TIME

This Doctor Volunteers to Help Suffering Soldiers

The trauma war brings can become part of veterans, their families and communities

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Though her practice specializes in treating children, clinical psychologist Barbara Van Dahlen’s greatest influence may be getting fellow doctors to give their time and expertise to help soldiers returning from war.

Concerned about the mental health consequences of the wars in Afghanistan and Iraq, she founded in 2005 Give an Hour, a national network of mental-health professionals like herself who provide free services for American veterans, their loved ones and their communities.

TIME honored Dr. Van Dahlen as one of the 100 Most Influential People in the World in 2012. Former Chairman of the Joint Chiefs of Staff Admiral Mike Mullen said of Dahlen: “Barbara has tenaciously attacked the epidemic of post-traumatic stress disorder, helping break through the stigma that prevents many from seeking help. She has also created an opportunity for many who have not served in uniform to make a difference.”

TIME Military

‘Busting My Ass, Defending Yours’: Everyday, the Cost of War at Fort Hood

U.S. flags are pictured in front of the Central Christian Church in Killeen, Texas
U.S. flags are pictured in front of the Central Christian Church in Killeen, Texas, April 3, 2014. Erich Schlegel—Reuters

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.

Gate Ticker
Dana DeLoca/Courtesy of Kenneth T. MacLeish

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.

TIME Veterans

Afghan Vet Dies of Overdose in VA Substance-Abuse Center

Agency Delays $765 Million in Spending for U.S. Veterans' Care
Andrew Harrer—Bloomberg/Getty Images

A new report by the Department of Veterans Affairs’ inspector general on the unexpected death of an Afghanistan war vet at a government rehab center suggests that programs to help former service members aren't working well enough

The United States has gone out of its way to support the 1% of Americans who have gone to fight in Afghanistan and Iraq following the 9/11 attacks. But, frankly, a lot of the cheers are simply rhetoric making cracks through which returning troops fall all too often.

Sure, the Department of Veterans Affairs budget has more than doubled, rising from $73 billion in 2006 to a proposed $164 billion next year. But all that spending hasn’t done enough to salve the wars’ unseen wounds, as a nationwide survey of post-9/11 U.S. veterans detailed in Sunday’s Washington Post makes clear.

That becomes even more apparent when you stumble across a report like Unexpected Patient Death in a Substance Abuse Residential Rehabilitation Treatment Program, issued Friday by the Department of Veterans Affairs’ inspector general.

An Afghanistan war veteran went to the VA to get help fighting his struggles with drugs and alcohol. That’s why he was in a 24-bed section of Miami, Florida’s VA hospital dedicated to treating addicts.

The Substance Abuse Residential Rehabilitation Treatment Program [SARRTP] facility has a single entrance. It has a camera there to monitor everyone’s coming and going. And while patients can leave the center, they’re searched when they get back to ensure they’re not bringing in any contraband.

The details in the report are too blurry to identify the vet involved. But the few specifics are clear enough: He spent several months in early 2013 in the SARRTP unit, after he had bounced from the VA’s Psychosocial Residential Rehabilitation Treatment Program to the VA’s PTSD Residential Rehabilitation Treatment Program then to the VA’s acute inpatient mental health unit.

The VA’s goal: get him “into PTSD residential treatment once he improves coping skills, mood stability, and functioning.” He never made it. Perhaps his craving to get high would have doomed him in any event. But the VA’s inaction, as detailed in the following excerpts from the IG’s report, guaranteed his failure:

The patient was an Operation Enduring Freedom (Afghanistan) combat veteran in his twenties, who was diagnosed with polysubstance dependence, PTSD, sleep apnea, mood disorder and traumatic brain injury.

We found that camera surveillance was not present as required. VHA [the VA's Veterans Health Administration] policy requires that RRTP [Residential Rehabilitation Treatment Program] unit entrance doors be monitored by Closed Circuit Television (CCTV). Additionally, CCTV with recording capability must be used to monitor RRTP public areas such as hallways. Local policy mandates that closed circuit video cameras be focused on each MHRRTP [Mental Health Residential Rehabilitation Treatment Program] entrance and hallway and viewed and recorded in Police Service. The recordings are to be kept for at least 2 weeks.

Upon admission to the SARRTP, UDS [urine drug screen] results were negative for illicit substances.

We met with Police Service staff to review the surveillance conducted on the SARRTP unit. A Police Service employee was unable to correctly identify which screen was showing feed from the SARRTP. We were subsequently told by the Chief of Police that the camera which monitors the main hallway on the SARRTP unit had been inoperable since at least December 2012.

Two days later, UDS results were positive for cocaine.

The Police Service employee who was monitoring the CCTV feeds at the time of our visit was unaware the SARRTP camera was inoperable. Similarly, key SARRTP staff were unaware that the camera was inoperable, including the Nurse Manager.

