Supporting Our Troops: Once More, With Feeling

by hilzoy

The NYT has an article on the Army's efforts to deal with violence by soldiers returning from Iraq -- apparently, there have been nine murders by soldiers back from Iraq in Fort Carson alone, and rape and domestic violence are also up. Three bits from the story are particularly awful. First:

"The latest killing was in October, when the police say Robert H. Marko, an infantryman, raped and killed Judilianna Lawrence, a developmentally disabled teenager he had met online. Specialist Marko believed that on his 21st birthday he would become the "Black Raptor" -- half-man, half-dinosaur, a confidential Army document shows. The Army evaluated him three times for mental health problems but cleared him for combat each time."

I would have thought that someone who thought he was going to become half-dinosaur on his 21st birthday was plainly psychotic. You have to wonder just how low the bar for mental health is if a soldier like that manages to clear it not just once, but three times. I find the idea that we let soldiers with that kind of psychiatric problems wander around Iraq with guns terrifying.

Second, about a man who tried to commit suicide while in Iraq and was sent home with a back injury and a diagnosis of PTSD:

""The first words out of the Mental Health Authority was, 'we are severely understaffed,'" Mr. Needham said in an e-mail message to an officer at Walter Reed. "If you're suicidal we can see you twice a week, otherwise once a week."

Fort Carson assured Mike Needham that his son was receiving proper care. But during his son’s visit home during the Thanksgiving break, Mr. Needham found him smearing camouflage-colored makeup on his face and frantically sharpening a stick with a kitchen knife."

This is a soldier who had tried to shoot himself in Iraq. He eventually beat a woman to death. Under the circumstances, outpatient care is probably not a good idea, but if you can't take him in for observation, you need to see him more than twice a week. Moreover, he would absolutely have to have a network of people to check up on him. If someone missed the seriousness of his problems initially, the episode with the makeup and the kitchen knife should have made it clear. If the Army and/or the VA was too understaffed to do right by him and his fellow soldiers, then someone should be held accountable for that fact.

Third, about the son of Maj. Gen. Mark Graham, who has been in command at Fort Carson since 2007:

"His 21-year-old son, a top R.O.T.C. cadet, hanged himself in 2003 after battling depression. He had stopped taking his antidepressants because he did not want to disclose his illness, fearing such an admission would harm his chances for a career as an Army doctor, General Graham said.

"He was embarrassed," the general said."

To his credit, Maj. Gen. Graham is taking this problem seriously, and so is the Army. However, they need to do a lot more to deal with mental health issues. They could start by putting rules in place that absolutely ensure that if a soldier seeks treatment for some mental health issue that does not require that others know (the way, for instance, being homicidal would), that soldier's confidentiality will be respected, and that ensured, insofar as possible, that that confidentiality extended to the fact of having sought psychiatric treatment. In a perfect world, no soldier would be embarrassed to have sought help -- it would be a sign that he was responsible enough to try to deal with his problems. But until that world arrives, making sure that when possible, soldiers can seek psychiatric help confidentially would be a very good start.

It's no good for anyone if soldiers are wandering around with untreated psychiatric problems. It is obviously bad for the soldiers. It's bad for their friends and families: it's hard enough to know that your loved one is in Iraq without knowing that he or she is literally insane there. (Imagine the friends and family of Specialist Marko, as his messages home got more and more bizarre.) And, of course, it can be very bad for any disabled teenagers or Iraqis they might happen to encounter.

But it's also bad for the Army: any institution works better if its members are not suffering from untreated depression or PTSD. While it's impossible to ensure that none of its members will ever fail to seek treatment, it's just good sense to make sure that there are no institutional obstacles to their doing so. If soldiers worry that getting help will damage their careers, the Army as a whole will suffer.

Besides, it's a matter of basic humanity.

The Army prides itself on taking care of its own. Here's hoping that Maj. Gen. Graham and officers like him succeed in getting it to address the needs of soldiers with psychiatric problems better than they have done to date.

Comments

[Hartmut]

I can imagine the downplaying comments by the professional "troop supporters" who will never be seen anywhere near an actual combat situation:
1. War is hell
2. As long as they can fight it does not matter what funny ideas they have* (except if they are openly gay of course)
3. They volunteered, now they have to take the consequences
4. Wehrkraftzersetzer!!!
5. Something about omelets and eggs and necessary sacrifices.
6. There are always some whackos. The war is too important to be considerate of that.
7. Lalalalala, can't hear you

*some history buff may mention field marshal Blücher, who confided to Wellington that he was pregnant and would give birth to an elephant soon

[DecidedFenceSitter]

Nothing really to add to this - outraged, wishing there something more productive that I can do then what I have already done (write and donate).

