“While there are undoubtedly many causes for veteran and service-member suicide, within the sub-group of combat veterans, we see clearly elevated rates of suicide. The primary reason behind those deaths to suicide may be the guilt, shame, and regret that come home with us after the war. The obstacle, and thus the very thing that will keep these veteran suicides continuing, is the unwillingness of American politicians, generals, bureaucrats, the media, and, yes, the population as a whole, to honestly ask and answer why so many combat veterans kill themselves.”
“This journey towards courage continued until I finally had the strength to confront my own moral and intellectual dishonesty. In many ways it was a breakdown, a collapse of my mind and spirit due to the weight of mendacity, yet it was also a rebirth. To find such courage I needed examples and Mike Gravel was one of them.”
“Much of the argument against withdrawal ignores how truly counterproductive the war in Afghanistan has been. Consider just two facts: In the years prior to the US invasion in 2001, Afghanistan and Pakistan were home to four international terror groups. Now, the Pentagon testifies that the number of such terror groups has grown to 20 or more.
“On my TV, I watched Chris Pratt heroically battle aliens 30 years in the future. However, such a war would be fought almost entirely by robots. The idea of robots fighting aliens is no longer a purely speculative one, as the robots do exist. Autonomous robots that utilize artificial intelligence, machine learning, computerized fire control systems, and amazingly sensitive sensors are machines that do not seem to miss and never hesitate to pull the trigger. It is clear the aliens Chris Pratt fights in the future would not stand a chance against today’s robots. That is Hollywood, though. The question for us, outside of the movie theater and away from our TVs, is what chance we as human beings stand?”
As many of you know my health has limited my ability to work for pay. Thanks to some really excellent care from my doctors at the VA I am now in a place where I feel healthy enough to accept a paycheck. These last several years I’ve been too beset with migraines, exhaustion, cognitive issues and other aspects of brain injury to allow me to reliably accept money in return for work. I am very happy and proud to say I feel I am past that point.
I’ve been been a Senior Fellow at the Center for International Policy (CIP) for almost a decade now and during my period of disability I have maintained that position. Unlike most think tanks we do not accept contributions from corporations for our work at CIP, rather we rely on support from individuals and non-profit foundations; I am sure you understand our reasons for doing so and how this makes CIP rather unique in the Washington, DC policy and advocacy world.
As a Senior Fellow, I am largely responsible for raising my own funding. Since I am essentially starting over, I have decided my first step will be to utilize Patreon to raise support from friends, associates and allies who value my work and would like to see it continue. If you are interested in helping me in my work, please go to my Patreon site. You will find a further explanation of why I am asking for your support, as well as what your support will assist me in doing. I appreciate any help you can provide, as I can’t continue to do this without support.
I’ve included a few interviews I have done in the last month or so in this message. The first two are in relation to Afghanistan, while the third interview is about the historical and current circumstances of veteran suicides. I honestly feel this third interview is one of the best interviews I have done in the last ten years.
Thank you for your support over all these years and thank you for considering to support me via Patreon.
Counterpunch was kind enough to publish a long essay of mine that deconstructs the myths and lies used to continuously propel the war forward in Afghanistan. The essay utilizes US government, UN and major media sources, as well as many of my experiences, to argue for peace in Afghanistan. I am very happy with the reception this essay has received, most especially honored by its translation into Dari and Pashto by Afghan friends.
MARC STEINER:Welcome to The Real News Network. I’m Marc Steiner. Great to have you with us today.
Seventeen years ago, the war started in Afghanistan. Seems like this is a war with no end. I remember interviewing Hamid Karzai as he was hiding in a cave just crossing the border back into Afghanistan. So many thought it was just, a war that we needed; it was a just war because Americans were revenging the 3000 deaths of 9/11. But doing so completely unaware of why the Taliban was in power in the first place, and how the United States was complicit in their coming to power in many ways, and in creating the likes of, yes, bin Laden.
Now, this week three Americans were killed, more in one day than any time this year. In retaliation, American and allied forces bombed a village they said was Taliban controlled. And later, when they learned that 30 civilians were killed, said they didn’t realize civilians were living there. Among the dead were 16 children. Then a British office was bombed in retaliation, and others were killed, one Brit and five Afghans. The UN reported that the number of civilian casualties from air attacks was higher in the first nine months of this year than any year since 2009.
It’s been a year since the Trump buildup of forces to Afghanistan and more money being spent. So what are we actually fighting for? What Is this war about? When will it end? How do we know where this war is taking us? These are questions many people are to ask themselves. The war’s cost 105,000 Afghan deaths, 7,000 American lives, hundreds of thousands wounded, and even more affected by the war. All this and the Taliban’s still strong enough to be on the verge of seizing power.
To help us wade through the latest news and what lies ahead is Matthew Hoh. A senior fellow at the Center for International Policy, former director of the Afghan Study Group, who was a Marine Corps officer in the Iraq war. And he 2009 he publicly resigned his position in the State Department in Afghanistan in opposition to the escalation of that war then, in 2009. He’s also a member of Veterans for Peace. And Matthew, welcome. Good to have you with us.
MATTHEW HOH:Hi, Marc. Thank you for having me on.
MARC STEINER:So I’m just curious about your reaction to the latest series of events, to start with, what’s at the top of the news. The killing of the American soldiers, the death of American soldiers, the retaliation to the bombing that killed 30 civilians, 16 children; then the next attack that took place at a British office. So I mean, every time we hear this news it seems like greater escalation, more deaths. What was your initial reaction to all this?
MATTHEW HOH:Well it’s the cycle of violence. I mean, this is, this is what’s occurred there in Afghanistan, not since 9/11, but since the 1970s. Something, as you mentioned in your introduction, we’ve been complicit in. I mean, we were–the United States–was funding the Mujahideen in Afghanistan prior to the Soviet Union invading Afghanistan. I mean, this has been going on for nearly 40 years now. And it is, it is a tragedy. It’s immense suffering. The numbers of casualties are undercounted. When an airstrike occurs like what we saw this week in Helmand and kills 30 people, we are aware of it. But smaller airstrikes, I could tell you this from my experience being there, smaller airstrikes, or airstrikes where the locals don’t alert the media, or the Afghan government doesn’t alert the media, go underreported, or undercounted.
