March was the first month without a U.S. casualty in Iraq or Afghanistan in over a decade. But the cost of war is still being borne on the home front.
On April 2, a junior enlisted soldier, Specialist Ivan Lopez, went on a shooting spree at the U.S. Army’s Fort Hood, next to the city of Killeen in central Texas. He killed three people and injured 16 others before taking his own life. Some of the first things we learned about Lopez were that he had apparently served for several months in Iraq in 2011, that his violence may have been motivated by a dispute with some fellow soldiers, that he was being treated for depression and anxiety (including with medication), and that he had legally purchased his weapon, a .45 caliber Smith and Wesson semiautomatic handgun, but violated Army rules when he brought it onto the post without registering it.
These scant details — the military status, the deployment, the diagnosis — seem to tell a familiar story: a soldier gone to war returns home mentally unhinged by what he has seen and done and unleashes that violence like a contagion on his family, his neighbors, his homeland.
This story is dangerous, though. Not because it gets any of the substance of this most recent tragic violence wrong, necessarily. Rather, its focus on isolated and dramatic violence distracts from the subtle, chronic, and widespread effects of war on the people who fight it. It draws crude links between experiences of war, mental anguish, and violence that stigmatize mental illness in general and soldiers in particular.
At best, it risks overlooking the routine, ongoing experiences of the community most directly affected by Wednesday’s events. At worst, it callously misrepresents the members of that same community and lets civilians off the hook for the effects of wars waged in our name.
‘My Other Car Is a Tank’
Americans are accustomed to thinking of war as a literally foreign entity, something that takes place on a distant battlefield on the other side of the world. Decades of an all-volunteer military have enabled this fantasy. The wars in Iraq and Afghanistan represent a major commitment of national purpose and resources, but less than one percent of the U.S. population has served in them. For those who have, though — people at Fort Hood and places like it — war isn’t confined to one time and place. Instead it’s ongoing and ubiquitous, its effects finding their way into the most mundane and intimate aspects of life. In the process war becomes “normal,” but not necessarily any easier to live with.
These slogans emphasize a mix of fierce purpose, wry self-awareness, and mild unease toward the broader civilian public.I spent 12 months at and around Fort Hood in 2007 and 2008, living near the base and learning about the everyday lives of soldiers and those close to them in the midst of ongoing war. Fort Hood is one of the biggest military bases in the world. Its population of around 50,000 soldiers and tens of thousands more military family members, civilian workers and contractors, and retiree veterans demographically and economically dominates the city of Killeen and the other towns neighboring the post.
Motels and chain restaurants run off the constant traffic of a military kept busy by war. Used car dealers, pawnshops, and payday lenders thrive amidst a captive market of young soldiers. The bumper stickers you see on cars sitting in traffic announce that “Half My Heart Is In Iraq” or that “My Other Car Is A Tank”; they declare “Busting My Ass, Defending Yours” or indicate with a wordless configuration of blue stars on a white background that the driver’s family members are deployed. These slogans emphasize the mix of fierce purpose, wry self-awareness, and mild unease toward the broader civilian public that many people I met there shared. Bars, dry cleaners, and big box stores are all adorned with yellow ribbons, “Support the Troops” banners, and the insignia of the 1st Cavalry Division, 3rd Armored Cavalry Regiment, 13th Sustainment Command, and the other units that call the base home.
The base itself is massive, spread out across 150,000 acres mostly devoted to ranges and training areas. Its main built-up area features classically bland, modernist government architecture, like the campus of a giant, sleepy state university, but decorated here and there with decommissioned war machines, old tanks, and helicopters. But just a few blocks away stretches its famous “ten miles of tanks” — the world’s biggest concentration of armored military vehicles (when they are not dispersed across the Middle East) in the form of a nearly 10-miles-long row of chain-link pens full of Abrams tanks, Bradley and Stryker fighting vehicles, and Humvees. They are all painted a uniform desert tan, and look just as at home parked on arid central Texas asphalt and limestone as they do in the deserts of Iraq.
