Bad Brains

Since my last post on the Afghanistan shooting case, the Army released the name of Sgt. Robert Bales and many details have emerged. The New York Times reported that he suffered a traumatic brain injury during a 2010 explosion in Iraq. Earlier this week The Huffington Post reported that on March 20th, Assistant Secretary of Defense for Health Affairs Johnathan Woodson ordered an urgent review of troops who are currently taking mefloquine, a malaria medicine shown to cause troubling psychiatric side effects. In 2009 the Army decided to prohibit any soldier who had suffered a traumatic brain injury from taking the drug.

The Army did not say if Bales was taking mefloquine, but The HuffPo story invites speculation that a combination of past head trauma combined with a medicine known for it's psychosis-inducing side effects could have been the trigger for Bales' alleged rampage.

In the past few years a heightened awareness of traumatic brain injuries has arisen in both military and sports medicine due to ground breaking research on the effects of concussions. In Iraq and Afghanistan many soldiers have survived what would previously have been fatal wounds. Yet surviving these injuries means not only living with bodily disfigurement but also living with the lingering effects of concussive damage to the brain from explosions.

ProPublica has run an investigative series called Brain Wars in which has looked into the effects of traumatic brain injuries in soldiers. It reported last year that the Automated Neuropsychological Assessment Metric, or ANAN test, which the military had spent $42 million designing, was an ineffective diagnostic tool for brain injuries. Bales likely took the 20-minute long, computerized ANAM test, but obviously it failed to restrict him from a combat deployment.

It is easy to jump to the conclusion that a combination of stress from multiple deployments, the effects traumatic brain injury, and the possible presence of alcohol and/or a notorious malaria medicine combined to form a toxic combination in Bales' head on the night of the incident. While the military should undoubtedly review its procedures for ensuring the mental fitness of its personnel, particularly in combat zones, we should not lose sight of the fact that Bales is still an outlier. Hundreds of thousands of soldiers have served in these wars and most have performed as consumate professionals throughout.

Still, while most mental health problems in the military have not been borne out in such a disturbing manner as a 16-death massacre, the Bales case can serve to spotlight one of the military's major problems. A recent study by the Army Behavioral Health Integrated Data Environment found that suicides by service members increased by 80% between 2004 and 2008. Most of these were enlisted men who had seen combat duty. A joint study by the Departments of Housing and Urban Development and Veterans Affairs also found that a disproportionate number of the homeless population are veterans of Iraq and Afghanistan. It seems logical that disabilities and PTSD play a significant role in these disturbing suicide and homelessness statistics. The White House, Defense Department, and Congress should push for reforms that ensure that the soldiers fighting the USA's wars are treated with the highest level of care, for both physical and mental injuries. Reworking of the ANAM test is a good place to start.