Post-traumatic futility disorder

Disillusionment with war is an overlooked psychological liability on the battlefield, experts say -- and could lead to higher rates of PTSD among U.S. soldiers in Iraq.

By Mark Benjamin

Read more: Politics, Veterans, News, post-traumatic stress disorder, Vietnam War, Iraq War, Mark Benjamin

Dec. 21, 2006 | Corey Davis, a machine gunner with the Army's 2nd Infantry Division, has a simple description of what was expected of him during his yearlong tour of duty in Iraq.

"Pretty much," said Davis, who was assigned to protect a road used as a supply route, "our job was to get fired at or have IEDs [improvised explosive devices] blow up on us."

Davis left the Army in October and has been diagnosed with post-traumatic stress disorder, or PTSD. Since he returned to the States in August 2006, he has been troubled by thoughts about the futility of day-to-day tactics in Iraq, where several of his friends died. "This was just for us to make the route secure. You would think a human being would be more valuable than a supply route ... What the hell did we do all that for?"

A lot more soldiers may soon be asking similar questions. This week, even as former Secretary of State Colin Powell lamented that "the active Army is about broken" from repeated combat tours, President Bush announced that he is thinking about sending as many as 30,000 more troops to Iraq. Nearly simultaneously, the Army released a study that suggests that those troops who have served more than one tour of duty -- true of a large percentage of all military personnel -- are 50 percent more likely to suffer from acute combat stress, a possible precursor to PTSD.

According to experts contacted by Salon, however, there is another overlooked risk factor likely to lead to a high rate of PTSD among those troops already in Iraq or yet to be "surged" there. As the U.S. mission in Iraq has morphed from overthrowing Saddam into a vague cross between nation building and refereeing a civil war, returning soldiers like Davis express a growing disenchantment with that mission. Questioning the mission is a psychological liability on the battlefield -- and such disillusionment means that American soldiers in Iraq are at greater risk of developing PTSD.

In a series of interviews, some of the nation's experts on psychological injuries pointed to a little-known and rarely studied connection between demoralization and exacerbated mental trauma from war, which can include a diagnosis of PTSD. Another Army study earlier this year showed that an alarming 35 percent of Iraq veterans sought help in military facilities for mental problems in the first year after their return. Experts think that the deteriorating sense of mission could worsen the incidence of PTSD and exacerbate its symptoms.

There is remarkable unanimity among experts on the issue, largely based on their experiences treating veterans. "When people have grave doubts about whether it was all worthwhile, it may make their psychological problems worse," explained Dr. Arthur S. Blank Jr., who helped pioneer the diagnosis of PTSD after the Vietnam War. Even those who question the pervasiveness of PTSD accept the connection between mental health and a belief in the military's mission. Sally Satel, a psychiatrist and resident scholar at the conservative American Enterprise Institute, has drawn fire from veterans' groups and some of her medical colleagues for claiming that PTSD might not be as widespread as some data suggests. But on the connection between disillusionment and PTSD, Satel and her peers agree. "Demoralization, or the difficulty of making meaning of a task, is one of the risk factors," Satel confirmed in an interview.

PTSD in veterans is a delayed response to the trauma that occurs when the brain's normal processing functions are overwhelmed by the extreme images and experiences of war. "Think of PTSD as a processing deficiency disorder," explained Blank, who for 12 years ran a network of government centers that treated a half million veterans with PTSD. "The mind and the brain are overwhelmed by the experiences, and they get registered inside in odd ways."

The improperly encoded data can haunt veterans for the rest of their lives, disrupting sleep patterns and altering mood and personality, even tinkering with the central nervous system. Veterans with PTSD sometimes have a hypersensitive startle reflex. Researchers are now examining a slate of physical "biomarkers" -- such as long-term physiological changes in the brain and alterations in brain structure -- that suggest a biological basis for PTSD.

On the battlefield, a strong sense of commitment can act as mental insulation from the stress that causes PTSD. "Some sense of conviction about what one is doing can be psychologically useful," said author and psychiatrist Robert Jay Lifton. The absence of conviction, on the other hand, "makes it more difficult to take in the death or inwardly justify the very extreme kind of trauma you are going through."

Once a soldier has returned home, an enduring belief in the mission helps the brain think about what happened and file it away properly. Without a strong commitment, images are more likely to remain improperly processed and return as flashbacks, one of the hallmarks of PTSD.

PTSD became an official disorder only in 1980, when it was first included in the American Psychiatric Association's "Diagnostic and Statistical Manual of Mental Disorders." There is limited data on mental trauma from Korea and World War II. The Vietnam War -- a war that resembles Iraq in many ways, including the duration of the conflict and the ambivalence of its combatants -- is the first conflict for which extensive PTSD data is available. By the time of a 1988 survey, 31 percent of Vietnam veterans reported experiencing symptoms of PTSD at some point after their combat duty.

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