The Psychological Toll of 12 Years of War

How our nation’s military has become an experiment in how prolonged conflict affects mental health.

KILEEN, TX - APRIL 9: A U.S. Army soldier reacts as U.S. President Barack Obama speaks at a memorial for victims of last week's shooting on the U.S. Army post at Fort Hood military base on April 9, 2014 in Kileen, Texas. During the shooting rampage on April 2, Army Spc. Ivan Lopez killed three people and wounded 16 others before taking his own life.
National Journal
Clara Ritger
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Clara Ritger
April 9, 2014, 2:24 p.m.

Twelve con­sec­ut­ive years of war have turned sol­diers in­to the sub­jects of an un­in­ten­ded ex­per­i­ment in the im­pact of pro­longed con­flict on the hu­man psyche.

And the res­ults are still out, ac­cord­ing to Army Sur­geon Gen­er­al Pa­tri­cia Horoho, who test­i­fied Wed­nes­day at a con­gres­sion­al hear­ing.

“I worry about the long-term re­per­cus­sions of these wars on our vet­er­ans,” Horoho told the Sen­ate De­fense Ap­pro­pri­ations Sub­com­mit­tee. “We’re in an era where I don’t think we know what the im­pact of 12 years of war has on an in­di­vidu­al.”

Sen. Dick Durbin chaired the hear­ing in the wake of the shoot­ing on the mil­it­ary base in Fort Hood, Texas, hop­ing to find a way to pre­vent fu­ture tra­gedies.

One in five Amer­ic­an sol­diers re­turn­ing from Afgh­anistan and Ir­aq re­port symp­toms of PTSD or ma­jor de­pres­sion, ac­cord­ing to a 2008 Rand Cor­por­a­tion study. Only half of those in­di­vidu­als seek treat­ment. But even those who do seek help don’t al­ways find solu­tions — in­clud­ing the Fort Hood shoot­er, who was re­portedly be­ing treated for anxi­ety and de­pres­sion.

“I don’t want to spec­u­late about what happened in Fort Hood,” Durbin said, “but I want us to real­ize that the mil­it­ary is fa­cing chal­lenges I don’t think we’ve faced be­fore.”

Between 2004 and 2009, the years after the United States ex­pan­ded its con­flict in the Middle East to Ir­aq, the an­nu­al sui­cide rate in the mil­it­ary more than doubled.

Nearly one in five sol­diers had a men­tal dis­order pri­or to en­list­ment, ac­cord­ing to a re­cently pub­lished study in the journ­al JAMA Psy­chi­atry. Ap­prox­im­ately one-third of post-en­list­ment sui­cide at­tempts are as­so­ci­ated with pre-en­list­ment dis­orders, an­oth­er JAMA Psy­chi­atry study found.

It’s un­clear wheth­er com­bat, or the stress of de­ploy­ment it­self, pushes sol­diers already prone to sui­cide over the brink.

For its part, the mil­it­ary has in­creased the num­ber of be­ha­vi­or­al-health pro­viders made avail­able to sol­diers by 150 per­cent, Horoho said.

That boost in per­son­nel was ac­com­pan­ied by an in­crease in the use of be­ha­vi­or­al-health ser­vices, up to nearly 2 mil­lion vis­its in 2013 from 900,000 in 2007.

“Will we ever have enough?” Horoho said of the num­ber of psy­chi­at­rists and oth­er pro­viders avail­able to sol­diers for men­tal-health treat­ment. “I don’t know.”

The Army is grap­pling with a re­ten­tion prob­lem, too: It cur­rently only has six psy­chi­at­rists, when it should have 10, ac­cord­ing to Durbin.

“Are we re­cruit­ing and en­list­ing ad­equate be­ha­vi­or­al health pro­viders?” the Illinois Demo­crat said. “And why are we fall­ing short in re­cruit­ing psy­chi­at­rists?”

Durbin said he in­tends to have the Gov­ern­ment Ac­count­ab­il­ity Of­fice look in­to how the mil­it­ary can bet­ter re­cruit psy­chi­at­rists.

Mean­while, changes to mil­it­ary policy could re­as­sure more troops that it’s safe to seek help. Doc­tor-pa­tient con­fid­en­ti­al­ity isn’t a guar­an­teed right for ser­vice mem­bers, be­cause com­mand­ers find out about the men­tal-health con­di­tion if the ser­vice mem­ber is deemed un­fit to com­plete a mis­sion, ac­cord­ing to Navy Vice Adm. Mat­thew Nath­an.

“We wrestle with how much to share with com­mands,” Nath­an told the Sen­ate com­mit­tee mem­bers, “be­cause the sol­dier will not seek treat­ment if they fear that everything will be passed along to their com­mand­er. We worry about the in­di­vidu­als who won’t step for­ward if they know that their com­mand­er will know about it right away.”

Oth­er policy changes — in­clud­ing length of de­ploy­ment and im­proved dis­tri­bu­tion of re­sources — are be­ing weighed by the mil­it­ary as well, ac­cord­ing to Horoho’s testi­mony. But a defin­it­ive an­swer about how to pre­vent, dia­gnose, and treat be­ha­vi­or­al-health con­di­tions in the mil­it­ary re­quires fur­ther re­search.

“Though we live in un­cer­tain times, one thing is cer­tain: A healthy, re­si­li­ent, and ready Army will be — as it has al­ways been — the strength of our na­tion,” Horoho said.

COR­REC­TION: An earli­er ver­sion of this art­icle in­cor­rectly said that Navy Vice Adm. Mat­thew Nath­an was an Army of­ficer.

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