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Witness Testimony of Penny Coleman, Author, <i>Flashback: Posttraumatic Stress Disorder, Suicide, and the Lessons of War</i>, Rosendale, NY

INTRODUCTION

The Roman poet Horace said that it is a sweet and fitting thing to die for one's country.  That sentiment has been offered as comfort to widows and orphans for more than 2,000 years.  However hollow and inadequate it might seem to those who are left only with memories and a folded flag, it remains central to the allure and romance of military culture. But I have never heard it suggested that there is anything sweet or fitting about being a psychiatric casualty for one's country, though surely soldiers and veterans who were injured in their minds pledged the same and risked as much as their fallen comrades.

My husband, Daniel O’Donnell, came home from Vietnam in 1969, eleven years before Posttraumatic Stress Disorder (PTSD) became an official diagnostic category.  Like most veterans, he simply refused to talk about his war experiences, so I had no way of knowing what he had experienced or what was going on in his head. In retrospect, I imagine he just thought he was going crazy.  It must have been terrifying. I can only image his despair.

After Daniel died, it never occurred to me to blame the war for what had happened to us. I tried to blame him, but ended up blaming myself. If only I had been kinder, more patient, more understanding, quicker to notice and identify trouble. I can find more compassion for us both from this distance. I can see now that he was just a kid who had tried to stay alive in a situation that exploded all the rules he had ever lived by, and that he was too sorry and too ashamed to start over. And I can see now that I, too, was in over my head in a situation I neither understood nor controlled. But at the time, and for decades after, I believed his death was my fault, and I crept into a psychic lair to hide my shame and lick my wounds in private. I married again and had two children, but it was an awful way to live, tip-toeing around everybody I loved, trying not to kill one of them by mistake. It was a long time before I could find some compassion and forgiveness for that young woman who had no idea what she was up against.

The research I did for my book, Flashback: Posttruamatic Stress Disorder, Suicide, and the Lessons of War[i] included interviews with sixteen widows, mothers, and daughters whose loved ones also took their own lives after serving in Vietnam. The story I have just told is only my version of a litany that ran through every interview.

POSTTRAUMATIC STRESS DISORDER AND MODERN WARFARE

Every war in historical memory has produced psychiatric casualties. In fact, in every war American soldiers have fought in the past century, the chances of becoming a psychiatric casualty were greater than the chances of being killed by enemy fire.[ii] So surprise is at best a disingenuous response to what is happening yet again. At the same time, several issues have emerged that have affected rates of posttraumatic stress injuries in modern warfare; these include the intensity and time a soldier is exposed to combat; unit cohesion, that is, the extent to which soldiers have been given a chance to know and trust those with whom they are fighting; and the nature of contemporary military training.

Length of exposure versus unit cohesion: There were two central lessons that military psychiatrists took from the wars of the 20th century.  The first is that soldiers fight for love-- not hate. And not love of country.  They’re fighting for the soldier next to them, the one they can trust to take their back. The interpersonal bonding that happens when soldiers get to know and trust each other is what the military calls unit cohesion, and it is known to be one of the most effective protections against traumatic stress injuries.[iii] The second lesson is that if it is bad enough for long enough, any one will fall apart. Anyone. It’s not about how strong you are or how brave you are—how truly manly you are.   There is no such thing as a bullet-proof mind.[iv]

During the Vietnam era, the military took the second of these two lessons seriously. The DEROS policy (Date of Expected Return from Over Seas) let every soldier know they would be leaving Vietnam exactly one year after they arrived. They hoped that a year would be a manageable time for a soldier to withstand the stress of the combat environment.  And indeed, the limited amount of time spent in the combat zone may have been the reason that only about 1% of soldiers were evacuated for psychiatric reasons, compared to World War II.[v] At the same time, in the interest of efficiency, the military ignored the first rule, about the importance of personal loyalty and unit cohesion.  After basic training, soldiers were inserted individually into the war machine according to some bureaucratically efficient system. They were cut off from the friendships they had established during training. They were sent into terrifying situations surrounded by strangers who they didn’t know or have any reason to trust. Furthermore, their officers were also rotated, serving for only six months with a unit. It has now been established that the ways in which DEROS undermined unit cohesion were a major contributor to the psychic injuries of the Vietnam war.[vi]

Current military policy has turned that on its head.  Now, the military keeps units together, but ignores the time/intensity rule. Soldiers are repeatedly deployed, spending far more time in combat than even the generous limits the Army considers safe.[vii]  Some units have been deployed three or four times in as many years, and it is becoming ominously clear that the psychic resources of our soldiers has been exhausted.