So the idea that this is the most amount of civilians killed by air strikes since ’09 is certainly true. But I would hesitate to believe that that’s the actual number. The number is probably a much greater. And you see with this war a continual pattern, a continual pattern now of talks, a continual pattern of money and foreign troops being put into Afghanistan, a continual escalation of the war by the West and the Afghan government. And, of course, the response by the insurgency, most prominent among them what we call the Taliban, in a complete [an] appropriate response. Again, you’re in a cycle of violence here that, unless it’s broken–and when I mean broken, I mean the funding is cut off, the support is cut off for all parties so that the violence simply can’t occur anymore–it’s just going to continue to go on.
So we’re all kidding ourselves if we’re thinking that these talks, like this five-year plan which is the latest thing that’s coming out the Afghan government, peace will come in five years, we’re kidding ourselves if we think that’s going to make any real difference for the lives of the Afghan people.
MARC STEINER:This is a slight digression. I’m very curious, as you were speaking about this. I mean, so whether you were in Vietnam, whether you were in Afghanistan or Iraq, if you are a soldier fighting or whether you are a civilian working in that war, you get jaundiced pretty quickly about what’s going on around you. So the question is, I’m curious, from your time both as a soldier in Iraq–as a Marine, excuse me. Don’t want to insult you. [crosstalk]
MATTHEW HOH:I don’t, I’m not the guy that does the whole [inaudible]. I can’t do nearly the number of pullups I used to be able to do. I don’t [inaudible] get too concerned if people don’t get the right title.
MARC STEINER:OK, just checking. Just–I know how it is. But given your time in Afghanistan working with the State Department, I’m curious what is the tenor of the men and women working there, working on the, in the American sphere, about what we’re doing, what we’re really accomplishing, or not. And how you have to hide the reality from yourself, almost, to continue the work that you’re doing.
MATTHEW HOH:Yeah. I mean, I can–one thing I can tell you is that it has been nine years since I publicly resigned, and it was on the front page of the Washington Post, the Today Show, and everything. So it wasn’t–my resignation was pretty prominent. And you know, no reason of my own, really Forrest Gumped myself into that. But in the last nine years, the number of negative responses I’ve received from service members who are folks who served in Afghanistan I can count on my one hand. I have received hundreds, if not thousands, of positive responses from men and women who have been with the military, or with our civilian agencies in Afghanistan.
What you’re seeing is within the military, guys get the golden handcuffs. They get locked into their careers. They get locked into the fact that pay and benefits and everything in the military is pretty good right now. They get into the notion that I’m a professional soldier, or a professional Marine, or sailor, or airman. And so I don’t make the policy, I just enforce it. A lot of us would say, hey, that’s … You’re surrendering your soul and your conscience that way. So this zombie-like adherence to what’s occurring there, and looking for excuses, looking for ways to lie to yourself, looking for other metrics to determine whether or not what you’re doing is successful. I took my Marines to Iraq, or I took my Marines to Afghanistan, and only a couple were killed, or none were killed, or only a few were wounded, or–you know, trying to find ways to justify your actions. And that’s certainly what I did. I went three times to war, twice for Iraq and in Afghanistan. And it was–you become numb to that.
But when you get to a position, I think, where you’ve seen the realities of the policymaking, you’ve seen the realities of what we’re doing there, you’ve seen both conflicts–in my case both Iraq and Afghanistan–you see that neither is different. The only thing that matters is that the U.S. is occupying both countries. You’re going to have the same outcomes. In my case, where in Afghanistan I was meeting with the interlocutors, or actually Taliban themselves, and reporting back to the embassy and being told we’re not interested in negotiating, we’re not interested in finding peace, we’re interested in victory, we’re interested in winning, you realize, like, well, I can no longer go home and meet somebody who lost a son or a husband in these wars and tell them it was worthwhile. At the same time too, you see enough dead children, you see enough dead kids, you see enough grieving women in these countries, many of it from our actions, and you start to break, as I was doing.
So part of it is the constant cycling of people into Iraq and Afghanistan, or into Syria, into into these positions, so that they’re coming back out and then going back in, they’re not continuously getting burned out or overwhelmed by it. But it is a question, because–and I think now you start to get into issues of like, why did we get rid of the draft? We have not seen anything like what we saw in Vietnam, where by the early ’70s the U.S. Army, in particular, was completely broken. Where the U.S. Army was experiencing mutinies nearly every week, where units were refusing to fight. By the Army’s own estimate, a quarter of its officers who were killed in Vietnam were killed by their own soldiers. And that’s a conservative estimate. I mean, so we have seen nothing like that in these wars. And that’s, that’s, part of it is why they created this volunteer army, or in many ways like a mercenary army.
MARC STEINER:So–I’m sorry, go ahead. Americans are deeply disconnected from this war. It is very different in Vietnam, or even–especially World War II. People are disconnected because people don’t have a, aren’t in this fight personally at any level, for the most part, in this country.
So the question becomes if we are now in this war that is being escalated by the Trump administration, where more people are being killed then were in the previous years, and in the last years, here, of Obama–not saying it was great under Obama, but nonetheless was of Obama. And I just spoke just the other day with people who had just come back from Helmand province who were saying that, you know, the Taliban is in complete control of the rural areas. You cannot go out at night. Even in the cities you can’t go out at night. So if that’s the case, I mean, what is the endgame here? I mean, how do you get out of this war? How do you stop it? And if the Taliban is really that strong, and you know, for years you’ve seen people some people in the Karzai government and others were trying to negotiate with what they call the good Taliban, to try make some peace, headway. And the Americans didn’t like–kind of opposed them doing that, as well. So in any sense, what is the endgame here? I mean, what–how do you see it?
MATTHEW HOH:The Trump administration has brought about a new era in U.S. foreign policy and U.S. militarism. The Trump administration is different than the Bush and Obama administrations. While both Bush and Obama with the wars in Iraq, Yemen, Syria, Afghanistan, Libya, were completely wrong-headed, criminal, they honestly thought they could find a way out. They honestly thought that they could bring about some type of political change. They believed that with elections, by building schools and healthcare centers, that we could bring about a change in political structure in these countries that favored the United States.
