Redstate

By streiff Posted in War — Comments (14) / Email this page » / Leave a comment »

A year and a half ago I wrote about the media campaign to turn Iraq into Vietnam by recycling thirty-year-old story lines with updated color commentary.

PTSD suffering veterans. A subspecies of the pathetic, drug addled homeless veteran is the PTSD suffering veteran. Often prone to cowering after hearing car backfires and assaulting foreigners as a result of their combat trauma, though the latter is going to be much harder to expound upon because of the paucity of Middle Eastern waiters as opposed to Asian waiters, not only are they doomed to a life of homelessness many turn to violent crime which is explained by the media because of their combat trauma. As discussed above the Gulf War was too short for this subspecies to appear but the Iraq war is on track to produce a bumper crop.

Last week the Hartford Courant ran a four part series alleging soldiers and Marines who were psychologically unfit were being forced back into combat and becoming victims of PTSD and suicide.

Read on.

The parts of the Courant’s series are:

Potent Mixture: Zoloft & A Rifle

Amid Patriotism, Anger And Questions

Health Chief Responds

Slipping Through The System

Mentally Unfit, Forced To Fight

`Jeffrey Was Really Messed Up'

No one, at least so far as I’ve divined, has claimed that combat is not stressful nor have they claimed suicide is not a tragedy. Most people, myself among them, would clearly believe that is the case. The question here is not the various anecdotes the Courant features, I’ve no doubt that all of them are true to one degree or another. The question is whether or not the Courant’s thesis is true:

The Courant's series, which concludes Wednesday, found that the military has increasingly sent, kept and recycled troubled troops into Iraq, sometimes in conflict with its own policies.

Although Congress ordered that every deploying service member receive an "assessment of mental health," The Courant reported that fewer than 1 in 300 troops receives a referral to a mental health professional before being sent to war. But a study by the military's own doctors estimated that 1 in 11 deploying troops suffer from major depression, anxiety or PTSD.

And secondarily, the question is whether the suicide rate among servicemembers in Iraq and on active duty differs markedly today from the past and from the nation at large.

Pre-deployment screening

The Courant claims that the Department of Defense is scoffing at congressional will in how it screens for those with potential mental health problems:

Although Congress ordered that every deploying service member receive an "assessment of mental health," The Courant reported that fewer than 1 in 300 troops receives a referral to a mental health professional before being sent to war. But a study by the military's own doctors estimated that 1 in 11 deploying troops suffer from major depression, anxiety or PTSD.

They further elaborate:

Under the military's pre-deployment screening process, troops with serious mental disorders are not being identified - and others whose mental illness is known are being deployed anyway.

A law passed in 1997 requires the military to conduct an "assessment of mental health" on all deploying troops. But the "assessment" now being used is a single mental health question on a pre-deployment form filled out by service members.

The first statement is simply tendentious and not supported by much beyond the reporter’s own opinion of what constitutes a “serious mental disorder.” The military uses a system known as a medical profile built around the PULHES code. Any type of psychiatric problem would be identified by the awarding of a 2 or higher under the “S” factor. There is no evidence presented in the series that anyone with a diagnosed “serious mental disorder” was deployed. Reviewing the Courant’s articles, it seems that anyone who was receiving antidepressant medication prior to deployment was considered to have a “serious mental disorder,” and given the frequency with which antidepressants are prescribed that seems to be hyperbole at the least.

The second statement is just untrue. A May 2006 report by the GAO, which obviously served as a backdrop for this article though none of the reporters apparently bothered to read it, describes the screening for PTSD and risk-of-PTSD:

The DD 2796 is a questionnaire that DOD uses to identify servicemembers who may be at risk for developing PTSD after their deployment and contains the four PTSD screening questions that may identify these servicemembers. The four questions are:

Have you ever had any experience that was so frightening, horrible, or upsetting that, in the past month, you:

• have had any nightmares about it or thought about it when you did not want to?
• tried hard not to think about it or went out of your way to avoid situations that remind you of it?
• were constantly on guard, watchful, or easily startled?
• felt numb or detached from others, activities, or your surroundings?

That report documents this particular form has been in use since at least April 2003, the same period covered by the Courant’s study.

Not surprisingly, this is essentially a modified version of the DSM IV screening criteria for PTSD

When the Courant makes this claim:

Instead, the military's assessment consists of the single yes-or-no question on a form filled out by deploying service members: "During the past year, have you sought counseling or care for your mental health?"

they are simply misstating the facts.

Despite a congressional order that the military assess the mental health of all deploying troops, fewer than 1 in 300 service members see a mental health professional before shipping out.

