I know, that didn't make sense to me at first. I mean, how can getting bitten by a mosquito measure anything but the nettlesome persistence of the insect? But a footnote to the 1972 article in the American Journal of Psychiatry article I mentioned the other day says that the 1st Infantry Division in Vietnam used the rate of malaria in a given unit as an indicator of command performance "because the incidence of vivax malaria directly reflected whether or not the men had taken their chloraquin primaquine tablets, a function of discipline and morale." (P. 699)

By Rebecca Frankel
Best Defense Chief Canine Correspondent

It was only a few years ago that Lex, a German Shepherd, was patrolling the streets of Fallujah sniffing out roadside bombs with his handler, 20 year old Corporal Dustin J. Lee. The two made quite a pair and were said to be inseparable. But during an attack on March 21, 2007 a rocket-propelled grenade killed Cpl. Lee. Lex sustained serious shrapnel wounds to his hindquarters including a piece still lodged in his spine.

Cpl.'s Lee's family, knowing how much their son had cared for his canine partner, lobbied to adopt Lex. Getting Lex released into their custody, however, was no easy feat. Undeterred by military regulations, the family "launched an Internet petition and enlisted the aid of a North Caroline congressman..." and by December Lex was at home with the Lees in Mississippi. It was, apparently, the first time the military has "granted a dog early retirement to be adopted by someone other than a former handler." Dustin's father said he and his wife were only acting in their son's stead. "He knew that we would take care of Lex and love him, just like our own."

But once Lex arrived, there was no escaping the depth of his injuries -- the nine-year-old dog could barely walk on his own.

Read on

My CNAS colleague Nancy Berglass has a good new study on how we need to bring together the efforts of the Defense Department, the VA and the non-profit sector:

The U.S. government can draw upon an emerging network of nongovernmental organizations to form a model of public-private partnerships that will greatly enhance the care and services provided to those who have served the nation.

There are a lot of private outfits that want to help, she notes:

By working largely within the confines of governmental structure, both DOD and VA fail to take advantage of private-sector resources. Both agencies could fulfill their missions more quickly, effectively and with a desperately needed personal touch by leveraging the exceptional promise of community partners to help them meet their charges.

I was impressed by this video in which more than 30 people who received the Medal of Honor talk about the need to get counseling when, as one puts it, the enemy comes home with you. It portrays seeking care as an act of strength. Take two minutes to check it out -- you won't regret it.

I am told that Gen. Pete Chiarelli, the vice chief of staff of the Army, was one of the people who made this video happen. A job well done.

Military spouse Alison Buckholtz proposes an "It Gets Better" campaign that speaks to suicidal service members, akin to the current campaign reaching out to gay teens. "Stoicism and name-calling doesn't work," she writes. "Nor do stand-downs and speeches. Individual Americans can help close the military-civilian divide by demonstrating the belief that suicides among service members demand our immediate attention as a society. Soldiers and sailors need reassurance that it gets better for them too."

Oh man. Take a minute to read this widow's account of watching her Marine sergeant husband fall apart after he came home from Afghanistan. Two quotations that really struck me: 

"I knew that we had run out of time."

And, as he contemplated suicide:

"There is no way I can stop you from doing this, is there?" she said she asked her husband.

"No."

If you know someone who seems suicidal, here is a phone number:

1-800-273-TALK

(HT to BD)

My e-mail lately brings notice of two organizations doing good things:

First is the National Action Alliance for Suicide Prevention, which rolls out this morning. This one involves a bunch of bigwigs, like the defense secretary, the Army secretary and the VA secretary, but what caught my attention was the participation of the Rev. Robert Certain, who before becoming a minister was a PoW in Hanoi.

By the way, here is the recent Defense Health Board report on the issue. 