You have to understand, this is something that goes back decades now. I won’t get into prior to World War II, but certainly we had our imperial ambitions, right, for in this country before World War II. Simply ask the Native Americans, ask Hawaiians, ask Filipinos, et cetera. But after World War II what you see is the United States gets put in this position that is summarized best by George Kennan, who was the American diplomat who came up with the containment strategy of the Soviet Union. So a famed American diplomat. In 1948 he says, you know, he says, the United States now has 50 percent, more than 50 percent of the world’s wealth. We’re only 6 percent the world’s population. That’s a disparity that’s going to prove really hard to keep. But it’s our purpose to keep that disparity, and we have to do whatever it takes.
And from that point, I mean, you can trace when he says that to seeing what we did in Italy and Greece, right into Korea, into Vietnam. The dictatorships we supported in Indonesia, the Philippines, what we did in South America, and especially what we’ve done in the Middle East. Now, the idea of the Bush and Obama administration was that somehow we would do these military actions that would bring about political change in these countries that would make Iraq be the same color on the map that the United States is, right. It’s like this is one big game of Risk, basically. Or Afghanistan was going to be the same color as the United States.
Under the Trump administration, because I really believe of the significant influence that the generals like General Mattis and General Kelly, who are the secretary of defense and White House chief of staff, as well as other officials and other theorists who have gone into this Trump administration, you have a Trump administration that doesn’t see any purpose in trying to have such political change in these countries to create a new political order. What they believe is that you can just subjugate, and that’s the best way to go about it. You’ve tried elections, you’ve tried building healthcare centers, you tried building schools, you’ve tried to win hearts and minds. It didn’t work. So what we do is basically we subjugate those parts of those countries, and in this way keep our proxies in power.
So we’ve seen that. We’ve seen that already, say, like in Iraq, where rather than trying to do any type of political change with the Sunnis, we basically backed Shia armies and Kurdish armies with massive airpower, flattened every Sunni city in Iraq. I mean, the cities along the Euphrates and Tigris river valleys are completely flattened. Tens and tens of thousands killed; tens and tens of thousands are still missing. Millions displaced. And that’s the way they’re going to do it from now on. So basically–yeah.
MARC STEINER:I’m curious about–so what you’re describing here, though, as we conclude, just describing here is a strategy in the Trump administration that in some ways, even though the other strategies have been wrong-headed, flawed, and this war is insanely wrong. But this is–we’re escalating in a dangerous new way, here, in which rather than finding a way to pull out and end it, we’re actually escalating this in a way that is detrimental to Afghanistan and to us.
MATTHEW HOH:Yes, exactly. And this is what you expect from a cycle of violence, right. Cycles of violence continue to escalate. We engage in these wars in the Middle East, we occupy these countries. We tried by using religious sects against one another, by using ethnicities against one another. You’re seeing that right now in Afghanistan, the ethnic splits really occurring, with the Taliban attacking the Hazara minority. And this is this goes back–again, this goes back 40-some odd years. That goes back to Zbigniew Brzezinski’s ideas in the Carter administration to use ethnic and religious differences in the Soviet Union, particularly in Central Asia, to light the Soviet Union afire; to cause them problems, right.
So this is why it’s important that we don’t talk about Afghanistan in the sense that it began on 9/11, because this goes back decades. And what we’re seeing right now is the culmination of this type of imperial militarist policies that have by necessity morphed into–look, if you’re looking to see how Secretary Mattis talks about himself, he speaks of himself as if he’s like a legionnaire. He speaks about defending the republic. He describes the United States as being the apex of civilization. Basically, the idea that they are defending the United States and other parts of the empire, Europe and such, against the barbarians, and that we’re always going to be fighting in these borderlands, basically. And you’re going to look and you see John Kelly, the chief of staff of the White House, he said the same types of things.
And so that’s what you’re seeing with this Trump administration, basically. Subjugate those who won’t fall in line. Keep in power our proxies. Use other proxies. So that’s why you’re, that’s why this year you’ve only seen 12 Americans killed in Afghanistan. We’ve killed more Afghans than any other year since 2009. But we’ve only lost 12 Americans. That keeps it out of the papers, right. That keeps it off of CNN. You know, so let the Afghans kill the Afghans. Use the ethnic differences to really help subjugate one another. Use the Shia and Kurds to keep the Sunnis in line in Iraq. Use the Sunni Saudis and UAE forces to keep control in Yemen. So on and so on.
And so where this goes to–my God. I mean, it leads towards genocide. It leads to displacement, and it leads to further horrors and suffering that, you know, many people have been saying all along will be the consequences of this.
MARC STEINER:So very quickly here, as we conclude now. But I want to go back to where we began and just ask you, when the Americans and allied forces said they did not know there were civilians in this Taliban village, the Taliban-controlled village that they bombed in retaliation for the killing of the Americans, how real is that? I mean, how do you not know that where the Taliban are, civilians–you know, it’s the same stuff in Vietnam.
MATTHEW HOH:Yeah. As a guy–as a guy who did this, as a guy who was part of that stuff, as a guy who had Top Secret clearances, who took part in ground combat, who was involved–I’ve been involved in all kinds of levels. I was in the Secretary of the Navy’s office. Am I allowed to say–it was complete fucking bullshit. Can I say that on The Real News? I mean, like-
MARC STEINER:That describes it succinctly.
MATTHEW HOH:That’s bullshit. How can you not know–that, that’s like bombing a house in the United States and saying you didn’t know that there’d be a family in there. I mean, it’s complete bullshit. It’s complete nonsense. It’s–and what you do–this is what’s interesting. Last year, when the journalist Anand Gopal, and I’m blanking on who his counterpart was, they went into Iraq and they found that the United States was, by a factor of like 37 or 38, miscounting the numbers of civilians that were killed. Basically underreporting civilian deaths in the thousands. And then you look and you see what these Air Force general or Army generals say about it. And what it is, though, is that they basically are able to lie to themselves. And what it comes down to is if all the sources–if your sources in the military, if your intelligence people say they weren’t killed, if your pilots didn’t see them killed, if what the regulations say–if that’s, if that’s what–that’s what’s going. If that’s what it is, then they weren’t killed. That’s how they’re still able to lie to themselves so callously, so cruelly. How they were able to murder these people. And our generals shrug and say, well, now, that’s not the case. Because we didn’t–you know, our people said it didn’t happen. So it’s not the case.