In 2004, the release of the Abu Grahib photographs broke the unforgivable silence in the mainstream press about atrocities committed by American soldiers in Iraq. Haditha followed, then Mahmoudiyah, Ishaqi, and at this writing, multiple other instances of savage, homicidal violence directed against civilians have been reported. More recently, there have been the reports of veterans involved in violent incidents after coming home.[viii] These acts are being committed by American soldiers who are predictably out of control. They are the inevitable result of pushing our soldiers way beyond their limits. They are not the result of a few bad apples run amok. 

I’m not suggesting that American soldiers take no responsibility for their actions. I would argue that we must balance outrage at criminal and sadistic acts with the insistence that this new generation of soldiers and veterans not be asked to take responsibility for the terrible and tragic circumstances that led to those acts. Individual soldiers cannot be the only ones taking the blame.

The nature of contemporary military training: Military training has been part of the experience of millions of young American men since the Revolutionary War.  Prior to the Vietnam era, however, that training consisted largely of practicing military skills and learning to manage military equipment. It is only in the last half century that training has evolved into an entirely new phenomenon that makes use of the principles of operant conditioning to overcome what studies done over the last century have consistently demonstrated, namely, that healthy human beings have an inherent aversion to killing others of their own species. [ix]

War Psychiatry, the army’s textbook on combat trauma, notes that “pseudospeciation, the ability of humans and some other primates to classify certain members of their own species as ‘other,’ can neutralize the threshold of inhibition so they can kill conspecifics.”[x] Modern military training has developed carefully sequenced and choreographed elements to disconnect recruits from their civilian identities. The values, standards and behaviors they have absorbed over a lifetime from their families, schools, religions and communities are scorned and punished. Using cruelty, humiliation, degradation and cognitive disorientation, recruits are reprogrammed with an entirely new set of learned responses. Every aspect of combat behavior is rehearsed until response becomes reflexive. Operant conditioning has vastly improved the efficacy of American soldiers, at least by military standards.  It has proven to be a reliable way to turn off the switch that controls a soldier’s inherent aversion to killing. American soldiers do kill more often and more efficiently.  Lt. Col. Dave Grossman, author of On Killing, calls this form of training “psychological warfare, [but] psychological warfare conducted not upon the enemy, but upon one’s own troops.”[xi]

There are any number of ways that modern training methods both support violence, aggression and obedience and help to disconnect a reflex action from its moral, ethical, spiritual, or social implications. Drill instructors rely on sexist and homophobic labels like “girl,” “pussy,”  “lady” or “fairy” to humiliate, degrade and ultimately exact conformity. Recruits are drilled with marching chants that privilege their relationships with their weapons over their relationships with women (“You used to be my beauty queen. Now I love my M-16”), overtly conflate sex and violence (“This is my rifle, this is my gun.  This is for fighting; this is for fun.”), and treat the killing of civilians as humorous (“Throw some candy to the children. Wait till they all gather round. Then you take your M-16 now, and mow the little fuckers down.”)[xii] Aside from teaching these young soldiers to quash their innate feelings about killing in general, they are being programmed with a distorted version, not only of what it means to be a man, but of what it means to be a citizen.

