02/22/07 – Mark Boal – The Scott Horton Show

For Antiwar.com and Chaos Radio 95.9 FM in Austin, Texas, I'm Scott Horton, and this is Antiwar Radio.
My guest today is Mark Bole.
He's the author of this great investigative report for Playboy magazine called The True Cost of War.
We ran it as our cover story on Tuesday at Antiwar.com.
If you just click on the left side panel there on past and click Tuesday, you can find it right there.
It's called The True Cost of War, and it's about post-traumatic stress disorder.
And I was reminded of George Carlin's bit from, I guess, 1990, 91 or so about all the different euphemisms for shell shock that we went through in the 20th century and how by the time of Vietnam it was called post-traumatic stress disorder, which is what we call it today.
And as Carlin said, maybe if they had still called it shell shock, some of those Vietnam veterans would have got the attention, the medical care that they needed.
And so, Mark, I'd like to ask you, I guess first of all, just how much effect do you think that the language itself has in talking about this disease, syndrome, whatever it is?
Well, the language is, of course, very important.
What's happening now is that the military is using the psychiatric definition of PTSD, post-traumatic stress syndrome, which as you say was invented, or some people would say discovered, after the Vietnam War as a way to describe the psychological ailments that soldiers who saw a lot of combat were suffering from.
And what the Army is doing now is playing with the jargon and playing with the definition to the point where they're saying that a lot of troops who actually have the condition or something like it are not being treated.
Because what happens is a military doctor will see a soldier and say, well, you don't meet the actual technical criteria for post-traumatic stress syndrome and you're fine.
And when in fact that soldier may be suffering from a whole host of ailments.
The soldier that I focused on as kind of a way into the story in my piece for Playboy actually had a cluster of symptoms.
He was obviously sick in some sense.
He was diagnosed with PTSD and a military psychiatrist.
He was diagnosed with PTSD by a combat medic and then a military psychiatrist overruled that diagnosis and let the soldier return to duty and to civilization and two days later he killed somebody.
And is now doing 20 years, right?
So the definitions are very important and unfortunately bureaucracies are very good at using hair-splitting techniques to say that somebody isn't sick when in fact they pretty obviously are.
So we've gone from shell shock to battle fatigue to operational exhaustion to post-traumatic stress disorder to post-traumatic stress disorders defined so narrowly that you don't even have that.
Yeah, that's right.
It's more or less the same condition.
Historians looking back at Civil War records have found reports of soldiers that came off of the battlefield of the Civil War who look very much like the reports that describe soldiers coming off of the battlefield of Iraq.
And the bottom line is if you see enough combat and you see your friend get blown up in front of you and you have to shoot and kill people at close range, of course not everybody in Iraq has that experience, but a lot of them do, it's going to have some psychological effect on you to say the least.
And for some people they can come out of it fine, but somewhere between 15 or 20 percent of the people that experience that kind of trauma are permanently affected by it.
And it's not just that they have bad dreams or get a little short-tempered, it can be a really crippling condition because what happens is the fear that you experience in that moment when you experience the trauma doesn't go away.
So you kind of end up walking around in a very fearful state, and of course that's not an easy way to navigate life.
Yeah, the way you describe it in the book is that I guess you say any of us go through a traumatic event, the further we get away from it the less it affects us, and yet for these guys what's happened to them is they're stuck in this state where it doesn't dissipate.
In fact, in many cases it just builds and builds and builds and builds over their lifetime.
Exactly, they keep reliving it.
And so it's almost even, and I guess this depends on which school of psychology you're into or something, but in many ways this is looked at as a matter of brain chemistry, right?
Yeah, there's been a lot of work in neurochemistry and neurobiology on this, but it's pretty clear that there are biochemical reasons for it, just like there are biochemical reasons for depression.
But we don't have the anti-PTSD cocktails yet.
There's really no good medication that works very well on it.
There are combinations that work in terms of a little bit of medicine and therapy and cognitive therapy, but you need to do something.
The worst possible thing you can do is say to somebody that's suffering from this, just go home and sleep it off.
I mean, that's fine if you just have a trivial case and you're just a little bit anxious, but if you really have PTSD you're not going to be able to sleep it off.
And that's what the military is telling its soldiers to do, because they don't want to face the real psychological costs of this war because they can't afford to pay for the care for these guys, and they can't afford to lose the troops from the battlefield, so shorthand it as it is.
