In response to my To heal or to patch? Military mental health workers in Iraq, a reader, Christopher Bradley, has sent me the following story:
In the late 80s, early 90s I was friends, and for a while a roommate, with a mental health counselor with the 7th Light Infantry Division, then at Fort Ord outside of Monterey, California. He was very up front in conversations with me that the function of a mental health counselor in the Army was not to help the client but to return them to their unit as swiftly as possible and up front that this was the official policy of his unit, and the Army generally in regards to mental health. This NCO was aware of the moral quandaries of his job, but felt powerless to do anything about them. He was, after all, only a sergeant. (At the time, I accepted this reasoning. I have grown more morally nuanced since then in many areas.)
An officer in his unit, Captain Christopher C** [name deleted], was getting his Ph.D in psychology sponsored by the military, because he was doing studies about increasing aggression in young men! He laughed about it and did not seem to see the depravity of that position.
November 30th, 2005
In response to my recent piece on military mental health workers in Iraq, Andrew Pollack from Brooklyn sent me the following comments he had posted on a listserv. It concerns a recent Los Angeles Times article [A Journey That Ended in Anguish] on a military ethicist who, confronted with the rampant corruption in the Iraq occupation, ended up committing suicide. In response, a psychologist suggested that his lack of acceptance of the profit motive was pathological:
************* Andrew’s Comments **********************
I’m surprised no one commented yet on this piece of the article: “A psychologist… said that Westhusing had placed too much pressure on himself to succeed and that he was unusually rigid in his thinking. Westhusing struggled with the idea that monetary values could outweigh moral ones in war. This, she said, was a flaw.
“Despite his intelligence, his ability to grasp the idea that profit is an important goal for people working in the private sector was surprisingly limited,” wrote Lt. Col. Lisareitenbach. “He could not shift his mind-set from the military notion of completing a mission irrespective of cost, nor could he change his belief that doing the right thing because it was the right thing to do should be the sole motivator for businesses.”
Do you hear what this pig is saying? She’s not talking about private corruption (certainly because to protect her job she’ll deny it exists). She’s saying that Westhusing was wrong — in fact, that he was mentally unbalanced — to think his military ethics were more valid than profit-seeking!
The US military has always been the source of rampant corruption by camp travellers and back-home contractors — but this shrink is saying the new, open level to which it’s been taken by Bush is to be considered the norm and that anyone who challenges it is crazy!
Now Brian is right about the pitfalls of an overly rigid mortality for a soldier, and that would be true no matter the class character of the army (although a proletarian army has to have a superior, if still flexible, moral code). But that’s separate from the range of what’s considered acceptable — and even sane — in various bourgeois armies.
November 30th, 2005
My new article — To heal or to patch? Military mental health workers in Iraq — is now out on OpEdNews and Dissident Voice. It discusses mental health treatment for American service members in Iraq, and the tendency to patch them up and send them back into combat. This “treatment” conflicts with the ethics guidelines of most mental health professions, which emphasize the duty to put the best interests of the patient first.
EXCERPT:
The Wall Street Journal has a new article on the role of mental health professionals in treating war trauma in Iraq Therapists take on soldiers’ trauma in Iraq]. The military has caught on to how these workers can aid the war effort and has increased their per capita numbers. Rather than seeking the best treatment to help traumatized soldiers recover from their stressful and horrific experiences, these professionals attempt to patch soldiers in order to return them to combat. As the article illustrates in its lead paragraph:
Lt. Maria Kimble, an Army mental-health worker, runs a two-person counseling team out of a small plywood office here. As part of a “combat stress detachment,” her job is to help soldiers cope with the horror of the battlefield — so that they can return to it as soon as possible.
Ethical questions are raised, and then ignored by these workers, who after all, are primarily involved in serving the war effort:
“There are a lot of ethical questions about it,” says Col. Levandowski. “The oath I take as a physician is to do no harm,” he says. But “ultimately, we are in the business of prosecuting a war.”
