The Toll of War

This post was written by Niko Karvounis and Maggie Mahar

It’s no secret that the wars in Iraq and Afghanistan have stretched the military thin. Indeed, the past few years have seen a steady flow of news stories depicting just how desperate our armed forces are for warm bodies—including reports that the military is “at its breaking point” and has considered non-citizens for service; that states are seeing their largest mobilization of reservists since World War II; and that the army has abandoned the 24-month limit on time that reservists must serve.

Meanwhile, in November, Stars and Stripes reported that the Pentagon was quietly looking for ways to make it easier for people with “minor” criminal records to join the military. In 2007, the share of Army recruits needing waivers for infractions that included stealing, carrying weapons on schools grounds, and fighting rose to 18 percent –up from 15 percent a year earlier.

There’s no shortage of political objections one can level against the military’s never-ending need for manpower, but there are also some profoundly personal issues to consider when reflecting on just how dangerous it is for our military to deploy—and redeploy—so many soldiers. More than 100,000 American veterans have been sent back to Afghanistan and Iraq despite finishing the terms of their enlistment. Imagine what it means to think that you have fulfilled  your duty—and then to find yourself on the way back to hell.

Imagine being told that you will have a year at home before going back to Iraq—and then being ordered back, as the 4th Infantry Division from Fort Hood, Texas  was after a break of only seven months. “It just plays with your head," says one soldier. “The people in Washington think that this is a board game."

Two studies in the latest issue of the Journal of the American Medical Association (JAMA) explore the psychological toll of war, not only on soldiers but also on their families. The first study focuses on soldiers who were never heavy drinkers—until they became pawns in what seems a war that will never end.  The second piece takes a look how the stress and uncertainty leads to child abuse—not by the solider, but by the spouse who is left at home.

An AP report on the first study sums up its methodology and findings nicely:

“…researchers analyzed data from nearly 80,000 military personnel, including more than 11,000 who were sent to Iraq and Afghanistan. They looked at whether deployment and combat exposure were linked with new alcohol problems such as binge drinking...[and]…found that more than 600 combat troops who reported no binge drinking at the start of the study developed the problem after deployment and combat exposure.” Those 600 represented about 26 percent of the military personnel exposed to combat who said they weren’t binge drinkers at the start of the study—in other words, more than one-quarter of troops who were not heavy drinkers before combat become so after combat.

The Burden of Citizen Soldiers

Furthermore, “new patterns of regular heavy drinking and alcohol problems, such as missing work because of drinking occurred more often in [National Guard] and reserve troops who experienced combat. Their risk of developing new drinking problems, compared to guardsmen and reservists who weren't deployed, was about 60 percent higher.” The study also found that alcohol-related problems were more common for reservists than active-duty members: the prevalence of alcohol problems was 14.1 percent in the former group and 11.5 percent in the latter.

These numbers should not be that surprising: after all, for reservists, being a soldier is primarily a part-time job, hence their label of citizen-soldiers. One can assume that they are less prepared for combat situations and would have a harder time dealing with the traumas of combat. But there’s more: the study reports that Guard and reservists tend to be more disengaged from the military’s support infrastructure, and thus have fewer resources to help them cope after combat.

You might say that, in a wartime situation, increased drinking should be expected. But it’s not just booze that’s the problem. The stress that Guard and reservists face comes out in other, more deadly forms. In November, a Department of Veterans Affairs analysis found that “more than half of veterans who took their own lives after returning from Iraq or Afghanistan were members of the National Guard or Reserves”—despite the fact that the Guard and reservists make up just 28 percent of all U.S. military forces deployed in those two countries.

This is not to say that active-duty soldiers are immune to the psychological stresses of war: according to a military report released last year, army suicides hit a 26-year high in 2006, and "Iraq was the most common deployment location for both (suicides) and attempts.”  Meanwhile, many other soldiers suffer serious psychological problems: About one-fifth of Iraq and Afghanistan veterans endure depression or PTSD and one-third of Iraq veterans have mental health problems.

“Shifting the Goalposts”

No doubt some of these conditions are part and parcel of war. But the conflicts in Iraq and Afghanistan are particularly stressful because they (a) seem to have no end and (b) require so much manpower. To cope, leaders have been “‘shifting the goalposts’ on…soldiers’ deployment period[s],” in the words of a February report from the Veterans for America's Wounded Warrior Outreach Program—a practice which “greatly contributes to an increase in mental health problems."

Here “shifting the goal posts” refers to ever-changing standards and expectations as to how long a soldier can expect to serve and how often he or she can expect to be deployed. For example in 2007 Robert Gates decided to extend Army tours in Iraq from 12 to 15 months (a decree which President Bush reversed in April of this year). Then there was the decision to abandon the 24-month limit on time that reservists must serve. These abrupt changes in time horizons blind-side both soldiers and their families.  Imagine being the mother of three children, all under the age of eight, counting the days until your husband will be home for good—and then getting the news that the army has changed its mind.

The Children

According to Stephen Cozza, MD, a psychiatrist at the Uniformed Services University of Health Sciences, “active duty service members have 1.2 million dependents aged 23 years and younger; many of those serving have had at least 2 to 4 deployments, some lasting 18 months. About 44 percent of active duty troops have children, nearly two-fifths of whom are aged 5 years or younger.” Reservists “have 660,000 children and adolescents younger than 22 years, and their families face similar strains from deployment. About 38 percent of the selected reserve force have children, one-fifth of whom are aged 5 years or younger.”

In the newest JAMA, Cozza observes that the problem is not just that children miss their parents, or that their parents miss seeing them grow up. Rather, “we worry about the corrosive impact of stress with multiple deployments. [As soldiers are redeployed,] spouses at home may develop increased anxiety, and potentially pay less attention to children’s needs.”

Indeed, according to JAMA, “researchers found the rate of child maltreatment (through neglect or physical, emotional, or sexual abuse) in families of US Army enlisted soldiers was 42 percent higher during combat deployment than in nondeployment” and that “the rate of child maltreatment by female civilian spouses was significantly elevated.” When a parent is at war, families suffer.

Unfortunately, the situation doesn’t necessarily improve after a soldiers’ return, thanks in part to mental health problems that can go unacknowledged. JAMA reports that “re-screening of 88,235 US soldiers several months after their return from Iraq identified a large cohort whose mental health problems were missed on initial screening.” In the early screenings that soldiers received upon their return, “clinicians identified 20.3 percent of active and 42.4 percent of reserve component soldiers who needed mental health treatment. At the second screening, concerns about interpersonal conflict increased 4-fold.”

Cozza put it best when he declared that “there is no such thing as an ‘injured service member’”; instead, “we should be thinking, ‘injured family.’” We should also be thinking, ‘how much more can our soldiers—and their families—take?’ In Iraq, the troop surge is only going to make things worse: at the start of the surge last year, 4,000 Marines in the Anbar province had their deployments extended. In Afghanistan, Marines also  are seeing longer tours of duty in Afghanistan. (Meanwhile, the JAMA study found that “Marines…were…at increased odds of continue go binge drink after deployment, as well as to experience new-onset alcohol-related problems.”)

As the wars in Iraq and Afghanistan roll on, our military needs will continue to outstrip our capacity. Active-duty soldiers, National Guardsmen, and reservists alike will all be put under more and more pressure until they—and their families—reach a breaking point.

Comments

[Maggie Mahar]

Russell--

I trust you are e-mailing us from Iraq?

[Russell]

Yes. The U.S. should have surrendered to Tojo and the Nazis. Of course.

Better to be submissive and to kow-tow. Let the French be our guide.