Not If, but When

by PETER FARMER July 11, 2012

Suicide is now the second-leading cause of death in the U.S. military aside from combat, but perhaps not for long. Pentagon figures through 3 June 2012 show that there have been 154 confirmed or suspected suicides, and 127 deaths attributed to combat operations in Afghanistan; that is, deaths by suicide are actually outpacing those due to combat operations. The total of 154 deaths represents an 18% increase over the same period in 2011.

A team from the Military Operational Medicine Research Program, headed by Colonel Carl Castro, Ph.D., has been tasked with developing a prevention program. "No one so far," says Castro, "has answers." Jackie Garrick, head of the newly-formed Defense Suicide Prevention Office at the Pentagon, called the suicide numbers "troubling," and noted that experts are still struggling to understand suicidal behavior, "What makes one person become suicidal and another not is truly an unknown."

 This writer didn't fall off the turnip truck yesterday, and knows Pentagon double-speak when he hears it. The public isn't being told the truth about this issue - far from it. The above statements imply that little is known about the causes of military suicides and that the phenomenon is a new one; this is at best misleading and at worst, an outright falsehood. In truth, psychological casualties have always been a part of war.

Combat soldiers have always known the psychological as well as the physical costs of war. Medics who treat the wounded, the dying and the maimed are very familiar with the "butcher's bill" of war. In WWI, "shell shock." was observed in the ranks of soldiers from the trenches. In WWII, the condition was called "combat fatigue;" today, we know it as "post-traumatic stress disorder" or PTSD. Thanks to the work of numerous scientists and clinicians, and pioneers such as psychologist LTC David Grossman (U.S. Army ret.), we now know more about the nature of psychiatric casualties than ever before.

It is important to note that the military tracks man-hours lost to disability and wounds very-closely, not only for humanitarian reasons, but for reasons of operational readiness. Suicide in the ranks - and psychological wounds generally - are an old problem, albeit one the members of the military establishment do not like to talk about. 

 The problem isn't a lack of knowledge, medical or otherwise; it is that our policymakers and the military establishment have forgotten lessons learned from past conflicts, are in willful denial of them - or never knew them in the first place. What kind of lessons? Let us examine some of the unspoken-but-hard truths about our dirty little wars in Afghanistan and elsewhere:

1. All combat soldiers eventually break down under the stresses of battle; it is simply a question of "when," and not "if." Even the most resilient soldier wears eventually wears down and his and his effectiveness is dramatically reduced. There are no exceptions - everyone breaks, sooner or later.   Of those who break, a certain number are going to commit suicide.

2. The military (especially the U.S. Army and Marine Corps) is too small for the missions with which it is being tasked. There is a fundamental mismatch here between means-and-ends, one which has not been addressed honestly in policy debates. The ambitious strategic ends being advanced by policymakers likely cannot be met using the means available. Even the mention of the word "d-r-a-f-t" is political suicide these days. So, our leaders heap ever-more missions upon our already over-taxed forces. How many more straws before the proverbial camel's back is broken?

3. Because of high ops-tempo, some individual soldiers are doing as many as five or six tours. During WWI, WWII and the Korean War, men were often kept on the lines until they were wounded or killed or their units withdrawn.  Perhaps this practice was necessary, but it was also eventually recognized that such a system imposed terrific stresses on soldiers, and fed a sense of hopelessness and despair. This is why soldiers of that time spoke of receiving a "million dollar wound," one that would give them a ticket out of combat and possibly home. Essentially, you could only leave the battlefield "feet first" - as a corpse or litter case.  By the time of Vietnam, the armed forces were using a rotation system with a single 1-year tour of duty; if you could survive a year in country, you were done unless you volunteered for more. 

Today, however, we are back to the "feet-first" system. Soldiers with nothing to look forward to, no relief and deployments stretching far into the future - are going to be more prone to psychiatric disablement - or suicide. It is that simple. The Pentagon will not admit to this state of affairs explicitly, but it has done so implicitly by disclosing that anti-depressants, sedatives, and sleep medicines are being prescribed at sharply-higher rates to soldiers in theater. When a soldier needs psych meds to remain on duty, isn't it time to rotate that individual back to the States and bring in a replacement?

Put differently, the unrelenting pace of operations has stressed some individuals in the military to the breaking point - and past it. The warrior ethos tends to downplay complaint and adopt a "can do" attitude - but all humans have limits. People, like equipment and weapons, wear out.

4. Unconventional warfare places unique psychological stresses upon combatants. In counter-guerilla operations, there are no "safe" rear areas; insurgents often prefer to attack support troops in "secure" zones because they are softer targets. An insurgent or guerilla usually does not wear a uniform identifying him as an enemy; he may pose as a non-combatant or wear the uniform of an alleged ally and - as in the current conflict - does not observe civilized norms of conduct regarding the treatment of prisoners, casualties or non-combatants. These realities add to the already heavy psychological burdens our soldiers carry. 

5. Morale matters. The rank and file soldier knows how the war is going - whether we are winning or losing or just treading water - and is acutely sensitive to how he is being led. There is widespread demoralization in the ranks today because the troops sense that their leaders don't know - or perhaps don't care - how to win the war.  Ridiculous rules of engagement only worsen the problem. Soldiers with good morale can endure terrible hardships if they view them as being meaningful; conversely, demoralized soldiers are more prone to breaking or becoming apathetic and ineffective. These, too, are costs of waging war incompetently.

The political class has done a tremendous disservice to the country; it has sent us to war on the cheap.  As one Marine put it - the military is at war; the rest of America went to the mall. A tiny percentage of our population is contributing to our defense; the rest of us have been asked to do nothing - and are doing it. The presumption seems to be that since we have an "All-Volunteer Force" (AVF), the troops won't mind if we send them back into battle again and again, until they are used up.  Why should America's political class care? Our "elites" ceased joining the armed forces long ago. They have no skin in the game; it isn't their sons and daughters being sent off to war and possibly to their deaths.

In closing, it isn't all that surprising that our soldiers are taking their lives and becoming psychiatric casualties in greater numbers - but it is that so few have done so. Our troops are still doing their very best. They can't work any harder; they're running flat-out. In some cases, there isn't a whole lot left in the tank. One couldn't blame any one of them for wondering whether the folks back home still care about them and still "have their backs." Well, do we?