The military epidemics that aren't
A wildly off-base trend is medicalizing the armed forces as a group of victims, patients and predators.

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Article Highlights

  • Soldiers are no longer seen as models of self-control, courage and patriotism. Instead they are victims and should be treated as patients.

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  • The links between combat, the military and mental health are more complex than the war-as-disease construct allows.

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  • War demands unflinching discipline, courage and loyalty in the presence of our deepest animal passions, and in that sense it is anything but dehumanizing.

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There is a growing presumption in the West that war dehumanizes those who experience combat, or, in more extreme expressions, even those who only serve in the military. In this country, for example, journalist Robert Koehler writes of war itself as a "disease," one that produces a nearly infinite variety of violent "symptoms."

The wars of the post-9/11 era, particularly in Iraq and Afghanistan, might seem to reinforce the point—the Abu Ghraib scandal, for instance, or atrocities committed by U.S. soldiers like Staff Sgt. Robert Bales, who murdered 16 Afghan civilians in March 2012. Then there are the supposedly high rates of suicide, post-traumatic stress and sexual aggression, all of which tempt one to regard the military itself as a dehumanizing institution in need of therapeutic intervention.

Soldiers, in this view, are no longer seen as models of self-control, courage and patriotism. Instead they are victims and should be treated as patients. Yet the links between combat, the military and mental health are more complex than the war-as-disease construct allows.

Begin with suicides by servicemen and women, which have increased in recent years—but by dozens of deaths, not in the epidemic fashion that news coverage sometimes seems to suggest. That said, the 349 military suicides in 2012 did exceed the 295 deaths of U.S. soldiers in Afghanistan. The question is: why?

A major study published this month in the Journal of the American Medical Association found that factors such as substance abuse, depression, financial and relationship problems accounted for the rise in soldier suicides—in other words, the same factors that influence civilians to take their own lives. "The findings from this study," the authors concluded, "are not consistent with the assumption that specific deployment-related characteristics, such as length of deployment, number of deployments, or combat experiences, are directly associated with increased suicide risk."

Nor does the rate of military suicides differ significantly from suicides in the general population. Using data from 2009, another study by the U.S. Army and the National Institute of Mental Health calculated the military suicide rate at 18.5 per 100,000, just below the civilian rate of 18.8 per 100,000.

The science of military post-traumatic stress is also less settled than conventional wisdom has it. There is no doubt about the mental suffering that too many combat veterans endure. But there is confusion about the extent of the anguish or how to treat it. Yet, with hundreds of millions if not billions of health-care dollars per year at stake, the rush toward more treatments, therapies and medications for veterans is accelerating. Something like a "PTSD industry"—and an accompanying and powerful political lobby—has sprung up over the last decade. Our feelings of appreciation for military service, perhaps mixed with more than a little guilt, may be overruling better judgment.

Combat stress is a complex phenomenon. But research has confirmed what military commanders have long known: It is possible to identify those who are most prone to stress problems, and that has more to do with nonmilitary issues—again, substance abuse, money and family problems are the culprits—than with the experience of combat or deployment to a war zone.

Compared with other countries, the United States diagnoses PTSD cases at improbably high rates. Recent PTSD rates in the U.S. have reached as high as 30%, according to the Congressional Budget Office. By contrast, only 2% of Danish soldiers deployed to Afghanistan (and, per capita, the Danes have done as much fighting as anyone) are diagnosed with significant PTSD symptoms, according to a study published in December in Psychological Science. One consequence of high rates of PTSD diagnosis is that the treatment is too often conducted outside a military environment. Soldiers are deprived of what traditionally has been the best medicine: talking to other soldiers.

The recent debate about sexual assault in the military also reflects the notion that there is something fundamentally diseased about the institution itself. The New York Times has editorialized on "the military's entrenched culture of sexual violence." Sen. Kirsten Gillibrand (D., N.Y.) demands that the country replace the military chain of command with civilian legal processes in cases of sexual harassment and assault because the military is inadequate to deal with crimes of "dominance and violence and power." Ms. Gillibrand has been joined in her legislative effort by two leading libertarian Senate Republicans, Rand Paul and Ted Cruz.

Yet the numbers bandied about to show an epidemic of sexual violence in the U.S. military are questionable. In May, Capt. Lindsay Rodman, a judge advocate stationed at U.S. Marine Headquarters in Arlington, Va., reported on this page, for example, that the number of military sexual assaults frequently cited in Congress and elsewhere are based on a badly distorted interpretation of a Defense Department survey. In recent months the American public has often heard that 26,000 service members were sexually assaulted last year. But that statistic comes from an unscientific poll and refers to "unwanted sexual contact," including touching the buttocks or even attempted touching.

Moreover, as Gail Heriot, a law professor at the University of San Diego and a member of the U.S. Civil Rights Commission, wrote recently in the Weekly Standard, "there is no evidence that the military has a higher rate of sexual assault than, say, colleges and universities. Indeed, what paltry evidence there is suggests the opposite."

There is no doubt that "war is hell"—Gen. William Sherman lived through that hell in the Civil War. The 19th-century military theorist Karl von Clausewitz—who argued in a more antiseptic fashion that war was a "continuation of political intercourse by other means"—also understood that the veil between this political understanding of human conflict and the underlying, primal instinct for violence was thin indeed.

But war demands unflinching discipline, courage and loyalty in the presence of our deepest animal passions, and in that sense it is anything but dehumanizing. By regarding soldiers, sometimes condescendingly, as victims and patients, we are in danger of foisting our own, very civilian and very modern, therapeutic pathologies on people who don't need them and whose ability to do their jobs—that is, keep us safe—is likely to be diminished.

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