10 January 2008Penny Coleman
In June, the Department of Defense Task Force on Mental Health acknowledged "daunting and growing" psychological problems among our troops: Nearly 40 percent of soldiers, a third of Marines and half of National Guard members are presenting with serious mental health issues. They also reported "fundamental weaknesses" in the U.S. military's approach to psychological health. That report was followed in August by the Army Suicide Event Report (ASER), which reported that 2006 saw the highest rate of military suicides in 26 years. And last month, CBS News reported that, based on its own extensive research, over 6,250 American veterans took their own lives in 2005 alone -- that works out to a little more than 17 suicides every day.
That's all pretty bleak, but there is reason for optimism in the long-overdue attention being paid to the emotional and psychic cost of these new wars. The shrill hypocrisy of an administration that has decked itself in yellow ribbons and mandatory lapel pins while ignoring a human crisis of monumental proportion is finally being exposed.
On Dec. 12, Rep. Bob Filner, D-Calif., chairman of the House Veterans Affairs Committee, called a hearing on "Stopping Suicides: Mental Health Challenges Within the Department of Veterans Affairs." At that hearing suggestions were raised and conversations begun that hopefully will bear fruit.
But I find myself extremely anxious in the face of some of these new suggestions, specifically what is being called the Psychological Kevlar Act of 2007 and use of the drug propranalol to treat the symptoms of posttraumatic stress injuries. Though both, at least in theory, sound entirely reasonable, even desirable, in the wrong hands, under the wrong leadership, they could make the sci-fi fantasies of Blade Runner seem prescient.
The Psychological Kevlar Act "directs the secretary of defense to develop and implement a plan to incorporate preventive and early-intervention measures, practices or procedures that reduce the likelihood that personnel in combat will develop post-traumatic stress disorder (PTSD) or other stress-related psychopathologies, including substance use conditions. (Kevlar, a DuPont fiber, is an essential component of U.S. military helmets and bullet-proof vests advertised to be "five times stronger than steel.") The stated purpose of this legislation is to make American soldiers less vulnerable to the combat stressors that so often result in psychic injuries.
On the face of it, the bill sounds logical and even compassionate. After all, our soldiers are supplied with physical armor -- at least in theory. So why not mental? My guess is that the representatives who have signed on to this bill are genuinely concerned about the welfare of troops and their families. Patrick Kennedy, D-R.I., is the bill's sponsor, and I have no reason to question his genuine commitment to mental health issues, both within and outside of the military. Still, I find myself chilled at the prospects. To explain my discomfort, I need to go briefly into the history of military training.
Since World War II, our military has sought and found any number of ways to override the values and belief systems recruits have absorbed from their families, schools, communities and religions. Using the principles of operant conditioning, the military has found ways to reprogram their human software, overriding those characteristics that are inconvenient in a military context, most particularly the inherent resistance human beings have to killing others of their own species. "Modern combat training conditions soldiers to act reflexively to stimuli," says Lt. Col. Peter Kilner, a professor of philosophy and ethics at West Point, "and this maximizes soldiers' lethality, but it does so by bypassing their moral autonomy. Soldiers are conditioned to act without considering the moral repercussions of their actions; they are enabled to kill without making the conscious decision to do so. If they are unable to justify to themselves the fact that they killed another human being, they will likely -- and understandably -- suffer enormous guilt. This guilt manifests itself as post-traumatic stress disorder (PTSD), and it has damaged the lives of thousands of men who performed their duty in combat."
By military standards, operant conditioning has been highly effective. It's enabled American soldiers to kill more often and more efficiently, and that ability continues to exact a terrible toll on those we have designated as the "enemy." But the toll on the troops themselves is also tragic. Even when troops struggle honorably with the difference between a protected person and a permissible target (and I believe that the vast majority do so struggle, though the distinction is one I find both ethically and humanely problematic) in war "shit happens." When soldiers are witness to overwhelming horror, or because of a reflexive accident, an illegitimate order, or because multiple deployments have thoroughly distorted their perceptions, or simply because they are in the wrong place at the wrong time -- those are the moments that will continue to haunt them, the memories they will not be able to forgive or forget, and the stuff of posttraumatic stress injuries.
And it's not just the inherent conscientious objector our military finds inconvenient: current U.S. military training also includes a component to desensitize male soldiers to the sounds of women being raped, so the enemy cannot use the cries of their fellow soldiers to leverage information. I think it not unreasonable to connect such desensitization techniques to the rates of domestic violence in the military, which are, according to the DoD, five times those in the civilian population. Is anyone really surprised that men who have been specifically trained to ignore the pain and fear of women have a difficult time coming home to their wives and families? And clearly they do. There were 2,374 reported cases of sexual assault in the military in 2005, a 40 percent increase over 2004. But that figure represents only reported cases, and, as Air Force Brig. Gen. K.C. McClain, commander of DoD's Joint Task Force for Sexual Assault Prevention and Response pointed out, "Studies indicate that only 5 percent of sexual assaults are reported."
