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The Psychic Malignancy of the Afghan War Keith Raymond
a
a
International SOS Liberia AML Buchanan Hospital , Liberia Published online: 09 May 2013.
To cite this article: Keith Raymond (2013) The Psychic Malignancy of the Afghan War, Medicine, Conflict and Survival, 29:2, 104-110, DOI: 10.1080/13623699.2013.785111 To link to this article: http://dx.doi.org/10.1080/13623699.2013.785111
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sublicensing, systematic supply, or distribution in any form to anyone is expressly
Downloaded by [Lakehead University] at 06:11 14 March 2015
forbidden. Terms & Conditions of access and use can be found at http:// www.tandfonline.com/page/terms-and-conditions
Medicine, Conflict and Survival, 2013 Vol. 29, No. 2, 104–110, http://dx.doi.org/10.1080/13623699.2013.785111
COMMENTARY The Psychic Malignancy of the Afghan War Keith Raymond* International SOS Liberia AML Buchanan Hospital, Liberia
Downloaded by [Lakehead University] at 06:11 14 March 2015
(Accepted 23 November 2012)
The burnt sienna of Helmand Province, Afghanistan spreads out flat and forever from the Wire at Camp Leatherneck. The civilian contractor lifts not a weapon, but a spade, and digs a trench to widen the burn pit1. A Kenyan, far from home, cut off from family, working seven days a week and every waking hour for two years before his first day off. He justifies his enslavement as he earns more in a day than most of his family will make in a month back home. Meanwhile, children are born, cousins die, wives weep, villages burn and he is unaware. All he knows is the constant fear of a stray rocket dismembering him, and the ever-present fatigue. I bring him physical care and mental comfort – as a contracted physician, this is just one part of my responsibility to these folks. Those that collapse from the strain are the ‘normal’ ones; those that suck it up and soldier on are, to me, the ‘impaired’ – in that they have used maladaptive defence mechanisms to deal with their dangerous work conditions. This is the nature of war for a contractor. America is participating in its longest war ever, over 11 years in Afghanistan, with one more to go. However, the medical advances made outstrip the psychiatric ones. At the latest count 67% of soldiers return home with symptoms of depression and up to 71% have anxiety symptoms (Lopes Cardozo et al. 2004). The United States military tour of duty lasts only six months. Soldiers have access to a gym, welfare and recreation, as well as support for morale. In Iraq, the civilian contractor was allowed one day off a week; in Afghanistan, there are no days off. It is an experiment in slavery, where the only solace is food (American-style) and sleep. While injuries can be minor, though often resulting in infection, or major, requiring stabilisation and demobilisation, the psychic malignancy is treatable but career ending. Medication requires 90 days out of theatre, as per US military regulations for deployment, and a contractor’s position is forfeit at 45 days. However, the need for counselors and social workers has only recently been identified and implemented for the civilian contractors. Submit*Email: [email protected] Ó 2013 Taylor & Francis
Medicine, Conflict and Survival
105
Downloaded by [Lakehead University] at 06:11 14 March 2015
ting to the process is not without consequence, however, as numbers and names are monitored. Typically, the patient is seen by the counselor two to four times; beyond that, the recommendation for demobilisation may be advised. Long term Consequences Fear is the operational imperative. It is present from without and within the company framework. Fear is the catalyst for the psychic malignancy, and it becomes addictive. It makes one want to return repeatedly to war zones – despite its disagreeable nature, as the soldier or contractor is disenfranchised back in ‘the world’. One feels alive while huddling against a cement wall out in the open during a rocket attack. The affirmation of life in the face of death is both stimulating, yet life-numbing. The ultimate resolution is suicide. Standing beside a body, the grief is felt by tent-mates. The dead have found their release. We don’t really speak of suicide, although vigilance is part of the mandatory training. The tent-mates feel betrayed and violated by the action. In actuality, the Defence Base Act provides a million dollars to surviving family members if you are killed in a war zone. This self-destruction, however, is immolation of a spirit that has long since died. One fellow had seen action in both Iraq and Afghanistan for a combined total of 10 years. He was not in debt, and his family was well cared for – but he couldn’t let go of life in a war zone. He chose to live without his emotional support, to live separately