The Emotional Casualties of War

Association of Women in Pyschology

There is only so much emotional damage from war that psychologists and psychiatrists can fix. In this highly psychologized and psychiatrized society, there is a grave danger that the United States as a nation assumes that therapists will be able to make these repairs effectively and that the rest of us need not worry about it. During the Vietnam War, we sent large numbers of veterans behind the closed doors of psychotherapists to deal with the pain and anguish that that war had wrought. But as we see today in many Vietnam veterans, although therapists have been helpful to some, it is easy but wrong to assume that they will be able to seal or heal completely the psychological wounds that the current war creates. As a society, we must not leave it to psychotherapists to repair the emotional harm that is endemic in soldiers coming back from Iran and Afghanistan. It is not good for the soldiers, and it is dangerous to society to do so.

Many Americans recognize the term “Post-traumatic Stress Disorder,” a label that is found in the official manual of psychiatric diagnosis and is freely applied to returning soldiers. Although the term is sometimes helpful, it nevertheless denotes mental illness, and the implications of this application are troubling. When people suffer because they expected to be greeted as liberators but were reviled as invaders, because they expected to find a recognizable enemy but never know who or where the enemy is, it is wrong to call them mentally ill if they are terrified, hypervigilant, and tormented with nightmares and flashbacks. These returnees have enough to deal with; they do not need to be labeled mentally ill as well. But since some do want to talk to therapists and thus will almost certainly receive diagnostic labels in order for their sessions to be covered by insurance, it is all the more important for the rest of us to let them know we do not consider them weak or crazy for having these troubles.

Simply to send frightened, angry soldiers off to therapists conveys disturbing and wrong messages:

(1) That we don’t much want to listen,

(2) That we’re afraid we’re not qualified to listen, and

(3) That the person you should talk to is someone who gets paid to listen. The essential implication is that the returnee’s reactions to this war are abnormal.

It is commonly assumed that the best way to cope with painful memories is to set them feelings aside and not talk about them. Society’s traditional prescriptions for men to be tough and be silent add to the expectation that, no matter how they are suffering, they should not talk about it, should be handling it better somehow. Recently, these expectations have applied not only to men who come back from the war but also, on the theory that anyone who goes to war should be able to take it like a man, to returning women soldiers. To be sure, there are times for talking and times for not talking, and returnees should be able to know that, if they indicate they want to talk, that does not mean they have to answer every question anyone might ask.
The response of the military psychiatrists to fear and anguish resulting from war has been largely inadequate and misguided. For instance, when soldiers have emotional breakdowns in combat, in almost every case, military therapists give them a few hours or a few days to rest and a chance to talk with a counselor, then send them back into combat. Their rationalization for this is that in the past, soldiers who broke down in combat and were not sent back to the battlefield have felt guilty. However, the likelihood is that, no matter what, they will have some survivor guilt, and sending them back into battle is no guarantee they will avoid it; indeed, back in combat, they are likely to survive the deaths of still more comrades. For any human emotional problem there is more than one choice about how to respond. Mental health professionals entrusted with making key decisions about the best interests of their patients can choose whether, in essence, to try to help their patients fit into the status quo or whether to help them do something else. Sending back into combat soldiers who are clearly in a psychologically fragile state, as evidenced by their recent breakdown, is an option that promotes the status quo. A different option would be to advise their commanding officers that these are among the last people who should be sent back to into battle and to work on a variety of ways to try to decrease and also to assist them in dealing with the survivor guilt they are likely to feel. For instance, it can be helpful to draw their attention to the fact that if they were to die, that would by no means guarantee that any other soldier would live, as well as to the fact that they can serve in other ways because of having survived (including public education and other social and political action aimed at decreasing the risk to soldiers who are still there). These are the kinds of things that have helped veterans of other wars to deal with their survivor guilt.