The SARRTP psychiatrist addressed the results with the patient.

VA Handbook 0730 requires that when surveillance television systems are in use, performance checks be conducted daily and substitute coverage be provided during maintenance or breakdown periods. We found no evidence that the facility provided substitute coverage or other means of securing the unit during camera failure.

The patient admitted that he used cocaine after admission to the SARRTP.

We found that access to the SARRTP was not monitored or controlled appropriately.

He had left the unit to pick up money that had been wired to him and used the funds to purchase cocaine.

Access to the SARRTP unit is controlled by a keyless entry badge-activated system. Individuals without a badge ring a buzzer and request entrance. Local policy states that only authorized patients, staff, and visitors may be allowed access to the unit.

He was placed on pass restriction (no overnight or weekend passes) for 3 weeks.

At the time of our inspection, we visited the SARRTP unit twice unannounced. SARRTP staff did not request identification or verify the purpose of the visit on either occasion. During a day shift visit, an OIG [Office of the Inspector General] inspector was “buzzed in” without displaying a badge or credentials or explaining the reason for the visit; the inspector walked through the unit and after several minutes, approached unit staff to identify himself.

However, the veteran was permitted to leave the unit for up to 2 hours without a pass.

During the evening shift, three inspectors, dressed in casual clothes and not wearing badges, followed two patients into the unit without SARRTP staff’s knowledge of an unauthorized entry.

UDS results from the next month were again positive for cocaine.

During staff interviews, we learned that SARRTP staff on evening, night, and weekend tours routinely sit in a back room that does not have visibility of most of the main hallway of the unit, nor the entrance and exit doors. During our evening site visit, we found the staff in this back room. Had the staff been present at the nurses’ station, they would have been able to observe and monitor the main hallway and entrance and exit doors.

The SARRTP psychologist addressed this with the patient and he was placed back on pass restriction for another three weeks.

We found that patients’ whereabouts were not being monitored as required. VHA requires that RRTP programs have a system for tracking the whereabouts of patients, typically by maintaining a sign-in and sign-out list. Local policy states that patients can sign themselves off the unit for up to 2 hours without a pass but must include their destination, remain on campus, and sign back in upon return so that their whereabouts are always known to staff. We found that the sign in/sign out list on the SARRTP unit was not being reviewed by staff for suspicious activity (patterns of leaving the unit) and that patients did not consistently sign in/sign out. The sign in/sign out entries that we observed did not include dates.

The day before his death, the patient left the SARRTP on a pass in the early afternoon.

We found a lack of consistency among staff in performing contraband searches. According to local policy, nursing staff will conduct and document inspections of all patients being admitted to the program and returning from pass in order to detect any possible contraband that could be brought onto the unit.

Upon his return that evening, a breathalyzer test was completed with negative results (no alcohol detected).

We interviewed staff to determine how contraband searches were conducted upon a patient’s return from pass and received conflicting information. Several staff reported that they were not permitted to search patients’ pockets or to request patients to empty their pockets as this was equivalent to a body search and not allowed. However, the RRTP Program Manager told us that he expected pockets to be emptied as part of a routine contraband search.

A staff nurse documented at that time, “bag(s) checked: no.”

We also found that the EHR [electronic health records] template progress note used to document whether bags had been searched upon a patient’s return from pass was unclear. A line item in a note stated “bag(s) checked: no.” We could not determine from the “no” documentation if there were no bags to check or that bags were not searched.

SARRTP patients who were interviewed by CID [Criminal Investigations Division] agents reported that while on the SARRTP that evening, the patient was intoxicated from illicit drugs and required assistance to get into bed.

We found that the methods used for monitoring SARRTP patients for illicit drug use could be strengthened. UDS were collected every Sunday in the late afternoon or early evening. Staff told us they were consistent with the time of day and day of the week for collections. As the timing of the collection was predictable, patients were aware of when the UDS would be done and could modify their behavior accordingly. Some random UDS were collected during the week, but staff told us this tended to be on the same days of the week, so the pattern of collection times was again fairly predictable.

The patient was found dead in his room on the SARRTP unit the next morning.

The facility is located in a part of Miami with reported high drug activity. Patients who are allowed to leave the unit unsupervised have potentially easy access to illicit drugs. We reviewed the EHRs of other patients in the SARRTP at the time of the patient’s death to determine the extent of illicit drug use among patients. In addition to the patient under review, we found that 7 of 21 patients had a positive UDS and/or breathalyzer test at some point in their substance abuse program stay. Five additional patients had a positive UDS but were not included in the 33 percent positive result category, as either the UDS was completed at admission and positive results could have been from drug use prior to admission or patients were prescribed medications that are associated with a false positive result.

The medical examiner determined that the official cause of death was acute cocaine and heroin toxicity.

SARRTPs should provide a safe recovery environment for the treatment of patients with substance use disorders who require a controlled and sober environment.