Yeah, in your article, again it's called The True Cost of War in Playboy, and now is this on Playboy.com only, or is this in the magazine as well?
It's in both places.
It's in the March issue, which is obviously on the newsstands now, and it's on Playboy.com.
And now in this article you describe what, I don't know what else to call it, except a jihad by the generals against their own soldiers, doing everything they can to define this problem out of existence.
I spoke to a Marine I guess last summer, Jimmy Massey, who I actually met him up at Camp Casey, and he told me, and he closes his eyes, he sees dead people all the time.
The guy is a basket case, and he told me that he was one of the lucky ones because he was already freaking out while he was in country, as they call it.
He was in Iraq and he answered the questionnaire, I'm having nightmares, I'm going through all this trauma, and he said they were actually taking pretty good care of him, but he pointed out that if you say on the questionnaire while you're in Iraq that you're okay, and then when you come home you start coming down with symptoms, panic attacks, nightmares, insomnia, flashbacks, etc., like that, then they'll say, tough, you're just faking it, you're just trying to get paid, and if you really had post-traumatic stress disorder, you would have told us so while you were still in Iraq.
Yeah, exactly, there's a real catch-22 there, isn't there?
Yeah, it sure sounds like it.
In fact, catch-22, I was reminded of that book also when I was reading this because that's how the catch-22 is that you can't go home unless you're crazy, but the only way to prove you're crazy is if you want to fight, and if you want to fight, sorry, I don't care how crazy you are, we need you.
Exactly.
So get back out there.
Exactly.
Yeah, well, and again, this is what we call support the troops, right?
That means let the politicians do whatever they want with them, you know, cheer and wave your ribbon and wave your flag and denounce anyone who opposes the policy and then betray these guys.
As soon as they're done and they come home and every time they close their eyes they see a little kid getting blown apart or something, oh, well, tough, quit being such a pussy, drink a beer and be a man and, you know, go back to your life.
That's the way we treat them.
That's what we call supporting the troops in this country.
Yeah, well, the military, it's sad to say, is very supportive of soldiers when they're in perfect condition, but as soon as the soldier gets sick or gets injured, the military has a really backwards way of the battlefield treatment is good, but the long-term care for the soldier is really quite backwards and the military doesn't do a good job of taking care of its broken soldiers, and what it does is it shuttles them over to the VA, which is the Veterans Administration, which is responsible for taking care of poor soldiers who can't access medical care.
And the VA is just a complete mess in terms of its ability to take care of the number of soldiers that are coming in.
They can barely take care of the World War II guys who are still going to VA centers, let alone the Vietnam guys who are just now starting to come in in even greater numbers.
And when it comes to the Iraq War veterans, I've actually seen internal VA memos which say, don't advertise our services to new veterans because we don't have the capacity if they come knocking on our door.
Yeah, in fact, in your article, you quote at least one source as saying, there's really nothing malicious about this.
It's just that, well, frankly, it's socialized healthcare and government, you either sell stuff or you ration it, and this is what happens when government rations healthcare.
It's just the way it goes.
Well, that's part of it, and it's also part of an unwillingness on the part of the Bush administration to actually calculate the real cost of the war.
From the very beginning, Rumsfeld and the whole crowd wanted to describe this conflict as basically something that we would be able to do for free if not get paid for.
I seem to remember some talk of Iraqi oil money paying for our expenditures and going over there.
Do you remember when $87 billion was a shock?
Everybody went, $87 billion?
That was $400 billion ago.
Exactly.
There's real pressure in Washington, D.C. to cut budgets in light of the hemorrhaging that's going on to pay for the war, and one of the places they cut is, sadly and almost shockingly, is healthcare for the troops.
This is so important.
Again, this article is called The True Cost of War.
It's in the March issue of Playboy.
It's on the website.
It was the cover story on antiwar.com Tuesday.
I really urge everybody to read it.
There's a deliberate effort going on here as well.
You talk in your article about how the old head of the VA was replaced by a Bush appointee who immediately said about three or four different ways, maybe more than that, to try to undermine the idea of post-traumatic stress disorder to undermine treatment for these guys.
Yeah, I think people in the veterans community were shocked when Jim Nicholson was appointed.