Thankfully, the brainwashing has not yet been developed that will override the humanity of most American soldiers.  As multiple deployments become the norm, however, and as more scrambled psyches are sent back into combat instead of into treatment, it is frightening to consider that the brainwashing may yet prevail. Given the training to which these soldiers have been subjected and the chaotic conditions in which they find themselves, it is inevitable that more will succumb to fear and rage and frustration.  They will inevitably be overwhelmed by cumulative doses of horror and they will lose control of their judgment and their compassion. It is a credit to their humanity, not a sign of their weakness,  that these men and women find it hard to live afterwards with what they have seen and, in some cases, done. The soldiers who, following orders, have run over children in the road rather than slow down their convoy will never be the same again.[xiii]   Nor will the soldiers manning checkpoints who shoot, as ordered, and kill entire families who failed to stop, only to learn later that no one had bothered to share with them that the American signal to stop-- a hand held up, palm towards the oncoming vehicle-- to an Iraqi means, “Hello, come here.”[xiv]

This generation of soldiers wants to tell their stories because they want to believe that Americans want to know.[xv] They are not looking for absolution, but they want the architects of current policy to accept their share of the blame.  They have already carried home the psychic wounds and the dangerous reflexive habits of violence that will always diminish their lives and their relationships.  In return, they are hoping we will listen to them this time when they ask us to look a little harder, dig a little deeper, use a little more discernment.

In addition, a number of aspects of deployment and treatment in the current situation are directly responsible for adding to the problem of PTSD and suicide.  These include the failure to screen sufficiently for mental health problems, the inappropriate use of drugs, and the re-triggering of PTSD symptoms among Vietnam veterans.

Failure to screen: In May, the Hartford Courant ran a series of articles exposing the common practice in this army of deploying soldiers in spite of serious, documented mental health histories, including severe depression, bi-polarity, even autism.  On their pre-deployment health forms, there’s a box a recruit can check if they’ve had any kind of mental health issues in the past year.  Of the 3% who checked the box, 1 in 300 was given any kind of follow-up assessment. Some were already on anti-depressants when they were recruited. [xvi]  The use of waivers has meant that individuals with histories of emotional problems, problems that have involved them in felonious activities, including drug abuse and sale, domestic violence and other violent crimes, individuals who would never have been previously accepted into the military, are now being enlisted and deployed.[xvii].

The inappropriate use of drugs:  Self-medication with  marijuana and heroin by soldiers in Vietnam is legendary; what is less well know is that, for the first time, the military made aggressive use of powerful tranquilizers and anti-anxiety drugs.[xviii] In the short run, those drugs were effective, if the definition of effectiveness was boots on the ground, but in the long run, they were the moral equivalent of giving a soldier a local anesthetic for a gunshot wound and sending him back into combat.

It may be that the doctors prescribing in the Vietnam era did not realize the effects of those drugs over time, but today’s military doctors have the benefit of ample evidence.[xix]  When soldiers are given those kinds of drugs while they are still experiencing the stressor, the drugs interrupt the development of normal coping mechanisms—and the long-term effects of the trauma are worse. Still, anti-depressants that come with warning labels about side effects that include suicide are being given to active-duty soldiers with little or no supervision, a practice that is virtually playing Russian roulette with their lives. 

The re-triggering of symptoms among Vietnam veterans: Contemporary warfare not only creates its own emotional casualties, but reignites the symptoms of veterans of previous wars. The Washington Post reported a year ago that “Vietnam veterans are the vast majority of VA's PTSD disability cases--more than 73 percent." These included ten thousand new claims filed by veterans who were entering the system for the first time, more than thirty years after their war came to an end.[xx]

Apologists such as American Enterprise Institute scholar Sally Satel have accused veterans of memorizing the diagnostic criteria for PTSD before going to see a VA doctor.  They have accused the VA doctors of over-diagnosing and thereby making their patients believe they are sick, and the particularly cynical accusation that Vietnam vets who are getting close to retirement are angling for ways to pad their old age with inflated disability checks.[xxi]

Veterans, however, claim that the cause of their applications for benefits, far from being fraud, is the daily onslaught of horrific images and stories coming out of Iraq and Afghanistan that have triggered their flashbacks and reactivated intolerable symptoms. One of those is former senator Max Cleland, a triple amputee from the war in Vietnam, who was compelled to re-enter therapy at Walter Reed for PTSD symptoms that have flared up since the war in Iraq began. Cleland recounts that he cannot read newspapers or watch television now because both are triggers for PTSD, something that he claims is happening to Vietnam veterans all over America.[xxii] 