and alone. The price of isolation, especially in a war zone, is the skewing of perspective. We need others to ground us, to keep our worldview in line. Isolation creates a warp in the personality, a disturbance of the thought processes, an infatuation with falsehoods that separates thought from belief. The magical powers of homemade oatmeal and goji berries to promote mental stability were reported to me by a colleague, who was discovered early one morning in the dining room talking to himself and throwing fits of rage at no one in particular – but certainly scaring the waiters. He was brought to me for evaluation. Following an hour-long interview, I discussed the case with the company social worker. The man and two friends were assigned to a ‘Forward Operating Base’. He had worked with these friends for years, but within a month they were shifted to other bases and he was left by himself. Over a period of several months, his new co-workers noticed his increasingly bizarre behaviour. While his work remained superlative, his speech became increasingly disturbed, and concern that he was having some kind of psychotic episode brought him to medical attention. Because of his nationality, he was allowed a ‘Rest & Relaxation’ (R&R) period of two weeks every four months, to allow the contractor time to catch up with life at home and to ‘decompress’.
106
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Downloaded by [Lakehead University] at 06:11 14 March 2015
Factors Contributing to Decompensation A pattern of behaviour and mental dissociation has been identified in those susceptible: sometime between 120 and 160 days in theatre, an emotional ‘decompensation’ occurs. Depending on the internal defence mechanisms in place, a person may weather this period well, or psychologically collapse under the constant strain of fear, work, and lack of recovery. This period is a test of personality and psychological strength. Those that have less defined personalities actually seem to fare better, as the elements needed to undergo disassociation need to have matured sufficiently to cause depersonalisation. Since these military bases are mostly manned by contractors from blue collar backgrounds, many of the contractors are defined by broken family backgrounds, and as such their emotional evolution is defined by these influences. A robust personality combined with isolation and fatigue can lead to a breakdown of perspective that ultimately concerns strangers and necessitates early medical evacuation. Some contractors receive treatment back home, especially if it is medically directed, requiring consultation, stabilisation and clearance prior to redeployment. I have directed the paramedical teams I supervised to always question about suicide ideation, issues at home, and how the contractors are coping at work. Unfortunately, medical and psychological support in theatre is often seen as the enemy too, as we have the ability to demobilise personnel – and many of the contractors would eagerly sacrifice their health for financial gain. This was evident during the testing of personnel that worked the ‘Burn Pit’. Mandatory periodic evaluation of lung function of the majority of the contractors showed a deterioration of forced expiratory rate, consistent with damaged lungs and risk of emphysema from the constant exposure to smoke. The response from these guys when the results were reported with alarm was to say, ‘Just give me the inhaler so I can get back to work’. Psychologists back home describe depression, anxiety, and post-traumatic stress disorder (PTSD) in many of the contractors, but I wish to focus on the majority. These are the abnormal folks, those that have managed to adapt to a clearly abnormal environment. They bring home emotional baggage unlike any other: they quietly suffer. They are the ones who, like our forefathers, ‘never talk about’ the War. They have seen their friends and comrades become disenfranchised from the outside world, if not dismembered or killed. They take it in their stride, but the scars are there. Their ability to respond to affection is forever stunted. They minimise the issues of their loved ones, as they do not have the same traction as the mutilation of a colleague during a rocket attack. This emotional blunting is soul destroying. Blast Effects I think I have discovered a unique phenomenon inherent in the aftermath of rocket attacks – I believe that there are actually two detonations. The first is
Downloaded by [Lakehead University] at 06:11 14 March 2015
Medicine, Conflict and Survival
107
