Page 2 of 2 DISPATCHES FROM AMERICA Nearly shell-shocked in Iraq
By Jeremiah Goulka
Efforts to avoid activities, places, or people that arouse recollections of the trauma.
Feeling of detachment or estrangement from others.
All are familiar.
In the past month, I had come to a sudden appreciation of the war veteran's reticence. Everyone wanted to ask me about my experiences in Iraq: What was it like there? Something kept me from talking. That bad morning, the pain and displacement of the war on everyone involved, the constant tension. I couldn't bring
myself to speak about it. It was too much to face, too much to explain. And I had seen next to nothing.
To avoid being rude, I had a pat response memorized: "I learned three things in Iraq. Military toys really are cool. Our troops are even more impressive than I had thought they were. And war is much, much worse than I had ever imagined."
For months, that's all I was willing to say.
And here's another thing from that manual I recognized: Persistent symptoms of increased arousal (not present before the trauma)... [such as an] exaggerated startle response.
Oh yeah. Definitely.
On my very first day out of Iraq, weirdly laced with survivor's guilt, I checked into a hotel in Amman, Jordan, and fell onto the bed, beyond exhausted. Down the hall a door slammed shut and I panicked. I thought it was gunfire.
On my way home, I stopped in London. With a friend, I visited the Imperial War Museum to catch an exhibit on war propaganda. Half an hour of looking at posters demonizing enemy peoples turned out to be enough for me, and so I wandered into a World War I exhibit, a diorama of one of that war's many murderous charges. To make the viewing experience more interesting, the designers had darkened the room and added an occasional flash of light and a soundtrack of kerblammy explosions.
I was unimpressed. It was just noise. Real explosions rattle your chest.
But when my buddy found me, he was horrified. I had gone pale. He should have known better, he insisted, than to let me come here so soon.
"Duration of the disturbance",says the manual, "is more than 1 month."
I look at my colleague's wall calendar. It's 29 days since I left Iraq and the nightmares have stopped, so I don't have PTSD. Or at least I'm not diagnosable. I feel a wash of relief.
Later, when the study he's working on is released, I learn that, as of 2007, some 300,000 veterans are already diagnosable with PTSD, and it's obvious that the wars in Iraq and Afghanistan aren't about to end any time soon. How many more, I wonder, will be suffering from PTSD before it's all over? How many will have some of the symptoms, but not enough to qualify for care? And what about civilians and contractors? What about Iraqis? Was anyone counting their incidence of sub-diagnosable symptoms?
Back in my office, I find the checklist online and stare at it. I berate myself. I should've sought care. No, I think, go easy. After all, I hadn't recognized the symptoms. And even if I had, in Iraq I had no unit for support, no routine, no institutional refuge. Military culture is clear: suck it up, get tough, be a man. And I had kept it all from my family. I wanted them to sleep at night.
Worst of all, I hadn't really seen anything of war. In that morning's attack, no one got hurt, at least not physically. None of us had been out shooting people or dodging bullets. Still, how could it not be a big deal? Just because so many things were far bigger deals didn't turn that morning into nothing.
People said they got used to it. I didn't believe them.
I thought I was done with the symptoms, but I was wrong. Some lingered for months, even years. The startle response, for instance. Doors, horns, any sudden noise and adrenaline would fire off, unwanted.
By the end of the following year, I was convinced it was finally over - until, on the Fourth of July 2009, my girlfriend (now wife) and I went to a party and stood on a balcony to watch the usual fireworks. At the first explosion, I felt the panic return, and I had to retreat inside.
For commiseration, I phoned a friend who had spent a year in Iraq with the State Department. When I had seen him in the Green Zone back in 2007, he had already aged frighteningly, his hair newly flecked with gray. He, too, was watching fireworks, and he, too, was experiencing the same sense of panic. Only he was on an open boat in the middle of a lake with nowhere to hide.