It’s unnerving that heroin helped kill this Afghan vet. Afghanistan is the source of about 80% of the world’s heroin. Poor Afghan farmers dedicated more than 500,000 acres to the opium poppy’s cultivation in 2013. That’s up 36% from 2012.

United Nations
TIME

Band of Brothers WWII Veteran ‘Wild Bill’ Guarnere Dies

South Philly native served in the famed Easy Company, and lost a leg holding the Belgian town of Bastone during the Battle of the Bulge

William “Wild Bill” Guarnere, one of the World War II veterans who gained fame from the book Band of Brothers and its HBO adaptation, died of a ruptured aneurysm on Saturday night. He was 90 years old.

A native of south Philadelphia, Guarnere served as a non-commissioned officer in the famed Easy Company, 506th Parachute Infantry Regiment, 101st Airborne Division during World War II, where he participated in some of the biggest battles in the European theater. Guarnere parachuted into Normandy the night before D-Day, fought in Operation Market Garden and helped hold the critical Belgian town of Bastogne during the Battle of the Bulge.

His war ended in Bastogne when he lost a leg while trying to help another wounded soldier, and he returned home having been awarded the Silver Star – the nation’s third-highest award for valor – two Bronze Stars and two Purple Hearts for wounds suffered in combat.

Guarnere and other veterans of Easy Company gained fame decades after the war when historian Stephen Ambrose wrote Band of Brothers about their war experience. HBO turned the book into a highly popular mini-series in 2001. After the war, Guarnere was an active member of many veterans organizations and traveled widely, telling Easy Company’s story. Along with fellow south Philadelphia native Edward “Babe” Heffron, Guarnere published the bestseller Brothers in Battle, Best of Friends in 2008.

TIME Veterans

Medal of Honor Will Go To 24 Overlooked Veterans

These images provided by the U.S. Army show Korean War veterans, from left, Sgt. 1st Class Eduardo Corral Gomez, Master Sgt. Juan E. Negron and Master Sgt. Mike C. Pena, who are among 24 minority veterans receiving the Medal of Honor.
These images provided by the U.S. Army show Korean War veterans, from left, Sgt. 1st Class Eduardo Corral Gomez, Master Sgt. Juan E. Negron and Master Sgt. Mike C. Pena, who are among 24 minority veterans receiving the Medal of Honor. U.S. Army—ap

Mostly Jewish and Hispanic veterans were passed over due to prejudices, review finds

President Barack Obama will award the country’s highest military honor to 24 veterans who were found to have been passed over for the award because of long-standing prejudices against minorities.

The ceremony, scheduled for next month, will award the Medal of Honor to mostly Jewish and Hispanic veterans after a congressionally mandated review found many of them had been passed over for the medal, reports the Associated Press.

The National Defense Authorization act passed by Congress in 2002 required the Army to conduct the review, which looked at the cases of the 6,505 recipients of the Distinguished Service Cross from World War II, the Korean War and the Vietnam War .

The review found eight Vietnam veterans, nine Korean war veterans, and seven World War II veterans deserving of the higher honor. Only three of the recipients are still living.

[AP]

TIME Veterans

A Troubled Marine’s Final Fight

When his nation called, Marine Sergeant David Linley answered. But when he came home hurting, his country let him down.
When his nation called, Marine Sergeant David Linley answered. But when he came home hurting, his country let him down. Peter Van Agtmael—Magnum for TIME

When his nation called, Marine Sergeant David Linley answered. But when he came home hurting, his country let him down

‘At some point I remember looking out the window and seeing a man hiding behind a tree. I knew I could kill him, but some part of me kept saying, No, don’t hurt anyone. I fired at the tree and laughed because I knew I could have hit him. When I smelled the smoke from the rounds fired, I had a rush. Suddenly I was back in the fight.’ David Linley’s last night as a free man began, like so many others before it, in his dark basement, watching Band of Brothers. Or was it Saving Private Ryan? Deep into a bottle of Bombay gin at the time, Linley can’t recall what was on the screen when his wife Kristin came downstairs to do the laundry. She was surprised to see him wearing, for the first time at home, the Marine fatigues he had worn in Iraq.

Her interruption was minor and routine–a light switched on, a noise from the washer–but it triggered in Linley something he couldn’t ignore. Feeling an irrational rage welling up inside, Linley ordered Kristin to leave the house with their 3-year-old son Hunter and 3-week-old daughter Hannah. Then Linley, age 41, kept drinking. Over the next 24 hours, he tried to kill himself twice by filling the house with natural gas, once by sitting in his running car inside the garage and once by hanging.

As a Marine sergeant, Linley saw action and witnessed horrors in Grenada, Lebanon and Iraq a generation ago. Ten years ago in January, he headed back to Iraq on his final combat deployment. He had earned an expert rifleman’s badge, the corps’s highest. The Marines tapped him for prized assignments guarding U.S. diplomatic outposts in Brazil and Pakistan, jobs that required top-secret clearance. He was discharged from the corps, honorably. Twice.