the physical detonation: the destructive force of a rocket attack tears through aluminium structures that predominate over the base landscape, throwing shrapnel in a deadly spray. It can damage eyesight, limbs, and sometimes even kill, but more often than not it maims. The majority of victims experience concussion – a sudden compression and expansion of air and sound that is more often felt than heard. It pummels the body; shifting the organs just enough to make you feel that you never quite return to the place you were just a fraction of a second before. It can even return you briefly to a juvenile state. As an adult, we brace when we see imminent pain; that bracing can even result in greater injury, but it prepares us for the impact. As children, we react after the blow, not before it. During a rocket attack, even the most mature adult who experiences the concussion rather than hearing the explosion is caught unawares, and is startled, regressing to a more childlike response, and with it silent tears hiding fears. The second detonation, I propose, is the psychological concussion – its propagation inversely proportional to the locus of the blast. Those furthest from the impact crater on the base are often the most affected. They experience a range of symptoms, from sleeplessness, altered bowel habits, as well as gossiping about those that were injured, and only feeling minor guilt as to why they themselves were not injured. They feel fortunate, but it is not fortune one can bank on; they just shiver with anticipation and anxiety about the next attack. The psychological concussion occurs later, has a more lasting impact, and resolves more slowly. The effect is cumulative, and it increases personal fatigue over time. It spreads like cancer through the population, collecting in nodes that are not necessarily commensurate with the work site. The Afghanistan factions abandon the launch sites prior to the rocket’s departure for their own preservation, but they monitor the random destruction of the unguided missiles, noting the number of ambulances deployed after an attack, and if there are many, they note the coordinates for targeting in the future. It is especially unsettling when the rockets fall in the company camp. While bunkers abound, over time they are less and less frequented, as a laissez faire attitude develops. It is this lack of caution, of throwing cares to the wind, which is a manifestation of the addiction to the war zone, and the affliction of the malignancy. It is an abnormal response to a very real danger, and represents maladjustment as well as a kind of compensation for an inability to cope with a hostile environment. Over time, the ability to return to normal life deteriorates, and the individual carries the war home within them, responding to a society at peace as if they were still living in a war zone. Home Repercussions and Coping It is a source of constant astonishment to the civilian contractors that life goes on out in the rest of the world while time progresses but is somehow stymied on the base. Teenage children succumb to drug and alcohol addiction or crime,
Downloaded by [Lakehead University] at 06:11 14 March 2015
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spouses cheat, debt increases, and they have to try to manage it from afar – if they are even aware that it is occurring at all. Meanwhile, loneliness and frustration eat away at them, and the earned R&R time is attenuated by having to address the accumulated crises that could not be attended to from the theatre. Sometimes this period is forfeited altogether, or another crisis intervenes shortly after redeployment, forcing a return home to start over again, or not to return at all. One of the truly interesting ironies for me was the vulnerability of both contractors and soldiers on the bases in Afghanistan. This was a surprising observation, as one expected the personnel to be hard-boiled leathernecks – tough on both the outside and the inside. In fact they were often overly sensitive to criticism, and unable to manage the common stressors in office and worksite life. This disconnect, to me, had more to do with ‘raw nerves’ than an actual inability to complete a task. If anything, the personnel seemed overly sensitised rather than resilient. This failure to cope seems to be a direct result of the permeation of low grade fear throughout the base as a result of the war, and an evolving sense of helplessness and hopelessness generated by the maiming, deaths, and mental decompensation of those around them. Up until the end of the Balkans conflict, the life of the military contractor could be characterised as one of lawlessness in a land without a country. Governance of behaviour was controlled only by the company they worked for, and off duty hours allowed for actions free of repercussions. If the employee performed well while on duty, all other behaviour was of little consequence. Many women made more money selling sex in their off duty hours – perhaps also attempting to assuage their fear. Men built stills and made liquor, organised gambling rings, pleasure