On a day like today, when 19 American soldiers were killed in a single blast at a military base near Mosul, “the deadliest single strike against US troops since the start of the Iraq war,” we tend to forget that there are casualties in this war that are not as easily quantified. We’ve heard, for example, that there have been in excess of 1,300 US service members killed, and well over 8,000 wounded. But there have been a reported 30,000+ “medical evacuations” from Iraq, and some of these relate to wounds that are not apparent to the naked eye.

On three successive nights last week, Nightline, hosted by Ted Koppel, featured a series entitled “Coming Home: Invisible Casualties.” These are the kinds of casualties that were once characterized as “combat stress” or “battle fatigue” or “shell shock.” But while there is no “shame” in returning to the states with one less limb, the emotional scars are all too often hidden by a military culture that deplores “weakness.” As one soldier puts it: “You don’t want ... the people who work under you to think that you’re weak.” ABC News reporter John McQuethy points out that it is never “easy to confess doubt, let alone depression. ... Even the women soldiers are discouraged from showing emotion.”

Koppel summarizes the startling facts:

It’s still a macho culture. ... And talking about it is not the best way to advance your career. But [according to the New England Journal of Medicine] an estimated 1 out of 6 combat troops returns with Post-Traumatic Stress Disorder (PTSD). 1 out of 6. Here’s the problem. The army takes perfectly ordinary men and women, mostly men, and teaches them how to kill. In peacetime, that’s a purely theoretical exercise. Soldiers are trained how to use their weapons but they never actually have to go out and kill anyone. And except for the occasional accident during a training exercise, none of their buddies is ever killed. ... But in wartime, things are different. ... Two recent medical surveys estimate that of the roughly 140,000 troops now in Iraq, about 23,000 will come home with some sort of depression or generalized anxiety.

This is not the typical portrait that is being painted by an embedded media. As NY Times journalist Chris Hedges argues, the media is too busy peddling “the myth of war ... the myth of heroism, the myth of glory, the myth of honor. The reality of war is so revolting and horrifying that if we actually saw it, we would be disgusted.” Hedges’s book, War is a Force That Gives Us Meaning, is taught regularly at West Point. In it, Hedges discusses the “intoxicating powers of violence and war.” He explains that when he covered his first war, it had all the excitement of a “first sexual experience,” something that could never be duplicated. It had a narcotic effect on him. For Hedges, “war is the most powerful narcotic invented by humankind,” and in many respects, it has a “direct correlation” to the experience of taking drugs. On the battlefield, one feels a “pumped-up” rush of adrenaline, a “combat high,” a sense of being

present in a way that you never were before, when even colors are brighter. You have these grotesque hallucinogenic landscapes where you see things that were unimaginable to you, in terms of ... what happens to human bodies, entire villages in flames. ... The concussions of explosive devices. You never sleep very well. And you can fall into these sort of zombie-like trances, and all of this can happen within a 24-hour period.

But Hedges maintains that none of the battle footage that is broadcast today truly captures the reality of war. Journalists may seek to impose a sense of order and logic on that which they report, but the situations on the battlefield are usually characterized by chaos and destruction:

You never watch somebody with their legs blown off ... bleeding to death for twenty minutes in the sand. ... When we wage war too easily, when—as a nation—we think war is a form of entertainment, that war is somehow like a video game, then perhaps we need a dose of that to understand what war actually is.

Alas, the soldiers returning from Iraq understand it. McQuethy interviewed many of these men and women, who tell us how they are suffering from assorted mental and emotional stresses, where even “loud noises like thunderstorms in the night become a crippling trigger.” Many of the more than 300,000 US troops that have served in Iraq are returning to a very unstable emotional life. Robert Ursano, who is the Director of the Center for Traumatic Stress and Chief Psychiatrist at the military’s “own medical school says Iraq today—with suicide bombers, roadside mines, and the constant threat of attack—poses a unique challenge to the mental health of American troops.” These troops are suffering under the threat of “extreme uncertainty [which] is likely to cause even deeper psychological scars.”