Clearly, the best interests of the patients are at best one of several factors weighed by these professionals:
“I do ache for these guys,” says Col. Levandowski. “But if you send too many (soldiers) home, the risk is that mental health will be seen as a ticket out of country.”
Success is measured as much by whether a soldier returns to combat as whether (s)he feels better….
November 29th, 2005
Seymour Hersh, interviewed on CNN’s Late Edition With Wolf Blitzer, says US planning to accelerate air war to allow them to pull out more US troops:
Interview With Seymour Hersh. [Scroll 1/4 of the way down]
Evidently, this is covered in a new New Yorker article, Up in the Air, which I have net yet seen. Remember, the October, 2004 study [
Mortality before and after the 2003 invasion of Iraq: Cluster sample survey] in the Lancet that estimated that 98,000 Iraqis had died as a result of the US invasion, also reported that most of those who died violent deaths, died as a result of US air strikes. Imagine what devastation this new escalated air war will cause. In addition, the air power may well be used in internecine warfare:
BLITZER: And then you go on to write this: “The prospect of using air power as a substitute for American troops on the ground has caused great unease. For one thing, Air Force commanders, in particular, have deep-seated objections to the possibility that Iraqis eventually will be responsible for target selection. ‘Will the Iraqis call in air strikes in order to snuff rivals, or other warlords, or to snuff members of your own sect and blame someone else?’ another senior military planner now on assignment in the Pentagon asked.”
Also, Hersh reveals what I have long suspected, that, Bush is a true believer in his war, and is not about to call it quits just because it’s become unpopular and is hurting him politically:
HERSH: Suffice to say this, that this president in private, at Camp David with his friends, the people that I’m sure call him George, is very serene about the war. He’s upbeat. He thinks that he’s going to be judged, maybe not in five years or ten years, maybe in 20 years. He’s committed to the course. He believes in democracy.
HERSH: He believes that he’s doing the right thing, and he’s not going to stop until he gets — either until he’s out of office, or he falls apart, or he wins.
BLITZER: But this has become, your suggesting, a religious thing for him?
HERSH: Some people think it is. Other people think he’s absolutely committed, as I say, to the idea of democracy. He’s been sold on this notion. He’s a utopian, you could say, in a world where maybe he doesn’t have all the facts and all the information he needs and isn’t able to change.
I’ll tell you, the people that talk to me now are essentially frightened because they’re not sure how you get to this guy….
BLITZER: Here’s what you write. You write, “Current and former military and intelligence officials have told me that the president remains convinced that it is his personal mission to bring democracy to Iraq, and that he is impervious to political pressure, even from fellow Republicans. They also say that he disparages any information that conflicts with his view of how the war is proceeding.”
If Hersh is right, and I suspect he is, then don’t expect the US to get out of Iraq in the near future, no matter what the press says. Pull a few troops out, maybe. But withdraw? Never. Not while Bush is in office, unless Congress forces it. The latter is unlikely, as those who pull the plug on spending will fear taking the rap for “losing Iraq.”
November 27th, 2005
A friend has e-mailed several pieces from the new Science that discuss skeptics who raise questions about the likelihood of a influenza pandemic arising from the current H5N1 virus. As my friend points out, unlike the global warming issue, where little serious doubt remains among disinterested researchers, there is still considerable controversy regarding the threat posed by H5N1.
I’ve known since I started writing about it that there is considerable controversy as to how likely a H5N1 pandemic is. Given the uncertain state of knowledge, and the devastation that a near worst-case scenario would cause, it seems prudent to prepare. There are three policy issues that are involved.
1. How to make decisions when the experts disagree. In a case like this, to wait until there is consensus of all serious thinkers is to do nothing. Is this reasonable? Probably not, as sometimes, the dangers will indeed occur. Decisions often have to be made in conditions of uncertainty. However, it is important to foster open dialog and avoid premature artificial consensus is major mistakes are to be reduced.
