When the war is over, when the troops are finally home and reunited with their families, when the dead have been buried and the wounded cared for -- then comes the reckoning. Sometimes it happens quickly, with the terrible cost of war weighed against the tyrants silenced, rebellions crushed, or populations rescued. Sometimes the reckoning takes longer, after the parades are over, flags furled and cased, subjects quietly changed. But no matter the form, the reckoning always comes. And after Washington's current military campaigns, it will be a heavy one indeed. Nine years, more than $1 trillion, at least 5,600 dead and 43,000 wounded. These are the costs of the Iraq and Afghanistan conflicts -- the ones we can tally.
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Less visible, but no less important, is that these wars are creating a new version of what writer Gertrude Stein called une génération perdue, a lost generation, analogous to the shellshocked men who returned home after the horrors of World War I. Many soldiers coming home today have struggled to reintegrate into civilian society, their mental wounds running deeper than any bone or flesh cuts ever could. And the country and the military will be changed by their return.
Rand Corp. now estimates that about 20 percent of returning veterans either have or will develop post-traumatic stress disorder (PTSD). The suicide rate in the Army is out of control: During the first half of 2009, more American soldiers committed suicide than were killed in combat. In June, an average of one soldier a day committed suicide. A couple of years ago, just after I completed my second deployment, I came close to killing myself too.
The Army's field manual for "combat stress" -- the current term in vogue for mental-health problems in and after combat -- offers some context for what PTSD has done to our ranks in the past. In Europe and Africa during World War II, the proportion of mental traumas among all casualties was close to one in four -- one mental health case for every three blood wounds. On Okinawa island in the Pacific theater, the ratio for the 6th Marine Division (which suffered more than 2,600 wounded and added about 1,300 combat exhaustion casualties) was one in two, or half as many mental health evacuations as blood and bone wounds. This statistics varied wildly in Vietnam, but rose dramatically as the war went on. At first, proportions were roughly one mental trauma per 10 wounded. Later, neuropsychiatric cases constituted almost 60 percent of medical evacuations (though this number is skewed by the inclusion of drug and alcohol cases.) As many as one in five Vietnam veterans suffered PTSD, and even as late as 1990, one in 10 still did.
At present, it's not clear whether these wars have brought on more psychological trauma than earlier conflicts. We do know that more soldiers have been evacuated from Iraq and Afghanistan for mental-health issues than for combat wounds. It's possible that better body armor, mine-resistant vehicles, and a smaller number of force-on-force engagements have produced fewer blood-and-bone casualties, so we just see more of the mental-health trauma than we used to.
We don't yet know where the current balance between blood and mental wounds lies. Between 2002 and 2009, there were about 33,000 wounded in action in Iraq and Afghanistan. During that same period, about 4,700 troops were evacuated for mental-health reasons -- just over 14 percent of all troops serving in theater. But this figure only counts those cases so dramatic that the soldiers were sent home from the war. Doctors always prefer to get soldiers back to their units rather than out of theater, and not everyone who is treated appears on the record. My doctor kept my treatment quiet to keep from tarnishing my record and to protect my Top Secret security clearance. In short, that 14 percent is just a fraction of the actual number of soldiers suffering.
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