But his final firefight was on his suburban street 30 miles (48 km) southwest of Chicago, and the enemy was local police. When it ended, he’d traded 17 years in uniform for 16 years behind bars.

This is a story about what untreated posttraumatic stress can do to a man, his family, his life and his neighborhood. There are about 200,000 incarcerated veterans in the U.S., about 14% of the nation’s prisoners. Contrary to public perception, Afghanistan and Iraq vets are only half as likely to be incarcerated as those who fought in earlier wars, but they, like Linley, suffer from PTSD at three times the rate of older veterans. All told, perhaps as many as 10,000 Afghanistan and Iraq War vets–there is no sound estimate–are in the nation’s prisons, where mental-health treatment is spotty at best. Linley is one of them, a sad and costly example of a nation too busy to care. “These cases are much too common,” says psychiatrist Stephen Xenakis, a retired Army brigadier general. “We are throwing these guys away.”

I was wearing my full camouflage uniform that I wore in Iraq, including dog tags, survival gear and my fighting knife on my belt. I don’t know when, or why, I put it on. It just felt appropriate to die as a Marine in combat gear.

Shortly after 2 p.m. the next day, on Sept. 22, 2006, a pair of police officers showed up at Linley’s two-story house, bought a year earlier for $232,500. They’d been dispatched because Linley’s new employer was concerned by his absence from work. One knocked at the front door, arousing Linley from a drunken stupor. “Linley appeared calm, polite and cooperative,” the police report said, although the police noted the bayonet-style knife hanging from his webbed belt.

The officer ordered Linley outside once he smelled gas. But Linley locked the door and barricaded it with a wooden bench. Then he made the biggest mistake of his life.

He grabbed a bolt-action .22 from an upstairs closet. He had bought it as a gift to give his son someday. It was the only gun in the house. He retrieved bullets from the basement.

The police, given the gas, the knife and Linley’s retreat inside, summoned reinforcements, who began to encircle the house as they arrived on the scene. They turned off the exterior gas valve to 130 Wethersfield Lane.

A short time later, Linley, unprovoked, began squeezing off rounds from a second-story window above his garage. The initial volley shattered windows in an unoccupied police car parked in front of his house. He moved to the back of the house and began firing at a neighbor’s storage shed that was shielding two police officers. “We had several officers basically pinned down behind sheds and trees,” Bolingbrook police lieutenant Michael Rompa says. “I don’t know the exact amount of rounds that he fired, but it was listed in the hundreds … it was probably closer to a thousand rounds.”

Once I opened the door we spoke briefly, but then the officer began yelling at me to come outside. He started reaching back, as if to draw his weapon. I instantly went into fight mode. I slammed the door shut, saw the officer trying to get in and saw the second officer begin to run around toward the back of the house. I was being surrounded.

As the afternoon dragged on, some 30 officers–including state police–arrived. They asked the FAA to order a news helicopter buzzing overhead to leave the scene. They approached Linley’s house in an armored vehicle. They deployed a pair of robots in an unsuccessful effort to search the house. They lobbed tear gas inside. Nothing seemed to work.

Police restricted access to the 95 other homes in the Hunters Trail subdivision and sent bewildered neighbors fleeing or into their basements. “He was a very gentle person,” says Mike Dahlberg, who lived across the street. Police kept Dahlberg from his home as his wife and son huddled inside with five police officers during the standoff. “Whatever war can do to a person,” he says, “I think it did it to him.”

Linley now maintains that he never intended to hit anyone; none of the 125 shots Linley fired–Rompa’s estimate was considerably off the mark–during the nine-hour shoot-out found a human target. The onetime Marine marksman says what he did was “stupid,” triggered by PTSD and fueled by alcohol.

Linley says he was aiming at trees and over the heads of responding police officers. “If Dave had wanted to kill a cop, he would have killed a cop,” Pete Gill, a Marine comrade, says flatly. “Because even your most basic Marine can hit something at 100 yards, and he didn’t hit a one of them. If that wasn’t a cry for ‘Shoot me because I don’t want to shoot you,’ I don’t know what was.”

I was acting like I was in a firefight, but there was that voice in my head telling me I was in a safe place and there was no danger. I was supposed to be dead, and I was determined to die, to not hurt my family. Now I was being hunted down.

Talking with Linley, now 48, inside the visitors’ center at the Graham Correctional Center in southern Illinois, is bleakly enlightening. His records and the accounts of fellow Marines, relatives and neighbors reveal a once squared-away sergeant–he has no record of parking, never mind speeding, tickets–tormented by what he witnessed during his four combat tours.