Second is Spirit of America. A friend of a friend writes that it is

a 501c3 nonprofit that helps our troops help the people in Afghanistan, Iraq and Africa. Since 2003 we've responded to needs identified by U.S. Soldiers and Marines for things that will help the local people -- sewing machines, school supplies, solar water pumps, solar radios, sandals, blankets, mosquito nets, playground equipment, saffron bulbs... any kind of humanitarian or economic development assistance that is needed. This support improves relations and increases trust and cooperation. it is especially helpful in counterinsurgency operations now in Afghanistan. Ultimately, SoA support helps our troops be safer and more successful in their mission.

Spirit of America's support is fast, flexible and decentralized. We fill gaps in military and US government assistance programs. In Afghanistan, it can be difficult to get aid to the remote villages -- far from Kabul -- where much of the war is being fought and where little things can make a big difference. That's where SoA is most active. You can think of this as grass roots public diplomacy. We help the troops be effective unofficial ambassadors... ambassadors of the goodwill of the American people. Most NGOs keep their distance from the military. Spirit of America takes a different approach that offers a new model for military-NGO collaboration.

Everything we do is supported by private-sector donations. We provide Americans with a meaningful way to help and to connect with the service of our troops. People can choose where their money goes and 100% goes to provide what those on the front lines say is needed.

This blog is probably not the best place to run this column, because many of you will know instantly what Blake is talking about here. But I am happy to have him start here, and I hope others, outside of those who pay steady attention to our wars, will hear what he has to say.

I am turning the whole column over to him today.

By Blake Hall
Best Defense guest columnist

Every day is a national tragedy. This is not hyperbole. Eighteen veterans kill themselves every day, a figure that represents twenty percent of the suicides in this country, and veterans constitute twenty-three percent of this nation's homeless population. Veterans represent nine percent of America's population, so those numbers, to me, are staggering.

Last month, I sat down for dinner with my former battalion commander. I brought up these numbers and he responded with valid questions, "How much of that is self-selection? Were these vets already struggling with problems before the military? Were they already pre-disposed to engage in high-risk activity? How many of them fought in combat?" I noted that the figures don't include the veterans who kill themselves with alcohol or who kill themselves on motorcycles or in single-car accidents, because those types of fatalities don't fit into neatly quantifiable categories. But, ultimately, I do not have the academic knowledge or expertise to respond authoritatively to his queries. I can only comment on my former scouts and snipers, who call me from time to time, as they fight their demons.

I led twenty-four scouts and five snipers in Iraq from July 2006 to September 2007. Our mandate as a platoon was to kill/capture High Value Targets -- typically Al-Qaida or Iranian backed militants. We were in some rough spots, and, as you can imagine, we saw some terrible things. It affected all of us. As the prophet Isaiah noted, "Behold, I have refined thee, but not with silver; I have chosen thee in the furnace of affliction."

I've had two calls from my men in the last month and a half. One of them was from a sniper team leader I nominated for the Bronze Star with Valor for his actions in combat. The other was from a sniper I consider one of the bravest men in my platoon. Both men told me they considered killing themselves either during deployment or when they returned home from war.

In Mosul, the sniper team leader, "David," rescued the crew of a Stryker Reconnaissance Vehicle taking heavy fire from three different directions. He exposed himself to that fire in order to secure a winch to the vehicle, which was in danger of rolling over into a draw. He saved the crew after he had emplaced and directed his sniper teams to engage insurgents firing four mortar tubes on a combat support hospital -- an action senior commanders credit with saving twenty American lives, for ten coalition service members, some of them nurses, had already been critically wounded at the base from the mortar fire. And then he subdued an Al-Qaida militant in hand-to-hand combat inside of a building.

In Baghdad, another sniper, "Jonathan," was on the rooftop of a building with my company commander during a firefight. Afterwards, the company commander walked up to me with shaky legs and said, "Blake, your snipers are crazy. They were walking around on the roof, bullets everywhere, just pointing and shooting. I was huddled behind the wall taking cover. You might tell them to get down once in awhile."

Both men are brave. I want them by my side in a firefight -- the highest compliment a soldier can give. So it breaks my heart when a soldier like Jonathan calls me and tells me that he wants to kill himself. Jonathan was brave in some of the scariest situations I can imagine, but it is the way that he is being treated now that he is back home that is breaking him down.