FACTORS IN THE CURRENT POLICIES THAT ARE TRAGICALLY INCREASING THE INCIDENTS OF SUICIDE

In November 2007, CBS News released the results of their investigation into veteran suicides. Using the clout that only major broadcast networks seem capable of mustering, CBS News contacted the governments of all 50 states requesting their official records of death by suicide going back 12 years. They heard back from 45 of the 50 states. From the mountains of gathered information, they sifted out the suicides of those Americans who had served in the armed forces. What they discovered is that in 2005 alone -- and remember, this is just in 45 states -- there were at least 6,256 veteran suicides, 120 every week for a year and an average of 17 every day.[xxiii]

I am grateful to CBS News for undertaking this long overdue investigation.  And though I am also heartbroken that the numbers are so astonishingly high, I am tentatively optimistic that perhaps now that there are hard numbers to attest to the magnitude of the problem, it will finally be taken seriously.

Part of taking that seriously will be to acknowledge the ways in which the current spate of suicides is being exacerbated by government and military policy. In the above section, I presented a number of the major factors in the high incidence of PTSD among American soldiers and veterans. In this section, I will point to additional factors that explain why PTSD so often leads to suicide. A few examples include the redeployment of psychically injured soldiers, a lack of sufficient medical care professionals, lengthy waits for treatment, complex bureaucratic red tape, and a variety of justifications for dishonorably discharging traumatized veterans, thus rendering them ineligible for VA psychiatric care. It is difficult not to connect all of these factors to a tragic prioritizing of budgetary considerations at the expense of the lives of soldiers and veterans.

Redeployment of psychically wounded soldiers:  In November 2006, the Pentagon released guidelines that allow commanders to redeploy soldiers suffering from traumatic stress disorders. Service members with "a psychiatric disorder in remission, or whose residual symptoms do not impair duty performance" may be considered for duty downrange. It lists post-traumatic stress disorder as a "treatable" problem and sets out a long list of conditions when a soldier can, and cannot be returned for an additional tour in Iraq.[xxiv]  Posttraumatic stress injuries, under the best of circumstances, are treatable, but not curable.  Sending soldiers back into the situation that triggered their injury in the first place is taking undue, I would say cruel, license with their mental health. 

Lack of sufficient medical care professionals/ Lengthy waits for treatment: The Defense Health Board’s Task Force on Mental Health has reported that there is a shortage of active duty mental health professionals. According to the report, "DoD has already dramatically reduced its number of active duty mental health professionals and there are proposals to further reduce active duty staffing"[xxv] As a result, according to other researchers, “doctor-to-patient ratios are climbing, waiting periods to see specialists are growing, and the time that psychiatrists spend with the most troubled patients – those with post-traumatic stress disorder, or PTSD – is shrinking.”[xxvi] In September 2007 a Congressionally mandated report by the non-partisan Government Accountability Office found the Pentagon and VA care for service members suffering from PTSD and Traumatic Brain Injury was “inadequate” with "significant shortfalls" of doctors, nurses and other caregivers necessary to treat wounded soldiers.[xxvii] The result is that soldiers and veterans requesting treatment for PTSD still typically are put on waiting lists and wait six months to a year.

Complex bureaucratic red tape: Since the start of the Iraq war, the back-log of unanswered disability claims has grown from 325,000 to more than 600,000, with 800,000 new claims expected in each of the next two years.[xxviii] On average, a veteran must wait almost six months to have a claim heard.  If a veteran loses and appeals a case, it usually takes almost two years to resolve.[xxix] The number of claims adjusters at the VA likewise dropped. It is worth noting that if a service member or veteran dies while an appeal is pending, the appeal dies as well.[xxx]