2. How to make decisions when a worst-case is rather unlikely, but devastating? It is hard to know how much resources to put into preventing/coping with unlikely events. New Orleans shows the consequences of making the wrong decision in the resource-preserving direction. The billions spent on air safety, in order to avert a major accident every other year shows how substantial resources can be squandered. The many millions of dollars spent per life saved could save thousands of lives if spent on something else, e.g., childhood immunizations. Where the right balance lies is a difficult decision. Unfortunately, our society makes it rather suboptimally, without a serious public weighting of the costs and risks.
3. How to take action against unlikely dangers without fostering so much cynicism that it interferes with being able to take action against future risks?
The only answer I can see to dealing with the third, and indeed all three issues, is truly informing the public and involve them in the decision-making process. Informed, involved people are more likely to pay attention to both sides of the issue. Of course, in our society, that seldom, if ever, occurs. Yet another argument for a truly participatory democratic society!
November 23rd, 2005
My article, Press Freedom or Freedom to Bomb the Press? The Bush Plan to Bomb Al-Jazeera has appeared on ZNet. An extract:
The British Daily Mirror newspaper reported today that, in April 2004, President Bush planned to bomb the independent Al-Jazeera television network headquarters in US ally Qatar. Tony Blair reportedly talked him out of it. In case one doubts this report, the fact that the British government has already indicted a civil servant for leaking this document confirms its validity. In typical fashion, the White House press spokesman Scott McClellan issued one of his typical nondenials in an e-mail to the Associated Press, writing: “We are not interested in dignifying something so outlandish and inconceivable with a response.”
In evaluating this report, we should remember that on April 8, 2003, Al-Jazeera ’s office in Baghdad was bombed by US forces, killing a journalist, Tarek Ayoub, an event movingly described in the movie Control Room. This attack was despite the coordinates of the office being given to US forces, and despite huge markings being placed on the roof. [On the same day, a US tank slowly aimed and fired in broad daylight on the Palestine Hotel, killing two journalists.]
The April 8th attack was not the first or the only time the US attacked Al-Jazeera….
Read the full article here.
November 23rd, 2005
In preparation for an article, a reporter has asked for my comments on a recent letter in the American Journal of Public Health on the risks of young people switching from smoking cigarettes to smoking cigars. The letter cited data from the New Jersey Youth Tobacco Survey indicating that males had a higher rate of current cigar than of cigarette use. Further, they cited data from the 2003 National Survey on Drug Use & Health which indicate that youth and females constitute a large fraction of those initiating [starting use of] cigars.
I was asked to comment because I have done extensive research on youth use of alternative tobacco products, namely cigars, bidis [small hand-rolled cigarettes imported from India, and, in the US, often given kid-friendly flavors like “chocolate raspberry”] , and kreteks [tobacco cigarettes flavored with clove extract]. Those interested in reading my papers on this topic can find them on my publications page.
What follows are the reporters questions and my slightly edited replies:
1. What do you think of these study findings? Do they seem reasonable?
This study raises an important issue: whether declines in youth cigarette smoking are accompanied by an increase in alternative tobacco use, including most notably, use of cigars. I shared this concern when I did my work. As the authors point out, tax law currently facilitates this substitution process by making alternative tobacco cheaper than cigarettes.
As to whether this substitution is occurring, I don’t know. Examining the 2003 National Survey on Drug Use & Health: Results reference it isn’t as clear as the authors indicate. The authors refer to the following statement:
Initiation of cigar smoking more than doubled between 1990 and 1998, reaching a peak of 3.7 million new users in 1998. Between 2000 and 2002, cigar initiates declined from 3.6 million to 3.0 million. Since 1990, youths under 18 have constituted an increasingly greater proportion of the number of new cigar smokers, from 23 percent in 1990 to 46 percent in 2002. During that period, the proportion of cigar initiates that was female also increased, from 24 to 45 percent.
However, the same report states:
Current cigar use among the three age groups also was unchanged between 2002 and 2003. The rate was 4.5 percent in both years among youths aged 12 to 17; 11.4 percent in 2003 and 11.0 percent in 2002 among young adults aged 18 to 25; and 4.5 percent in 2003 and 4.6 percent in 2002 among adults aged 26 or older.