The soldiers operate in an environment where everything is performed under fire or threat of fire. As one soldier puts it: “Everyday, it never changes. Everyday, you’re scared.” That fear of “not really knowing if you’re going to come home. ... It’s just not knowing. That’s the worst part about it.” That, and the fact that soldiers are seeing all forms of unspeakable horror, inspiring intense feelings of fear, disbelief, agitation, and irritability, leading to decreased sleep, changes in appetite, depression, and isolation.

In essence, many of these soldiers have been reduced to a state of metaphysical uncertainty and inefficacy, which is profoundly disabling.

There is a basic human need for efficacy, a need to know that one’s actions will bring about a desired effect. In his book, The Power of Self-Esteem, psychologist Nathaniel Branden stresses that this need for cognitive efficacy

is not the product of a particular cultural “value bias.” There is no society on earth, no society even conceivable, whose members do not face the challenge of fulfilling their needs—who do not face the challenges of appropriate adaptation to nature and to the world of human beings. The idea of efficacy in this fundamental sense ... is not a “Western artifact.” ... We delude ourselves if we imagine there is any culture or society in which we will not have to face the challenge of making ourselves appropriate to life.

In the atmosphere that is Iraq, terrorism is used as a weapon to undermine certainty and efficacy as such. Its aim is to strike in unpredictable and violent ways.

Some soldiers have attempted to deal with these realities by keeping a journal. One man

described seeing an enemy fighter after he had been shot."The left side of his skull had been blown off and all that was visible was his brain. Yes, that’s right. His brain. I do not know what to do. I have seen so much blood and death. It is enough for a lifetime." He also wrote dark poetry to calm his nerves. As death comes like the shadows creep/ We watch children suffer as parents weep/We came to give a better life/ We leave in the midst of turmoil and strife.

Journal-keeping is not the only method of calming a soldier’s nerves. The military has become proactive in assisting soldiers while they are in Iraq, and in offering additional assistance upon their return home. But there is still “the stigma of getting help for psychological problems,” which is “an enormous barrier.” True, the military has come a long way from that episode immortalized in the film “Patton” when the General, played by George C. Scott, slapped a soldier across the face, calling him a coward for manifesting “battle fatigue.” Today’s military takes the soldiers’ emotional burdens much more seriously. Troops are getting briefings and filling out questionnaires upon their return home. And they receive a second full “mental health” screening three months after their return from combat. But it often takes months for “post-traumatic stress disorder” to become obvious.

Now, I’m not concerned here with the debate over whether PTSD is a real “disease”; see, for example, Thomas Szasz. Nor am I concerned here with the cozy, troubling relationship that has developed between the military and the state-psychiatric nexus: Often what happens is that a soldier’s emotional turmoil is treated with Paxil or Zoloft before he or she is sent out for yet another tour of duty.

All that concerns me here is a simple acknowledgment of the “invisible casualties” that have consumed US troops in the Iraq war. All the more reason to think long and hard about the nature and purpose of their mission.

Lots of eye-blotting and faux sobriety over at the WaPo editorial page today about the Mosul bloodbath.  In it, they cling unthinkingly to the "if only that bastard Rumsfeld had sent more troops!" mantra:

Thanks in part to the mistakes of the Bush administration, which has failed to deploy enough troops to places such as Mosul, it's not yet clear which side will win this fateful battle...

I'd just like to ask, though, what is it exactly that these extra troops would be doing in Mosul to prevent these attacks?  Maybe they would be going house to house, kicking in doors, looking for insurgents.  Certainly that would decrease the body count, right?  Isn't it much more likely that more troops would equal more targets?  It's not like we're weak on our right flank and need air support and an armored division.  More troops would mean one of two things: a different (indefinite colonial/nation-building style) mission, or else more targets for insurgents.

Get 'em out, already.