When Jonathan returned home from Iraq, he exhibited classic signs of PTSD, a term I hate, for PTSD is a disease that every veteran suffers from to some degree or another. He had trouble sleeping. He was nervous and hyper-alert in normal everyday situations. He couldn't concentrate on a task for longer than a few minutes.

When he went to the chain-of-command for support, he was removed from the sniper section and placed into an administrative role while the command figured out what to do with him. I had moved to the battalion staff, but I took him to lunch one day and he told me, "Sir, I'm not even in the platoon anymore. I feel like a shitbag."

That Jonathan could be treated this way, even by Infantry officers, many of whom have not seen combat to the degree that he has seen it, is unacceptable to me. There is a very real dilemma facing commanders who must decide whether they can allow a soldier to train with live weapons while they are dealing with psychological trauma, but, ultimately, the narrative needs to change. All of us hit lows from time to time, everyone who has experienced heartbreak in a relationship knows how utterly depressing the next few weeks after that cut can be, but, with the help of family and friends, you can make a full recovery and heal.

To understand the current narrative, read this quote from General George S. Patton:

The greatest weapon against the so called ‘battle fatigue' is ridicule. If soldiers would realize that a large proportion of men allegedly suffering from battle fatigue are really using an easy way out, they would be less sympathetic... If soldiers would make fun of those who begin to show battle fatigue, they would prevent its spread and also save the man who allows himself to malinger by this means from an after-life of humiliation and regret.

From the moment a soldier enters basic training to the day he takes off the uniform, he is taught that to admit weakness is to invite ridicule. In The Things They Carried, Tim O'Brien noted how the fear of embarrassment is the greatest motivator of valor. He focused on the negative. Certainly, a hunger for admiration can also enable bravery. But they both center on a certain primal desire for respect we all retain. When I was scared in combat, I knew that I could not shrink from danger, for I would never be able to stand in front of my men again with credibility. So I stood and fought.

We soldiers have been conditioned to never, ever admit we are hurt or suffering. But dealing with the aftermath of war, when you are no longer surrounded by the men who fought with you, when you are no longer working for a chain of command that can give you feedback from a position of authority, when you are alone -- is a battle that far too many of us lose. When some of the bravest guys that I know can't admit weakness, or do admit weakness, and then are subject to ridicule, then I posit that the narrative for the "after," for the persistent battle that we veterans fight for the rest of our lives, should be distinct and separate from the Army's normative weakness -- ridicule relationship that is appropriate for combat.

I told Jonathan that he was brave when it counted. I said that when the chips were down, he faced the bullets and he moved forward, often at the head of the platoon. I let him know that I thought it was far more manly and heroic to admit weakness back here at home because it defies everything we have been taught in our culture that celebrates strength and filters out weakness lest it corrupt the unit.

After a long pause, he said, "Thank you so much for talking to me sir. I already feel a lot better." He shouldn't have to thank me, the nation should thank him. He should feel the respect and gratitude of the country every day by the way he is treated, not just in the popular culture that celebrates America's service members, which all of us who have served appreciate.

Sadly, some of the articles I have read on this blog from the systematic mismanagement and scope creep that have ruined the Army's Warrior Transition Units to single anecdotes about a veteran living alone with PTSD to op-eds that note some businesses are afraid to hire vets due to PTSD and TBI concerns (your article about Obamacare), reinforce the broken nature of the ecosystem of programs design to re-integrate American veterans. David visited a VA counselor three times to talk about the issues he dealt with every day. On his fourth visit, his normal counselor wasn't there, so a new counselor saw him. The counselor asked, "Why are you here?" Then, the counselor sat back and expected David to fill him in on everything that he had already covered with his normal counselor. David got up and left, without treatment, because he got the sense that the therapist didn't care. No one tried to stop him from leaving.

When you go to sleep tonight, eighteen more veterans will be gone by their own hand. Many more will lay their heads down without shelter, because they have lost their way. The thought that one day David and Jonathan could join their ranks is more than I can bear.