There are other uncanny reminders of the nearness of violence too: On the way into town from the south, next to a billboard advertising a local lingerie shop changes with the seasons, the firearms store Guns Galore invites you to “CHOOSE FROM 1,200 GUNS ON DISPLAY” (news reports say both Lopez and Nidal Hasan, who killed 13 people and injured more than 30 at Fort Hood in a 2009 shooting spree, bought their guns there). Just inside the exit lanes of each gate of the post, giant signs enjoin drivers, “YOU SURVIVED THE WAR, NOW SURVIVE THE ROAD—DRIVE CAREFULLY.” Big red digital numerals indicate “[X] DAYS SINCE THE LAST TRAFFIC FATALITY” beside a blinking light that goes from red to amber to green as the number of safe days rises. I rarely saw the number of days go higher than 10 when I was there in ’07 and ’08 (though when I visited most recently in 2010, a few months after the first Fort Hood mass shooting, it was well into the green).
Jumping at Loud Noises
Fort Hood is the single largest point of departure and return for US forces deployed overseas, a central node in the U.S. wars in Iraq and Afghanistan. At the time of my research, Fort Hood was home to the 1st Cav and Fourth Infantry Divisions — brigades from each saw especially heavy combat as part of the 2006 Iraq War surge — as well as numerous smaller expeditionary units. The tremendous personnel demands of the wars necessitated a grueling rotational schedule that most of these units followed: 12-month tours frequently extended to 15 months and separated by 12 months or less of “dwell time” back in Texas.
She didn’t want to know what had instilled in her husband that lingering, disruptive sensitivity to signs of violence and danger.All this meant that going off to war was often less a one-time event than a repeated shuttling between home and Iraq, giving rise to a sense of both inevitability and uncertainty that loomed over the entire community. I remember my surprise when a friend who was waiting impatiently to learn when her husband, a career infantry noncommissioned officer (NCO), would return from his third deployment casually mentioned that he already expected orders to deploy again a year later. Decisions about policy and tactics may seem like abstract matters, but in such tiny but profound ways as this they show up in people’s everyday lives: The nation going to war means that some one, some person goes. Staying at war means they go again, and again.
I asked a friend I’ll call Jessica if her husband, I’ll call him Cal, a logistics NCO, seemed changed by his time in Iraq (I use pseudonyms to protect the privacy of the people who spoke with me). Cal had just finished a 15-month tour. When Jessica and I first met in 2007, his tour had just been extended, meaning he’d be home by Christmas instead of by Labor Day. She said she could tell that certain things bothered him more, that certain things stressed him out, even though he hid it well and didn’t talk about it. He could be pretty quiet anyway, so she didn’t worry about it much. She would sometimes notice how uncomfortable he seemed around crowds or loud noises — tense, jumpy, and extra quiet. She would ask him if a loud noise had bothered him, he would say yes, and she would leave it at that. I asked her what it made her think. She said she just didn’t want to think about what he might be being reminded of. She didn’t want to know what had instilled in him that lingering, disruptive sensitivity to signs of violence and danger.
People had different ways of responding to such things, though. Jessica told me about a close friend, also a spouse of a frequently deployed NCO. Every time this woman returned home from work or running errands when her husband was gone, as she rounded the carefully planned curve of her street in an Army housing subdivision, she would picture in her mind a car with government plates parked at her front door, and a couple of soldiers in shiny shoes and class A dress uniforms there to notify her that he had been killed. Every time. “Why would you think that?” Jessica wondered aloud to me. “Why would you do that to yourself?”
Army spouses like Jessica and her friend say that “they also serve” and invoke their status as “the silent ranks”: there is a state of war that happens in the sudden sense that your easygoing, imperturbable husband is silently crawling out of his skin as he stands next to you, or that violent death may reach you through the thing you value most and find you out of nowhere on the way home from the grocery store.
They and others told me stories of the terror that can come from the sound of a phone ringing or a knock at the door when a loved one is deployed, the discipline it takes to avoid watching or reading news about the war, the force of will required to ignore gossip and reign in rumor. Jessica kept herself on an even keel by assiduously not giving in to anxious fantasies, not thinking the worst, or indeed trying not to think about the whole thing at all — no simple feat. “I’d rather not go there,” she said. But there is nevertheless an inescapable “there” to go to: the brute fact of loved ones being sent into harm’s way over and over again, of the pain of their absence, of the changed and uncertain condition in which they return home.