Moreover, a veteran applying for compensation for Post Traumatic Stress Disorder must submit a 26 page form, the key to which is a detailed essay on the specific moments when he or she experienced a terrifying event or series of incidents that caused mental illness to develop. This is not easy because one of the symptoms of PTSD is for a person to try to block out any memory that event. According to the psychiatric guide DSM IV, a person with PTSD often displays a “persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness.”[xxxi] In other words, the last thing a person experiencing PTSD wants to do is sit down and write an essay on why, and exactly how, they’ve become mentally ill.  A veteran must also back that claim up with hard evidence that their PTSD is indeed “service connected” – in essence proving he or she was indeed in the place they said they were and that the terrifying incident did indeed occur. If the veteran received a medal during the incident the job is easier. If not, the vet must track down their service records to see if any paperwork was generated as a result of the incident that caused the development of their injury. DoD paperwork is notoriously difficult to track down, if it exists in the first place. I applaud the efforts of Representatives Donnelly and Upton for introducing H.R. 1490, The Fairness in Veterans Disability Benefits Act, which aims to simplify the process for new veterans as they transition out of the military and try to provide for their families.  It is certainly a step in the right direction, but $400 per month is not going to pay the rent anywhere in this country.

Ineligibility for medical benefits: A variety of patterns related to PTSD are currently leading to a denial of medical benefits. In some cases, soldiers and veterans who have applied for help with PDST symptoms try to manage terrifying symptoms by self-medicating with drugs or alcohol; this substance abuse, itself a complication of PTSD, is then used to justify a dishonorable discharge, even in cases in which a soldier has repeatedly asked for treatment.[xxxii] In other cases, diagnoses such as “pre-existing conditions” are used by the military to deny its responsibility for treating soldiers suffering emotional trauma.[xxxiii] 

One of the saddest consequences of the Bush administration’s failure to anticipate and plan for an extended conflict in Iraq is the billions of additional dollars the VA has discovered it needs to cover the shortfall in its healthcare budgets for the past three years. Administration apologists such as Sally Satel have kept up a steady stream of accusation and innuendo in the media ever since it became clear that their new war was going to suck in, chew up and spit out devastated soldiers every bit as reliably --and expensively -- as the war in Vietnam did.[xxxiv] It is worth recalling that, prior to the scandal concerning conditions at Walter Reed, President Bush’s appointees at the Pentagon had strenuously lobbied Congress against funding military pensions, health insurance and benefits for widows of retirees. Their argument: that money spent on caring for wounded soldiers and their families could be better spent on new state of the art military hardware or enticing new recruits to join the force.  In January 2005, Bush’s Undersecretary of Defense for Personnel and Readiness David Chu, the official in charge of such things, went so far as to tell the Wall Street Journal that veterans’ medical care and disability benefits “are hurtful” and “are taking away from the nation’s ability to defend itself.”[xxxv]

Indeed, what we have seen in the past four years are frantic and often tragic attempts to save money, all at the expense of the veterans.  The military tried charging wounded soldiers at Walter Reed for their lunches. Congress made them take that back.  They tried spinning PTSD as veteran fraud and insisted that 72,000 100% disabled vets get themselves recertified.  100% disabled vets are the most fragile and the most likely to be further traumatized by a complicated bureaucratic process. Congress made them take that back as well, but not before at least one overwhelmed veteran took his own life with his recertification request papers on his chest.[xxxvi]

A new study by Columbia University economist Joseph E. Stiglitz, who won the Nobel Prize in economics in 2001, and Harvard lecturer Linda Bilmes concludes that the war is costing $720 million a day or $500,000 a minute.[xxxvii]  This total, which is far above the administration's prewar projections, attempt to take into account the long term healthcare costs for the US soldiers injured in Iraq so far. Veterans groups joke the Bush Administration has instituted a policy of “don’t look, don’t find,” in order to absolve themselves of criminal, financial, and medical liability for their treatment of veterans.

RECOMMENDATIONS

The basis for addressing the virtual epidemic of death that constitutes suicide among soldiers and veterans much be first to acknowledge the problem. While Americans may disagree about current American policy in Iraq, surely we can all agree with the motto of the VA, “To care for him [and now her] who shall have borne the battle and for his widow and orphan.”