You develop a mentality–it’s a sickness, really. But to be able to have that kind of dissonance with reality … yeah. And these generals who are in charge now, they were junior officers when this war began. So they’ve been brought up on-.
MARC STEINER:On this war.
MATTHEW HOH:Just decades now of lying. And getting away with it. And being promoted because they lie, or lied.
MARC STEINER:That’s an interesting perspective. I never thought about that before.
Matthew Hoh, this has been a pleasure to talk with you. I look forward to doing many more conversations. Thank you for the work, and thank you for standing up.
MATTHEW HOH:Thank you, Marc. Appreciate it.
MARC STEINER:We were talking to Matthew Hoh, a senior fellow at the Center for International Policy, and a Marine Corps veteran of the wars that we seem to be stuck in. And I’m Marc Steiner here for The Real News Network. Thank you so much for joining us. Take care.
This past weekend I spoke as part of the Poor People’s Campaign event: The Necessity of Moral Resistance in the Face of Militarism. Reverend William Barber was, of course, the main speaker, and if you are uncertain as to how war and militarism play a role in the demands of the Poor People’s Campaign or in the way war and militarism have always played an oppressive and devastating role in our society, then please listen to Reverend Barber’s sermon as he clearly and definitively explains those two things. My talk, on the effect of war on veterans, is here below, while Reverend Barber’s sermon and the comments from Phyllis Bennis are in the Youtube clip below. Wage Peace.
I received a good number of emails, as well as a couple of comments asking for references on last week’s post. I’ll summarize my response here, as well as post an email I sent to the author of an essay in Task and Purpose, a military focused blog, on the relationship of PTSD and combat veterans. That letter, which was more than 600 words and documented, was not even acknowledged, let alone responded to or published…so it goes 😉
As I noted in last week’s post I am dealing with traumatic brain injury (TBI). I also have a diagnosed neuro-cognitive disorder. For the purposes of this blog and the work I try to take part in, this is causing tremendous problems. I suffer from constant headaches, migraines and fatigues, as well as difficulty with concentration, thought and cognitive tasks. Since I published that post last Tuesday, today is the first day, the Tuesday before last, it’s now taken me more than ten days to have had the mental clarity, ability and energy to work on my computer, write and finish this post. I’ve had at least six migraines, lasting from four to sixteen hours, and the constant headaches and fog in my head have kept me just not off my computer, but away from reading books, essays and articles, as well as watching movies, documentaries and tv shows, walking my dogs and spending time with my partner. It should be noted that these cognitive and migraine problems can also be related to PTSD, depression, and alcohol abuse, but my doctors, both in NC and now here in DC, believe it to be rooted in brain injury. Most likely I believe this brain injury comes from the hundreds of explosive blasts I was exposed to during my time in the Marines, both in training and in Iraq, and as a government official in Iraq – live by the sword, die by sword. This type of brain injury may be similar to what football players and boxers experience later in life. I say all of this to explain why I have not responded sooner to requests for more information, as well as why I am not generally traveling, writing, commenting, appearing on media, etc these days.
However, back to the post from last week: When I speak of guilt, I am speaking of the guilt that comes from being ashamed of one’s actions, whether one engaged directly or indirectly in those actions, or whether one was trying to act morally as individual in otherwise immoral circumstances; eg. an individual takes part in the Iraq War, acts in a manner that an outsider would regard as moral, but because he/she has taken part in an event with ill aims and purposes he/she assumes a greater responsibility and role and feels as if he/she has transgressed his/her own morality. This form of guilt is known as moral injury and is becoming well understood to be one of the three signature invisible wounds of war alongside PTSD and TBI.
While different than PTSD and TBI, moral injury often co-exists and overlaps with either one or both. Often moral injury/guilt, PTSD and TBI reinforce and exacerbate one another and where one wound ends another may begin. However, it is important to remember that although the three wounds manifest symptoms in the same manner and are often closely linked, moral injury/guilt, PTSD and TBI are different from one another in their causes and treatment. Simply put PTSD is the body and mind’s reaction to a traumatic or series of traumatic events, TBI is actual damage done to the brain as the result of an external force, whether it be a physical blow or explosion, and moral injury/guilt is a psychological wound caused by the betrayal of an individual’s own values, ethics, morality etc. For further definitions please see here for PTSD, here for TBI and here moral injury/guilt.
With regards to guilt and moral injury, many people recognize that it can take the form of guilt that is widely known as survivor’s guilt. This is the guilt one feels from being left alive or unhurt when others were killed or injured. In veterans survivor’s guilt can be very pronounced as those that are killed or wounded are often friends or subordinates for whom the service member feels a parental like responsibility. I dealt with this in a very awful manner from a helicopter accident that I survived in 2006, but from which four others did not, including a man I consider a friend. In this case, my guilt was not because I solely survived and they died, but because I did not save them. This aspect, of not doing more to help or save others, is also seen often in veterans, as young men and women are recruited into the military and then conditioned to see themselves as heroes in the waiting.
There is another aspect of guilt and moral injury that comes with combat veterans and this is the guilt that comes from taking part in killing. Studies tell us the guilt that comes from this killing can come from either directly or indirectly taking part in the killing, e.g. you don’t have to have been the one who pulled the trigger, and that this guilt can come from not just the killing of civilians and innocents, but also from killing the “enemy”. This guilt over killing the enemy is particularly understandable if the veteran recognizes the enemy as human and as someone who is simply fighting occupation, ie. acting justly, such as the Afghans, Iraqis and Vietnamese fighting against occupation. In this enemy they recognize actions they would do themselves if the situation was reversed. For example, I used to say of the 153 Marines and Sailors I commanded in Iraq in 2006, that if they were young sunni males living in Anbar Province, 51 would be fighting us, 51 would be in Abu Ghraib and 51 would be dead. It is not a very long or difficult path for many veterans to reach this empathy for the enemy, particularly once they leave the bubble and cocoon of group-think that dominates military life and they are able to freely and independently examine both the micro and macro aspects of the war in which they took part.
In the video I shared last week, when I spoke of veterans killing themselves from guilt, I was referring to this guilt or moral injury: that of taking part in something criminal, unjust, and wrong and/or of having done something that violated spiritual, religious, professional or self-held values, principles, beliefs, etc. See the video I posted above for description of how the US Armed Forces mentally condition young men and women to see themselves as heroes and then what happens when they realize they are more a pawn or villain than a hero. For many this is the crux of moral injury and it is a soul crushing and existential crisis that I believe leads to a great many suicides.