While this is true, the Courant is making a patently dishonest attempt to create a story by using the word “despite.” As the GAO established, all troops deploying to Iraq and Afghanistan are screened for actual and potential vulnerability to PTSD.

Using data provided by DOD, GAO found that 9,145 or 5 percent of the 178,664 OEF/OIF servicemembers in its review may have been at risk for developing PTSD. DOD uses a questionnaire to identify those who may be at risk for developing PTSD after deployment…Of the 5 percent who may have been at risk [emphasis mine], GAO found that DOD providers referred 22 percent or 2,029 for further mental health evaluations.

The Courant claims

Last week, the Government Accountability Office reported that among soldiers who screened positive for possible PTSD on a post-deployment questionnaire, only 22 percent were referred for a mental health evaluation. That figure - which caused outrage among some in Congress - is still more than three times as high as the percentage of soldiers referred to a mental health professional after self-reporting problems on the pre-deployment form.

Overall, from March 2003 to October 2005, the military processed 935,797 troops facing deployment. Of those, 2,538 were referred for a mental health evaluation - less than 0.3 percent. That amounts to an average of 18 referrals per week worldwide.

This statement is simply impossible to square with the GAO analysis. To believe that the GAO could have erred to this degree requires one to simply ignore the several hundred years of the study of statistics (that the GAO found 2,029 mental health referrals in a sample of 178,664 but only 509 referrals were made in the remaining 757,133 cases) and discount the relative analytical power of the GAO versus the Courant.

By delving into our elementary school arithmetic books we find that actually one in 88 servicemembers see a mental health professional before deployment. In the Defense response to the GAO report, Defense offered a more in depth explanation:

Part of that new ground -- the subject of the recent GAO study -- is a questionnaire that screens servicemembers for a variety of health issues, including indicators that they may be at risk for post-traumatic stress disorder. DoD has screened more than 1 million servicemembers through questionnaires and face-to-face interviews with medical professionals, both before, during and after their deployments to identify possible mental health problems and prevent or treat them, [Dr. William] Winkenwerder [Jr., assistant secretary of defense for health affairs] noted.

However, the GAO study found that just 23 percent of the surveyed servicemembers whose responses showed they were potentially at risk were referred to mental health providers. What it didn't record was how many of those people were referred to other sources of care or support -- primary-care doctors, group counseling sessions, chaplains and other services, Winkenwerder noted.

Suicide

It wasn’t only the Courant who hopped on the bandwagon. The Christian Science Monitor ran a supporting story:

According to the statistics given to the Courant by the military, the suicide rate in Iraq is about 20 per 100,000. By comparison, the adjusted suicide rate in New York State in 2002 was 5.4. The suicide rate for the US per 100,000 people in 2002 was 14.6 for males and 3.4 for women, a combined rate of around 10 people per 100,000.

MSNBC says that suicide rates overall in the Army in 2005 reached their highest levels since 1993. The overall suicide rate of the US Army has fluctuated from a high of 15.8 per 100,000 in 1985, to a low of 9.1 in 2001.

One hardly knows what to make of this when one actually follows the link to the MSNBC story:

Of the confirmed suicides last year, 25 were soldiers deployed to the Iraq and Afghanistan wars — which amounts to 40 percent of the 64 suicides by Army soldiers in Iraq since the conflict began in March 2003.

The suicide rate for the Army has fluctuated over the past 25 years, from a high of 15.8 per 100,000 in 1985 to a low of 9.1 per 100,000 in 2001. Last year it was nearly 13 per 100,000.

The Army recorded 90 suicides in 1993, with a suicide rate of 14.2 per 100,000.

The Army rate is higher than the civilian suicide rate for 2003, which was 10.8 per 100,000, according to the National Centers for Disease Control and Prevention. But the Army number tracked closely with the rate for civilians aged 18-34, which was 12.19 per 100,000 in 2003.

The suicide rate for the troops in Iraq is “about 20 per 100,000” in the same sense that it is also “a crap load.” Again, if we resort to elementary school math we find the suicide rate of those deployed in Iraq and Afghanistan was approximately 15.9 per 100,000, approximately 15.9 for those deployed to Iraq (22 suicides vice 138,000 +/- troops deployed there) and 15.8 (3 suicides and some 19,000 +/- troops deployed) for those deployed to Afghanistan.

The dishonesty of the CSM in comparing disparate populations (troops in Iraq to people in New York or men and women in the United States) just boggles the mind. Suicide rates vary wildly with age (check the number of toddler suicides if you doubt this) and sex (compare teen boys with teen girls).