NPR had a similar article on Morning Edition today on Recruiter suicides - 5 within the last 6 years in the Houston recruiting command.

[john miller]

The fact is that the militry, like the non-military segments of oour society, has never been at its best dealing with mental disorders.
The VA has an excellent record of dealing with medical problems and actually does a fair job with MH issues, but the active military medical system not so good.
But as I said, this is really a reflection of society at large.
One of the best thing about the big bailout bill was that it required true parity with medical coverage for mental health conditions. However, the mere fact that most people don't know that or that it took until 2008 for that to happen displays, in and of itself, what I mean.
Add to this the tendency among military people to appear strong and not need help (we wouldn't want a military full of wusses, would we?) even having the individual reach out for help, an almost necessary precondition for successful treatment, is diificult to achieve.
This is not acriticism of the post, merely a comment that a similar post could be written about society in general.

[AIMAI]

The New Yorker had a gripping and horrifying story about a top marine who ended up taking his own life in a murder suicide pact with his brother after serving three tours in Iraq.

http://www.newyorker.com/reporting/2008/09/29/080929fa_fact_finnegan

He was a beloved, top soldier, and he couldn't keep it together. Not only that, but the article explores the way PTSD and feelings of guilt and anxiety make it impossible for some vets to function in normal society *and they know it* causing them to try to re-enlist or to return to the battlefield because its the only place they are needed, wanted, and feel in control. As their behavior becomes more erratic and more dangerous in civil society, it can seem more adaptive in a war zone.

aimai

[russell]

A couple of months ago there was a piece on NPR about a town in CT (IIRC) that was trying to set up some kind of program to ease returning GWOT troops back into the community.

The interviewer talked briefly with a local cop about why they were doing this. He replied that, in his estimation, and based on experience he'd already had dealing with these guys in domestic situations, bar fights, etc., the odds were about 50/50 that, over the next couple of years, he was going to have to face one of these guys in a hostage situation, and he was hoping to head that off, if possible.

We've asked a lot of these people, and they need our help. This is also an area where anyone can help make a difference, just by contacting your Congresspeople and letting them know you want good programs funded.

Thanks -

[Slartibartfast]

Blücher?

[sonia]

Yeah, needless to say; this is a hugee problem in the army. Years ago, I wrote a paper (for grad vschool) on mental health and the military where I interviewed veterans from the vietnam war with veterans from iraq war. I also spoke with my friend who worked as pharmacist for the Psych ward at the VA. The VA is still ages behind when it comes to mental health treatment. But it's only fairly recently that this has even been on the radar. The bar has been raised; but it was pretty much on the ground before.

[evil fizz]

It's hard to underestimate the degree to which the "suck it up" attitude permeates a lot of units.

If soldiers worry that getting help will damage their careers, the Army as a whole will suffer.

To clarify, are you talking about harming their careers in terms of being seen as weak or incompetent by the chain of command or other potential implications which may follow from certain diagnoses? There are certainly soldiers whose mental health issues clearly indicate that they should not, for example, be handling firearms. For an 11B (infantryman), not being able to handle a weapon means that they're no longer qualified for their primary MOS. That's going to hurt their career, regardless of how sympathetic their command is.

The Army has also struggled with how to assess mental health problems that are combat related. (Essential in determining whether to administratively separate a solider or medically retire them.) What does it mean for a mental health problem to be combat related? Was the solider prone to or already experiencing symptoms before deployment? What distinguishes exacerbation of a condition from causing it? These problems can get tricky enough when all we're talking about is a physical injury, but with mental health, they're even more complicated.

[knowdoubt]

I agree with everything except, sending soldiers to fight in this war, still looking for a cause to justify it, is making insanity a prerequisite. It cries out of psychosis that we are even there. Requiring participation in this atrocity presupposes mental illness. I have difficulty conceiving of a treatment regime that ignores the root cause of this evil. We need to get out sooner rather than latter and hold the perpetrators accountable for their crimes against humanity. Then the healing might credibly begin. Disclaimer:Not responsible for punctuation or grammatical errors, responsibility for ideas expressed belongs to others. Thanks in advance.

[Henry]

This should be obvious, but perhaps it is worth saying that George Bush, by lying us into war, is responsible for these soldiers' mental problems and for the fate of their victims.