houses, and meted out punishment to those who could not pay their dues. Some of the so-called suicides were actually murders, and with the million dollar payouts by the Defence Base Act to surviving family members, the debts were ultimately paid by pressure on those back home. While this still goes on (albeit on a far more limited scale), much of this activity has fortunately been curtailed by the institution of – and recent reinforcement of – the application of the Uniform Code of Military Justice to defence contractors. Historically, these laws came into play following the scandal surrounding human trafficking within the DynCorp and United Nations peacekeeping mission in Bosnia after the war there (Human Rights Watch 2002). The trafficking of females for sex was brought to light during an investigation by Kathryn Bolkavac (2011), and was recently made into a movie called The Whistleblower. Deviant Refuge While many of those undertaking such activities have been purged during this process, and the subsequent use of US Army Investigation and clearance for Combined Access has eradicated individuals with felony records, there are still a subset of individuals who are contractors and ‘deviants’. These are the more
Downloaded by [Lakehead University] at 06:11 14 March 2015
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malignant personalities, able to submerge their deviance during working hours, but allowing it free range at night. There are sado-masochists created in the fire of interrogation either as victims of torture or the interrogators themselves. Forever changed by the process, they can only find pleasure in the extreme of sexual pleasure by harming or sustaining harm. Another type is the ‘Afghanophile’, growing beard and long hair, dining in Afghan dining facilities, assimilating with the one third of the contractor population who are indigenous to Afghanistan and then infecting them with ideologies ranging from Christianity to inciting violence. They survive and even thrive in this environment as it is the only place where they actually fit in. These, along with the military retirees unable to give up the fiction of comradery, are contractors motivated to work to avoid abject poverty that a military life portends for those unable to find a meaningful career, and are devoid of a skill set that is amenable to civilian life. It is this comradery that feeds the addiction to work in a war zone. As Chris Hedges (2012) described in his article ‘Murder is not an anomaly in war’: War is necrophilia. This necrophilia is central to soldiering just as it is central to the makeup of suicide bombers and terrorists. The necrophilia is hidden under platitudes about duty or comradeship. It is unleashed especially in moments when we seem to have little to live for and no hope, or in moments when the intoxication of war is at its highest pitch. When we spend long enough time in war, it comes to us as a kind of release, a fatal and seductive embrace that can consummate the long flirtation with our own destruction.
To the contractor, the journalist, and the soldier, war is a cancer of the mind, both seductive and repulsive, until the adrenaline purges all other feelings from the body, and they are left drowning on the shore, washed up on barren psychological sands. Note These observations are drawn from the direct personal experience of the author, and do not reflect the views of ISAF or other military forces. Identities of individuals in the article have been anonymised to protect their identities. 1. A hole dug to burn waste. Note on contributor Dr Keith Raymond is a US trained physician, trained in both family and emergency medicine. He has practiced in the United States, Germany, Saudi Arabia, Botswana, Dubai, Afghanistan, several islands in the Caribbean, and now in Liberia. This article was derived from direct experience while working as a civilian contractor in Kandahar Air Base and Camp Leatherneck/Bastion in Helmand Province, Afghanistan in 2011 and 2012.
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References
Downloaded by [Lakehead University] at 06:11 14 March 2015
Bolkovac, K. 2011. Sex Trafficking, Military Contractors and One Woman’s Fight for Justice. Basingstoke: Palgrave Macmillan. Hedges, C. 2012. “Murder is Not an Anomaly in War.” Truth Dig [online]. Accessed 4 March 2013. http://www.truthdig.com/report/item/murder_is_not_an_anomoly_in_war_ 20120319/. Human Rights Watch. 2002. Hopes Betrayed: Trafficking of Woman and Girls to Bosnia and Herzegovina for Forced Prostitution. Accessed 4 March 2013. http://www.hrw. org/reports/2002/bosnia/. Lopes Cardozo, B., O. O. Bilukha, C. A. Gotway Crawford, et al. 2004. “Mental Health, Social Functioning, and Disability in Postwar Afghanistan.” JAMA: The Journal of the American Medical Association 292: 575–584.
