Jonathan P. Baird

A little-explored cost of the Iraq war is the extent of psychiatric injury to our troops. While the Vietnam War led to more awareness about the mental-health consequences of combat and a recognition of post-traumatic stress disorder, the likely psychiatric cost of our involvement in Iraq was never considered in the run-up to the war.
Probably this is like other wars. Architects of war have a way of rationalizing and minimizing the staggering level of violence and death wars unleash. If thousands of deaths and grievous bodily injuries are considered an acceptable sacrifice, unseen and private psychiatric injuries are not even part of the calculation.
Three years after the start of the Iraq war, all indications point to a heavy psychiatric toll on our troops. Dr. Jonathan Shay, a psychiatrist at the Boston VA and an expert on post-traumatic stress disorder, estimates that about one-third of our combat veterans will have significant psychiatric injury after the war. That is many thousands of suffering veterans.
The nature of the Iraq war seems particularly problematic. Americans are strangers in a strange land, neither speaking the native language nor comprehending an alien culture. Because it is a guerrilla conflict, random and unexpected death often lurks nearby. Soldiers are subject to the stresses of not knowing when danger will emerge and not even knowing who the enemy is. They must be mobilized to respond immediately if anything is out of place in their environment. Life may well depend on an instant response.
These stresses return home with the troops. Post-traumatic stress disorder is a persistence on the home front of behavior truly needed to cope with war. It is a misperception of a present situation as being a past situation.
Jim
In my legal career, I have represented many veterans seeking Social Security benefits for post-traumatic stress disorder. I’d like to tell you about one of them, whom I’ll call Jim. Although his problem was the result of an earlier conflict, I believe Jim is typical.
Jim lives in Claremont. He is a veteran of both the Vietnam era and the first Gulf War. He first started having symptoms of post-traumatic stress in the mid-1990s. He had flashbacks of buildings blowing up and dead bodies on the side of the road. He reported significant irritability and episodes of rage.
Jim experienced memory loss, mood swings and hand tremors. He lost track of time and could not remember things he did. He had great difficulty sleeping. There were instances when he struck his wife in his sleep. Jim’s wife said he had tried to strangle her once when he was asleep. Compounding these issues, Jim developed a serious alcohol problem.
After his return from the Gulf,
Jim started many jobs but could hold none of them for long. For years he had minimal earnings. Because Jim had a back injury from his time in the Gulf, he received some compensation from the VA. However, his claim for disability based on post-traumatic stress disorder was denied. The VA ruled he had insufficient proof.
Jim did get important counseling and medicine from the VA. Still, he had trouble restraining his anger.
No time limit
At least Jim sought help – and received some. A Defense Department study of returning Iraq combat troops found that many soldiers who need counseling the most are least likely to seek it due to the stigma of mental health care in the military. It is common for soldiers to worry that disclosure of symptoms will adversely affect their careers.
Unfortunately, there appears to be no time limit on when post-traumatic stress symptoms surface. It may be weeks, months or years after combat. The military has been willfully blind in lengthening deployments and in allowing multiple combat tours.

There are no adequate studies on the effect of multiple tours of duty and post-traumatic stress disorder. It seems likely, however, that the greater the exposure to combat, the higher the risk of mental-health injury.
Because of the overriding need to retain soldiers, the military has focused on patching them up and returning them to Iraq to finish their deployments. Is it wise to return veterans with post-traumatic stress disorder to combat? Is it ethically proper for mental-health workers to place the manpower needs of the military ahead of the mental-health needs of their patients? How much trauma is too much before a soldier is sent home?
Maybe someday war planners will consider likely psychiatric harm (along with death and physical injury) before they send our troops on a mission. Maybe they will actually keep track of all the mentally wounded and figure a way to quantify the pain and suffering. But I would not bet on it.