In my case, my personal foundation, my very essence and being was ripped from me; to say my world was turned upside down is not just a minimalist description, but a trite one, as the experience, lasting years and managed now because of the great help of psychologists at the VA Medical Center in Durham, reached such depths as are only encountered in the most intense spiritual or awakened moments. Coupled with traumatic brain injury, depression, PTSD and alcohol abuse, it is easy to understand how with no ability to make amends and the constant hero worship of the American public this guilt could only be assuaged with thoughts of suicide. As my life crumbled and I believed in nothing, I was already an atheist, believing neither in the gods of Abraham or deism, despair and despondency became exaggerated and resounded in my head and soul with every little failure and misstep. Alcohol self medicated me for awhile, but the only escape from the sheer distress at the very base of my being was to end it.
Guilt driving someone to suicide should not be a striking idea, it is common in the literature and religion that we are first introduced to as children and teenagers: think of Judas in the Gospels or Lady Macbeth shouting: “Out, out damn spot!”. Guilt, however, has not been something men and women returning home from war have traditionally been screened for or asked about, more than likely I believe as any guilt associated and announced with the wars of the United States is politically and patriotically unacceptable (in that spirit RootsAction and myself received several angry and righteous emails denouncing the linking of suicide in veterans to feeling guilty about what they took part in during the war or killing the enemy).
As mentioned above, I will paste a letter I sent to the military blog Task and Purpose, but first I would like to list a number of references I use to support my conclusions that it is guilt that is the chief driver of suicides in combat veterans. Additionally, I have a pdf that contains links and abstracts to 25 separate studies that exam the relationship of guilt/moral injury, TBI, and PTSD to suicide in veterans. Please send me an email at firstname.lastname@example.org if you would like a pdf copy of that.
For information on suicide rates of veterans with PTSD compared to other mental health populations, please see Figure 3, page 9 in the report.
For information on suicide rates for veterans, broken out by age group and sex and compared to the US population, see Table 4, page 18
For information on suicide rate of Iraq and Afghan war veterans see Table 5, page 19 and Figure 22, page 33. By comparing these tables and utilizing the information available from the CDC in figure 2 of its suicide data on the general US population, you’ll see for example that the youngest male veterans of the Iraq and Afghan wars have suicide rates nearly 6 times that of other young men their age. By looking at other tables and figures in the suicide report and comparing them to the rate of civilian suicides you’ll note that veterans in the age groups where the United States was in major and lengthy wars (WWII, Korea, Vietnam, Iraq and Afghanistan) have significantly higher rates of suicide than non-veterans. During periods of time when the United States was not in these large wars veteran suicide rates are on par or below civilian suicide rates.
Of course, being in war doesn’t mean that a service member sees combat or takes part in the killing experience that may lead him/her to later take their own life. However, there have been a number of studies that have shown that veterans who have been in combat have a higher rate of suicide than veterans who have also deployed to war but not seen combat (and incidentally, despite common perception, Iraq and Afghan veterans have been more likely to be in combat than veterans of any previous war, see my letter below to Task and Purpose).
The linking of combat and suicide has also been reported through journalism, such as this NY Times story which tracked a battalion of infantry Marines after their return home and to civilian life after their time in Afghanistan. At the time of the reporting, this unit of approximately 1,000 men who had been engaged in heavy fighting in Helmand Province, had a suicide rate 14 times higher than their civilian male counter-parts. As I know Marines who were in this unit, nothing makes me suspect that the rate of suicide has lessened for these men. Another news story detailed how WWII veterans kill themselves at 4 times the rate of non-veterans of the same age, which demolishes the myth that such a problem with mental health and suicidality didn’t exist for previous generations of war veterans or goes away with time and age. From the Washington Post linked in the previous sentence:
The reality was that of the 16 million Americans who served in the armed forces during World War II, fewer than half saw combat. Of those who did, more than 1 million were discharged for combat-related neuroses, according to military statistics. In the summer of 1945, Newsweek reported that “10,000 returning veterans per month . . . develop some kind of psychoneurotic disorder. Last year there were more than 300,000 of them — and with fewer than 3,000 American psychiatrists and only 30 VA neuropsychiatric hospitals to attend to their painful needs.”
One of those hospitals was the subject of John Huston’s 1946 documentary, “Let There Be Light,” which said that “20% of all battle casualties in the American Army during World War II were of a neuropsychiatric nature.” The film followed the treatment, mostly with talk therapy, drugs and hypnosis, of “men who tremble, men who cannot sleep, men with pains that are no less real because they are of a mental origin.” Huston’s movie was confiscated by the Army just minutes before its premiere in 1946 and was not allowed to be shown in public until 1981. The government rationale at the time was protecting the privacy of the soldiers depicted, though Huston maintained all had signed waivers..
“Most of the World War II men that I worked with came to me in their 70s or 80s, after retirement or the death of a spouse,” said Joan Cook, a professor of psychiatry at Yale and a PTSD researcher for Veterans Affairs. “Their symptoms seemed to be increasing, and those events seemed to act as a floodgate.”
For so many veterans, that was when they finally learned they were not crazy or weak. “Pretty much to a person, for them, learning about PTSD and understanding that people were researching it in World War II veterans was a real relief,” Schnurr said. “Many people felt isolated and crazy, and they thought it was just them. And they didn’t talk about it.”
“Across all suicide-related outcomes (i.e., suicide ideation, suicide attempt, and death by suicide), the relation of specific combat exposure with suicide-related out- comes was twice as large (r = .12) as the relation of general deployment across all suicide-related outcomes” and
“the difference between the relation of combat-specific experience and general deployment history with suicide- related outcomes was significant”.
The report goes on to say that being involved in combat increases the likelihood of suicide in veterans by 43%.
You can also watch a short video summarizing this report here.
In the video from RootsAction I mention that as early as 1991 researchers had determined combat related guilt to be the most significant predictor of suicide in Vietnam veterans. That study can be found here. Its conclusion reads: “In this study, PTSD among Vietnam combat veterans emerged as a psychiatric disorder with considerable risk for suicide, and intensive combat-related guilt was found to be the most significant explanatory factor. These findings point to the need for greater clinical attention to the role of guilt in the evaluation and treatment of suicidal veterans with PTSD.”