‘To Know If You’re Crazy’
The Army has a massive medical system meant to treat the physical injuries that such circumstances produce as well as their mental impacts. Anywhere from 15 to 50 percent of U.S. service members who served in Iraq and Afghanistan are estimated to suffer from post-traumatic stress disorder (PTSD), and even more from related conditions like depression and anxiety. But what exactly becomes of veterans with these conditions is another question, especially given the tremendous overburdening of the Army medical system and the pressure it is under to keep soldiers healthy, able-bodied, and ready to deploy. The Army’s own medical command estimated that a soldier with PTSD could cost the military $1.5 million over the course of a lifetime. There are numerous examples over the last 10 years of individual and concerted efforts by military and Veterans Health Administration personnel to minimize or deny PTSD diagnoses or to rediagnose soldiers with other, non-service-connected afflictions for which the military will not bear as much financial responsibility.
At worst, medicalizing the routine work of war provides yet another way for civilians to fear and pity soldiers without actually understanding them any better.The medical system that cares for ill and injured soldiers also places them under careful scrutiny, trying to distinguish if their pains and complaints are real and if they are worthy of care and compensation. So soldiers themselves often have an ambivalent relationship to a PTSD diagnosis — not least because they know how readily the Army can bend it to suit its purposes, but also because the diagnosis may not accord terribly well with how soldiers think about their war experiences.
Since 2004, all soldiers have been screened for PTSD and other mental illnesses when they return from deployment with questions about whether they participated in combat, were shot at, saw friends get injured, felt afraid that they might be hurt or killed, experienced intrusive memories or dreams, and so on. But soldiers know that answering affirmatively to any of these questions can, at the very least, keep them tied up with doctors and counselors when all they want to do is go on leave and see their families. Even worse, it could stick with them in their medical records, rendering them (officially or unofficially — it happens both ways) unsuitable for their jobs, ineligible for a security clearance, or unfit for promotion.
Aside from these structural disincentives, there is a more basic contradiction at work in these screening questions. The point of the questions, an infantry NCO I’ll call Ernie, who had led countless combat patrols in eastern Iraq, told me, is “to know if you’re crazy,” but the things they are asking after — seeing dead bodies, feeling afraid — were from his perspective simply normal parts of going to war. It is only on contact with the civilian world that the experience of soldiering is made to seem crazy. Ernie told me stories of firefights, near-miss IED strikes, and the gruesome aftermaths of car and suicide bombers — all the things that civilians know are part of war, and may even be comfortable consuming as entertainment, but which we are rarely comfortable hearing about in real life.
Doing and seeing these things and leading his fellow soldiers through them was all part of Ernie’s job, though. “Everything you go through, you go through with the same people you see day in and day out,” Ernie said. “So when you’re talking about it, it’s perfectly normal because you were doing the same shit I was doing, so you’re talking about it like it’s nothing.” In this catch-22, Ernie seems to be saying, it is not war but the experience of diagnosis that makes you “crazy,” both fitting you with the label and upending your own sense of what’s normal.
This process — by which a normal, routine experience comes to be understood as a sign of medical or psychiatric pathology — is what anthropologists refer to as medicalization. Medicalization can be a boon to people afflicted with a previously unnamed or unrecognized condition, giving them access to care and legitimating their suffering. This has unquestionably been the case with PTSD, which names a very real set of symptoms that often go unrecognized and provides at least some hope of care and treatment.
But medicalization can simultaneously have stigmatizing or pathologizing effects of its own, especially when it comes to mental illness diagnoses: Subjectively normal feelings become signs of illness, dysfunction, madness. Reducing soldiers’ experiences to nothing more than individual psychological phenomena in this way makes it all the easier to ignore how our ways of waging war make their suffering inevitable, not exceptional. At worst, medicalizing the routine work of war provides yet another way for civilians to fear and pity soldiers without actually understanding them any better.
