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“We are often more dangerous to ourselves than the enemy”

18 August 2010

Summary:  This is another post in the long series about our military — an army near the breaking point.  Links at the end go to the reference page, which has links to news articles, studies, and more information.  We can all help a little with this.  Thank a vet.  Support the Blue Star Mothers and USO.  Make sure your representatives understand the importance of these issues.

One of the oddities of our wars is that so many (not all) of the war’s advocates ignore the cost paid by our troops.  Look though pro-war websites.  Posts about the threat of Islam.  Posts about COIN.  Our latest plans.  Genius generals.  New ops.  Perfidy and valor of our local allies.  Seldom do they mention the rising rates of illness among soldiers and vets.  Such as spousal abuse, divorce, drugs addiction, PSTD, suicide.  These are the costs of a long war, paid only by those fighting it — and their friends and relatives.

The Army has published a new report (here), probably of greater long-term significance than any of the many reports extolling our latest re-working of post-WWII counter-insurgency theory.  This post’s title is a quote from that report.  Below are excerpts; here as an introduction is an excerpt from an NPR interview on 17 June with Army officers grappling with this problem.

JAMIE TARABAY (NPR): Every month, Army leaders meet at the Pentagon to review the suicide numbers. There were 197 Army suicides in 2008, according to the Army’s own figures. It includes active and non-active duty soldiers. That was the first time the Army rate exceeded the national average suicide rate.  Last year, that number was 245. This year, through May, it’s already 163. The Army has instituted all manner of programs to counsel and train soldiers. Stephen Colley had himself undergone suicide-prevention training. Yet the suicides continue.

There’s no main cause. For every PTSD-suffering soldier who takes his own life, there’s a young recruit who’s never been deployed, moves to a new unit, and can’t handle it. There’s no simple answer … but there are warning signs, and hindsight reveals so much. Throughout that two-hour Army review meeting, detail upon detail present portraits of troubled men. One soldier was on at least 12 different medications; another was in relationship counseling and had severe alcoholism issues. One soldier was diagnosed with both depression and bipolar disorder, was medicated, and then deployed to Iraq.  …

GENERAL PETER CHIARELLI: I think that you’d have to have your head buried in the sand to not think that a lot of them come out of eight and a half years of war.

TARABAY: Another theory? Soldiers in transition – moving from a combat zone to back home, for example – are at risk. Many cases appear to involve both alcohol and overdose of medication. And for the most part, they speak to the Army’s inability to deal with mental-health issues.

COLONEL CHRIS PHILBRICK (Suicide Prevention Task Force, U.S. Army): It doesn’t exist.Absolutely. Guilty as charged.  I’m certain that there are soldiers that we did not properly treat in the long period of time since we started combat operations, that if we had done a better job and had been able to recognize that – wouldn’t be where they’re at today: in Walter Reed, and on a street corner somewhere because they haven’t been taken care of. … What did we do? What did the Army normally do when there was soldiers with problems we didn’t understand? Thank you for your service; go find someplace else to work. We’re making those changes.

TARABAY: Those changes include a five-year, $60 million study with the National Institute of Mental Health. There are online programs designed to test emotional, mental and social fitness. The Army says screening methods are as strict as they could ever be.  Military psychiatrist Stephen Xenakis, a retired brigadier general, says there’s more that needs to be done.

Dr. STEPHEN XENAKIS (Psychiatrist): There’s a whole culture change that would really need to occur at the bases here in the United States. And it may not be for two or three years until we really recognize that.


From General Chiarelli’s introduction in the report

In Fiscal Year (FY) 2009 we had 160 active duty suicide deaths, with 239 across the total Army (including Reserve Component). Additionally, there were 146 active duty deaths related to high risk behavior including 74 drug overdoses. This is tragic! Perhaps even more worrying is the fact we had 1,713 known attempted suicides in the same period. The difference between these suicide attempts and another Soldier death often was measured only by the timeliness of life-saving leader/buddy and medical interventions. Some form of high risk behavior (self-harm, illicit drug use, binge drinking, criminal activity, etc.) was a factor in most of these deaths.

When we examined the circumstances behind these deaths, we discovered a direct link to increased life stressors and increased risk behavior. For some, the rigors of service, repeated deployments, injuries and separations from Family resulted in a sense of isolation, hopelessness and life fatigue. For others, a permissive unit environment, promoted by an out of balance Army with a BOG:Dwell of less than 1:2, failed to hold Soldiers accountable for their actions and allowed for risk-taking behavior – sometimes with fatal consequences.

… We all recognize the effects of working under an unprecedented operational tempo for almost a decade. The challenges of serving in today’s Army have tried our leaders, tested our Soldiers and exhausted our Families. On one hand we have successfully transformed the Army, simultaneously prosecuted contingency operations in two theaters, implemented BRAC, mobilized the Reserve Component in historic numbers and responded to natural disasters.