Another step the military has touted has been their creation of debriefing programs for returning soldiers. Rather than fly personnel from Baghdad directly to Boston, they take them to another location for ten days to prepare them for going home. This is a good idea and might help to prevent, for instance, the kinds of violence that some soldiers carry home to their families, like the Washington reservist back from Iraq who is charged with killing his wife and the four Fort Bragg commando soldiers accused of killing their wives after returning in 2002 from Afghanistan, is frightening The debriefing includes alerting returnees that they may have nightmares and short tempers, explaining to male soldiers that their wives have gotten used to making all the decisions while they were away, and warning fathers of babies and young children that their kids might not recognize them. Although that is a good beginning, and for some soldiers it might be sufficient, for many it is far from adequate. Those few days include not just discussion of emotional matters but also medical checkups and advice about veterans’ benefits, and the very brevity of the preparation may convey the message that this debriefing should be all they need. This message unfortunately dovetails with the expectation for men in general and now soldiers regardless of sex to “get over it” with great speed. Even with forewarning, the reality of having your child fail to recognize or shy away from you, when you’ve spent months longing to hold that child can be devastating. So, too, can learning that, as one Army reservist back from the wars said, “You think you might have a little better life when you get back, that people will give you a little help because of being a veteran. But then you find that the President wants to cut veterans’ benefits. Cut them! And with unemployment so high, you’re lucky to get a job digging ditches. It’s kind of hard, you know?”

Furthermore, in a short debriefing there simply isn’t time to go into detail about the wide variety of ways one might deal with problems after coming home. The same reservist said the debriefer told them not to withdraw and hibernate when they got home, but that was precisely what he wanted to do. As a result, in addition to wanting to withdraw, he had the added problem of believing it was wrong or “sick.” Some of the counseling the Army offers may work for some soldiers, but some of their advice, such as to buy flowers for their wives and ice cream for the children and take the kids to Chuck E. Cheese, is not always appropriate and unlikely to be sufficient to smooth the troubled waters of homecoming.

At least one military counselor actually tells men not to tell their wives what they saw in the war. This is unfair to the men and can increase trouble in their relationships, because keeping It is no easy matter to know what will help, because to have to keep silent about horrific memories can create a distance from loved ones, but so can a partner’s failure to comprehend fully how it felt to be in circumstances the partners have never experienced. But though the answers are neither simple nor obvious, the major, ongoing project of seeking them is a social responsibility.

A military pilot who had served a tour of duty in Iraq told me that while he was reeling from the shock of seeing Americans reviled as invaders and occupiers, he found it hard to send empathic emails to his fiancée in Dubuque when she told him she had a horrible day because her car overheated. “I understood that, given where she was, her day really was awful. But it showed me the chasm between us.” He was torn between, on the one hand, wanting to be able just to say he was sorry she had had a bad time and not mentioning how his day had gone and, on the other hand, fearing that if he tried to describe his experience, she could not truly understand, and that would make the chasm seem despairingly greater. “It’s hard enough to have a long distance relationship if she lives in Tampa and you live in Denver. But Dubuque to Iraq is much harder.” He was on his way back to the war zone after a few weeks at home, and he said his engagement to the woman in Dubuque was now a casualty of war.

A 38 ­year-old man we’ll call Robert joined the reserves in 1996 to get help with his college tuition. His life was interrupted after the September 11 attacks when he was called up and assigned to duty as an airport guard. Eight months later, he was sent to Kabul The members of his unit spent six months in close quarters and got along well. Then they started fighting among themselves, a change that was so startling that it impelled the men, none of whom had ever thought much about feelings or relationships to talk about what was happening. They realized that the arguing began when Secretary of Defense Donald Rumsfeld announced that they would not be going home at the end of the 6-month period as he had promised.

According to Robert’s sister, the entire time he was away, Robert could tell you how many months, weeks, and even minutes were left until he could go home. It’s hard to imagine that any homecoming could measure up to the images Robert must have had as he counted the minutes. And indeed, when he finally did return, he was “all at sea” and depressed, because it seemed like everybody acted as though he had never left. The contrast between the sameness and stability of the lives of his family and friends with the wrenching upheaval and the constant danger in which he spent those months away is an ongoing cause of great turmoil and disorientation, with feelings of unreality for Robert.