In truth, MSNBC bobbles this comparison, too. The military population in Iraq is mostly male, the suicide rate among males aged 18-34 is about 20.5 per 100,000 or 30 percent higher than among soldiers in Iraq and Afghanistan. Even adjusting for the smallish number of women in the theater, and ignoring those above 35 and above where suicide rates are higher, the worst that can be said is that the suicide rate among US troops in Iraq and Afghanistan is no higher than among a comparable US population.

These data also beg the question of why suicides were higher in 1985 and 1993 (well, 1993 was a bad year) than during any year of the war in Iraq. It would seem to the casual observer that for there to be causality between suicides and the war in Iraq, as the Courant strives to demonstrate, there should at least be a correlation demonstrating that the suicide rate is higher after the war started than it was in intervening peacetime years.

Use of antidepressants

The Courant makes much of the use of antidepressants by some number of soldiers and Marines in Iraq and Afghanistan. According to the National Center for Health Statistics, in 2003 there were 26.6 prescriptions for antidepressants issued per 100 Americans aged 18-44 making it the most commonly recommended class of drugs for this age group putting non-steroidal anti-inflammatory drugs (primarily Ibuprofen) into second place with 22.2.

I have no experience with antidepressants but I find it hard to believe that the use of these drugs 1) justify labeling the user as having a mental disorder or 2) constitute an abuse of the drug if used by deployed troops.

The constant use of “psychotropic drugs” to refer to anti-depressants is cheap agitprop designed to call up images of Thorazine and Jack Nicholson and not accurate in the bargain.

Commenting on the death of Spec. Jeffrey Henthorn, the Courant states:

Henthorn's case is perhaps the most egregious example of a military mental health system that is focused on retaining troops in combat, even when they exhibit clear signs of psychological distress. Since the war in Iraq began, the military has stressed the importance of treating troubled soldiers on the front lines and improving "return-to-duty" rates - principles that some believe are being taken too far, putting troops' safety at risk.

Again they raise the specter of soldiers being put unnecessarily at risk. In fact, since World War I treating soldiers suffering from PTSD (or shell shock or battle fatigue or a hundred other names) at the front lines has been commonplace. Delving into my personal library and referring to page 282 of Anthony Kellett’s Combat Motivation: The Behavior of Soldiers in Battle:

The experience of both world wars fought since 1945 indicate that the psychiatric casualty’s chances for recovery are greatest if he is treated quickly, near the front line, and as a solder rather than as a hospital patient. The importance of retaining a military ambiance was initially demonstrated in the First World War. The British evacuated their casualties to sanatoria in Britain, while the French treated their casualties near the lines, in an environment marked by daily routine, inspections, and drill; in general, the British casualties worsened, while up to 70 percent of the French casualties returned to duty.

Richard Holmes in Acts of War: The Behavior of Men in Battle writes:

In the fighting in the Lebanon in 1982 the Israeli army made widespread use of front-line psychiatric stations, where disturbed soldiers were visited by comrades from their unit, who assured them that they were in no way disgraced and would be welcomed back. Almost 60 per cent of patients were returned to duty from these centres.

The fact is that those suffering from PTSD in combat are also suffering from another primal fear, that of failing their primary social group. Separating them from their unit stigmatizes them to themselves and to their units and many, if not most, of those evacuated from the theater as psychiatric casualties will never fully recover.

In short, the Courant article is a shoddy piece of analysis which adds nothing at all to the discussion and obscures much. To the extent it contradicts the GAO is must be the subject of ridicule.

This is not to say that the manner in which the military handles actual and potential psychiatric casualties is optimal. Clearly some of the anecdotes, assuming they are treated with a greater regard for accuracy than the facts in the story, indicate that the chain-of-command of some of these soldiers fell short of what could be reasonably assumed to be their duty.

Of course, it is easier to make that judgment when you are simply bashing the military from the safety of your office rather than making considered judgments in a combat zone. I can tell you from experience in a peacetime Army that malingering and AWOL will blaze through a unit like the bubonic plague through medieval Europe. If you don’t stamp it out ruthlessly you will lose your unit. I can’t imagine behavior changes that radically in combat. So I, for one, simply refuse to judge a young company commander fighting a war.

What they propose is unclear. Apparently they’d like everyone to believe that there is a requirement that every deploying servicemember actually have an in-person psychological evaluation. Logic tells you that regardless what the feckless Chris Shays may believe, even a body as benighted as the Congress could not have intended that when they crafted the law in question. If they had they would have styled it the The Mental Health Professionals’ Perpetual Employment Act.