CSIS's Tony Cordesman has released a new report on the training and equipping of Iraqi security forces.  I haven't had time to read the whole thing, but it's rather grim.  Cordesman reports (pp. 52-53) for example that:

there have been many occasions on which various Iraqi forces have failed to perform their missions both as a result of these insurgent attacks, a lack of leadership and integrity on the part of some Iraqi officers, and a lack of experience and dedication on the part of other ranks.

The failure of the Iraqi police forces in Mosul during and after the battle of Fallujah in November 2004, and the need to dismiss their commander Brigadier General Mohammed Keri Barhawi is only one example of such problems.  Nearly 75% of some 4,000 Iraqi forces deserted when insurgents attacked on November 12, 2004, in the midst of the US-Iraqi attack on insurgents in Fallujah. The ranks of Iraqi National Guard units dropped from 1,100 to 300 men in hours, and two companies -- some 200 men -- abandoned all of their equipment. The 106th Iraqi National Guard Battalion did well, but the 307th Battalion virtually disintegrated.

Somewhat similar failures occurred in Samarra, although at a much lower level. Some 2,000 Iraqi troops did join the US forces fighting to retake the city in October 2004, but only after some 300 men out of a 750-man battalion deserted before the fighting even began.

At the same time, Iraqi forces are showing that they can be effective when they have the proper leadership, organization, training, equipment, and facilities. Some have fought well in demanding battles and engagements, and even less combat-capable forces like the police are taking hold in many areas.

He goes on to explain how the Iraqi forces, in general, do not have proper leadership, organization, training, equipment, and facilities.

I have occasionally mentioned the work of Thomas Szasz, a man who is one of my great personal heroes. Dr. Szasz's dedication to genuine human freedom and his ongoing resistance to the widespread destruction caused by the"therapeutic state" constitute one of the truly great achievements of our time, and his work deserves your very careful consideration. Look over his website, and read some of the many illuminating articles you will find there.

In connection with the story discussed below, consider these excerpts from a Szasz article which appeared in USA Today ("Mental Disorders Are Not Diseases"; emphasis added):

I maintain that the mind is not the brain, that mental functions are not reducible to brain functions, and that mental diseases are not brain diseases--indeed, that mental diseases are not diseases at all.

When I assert the latter, I do not imply that distressing personal experiences and deviant behaviors do not exist. Anxiety, depression, and conflict do exist--in fact, are intrinsic to the human condition--but they are not diseases in the pathological sense.

...

The core medical concept of disease is a bodily abnormality. Literally, the term"disease" denotes a demonstrable lesion of cells, tissues, or organs. Metaphorically, it may be used to denote any kind of malfunctioning of individuals, groups, economies, etc. (substance abuse, violence, unemployment, et al.).

The psychiatric concept of disease rests on a radical alteration of the medical definition. ...

[I]n Psychiatric Diagnosis, Donald Goodwin and Samuel B. Guze, two of the most respected psychiatrists in the U.S., state:"When the term `disease' is used, this is what is meant: A disease is a cluster of symptoms and/or signs with a more or less predictable course. Symptoms are what patients tell you; signs are what you see. The cluster may be associated with physical abnormality or may not. The essential point is that it results in consultation with a physician." According to these authorities, disease is not an observable phenomenon, but a social relationship.

...

Linguistic considerations help to illuminate the differences between bodily and mental disease, as well as between disease and diagnosis. We do not attribute motives to a person for having leukemia, do not say that a person has reasons for having glaucoma, and would be uttering nonsense if we asserted that diabetes has caused a person to shoot the President. However, we can and do say all of these things about a person with a mental illness. One of the most important philosophical-political features of the concept of mental illness is that, at one fell swoop, it removes motivation from action, adds it to illness, and thus destroys the very possibility of separating disease from non-disease and disease from diagnosis.

...

