Post-traumatic futility disorder

Among the soldiers who have fought in Iraq, "disillusionment" often refers to nuts-and-bolts concerns about the way the war is being conducted on a day-to-day basis. Some soldiers, like Davis, describe the Sisyphean quality of endlessly repeated vehicle patrols through the same Iraqi neighborhoods, punctuated by unpredictable, violent attacks, with no productive results. The lack of progress on the ground is bad news for the mental health of troops, according to psychiatrist Jonathan Shay, the author of "Odysseus in America: Combat Trauma and the Trials of Homecoming" and an advisor to the Army on personnel issues. "The soldier in a fight needs to know that his direct leaders and his direct leaders' bosses know what they are doing and are doing something really, truly worthwhile when they send them into these situations."

In another echo of America's other recent protracted war, endlessly repeated patrols are themselves a PTSD risk factor. In Iraq, the soldiers are making the rounds in vehicles, and death comes from roadside bombs. Decades earlier in Vietnam, they patrolled on foot through ambushes and booby traps. In both wars, the troops were there to draw fire. They were as likely to feel like the hunted as to feel like hunters, leading to combat stress and PTSD. "It's not new for American soldiers to feel like sitting ducks," Lifton says. He calls what the troops experience on patrol "the psychology of helplessness."

When the troops return home, they share something else with their Vietnam-era predecessors. Researchers agree that what they call a "lack of social support" from family, friends and community upon a soldier's discharge is considered a risk factor for the development of PTSD. After Vietnam, many veterans felt spurned by the American public. While there is no shortage of "Support Our Troops" bumper stickers nowadays, troops returning from Iraq report feeling disoriented and isolated by an American public that seems detached from, even uninterested in, the wrenching experience of the grunt in Iraq. That kind of culture shock, Shay said, is "often experienced like a kick in the stomach."

To date, the government has shown no indication that it wants to study the psychological impact on soldiers of mission drift and disillusionment. There may be, as Shay put it, "a strong sense among veterans and the people who work with them that meaning is a crucial issue," but the federal government has tended to shy away from looking at it. Blank, for one, thinks that's due to political considerations.

Despite nearly a week of phone calls and e-mails, Army medical officials failed to make anyone available to Salon to discuss the issue. Ira Katz, deputy chief patient care services officer for mental health at the Department of Veterans Affairs, did speak with Salon. Not surprisingly, he seemed much more circumspect than the nongovernmental experts about any relationship between disenchantment and mental wounds. He emphasized that such a correlation has not been thoroughly studied. "I don't think it is proven," Katz said. He then suggested that it might not even be worth studying. "Why does it matter? ... Our job is to treat suffering and impairment." (The outside experts also argue that discussing serious disenchantment with PTSD-afflicted veterans should be an important part of their therapy. Katz disagreed.)

The government's attitude toward exploring a soldier's sense of purpose as part of PTSD research was apparent as long ago as 1988. That year, the landmark survey of PTSD known as the National Vietnam Veterans Readjustment Study produced the estimate that 31 percent of the veterans will show signs of PTSD at some point in their lifetime. (A controversial reanalysis of the data earlier this year revised the figure downward to about 20 percent.) Part of the study included responses from thousands of Vietnam veterans to a questionnaire.

Blank, who ran the network of V.A. treatment centers, worked on that study and oversaw the development of the questionnaire. But because the study was conducted with federal funds, the questions had to be vetted by the White House Office of Management and Budget. More than a decade after the last combat death in Vietnam, the Reagan administration apparently still balked at questions that had to do with disillusionment. The OMB removed them from the questionnaire. "The government is reluctant to study this factor," Blank said.

But there may be less politically charged reasons for the lack of information. "Part of it," Shay said, "might have been that if we ask these questions, it might make somebody look bad." Yet he also noted that mental states are difficulty to quantify. You can count, say, the number of people a soldier believes he killed. But how do you measure disillusionment? In a scientific study, Shay noted, there is "a constant suction toward measurability" and away from topics that seem too squishy to quantify.

Meanwhile, in Iraq, the military's top brass is considering some major tactical changes. The focus on combating insurgents and deploying repetitive vehicle patrols may shift to supporting Iraqi troops and hunting terrorists. Perhaps new strategies and tactics will result in a renewed sense of mission among the troops -- and any new strategies and tactics could help the troops who may soon be headed to Iraq. They come too late, however, to make much difference to the thousands of soldiers who have already served in Iraq and are now wrestling with what was asked of them.

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