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Indirect deaths: the massive and unseen costs of America’s post-9/11 wars

by Andrea Mazzarino

Part 3 - A Gaping Hole in Our Knowledge
 
My colleagues and I have started to examine the indirect costs of war through interviews with people who have born witness to war or lived through it, as has the U.S. government through its own limited collection of statistics. For example, in 2018, some 18 American active-duty military personnel or veterans died by suicide each day. (Yes, daily.) But all we really know so far is this: self-inflicted deaths from violence, car accidents, substance abuse, and chronic stress that can be traced back to this country’s post-9/11 wars are problems that plague military communities, and they didn’t exist at this magnitude before Washington decided to respond to the 9/11 attacks by invading Afghanistan and then Iraq.

Still, we have remarkably little information about the scope and nature of such problems. I’ll tell you what I do know with certainty, though: the only consistent and cohesive institutions sustaining troops home from America’s battle zones are the “families,” formal and informal, of servicemembers and the communities in which they live — not just their spouses and children, but also extended families, neighbors, and friends. When it comes to the more formal support structures — Veterans Affairs hospitals and outpatient clinics, providers that accept military insurance, small nonprofits that provide recreational and other forms of support and the like — there just aren’t enough of them.

It’s common knowledge in my community that referral processes and wait times for such aid are often long and stressful. If you’re a veteran seeking help, it’s likely that you’ll find yourself having to switch doctors more than once a year, rather than getting the continuity of care you might need to treat complex physical and emotional trauma. Meanwhile, childcare and other kinds of supportive caregiving that might help control neglect and abuse are laughably sparse.

As the upper-middle-class wife of an officer in a family that enjoys the benefit of dual incomes, I can still offer examples from my own life and community that should raise questions about how someone with fewer resources and already under the stress that accompanies multiple “tours” of America’s battle zones can survive. My husband and I had to pull years’ worth of retirement savings from our bank account to afford a lifesaving prenatal treatment for me that military insurance would not then fund (though it would indeed be covered later) — a problem that could have been avoided had the customer service representatives of the Department of Defense’s health and medical program, Tricare, been appropriately funded and trained.

The wife of an officer we know whose son has autism had to go through months of letter-writing and advocacy to receive care both for that boy and her other young child so she could apply for jobs and travel to her own medical appointments during her husband’s multiple deployments. (Tricare would only fund care for one child, leaving her watching the other.) Active-duty and veteran servicemembers I know regularly drink and use drugs heavily each night to calm their anxieties and post-traumatic stress symptoms sufficiently to sit through family dinners, watch our ever-more-distressing news, or get a few hours of sleep.

Many fear seeking mental-health treatment because of the real threat that, in the military, exposure for doing so will result in professional demotion. We live in an era where so much depends on competent, trustworthy security to shield us from the dual threats of a deadly pandemic and domestic terrorism and yet our security forces often lead lives that are problematic indeed.  The toll in such lives — what might be thought of as indirect deaths from combat — that we’ve endorsed by failing to welcome home and provide adequately for the some two million servicemembers who have fought in “our” wars should be a focus of our attention and yet is largely unnoticed.

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