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ImageThe murder of 16 Afghan civilians on March 11th 2012 shocked the international world and brought more tension to the already strained relationship. U.S. Army Staff Sgt. Robert Bales allegedly killed the civilians in cold blood but according to the Pentagon, Bales had been treated for a traumatic brain injury that he suffered in Iraq in 2010. Other information leaked by military officials indicated that Bales, who was on his fourth deployment, may have “snapped” under pressure due to a brain injury and/or alcohol abuse.
Robert Bales had broken into three homes in three different locations in Panjwai district -villages of Alkozai and Najeeban and another settlement known locally as “Ibrahim Khan Houses”.
By the end of the attack, 16 people, 9 of them children were dead and 5 wounded. Some of the bodies had also been set on fire. According to pictures, some of the victims had been killed by a single gunshot to the head.

Suicide and health problems
It’s no surprise that U.S. military personnel and veterans are plagued by substance abuse, depression and suicides.
In various studies, researchers surveyed nearly 600 veterans returning from war zone deployment in Iraq or Afghanistan, finding out that they were at increased risk for mental health problems and alcohol and drug abuse.
Nearly 14% of the veterans screened positive for probable post-traumatic stress disorder (PTSD), 39% for probable alcohol abuse, and 3% for probable drug use. Men reported more alcohol and drug use than women, but there were no gender differences in PTSD or other mental health conditions.
Another important founding was the difference between veterans returning from Iraq who reported more depression or functioning problems and more alcohol and drug use than those returning from Afghanistan.
The studies were published online on Jan. 25th in the American Journal of Public Health and are scheduled to appear in the March supplement print issue of the journal.
In a second study, researchers found that major depression and substance use disorders have increased among active duty combat-exposed veterans. The finding comes from an analysis of data from 678,382 active personnel that served between 2001 and 2006.
“Given the continuing U.S. military presence in Afghanistan and other parts of the world, and the increasing trend in major mental health conditions reported in the U.S. military, it would be important for the Department of Defense to assess whether the current system has adequate resources and manpower to handle the increasing number of active duty personnel who need mental health services,” the researchers concluded.
The third study found out that suicide rates for all U.S. military services increased between 2005 – 2007, particularly for members of the regular Army and National Guard. The increased risk of suicide in 2007 compared with 2005 may be due to the extended duration of war and increased lengths of deployment for Army and Air force personnel the researchers concluded.
Already in 2008, researches had presented study results where 300,000 U.S. troops were suffering from major depression or post-traumatic stress in the wars in Iraq and Afghanistan and 320,000 received brain injuries and only half of them had applied for help according to the nonprofit RAND Corporation. Terri Tanielian, the project’s co-leader and researcher at RAND already warned about the health crises 5 years ago. -“There is a major health crisis facing those men and women who have served our nation in Iraq and Afghanistan. Unless they receive appropriate and effective care for these mental health conditions, there will be long-term consequences for them and for the nation,” she said in an interview with The Associated Press.
The 500-page study was the first large-scale, private assessment of its kind, including a survey of 1,965 service members across the country, from all branches of the armed forces and including those still in the military as well veterans who have left the services.

RAND researchers also found:
• About 19% or some 320,000 services members reported that they experienced a possible traumatic brain injury while they were deployed. In wars where blasts from roadside bombs are prevalent, the injuries can range from mild concussions to severe head wounds.
• About 7% reported both a probable brain injury and current PTSD or major depression.
• Only 43% reported ever being evaluated by a physician for their head injuries.
• Only 53% of service members with PTSD or depression sought help over the past year in 2008.
• They gave various reasons for not getting help, including that they worried about the side effects of medication; believing that family and friends could help them with the problem; or that they feared seeking care might damage their careers.
• Rates of PTSD and major depression were highest among women and reservists.
The report is titled “Invisible Wounds of War: Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery.” It was sponsored by a grant from the California Community Foundation and done by 25 researchers from RAND Health and the RAND National Security Research Division, which does work under contracts with the Pentagon and other defense agencies as well as allied foreign governments and foundations.

