Suicide rates for troops returning from Afghanistan and Iraq are out of control, and post-traumatic stress disorder is reaching epidemic proportions. But is the Pentagon willing to tally the true cost of war?
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.
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.
But the differences between today and earlier conflicts run much deeper than numbers alone reveal. What's different about these conflicts is their conduct, which leaves little down time and has nearly everyone in the line of fire. In prior wars, combat units served at the front of combat for a set period of time before being rotated to the rear to rest and refit, and support units were mostly kept in the rear area. Counterinsurgency doesn't work that way. China's Chairman Mao Zedong once said that insurgents must live in a population the way a fish swims in the sea. The same goes for counterinsurgents. There is no front line and no rear area; soldiers and units are always at war. Every movement a unit makes is a combat patrol, and every contact with a local is a political act. There is no down time, no rest. And both our soldiers and their commanders know that this is a significant factor in the development of PTSD.
The Army is aware of the psychological toll of the current wars on soldiers: The most recent mental-health survey notes that "soldiers on their third or fourth deployment report significantly more acute stress, psychological problems and . . . marital problems." And among the winners chosen in the Army's recent mobile-phone "app" competition was Telehealth Mood Tracker, a "self-monitoring app that allows users to track their psychological health...[and] experiences associated with deployment-related behavioral health issues."
That may not be enough. At exactly the time that U.S. soldiers are being asked to do more than ever, the well of U.S. support for the wars abroad is drying up. After World War II, veterans came home to a hero's welcome and a booming economy; they embraced civilian life. It was only later, the Deparment of Veterans Affairs recounts, that World War II veterans developed PTSD -- after the parades, once they had retired, when the family was gone, and friends were dying off, the painful memories came back.
Today, there is no such hero's welcome for returning troops. In fact, ask a soldier who has served in these wars what surprises him most about returning home, and he will likely tell you he's shocked that America isn't at war. "Look around you," he will continue. "Does this look like war?" And he'd be right: It does not. We've been in Afghanistan for nine years. We've had no draft, no mobilization of industry, no substantive change in our behavior here at home. At the same time that the U.S. military was first entering Afghanistan, our president told us to go shopping, and we did. Most won't even notice when the soldiers come home.
Nor are jobs eagerly awaiting soldiers when they return. The law requires that a soldier mobilized for war can get his old job back when returns. But what if the company has gone under, as so many have in this recession? What if he or she is gone for more than the five years that Congress mandates employers must hold a job for a mobilized reservist? After that point, there is little the government can do. Programs to help veterans make the transition back to the civilian marketplace help, but with the jobless rate for young veterans at over 21 percent, lots of soldiers stay in military service for the steady paycheck.
What all this will mean for the United States is a generation of men and women who struggle both in and out of the military. They will come from the lowest and the highest ranks; in 2009, two generals admitted they had been treated for the disorder. But there is still a real stigma attached to seeking care for mental-health issues. In the Army's most recent mental-health assessment, more than half of the soldiers queried said they feared they would be considered weak if they sought treatment. I know this is true because I was also afraid to seek treatment for PTSD in Afghanistan. I thought the soldiers in my airborne unit would think I was broken.
At the end of America's involvement in the Vietnam War, the Army was traumatized. Rampant drug use, poor leadership, and severe racial problems threatened to overwhelm the entire military institution. Today, drug use is back, and young officers are leaving the Army at alarming rates. We haven't descended to the dark days of the post-Vietnam era, but the stress of long, repeated deployments is dangerous -- to both the military itself and families awaiting the return of loved ones. The fallout from Vietnam reverberated for decades; it was a long and hard period for the services and for the country. The coming reckoning will happen in an America where politics are blood sport, and where neither political party has recently covered itself in glory. Like war itself, it will be a grim, untidy business.
I don't know how the United States will determine the cost of these wars. I suspect the vast majority of the population will simply shrug and go about their lives. Memorial Day will still mark the beginning of summer rather than a day of solemn reflection on the cost of war. But try as America may to move on, many of its soldiers will not. The risk of another lost generation is at hand.
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