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Authors: Jonathan Shay

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In a certain sense, VIP's veteran community is open 24/7. The veterans in it have each other's telephone numbers and most know where the others live. There is a fair amount of visiting back and forth by phone and in person—and increasingly via e-mail—and they do call upon each other when they feel desperate. Among the team members, I am the only one who has given them my home telephone number.
26
I do this with the periodic reminder that they are not only permitted, but also invited, to call me if they need assistance in getting into a hospital because they are in
danger of hurting themselves or someone else. I make it clear that calls at home for other purposes are not welcome, because I need my sleep, my time with my family, and for the missionary work that I do on their behalf to the armed services. In fourteen years as the psychiatrist for VIP, not one veteran has abused my privacy. I am certain that if anyone did the other veterans would not tolerate it.

From time to time, the VWAR cybercommunity seemed sorely in need of the VIP rules that work together to prevent the veterans from wearing each other out or bringing each other down:

Any vet who is jeopardizing his or her own health and safety, or that of others, authorizes other vets to bring this to the Team, rather than be burdened by it. Any vet who is suicidal or homicidal authorizes anyone in the VIP to take emergency measures to prevent this from occurring.

No bringing other vets down. Some examples are: calling for rescue when none is needed, borrowing money from another vet beyond the lender's means, offering street drugs or alcohol to someone who is trying to stay clean, involving other VIP vets in illegal activities, or making excessive phone calls.

Whoever feels they are being taken advantage of should speak up. Don't get carried away rescuing others.

Lydia Fish neither wished, nor had the resources, to play the role toward the VWAR community that the VIP clinical team does toward its veterans.

I have been away from VWAR for about five years. No doubt it is very different today than it was then, if only because every human community changes constantly, even when it has a strong commitment to imagining itself eternally the same. I am almost afraid to rejoin it for fear that it no longer offers its members what it did when I happened to be there to witness it in the mid-1990s.

However, I never worry that the Vietnam Veterans Memorial—the Wall—is morphing into something less profound. Like Homer's great poems, every truly great work of art, which the Wall is, constantly refreshes itself, goes on giving and giving as circumstances change.

PART III P
REVENTION
19 Introduction

In Part One we saw the enormous price that veterans and those around them pay when their capacity for social trust has been diminished or destroyed. In Part Two we examined various spontaneous and intentional practices that can restore social trust. In this section I address those things that our armed services can do to protect the capacity for social trust and to
prevent
psychological and moral injury in military service. This is the fire in my belly stemming from a passionate commitment of the men that I work with as patients in the VA. They don't want other kids to be wrecked the way they were wrecked. My passion about this comes from theirs.

The best approach is to reduce
all
casualties, not just psychiatric casualties. Psychiatric and physical battle casualties rise and fall together. The more war wounds in the body, the more mind wounds. This has been observed among American troops in World War II and among Israelis in the Yom Kippur War.
1
Reducing casualties overall will reduce psychiatric casualties. Is there any way to do this? The answer is neither new nor surprising: the surest path to casualty reduction is swiftly and skillfully to
win
the fights that the nation sends our troops into. The three protective factors that this section emphasizes—cohesion, leadership, and training—are combat strength multipliers that produce this outcome.
2

Combat soldiers at war struggle with the enemy in a two-dimensional world. Those two dimensions are
biē,
violent force, and
mētis,
cunning tricks and strategy. The
Iliad
and the
Odyssey
are equally powerful and equally convincing accounts of which of these military capacities is most important to vanquish the enemy, and to win the war. Achilles, the hero of the
Iliad,
embodies
biē,
while Odysseus, the hero of the
Odyssey,
embodies
mētis.
When I finish reading the
Iliad,
I am certain that the superiority of Achilles' straight-up-the-middle fighting strength has won the
Trojan War for the Greeks by bringing down the Trojans' main man, Hector. And when I have finished reading the
Odyssey
I am equally certain that Odysseus won the war by pulling off the trick of the hollow Horse, filled with elite fighters.

Biē
or
mētis,
which is more important in war? This is not an academic question about long-dead antiquity. It is a subject of ongoing struggle within our own armed services today. What is more important, fire superiority or information dominance? Attrition or maneuver? “Heavy” armored forces or “light” infantry? Huge, survivable-through-redundancy air and missile fleets, or stealth technology? Crushing the enemy or surprising the enemy? Read
both
of Homer's epics and you'll find that the answer to this generic military question,
“biē
or
mētis,
which one?” is “Uh—yes! Both!”

For things to go well for a soldier, a third dimension must be added to his own army's
biē
and
mētis:
trust that those people who wield official power will do it in accordance with
themis,
“what's right.” The catastrophic operational failure that the Greek army suffered in the
Iliad
flowed directly from betrayal of “what's right” by its commander, Agamemnon.
The trustworthy structure of “what's right” in a military organization—horizontally with peers, vertically in the chain of command, and personally in the training and equipment the military service has supplied—is what allows that armed service's force and cunning strategy to be put into effect against the enemy.
3

The keys to preventing psychological and moral injury are in the hands of uniformed and civilian military leaders and of their civilian bosses in the executive branch and the Congress. In this section I shall explain the measures that can protect our troops, in the hope that readers of this book will intelligently and passionately support reforms. First and foremost, I will argue that we must demand that our top military and civilian policymakers replace the existing institutional ethos of “scientific management” with a new military ethic that creates and maintains well-founded
trust.