Another study which has been published in Injury Prevention, it has been revealed that American soldiers are not able to tackle situations at work front and this has led to commit suicide. The study was being conducted by Kathleen E. Bachynski and colleagues from the U. S. Army Public Health Command in Aberdeen.
They found that from 2007 and 2008, there have been 255 suicides in the US and the majority of the deaths that took place in 2008 were mainly associated with troops who were deployed in the 2003 Iraq war.
In addition, the study authors found soldiers to be suffering from mental illnesses as well like post-traumatic stress disorder, personality disorder, mood disorders, and anxiety disorders. It is said mental disorders have contributed a major portion to increase the number of suicides taking place in the US Army.
Who is responsible to see the signs?
The commander on the ground is supposed to be responsible to look out for the mental health of those under his command. It’s something they are thought to do and should do as people understand when someone shows signs of disorder.
The signals vary from high-risk behavior, such as self-medicating with alcohol, anger management, involvement in partner abuse, drug abuse, and alcohol abuse. I personally see the families of the soldiers as responsible as well to some point. Last year for instance, an Army private accused of killing a Taliban prisoner by shooting him in the face agreed to plead guilty in the slaying, despite his diagnosis of schizophrenia. His parents said he had repeatedly told them through email and phone conversations that he was hearing voices. If parents or partners see signs of disease or other, they should report it, so that both sides should be spared of damages.

Proactive work
What is obvious from past and present studies is that there is a stigma closely tied to getting help for mental health problems.
The Army has tried to prevent suicides in the past year through training, a suicide prevention task force, and a day of standing down from official duties to focus on suicide prevention. Top military officials including former Defense Secretary Robert Gates have encouraged military personnel to seek counseling.

While PTSD can be treated effectively with talk therapy, the military has also begun focusing on whether the problem might be prevented in the first place — for instance by identifying those at high risk and preparing them psychologically for conflict.
In the new study, published in the Archives of General Psychiatry, more than 22,000 soldiers completed a health questionnaire before they were deployed to Iraq or Afghanistan, and again after they returned.
Just over 3% had some mental illness, including PTSD.
Upon returning, however, 8% had symptoms of PTSD. Those who had mental illness other than PTSD before deployment, had more than twice the odds of developing the condition after they returned home.
According to the Army Medical organization who conducted another study, the suicides rose 80% from 2004 to 2008. As many as 40 percent of these suicides may have been linked to combat experience in Iraq, yet nearly a third of the soldiers who committed suicide saw no combat at all, said the researchers, from the U.S. Army Public Health Command published in the March 7th online edition of the journal Injury Prevention.
The findings are based on analysis of data from the U.S. Army Behavioral Health Integrated Data Environment, a registry including consultations, diagnoses and treatment on suicides from many military sources.
Almost half (45%) of those who committed suicide were between 18 and 24 years old and what the researchers found out was that the soldiers who committed suicide were more likely to have been diagnosed with a mental illness in the year before their suicide.
The reasons behind the increase in the suicide rate was related to increased rates of depression, anxiety, post-traumatic stress, substance abuse, personality and adjustment disorders, and serious mental illness, the researchers said. Those with severe depression were more than 11 times more likely to take their lives, and those with anxiety disorders were 10 times more likely to do so according to the researchers in Montefiore Medical Center in New York City.
Diagnoses linked to a higher suicide risk included depression, anxiety disorders, post-traumatic stress, substance misuse, along with psychosis and adjustment disorders.

Past and present – what have we learned?

The authors of the study, the Army Public Health Command (APHC), estimated that 25% to 50% of the suicides were directly related to combat in Iraq and Afghanistan. Some of the key psychological issues affecting the approximately two million American troops deployed to Iraq and Afghanistan since 2001 have been traumatic brain injury (TBI), depression and post-traumatic stress disorder (PTSD).
One mistake made by the U-S- government was that there was a critical shortage of health care personnel, especially specialized on mental health to meet the demands of those who returned from Iraq and Afghanistan according to a 2010 report from the Institute of Medicine.