The product of a broken New York City family, Linley joined the Marines as a radio operator in 1982 at age 17, with his mother’s signature on his enlistment papers. During his first 10-year stint on active duty, he spent six years overseas, seeing action in Grenada and Beirut and in the 1991 Gulf War. In between deployments to war zones, he spent three years as a Marine security guard at U.S. diplomatic outposts in São Paulo and Islamabad. After a decade as a civilian, he reupped at age 36, angered by the 9/11 attacks. “I was anxious to be back into the fight,” he says. “I felt I had a duty that was not finished.” He spent seven months as a sergeant in Iraq’s violent Anbar province in 2004.

Once he returned from Iraq, Linley and Kristin moved to suburban Chicago, near her parents. They bought a house and had their second child as his life slowly unwound. “He was no longer outgoing but became socially and emotionally withdrawn,” Kristin recalls. “We’d always attended church regularly, but he stopped going with me.” Once a beer drinker, Linley began “self-medicating” with liquor. “He hit the bottle hard when he came home,” Kristin says. “He started locking himself in the basement to get drunk.”

Nine months before the shoot-out, Linley acknowledged the disconnect between those who fight and those back home. “They either ignore you or become scared of you,” he wrote in a letter to the independent Marine Corps Times newspaper. “When they ask, ‘What was it like?’ they zone out with dazed looks on their faces when you start to describe what you have seen.”

And he said he had seen plenty. His Beirut and final Iraq tours were especially bloody; many Marines were killed, but it was the civilians, especially children, caught in the cross fire who Linley says fueled his nightmares. In Beirut, he’d called for a strike on a threatening bus that local newspapers later said had killed 12 children. In Iraq, he saw a young teenager rummaging in an ammo dump lose both arms in an explosion. He survived roadside-bomb blasts.

Linley sought help from the VA and others but was leery of what acknowledging his ills would mean for his career. (He says they had already derailed a job with the U.S. Border Patrol.) “I fault myself for not reaching out more,” Linley says. “You get cocky and prideful and think, I’m a sergeant. I can handle this.” He wanted to head back to Iraq for a fifth combat tour, but Kristin thought he had done his duty. Job hunting, a new baby and his wife’s brain tumor (successfully removed) added to the stress.

So did a lack of comrades. All his earlier trips home from overseas had been to Camp Lejeune in North Carolina, where he could soak in the warmth and understanding of his Marine buddies. But when he returned home for the last time, in 2004, he found himself in an unfamiliar Midwestern suburb where such fraternal solace was harder to find.

Linley recalls being surprised by how the sight of police at his door triggered a flashback. “I thought those dark memories were buried forever,” he says. But a 1987 study of Israeli troops who fought in Lebanon five years earlier shows such thoughts don’t always stay buried. “Even when combat-related posttraumatic stress disorder remits … the afflicted person may become highly sensitized to stress in general,” it concluded. “He is permanently altered, harboring the potential for a future response on re-exposure to threatening stimuli.”

What began as a sad ritual in Linley’s basement on a Thursday night became a matter of life and death for his neighborhood as Friday afternoon darkened into evening. He fired in the direction of the police negotiator’s voice and fire trucks on the scene. In between shots, Linley bellowed out the Marines’ Hymn. “Today’s a good day to die!” he shouted to the cops. He almost got his wish. Three hours after the officer had knocked on his door, a police marksman fired law enforcement’s lone bullet that day, a .308 round that winged Linley but didn’t bring him down.

People were foolishly standing in a place I could have easily shot them, but it was more of a game now. I was shooting close enough to let them know I was there and waiting for them to shoot me. They didn’t. Eventually they did shoot me. At the time, it really pissed me off that they didn’t kill me.

He surrendered seven hours later, after what he says was a failed effort to hang himself with parachute cord. Shortly after midnight, Linley stumbled out of his front door, wounded, haggard and unarmed. “Linley’s shirt is soaked in blood and there is an evident hole in the upper left arm of the shirt,” the police report said. His eyes were bloodshot and watery. “He appears pale in color and moves very slow.”

Police arrested Linley at 12:30 a.m. “We were able to take him into custody, get him medical attention and save his life,” Rompa says. Linley has been locked up since. The state charged him with two counts of attempted first-degree murder, six counts of aggravated discharge of a firearm and one count of criminal damage to government property. Bail was set at $3 million; he faced up to 240 years in prison.

Linley spent nearly three years in the county lockup awaiting trial in the Illinois courts. (Their motto: Audi alteram partem, Latin for “Hear the other side.”) During his trial, Linley’s legal team argued that he was legally insane during the shoot-out. “This guy’s not a criminal, and he’s never been a criminal,” says psychologist Don Catherall. “He was hurting in many ways by that point.”

