Trauma of Killing - Cut for Space?
I emailed the author of the LA Times article to complain about this omission. David Zucchino kindly wrote back, telling me, "My original story did indeed have a short section on the effects of killing, but it was edited out for space. So it goes in the ever-shrinking world of original journalism." (Zucchino authorized me to quote his email). Editing out the key section of an article that would go a long way to explaining the phenomenon described in the rest of the article sounds more like a political decision than a journalistic one. In journalistic editing, you're supposed to cut the material that is least important to the story, not the most salient insights.
Killing is a Major Contributor to Post-Traumatic Stress - But the Military Ignores this Reality
Dan Baum, in his award-winning article "The Price of Valor" in the New Yorker (pdf), describes the work of Lt. Col. Grossman, who wrote the book On Killing, The Psychological Cost of Learning to Kill in War and Society:
A military “conspiracy of silence” surrounds the topic, Grossman argues, because the Army hasn’t confronted the issue of how psychologically fraught is the killing that its soldiers are ordered to do. In “On Killing,” Grossman writes, “If society prepares a soldier to overcome his resistance to killing and places him in an environment in which he will kill, then that society has an obligation to deal forthrightly, intelligently, and morally with the psychological event.”
Grossman has argued with the military and the VA for years against neglecting this topic. Grossman's website is called killology.com
Rachel MacNair analyzed data from Vietnam Veterans suffering from PTSD and coined the term PITS (Perpetration-Induced Traumatic Stress) in her book of the same name to explain her findings. On her website, she summarizes:
Even so, people were still thinking in terms of PTSD being caused entirely by being a victim of a trauma. The soldier was scared of being shot, the soldier was grieved over buddies being shot. The idea that the act of shooting could be traumatizing to the soldier rarely occurred to people. When it did, it was mainly the "atrocities" -- killing civilians or prisoners in gory ways -- that got the attention, not the ordinary killing of traditional combat.
More recently, some research has been done on this. From U.S. government data on its Vietnam veterans, those who say they killed have more severe PTSD than those who say they did not. It was not just that they were in more intense battle, because those who killed in light combat had heavier PTSD scores than those who did not kill even though in heavy combat. The form of PTSD shows those who say they killed had much more by way of intrusive imagery -- nightmares, flashbacks, unwanted thoughts that just will not go away -- and also much more by way of irritable outbursts. They also tended to have higher scores on measures of alienation, hypervigilance, and feelings of disintegration. But those who had not killed were more likely to have the pattern of concentration and memory problems. (For the statistical analysis MacNair conducted of the National Vietnam Veterans Readjustment Study, see pp. 174-181 of her book).
As Dan Baum documents in the article cited above, the VA has also been reluctant to address the issue of the trauma of killing directly, thus impeding the treatment of veterans. He interviewed Dan Knox, a Vietnam veteran, who told him:
In order to properly treat combat veterans, Knox said, the V.A. would have to change its mission. “They’d have to change from the ‘me’ to the ‘I.’ Not just ‘What happened to me?’ but ‘What did I do?’ But they can’t go there.” The V.A., Knox said, “is not there for the veteran. They’re there as a palliative for the non-veteran. To make people feel good, like they’re doing something for the vet.” Knox occasionally speaks to high-school students about war, but he is rarely invited back. The message he tries to leave behind is: “Killing people sucks.”
Hundreds of Thousands of Veterans Are at Risk
In "Returning Home from Iraq and Afghanistan: Preliminary Assessment of Readjustment Needs of Veterans, Service Members, and Their Families" the Institute of Medicine, under contract from the Department of Defense, attempted to conduct an overview of the needs of veterans returning from Iraq and Afghanistan. They report:
A recent RAND report (Tanielian and Jaycox, 2008) estimated that some combination of comorbid PTSD, major depression, and TBI is not uncommon in OEF and OIF veterans. The report noted that about one-third of service members who have been deployed have at least one of the three conditions, and about 5% manifest symptoms of all three (Tanielian and Jaycox, 2008). Furthermore, of 289,328 OEF and OIF veterans seen at VA health care facilities following deployment, 106,726 (36.9%) received mental health diagnoses and of those receiving any such diagnosis, 29% had two and 33% had 3 or more different mental health conditions (Seal et al., 2009). Of those veterans, 62,929 (21.8%) were diagnosed with PTSD and 50,432 (17.4%) with depression. (page 64)
In a RAND study of OEF and OIF veterans, 18.5% reported depression or PTSD (Tanielian and Jaycox, 2008), slightly higher than the prevalence found in its review of 22 other studies, which showed that 5–15% of veterans experienced PTSD symptoms when deployed to war zones. The study also suggested that prevalence of PTSD symptoms increases with time after deployment (the readjustment period) (Tanielian and Jaycox, 2008). (page 68)
Repeated deployments themselves have also contributed to mental health issues. About 27% of those who have been deployed three or four times have received diagnoses of depression, anxiety, or acute stress compared with 12% of those deployed once (MHAT-V, 2008). (page 29)
According to the report, over 1.9 million soldiers have been deployed to Iraq and Afghanistan since 2001. Even if we utilize the (very) low-end estimate reported above that 10% of these soldiers are suffering or will suffer from Post-Traumatic Stress, it is reasonable to expect that over 190,000 veterans of these wars will suffer from PTSD as a result of their war experiences, and it is quite possible that the real number of sufferers will be twice as high. As reported above, almost as many will suffer from depression and endure other mental health problems.
Yet despite the distinguished panel who worked on this official report for the Institute of Medicine, the word "kill" does not appear in the report, except to note that asking for mental health services is known in the services as a "stripe killer," i.e. a barrier to promotion.
I don't know how many of the 1.9 million soldiers deployed killed or believe they killed anyone (no one does, partially because the military doesn't ask in its psychological questionnaires upon leaving the military). But the real psychological needs of these soldiers and veterans are rendered invisible by reports such as the one above from the IOM, and from the LA Times story on drone operators.
Of course, when discussing these kinds of numbers, the pain of each and every veteran can get lost, so I'm including below a video for a song by a veteran who goes by the name of Washed Up Soulja. This is his "PTSD Song," and it speaks eloquently to the powerful role of guilt as he struggles to survive post-traumatic stress. Warning: this song describes suicidal ideation. If you or anyone you know is considering harming yourself, please get assistance and call the National Suicide Prevention Lifeline, 800-273-8255, and if you're a veteran, push 1, or text 838255. (According to the IOM study quoted above, "Veterans were twice as likely to die of suicide as nonveterans in the general population (Kaplan et al., 2007)." (page 70).
Veterans for Peace and Iraq Veterans Against the War are two organizations seeking to address these traumas. VFP organizes Healing the Wounds of War projects, for example, through which veterans help rebuild civilian lives in Vietnam and Iraq. IVAW co-sponsors the War is Trauma art project, has initiated Operation Recovery, a campaign to stop the re-deployment of soldiers already suffering from trauma, and has a list of additional resources for veterans.
When young people are being recruited, military recruiters straining to meet their quotas rarely talk with young people about the realities of war, including the danger of psychological harm arising from experiences in the military. In fact, as I've written about elsewhere, too many recruiters actually lie, including telling recruits that they won't get deployed. It is up to all of us to counter the falsely glamorized picture of military life and war too many young people still receive.