Empathizing With a Ticking Bomb
And so we are left with the “war makes you crazy” story that is being offered as an explanation for this week’s shooting. In the understandable search for answers, questions about Lopez’s mental illness were among the first to be asked. The Army was quick to provide answers and the media quick to pass them on. But to what end? The New Yorks Times’s online headlines for the story on Thursday, for instance, announced that Lopez suffered from depression and was being treated by a psychiatrist. We also learned that he was “being assessed” for PTSD and had been prescribed medication, though the only drug named was the sleep aid Ambien. It was also revealed that Lopez had served in Iraq.
Seeing mental illness as a potential source of violence magnifies the stigma already attached to it.The implication was clear that deployment, military status, and above all mental illness and psychopharmaceuticals could somehow explain his murderous actions. Of course it is tempting to turn to mental illness now, as has also been the case with other incidences of both military violence (like Robert Bales’ massacre of Afghan civilians) and domestic mass shooting in the U.S. (Newtown, Appleton, Aurora) over the past several years. Diagnosing Lopez and other mass shooters seems to provide a comfortingly rational scientific explanation for a terrifyingly irrational act. But while particular details of some mass shootings may seem to justify such assumptions, on the whole the connections between mental illness and mass violence are slim to nonexistent.
This is the case with conditions more typically (though wrongly) associated with violence in popular imagination, like schizophrenia, but just as much with the depression, anxiety, and PTSD mentioned in connection with Lopez. People with severe mental illnesses are in fact far more likely to be the victims of violent crime, and those with severe depression potentially a far greater risk to themselves than to those around them. Psychiatrist Jeffrey Swanson has pointed out that mass shootings are incredibly rare events, and that focusing on their links to mental illness entails creating “common evidence” out of “uncommon things.” In the case of Fort Hood, we might also add that the very “common things” that are the source of regular suffering there disappear from view: the impact of long wars, long deployments, and insufficient resources only enter public perception at these moments of uncommon violence.
Even worse than this misunderstanding, however, is the fact that perpetually referring to mental illness as a potential source of violence magnifies the stigma already attached to it. In a military setting like Fort Hood, where many soldiers and those close to them already struggle to find care, sympathy, and assistance for their mental suffering — perhaps even more so in the wake of recent events — the damaging impact of such stigma is only made worse. The notion of stressed-out veterans as over-medicated “ticking bombs” primed to “go postal” — exactly as Lopez is alleged to have done — is often deployed with good intentions to emphasize the real and urgent need for better military health care, as will doubtless happen now, too.
But this rhetoric itself only serves to reproduce the stereotype of what my friend Stan, an Iraq War vet and veterans advocate, refers to as the “crazy vet” stereotype, according to which those touched by war are damaged, vulnerable victims — and also prone to deadly violence. Even as the stereotype pathologizes all soldiers, it focuses attention on a very narrow range of extreme behaviors, actually making it harder to see the broad and far-subtler range of burdens that war inevitably lays on those whose job it is to produce it.
Regardless of one’s perspective on this war, or war in general, the “crazy vet” can both confirm our worst fears about war and justify our outrage about it without prompting us to face these more everyday violences. This haze of pity, anxiety, and fear that swirls around many images of service members is fueled by popular culture, from Vietnam War films to breathless news reports like the ones we are reading this week. But a “ticking bomb” can never be the object of our empathy our understanding — it only tells us to run the other way.
The Stories We Tell About War
One of the things I found in my research is that the stories we tell about war tend to confirm what we think we already know. They often do this at the expense of the people who actually make war, letting us pretend that the violence of war is an exception rather than its essence. Allowing spectacular mass violence like this week’s shooting to be the thing that prompts public concern about the constant stresses faced by soldiers, vets, their families — and anyone who lives with ongoing war — does exactly this.
If we want people afflicted with mental illnesses to be well cared for, we need to talk about their suffering in ways that do not marginalize or pathologize it. And if we truly care about soldiers, veterans, and those close to them, we need to put aside the stereotypes that pop culture, military publicity, media saturation, and “common sense” offer us.
We need to listen to the “normal” experiences of making war — not least so that we may better hear the stories of those in pain in the wake of this most recent violence.
Kenneth T. MacLeish is an assistant professor at Vanderbilt University’s Center for Medicine, Health and Society. He is the author of Making War at Fort Hood: Life and Uncertainty in a Military Community (Princeton University Press, 2013), from which this essay is adapted.