These prevalence rates are more in line with those usually seen in recent years in household surveys [school-based surveys, for methodological reasons, typically report higher rates for prevalence of most substances, making the two types of surveys not directly comparable.]. The higher initiation rates among youths under 18 are of concern and should be tracked. However, the overall prevalence rates do not suggest a mushrooming problem so far.
The rates reported in the letter for the New Jersey Youth Tobacco Survey are anomalous, as far as I am aware [I have not followed all the individual state prevalence reports.] In the 2004 National Youth Tobacco Survey they found:
In 2004, a total of 28.0% of high school students reported current use of any tobacco product (Table 2). Cigarettes (22.3%) were the most commonly used product, followed by cigars (12.8%), smokeless tobacco (6.0%), pipes (3.1%), bidis (2.6%), and kreteks (2.3%).
However, looking at the stats by gender in the New Jersey Youth Tobacco Survey Table 2, we see, for males: current cigarettes use — 22.1 (Confidence Interval 2.7); current cigar use — 18.4 (CI: 1.8) and A female cigar rate of 7.5 (CI: 1.4).
Thus, New Jersey has a much male lower cigarette use than nationally [great for them!], but little difference on cigars. This pattern is consistent with the authors’ argument in the letter. One would suspect that the cigarette tax there, perhaps accompanied by other tobacco control efforts, are responsible for the lower cigarette rate. So, efforts [taxes and other tobacco control efforts] may be necessary to reduce cigar use.
However, the authors don’t present their confidence intervals, a measure of the precision of their prevalence rates. It seems likely that the male cigarette and cigar rates are not in fact, significantly different. In other words, the higher rate for cigars is likely just a chance finding, not really higher. Of course, an equal rate for cigarettes and cigars could still be a serious problem.
In order to evaluate the New Jersey findings, we will need similar data from other states, or another year’s survey data from New Jersey.
2. Why is cigar use among teens a growing problem?
We don’t know. Originally, it was thought that the allure of cigars, a la, Cigar Aficionado magazine was the reason. My research suggested that this was a factor only among suburban kids.
An other factor [often ignored by tobacco control folks who don't think much about other types of substance abuse] include the fact that cigars are often hollowed out and used to smoke marijuana [called 'blunts']. Interestingly, I found that Philly’s blunts were the most frequently smoked cigar brand by kids, both when smoking cigars, and when making blunts.
Finally, there is the price factor, raised by these authors. They are perfectly correct that it makes no sense to tax alternative tobacco at lower rates than cigarettes are taxed.
3. In terms of danger to health, how do cigars compare to cigarettes?
Dangerous, but possibly somewhat less so. The National Cancer Institute, in their Cigar monograph: Cigars: Health Effects and Trends, found that cigars are associated with most diseases that cigarettes are, with the partial exception of lung diseases. The latter is because cigars are usually not inhaled.
However, there is some anecdotal evidence that some kids may inhale cigars. This was the issue I most regretted exploring in my own research on this. If kids inhale cigars, then cigars may be as, or even more dangerous than cigarettes, as cigars are less likely to be filtered.
A related issue that I have no data on is the relative addictiveness of nicotine as received from cigars as compared to cigarettes. The biggest reason tobacco use among teens is such a concern, is not the immediate health risks, but the fact that nicotine is highly addictive. Studies show that a fraction of teens start showing withdrawal symptoms within weeks of initiating smoking. Thus, youth tobacco use sets the young person up for a potential of many years of tobacco use, leading to the variety of chronic diseases.
Another issue we do not know the answer to is how much nicotine is absorbed when cigars are used as blunts to smoke marijuana. Is it enough to begin the addictive process? I wish we knew.
If cigars are as addictive as cigarettes, they would also hold the potential to create long-term smokers, whether of cigars or of other forms of tobacco. If youth inhale cigars, this likely would increase the addictive potential. There are a number of “ifs” here, but we should be finding out.