Medicine, Conflict and Survival Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/fmcs20
The Psychic Malignancy of the Afghan War Keith Raymond
a
a
International SOS Liberia AML Buchanan Hospital , Liberia Published online: 09 May 2013.
To cite this article: Keith Raymond (2013) The Psychic Malignancy of the Afghan War, Medicine, Conflict and Survival, 29:2, 104-110, DOI: 10.1080/13623699.2013.785111 To link to this article: http://dx.doi.org/10.1080/13623699.2013.785111
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sublicensing, systematic supply, or distribution in any form to anyone is expressly
Downloaded by [Lakehead University] at 06:11 14 March 2015
forbidden. Terms & Conditions of access and use can be found at http:// www.tandfonline.com/page/terms-and-conditions
Medicine, Conflict and Survival, 2013 Vol. 29, No. 2, 104–110, http://dx.doi.org/10.1080/13623699.2013.785111
COMMENTARY The Psychic Malignancy of the Afghan War Keith Raymond* International SOS Liberia AML Buchanan Hospital, Liberia
Downloaded by [Lakehead University] at 06:11 14 March 2015
(Accepted 23 November 2012)
The burnt sienna of Helmand Province, Afghanistan spreads out flat and forever from the Wire at Camp Leatherneck. The civilian contractor lifts not a weapon, but a spade, and digs a trench to widen the burn pit1. A Kenyan, far from home, cut off from family, working seven days a week and every waking hour for two years before his first day off. He justifies his enslavement as he earns more in a day than most of his family will make in a month back home. Meanwhile, children are born, cousins die, wives weep, villages burn and he is unaware. All he knows is the constant fear of a stray rocket dismembering him, and the ever-present fatigue. I bring him physical care and mental comfort – as a contracted physician, this is just one part of my responsibility to these folks. Those that collapse from the strain are the ‘normal’ ones; those that suck it up and soldier on are, to me, the ‘impaired’ – in that they have used maladaptive defence mechanisms to deal with their dangerous work conditions. This is the nature of war for a contractor. America is participating in its longest war ever, over 11 years in Afghanistan, with one more to go. However, the medical advances made outstrip the psychiatric ones. At the latest count 67% of soldiers return home with symptoms of depression and up to 71% have anxiety symptoms (Lopes Cardozo et al. 2004). The United States military tour of duty lasts only six months. Soldiers have access to a gym, welfare and recreation, as well as support for morale. In Iraq, the civilian contractor was allowed one day off a week; in Afghanistan, there are no days off. It is an experiment in slavery, where the only solace is food (American-style) and sleep. While injuries can be minor, though often resulting in infection, or major, requiring stabilisation and demobilisation, the psychic malignancy is treatable but career ending. Medication requires 90 days out of theatre, as per US military regulations for deployment, and a contractor’s position is forfeit at 45 days. However, the need for counselors and social workers has only recently been identified and implemented for the civilian contractors. Submit*Email: [email protected] Ó 2013 Taylor & Francis
Medicine, Conflict and Survival
105
Downloaded by [Lakehead University] at 06:11 14 March 2015
ting to the process is not without consequence, however, as numbers and names are monitored. Typically, the patient is seen by the counselor two to four times; beyond that, the recommendation for demobilisation may be advised. Long term Consequences Fear is the operational imperative. It is present from without and within the company framework. Fear is the catalyst for the psychic malignancy, and it becomes addictive. It makes one want to return repeatedly to war zones – despite its disagreeable nature, as the soldier or contractor is disenfranchised back in ‘the world’. One feels alive while huddling against a cement wall out in the open during a rocket attack. The affirmation of life in the face of death is both stimulating, yet life-numbing. The ultimate resolution is suicide. Standing beside a body, the grief is felt by tent-mates. The dead have found their release. We don’t really speak of suicide, although vigilance is part of the mandatory training. The tent-mates feel betrayed and violated by the action. In actuality, the Defence Base Act provides a million dollars to surviving family members if you are killed in a war zone. This self-destruction, however, is immolation of a spirit that has long since died. One fellow had seen action in both Iraq and Afghanistan for a combined total of 10 years. He was not in debt, and his family was well cared for – but he couldn’t let go of life