military takes the soldiers’ emotional burdens much more seriously. Troops are getting briefings and filling out questionnaires upon their return home. And they receive a second full “mental health” screening three months after their return from combat. But it often takes months for “post-traumatic stress disorder” to become obvious.

Now, I’m not concerned here with the debate over whether PTSD is a real “disease”; see, for example, Thomas Szasz. Nor am I concerned here with the cozy, troubling relationship that has developed between the military and the state-psychiatric nexus: Often what happens is that a soldier’s emotional turmoil is treated with Paxil or Zoloft before he or she is sent out for yet another tour of duty.

All that concerns me here is a simple acknowledgment of the “invisible casualties” that have consumed US troops in the Iraq war. All the more reason to think long and hard about the nature and purpose of their mission.