In August of 2006, Fox News proposed that Congress provide that certain types of military service -- such as any service in theaters of combat, not just actual combat experience, and other forms of hazardous duty -- automatically qualify veterans for lifetime health benefits. There is much to be said for that proposal. Among other things, it would eliminate the motivation for unjust dishonorable discharges and alternative diagnoses. It would also mean that scientific research involving combat veterans might be less politicized and less likely to be skewed.[xxxviii]

Less extreme but still vitally needed specific steps include:

  • Attack stigma: The “D” in PTSD should immediately be dropped. To call the psychic injuries of soldiers a disorder reinforces the misperception that there is something inherently wrong with the soldier.  The prejudice that reinforces, in soldiers, veterans, caregivers and military officers alike, is in many ways responsible for the resistance of sufferers to ask for the help they so desperately need.   Military personnel at all levels must be educated to understand that PTSD is not a sign of weakness or cowardice.   Soldiers and veterans must be debriefed to help individuals understand and cope with the stress that is a normal response to an overwhelming situation. Treatment for emotional injuries must be given parity with treatments for more visible physical wounds.  For example, promoting the elimination of stigmatizing questions on security clearance questionnaires can set the precedent for culture change within the Department of Defense and model similar changes in procedure for other employment categories, thus eliminating the risks to future employment for individuals in need of treatment for PTSD.[xxxix]
  • Multiply the caregivers: The military’s cadre of mental-health workers is “woefully inadequate to meet their needs. The current decline in military mental health professionals must be reversed as quickly as possible.
  • Provide mandatory and adequate screenings for all enlistees and for all returning soldiers: In the first instance, this will help to stop the practice of deploying soldiers who are already emotionally fragile. It will also serve to create a medical history enabling a veteran to later prove service-connection in the event of emotional trauma. Finally, because everyone participates, such a screening policy would eliminate the shame and stigma.
  • Stop redeploying psychically injured soldiers. 
  • Create a structure for screening soldiers and veterans outside of the chain of command.
  • Eliminate the wait for soldiers and veterans reporting symptoms and requesting treatment and ensure that sufficient emergency contacts and treatment options are available.
  • Hire and train additional Veteran Service Representatives and Veteran Service officers to help veterans navigate the system.
  • Streamline application and benefit procedures and make them more `vet-friendly.’
  • Increase the number and size of Vet Centers, which provide flexible and easily accessed programs and resources, and create procedures for collaboration between Vet Centers and demobilizing troops.
  • Hold follow-up interviews with demobilized troops at 30, 60, and 90 day intervals and then periodically for several years.

CONCLUSION:

I will never know if any or all of the above recommendations, if implemented, would have saved my husband Daniel’s life. I do know that they would have given both of us a better chance. I believe as well that, had deaths such as Daniel’s been officially acknowledged, studied, and  counted, not only would our lives as survivors been very different, but it would be far more difficult for officials now with any credibility deny a connection between combat-related PTSD and suicide.

I find hope in the fact that public attention and better knowledge of mental health issues have helped legitimize the psychiatric injuries soldiers sustain in every war. Though government apologists still shamefully spin and distort the numbers, and though military culture still encourages stigmatization, and even punishment, for what they insist on calling weakness or malingering, there is still far more information about posttraumatic stress injuries available, and that makes it less likely that this generation of soldiers and their families will experience the same degree of isolation on top of their grief that we felt. The difference is that we are talking about it now.


[i] Penny Coleman, Flashback: Posttraumatic Stress Disorder, Suicide, and the Lessons of War (Boston, MA: Beacon, 2006).

[ii] Lieutenant Colonel David Grossman, On Killing (New York: Little Brown, 1996).

[iii] Jonathan Shay, Achilles in Vietnam (New York: Touchstone, 1995).

[iv] Ibid.

[v] Ibid.

[vi] Ibid.

[vii] Davis H. Marlowe, Psychological and Psychosocial Consequences of Combat and Deployment: With Special Emphasis on the Gulf War (Santa Monica, California: Rand, 2001).

[viii]http://timelines.epluribusmedia.org/timelines/index.php?&mjre=PTSD&table_name=tl_ptsd&function=search&order=date&order_type=ASC

[ix] S.L.A. Marshall, Men Against Fire: The Problem of Battle Command in Future Wars (Gloucester, MA: Peter Smith, 1978).