[Henry]

This should be obvious, but perhaps it is worth saying that George Bush, by lying us into war, is responsible for these soldiers' mental problems and for the fate of their victims.

[George Tirebiter]

I recall reading recently a report that COs are in the habit of suggesting to their soldiers that anyone who suffers from PTSD, or any other psychological problem are, in effect, "girlie men." This type of ignorance in positions of authority has to change.

[Beau]

Rudyard Kipling says it all for me in the last stanza of 'Tommy'.

You talk o' better food for us, an' schools, an' fires, an' all:
We'll wait for extry rations if you treat us rational.
Don't mess about the cook-room slops, but prove it to our face
The Widow's Uniform is not the soldier-man's disgrace.
For it's Tommy this, an' Tommy that, an' "Chuck him out, the brute!"
But it's "Saviour of 'is country" when the guns begin to shoot;
An' it's Tommy this, an' Tommy that, an' anything you please;
An' Tommy ain't a bloomin' fool -- you bet that Tommy sees!

[ginmar]

"The VA has a fairly good record of dealing with MH issues?" Are you shitting me? Seriously? I got put in two therapy groups, one full of non-combat men who were there hoping to get their sentences reduced on various wife beating and sexual assault charges, and one full of secretaries dealing with civilian problems. I'm a woman and a combat veteran. Oh, yeah, and I had a guy try and sexually assault me in Iraq, after which he retaliated against me. Now think. Would you put someone dealing with attempted sexual assault in with a bunch of guys who'd committed sexual assault? The VA still thinks women are either nurses, or wives or children, not soldiers themselves, facing a double whammy of combat and sexual assault.

[Nell]

It might also go without saying, but in case not: most of those murdered by returning war vets are women (direct killings, as opposed to the random deaths and injuries caused by vehicle crashings).

The staff and volunteers of the GI Hotline in Fayetteville, NC have been working to get the wider world to take notice of the several spikes of murders (of [female] fellow soldiers and of wives and girlfriends) by returned war vets at Ft. Bragg -- the four or five during 2008 being the most recent.

Contempt for women and for qualities identified as feminine runs all through U.S. culture, but is especially strong in the military. The epithets 'girly men' and 'pussy' exist on a continuum; further along is the high incidence of military rape, and at the extreme end are the women who are dead because men they were around found them acceptable "targets". Women war vets are just as messed up by their experiences, which too often include rape by their colleagues, but have not so far killed husbands, boyfriends, or other soldiers as a result.

[Nell]

If I'd previewed and noticed ginmar's comment, I doubt I'd have posted mine as is. Not that I don't stand behind it, but the lived experience and the detached observation are a little jarring next to each other.

[Doctor Science]

I'm glad to see that ginmar has come over here in e-person, before I started to talking about her experience second-hand.

As George Tirebiter says above, the "suck it up" principle in the military is linked into an image of masculinity and gender norms. It should not be surprising, then, that male vets tend to take out their mental health problems on women. The problem isn't just violence, it's gendered violence.

The fact is that "suck it up" is a universal cornerstone of military life -- it's *all* about maintaining discipline under conditions ranging from numbing boredom to catastrophe. In the US military now (and in most armed forces historically) one tool for reinforcing that discipline, that ability to "suck it up", is linking it with masculinity: sucking it up is what men do, whining is what women do, so insecure young men get the carrot of having their masculinity certified along with the stick of discipline.

And yes, every Freudian thought you're having about sucking, carrots, and sticks is *completely justified*.

[double-plus-ungood]

This post got me sadly remembering last year at this time. Will there be a memorial post, Hilzoy?

[john miller]

ginmar, first my apologies for a overly broad statement. When talking about the VA I was really using a comparative to the active military treatment.
The VA, like much of society, and particularly the military, does not do a good job in dealing with MH issues that involve female veterans.
In the real world, even, it has only been in the last decade or so that the gender differences in basic psychiatric and psychological disorders have really been explored.. The is both from a symptom and treatment approach.

[hilzoy]

d+u: Take a guess. :( Though I have no idea what to say. It's been creeping up on me, psychologically.

[Ugh]

With malice toward none, with charity for all, with firmness in the right as God gives us to see the right, let us strive on to finish the work we are in, to bind up the nation's wounds, to care for him who shall have borne the battle and for his widow and his orphan, to do all which may achieve and cherish a just and lasting peace among ourselves and with all nations.