Take note that the current checklist for screening veterans at the VA does not include specific questions about or references to guilt and a 2012 VA study noted:“Killing experiences are NOT routinely examined when assessing suicide risk. Our findings have important implications for conducting suicide risk assessments in veterans of war.” (emphasis mine)
As mentioned above I have links, citations and abstracts for 25 studies I have reviewed that are available online, primarily through NIH, that explore the connection of suicide, combat, guilt, PTSD and TBI. As it it 12 pages long I will not paste it here, but if you would like a PDF, please let me know by comment or by email (email@example.com).
As I noted in my original post last week, there is also a very real connection between TBI and suicides, and with so many Iraq and Afghan veterans living now with TBI many of the suicides that are occurring would likely be connected to TBI. More information on TBI and veterans is found in the letter below.
Please do not hesitate to contact me with any questions.
Peace to you.
Below is a letter I sent to the military blog Task and Purpose, which went unacknowledged, regarding many of the common misperceptions of PTSD and veterans.
From: Matthew Hoh Date: February 5, 2018 at 2:28:11 PM EST To: james…. Subject:Your article on PTSD
Thank you for your recent article on PTSD and the effects of transition on veterans. I believe the broad outlines of the study and its conclusions are correct. It reminds me of what I heard said about American soldiers returning from WWI: “how are you going to keep them on the farm when they have seen Paris?” There are a few things that the study’s authors, however, did not take into account and that can lead to misunderstanding about veterans by the public, particular the effects of combat.
First, the study’s authors do not differentiate between the veteran population as a whole, those who deployed, and those who saw combat. This is crucial for understanding the stresses and challenges veterans face and why they face them. For example, a meta-study from the National Center for PTSD by Brett Litz and William Schlenger, examined 14 published PTSD studies of Afghan and Iraq war veterans, and found that troops who had seen combat had PTSD rates of 10-18% but for troops that had not seen combat the rate was only 1.5%. An important differentiation.
The authors also do not make the correlation or connection to the symptoms that they identify in veterans due to transition stress to the same symptoms that occur in unemployed civilians. There is a vast body of literature on unemployment related symptoms that has come out of the Great Recession, particularly in men. These symptoms include depression, anger, listlessness/apathy, mood impairment, sexual dysfunction, relationship problems and other issues that are similar to the symptoms that veterans experience upon separating from the military.
Secondly, the authors do not discuss the role of TBI in OIF/OEF veterans. Rates of TBI among all OIF/OEF era veterans range from 10-20% according to the VA. The Rand Corporation and the Congressional
Research Service put the rate as high as 23%. So, more OIF/OEF veterans suffer from TBI than PTSD, and as you most likely know, TBI can have a latent development and is often under reported (as is PTSD).
“The soldiers in Iraq and Afghanistan are having a very unique experience both because they have very good body armor now and because of the way in which insurgents use a lot of explosives. The soldiers are exposed to a lot of explosions, so they get hit over and over again, but they’re protected from all but the worst cases of secondary and tertiary effects. Whereas had it been the Vietnam War, for example, they [the soldiers] would have been much more grievously injured and would have been evacuated.”
And the study’s co-author said this:
“Probably the only war that is comparable to the wars in Iraq and Afghanistan is World War I, the trench and artillery warfare. The term “shell shock” came from that war and that really refers to the effects of these post-concussive symptoms.
In the group of veteran participants in this study, the average number of blast exposures that were severe enough to cause acute symptoms consistent with the diagnosis of mild traumatic brain injury was 20. It was more common to have been exposed to between 50 to 100 blasts than to have a single one.”
That leads to my third point, which I think would make an excellent article for you. The notion as advanced terribly by Sebastian Junger that these wars have been safer is demonstrably false and there is no evidence to demonstrate such, rather OIF/OEF (not just combat arms but all veterans) have had higher exposure rates to combat, violence, death and injury than any previous generation of veterans. Looking at a broad range of studies and surveys we see that OIF and OEF veterans experience combat at rates of 50% or higher, again a higher rate than any previous generation of American veterans.
I have pasted below summaries I have written from various studies on OIF/OEF combat exposure, please note that some of the studies, such as the last study I reference, include veterans who did not deploy, so the rate of combat exposure is much higher than stated for deployed veterans:
Studies and surveys have shown that veterans from OIF and OEF have experienced greater or equal rates of combat/trauma exposure of veterans of other wars. For example, the 2010 National Veterans Survey reported that the overall veteran population has experienced combat at a rate of 34%. However, among veterans who deployed to Afghanistan and Iraq 63% of veterans had combat exposure. For veterans who went to war zones prior to WWII the rate was 55.4%, for those who went to war zones during WWII it was 44.9%, in Korea it was 26%, in Vietnam it was 44% and in the Gulf War it was 41%. That information comes from a study done by Ryan Edwards of Queens College, City University of New York in 2014.
Additional sources debunking Junger’s and others unsupported and undocumented notion that only 10% of American troops saw combat or experienced danger/trauma in Afghanistan and Iraq, include:
–a 2004 study by Walter Reed Army Institute of Research that found 77-87% of American troops discharged their weapons in Iraq and more than 90% reported coming under small arms fire
–a 2009 study from the Rand Corporation, by the same authors from aRand study that Junger cites in his book, reports that only 10-15% of Afghan and Iraq veterans report no combat trauma experienced at all during deployment and close to 75% report multiple exposures to combat trauma
–a 2011 study from the National Center for Veterans’ Studies at the University of Utah reported 58-60% of Afghan and Iraq veterans had experienced combat
–a 2014 study published by the British Journal of Psychiatry found that contrary to Junger’s claims on p87 of his book that British troops had half the rate of PTSD than the American troops that “were in combat with them”, both British and American troops that experienced comparable levels of combat exposure had comparable rates of PTSD. The authors of the 2004 Walter Reed report referenced above also shared this finding. In the 2014 study of the American veterans of Afghanistan and Iraq nearly 70% reported receiving small arms fire; 85% experienced artillery, rocket or mortar fire; 43% handled human remains; 62% experienced dead/injured US forces; 24% had a friend injured near them; 28% gave aid to the wounded; 42% experienced sniper fire; 50% cleared and searched buildings; 51% experienced hostile civilians; and 45% reported a threatening situation to which they could not respond
–a 2014 survey of studies by the Walter Reed Army Institute of Research and published in the Journal of Clinical Psychiatry found that among veterans and service-members the greatest predictors of PTSD were high combat exposure rates and sexual abuse as an adult, and not events that occurred prior to service in the military as is often alleged. This is confirmed by many other studies, including a study by the VA from 1991 that found the best predictor of suicide in Vietnam veterans was combat related guilt.