4. Do you think public health folks are doing enough about the cigar problem? What more could be done?
No. There has been very little attention to cigars among public health folks. When I conducted my study, it was virtually the first study focused on alternative tobacco use. Many health educators and others were completely unaware of issues around alternative tobacco use. This needs to change. I think it is starting to change, but more needs to be done. I also think we need to learn more about effective tobacco control strategies for reducing cigar use.
5. Might there be any benefit to teens smoking cigars instead of cigarettes? (i.e., less exposure to tobacco, they’re less socially acceptable in some parts, etc.)
As to the exposure to tobacco, see my comments above. We simply don’t know enough about how kids use cigars to know if they’re getting less nicotine. Same about the relative social acceptability and its effects. On the other hand, young people are often attracted to substances because they are “forbidden”. We don’t know enough to know how these relative factors work out.
November 23rd, 2005
Notice the headlines out of Iraq in just the last two days:
- After months of denying it, the Pentagon has been forced to admit that US used white phosphorus in Iraq as reported by the Italian TV network RAI last week. Remember that White Phosphorous is a chemical that burns like napalm, sometimes burning flesh right through to the bone. A number of witnesses in Fallujah report seeing the corpses of civilians with their flesh burned off. While legal experts debate whether White Phosphorous is technically a “chemical weapon,” there is no doubt that it is as horrific as the chemical weapons Saddam Hussein is accused of using agaist Iraqis.
- An investigation found at least 170 Iraqis in a prison maintained by the Iraqi Ministry of the Interior, many of whom had been tortured. As Reuters quotes an Iraqi official:
“I saw signs of physical abuse by brutal beating, one or two detainees were paralysed and some had their skin peeled off various parts of their bodies.”
- And new accounts appearing in an ACLU lawsuit give testimony of the depths of torture resorted to by US troops in Iraq. Two Iraqi businessmen report being arrested by US troops, report being threatened with being fed to lions, stunned with Tasers, being threatened with simulated anal rape, witnessing mistreatment of the Koran, and, of course, deprivation of food and water and repeated
beatings. Note that the torture took place at three different sites. One of these sites was Saddam’s Republican Palace, using his lions for the sport of the new brutalizers. This torture, so widespread and so routine, was in no way the actions of a “few bad apples,” but was obviously policy.
Meanwhile, this country locks people up indefinitely without any semblance of a fair trial; the administration fights tooth and nail to preserve the right to torture; and the attacks on Iraqi city after city roll right along.
At this point, the news from these few days alone makes it totally obvious that “freedom,” “democracy,” or “human rights” have absolutely nothing to do with the US invasion and occupation of Iraq. Any prosecution of the fallen dictator by the current torture regimes (US and Iraqi) will only increase the farce. I, for one, would love to see Saddam Hussein on trial, but only if accompanied by his fellow war criminals.
November 15th, 2005
In the editorial in its new issue, Democrats and the War, the Nation has finally taken the pledge that all progressives and leftists should take NOW, while it can have a major effect:
We will not support any candidate for national office who does not make a speedy end to the war in Iraq a major issue of his or her campaign. We urge all voters to join us in adopting this position.
They go on to explain their position:
Many worry that the aftermath of withdrawal will be ugly, but we can now see that the consequences of staying will be uglier still. Fear of facing the consequences of Bush’s disaster should not be permitted to excuse the creation of a worse disaster by continuing the occupation.
We firmly believe that antiwar candidates, with the other requisite credentials, can win the 2006 Congressional elections, the 2008 Democratic presidential primaries and the subsequent national election. But this fight, and our stand, must begin now.
Whatever one thinks of the Democratic Party as a vehicle for major social change (a prospect I view as exceedingly unlikely), election of antiwar candidates is an essential part of a movement to end this bloody war. Given the degree of popular disenchantment and disgust with this war, if they don’t come from the Democratic Party, they will likely come from the Republican. But antiwar candiates there will be.
November 14th, 2005