[Gary Farber]

"One of the best thing about the big bailout bill was that it required true parity with medical coverage for mental health conditions."

Just to note, John, the Mental Health Parity Act did that back in March of last year.

The element of the bailout inclusion in October that broke a small remaining logjam was over this issue:

[...] A breakthrough occurred when sponsors of the House bill agreed to drop a provision that required insurers to cover treatment for any condition listed in the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association.

Employers objected to such a requirement, saying it would have severely limited their discretion over what benefits to provide. Among the conditions in the manual, critics noted, are caffeine intoxication and sleep disorders resulting from jet lag.

But all the heavy lifting, and the huge breakthrough, was actually done in September of 2007 and March, 2008. As the October story notes:

[...] The Senate passed a mental health parity bill in September 2007. The House passed a different version in March of this year.

Also worth noting:

[...] Federal officials said the law would improve coverage for 113 million people, including 82 million in employer-sponsored plans that are not subject to state regulation. The effective date, for most health plans, will be Jan. 1, 2010.

So there's another year to go; also, businesses with under 50 employees are exempt. And, of course, it does nothing for unemployed people.

Not to say it isn't great; just that it's not a cure-all.

"However, the mere fact that most people don't know that"

I did post about it here a few weeks ago when I was listing accomplishments of the Congress in the past year.

[Josh]

I don't see only gender violence in the NYT articles, thanks to the pictures; I also see white guys killing women of color and wonder whether the mentality of troops in Iraq can, in some psyches, encourage racial violence.

[Doctor Science]

Thank you for drawing that to our attention, Josh. I hadn't clicked over to the article because I didn't want to get too upset, but you're right, it does jump out at you.

[RICH]

Look, one name stands out Colonel Elspeth Ritche MC USA, Army spokesperson for mental health issues in the Army. What did you expect from a woman/physician/psychiatrist who parroted the company line espoused by the 3 armed services surgeon generals that mistreatment of psychiatrically impaired soldiers and in turn participation in torture of prisoners was justified by their allegiance to a higher ethical and moral calling, namely Justice. Deeper irony that the wannabe doctor son of an Army General kills himself out shame. We are all shamefully participant in this debacle.

[ginmar]

John Miller, Nell, it's okay. I was a bit...irate. The problem for me is that it's either/or. I've had some of the best experiences in my life in the military, including being treated as a human being---and not just as a woman----by men. OF course, sometimes it was because of the rigid wife/girlfriend/fuckable/unfuckable mindset some of these guys have. More often, though, it was genuine cameraderie. The military was the first place where my attractiveness and feminine conformity weren't the important things.

The military tests for all sorts of things in its incoming troops. Why can't it check for sexism, racism, and so forth? A lot of the jobs after the battles are compassionate ones. And let's face it, the military did a piss poor job of preparing the troops for the culture in Iraq, much less respecting it.

The VA, on the other hand, has been a horrible experience from day one. They have a skeptical attitude toward soldiers that verges on the downright contemptuous, and in some cases they actively try and dissuade you from pursuing benefits and compensation. The Womens' Center is more suitable for pap smears than treating the illnesses of the modern female combat soldier. A dose of feminism would be a good idea, otherwise you're going to wind up with more female MST survivors put into therapy groups with sexual assaulters. I've been told, repeatedly, that there's no need for therapy groups for female combat veterans, or female locked wards, or anything like that. They say there's no need for it, no requests. Given how the VA handles requests..."Um, we'll look into it, and we really take these things seriously"----I'm willing to bet those requests get dismissed the minute the phone hangs up. Sometimes they can barely wait to get rid of you, and it shows.

I'm older and I'm more used to bucking authority when necessary. The younger kids are still in Basic Training mode, and they respect authority. They're killing themselves in huge numbers after being denied psychiatric treatment, and the Pentagon is more interested in fudging the numbers than helping the huge numbers of soldiers who need help.

Iraq was a textbook case of how to damage your soldiers: an unseen enemy hiding in the population, death at every and any turn, each day possibly being your last, and hidden invisible bombs. The flag scarcely got raised every day without being lowered to half mast. My first day in Iraq, a Major and his interpreter were murdered. My first week, we lost one of our own. My first month, combat and a doomed battle that we had no logical right to escape---outnumbered twenty to one for twenty two hours. We rolled over bombs only to have the timers malfunction and explode afterwards. We watched convoys get hit in front of us, behind us, on the other side of the highway. It's a recipe for disaster--for both the Iraqi people and the soldiers.