Every time I try and convince myself that I'm being oversensitive to the drumbeat of 'damaged soldiers' stories - which I am at root convinced are about the notion that war is simply too damaging to the delicate sensibilities of our troops to actually, you know, send them into combat - the press steps to the plate and hits the ball right at me.
Here's the latest piece at Bloomberg:
The number of suicides among veterans of wars in Iraq and Afghanistan may exceed the combat death toll because of inadequate mental health care, the U.S. government's top psychiatric researcher said.
Community mental health centers, hobbled by financial limits, haven't provided enough scientifically sound care, especially in rural areas, said Thomas Insel, director of the National Institute of Mental Health in Bethesda, Maryland. He briefed reporters today at the American Psychiatric Association's annual meeting in Washington.
Insel echoed a Rand Corporation study published last month that found about 20 percent of returning U.S. soldiers have post- traumatic stress disorder or depression, and only half of them receive treatment. About 1.6 million U.S. troops have fought in the two wars since October 2001, the report said. About 4,560 soldiers had died in the conflicts as of today, the Defense Department reported on its Web site.
Based on those figures and established suicide rates for similar patients who commonly develop substance abuse and other complications of post-traumatic stress disorder, ``it's quite possible that the suicides and psychiatric mortality of this war could trump the combat deaths,'' Insel said.
Well, d'ooh. Welcome to the magic of bad statistics. If the 1.6 million troops who have been to Iraq or Afghanistan during this war have exactly the same rate of suicide as the general population for the rest of their lives - more of them will die than died in the war. The national rate of suicide in 2005 for ages 15+ was 13.14/100000. Assume that the average age of the soldiers is 30, this gives them ~40 years of exposure to the risk of suicide - so 1.6 million * 13.14/100,000 * 40 years = 8,409 suicides. The issue is that the rate of combat deaths is so low that by comparison to other low-probability events - they seem remarkably high.
Men apparently have a 1:34 lifetime chance of dying of prostate cancer (it's dropping now, thankfully); that means some 40,000 of the returning troops will probably die of prostate cancer. If you look at the CDC's 'cause of death by age' table, suicide ranks 11th for all ages - and it's doubtless lower for veterans who have a lower suicide rate than the average population. The article suggests that we should spend more on counseling - and we doubtless should. But shouldn't we balance that consideration against the consequences for our veterans of - say - better prostate cancer screening?
So the article is a twofer - on one hand, it helps drive home the notion that veterans are irremediably damaged by their exposure to war - something that is popular in movies, but just not borne out by the facts, not post-WW II, not post-Vietnam, and I will wager, not post-this war. And on the other, it manages to try and drive public policy by using veterans to suggest that we invest more in public mental health (which might be good to do, balanced against other priorities) - it's the 'poster-child' school of policy making, which ignores facts in favor of dramatic incidents.
Some veterans will be damaged, and we should absolutely do what we can to help them overcome it, and make thoughtful decisions on investment to improve counseling and their access to the help they need.
And maybe, just maybe, one of the things I'll suggest is not treating them - contrary to the facts - like they are going to go psycho any second..