He's the fellow you are referring to because Jim has a long history in the Republican Party as a fundraiser and as a chairman of the party while Bush was running for president in 2000, with absolutely no experience running a major government healthcare provider, which is basically what the VA is.
The first thing he did when he came in was start an investigation into the case files of 72,000 veterans that were receiving disability compensation for PTSD.
The effort was basically an attempt to prove that these 72,000 soldiers had somehow defrauded the government and that they were exaggerating their symptoms and that they didn't really need to be getting disability compensation.
So when you have the head of the healthcare agency for soldiers, basically his first move when he comes into power is to say, a lot of you soldiers who say you're sick are probably lying, and I'm going to put an investigator on each of your claims.
And just to be specific here, we're not talking about Vietnam veterans or Grenada or anything else.
We're talking about 73,000 men who have sought treatment from Afghanistan and Iraq.
No, that would include Vietnam veterans and maybe even some veterans from World War II.It was in anticipation of making it harder for veterans from Iraq and Afghanistan.
So they were going to start with the existing cases and see how far they could get on those guys.
And now I think in your article you say that they were thwarted in their attempt to go back and review these cases somehow.
Is that right?
Well, they were.
What happened was there was a veteran in, I think it was New Mexico, who shot himself.
And when they found the body, the letter from the VA stating that they were going to investigate his PTSD claim was on his bed.
And that led to a bit of an uproar in Congress about this investigation.
And the then minority Democratic Party was able to pressure the VA to stop this investigation.
But then the VA turned around and started another attempt to limit PTSD cases by trying to change the definition that the VA uses for the disease.
And so they just keep trying.
If they get shut down on one area, they try another way to achieve the same goal.
And now I hate to argue the point of view of the American Enterprise Institute in this case.
And I was shocked to find out, you know, when you said neoconservative psychiatrists.
I went, wait a minute, neoconservatives who became psychiatrists?
I don't even know about that.
I read further, it's the American Enterprise Institute in your article, Newt Gingrich and his buddies at AEI who are saying, you know, be a man and quit whining.
And that the problem here is that these guys all just want to get paid.
And so then if I remember the way you explained it in your article, this guy Nicholson, a Bush donor, a Republican Party hack who was placed in charge of the Veterans Administration.
First he tried to review all the shell-shot cases.
Then he tried to redefine it out of existence.
And then he decided to commission a study to find out whether the fact that the VA pays people with post-traumatic stress disorder is causing people to, you know, sign up to get the benefits.
And I hate to argue their point of view at all, but that does sort of make sense like just on a logical level without any like actual evidence of the cases that if you're paying people to be sick, they'll be sick, right?
Well, it does if you don't know anything about PTSD.
There's this assumption among people that don't have it that because it goes on in your mind, it's easy to fake that you or I could go into a psychiatrist and say, hey, doc, I've got PTSD.
And the doctor would say, well, if you say so.
But the truth is there are a very complicated set of criteria that psychiatrists use before they get the diagnosis.
And you might trick somebody for five minutes, but over the course of a long interview, the psychiatrist that I've spoken to said it's highly unlikely that you'd be able to fake the disease.
It's like, you know, you or I could try to fake, say, schizophrenia, but without really having it, you know, you're kind of just imitating what you've seen on TV as what a crazy person looks like or sounds like.
And when you're standing in front of a real medical professional, they're going to know that you're the essence.
So the issue of faking comes out of the 70s when PTSD was just in its infancy as a medical term.
And a lot of psychiatrists who were treating veterans also had anti-war feelings, and they were quite quick to diagnose veterans as having PTSD.
But that was 30 years ago, and now it's quite an established field, a subset of psychiatry.
There are institutes and journals and new research on it coming out every day, so it's not as loosey-goosey as it was.
But what the neo-coms have done is kind of take the situation from the 70s and superimpose it on the present and act like all psychiatrists today are basically anti-war, which most of them probably are not.
And now, you know, what we're talking about here again is, as you say, nothing that would be easy for a man to fake.
Your article begins with the story of this guy, Jacob Burgoyne, who's now doing 20 years for murdering a fellow soldier for he-can't-tell-you-what reason, other than PTSD.
And his examination by this guy, Adam Caroll, this American Army medic, basically.
And what he described was this guy going from, you know, crude jokes and light laughter to, you know, bloodlust.
Just, I want to go kill women and children, you know, my first opportunity.
