Psychiatric Screening and Sgt. Bales

Army doctor Stephen N. Xenakis:

Ten years into the war in Afghanistan, and after nearly nine years of war in Iraq, we know that the defining injuries of these conflicts for our service members include traumatic brain injury and post-traumatic stress disorder. We also understand that the all-volunteer force is stretched thin and that multiple deployments to combat zones are routine.

What military physicians don’t have a good sense of, however, is how to tell whether a combat veteran is still qualified for the battlefield. And the tragedy this month in Afghanistan, where Army Staff Sgt. Robert Bales, on his fourth combat tour, allegedly slaughtered 17 civilians and has been charged with murder, underscores the urgency of finding a better solution. . . .

Soldiers are, of course, screened before and after deploying. But although this process involves multiple questionnaires and a review of medical records, it varies from base to base. No physiological tests are used, and soldiers may or may not see clinicians. Assessments are highly subjective and have been criticized for relying on self-reports. After all, soldiers may not be honest about their problems. If injured or unstable, they may be unable to deploy with teammates who rely on them or may face delays in going home.

Gee, wouldn't it be nice if we had a standard test that told us who was about to embark on a mad shooting spree? Or who was likely to abuse children? Or anything else about future behavior?

But we don't. When it comes to predicting how people will behave, our "science" is mostly a sham. A huge amount of effort has been put into this by researchers, governments, and corporate human resources departments, with no meaningful results. My teenage son and his friends have been applying for jobs at places like PetSmart and Home Depot, and these days this involves filling out, online, hundred-item questionnaires full of intensely personal questions. They rage about what a pain this is, and I think, pity the people who think such tests have  any value in predicting who will work out and who won't.

One thing we have learned from psychological science is that how we act is strongly determined by the situations we are in. People who would not (for example) abuse helpless prisoners alone may get into it if their whole platoon is doing it. People who are great in civilian life may crack on the battlefield. And people who are extraordinary soldiers are sometimes complete failures in civilian life. To get back to PetSmart, I bet that whether new employees slack off or steal has more to do with the atmosphere in the store than whatever characteristics they bring with them.

Another thing we know is that combat is bad for your mental health. That long term study of the Harvard class of 1940 found a strong correlation between the amount of combat men saw in World War II and their mental health in later life -- the more combat, the more likely they were to suffer from alcoholism, depression, and even physical ailments like heart disease. As long as we are going to fight wars, somebody has to go into combat, but the politicians and generals who make those decisions ought to think harder about the long-term harm they are doing to their soldiers. The real culprits in Sergeant Bales' shooting are the leaders in the Taliban and Washington who launched this war and kept it going so long that somebody, somewhere, was bound to crack.