in a war zone. He chose to live without his emotional support, to live separately and alone. The price of isolation, especially in a war zone, is the skewing of perspective. We need others to ground us, to keep our worldview in line. Isolation creates a warp in the personality, a disturbance of the thought processes, an infatuation with falsehoods that separates thought from belief. The magical powers of homemade oatmeal and goji berries to promote mental stability were reported to me by a colleague, who was discovered early one morning in the dining room talking to himself and throwing fits of rage at no one in particular – but certainly scaring the waiters. He was brought to me for evaluation. Following an hour-long interview, I discussed the case with the company social worker. The man and two friends were assigned to a ‘Forward Operating Base’. He had worked with these friends for years, but within a month they were shifted to other bases and he was left by himself. Over a period of several months, his new co-workers noticed his increasingly bizarre behaviour. While his work remained superlative, his speech became increasingly disturbed, and concern that he was having some kind of psychotic episode brought him to medical attention. Because of his nationality, he was allowed a ‘Rest & Relaxation’ (R&R) period of two weeks every four months, to allow the contractor time to catch up with life at home and to ‘decompress’.
106
Commentary
Downloaded by [Lakehead University] at 06:11 14 March 2015
Factors Contributing to Decompensation A pattern of behaviour and mental dissociation has been identified in those susceptible: sometime between 120 and 160 days in theatre, an emotional ‘decompensation’ occurs. Depending on the internal defence mechanisms in place, a person may weather this period well, or psychologically collapse under the constant strain of fear, work, and lack of recovery. This period is a test of personality and psychological strength. Those that have less defined personalities actually seem to fare better, as the elements needed to undergo disassociation need to have matured sufficiently to cause depersonalisation. Since these military bases are mostly manned by contractors from blue collar backgrounds, many of the contractors are defined by broken family backgrounds, and as such their emotional evolution is defined by these influences. A robust personality combined with isolation and fatigue can lead to a breakdown of perspective that ultimately concerns strangers and necessitates early medical evacuation. Some contractors receive treatment back home, especially if it is medically directed, requiring consultation, stabilisation and clearance prior to redeployment. I have directed the paramedical teams I supervised to always question about suicide ideation, issues at home, and how the contractors are coping at work. Unfortunately, medical and psychological support in theatre is often seen as the enemy too, as we have the ability to demobilise personnel – and many of the contractors would eagerly sacrifice their health for financial gain. This was evident during the testing of personnel that worked the ‘Burn Pit’. Mandatory periodic evaluation of lung function of the majority of the contractors showed a deterioration of forced expiratory rate, consistent with damaged lungs and risk of emphysema from the constant exposure to smoke. The response from these guys when the results were reported with alarm was to say, ‘Just give me the inhaler so I can get back to work’. Psychologists back home describe depression, anxiety, and post-traumatic stress disorder (PTSD) in many of the contractors, but I wish to focus on the majority. These are the abnormal folks, those that have managed to adapt to a clearly abnormal environment. They bring home emotional baggage unlike any other: they quietly suffer. They are the ones who, like our forefathers, ‘never talk about’ the War. They have seen their friends and comrades become disenfranchised from the outside world, if not dismembered or killed. They take it in their stride, but the scars are there. Their ability to respond to affection is forever stunted. They minimise the issues of their loved ones, as they do not have the same traction as the mutilation of a colleague during a rocket attack. This emotional blunting is soul destroying. Blast Effects I think I have discovered a unique phenomenon inherent in the aftermath of rocket attacks – I believe that there are actually two detonations. The first is
Downloaded by [Lakehead University] at 06:11 14 March 2015
Medicine, Conflict and Survival
107