–a 2016 study by Texas Tech University of student service–members and veterans found that 44% of those surveyed had experienced combat. This study included veterans and active duty/reserve service members, both those that deployed to Afghanistan and Iraq and those that did not.
Suicide is another factor the authors do not address. According to the VA, among the youngest male veterans of OIF/OEF, ages 18-29, the suicide rate is almost 6x higher for them than for their civilian male peers. For veterans in their 30s it is 3-4x higher. Among combat units that have been tracked the suicide rate is as high as 14x that of their civilian peers. This high and exaggerated rate of suicide holds true for all generations of American veterans who served during a war era. WWII veterans have a rate 4x higher than their non veteran peers. The link between combat and suicide is undeniable and has been well documented (a meta-study by the National Center for Veterans Studies in 2015 found a significant and clear link between combat and suicide in 21 of 22 studies examined). For veterans who did not serve in a war era, the rate of suicide is comparable or less than the civilian peer population. Veteran suicide is very troubling and not something to be disregarded when talking about veterans issues, particularly mental health.
One final note, and thank you for indulging this long correspondence, but the source in the study you write about, that cites less than a 10% PTSD rate in veterans comes from a survey of 700 Danish soldiers. The Danes faced very hard fighting in Helmand, at one point I believe they had the most casualties per capita of the nations in ISAF (they had one deployed battalion on infantry), but I think it is disingenuous and unwise of the study’s authors to use a study of Danish troops, to make a broad statement about American veterans.
For your reference, I was a Marine combat engineer officer for ten years. I have PTSD, TBI and neuro-cognitive disorder diagnosis from my time at war.
Let me know if you’d like more information. Again, thank you for indulging this long email (I thought this a better format than leaving a comment), and please consider writing an article on the documented level of combat in OIF and OEF veterans to dispel the myth that only 10% see combat, that these wars were safe, OIF/OEF vets had it easy, etc.
After almost 4 years I decided to give Twitter another try. I’m at @MatthewPHoh if you’d like to follow. I do interviews on a few radio and TV shows each week and so I figure Twitter might be a good, and simple, way to share those appearances.
With the assistance I’ve gotten from the doctors and the staff at the Durham VA Hospital, I also feel I am much more capable in handling the deluge of information that comes from Twitter and social media. An overabundance of information is something that easily overwhelms me cognitively and emotionally because of my TBI, Neuro-cognitive Disorder and PTSD. So let’s see how this works for me. I’m confident I’ll be able to handle it due to the training I’ve gotten from the VA to manage, adjust to and cope with the various issues in my brain. 🙂
$5.6 trillion, with no end in sight. That’s the cost of America’s wars since 9/11.
But as a Marine who served in Iraq, I don’t need a price tag to tell you about the cost of our wars for veterans like me. I’ve seen for myself the amputations, traumatic brain injuries, post traumatic stress disorder and moral injury that all lead to massively disproportionate levels of suicide, depression, substance abuse, domestic violence and homelessness in veterans returned home from war. And I’ve witnessed the human cost of our wars beyond our borders, in Iraq where I was stationed and for millions around the world.
Today, Veterans Day parades will celebrate the bravery of servicemembers, and I will be remembering those who were alongside me overseas. But before Cold War hysteria took over, November 11th was Armistice Day — a day for peace. The original Armistice Day marchers, veterans who survived the killing fields of the First World War, carried banners declaring “Never Again.” Imagine if we had listened to those veterans. Instead, our country continues to pour troops into stupid, bloated, and deadly wars.
$5.6 trillion by next September works out to $310 billion per year to prop up our endless wars. That’s $23,386 per taxpayer per year. Slice it however you want, it’s an incomprehensibly massive number. And instead of asking ourselves if a single penny is worth it, we just keep freefalling into gargantuan war debt.
As for the spiritual, emotional, mental, and physical costs of my time at war — we won’t ever pay those off. Neither will the friends I remember today who died for a country that won’t acknowledge the cost of their loss. Neither will our families and communities who continue to shoulder the burdens of our service long after we leave the battlefield.
That’s why Rep. John Lewis is speaking up to demand a public, national conversation on war financing. His amendment to Trump’s tax bill would prohibit cutting taxes on the rich — a loss of revenue that would add right onto our pile of war debt — until we get our troops out of Afghanistan, Iraq, and Syria and eliminate the war deficit gobbling up our budget.
From a talk I gave to the Licensed Professional Counselors Association of North Carolina in October on my own issues with PTSD, depression, moral injury, alcohol abuse and suicidality. Please feel free to share this video with others. Other men and women sharing their stories with me has helped in my recovery and I want to do my part and pass that kind of assistance along.
Prior to giving this talk, as I was driving to the conference and walking into the venue, I planned on drinking as soon as I was done. Not just a few beers to watch my Mets play the Dodgers in the playoffs, but a medicinal drowning and extinguishment of that all too familiar, exhausting and debilitating anguish in my head, heart and soul. When I was finished with my talk, although tired, the plan was still there. I drove to a bar, got out of my car, and walked to the bar door. My desire, at that moment, not to be a liar was stronger than my need to drink, and I got back in my car and drove home.
From watching the video I doubt you can tell the pain I was in during this talk, an emotional, existential pain, unlike any known physical pain, and a sort of pain that seems to have no hope or end to it. It is as if a wedge or filter is placed into my head, not allowing me to access the functional, rational, more evolutionary modern parts of my brain. I am living in the poisonous fog that William Styron so masterfully articulated in his Darkness Visible: A Memoir of Madness; a book that I can’t recommend enough to help friends and family understand how such mental pain and torment seems inescapable and unending, and drives otherwise very strong men and women to levels of despair that self-euthanizing becomes, in that ill and pained mind, a prudent, practical and necessary option.
