War without End
Ridgway, James D., Judicature
War Without End Veterans on Trial: The Coming Court Battles over PTSD, by Barry R. Schaller. Potomac Books 2012. 227 pages. $29.95
Time after time, the difficulty of confronting the traumatic nature of war has driven the public's attention away from conflicts upon their conclusion, if not sooner. Nevertheless, that same trauma lives on for many of those who experienced the field of battle. In a thought-provoking book, retired Connecticut Supreme Court Justice Barry Schaller explores the long term mental health effects of the Iraq and Afghanistan conflicts - conflicts with which the nation's criminal court systems will be wrestling for decades. As Justice Schaller details, our veterans with post-traumatic stress disorder (PTSD) have long posed a challenge for society. The coming decades will be distinguished not by the burdens, however, but by the choices we make in handling them. The criminal justice system will be faced with many of these choices; how it should begin to prepare is the destination of a long journey through the history of war and psychiatry.
When They Come Marching Home
Justice Schaller spends a substantial portion of the book laying the groundwork for his arguments by advancing steadily across the history of American wars and the mental health casualties that they produced. It is a two-pronged approach.
On a macro level, he predicts the future prevalence of PTSD in Iraq and Afghanistan veterans by extensively reviewing the historical record and reports on the recent conflicts. Even if his book were to accomplish nothing else, it would be a tremendous resource for anyone seeking a guide to the large body of past research on PTSD. In presenting his digest, Justice Schaller is careful to acknowledge the limitations of the reports and studies he cites. He points out such issues as limited sample sizes and analytical differences that limit their applicability and make it impossible to compare studies on an apples-to-apples basis. His conservative estimates based upon a large body of data show that his goal is not to inflame, but rather to present a sober view of a serious issue.
Nonetheless, the numbers are eye-opening. As of 2011, approximately two million service members have been deployed to either Iraq or Afghanistan. The history of the twentieth century's wars suggests that thirty to forty percent of these veterans will develop PTSD. The early numbers bear this out. In 2004, twelve percent of returning soldiers and marines surveyed met the strictest definition for PTSD, and many more showed warning signs. As of October 2007, an estimated 300,000 veterans of Iraq and Afghanistan were suffering from either PTSD or major depression. In 2009, over thirty-six percent of Iraq and Afghanistan veterans receiving health care from the Department of Veterans Affairs (VA) had at least one mental health diagnosis. Regardless of whether the final numbers reach the projected worst-case scenario of 700,000 veterans with PTSD, they are certainly substantial and merit serious study and concern.
On a micro level, Justice Schaller humanizes the mountain of data with regular interludes to discuss the realities of veterans' experiences. Throughout the book, he provides context by including narratives from eight veterans who have wrestled with PTSD in some shape or form. Their accounts help clarify how much the ostensibly black-and-white numbers dissolve into countless shades of grey in the personal experiences of hundreds of thousands of individual veterans.
As Justice Schaller takes care to note, PTSD is not just a product of combat and is not exclusive to men, regardless of stereotypes. The Iraq and Afghanistan conflicts have illuminated as never before the issues faced by women, both as warriors and as victims of assault by their fellow service members. History poorly equips us to anticipate their unique issues, but their experiences will nonetheless have a far-reaching impact.
An Invisible Wound
Inevitably, the book also spends some time discussing the development of PTSD as a diagnosis recognized by the psychiatric community and issues related to its current definition. …