Questions . . .

I did get a few questions on a previous post that I’d like to answer. But first I want to thank those who responded. I'm glad when others like my blog . . . and even gladder when someone actually reads it. Oh the horror . . . of writing stuff that no one ever reads, or ever wants to.

I’ve been asked whether or not Post Traumatic Stress Disorder (PTSD) is more prevalent now, and did it even exist back in WWII? It’s hard to know, but PTSD may well be affecting more vets now. (Relatively speaking that is; about 13 million served in our armed forces during WWII and the actual number of vets with subsequent mental problems had to be far greater). Probably because they've been having to repeatedly go back for another tour of duty – each tour lasting about a year. Some have now had to serve 3 or 4 tours. And perhaps because of the highly asymmetrical nature of today’s combat experience, and the dichotomy between their lives and those of the rest of us.

(A cousin had about as extended a WWII combat experience as possible – landing in Africa with the first Allied invasion, fighting in Italy, and then in France and Germany. That's November 1942 to May 1945 – two and a half years. Other friends served in Vietnam – in combat battalions – but only for a year. Vietnam vets experienced many different Vietnam Wars. Most, thankfully, did not have to serve in line companies. We should be mindful of vast difference between those who serve at the point of the spear, and those who back them up.)

It may well be that we are also more prepared as a society to recognize PTSD as a problem. How many suffered from "acid reflex disease" 30 years ago? Or "restless leg syndrome." Give something a name and the number of cases dramatically increases.

We call it "PTSD." We often just give things initials. Initials sound less threatening than words, and it helps conflate what soldiers might be suffering from the occasional odd incident civilians experience. Not to diminish the possible impact of tragedy on the rest of us, but to me there's a world of difference between a school shooting or airplane crash, say, and a year of combat. We don't call what you go through after a parent or a child dies PTSD, as difficult as that might be. And even if we did, it wouldn’t be the same kind of experience.

PTSD has always existed. In WW1 they called it "shell shock." In WWII it was called "combat fatigue" (recall the slapping incident in the movie Patton). It had other names in Korea and Vietnam. And although it existed during the Civil War (we know from stories that survive) they didn't seem to have a special name for it. It seems that PTSD can also be separated into two components, a reaction during or immediately following combat and that brought on by memories afterward. In WWI and WWII attention was mostly focused on the combat reaction (but because the afterwards business was generally not recognized doesn't mean many didn't suffer). In Korea, Vietnam, and at present, the "while in combat" effect seems to be much diminished – probably because of the aforementioned asymmetric nature of our more recent wars.

It may be worse now because modern ways of destruction have become more impersonal and arbitrary, and more removed from what we consider “normal” existence. The complexities and cognitive dissidence of guerilla war – now called “asymmetric” or “counterinsurgency” warfare, or (initials again) “COIN” – may be particularly hard on a soldier’s mental state and memory. A particular horror may lie in the IEDs causing the majority of our causalities. A great contrast between civilian and military life probably doesn’t help. Nor may the reaction of returning vets to society at large. Saying "I appreciate your service" and understanding what many have gone through are two very different things.

I also think that the prospect of a very serious wound may cause a greater dread than that of death. It would to me -- I'd rather die than face life without arms or legs, or with half a brain (or at least I can say this from the confort of my computer). During the Civil War the ratio of dead to wounded was about 2.5 to one. In WWI and WWII, and Korea and Vietnam, it was about 3 to one -- three wounded for every man that died. (Medicine greatly improved, but modern weapons became much more deadly.)

Modern battlefield medicine has gotten so good that the present ratio is about 9 to 1. (And it's not only medicine but the nature of these two wars, where the might of the American military is so overwhelming that wounded can be rushed to medical care within very short times – it's both medical care and the speed of reaching medical care.) All this means, of course, that soldiers who would have died in earlier wars are now living – and the percentage of those with mind-boggling injuries is almost overwhelming. Think of it this way: if the expected ratio of wounded to dead once 3 to 1 is now 9 to 1, roughly 6 of those 9 probably have truly horrific injuries. This is the understated cost of these wars. Something the our military and politicians can be happy about since it diverts attention from the true price. When adding up the butcher’s bill we usually only count the dead. And only the American dead at that.

We don’t have to consider returning vets heroes. Most of them probably weren't – just people, people like us, who were trying to survive. But theirs was not quite an ordinary job either. Most of us go to work every day without the expectation of being killed or catastrophically wounded. Or seeing it happen to our friends and co-workers. Normally the military just sits around training and practicing. But now they are off to war – we sent ‘em off to war. It's us, voting citizens, who are ultimately responsible for that decision. The fact that we sent them and were, and remain, mostly unwilling to go ourselves adds to our responsibility.

So whatever help we can give them is OK by me. Medical care – good, timely, and un-begrudged medical care – not to mention educational opportunity, should be the least of it. We just spent a couple of trillion helping out Wall Street and the Banks – benefiting people I'd much rather see die in the gutter – so I don't care what it costs. Being adult, to me, means being willing to pay for your mistakes. And this war is not just Obama's mistake, it belongs to all of us.
Al