Attrition: Psychological Casualties in the War on Terror


July 9, 2006: As of May 2006, some 560,000 U.S. troops had rotated home from service in Afghanistan or Iraq (some, of course had by then returned more than once). Of these, some 30 percent received some form of medical attention, mainly for (in order of frequency) diseases, injuries, psychological conditions and combat wounds. Apparently there about ten percent of the troops have had problems that required the use of mental health services. These included;
@ Some 25,000 cases of "Post-Truamatic Stress Disorder" (PTSD)
@ 1,775 cases of "Acute Stress Disorder" (ASD) (a very severe form of PTSD)
@ 17,500 cases of Depression.
@ 9,100 cases of "effective psychoses"
@ 27,300 of alcohol or drug abuse.
Despite the statistics, getting a handle on the actual extent of mental health problems among personnel who've served in Iraq and Afghanistan is difficult, as there is apparently a good deal of "double counting" in casualty figures. For example, personnel who've suffered from "polytraumatic or blast-related injures" (i.e., been wounded by an explosion), are going to receive "counseling" to insure they're adjusting well, whether or not they actually display any symptoms. Similarly, someone who's diagnosed with ASD may also be suffering from depression and substance abuse, and has already been diagnosed as suffering from PTSD, and so may actually have been counted four times in the figures above
There is also a problem of trying to figure out what caused someone's mental health condition. Some problems may have existed before the person deployed to Afghanistan or Iraq. Furthermore, military medical personnel may be "erring on the side of caution" in many cases, which may result in an overstating of the proportion of mental health problems among troops returning from overseas, which would inflate the number of cases.
Despite this, there are some very real problems with the present system for looking after the mental health of returning personnel. Perhaps the most important difficulty is that some problems may take years to appear. But once someone's out of the armed forces there isn't likely to be any follow-up. After two years out of the service, a veteran may find it difficult to secure diagnosis and treatment because of jurisdictional disputes among the Department of Defense, the Department of Veterans' Affairs (VA), and civilian public health agencies. So far, however, it appears that the psychological casualties of the war on terror are less than in past wars. This is largely because of better screening of recruits, better training, equipment, weapons, tactics and living conditions in the combat zone. These were all factors that contributed to psychological casualties in the past.
Meanwhile, better communications with the folks back home is causing combat stress back there as well. In past wars, the folks back home were very removed from the more brutal realities of war. To be sure, they knew the risks. But communications from the troops were slow, and usually "self censored"; that is, in writing home, a soldier would likely edit out the bad parts, merely saying "we saw a little action the other day" when he'd actually been on Omaha Beach, for example. Today, it's not unusual for a soldier who's been in a fight, to pick up his cell phone and call home to say "We just got his with some mortar rounds, but I'm OK." This may actually help the soldier's mental health, but its effects on the folks back home has not been considered.




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