Veterans need to know that it is okay to admit weakness after dealing with the trauma of war. They need to know that they won't be judged for opening up about their pain. They need to know that Americans care.

I am willing to keep up this discussion. So is Noel Koch,
who this morning sent along this reply to General Cheek's comments posted
yesterday:

By Noel Koch
Best Defense wounded warrior columnist

General Cheek has
kindly suggested I might offer my vision of how the Army's Wounded Warrior
program should be run, and I shall in due course. In the interim, one useful
start might be to adopt the General's own vision of a tiered system in which
Wounded Warriors are managed separately from those camping in the WTUs for as
long as they are able to game the system. I believe this notion came up during
one of our discussions involving his consternation over an Army Colonel who was
managing to squat in one of the WTUs for something on the order of 600 days,
resorting to various subterfuges, including threats of suicide, to defeat
efforts to move him on. 

Regarding the
matter of satisfaction surveys, which seem to be a running point of contention,
the following is an excerpt from a report by the US Government Accountability
Office: 

"The Army's feedback mechanisms include its Warrior Transition Unit
Program Satisfaction Survey, which collects information from servicemembers in
WTUs on a number of issues, including the primary care manager and nurse case
manager. However, the surveys response rates for the WTUs have been low (13 to
35 percent) and the Army has not determined whether the results obtained from
the respondents are representative of all WTU servicemembers. An Army official
told GAO that the Army does not plan to conduct analyses to determine whether
the survey results are representative, because it is satisfied with the
response rates. In GAO's view, the response rates are too low for the Army to
reliably report satisfaction of servicemembers in WTUs." 

Read on

I had a couple of flights yesterday so I caught up on my reading of military magazines -- Proceedings, Marine Corps Gazette, Air Force, and Army. Brig. Gen. Loree Sutton, the Army's highest-ranking psychiatrist, tells her service's magazine what sort of homecoming soldier worries her most:

As a psychiatrist, I must say that an individual who comes back from 12 to 15 months, moreover a series of repeat tours over the last nine years, and says, 'It hasn't affected me at all' -- that's the person I'm most concerned about.

Here's another comment from a military spouse. I am going to keep running these until the little grasshoppers begin to grasp that stresses on the military family may be what breaks the all-volunteer force.

By Alison Buckholtz

"Has your dad been killed yet?" 

My seven-year-old son recently revealed that a well-meaning, worried friend in his class asks him this question nearly every day. My husband is a Navy pilot serving a one-year deployment in the Middle East, and first graders at the school have written him letters and seen many photos of him; he even dressed kids in his flight gear during career day.   

When my son repeated to me his friend's question, I started to wonder about the drawbacks of our outreach to the civilian community. Usually, I go out of my way to facilitate contact with non-military groups because I believe that greater public awareness of servicemembers' lives can help close the civilian-military gap in perception that has widened since the abolition of the draft. I work to bring civilians closer to the experience of military families in a time of war, with a memoir and a monthly column about our current deployment.   

But it wasn't hard to convince me that the Congressional Military Family Caucus, a new group which takes a much different approach, is an important national step forward. The Congressional Military Family Caucus aims to create legislation and shape policies that will benefit military families. A combination of legislation and public awareness on behalf of military families can build morale and ease roadblocks like spouse education and employment, tax inequities stemming from residency requirements, and federal services for military children with special needs. If legislators craft policies that lighten the burden of their constituents -- in this case, military moms and dads -- America benefits from retention of the best people the Armed Forces can attract.

The connection between a strong military family and a strong military force has long been documented; in the current Administration, Michelle Obama's outreach to military families has anchored her agenda as First Lady. But the Caucus aims to formalize the connection between a strong family and a strong force. It launched last fall, and recently held its first Military Spouse Summit to help set its priorities. I was an invited speaker at the Summit, and stayed to participate. My son's comments were still fresh, and still hurt. I wasn't sure if I should share them with the group.  