My greatest gratitude to my good friend John Shuford who organized this talk and provided me with the video. I hope, in the future, to provide more information on an initiative John is working on to provide greater clinical training to therapists assisting veterans with combat related issues of PTSD, moral injury, depression, alcohol abuse and suicidality.
[Note: The introduction to the video gives a bit of a distorted summary of my career. You can find a professional biography on the About Me page of this blog. Not that it really matters though, as Babe Ruth said: “yesterday’s home runs don’t win today’s ball games”]
Back in March, Quaker House in Fayetteville, NC, the home of America’s largest military base, Fort Bragg, hosted me to discuss my recovery from PTSD and moral injury. The full video is below, along with a three minute clip that Lynn Newsom, the co-director of the Fayetteville Quaker House, is using in the talks she gives to military and non-military audiences on moral injury.
During my talk I am not very clear about the correlation, and, yes, I would also say causation, between combat and suicide. However, there is a very clear link between combat veterans and suicide, a link that is obviously very dangerous to cherished American myths of war, with all too familiar, prevalent and false motifs of justice, honor and redemption. To illustrate the connection between war, violence and suicide, a connection that manifests in veterans through PTSD, depression, substance abuse, and moral injury, I have included, at the end of this essay, 15 fairly easy to find studies of the last few decades documenting the prevalence of suicide in combat veterans.
Among the below studies, and among the most recent, dealing with my fellow veterans of the Afghan and Iraq Wars, researchers at the National Center for Veterans Studies have found that veterans who were exposed to killing and atrocity had a 43% greater risk of suicide, while 70% of those Afghan and Iraq veterans who participated in heavy combat had attempted suicide. We spends millions of dollars and thousands of hours to physically, mentally and morally condition each young man and woman who volunteers to serve in the military to travel abroad and kill, but upon their return, in reality, effective and thorough programs to decondition our veterans, help them reenter and reintegrate into society and regain emotional, moral and spiritual balance and health are nonexistent, while care for developed wounds, both physical and mental is underfunded. Continue reading →
Healing a Wounded Sense of Morality
Many veterans are suffering from a condition similar to, but distinct from, PTSD: moral injury, in which the ethical transgressions of war can leave service members traumatized.
MAGGIE PUNIEWSKA JUL 3, 2015
Amy Amidon has listened to war stories on a daily basis for almost a decade.
As a clinical psychologist at the Naval Medical Center in San Diego, she works with a multi-week residential program called OASIS, or Overcoming Adversity and Stress Injury Support, for soldiers who have recently returned from deployments. Grief and fear dominate the majority of the conversations in OASIS: Amidon regularly hears participants talk about improvised explosive devices claiming the lives of close friends; about flashbacks of airstrikes pounding cities to rubble; about days spent in 120-degree desert heat, playing hide and seek with a Taliban enemy. Many veterans in the program are there seeking treatment for post-traumatic stress disorder.
But many of Amidon’s patients talk about another kind of trauma, a psychic bruise that, unlike PTSD, isn’t rooted in fear. Some of these soldiers describe experiences in which they, or someone close to them, violated their moral code: hurting a civilian who turned out to be unarmed, shooting at a child wearing explosives, or losing trust in a commander who became more concerned with collecting decorative pins than protecting the safety of his troops. Others, she says, are haunted by their own inaction, traumatized by something they witnessed and failed to prevent. In 2012, when the first wave of veterans was returning from the Middle East, these types of experiences were so prevalent at OASIS that “the patients asked for a separate group where they could talk about the heavier stuff, the guilt stuff,” Amidon says. In January 2013, the center created individual and group therapy opportunities specifically for soldiers to talk about the wartime situations that they felt went against their sense of right and wrong. (Rules of engagement are often an ineffective guide through these gray areas: A 2008 survey of soldiers deployed at the beginning of the conflict in Iraq found that nearly 30 percent of the soldiers in each group encountered ethical situations in which they were unsure how to respond.)
Experts have begun to refer to this specific type of psychological trauma as moral injury. “These morally ambiguous situations continue to bother you, weeks, months, or years after they happened,” says Shira Maguen, the mental-health director of the OEF/OIF Integrated Care Clinic at the San Francisco Veterans Affairs Medical Center and one of the first researchers to study the concept. Examples of situations that might precipitate moral injury are betrayals by those in leadership roles, within-rank violence, inability to prevent death or suffering, and hurting civilians. Sometimes it co-exists with PTSD, but moral injury is its own separate trauma with symptoms that can include feelings of shame, guilt, betrayal, regret, anxiety, anger, self-loathing, and self-harm. Last year, a study published in Traumatology found that military personnel who felt conflicted about the “rightness” or “wrongness” of a combat situation were at an increased risk for suicidal thoughts and behavior afterwards, compared with their peers who didn’t have that same sense of ambiguity. The main difference between the two combat-induced traumas is that moral injury is not about the loss of safety, but the loss of trust—in oneself, in others, in the military, and sometimes in the nation as a whole. Continue reading →
“In war, truth is the first casualty.”
— Aeschylus 525-456 BC
As reported by the BBC this month, the Taliban have rejected an offer by the newly installed President of Afghanistan, Ashraf Ghani, of Cabinet positions and governorships in three Afghan provinces. The provinces include Helmand and Kandahar, where thousands of American and Western troops have been killed and wounded, particularly since 2009 when President Obama chose to escalate the war in Afghanistan rather than seeking a political solution to end the war.
Five years on and Afghan civilian and security force casualties are at record highs, the Taliban is larger and stronger than it has been at any point since 2001, government and police corruption is massively untamed, and Afghans last year were subjected to their third incredibly fraudulent national election in five years. In fact, the only thing going well for anyone in Afghanistan, besides the Taliban and those on the take of Western foreign aid, are the bumper narcotics crops, which each year produce historic yields.
The Taliban, having been offered power in their home region, have spurned any opportunities for reconciliation and compromise. “Moderates” within the Taliban, whom we could have negotiated with in 2008 and 2009 prior to President Obama’s escalation of the war, have been proven wrong and largely eliminated. The hard-line elements of the Taliban, having seen the Taliban weather the full force of the United States of America, see history as repeating itself or, at the very least, rhyming. Like the departure of the Soviet Union from Afghanistan in 1989, it is now just a question of time before the foreign backed regime in Kabul collapses. Time, among many other factors, was always on the side of the Afghan insurgents. Continue reading →