On the other hand, we now must face the unintended consequences of leading an expeditionary Army that included involuntary enlistment extensions, accelerated promotions, extended deployment rotations, reduced dwell time and potentially diverted focus from leading and caring for Soldiers in the post, camp and station environment. While most have remained resilient through these challenges, others have been pushed to their breaking point. It is up to us to recognize the effects of stress in our ranks. I call on each of you to thoroughly study this report and work together with me to promote health, reduce risk-taking behavior and impose good order and discipline in the force.

Excerpts from this 350 page report

In Fiscal Year (FY) 2009, 160 active duty Soldiers took their lives, making suicide the third leading cause of death among the Army population. If we include accidental death, which frequently is the result of high risk behavior (drinking and driving, drug overdose, etc.), we find that less young men and women die in combat than die by their own actions. Simply stated, we are often more dangerous to ourselves than the enemy.  (p11)

Post Traumatic Stress (PTS)

PTS is the normal reaction to extraordinary circumstances. Post Traumatic Stress Disorder (PTSD) is the medical condition that develops when PTS adversely impacts normal activities of one’s daily life. PTSD decreases marital satisfaction, exacerbates depression and may be related to other behavioral health problems and high risk behavior.

PTSD requires medical intervention. Research indicates that when untreated, PTSD greatly increases the risk of suicidal behavior.   PTSD diagnoses have been steadily increasing in the Army over the past 7 years. For these reasons, the Army’s objective is to prevent PTS from becoming PTSD. The 2008 Department of Defense Survey of Health Related Behaviors Among Active Duty Military Personnel indicated that an estimated 13% of the Army met the screening criteria for PTSD. According to the Office of the Surgeon General (OTSG), the number of newly diagnosed cases of PTSD for Soldiers with a deployment history has increased from 2,931 in 2004 to 10,137 in 2008. Since 71% of the Army has deployed at least one time, the potential for PTSD is significant.  (p26)

Drug and alcohol abuse

{This} is a significant health problem in the Army. The Millennium Cohort Study found that Army National Guard and Reserve Soldiers who deployed were significantly more likely to abuse alcohol than their non-deployed peers. … Almost 30% of the Army’s suicide deaths from 2003 to 2009, and over 45% of the non-fatal suicide behavior from 2005 to 2009, involved the use of drugs or alcohol. (p27)

Medication 

The impact of increased use of antidepressant, psychiatric and narcotic pain management medications has not been comprehensively studied in a military population. The percentage of Soldiers who have been prescribed antidepressants within 90 days of deploying or during a deployment has increased from 1.1% in 2005 to 5% in 2008.  (p28)

The Current Reality of the High Risk Population 

Due to a change in operational requirements since the start of OEF/OIF, a subculture has been created that engages in high risk behavior. This population is every leader’s concern. Tolerating high risk behavior for convenience and passing on the problem to the next commander is unacceptable. With the current operational tempo of the Army, it is essential that leaders step up and take responsibility for their Soldiers. Reporting is critical to maintaining situational awareness. Without reporting, it is difficult to assess newly assigned Soldiers among a transient population that exceeds 700,000 on active duty. (p68)

Sexual Offenses

One of the more disturbing trends from FY 2001 – FY 2009 is a clear and steady rise in the number of sexual offenses, which have essentially tripled since FY 2003. This represents a specific increase from 265 cases in FY 2003 to a substantial 1,015 in FY 2009. In addition, there were 293 restricted reports in FY 2009 that are not reflected in these data. While these increases may be attributed to overall Army efforts to increase awareness, reporting and intervention, the steady rise is still cause for concern. (p78)

Other posts about an army near the breaking point

  1. The Army is losing good people. That is only a symptom of a more serious problem., 18 January 2008
  2. News: “U.S. Army Isn’t Broken After All, Military Experts Say”, 20 March 2008
  3. An effective way to support our Troops: help the Blue Star Mothers of America, 8 June 2008
  4. Time: “America’s Medicated Army”, 12 June 2008
  5. “VA testing drugs on war veterans” – The Washington Times and ABC News, 18 June 2008
  6. Support the USO – more effective than a bumper sticker, 5 July 2008 — Another way to support our troops, more effective than a bumper sticker.
  7. Is post-traumatic stress disorder more common now than in past wars?, 17 July 2008
  8. “VA testing drugs on war veterans” – The Washington Times and ABC News, 18 June 2008
  9. Is post-traumatic stress disorder more common now than in past wars?, 17 July 2008
  10. Suicides skyrocket among US soldiers, 26 March 2009
  11. Another important story about our army nearing the breaking point, 28 July 2009
  12. “For many soldiers, mental trauma lingers at home”, 13 June 2010
  13. The wounded warrior debate – how to treat casualties of our wars, 19 June 2010

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