February 13, 2020 21
‘The Human Mind Was Not Made for War’
David Oshinsky
Signature Wounds :
The Untold Story of the Military’s
Mental Health Crisis
by David Kieran.
New York University Press,
403 pp., $35.00
Almost every major war brings the in-
troduction of a terrifying new weapon.
During the US Civil War, Union and
Confederate troops employed a revo-
lutionary bullet—known as the Minié
ball after its creator, the French army
captain Claude-Étienne Minié—that
spun from the gun barrel, dramati-
cally increasing its velocity,
accuracy, and lethality. World
War I saw submarines, poi-
son gas, and nonstop artillery
barrages. World War II intro-
duced indiscriminate air as-
saults, kamikaze attacks, and,
of course, the atomic bomb.
The Vietnam War brought the
helicopter gunship, napalm,
and chemical defoliants.
With these weapons came an
ever-expanding vocabulary
to depict their hellish conse-
quences, from shell shock to
radiation poisoning to Agent
Orange Syndrome.
In 2005 Barack Obama
told his Senate colleagues
that traumatic brain injury
(TBI), a condition afflicting
thousands of soldiers, “could
become the ‘signature wound
of the Iraq War.’” Little stud-
ied at the time, it appeared
to result from the impact
of roadside bombs planted
by insurgents. Before long,
however, the term “signature
wound” had come to include
the vaguely defined condition known as
post-traumatic stress disorder (PTSD).
These “are two of the signature wounds
of this conflict,” an army official told
Congress in 2007. “We’re working [on]
them, but we have a lot of work to do.”
David Kieran is hesitant to describe
these conditions as the raging epidem-
ics portrayed in much of the media.
“This is not to say... that [they] are
not materially real,” he writes in Sig-
nature Wounds. “Of course they are.”
The problem, as Kieran sees it, is that
the prevailing argument was molded by
the forces most opposed to the con-
flicts in Iraq and Afghanistan: the anti-
war left. As a result, he contends, the
distinction between the “ordinary and
temporary readjustment challenges”
faced by all veterans and the “long-
term, debilitating psychological issues”
faced by some was seriously blurred.
It’s natural for critics of any war to
stress the toll on soldiers and civilians
alike. Yet even a cursory reading of
Signature Wounds demonstrates that
public concern for the mental health
of returning Iraq and Afghanistan
veterans ranged widely across the po-
litical map. It may be true, as Kieran
contends, that congressional Demo-
crats like Obama focused on TBI to
help neutralize Republican charges
that those who opposed the Iraq war
didn’t much care about the welfare of
the troops who were fighting it. But
this was hardly their primary motive,
and to blame the left for concocting an
inflated story of a mental health crisis,
much less ensuring its widespread dis-
tribution, is an extraordinary stretch.
Kieran’s view is all the more curious
because he possesses an otherwise sure
grasp of the pressures of modern war-
fare and the US military’s stepped-up
efforts to address the consequences.
Unlike many, he concludes that the
Pentagon has become deeply invested
in mental health issues, and that the
Department of Veterans Affairs—ev-
eryone’s favorite whipping boy—has
made great strides as well, despite the
stinginess of politicians who purport to“love our vets” but rarely provide the
resources needed to assist them. Still,
says Kieran, it wasn’t the military’s
foresightedness that brought about
these changes; it was rather the brutal,
spirit-breaking conflicts in Iraq and
Afghanistan that plague us to this day.One of the weaknesses of Signature
Wounds is the absence of historical
background. Kieran ignores the age-old
fascination with mental trauma on the
battlefield, from Herodotus to Shake-
speare to Stephen Crane and beyond.
In the seventeenth century, army doc-
tors in Europe wrote of a condition they
called “nostalgia,” in which soldiers
fighting for long stretches, far from
home, became “sad, taciturn, listless,
solitary... indifferent to everything
which the maintenance of life requires.”
Worse still, wrote one physician, “nei-
ther medicaments, nor arguments, nor
promises nor threats of punishment are
able to produce any improvement.”
During the Civil War, medical of-
ficers used terms such as “irritable
heart” and “battle fatigue” to describe
a widening list of symptoms. Dr.
George Burr caused a minor sensation
by contending that “serious injury to
the nervous system” could occur “with-
out the body receiving either wound or
contusion.” Writing in the prestigious
New York Medical Journal in 1865,
Burr claimed that the impact of nearby
explosions—known colloquially as “thewind of passing shells”—produced tem-
porary blindness, hearing loss, and pa-
ralysis by compressing the brain. Most
physicians of that era thought the very
premise absurd, as did military leaders
who viewed emotional upset of any sort
as a moral failing of weak-minded men.
