Collateral Insanity in Afghanistan

War makes people crazy. 

The war in Afghanistan has taken a devastating toll on mental health – from depression to suicide, domestic violence to murderous rampages. And financial and family strains, as well as attempts at self-medication, have exacerbated the casualty count. 

I am talking about the war’s effect on Afghans. But after U.S. Army Staff Sgt. Robert Bales allegedly massacred at least 17 civilians, including nine children, on March 11, media and experts quickly rallied to lament how the mental stress of Bales’ multiple combat deployments provided sympathetic context to the Panjwai butchery. The ignored context is an Afghan population traumatized by more than four decades of cultural and military devastation wrought by invading armies, mercenaries, women-hating Taliban and warlords – on top of a life expectancy in the low 60s. 

Many Afghans – blameless in ways that volunteer soldiers never can be – have been pushed past sanity by violence; by becoming refugees or internally displaced; and by losing family, culture, educational opportunities, professions, houses, rights and hope. 

“[V]iolence is now embedded in daily routine,” concluded the Dutch nongovernmental organization (NGO) Healthnet. The World Health Organization (WHO) found that 60 percent of Afghans have mental illnesses including anxiety disorders, schizophrenia, suicide and post-traumatic stress disorder (PTSD). Women and children bear the brunt: More than half of all women are depressed, with 78 percent suffering anxiety disorders, according to Healthnet researchers. And 80 percent of children surveyed in Kabul ​“felt frightened, sad and unable to cope,” with 90 percent believing they will die in war, according to a 2011 report by the U.K.-based NGO Tearfund. 

While 227 health professionals serve the 40,000 troops at Bales’ military base – Lewis-McChord near Tacoma, Wash. – Afganistan’s 26 million inhabitants have a few dozen trained providers, and they lack medications and adequate facilities. Services in rural areas, where 75 percent of the population lives, ​“are nonexistent,” WHO reports.

Not surprisingly, many of the country’s mentally ill turn to self-medication, either with over-the-counter balms such as benzodiazepines (e.g. Valium) or with illegal opium and heroin. A 2009 U.N. study found that war trauma is a key factor for the almost 1 million Afghans with drug problems.

Some Afghans pay $100 or more a month to have loved ones treated at religious shrines where they are chained and fed only bread and water. One shackled patient scratched a drawing of a plane on his wall ​“so he can fly out of here,” his uncle told the Chicago Tribune.

Victims are plentiful in this ill-conceived war, in which America invaded a hostile and already brutalized nation instead of targeting a group of terrorists. The media have dissected Bales’ psyche, exploring reasons why he may have ​“snapped”; describing him as a family man, a good soldier, disgruntled, disappointed, disillusioned; and suggesting a host of mitigating factors: repeated tours, a house with an underwater mortgage, watching his comrade’s leg get blown off, and suffering a concussion, possibly not the first brain injury for the former high-school football star. 

Bales is not undeserving of compassion. With the collaboration of a military that failed to monitor his mental health, his government sent him again and again into combat that was beyond his ability to endure. Yet the most tragic victims are the dead and their families, along with the millions of Afghans for whom the traumatic wartime conditions Bales faced for several years have been the norm for generations. 

In their 1946 study of World War II Army combatants, psychiatrists Roy Swank and Walter Marchand found that after 60 days of continuous combat, 98 percent of the surviving soldiers had become psychiatric casualties. And the remaining 2 percent were identified as ​“aggressive psychopathic personalities,” or mentally ill to begin with.

If the researchers are right, it is inevitable that many people brutalized by war will become aggressive or mentally ill. But while the experience of war makes people crazy, those who perpetuate or profit from this failed conflict have no such mitigating context.