the physical detonation: the destructive force of a rocket attack tears through aluminium structures that predominate over the base landscape, throwing shrapnel in a deadly spray. It can damage eyesight, limbs, and sometimes even kill, but more often than not it maims. The majority of victims experience concussion – a sudden compression and expansion of air and sound that is more often felt than heard. It pummels the body; shifting the organs just enough to make you feel that you never quite return to the place you were just a fraction of a second before. It can even return you briefly to a juvenile state. As an adult, we brace when we see imminent pain; that bracing can even result in greater injury, but it prepares us for the impact. As children, we react after the blow, not before it. During a rocket attack, even the most mature adult who experiences the concussion rather than hearing the explosion is caught unawares, and is startled, regressing to a more childlike response, and with it silent tears hiding fears. The second detonation, I propose, is the psychological concussion – its propagation inversely proportional to the locus of the blast. Those furthest from the impact crater on the base are often the most affected. They experience a range of symptoms, from sleeplessness, altered bowel habits, as well as gossiping about those that were injured, and only feeling minor guilt as to why they themselves were not injured. They feel fortunate, but it is not fortune one can bank on; they just shiver with anticipation and anxiety about the next attack. The psychological concussion occurs later, has a more lasting impact, and resolves more slowly. The effect is cumulative, and it increases personal fatigue over time. It spreads like cancer through the population, collecting in nodes that are not necessarily commensurate with the work site. The Afghanistan factions abandon the launch sites prior to the rocket’s departure for their own preservation, but they monitor the random destruction of the unguided missiles, noting the number of ambulances deployed after an attack, and if there are many, they note the coordinates for targeting in the future. It is especially unsettling when the rockets fall in the company camp. While bunkers abound, over time they are less and less frequented, as a laissez faire attitude develops. It is this lack of caution, of throwing cares to the wind, which is a manifestation of the addiction to the war zone, and the affliction of the malignancy. It is an abnormal response to a very real danger, and represents maladjustment as well as a kind of compensation for an inability to cope with a hostile environment. Over time, the ability to return to normal life deteriorates, and the individual carries the war home within them, responding to a society at peace as if they were still living in a war zone. Home Repercussions and Coping It is a source of constant astonishment to the civilian contractors that life goes on out in the rest of the world while time progresses but is somehow stymied on the base. Teenage children succumb to drug and alcohol addiction or crime,
Downloaded by [Lakehead University] at 06:11 14 March 2015
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Commentary
spouses cheat, debt increases, and they have to try to manage it from afar – if they are even aware that it is occurring at all. Meanwhile, loneliness and frustration eat away at them, and the earned R&R time is attenuated by having to address the accumulated crises that could not be attended to from the theatre. Sometimes this period is forfeited altogether, or another crisis intervenes shortly after redeployment, forcing a return home to start over again, or not to return at all. One of the truly interesting ironies for me was the vulnerability of both contractors and soldiers on the bases in Afghanistan. This was a surprising observation, as one expected the personnel to be hard-boiled leathernecks – tough on both the outside and the inside. In fact they were often overly sensitive to criticism, and unable to manage the common stressors in office and worksite life. This disconnect, to me, had more to do with ‘raw nerves’ than an actual inability to complete a task. If anything, the personnel seemed overly sensitised rather than resilient. This failure to cope seems to be a direct result of the permeation of low grade fear throughout the base as a result of the war, and an evolving sense of helplessness and hopelessness generated by the maiming, deaths, and mental decompensation of those around them. Up until the end of the Balkans conflict, the life of the military contractor could be characterised as one of lawlessness in a land without a country. Governance of behaviour was controlled only by the company they worked for, and off duty hours allowed for actions free of repercussions. If the employee performed well while on duty, all other behaviour was of little consequence. Many women made more money selling sex in their