And then back and forth again, back and forth very rapidly this cycle.
And Caroll, the man you interviewed, said, this is when I decided, you know, this guy's definitely going to have to be sent home here.
He's not in control of himself at all.
Yeah, that's correct.
It was one of those just textbook cases that leap out of you.
And, of course, the story there is that the military overruled its own medic.
And they said, oh, no, don't send the guy home.
He's a hero and he should stay with his troops.
And so he did stay with his platoon mates and then he ended up killing one of them.
Yeah, you know, Jimmy Massey, the Marine that I interviewed who talked about his post-traumatic stress disorder, he asked the question, I guess somewhat rhetorically, what about all the Iraqis?
America's been bombing Iraq since 1991.
How many kids have seen their fathers blown apart in front of them?
How many fathers and mothers have lost their sons in front of their own eyes due to the violence brought to them by the United States?
And as a result of the violence we brought to them.
How much post-traumatic stress disorder do we have in Iraq?
I mean, if there was a quantitative measure for sorrow, it'd be pretty high off the charts by this point, wouldn't you say?
I would think so.
I mean, the Iraqi population obviously has suffered incalculably from all of this.
And some of the early work on PTSD actually came out of doctors who went back and interviewed survivors of Hiroshima.
And not to compare Iraq to the Second World War because I think there are two totally different cases.
But trauma is trauma and for sure there's widespread trauma within Iraq on a psychological level in addition to all the physical parts that we hear about on the news.
Yeah, and something that we hear our soldiers talking about a lot is the unseen enemy.
They're not fighting soldiers on a battlefield, which is what they're trained to do, is take on other state powers.
They're out patrolling and playing what they call the IED lottery out there.
And they don't know even which direction an attack is coming from when they are attacked.
They don't even have anybody to shoot back at.
Talk about stressful.
Yeah, that's about as stressful a war condition as you could have because there's no place to ever decompress in Iraq.
There's no place you can go and say, well, I'm behind enemy lines right now and I can relax and play a game of poker or whatever.
There are no enemy lines.
As soon as you leave the base, it's on.
You're in the red zone.
And you never know if the guy standing in front of you is there to ask you directions, is there to tell you that his brother was kidnapped or is there to blow you up.
So, yeah, it's basically a petri dish, I think is the phrase I use in the article.
It's a petri dish for PTSD because every single day there's an enormous amount of stress on the soldiers and no place to relax or let go of it.
Yeah, and now, I'm sorry, I have to harp again on this movement against post-traumatic stress disorder being waged by the war party.
It's not any other segment of society that's trying to deny that post-traumatic stress disorder exists or exists on the levels that it's claimed by the soldiers.
It's the war party, the people who denounce all of us for not supporting the troops.
They're the ones who are trying to destroy even the idea of the existence of post-traumatic stress disorder because, as you point out in your article, it hurts their narrative.
It's just as bad as flag draped coffins at Dover, which they've banned photographers from viewing.
Yeah, and as always, it's the armchair generals and the politicians who think this is a good idea.
If you talk to any soldier, and I think you realize this from talking to your friend who's a Marine, they know about PTSD and they may try to downplay it or they may be very upfront about it, but there's no soldier coming back from Iraq or Afghanistan who's going to say, yeah, it was a cakewalk, we're all fine, we don't need any treatment.
It's only the people that don't go there and that make the decisions that come up with this kind of formulation to make it sound good for the rest of the American public.
They're scared.
The people who supported this war and who continue to support it are very mindful that the narrative about the war ends up being, even if we lose the war, that our troops were not destroyed by it.
Because what happened after Vietnam, of course, was this idea emerged in the culture of Vietnam veterans being permanently, psychologically scarred by their fighting.
You saw it in movies like Taxi Driver and Rambo.
It really hurt the cause of war and it was, I think, part of a big reason why we didn't have another major troop commitment for a long time.
So the neo-cons that are in power now are looking in Iraq and saying, wow, when this is all over, the last thing we want to happen is to have this story be that everyone who fought in Iraq and Afghanistan is somehow suffering from it.
Right, and then if they all turn to murder and suicide, then, well, that's just the price that has to be paid to keep our neo-conservative narrative going, isn't it?
Well, it's a price they don't want to acknowledge.
Yeah, and I remember, I think this dates back to 2003, where there were four or five wives killed at Fort Bragg.
I've read lots of different reports.
