The New York TimesThe authorities will deal with Nidal Malik Hasan, the Army psychiatrist who is accused of bringing the nightmare of mass murder into the sanctuary of a military base on American soil. But the rest of us need to look very closely at the stress beyond belief that is being endured by so many other men and women in the armed forces - men and women who are serving gallantly and with dignity, who have not taken out their frustrations on one another, and who deserve better from the broader society.
Simply stated, we cannot continue sending service members into combat for three tours, four tours, five tours and more without paying a horrendous price in terms of the psychological well-being of the troops and their families, and the overall readiness of the armed forces to protect the nation.
The breakdowns already are occurring and will only get worse as the months and years pass and we remain engaged in the conflicts in Afghanistan and Iraq. None of this is the military's fault. There have not been nearly enough people willing to serve in the all-volunteer armed forces to properly staff two wars that have already gone on for the better part of a decade.
I spent some time on the West Coast recently interviewing doctors and researchers studying the enormous problem of troops returning from Afghanistan and Iraq with some form of mental health disorder, most commonly depression and post-traumatic stress disorder, or PTSD. The caseloads are off the charts, and very often the PTSD or depression (or both) is accompanied by substance abuse, problems with anger management, domestic violence and family breakdown.
These are not weak men and women we are talking about. This is the toll that the horror of combat, especially repeated doses of it, takes on people - even those who are young, physically fit and mentally sound.
"These invisible wounds of war are profound and relatively common," said Dr. Charles Marmar, a psychiatrist and one of the nation's leading experts on stress-related disorders. "Pound for pound, they may be more disabling than physical wounds. People often don't seek treatment for PTSD or depression or psychosis, and they are very disabling without proper treatment."
At the time I interviewed Marmar a few weeks ago, he was the chief of psychiatry at the Veterans Administration Medical Center in San Francisco and vice chairman of the department of psychiatry at the University of California, San Francisco. He is to become chairman of the department of psychiatry at New York University on Dec. 1.
Both Marmar and a colleague at the medical center, Dr. Karen Seal, noted the link between multiple deployments and an increased risk of mental health problems. "We know there is a statistically significant association between having more than one deployment and PTSD," said Seal.
Marmar added, "The Department of Defense is losing people right now - war fighters are being disabled by PTSD every day."
The military has been trying to cope, but the challenge is enormous and there are significant institutional obstacles to overcome. Just last week, Defense Secretary Robert Gates spoke publicly about the widespread fear among military personnel that they will be stigmatized if they seek help for psychological problems. And he criticized the military and government bureaucracy for often complicating the efforts of individuals who are trying to get help.
The fallout from the mental health challenges facing America's fighting men and women is vast, and it descends most immediately on close relatives. We have laid an unconscionably heavy burden on the volunteers and their families. The wives, husbands, children and parents bleed emotionally right along with those who are sent into the war zones.
This small sliver of the overall U.S. population has carried the burden of the wars in Iraq and Afghanistan, mostly without complaint, for years. It's time to reassess what we're doing to them.
By the end of last summer, the Army was reporting the highest tallies of soldier suicides since accurate record-keeping began. We're getting saturation media coverage of Thursday's outburst of horror at Fort Hood, but we haven't heard a lot about the scores of suicides at that same base - the highest of any U.S. military installation - since the invasion of Iraq in 2003.
If we're going to fight wars as a nation, then we need to draw our warriors from a wider swath of the population and give them the full and complete support that they need and deserve. We'll no doubt be analyzing the twisted psychological state of Nidal Malik Hasan every which way from sundown. But we'll continue to give short shrift to the daily struggles and frequent horrors of the honorable men and women who have taken on the thankless task of fighting our wars.
This is not just shameful, it's unsustainable.