Nowadays, names routinely are given not only to somatic pathology (real or bodily diseases), but to behavioral pathology (psychopathology or mental diseases). Indeed, if we propose to treat misbehavior as a disease instead of a matter of law or social policy, we name it accordingly (for instance,"substance abuse"). Not surprisingly, we diagnose mental illnesses by finding abnormalities (unwanted behaviors) in persons, not abnormalities (lesions) in bodies. That is why forensic psychiatrists"interview" criminals called"patients" (who often do not regard themselves as patients), whereas forensic pathologists examine body fluids. In the case of bodily illness, the clinical diagnosis is a hypothesis, typically confirmed or disconfirmed through an autopsy. It is not possible to die of a mental illness or to find evidence of it in organs, tissues, cells, or body fluids during an autopsy.

To summarize, anthrax is a disease that is biologically constructed and can, and does, kill its host. Attention deficit disorder, on the other hand, is socially constructed and cannot kill the patient.

...

In short, psychiatrists and their allies have succeeded in persuading the scientific community, courts, media, and general public that the conditions they call mental disorders are diseases--that is, phenomena independent of human motivation or will. Because there is no empirical evidence to back this claim (indeed, there can be none), the psychiatric profession relies on supporting it with periodically revised versions of its pseudo-scientific bible, the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders.

...

Because the idea of mental illness combines a mistaken conceptualization (of nondisease as disease) with an immoral justification (of coercion as cure), the effect is two-pronged--it corrupts language and curtails freedom and responsibility. Because psychiatrists have power over persons denominated as patients, their descriptive statements typically function as covert prescriptions. For instance, psychiatrists may describe a man who asserts that he hears God's voice telling him to kill his wife as schizophrenic. This"diagnosis" functions as a prescription--for example, to hospitalize the patient involuntarily (lest he kill his wife) or, after he has killed her, to acquit him as not guilty by reason of insanity and again hospitalize him against his will. This coercive-tactical feature of psychiatric diagnosis is best appreciated by contrasting medical with psychiatric diagnosis. Diagnosis of bodily illness is the operative word that justifies a physician to admit to a hospital a patient who wants to be so admitted. Diagnosis of mental illness is the operative word that justifies a judge to incarcerate in a mental hospital a sex criminal who has completed his prison sentence.

...

If we restrict the concept of treatment to a voluntary relationship between a medical practitioner and a competent client, then a coerced medical intervention imposed on persons not legally incompetent is, by definition, assault and battery, not treatment. Psychiatry is thus a systematic violation of this legal-political principle, one that is especially odious because most persons treated against their will by psychiatrists are defined as legally competent--they can vote, marry and divorce, etc. It is important to keep in mind that, in a free society, the physician's"right" to treat a person rests not on the diagnosis, but on the subject's consent to treatment.

Regardless of psychiatric diagnosis, the typical mental patient is entitled to liberty, unless convicted of a crime punishable by imprisonment. If that patient breaks the law and is convicted, then he or she ought to be punished for it as prescribed by the criminal law. In a free society, a person ought not to profit from psychiatric excuses or suffer from psychiatric coercions.

BOICEVILLE, N.Y. - Jack Thomas, a 10th grader at a school for autistic teenagers and an expert on the nation's roadways, tore himself away from his satellite map one recent recess period to critique a television program about the search for a cure for autism.

"We don't have a disease," said Jack, echoing the opinion of the other 15 boys at the experimental Aspie school here in the Catskills."So we can't be 'cured.' This is just the way we are."

From behind his GameBoy, Justin Mulvaney, another 10th grader, objected to the program's description of people"suffering" from Asperger's syndrome, the form of autism he has.

"People don't suffer from Asperger's," Justin said."They suffer because they're depressed from being left out and beat up all the time."

That, at least, was what happened to these students at mainstream schools before they found refuge here.

But unlike many programs for autistics, this school's program does not try to expunge the odd social behaviors that often make life so difficult for them. Its unconventional aim is to teach students that it is O.K. to"act autistic" and also how to get by in a world where it is not.