[x] Coleman, Flashback, 73-4.

[xi] Grossman, On Killing, 251.

[xii] Carol Burke, Camp All-American, Hanoi Jane, and the High-and-Tight. (Boston, MA: Beacon, 2005.

[xiii] Mark Benjamin, “Military Injustice,” Salon.com, June 7, 2005. http://archive.salon.com/news/feature/2005/06/07/whistleblower/.

[xiv] Deborah Scranton, Dir. The War Tapes (Sen Art Films, 2007).

[xv] http://www.ivaw.org/wintersoldier

[xvi] Lisa Chedekel and Matthew Kauffman, “Mentally Unfit, Forced to Fight, The Hartford Courant, May 14, 2006.

[xvii]  Mark Benjamin, Out of jail, into the Army. Salon.com, February 2, 2006. http://www.salon.com/news/feature/2006/02/02/waivers/.

[xviii] Grossman, On Killing.

[xix] Ibid.

[xx] Donna St. George, “Iraq War May Add Stress for Past Vets: Trauma Disorder Claims at New High,” Washington Post, June 20, 2006, A01 http://www.washingtonpost.com/wp-dyn/content/article/2006/06/19/AR2006061901400_pf.html.

[xxi] Sally Satel, “Stressed Out Vets: Believing the worst about post-traumatic stress disorder,The Weekly Standard, August 21, 2006.

[xxii] http://www.wsbtv.com/news/9747929/detail.html

[xxiii] http://www.cbsnews.com/stories/2007/11/13/cbsnews_investigates/main3496471.shtml.

[xxiv] Aaron Glantz, “Iraq Vets Left in Physical and Mental Agony,” Inter Press Service, January 4, 2007.

[xxv] http://www.usmedicine.com/article.cfm?articleID=1610&issueID=102.

[xxvi] Anne C. Mulkern, Denver Post, July 05, 2005.

[xxvii] “Vets Healthcare Not Meeting Standards: Army Has Yet To Fully Staff New Units Created To Fix Problems At Walter Reed (GAO: Washington, DC, Spet. 26, 2007). http://www.cbsnews.com/stories/2007/09/26/national/main3300260.shtml.

[xxviii] Brian Friel, “Hurry Up And Wait,” Government Executive, May 1, 2007.   http://www.govexec.com/features/0507-01/0507-01s4.htm.

[xxix] Chris Adams VA's ability to provide benefits worsens December 1, 2006 http://www.mcclatchydc.com/staff/chris_adams/story/15238.html

[xxx] St. George, “Iraq War May Add Stress.”

[xxxi] Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV) (Washington D.C.: American Psychiatric Association, 1994), available online at www.psychologynet.org/dsm.html.

[xxxii] Daniel Zwerdling, “Soldiers Say Army Ignores, Punishes Mental Anguish,” “All Things Considered,” National Public Radio, December 4, 2006.  http://www.npr.org/templates/story/story.php?storyId=6576505

[xxxiii] Joshua Kors, “How Specialist Town Lost His Benefits,” The Nation, April 9, 2007.  http://www.thenation.com/doc/20070409/kors

[xxxiv] http://www.sallysatelmd.com.

[xxxv] Jaffe, Greg.  “Balancing Act: As Benefits for Veterans climb, military spending feels squeeze.”  Wall Street Journal, Jan. 25 2005, pA1.

[xxxvi] Mark Benjamin, “ The VA’s Bad Review,” Salon.com, October 26, 2005.  http://archive.salon.com/news/feature/2005/10/26/suicide/index.html.

[xxxvii] Kari Lydersen, “War Costing $720 Million Each Day, Group Says,” Washington Post, September 22, 2007.   http://www.washingtonpost.com/wp-dyn/content/article/2007/09/21/AR2007092102074.html.

[xxxviii] Steven Milloy “Politicized Science Produces Bad Public Policy,” August 17, 2006.  https://www.foxnews.com/story/0,2933,209078,00.html.

[xxxix] “The War inside; troops are returning fro the battlefield with psychological wounds, but the mental-health system that serves them makes healing difficult,” The Washington Post, June 17, 2007.