Seventy military spouses (chosen from an application pool of 500) from around the country traveled to the Cannon House Office Building for the event -- some of them at their own expense, others supported by their local Navy League, USO or a veterans' organization. All of the services were represented, but each spouse's name tag listed her (or his) first name only, and participants were asked not to mention their partner's rank or job.   

Speakers on diverse topics such as PTSD and military-friendly voting initiatives alternated with brainstorming sessions, but I was struck most by the research findings presented by Purdue University's Military Family Research Institute MFRI's director, Shelly M. MacDermid Wadsworth, stressed that "the story of today's military families is still being written," but noted that the psychological stress and unpredictability of a servicemember's combat deployment is a "corrosive influence" on family life. Many of us in the audience nodded with recognition.   

I also detected a measure of silent satisfaction -- because bringing a research specialty into the mainstream is an important step toward acknowledgement that challenges exist in the first place. Military spouses tend to be as stoic as their servicemember, so it can be hard to share struggles and challenges with each other, or determine anecdotally how serious or widespread a problem is. Rooting the Caucus' priorities in research (MFRI estimates that over 1,000 studies on military families are underway) is critical to its success. 

To me, however, the most significant moment of the day never appeared on the agenda. During a lull, one of the military spouses at my table pulled that day's copy of USA Today from her bag. The headline read, "Military Health Care Costs Booming," and the story below it revealed that surging costs are prompting the Pentagon and Congress to consider the first hike in out-of-pocket fees for military retirees and some active-duty families in 15 years. Among the factors driving up costs were these two: 

• Behavioral-health counseling sessions for troops and family members rose 65% since 2004. The Pentagon paid for 7.3 million visits last year -- treatment of 140,000 patients each week.
• Many new patients are children suffering anxiety or depression because of a parent away at war. Children had 42% more counseling sessions last year than in 2005. 

The newspaper passed from hand to hand at our table, and each spouse frowned. I finally told a few of the women what my son's friend said to him, because several years' worth of similar comments have prompted me to seek out family counseling at various crisis points. Our visits were certainly folded into those statistics, and legislators' comments reported in the article seemed to rebuke us. It appeared that military families were being doubly punished: first by sending a family member off to war, and then for utilizing the resources made available to manage the ensuing trauma. Overusing these benefits -- though no one has ever specified what this overuse might be -- might now result in limited offerings, or higher costs for families who had been promised this care in exchange for their years of service.   

The irony of reading a story about Congress cutting military family health benefits while attending a meeting of the Congressional Military Family Caucus escaped no one. The power of legislation to change lives was clear to all of us in that moment. Only one spouse spoke. "Promises have to be kept," she said. Her words might well serve as the Caucus's motto. Because if the Congressional Military Family Caucus succeeds in ensuring that the promises made to America's military families are kept -- through legislation, public awareness, or any combination of the two -- it will strengthen our forces as well as our families. Including seven-year-olds.

By Rebecca Frankel
Best Defense Chief Canine Correspondent

We long for an affection altogether ignorant of our faults. Heaven has accorded this to us in the uncritical canine attachment. -George Eliot

Animal-assisted therapy has long been used as by the medical community as an alternative method for treating human depression. Dog lovers know that there are few things more comforting than the warmth and unchecked affection of a devoted canine companion.

The New York Times recently ran a piece by Janie Lorber about Iraq war veterans dealing with Post Traumatic Stress Disorder (PTSD) who are setting aside prescription drugs for the cathartic powers of "psychiatric service dogs specially trained to help traumatized veterans leave the battlefield behind as they reintegrate into society."

Read on

The New York Times discloses today that earlier this year, Gen. Petraeus was treated for prostate cancer. No wonder he looked a little peaked lately. This may also partly explain his relatively low profile on Afghanistan.

Alex Wong/Getty Images

I have a lot of sympathy for people carrying around PTSD. It sucks.

But now I see where a former spokesman for the British ministry of defense says he has post-traumatic stress disorder from telling so many lies about the Iraq war. Really? If that were really the case, I'd expect to see the sidewalks of Washington crowded with former Bushies gone barking mad.

Hey, look out the window ...  

Chris Hondros/Getty Images