Every year the Department of Defense distributes posters in honor of Armed Forces Day. Look at this image and answer the question, “What's wrong with this picture?” Uniformed and civilian defense leaders consistently say that people are the Defense Department's top priority, but in 1997, 1998, 1999, and again in 2002, the Department approved Armed Forces Day posters that celebrated only
weapons.
4
The retired officer who sent me this poster called it “an insult [to] the valor, sacrifices, and patriotism
of the American soldiers, sailors, and airmen who have spilled blood in the service of our country since the American Revolution.”

CELEBRATE
ARMED FORCES DAY

20 Preventing Psychological and Moral Injury in Military Service
1

“Mom. Dad, Brother, Sister, Grandma, Grandpa, you've seen and felt how hard it is for a soldier to come home. If even one man goes to combat why not make it easier for him to come home? And at the same time make our soldiers better. After all they are your loved ones and they are you.” And, to the men and women who have fought in Vietnam, Korea, and WW II, “What did you experience—Don't you want to change it? Write to your Congressman about what you think.”

—Dennis Spector, 101st Airborne and 1st Infantry Division veteran of Vietnam, 1968
2

Try to imagine going to war with strangers at your side! Do they know what they're doing? Can you trust them? Will they care what happens to you? Do you speak the same language, figuratively speaking, or even literally?
3

C
OHESION—
T
HE
H
UMAN
E
LEMENT
IN
C
OMBAT
4

In a famous and oft-quoted passage, the nineteenth-century French infantry colonel Ardant du Picq wrote:

Four brave men who do not know each other will not dare to attack a lion. Four less brave, but knowing each other well, sure of their reliability and consequently of mutual aid, will attack resolutely.
5

And yet, American military culture, policy, and habit since World War I—with a few noteworthy exceptions—has treated the connectedness of
soldiers to one another as irrelevant. Instead, soldiers with the same MOS (military occupation specialty) and training credentials are as fungible as dollar bills—utterly equivalent, substitutable, and replaceable. When first introduced into the U.S. Army in World War I by followers of the industrial efficiency expert Fredrick Winslow Taylor and his disciple Elihu Root,
6
this turning of soldiers into replaceable parts was regarded as rational and efficient. Many people still think that way.

But from a military point of view, it is
not
rational. Soldiers who know each other only slightly or not at all fight badly, regardless of their individual skills, training, and bravery. The great Israeli military historian Martin van Creveld blames the poor combat performance of American troops against their World War II German army adversaries on the individual replacement system:

The U.S. Army … put technical and administrative efficiency at the head of its list of priorities, disregarding other considerations, and produced a [replacement] system that possessed a strong inherent tendency to turn men into nervous wrecks.
Perhaps more than any other single factor, it was this system that was responsible for the weaknesses displayed by the U.S. Army during World War II.
7
[Emphasis added.]

Stephen E. Ambrose, the American historian of World War II, wrote:

The replacements paid the price for a criminally wasteful Replacement System that chose to put quantity ahead of quality…. It was paying lives but getting no return. It was just pure waste and the commanders should have done something about it.

Example: in January 1945, Capt. Belton Cooper of the 3rd Armored Division got thirty-five [individual] replacements to help crew the seventeen new tanks the division had received….

The previous night, the thirty-five replacements had been in Antwerp. At 1500 they lumbered off in a convoy of seventeen tanks headed for the front. Two hours later, fifteen of the seventeen were knocked out by German panzers.
8
[Emphasis added.]

Ambrose does not tell us how many of the thirty-five individual replacements survived. Many that did survive undoubtedly took horrible physical wounds and burns; and those lucky enough to escape unmarked were probably shattered psychologically. The rates of physical wounds and psychological casualties track each other very closely: what spills blood spills spirit.
9

During the Korean War, the individual replacement system continued
its lethal work, according to retired U.S. Army four-star General Donn A. Starry, who fought in both Korea and Vietnam and became one of the leaders of the military reform movement of the 1970s and 1980s:

Many commanders [in Korea] would remark that the new replacements would arrive with dinner, and after a night of contact with the Chinese, they would leave in
body bags
as breakfast arrived.
10

Social cohesion—from having trained together and traveled to the war zone together—is what keeps people physically alive and mentally sane when faced with a human enemy who
really is trying to kill them.
The malignity of the armed human enemy is not a psychological figment. Only the support of others makes it possible to face armed killers. Professional military literature on the combat strength multiplier effect of unit cohesion has been thoroughly reviewed by Nora Kinzer Stewart, a principal scientist with the U.S. Army Institute for Behavioral and Social Sciences.
11
The idea that the social connectedness and esteem of the soldier's unit are psychologically protective is
not
new, and is found in the lessons learned in World War II (but then forgotten):

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