But Randi Zoot, the state-appointed psychologist in the case, concluded that while Linley was suffering from mental ailments when the shoot-out happened, “they were not of such severity as to substantially impair his ability to understand the wrongfulness of his actions.” Rather, his “voluntary intoxication” that “impaired his judgment and loosened his impulse control” was to blame. His blood-alcohol content was 0.195% after the shoot-out, more than double the Illinois limit for driving. “If you go out and you get yourself drunk and you kill somebody while you’re driving, just because you’re very impaired by drinking isn’t enough” to absolve guilt, Zoot says. That’s true, she adds, even if Linley was trying to self-medicate his PTSD by drinking.

In September 2009, state judge Daniel Rozak found Linley not guilty of the two counts of attempted murder and “guilty but mentally ill” on the seven counts of firearms violations and damaging government property. (Linley and his family, on the advice of their lawyers, had waived a jury trial because of Rozak’s pro-vet record.) While the judge said he gave veterans “a huge break” at sentencing, the length of the shoot-out and the number of shots fired required imprisonment “to deter others from committing the same offense.” Although Linley hadn’t hit anyone, he’d come “close enough” and couldn’t control ricochets.

Linley, the judge added, didn’t prove that he was “unable to appreciate the criminality of his conduct as a result of a mental disease or defect.” In a 21st century variation on World War II’s catch-22, Linley was crazy–just not crazy enough. Rozak said that despite Linley’s mental illness, “with proper treatment” he “was unlikely to reoffend.”

The trouble is, Linley has never gotten that treatment. “I’ve seen a psychiatrist about every six months for 30 minutes, which is absolutely useless,” he says. “I have received no treatment for PTSD at all–nothing.” Linley says he sought an antidepressant in anticipation of a VA-sponsored prison PTSD-counseling group. Such counseling depresses Linley, so he wanted to get on an antidepressant for the sessions. He took Celexa, prescribed by a corrections psychiatrist, for about a year, awaiting the counseling. But the VA never came, prison officials say, because there weren’t enough veterans seeking such help there. Linley says he stopped being “doped up” on the medicine, which made him “foggy and nauseous,” once it became clear the VA wasn’t coming.

A prison official, who declined to discuss the specifics of Linley’s case because of privacy restrictions, said it’s possible he is being seen only twice a year by a psychiatrist “because he’s not behaving poorly, so there’s no issue that has to be addressed by a psychiatrist.”

There are 49,000 inmates in Illinois prisons–a fourfold increase since 1980–and 20% of them receive mental-health care. “There’s a real lack of capacity to deliver any meaningful mental-health care, especially specialized care like PTSD treatment for veterans,” says John Maki, who heads the Chicago-based John Howard Association of Illinois, dedicated to improving the state’s prisons. “It’s so overcrowded and underresourced that delivery of this kind of care, even when it’s ordered by a judge, is extremely difficult if not impossible.” Linley earns $125 a month keeping the furniture shop’s electronics humming; he spends much of it on phone calls to his kids and on instant coffee in the prison commissary. “Hey, I was in the military–I need my coffee,” he explains.

Some days I feel an overwhelming shame. When you strive to do your best, work hard and be honest in life, it’s not supposed to end up like this.

The state appellate court upheld Linley’s sentence in 2011, and he now has a clemency appeal pending before Governor Pat Quinn. “One week in a mental-health facility probably would have prevented this whole affair, and he would be happily married, raising his kids and working,” says Bruce Benson, who worked alongside Linley in the cable-TV business in the 1990s. “He had one bad day in his life, and it has cost him 16 years plus his marriage.”

Kristin divorced Linley in 2011. Struggling to make ends meet, she and the children rarely make the four-hour drive to visit him. “The divorce has nothing to do with the fact that he’s in jail,” she says. “It has to do with what the military did to him. The man who came back from Iraq wasn’t the man I married.”

Linley, like all those who wore their nation’s uniform after 9/11, volunteered for duty. “They have been proud to serve their country,” the Institute of Medicine said in a 2010 report detailing troops’ service and its consequences. “If they have been wounded, physically or mentally, they expect their government to return the favor.”

With time off for good behavior, Linley is slated to leave prison on April 28, 2020. Maybe then he will get the help he needs.

TIME Veterans

Are U.S. Veterans Selfish?

MOAA

As the Pentagon budget vise tightens, those who served complain over cuts

It’s an impudent question, but one that naturally surfaces given the outrage rolling in from assorted veterans’ groups as Congress and the Pentagon seek ways to trim government spending that sometimes affect those who have volunteered to fight America’s wars.

It’s also the predictable downside to enlisting only 1% of the nation’s citizens to fight, and possibly die, to strive to achieve national goals.

When presidents and congresses insist on waging war with no shared sacrifice, it should come as scant surprise that those who have done all the sacrificing squawk when their expected benefits end up on the chopping block.

But it is disquieting. It suggests that the nation is developing a military caste, separate and apart from the nation. It seems the military is in danger of becoming just another special interest group.