I don't know if this goes into the same category with the post-traumatic stress disorder, but I've read articles about soldiers dying on the freeway at hundreds of miles an hour on motorcycles and cars, where, well, basically, you know, like an adrenaline junkie, right?
If you go skydiving, the first thing you do when you hit the ground is want to go again, and here these guys are so used to being so amped up that when they're cruising through the countryside back home, they're, you know, killing themselves in traffic accidents, basically.
Well, yeah, and it's not really surprising to people who look at this.
I mean, if you think about a civilian police department, for example, if you're a cop and you shoot somebody in the line of duty, in most departments around the country, it is mandated that you take time off from work and that you see a counselor and that you kind of get your head straight before you come back and are put in a position of having that kind of responsibility again.
And there's a whole series of mechanisms, you know, mental health mechanisms that kick in as soon as you're involved in a shooting.
Now, in the military, obviously, you're supposed to shoot people.
For the most part, that's what you're trained to do.
And nothing happens after you, you know, there's a quick debriefing sometimes.
But after these guys come back from a year of shooting people and being shot at, they're just sent home.
And there's absolutely no follow up and no care.
So how can we know as a society that if you're a policeman and you're involved in a shooting, you have to be handled really carefully, but if you're a soldier and you're only 18 years old, you can just be released back into the mainstream of society without any kind of follow up?
It just seems like such a glaring contradiction to me.
Well, and, you know, all of us who have automobiles know that when you look out the window and see a homeless guy with a sign that, you know, nearly half the time, you know, maybe even more than that, it's a Vietnam veteran standing out there.
I mean, we all know that.
Our whole society knows that.
And yet, I guess for the next war, we'll just pretend we never learned this lesson this time either.
Well, the lessons just seem to have to be learned anew every generation.
And I don't know, that's one of the things that I hope people can realize is that this is actually happening and that history doesn't have to repeat itself.
But it requires an honest assessment of what's going on with our truth.
Yeah, we've really, we put ourselves in this position.
I saw an article where Ayman al-Zawahiri, who for some reason is still, you know, freer than you and I, was gloating and saying, look, my soldiers kill themselves, you know, out of altruism on behalf of, you know, their fellow fighters, their own people.
Your soldiers kill themselves out of despair.
And guess what?
He was right.
That's the situation our government has put our soldiers in.
Wow, this is an incredibly important article.
Please, everyone, run out and here's a great excuse to run out and get the brand new playboy.
It's called The True Cost of War by Mark Bole.
Thanks so much for your time today.
Hey, thanks for having me.
I don't like words that hide the truth.
I don't like words that conceal reality.
I don't like euphemisms or euphemistic language.
And American English is loaded with euphemisms because Americans have a lot of trouble dealing with reality.
Americans have trouble facing the truth.
So they invent the kind of a soft language to protect themselves from it.
And it gets worse with every generation.
For some reason, it just keeps getting worse.
I'll give you an example of that.
There's a condition in combat, most people know about it, it's when a fighting person's nervous system has been stressed to its absolute peak and maximum, can't take any more input.
The nervous system has either snapped or is about to snap.
In the First World War, that condition was called shell shock.
Simple, honest, direct language.
Two syllables.
Shell shock.
Almost sounds like the guns themselves.
That was 70 years ago.
Then a whole generation went by and the Second World War came along and the very same combat condition was called battle fatigue.
Four syllables now.
Takes a little longer to say.
Doesn't seem to hurt as much.
Fatigue is a nicer word than shock.
Shell shock.
Battle fatigue.
Then we had the war in Korea in 1950.
Madison Avenue was riding high by that time and the very same combat condition was called operational exhaustion.
Hey, we're up to eight syllables now.
And the humanity has been squeezed completely out of the phrase.
It's totally sterile now.
Operational exhaustion.
Sounds like something that might happen to your car.
Then, of course, came the war in Vietnam, which has only been over for about 16 or 17 years.
And thanks to the lies and deceit surrounding that war, I guess it's no surprise that the very same condition was called post-traumatic stress disorder.
Still eight syllables, but we've added a hyphen.
And the pain is completely buried under jargon.
Post-traumatic stress disorder.
I'll bet you if we'd have still been calling it shell shock, some of those Vietnam veterans might have gotten the attention they needed at the time.
I'll bet you that.
I'll bet you that.