After the withdrawal of U.S. soldiers from Vietnam in 1973, the same thing happened. The rates of mental health problems went up. American soldiers had fought in harsh conditions both in Vietnam and the Persian Gulf where being ambushed and taken as hostage was a part of their daily life, but the combat and weapons have changed with the years and even if the wars are effectively fought, the mental problems remains the same. The U.S. government has been too busy with planning wars and sending Iraq veterans to Afghanistan instead of focusing on mental health issues.
Stigma – Wrapped in shame
Bottom line is; the Pentagon’s mental-health workers are fighting a war of their own for the minds of the nation’s soldiers and Marines, but they continue to lose ground on this matter.

Many veterans are aware of the mental state they are in but have not seeked help or treatment. Some of the most important reasons they have given for not seeking help includes:
• Concern over being seen as weak.
• Concern about being treated differently.
• Concern that others would lose confidence in them.
• Concerns about privacy
• They prefer to rely on family and friends.
• They don’t believe treatment is effective.
• Concerns about side effects of treatments.
• Problems with access, such as cost or location of treatment.

I believe that the sense of shame has kept these men away from treatment and that’s also one of the reasons that they have committed suicide. Sometimes the conscience plays a role in suicides when war crimes have occurred.
Kandahar massacre
The American staff sergeant Bales who killed 16 Afghan villagers, had been drinking alcohol, something that is a violation of military rules in combat zones. He had served three tours of duty in Iraq and was deployed to Afghanistan for the first time in December serving a total of 11 years in the army.
With the alcohol running through his veins and stress because of being deployed on his fourth combat tour, Bales snapped American officials say. Bales also refused to speak to investigators asked for a lawyer shortly after he surrendered on the base.

Local journalists have said that the villages of Najeeban and Alkozai are about 5-7km (3-4 miles) apart. This immediately raises questions about if Bales walked by foot the whole time. An Afghan guard at the NATO base had also told the media that Sgt Bales left the base twice. He returned at 00:30 local time after the first trip out and was out between 02:00 and 04:00 for the second trip. In one village Sgt Bales reportedly went from house to house, trying the handles of several doors and entering the homes and killing those whose doors were unlocked. Although he had “snapped”, Bales had remembered to put on his night vision goggles before he killed the 16 villagers.

Apparently the U.S. military is quick to discover mental problems after the damages were done but isn’t that effective to examine them before. This man should never have been deployed out in the field, and he should certainly have never been sent back to America after the murders.
If an Afghan man had “snapped” and committed similar crime in Washington DC, I am sure, the U.S. would have never sent him back to Afghanistan to face trial but instead punish him in America as the US government has no problem in bringing “terrorists”, guilty or not to Guantanamo.
There is no doubt in my mind that this was planned from Bales’s side and he knew exactly what he was doing. His actions were not the results of PTSD and not only against military culture but against human behavior. When a person snaps, he does not put on his night vision, arm himself with weapons and walk several miles to nearby villages where he goes from door to door to kill and burn innocent people, mostly children. A person who snaps will instantly target those who are near him so why didn’t he shoot and execute the men and women around him on the base? I have no doubt that Bales has mental health problems but these killings were conducted effectively and in cold blood. This kind of act brings various consequences:
1.) Creates environment to encourage people to go on the path of extremism.
2.) Extremists exploit these kinds of situations.
3.) Opposing regimes of other neighboring nations takes advantage of such incidents.
4.) Whatever the percentage Afghan government leaders support US role in the region they become separated from its people and from those leaders who are already against the US; this makes the situation more badly.
5.) Afghanistan’s youth would slowly but gradually move towards extremism.
The country which has been affected and suffering unjustifiably would one day stand against the power that has made them victims. And Afghanistan has history of taking such unified stand against suppressive powers.

If America would not give justice to the affected family and may not maintain the transparency in punishing the culprit of the massacre then there would countless question marks which would raise against the leadership role and the system of America which it promote as democratic and justified.


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