Last week as I waited in line at the bank, I heard a customer with red hair cut military-style say loudly to the teller, “We were with the 82nd that got Saddam. Jeez, you shoulda seen the rathole he was in. Snickers Bars and everything.” When the teller expressed awe, he retreated a little, saying, “Well, I didn’t actually see him. But some of our guys did.” Another male customer greeted him warmly. They had graduated from the same high school two years earlier. The second man told the soldier, “Thanks for keeping us safe.” The soldier stood up straighter and boomed out, “Glad to do it. I’m home for 30 days, then going back for 10 more months. Goin’ to Afghanistan this time. Gonna get Bin Laden.”

All I could think of was that he could be killed less than a month from now. As he left, I caught up with him and said, “Pardon me, but I wanted to tell you that my father fought in the Battle of the Bulge, in an artillery unit attached to the 101st Airborne.” His face lit up: “The Bulge! Wow!” I felt like he thought I was a hero. I gave up trying to hide my fear for him and said, “My father never thought we should have invaded Iraq. And I am scared for you. I hope you will be safe.” His board-straight posture vanished, and he looked me right in the eye. “I got stabbed in Iraq. You know, we’re sitting ducks over there.” And it’s weird being home. I can’t seem to stop watching my back.” “Well, good-bye,” I said, “and be careful,” realizing how foolish that must sound.

The moment that young man had a chance to say anything other than the party line, out came the feeling of utter vulnerability that is surely a sane response to knowing you’re a target and not being sure who is targeting you or where they are. The least we can do for these frightened souls is give them every possible chance to say how scared they are. At the same time, though, we must recognize the importance both of allowing returnees to tell impressive war stories when they want and of enabling them to talk straightforwardly about the negative aspects of their feelings. And when they do want to talk, we need to find non-psychiatric, nonpathologizing opportunities for them to do so openly and to heal. We also must encourage vets to think and talk about the full spectrum of needs they have because of the war, many of which are just beginning to be identified. This is especially important not only because of the absence of an equivalent of the GI bill after World War II, which helped veterans with their education and provided loans at reduced rates so they could buy homes, but also because of proposed cuts in veterans’ benefits, which cause financial hardship and emotional insult.

We need to take on the social responsibility of telling these returnees not only that we will listen but that we will listen for as long as they want to talk about how it felt to be over there and how it feels to be back. We need to tell them not to censor themselves for fearing of upsetting us, offending our sensibilities, making us feel helpless to help them, or making us feel angry about what has happened to them. If we fail to do this, then we as a nation become complicit in concealing some of war’s most devastating consequences, and if we refuse to face these fully, we help increase the chances that we as a nation will go to war again.

All of this should be seen in the revealing context of who does and does not get diagnosed as mentally ill in relation to this war. Soldiers and indeed most people who repeatedly present as true what has been proven to be false would be described by therapists as “in denial” or even, depending on the nature of the lie, as sociopathic or even psychotic because of being utterly out of touch with reality. But despite the years-long series of revelations of purposeful concealment and distortion of the truth, with devastating consequences for untold numbers of soldiers and civilians in Iraq, Afghanistan, the U.S., and elsewhere, neither President George W. Bush, Secretary of Defense Donald Rumsfeld, Secretary of State Colin Powell, National Security Adviser Condoleeza Rice, Attorney General John Ashcroft, nor those who report to them are diagnosed as mentally ill. Having political power in this country means rarely or never being described as having serious psychopathology. There are ongoing debates about whom to call mentally ill and whom to call simply evil, and it’s not that it would be better to call our leaders sick than heedless and uncaring about the consequences their actions have for anyone other than those closest to and most like them. What is crucial is to recognize the enormity of diagnosing some of the victims of these actions as mentally ill and treating them solely on that basis, sending them behind therapists’ closed doors to deal with the pain that we as a country have allowed or even helped to create.

PAULA J. CAPLAN is the spokesperson for Association of Women in Psychology, which published this white paper. Caplan is the author of They Say You Are Crazy: How the World’s Most Powerful Psychiatrists Decide Who’s “Normal.” She may be reached at: