Clinicians Digest Sept/Oct 2008 - Page 2


The Fog of War

The United States Army reports that about 12 percent of combat troops in Iraq and 17 percent in Afghanistan, or about 20,000 soldiers in all, are taking Army-prescribed antidepressants and sleeping pills. An article by Mark Thompson in the June 16 issue of Time magazine says the actual number is probably much higher, since many soldiers are reluctant to go through official channels when they're experiencing mental distress.

Along with the unprecedented rates of PTSD and the record number of suicides, attempted suicides, and self-inflicted injuries among current and returned soldiers, the thousands of prescriptions may indicate how much our soldiers have been stretched to their psychological limits. The practice of such widespread prescribing brings up troublesome ethical issues. Does passing out antidepressants and sleeping pills constitute a humane act, intended to help soldiers cope with the unavoidable stress of combat and deployment, or is it a way to keep soldiers deployed and fighting when they aren't up to it psychologically?

During World War I, soldiers who showed signs of mental and emotional fatigue were often treated with painful electric shocks, on the grounds that they were either malingering or of weak character and that a jolt of punishing treatment would reawaken their fighting spirit. In World War II, soldiers suffering combat fatigue were often given heavy doses of the barbiturate sodium amytal. When they came out of their medicated trance several days later, still dazed but presumably cured, they were often walked back to the front lines.

Does the Army's willingness to provide psychological medications actually harm our soldiers? Is there a relationship between the high rates of suicide attempts among soldiers and the widespread use of SSRI antidepressants, which are known to intensify suicidal thoughts among some young people? It will be years before studies are complete that may provide the answers to these questions, but many feel that the prescription of these medications should be discontinued until the answers are known.

"The military use of SSRIs in theatre, where the warrior is faced with repeated, potentially traumatic, experiences, is an experiment with no solid research to support it," says psychiatrist and trauma expert Robert Scaer. "The ethical thing is to remove the trauma victim from the environment and source of their emotional distress."

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