Despite the fact that we know almost nothing about the facts of SSG Robert Bales’s alleged rampage in Afghanistan, that didn’t stop NPR’s On Point from using the case as a launching pad for a longer look at battle stress and the real cost of PTSD. Putting aside, for the moment, whether battle stress or PTSD played a role in the murders, I found much of the commentary on the program to be a dreary rehashing of the common complaint that the Army is “failing” in treating PTSD. This critique begs a rather important question: Is the PTSD problem (as we define it) susceptible to a satisfactory solution?
First, it’s entirely possible that PTSD is being over-diagnosed. Currently, American soldiers are seven times more likely to be diagnosed with PTSD than British soldiers, with 30 percent of American vets of the Afghan and Iraq wars allegedly suffering from the disorder. Yet are 30 percent of Americans really afflicted with the disorder? Or are we often medicalizing what is quite normal distress? For example, if you look carefully at the Department of Veterans Affairs description of PTSD, you’ll see that it is not only vague, it also describes entirely normal human reactions to extreme events. Many returning vets are grieving for lost friends and adjusting to a world that has no frame of reference for their experience. What is the “normal” way to endure a war?
Second, even if PTSD is generally over-diagnosed, it can still be individually under-diagnosed. I have no reason to doubt the stories of soldiers who refuse to seek help or have been actively discouraged from seeking help. During my redeployment process, I filled out lengthy questionnaires regarding my experience downrange (“Were you wounded?” “Did anyone close to you die during the deployment?” “Did you see a dead body?”) and was told many different times and many different ways that “resources were available.” Yet such wide nets don’t capture everyone, and there are no doubt some leaders who scorn the process and see even genuine PTSD as “weakness.” Some vets refuse to seek help because they don’t want to acknowledge weakness in themselves. We can cast the net as wide as we want, but some people will still slip through.
Third, PTSD and bureaucracy don’t mix well. Battle stress is not like a broken arm or a bad burn. A person can go through the assembly line of government medicine when health-care professionals are setting arms or changing field dressings. Yet PTSD, with its highly subjective symptoms and sometimes complex and uncertain treatments, often requires an immense amount of trust between patient and provider.
War is perhaps the single-most searing and difficult human experience. If we’re trying to create a world where combat veterans can endure pain, fear, and tragic loss and then seamlessly transition back into a prosperous and peaceful civilian life, then we’re chasing after the impossible. Some vets can pull that off, but many can’t — no matter how many resources (and pharmaceuticals) we throw in their direction. As we’ve known for centuries, war changes people. Yet enduring the horror and sacrifice of war — no matter how hard that is — does not justify, excuse, or even mitigate culpability for the intentional killing of innocent civilians. If SSG Bales’s attorneys try to argue that “PTSD made him do it,” he’ll likely argue in front of a military panel that’s endured multiple deployments as well and will be entirely unsympathetic to the idea that these deployments made him, them, or anyone else a cold-blooded killer.