SaveOurBenefit.org

Congress set off the latest fireworks when it proposed trimming the annual cost-of-living adjustment (COLA) for working-age veterans by 1 percentage point late last year. Then last week, a new storm arose when the Pentagon said it was considering cutting the subsidies it pays to military commissaries—on-base grocery stores boasting lower prices that are reserved for military personnel, including many veterans—that could force many such facilities to close their doors.

“This is yet another undeserved blow to our men and women in service—and their families—in the name of ‘necessary cutbacks’ to reduce an ungainly national deficit,” American Legion National Commander Daniel Dellinger said, after learning of the commissary proposal. “Like the trimming of expenses to be made by reducing military retirees’ pensions, this is an inexcusable way of attempting to fix a fault by penalizing the blameless.”

The notion that vets are seeking more than their fair share upsets some of their leaders. “Vets are anything but selfish!” says Norb Ryan, president of the Military Officers Association of America. “If anything, vets are too selfless. They are also idealistic…Vets are fair and therefore, they expect others to be fair.”

Recent veterans agree. “I don’t think veterans are any more or less selfish than the general public,” says Brandon Friedman, who served as an infantry officer with the Army in Afghanistan and Iraq. “However, I do think veterans are very vocal about protecting the benefits they’ve been promised.”

Alex Lemons, a former Marine sniper who served three tours in Iraq, is torn by the debate. “As a vet, I feel like we have made ourselves into a protected class and anyone else who isn’t in it can go to hell,” he says. “I took lives and watched lives be taken.” He says he’d prefer to see weapons cut before commissaries:

The commissary is where you bump into wives, girlfriends, boyfriends, children, chums and old vets, some of whom have family down range. They might ask you, `Will the guys in that platoon like this beef jerky or these potato chips?’ or `How have things been, emotionally, since you got back?’ Would anyone out there in the civilian world ask these questions? No. We don’t get the luxury of living in one house and in one community all our lives so places like this offer something else beyond cheap groceries. I know that won’t be popular amongst economists but this intangible stuff is what makes doing such a shitty job that much more manageable.

Besides, in the overall scheme of government spending, the veterans make a fair point: civilian entitlements, including Social Security, Medicare and Medicaid have ballooned, while dollars dedicated to defense have shrunk markedly as a share of the federal budget.

But that masks the growth in per-troop compensation, which has increased by 60% since 9/11, not counting inflation. “Military compensation has outpaced civilian wages and salary growth since 2002,” the Pentagon’s most recent Quadrennial Review of Military Compensation said. The average enlisted person now earns, in all forms of compensation, more than 90% of his or her civilian counterparts; officers are paid more than 83% of civilians with similar education and experience.

Congress has routinely boosted military pay raises, which also increase pensions, beyond that sought by the Pentagon. More than four out of five veterans never get a pension because they have served fewer than 20 years in uniform, although they are eligible for health care and other benefits from the Department of Veterans Affairs. Those who “make 20”—so-called “military retirees”—collect a pension worth at least half their basic pay.

VFW

“Such cost growth is unsustainable, and the leadership of the Army, Navy, Air Force and Marines all agree that the costs of benefits for personnel are starting to crowd out other important investments that support training, readiness and modernization,” four senior retired officers said in a statement in support of the pension trim issued by the nonprofit the Bipartisan Policy Center. “Such a change is much needed—but it’s only a first step. Additional reforms to compensation to ensure benefits are both fair and sustainable will be essential to slow the rise of personnel costs and to ensure the military is able to make the necessary investments to maintain sufficient capability to fight and win wars.”

It appears likely that Congress will reverse course on the veterans’ pension cut. The fact that lawmakers can’t make a minor trim to a benefit enjoyed by a minority (retired veterans under 62) of a minority (once again, less than one in five vets is eligible for a pension) doesn’t bode well for the wholesale revamping that the World War II-era military personnel system needs.

MOAA

But this slugfest comes as no surprise to anyone who has been monitoring the defense-budget debate in recent years:

– Former defense secretary Robert Gates, in his new book, Duty, views much of Congress as little more than scavengers, plucking carrion from the U.S. Treasury to keep wasteful military spending pouring into their districts. “Any defense facility or contract in their district or state, no matter how superfluous or wasteful, was sacrosanct,” he writes. “I was constantly amazed and infuriated at the hypocrisy of those who most stridently attacked the Defense Department as inefficient and wasteful but fought tooth and nail to prevent any reduction in defense activities in their home state or district.”

– Over the weekend, as if to prove Gates’ point, boosters of North Carolina’s Fort Bragg said they were readying to fight any proposal to shrink or close the post. As the Army’s most-populated installation, it’s not going to shut down. Congress, in fact, has recently barred the Pentagon from conducting additional base closings, even though the U.S. military has 20% more real estate than it needs. But it’s telling that Bragg’s backers already are preparing to preserve the post’s 70,000 soldiers and civilians, and are seeking even more. “In the past, we worked to keep what we have,” Greg Taylor, executive director of the Fort Bragg Regional Alliance, said. “This time, we intend to go after what we want.”