IV Real human costs
Last month was the 10th anniversary of our invasion of Iraq and already that war is fading out of memory, replaced by the latest rumblings of violence with North Korea and continued saber rattling over Syria and Iran. People who promote new wars have a tendency to give only a cursory nod to the costs of war itself. We hear the occasional mention of Iraqi civilian deaths (usually citing some preposterous lowball estimate as if it were established fact) or a nod to the way a whole bunch of soldiers got PTSD in Iraq and Afghanistan. But how often do we hear real consideration of the human costs of war, or even much in the way of the long-term financial and economic costs of treating thousands and thousands of people harmed by our wars?
Those costs are very real. The Veterans Administration reports that it has diagnosed 247,243 veterans who served in Iraq and Afghanistan with PTSD, or 30% of its patients from those two wars. That doesn't even touch on the huge number of veterans who haven't sought care yet, or are waiting for an evaluation, or suffer some symptoms but aren't quite diagnosable. Young veterans of the wars are unemployed at almost twice the rate of their peers. Suicides now outpace combat deaths as the Afghan War slows down.
An understaffed VA and the military are, for their part, at least trying to address the surge of PTSD among the troops, however ineptly. (The average wait time for the backlog of almost one million compensation claims is almost a year and appeals on the 46% of rejected claims take far longer). But what about civilian employees? As of 2007, the American Foreign Service Association estimated that approximately 40% of State Department diplomats who served in combat zones suffered some symptoms of PTSD.
And what about contractors? I know I wasn't alone, but there isn't much information out there. One small study of in-country contract employees at the major Pentagon contractor DynCorp found that 24% showed signs of PTSD or depression upon returning home. This is no small issue: there have been more contractors than troops in Afghanistan for much of that war.
And what about the people who actually live in the war-torn country, who don't get to escape the war and go back to a peaceful home at the end of a deployment? Civilians are the great victims of modern war. In Afghanistan, the Centers for Disease Control and Prevention found that 42% of Afghans suffered from PTSD and 68% showed signs of major depression - and that, mind you, was back in 2002. The country's health minister estimated in 2010 that 60% of Afghans suffer from mental-health problems. Beyond prayer, that country has close to zero services to help its people. Washington's "nation-builders" tend to forget about basic things like this.
These are not just short-term human costs that will fade away as my PTSD symptoms did. I was a lucky one, briefly in theater and mostly sheltered. For some, the trauma lingers for decades. Today, an American veteran of any war takes his or her own life every 65 minutes. Veterans account for 1% of the overall population but 22.2% of the nation's suicides, and the majority of those happen after age 50. In other words, as with the debt we used to fund the wars, we will pay - and shirk - these costs for many years to come.
It doesn't take much to develop PTSD symptoms. The folks clamoring for new wars should remember that. Those defending the Obama administration's drone-missile targeted assassination campaigns should keep that in mind, too. Admittedly, robots don't develop the disorder, but drone pilots hundreds or thousands of miles away are at risk, and civilians who live where drones regularly hover and strike are already suffering from PTSD. For me, it only took a few explosions.
Civilian officials who beat their chests about making "hard choices" and "tough decisions" should listen up. They have no idea how many eggs they are breaking to make their proverbial omelets. Would it matter if they did? I suspect that it would, if they recognized that people have soft shells, if they considered how war harms most everyone it touches, if they spent even a moment laying their cold assumptions aside and empathizing with war's victims - their victims - both foreign and domestic.
I have a mental image of them relaxing in their homes, watching a movie. On the flat screen, scenes of war flash by, inspiring them, giving them ideas. I used to love war movies, too. Almost six years later, I still can't watch them. The old panic sets in and I have to walk away.
Jeremiah Goulka, a TomDispatch regular and former RAND Corporation analyst, writes about American politics and culture, focusing on security, race, and the Republican Party. You can follow him on Twitter @jeremiahgoulka or contact him through his website jeremiahgoulka.com.
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