Trained in self-advocacy, students proudly recite the positive traits autism can confer, like the ability to develop uncanny expertise in an area of interest. This year's class includes specialists on supervolcanoes and medieval weaponry.

"Look at Jack," Justin pointed out."He doesn't even need a map. He's like a living map."

The new program, whose name stands for Autistic Strength, Purpose and Independence in Education - and whose acronym is a short form of Asperger's - is rooted in a view of autism as an alternative form of brain wiring, with its own benefits and drawbacks, rather than a devastating disorder in need of curing.

It is a view supported by an increasingly vocal group of adult autistics, including some who cannot use speech to communicate and have been institutionalized because of their condition. But it is causing consternation among many parents whose greatest hope is to avoid that very future for their children. Many believe that intensive behavioral therapy offers the only rescue from the task of caring for unpredictable, sometimes aggressive children, whose condition can take a toll on the entire family.

The autistic activists say they want help, too, but would be far better off learning to use their autistic strengths to cope with their autistic impairments rather than pretending that either can be removed. Some autistic tics, like repetitive rocking and violent outbursts, they say, could be modulated more easily if an effort were made to understand their underlying message, rather than trying to train them away. Other traits, like difficulty with eye contact, with grasping humor or with breaking from routines, might not require such huge corrective efforts on their part if people were simply more tolerant.

Spurred by an elevated national focus on finding a cure for autism at a time when more Americans are receiving autism diagnoses than ever before - about one in 200 - a growing number of autistics are staging what they say amounts to an ad hoc human rights movement. They sell Autistic Liberation Front buttons and circulate petitions on Web sites like neurodiversity.com to"defend the dignity of autistic citizens." The Autistic Advocacy e-mail list, one of dozens that connect like-minded autistics, has attracted nearly 400 members since it started last year.

The debate about the particulars of this controversy is irrelevant to the most critical issues here. First, there is overwhelming evidence that our society -- which insists, as Szasz puts it, on"medicalizing" every condition which fails to follow the demands of conformity -- diagnoses ailments and"problems" where no problems exist for the most part. When more and more children are forced to take Ritalin every year (see this Szasz article on that subject), you are witnessing a society which grows closer and closer to 1984: a world where individuality is crushed at every turn, and every form of"deviance" must be" cured." Similarly, when an astonishing and increasing number of Americans is diagnosed as “suffering” from autism, you can be certain that something has gone wrong on a fundamental level.

Second, I've been discussing Alice Miller's pioneering work on the roots of adult cruelty in early child rearing practices in a long series of essays. (I'm in the process of reposting those essays at my new site, necessitated by technical problems with the old one; you will find the ones currently available here.) As Miller points out, adults routinely inflict unimaginable cruelty on children and defend it all by contending the adults do it"for the child's own good." In fact, such efforts are directed at eliminating all traces of the child's authentic, vital self. The NYT story has several clues that it is precisely this mechanism that underlies much of the treatment of autistic children. For example, consider this statement from one parent of an autistic child who derides those who think is is"okay" to be autistic:

I intend to cure, fix, repair, change over etc. my son and others like him of his profound and typical disabling autism into something better.

Then consider these statements:

The touchiest area of dispute is over Applied Behavior Analysis, or A.B.A., the therapy that many parents say is the only way their children were able to learn to make eye contact, talk and get through the day without throwing tantrums. Some autistic adults, including some who have had the therapy, say that at its best it trains children to repress their natural form of expression and at its worst borders on being abusive. ...

"Behaviors are so often attempts to communicate," said Jane Meyerding, an autistic woman who has a clerical job at the University of Washington and is a frequent contributor to the Autistic Advocacy e-mail discussion list."When you snuff out the behaviors you snuff out the attempts to communicate."

And this raises an additional question in my mind: to what extent might autistic behavior represent an attempt to communicate that earlier abuse of the child has already occurred? I would be very interested to know of any research setting forth detailed family histories of autistic children, including how they were treated in the very first years of life, and I wonder if such research has even been done. I suspect it might be very instructive.

