Full Mental Jacket

The U.S. military worships at the altar of “battle damage assessments,” their after-action reports detailing just how much damage their latest bombing run or battle did to the enemy. It’s much more difficult to do BDA on the minds of those actually doing the fighting.

But the Pentagon’s latest Medical Surveillance Monthly Report offers us an interesting snapshot on the brains and mental conditions of those in uniform who belong to them. This publication, far from the front lines, keeps score long after the battle is over. It’s loaded with interesting facts and trends assembled by the Defense Department’s medical community. It’s never strident but can speak volumes in its measured, dry words. The just-issued edition is the annual summary of how many times troops seek medical help, and how long they’re hospitalized as a result.

The big surprise (for outsiders) is that “mental disorders” remained at the top of the list in 2016, even as the wars in Afghanistan and Iraq became increasingly less violent. “Mental disorders” is the basket into which the military lumps maladjustment, anxiety, mood and substance-abuse diagnoses.

These charts make the case pretty clearly. For active-duty troops, nearly 44 of every 100 days they spent in the hospital were due to “mental disorders.” While high, it kind of makes sense: active-duty troops do the most fighting, most often, and many mental-health woes don’t surface for years. And, as the report makes clear, individual hospitalizations for mental woes last longer than those for physical ones.

The problem was less severe in the guard and reserve forces, whose members are generally older and not deployed as often. Thirty of every 100 days they spent hospitalized were due to “mental disorders.”

While those number may sound grim, they’re actually better than the mental-disorder rate among active-duty recruits, which accounted for nearly 54 percent of their hospitalization days. You can look at that number and conclude that basic training is helping the military screen out a lot of people before they head downrange, which is good for them—and the military.

Makes you wonder how non-military people would fare. Well, the report handles that, too. The family members of those three military groups shows that they were hospitalized for “mental disorders” far less often: for only 15

“Adjustment and mood disorders were among the leading causes of hospitalizations of both male and female service members” in 2016, the report says. “In recent years, attention at the highest levels of the U.S. military and significant resources have focused on detecting, diagnosing, and treating mental disorders—especially those related to long and repeated deployments and combat stress.”

All this attention led to reduced levels of mental disorders between 2010 and 2015, the report adds, “but the number in 2016 was more than a thousand greater than in 2015”—about a 7% increase.

The Pentagon says the reasons for the changing rate in mental-health disorders “is not clear,” although it suggests the winding down of the wars, along with more access to mental-health care, may have played a role. But it offers no insights into last year’s rise. Of course, one year is a mere blip, and may not recur in 2017. Beyond that, it’s refreshing to hear anyone in uniform say they don’t know. Uncertainty is the mother of humility, which often seems in short supply in the U.S. military.

It’s tough to know what to think about these data. Interpreting them is challenging, and the authors don’t reach any grand conclusions. Plainly, someone in uniform has stresses that civilians can’t fully imagine. While some troops thrive on such strain, others buckle under it. The trouble has been that there is no way to tell the two groups apart until it’s too late.

When I began covering the Pentagon in 1979, reporters were consumed with hardware—the latest weapons, the latest procurement delays, and the extravagantly-priced coffee pots and toilet seats, even if customized for the military. But when the Cold War ended with a whimper, thankfully, rather than a bang nearly 30 years ago, the emphasis shifted from weapons. The story line for much of the 1990s was making the military more equal for more Americans, including women and the LGBT community. That story line receded on 9/11. The nation, or at least the 1% of it that has donned its uniform, has been in combat ever since.

Their constant redeployments—without a draft, cannon fodder has been in short supply—led to troops marching between home and the war zone for years. The press, always looking for a story, zoomed in on the damage that some troops were suffering from their turnstiling between home and horror.

I covered the wars, and their tactics and politics, but it was the tales of those who fought that intrigued me most. I wrote of heroes and physical wounds, but it was the strain on the brain of combat, or fear of combat, or fear of deployment, or of something, that drew me in. Someone has to document these invisible wounds.

While most troops have done fine, there has always been a few who broke. I felt their stories were important, because they, and often their families, suffered alone. If a soldier falls in a desert, and there is no one there to document it, did it really happen? This became important to me, especially given the rest of the nation’s lack of interest in the wars.

So I wrote about suicides (including among Army recruiters), a death due to neglect, a family’s suicide-murders, and a Marine who shot up his neighborhood—thankfully, he was the only one wounded—who is now serving a 16-year prison sentence. I wrote of the military’s best sniper, a one-time SEAL, felled by a one-time Marine with P.T.S.D.

I wrote of the Army’s desperate fight against mental ailments, including plying troops with pills, and the efforts to help them using dogs, marijuana, and the creation of the first-ever PTSD brain bank.

That’s a rather lengthy, yet incomplete, story list. But it’s important to remember that the damage done to those sent to fight in our name, not the battles won nor the trillions spent, is the true cost of war.