I have thought a lot about the implications of "psychological Kevlar" -- what kind of "preventive and early-intervention measures, practices or procedures" might be developed that would "reduce the likelihood that personnel in combat will develop post-traumatic stress disorder." How would a soldier with a shield against moral response "five times stronger than steel" behave?
I cannot convince myself that what is really being promoted isn't a form of moral lobotomy.
I cannot imagine what aspects of selfhood will have to be excised or paralyzed so soldiers will no longer be troubled by what they, not to mention we, would otherwise consider morally repugnant. A soldier who has lost an arm can be welcomed home because he or she still shares fundamental societal values. But the soldier who sees her friend emulsified by a bomb, or who is ordered to run over children in the road rather than slow down the convoy, or who realizes too late that the woman was carrying a baby, not a bomb -- if that soldier's ability to feel terror and horror has been amputated, if he or she can no longer be appalled or haunted, something far more precious has been lost. I am afraid that the training or conditioning or drug that will be developed to protect soldiers from such injuries will leave an indifference to violence that will make them unrecognizable to themselves and to those who love them. They will be alienated and isolated, and finally unable to come home.
Posttraumatic stress injuries can devastate the lives of soldiers and their families. The suicides that are so often the result of such injuries make it clear that they can be every bit as lethal as bullets or bombs, and to date no cure has been found. Treatment and disability payments, both for injured troops and their families, are a huge budgetary concern that becomes ever more daunting as these wars drag on. The Psychological Kevlar Act perhaps holds out the promise of a prophylactic remedy, but it should come as no surprise that Big Pharma has been looking for a chemical intervention.
What they have come up with has already been dubbed "the mourning after pill." Propranalol, if taken immediately following a traumatic event, can subdue a victim's stress response and so soften his or her perception of the memory. That does not mean the memory has been erased, but proponents claim that the drug can render it emotionally toothless.
If your daughter were raped, the argument goes, wouldn't you want to spare her a traumatic memory that might well ruin her life? As the mother of a 23-year old daughter, I can certainly understand the appeal of that argument. And a drug that could prevent the terrible effects of traumatic injuries in soldiers? If I were the parent of a soldier suffering from such a life-altering injury, I can imagine being similarly persuaded.
Not surprisingly, the Army is already on board. Propranolol is a well-tolerated medication that has been used for years for other purposes.
And it is inexpensive.
But is it moral to weaken memories of horrendous acts a person has committed? Some would say that there is no difference between offering injured soldiers penicillin to prevent an infection and giving a drug that prevents them from suffering from a posttraumatic stress injury for the rest of their lives. Others, like Leon Kass, chairman of the President's Council on Bioethics, object to propranolol's use on the grounds that it medicates away one's conscience. "It's the morning-after pill for just about anything that produces regret, remorse, pain or guilt," he says. Barry Romo, a national coordinator for Vietnam Veterans Against the War, is even more blunt. "That's the devil pill," he says. "That's the monster pill, the anti-morality pill. That's the pill that can make men and women do anything and think they can get away with it. Even if it doesn't work, what's scary is that a young soldier could believe it will."
It doesn't take a neuroscientist to see the problem with both of these solutions. Though both hold the promise of relief from the effects of an injury that causes unspeakable pain, they do so at what appears to be great cost. Whatever research projects might be funded by the Psychological Kevlar Act and whatever use is made of propranolol, they will almost certainly involve a diminished range of feelings and memory, without which soldiers and veterans will be different. But in what ways?
I wish I could trust the leadership of our country to prioritize the lives and well-being of our citizens. I don't. The last six years have clearly shown the extent to which this administration is willing to go to use soldiers for its own ends, discarding them when they are damaged. Will efforts be made to fix what has been broken? Return what has been taken? Bring them home? Will citizens be enlightened about what we are condoning in our ignorance, dispassion or indifference? Or will these two solutions simply bring us closer to realizing the bullet-proof mind, devoid of the inconvenient vulnerability of decent human beings to atrocity and horror? And finally, these are all questions about the morality of proposals that are trying to prevent injuries without changing the social circumstances that bring them about, which sidestep the most fundamental moral dilemma: that of sending people to war in the first place.
Penny Coleman is the widow of a Vietnam veteran who took his own life after coming home. Her latest book, Flashback: Posttraumatic Stress Disorder, Suicide and the Lessons of War, was released on Memorial Day, 2006. Her blog is Flashback.