I also think it might well reveal a great deal of parental abuse. In support of that contention, look at this passage about one mother who says she is"afraid" of the movement that seeks to remove the stigma from autism:

Ms. Weintraub's son, Nicholas, has benefited greatly from A.B.A., she said, and she is unapologetic about wanting to remove his remaining quirks, like his stilted manner of speaking and his wanting to be Mickey Mouse for Halloween when other 8-year-olds want to be Frodo from"The Lord of the Rings.""I worry about when he gets into high school, somebody doesn't want to date him or be his friend," she said."It's no fun being different."

Finally, think about the following. Every single one of the arguments used to justify"fixing" or"repairing" autistic children has been used in the past with regard to other"illnesses." I myself heard all of them as a teenager in the 1960s coming to terms with being gay. As I've discussed before (here, for example), I was even encouraged to undergo electroshock therapy, to" cure" me of homosexuality and make me straight. That way, I wouldn't have to worry about not having friends or having a date (at least, with a girl), or being"different."

I declined that offer -- and I am thrilled to see these children and their families resisting the calls that they be" cured" in much the same way. The extent to which our society -- nominally dedicated to individualism and personal freedom -- demands that everyone be essentially identical and cut from the same mold is astonishing. And the costs of all kinds exacted by those demands are terrible -- and the greatest cost is the destruction of the genuine, authentic person, even if it is a person who has tics and other behaviors that make"normal" people uncomfortable.

I had thought that, in certain ways at least, we had reached the point where we were beginning to celebrate our differences, rather than viewing them with suspicion, condemning them and always trying to"repair" them. But this story shows yet again how far we still have to go -- and how much damage we inflict on innocent victims in the meantime.

(Cross-posted at The Light of Reason.)

Can somebody tell me how it's possible that I just heard Sen. John Warner on C-SPAN right now blaming the Iraqis for the situation in Iraq?  I can't seem to find a transcript, but he said something very much like "We're just not getting the support that we need from the Iraqi people to make this project work."

I'd like to channel some Rumsfeldian dialectic in response to Senator Warner's grumbling.

"Well, my goodness!  Can you imagine, can you put yourself in the position of an Iraqi citizen when he hears things like this?  A wealthy pro-war senator from Virginia complaining about the failings of the Iraqi people?  Good grief!

"Senator Warner might care to try his hand at living in Iraq today.  The situation in Iraq today is terrible.  The security situation in broad swaths of the country would startle Thomas Hobbes.  The insurgency is growing, and U.S. troops have been unable to establish an increasing area of security.

"If I were an Iraqi, I would be outraged at Senator Warner's remarks.  After having lived under the tyranny of Saddam Hussein, and then in the bloody anarchy that currently exists, for the problem to be blamed on the Iraqis is just astonishing.  We have to be honest here: the responsibility for this situation rests with the United States.  Whether one cares to attribute it to a lack of planning on my part, or a flawed logic that couldn't succeed regardless, attempting to shift blame onto the Iraqis is just...well, I'm not quite sure what to say about it."

Now we have been subject to sermonizing about the firing of ineffective Tyrone Willingham as head coach. Since he was black, some people claim that the reason he was fired must therefore be racism, or even “systematic racism.” (For some sillier examples, see here and here.)

I have a hard time believing that racism had anything to do with Willingham’s firing, or with the relative dearth of black coaches in NCAA football generally. The one thing those college football programs want to do is win. They don’t care what color the players, coaches, staff, or anyone else is. In this they are quite unlike college and university administrators’ attitudes about other students—where their color does matter quite a bit. But in big-time football programs, like Notre Dame’s, Oklahoma’s, Alabama’s, Miami’s, and on and on, my suspicion is that if they thought they could win by hiring a particular black coach, they’d do it. Without batting an eye.

Raspberries to Major League Baseball and its policy of extortion. If it needs to steal from people to support itself, it can go to hell.