Civil War historians disagree about
the number of troops afflicted with se-
vere emotional trauma. Some who have
studied individual units during the con-
flict (and after) see it as a substantial
problem; others dispute this, insisting
that Civil War soldiers be judged by the
world in which they lived rather than bythe psychiatric standards of today. Their
point is that men of this era experienced
warfare with different expectations
than their modern counterparts—they
were more stoic, more religious, and
more likely to view an early death as a
common occurrence, which it was.
As psychiatry advanced in the late
nineteenth century, medicine became
more receptive to the connection be-
tween the mind and the body. That,
in turn, raised the question of whether
certain personality types were espe-
cially susceptible to battle trauma, and,
if so, whether a well-trained profes-
sional could weed them out in advance.
During World War I, a much-quoted
and somewhat alarming survey of
American recruits showed fully half
of them testing at or below the level of
“moron,” the mental age of a child be-
tween ten and twelve. (Many blamed it
on the “low intelligence” of immigrants
then pouring into the US from Southern
and Eastern Europe.) Less well known,
however, was the military’s attempt to
exclude the “insane,” “feeble-minded,”
and “psychopathic.” Though accounts
are sketchy, the rejection rate appears to
have been quite low, around 2 percent.
The war demonstrated the failure
of these early screening attempts—
not just among American troops, but
almost everywhere they were tried.
So many British soldiers developed
emotional problems during the brutal
months of trench warfare that physicians
invented a blanket term to describethem: shell shock. Medical opinion of
battlefield trauma softened a bit: what
had once been viewed as an affliction
of the weak and unstable was seen, in
some quarters, as a danger to all.
Military leaders almost unanimously
disagreed. And so, too, did US offi-
cials who faced the heavy costs of these
“nonphysical” diagnoses. The federal
government spent nearly $1 billion in
the 1920s and 1930s on benefits for
World War I soldiers who claimed a
psychiatric disability, a staggering sum,
due largely to the lobbying efforts of
new groups like the American Legion
and the Disabled American
Veterans. Fearing a repeat,
the War Department devel-
oped a more comprehensive
mental screening process for
World War II draftees—or
so it appeared. Relying on
the expertise of distinguished
psychiatrists such as Wil-
liam C. Menninger and Harry
Stack Sullivan, it devised a
program (including a fifteen-
minute interview) to uncover
signs of depression, alcohol-
ism, “homosexual proclivities,”
“stupidity,” and other “abnor-
malities.” In all, about two
million men—or 12 percent
of draftees—were rejected for
psychological reasons, with
another 750,000 discharged
following their induction.
The effort failed miserably.
What could a psychiatrist,
much less a poorly trained
draft board member, glean
from a brief, formulaic inter-
view? Precious little, it turned
out. The program not only
depleted the military’s draft
pool, it also stigmatized those it re-
jected. Meanwhile, the number of shell
shock cases among the troops kept
climbing as the war expanded—espe-
cially in places where soldiers experi-
enced long stretches of combat.
Much as they had during World War
I, military psychiatrists found that the
best ways to treat battlefield trauma
were also the simplest—rest, relax-
ation, and hot food, offered close to
the front lines—and that most men
returned to duty within several days.
While more severe cases might require
drugs, therapy, and hospitalization, a
short, comforting break from the bat-
tlefield was usually enough.To many in the military, however, even
modest remedies smacked of coddling.
The most notable example was General
George S. Patton—“Old Blood and
Guts” to his admirers, “Our Blood,
His Guts” to wary GIs. With his riding
britches and ivory-handled pistols, Pat-
ton had led the rout of crack German
armored divisions in North Africa be-
fore commanding American troops in
Operation Husky, the Allied invasion
of Sicily, in 1943. “Battle,” he believed,
“is the most magnificent competition in
which a human being can indulge.”
In Sicily, Patton was warned about
“a very large number of ‘malinger-
ers’... feigning illness in order to avoid
combat duty.” Shortly thereafter, while
visiting an evacuation hospital near theRobert Chamberlain, a veteran of two tours to Iraq and a Rhodes scholar who has struggled with post-traumatic
stress disorder, on the day he was promoted to the rank of army major, Brooklyn, 2011Peter^ vanAgtmael/MagnumPhotos