– Last week, William Hartung and the independent Center for International Policy said Lockheed Martin, the builder of the F-35 fighter, is inflating how many jobs production of the plane will create (Lockheed denies the charge).

SaveOurBenefit.org

Lockheed has said the $400 billion program—the most costly weapons system in world history—will produce 125,000 jobs. “There’s just one problem with Lockheed Martin’s assertions about job creation,” Hartung says. “They are greatly exaggerated.”

Hartung says using job-creation yardsticks from prior Pentagon programs suggests the program is likely to create only half that number of jobs.

But look at the bright side.

For decades, contractors exaggerated the threats that they said only their weapons could deter. Today, they’re allegedly exaggerating how many jobs assembling their weapons will generate.

That shift in emphasis—from deployment to employment—speaks volumes.

With Congress. communities and contractors now focusing so intently on themselves, why shouldn’t veterans?

TIME Veterans

The Wages of Foolish Wars

My friend William McNulty, the co-founder of Team Rubicon, has a very smart piece linking the appalling suicide rate among recent veterans to the existential emptiness of the wars in Afghanistan and Iraq.

Just think of it this way: Say you were a Marine in Fallujah in 2007 or 2008. You experienced one of the few unalloyed successes of that benighted war: with the help of local tribes that had grown sick of Islamic extremism–and new counterinsurgency tactics provided by Gen David Petraeus–you helped rid the city of Al Qaeda in Iraq. You saw it become civil, peaceful.

You may have lost some friends in the effort. You may have been wounded yourself. But you could still rationalize it: “I won my war,” a Fallujah veteran once told me. And that was sort of true, until a few weeks ago. Now Fallujah has slipped back under the control of Al Qaeda. How on earth could that happen? There are more than a few theories–although I’d put my money on the anti-Sunni bias and incompetence of the Maliki regime. But that’s not the point.

McNulty makes an important distinction: between depression and despair. Depression is one of the prevalent symptoms of post-traumatic stress. It is a natural reaction to the unimaginable terror that comes with combat, the survivor’s guilt that comes with the loss of friends, the frustration that comes with the loss of a limb or a traumatic brain injury. Despair is more profound: it comes when you’ve experienced any or all of those things–and you come to the conclusion that it was all in vain, that there was no earthly reason to have invaded Iraq in the first place or extended the war in Afghanistan beyond the counter-terrorist effort to snuff out Al Qaeda.

The latter feeling is beginning to settle in among far too many veterans. Will McNulty, who has one of the biggest hearts on the planet, spends hours on the phone with veterans who are ready to pull the trigger. Recently, a Team Rubicon volunteer with whom I served during the tornado cleanup in Moore, Oklahoma, nearly hung himself–his girlfriend cut him down just in time. I remember this fellow as an utterly sweet kid, with a big smile and lots of enthusiasm for the work. I am stunned by the despair beneath that smile. McNulty isn’t. He has lived his life with it; he has had close friends kill themselves.

And he is pissed off, because none of it needed to happen. The rest of us should keep this in the very front of our brains as assorted ‘patriots’–who aren’t really patriots, just ill-informed military zealots–would have us go back into Iraq, or into Syria, or would try to replace the promising nuclear talks with Iran with an unprovoked act of aggression. The rest of us should make it our number one priority as citizens: to stop those who would needlessly shove us toward war.

TIME Veterans

Report: Suicide Rate Soars Among Young Vets

The number of male veterans under 30 ending their own lives jumps by 44 percent in two years

The number of male veterans under the age of 30 who commit suicide jumped by 44 percent between 2009 and 2011, the most recent year for which data was available, according to numbers released Thursday by the Department of Veterans Affairs. Roughly two young veterans a day commit suicide.

Suicide rates for female vets also increased by 11 percent between 2009 and 2011. The suicide rate among veterans remains well above that for the general population, with roughly 22 former servicemen and women committing suicide every day.

The troubling spike in suicide rates among younger vets comes as overall suicide rates for people using the Veterans Health Administration have held relatively steady in recent years. Suicide rates among older veterans decreased 16.1 percent between 1999 and 2010, while the overall population of older U.S. males ages saw a 27.3 percent increase in the rate of suicide over the same period.

The leap in rates for the youngest vets has officials especially worried, Stars and Stripes reports. The cause of the increase remains unclear, but officials searching for reasons point to post-traumatic stress disorder, combat injuries and the difficulties young veterans face in re-entering civilian life.

“Their rates are astronomically high and climbing,” Jan Kemp, the VA’s National Mental Health Director for Suicide Prevention, told Stars and Stripes. “That’s concerning us.”

[Stars and Stripes]

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