SAN DIEGO — It is still not known if the soldier accused of killing 17 Afghans was ever diagnosed with post-traumatic stress disorder — but even if he had been, that alone would not have prevented him from being sent back to war.
The Army diagnosed 76,176 soldiers with PTSD between 2000 and 2011. Of those, 65,236 soldiers were diagnosed at some stage of their deployment.
Many returned to the battlefield after mental health providers determined their treatment worked and their symptoms had gone into remission, Army officials and mental health professionals who treat troops say. The Army does not track the exact number in combat diagnosed with PTSD nor those who are in combat and taking medicine for PTSD.
The case of Sgt. Robert Bales has sparked debate about whether the Army failed in detecting a soldier’s mental instability or pushed him too far. The Army is reviewing all its mental health programs and its screening process in light of the March 11 shooting spree in two slumbering Afghan villages that killed families, including nine children.
For some Americans, Bales is the epitome of a soldier afflicted by war’s psychological wounds, pushed by the Army beyond his limits.
Bales’ attorney says he does not know if his client suffered from PTSD but his initial statements appear to be building a possible defense around the argument that the horrific crime was the result of a 10-year military veteran sent back to a war zone for a fourth time after being traumatized.
Mental health professionals say it’s reasonable to consider PTSD but it was likely not the sole factor that sent the 38-year-old father from Washington state over the edge. Still, there is much that is not known about the psychological wounds of war and how they can manifest themselves, and even less is known about the impact of multiple deployments.
Military officials say they have to rely on their mental health experts to decide whether someone is mentally fit to go back into war, and they cannot make a blanket policy of not redeploying troops diagnosed with PTSD. The provider makes a recommendation, but the ultimate decision to deploy a soldier rests with the unit commander.
Army Secretary John McHugh told Congress this week that “we have in the military writ large over 50,000 folks in uniform who have had at least four deployments.” Some have served double-digit deployments, where they witnessed traumatic events.
“People do not understand that you can be treated for PTSD,” said Dr. Heidi Kraft, who cared for Marines in Iraq in 2004 as a Navy combat psychologist. “It’s a matter of turning a traumatic memory into just that — a memory rather than something that haunts you. “You can’t say the person hasn’t live through trauma, but symptoms can go completely into remission, where a person is very functional and in fact emerges from treatment better or more resilient. There is the misconception out there that if you have this diagnosis, you will always be disabled, and that’s just not true.”
It also depends on the severity of the PTSD, which can last anywhere from months to years.
Some troops treated for PTSD yearn to return to the battlefield where they feel more comfortable surrounded by their fellow troops and on a mission than in the unsettling quiet of their home life, mental health professionals say.
But Bales’ attorney, John Henry Browne of Seattle, said that was not the case with his client. He said Bales had suffered injuries during his deployments, including a serious foot injury and head trauma, and did not want to go on a fourth tour.
Military officials insist that Bales had been properly screened and declared fit for combat.
Army officials say soldiers sent to war may be checked up to five times, including before being deployed, during combat, once they return home and six months and a year later. The Army screens soldiers for depression and PTSD, asking questions to find out about any social stressors, sleep disruption and other problems. Those who are detected as having problems go on to a second phase of screening.
Officials say, however, that no test is considered diagnostically definitive for mental illness in general or PTSD in particular.
Critics say the Army has a history of bandaging the problem and rushing troops back into combat by loading them up on prescription drugs. Military courts also do not recognize PTSD as a legitimate defense, said attorney Geoffrey Nathan, who has represented a number of court-martialed troops.
“They’re still in a state of denial as to what combat soldiers go through in the field of battle,” Nathan said.
The Army says it’s committed to the health of the force, noting it has invested $710 million in behavioral health care and doubled the number of mental health workers since 2007.
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