off duty hours – perhaps also attempting to assuage their fear. Men built stills and made liquor, organised gambling rings, pleasure houses, and meted out punishment to those who could not pay their dues. Some of the so-called suicides were actually murders, and with the million dollar payouts by the Defence Base Act to surviving family members, the debts were ultimately paid by pressure on those back home. While this still goes on (albeit on a far more limited scale), much of this activity has fortunately been curtailed by the institution of – and recent reinforcement of – the application of the Uniform Code of Military Justice to defence contractors. Historically, these laws came into play following the scandal surrounding human trafficking within the DynCorp and United Nations peacekeeping mission in Bosnia after the war there (Human Rights Watch 2002). The trafficking of females for sex was brought to light during an investigation by Kathryn Bolkavac (2011), and was recently made into a movie called The Whistleblower. Deviant Refuge While many of those undertaking such activities have been purged during this process, and the subsequent use of US Army Investigation and clearance for Combined Access has eradicated individuals with felony records, there are still a subset of individuals who are contractors and ‘deviants’. These are the more
Downloaded by [Lakehead University] at 06:11 14 March 2015
Medicine, Conflict and Survival
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malignant personalities, able to submerge their deviance during working hours, but allowing it free range at night. There are sado-masochists created in the fire of interrogation either as victims of torture or the interrogators themselves. Forever changed by the process, they can only find pleasure in the extreme of sexual pleasure by harming or sustaining harm. Another type is the ‘Afghanophile’, growing beard and long hair, dining in Afghan dining facilities, assimilating with the one third of the contractor population who are indigenous to Afghanistan and then infecting them with ideologies ranging from Christianity to inciting violence. They survive and even thrive in this environment as it is the only place where they actually fit in. These, along with the military retirees unable to give up the fiction of comradery, are contractors motivated to work to avoid abject poverty that a military life portends for those unable to find a meaningful career, and are devoid of a skill set that is amenable to civilian life. It is this comradery that feeds the addiction to work in a war zone. As Chris Hedges (2012) described in his article ‘Murder is not an anomaly in war’: War is necrophilia. This necrophilia is central to soldiering just as it is central to the makeup of suicide bombers and terrorists. The necrophilia is hidden under platitudes about duty or comradeship. It is unleashed especially in moments when we seem to have little to live for and no hope, or in moments when the intoxication of war is at its highest pitch. When we spend long enough time in war, it comes to us as a kind of release, a fatal and seductive embrace that can consummate the long flirtation with our own destruction.
To the contractor, the journalist, and the soldier, war is a cancer of the mind, both seductive and repulsive, until the adrenaline purges all other feelings from the body, and they are left drowning on the shore, washed up on barren psychological sands. Note These observations are drawn from the direct personal experience of the author, and do not reflect the views of ISAF or other military forces. Identities of individuals in the article have been anonymised to protect their identities. 1. A hole dug to burn waste. Note on contributor Dr Keith Raymond is a US trained physician, trained in both family and emergency medicine. He has practiced in the United States, Germany, Saudi Arabia, Botswana, Dubai, Afghanistan, several islands in the Caribbean, and now in Liberia. This article was derived from direct experience while working as a civilian contractor in Kandahar Air Base and Camp Leatherneck/Bastion in Helmand Province, Afghanistan in 2011 and 2012.
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References
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Bolkovac, K. 2011. Sex Trafficking, Military Contractors and One Woman’s Fight for Justice. Basingstoke: Palgrave Macmillan. Hedges, C. 2012. “Murder is Not an Anomaly in War.” Truth Dig [online]. Accessed 4 March 2013. http://www.truthdig.com/report/item/murder_is_not_an_anomoly_in_war_ 20120319/. Human Rights Watch. 2002. Hopes Betrayed: Trafficking of Woman and Girls to Bosnia and Herzegovina for Forced Prostitution. Accessed 4 March 2013. http://www.hrw. org/reports/2002/bosnia/. Lopes Cardozo, B., O. O. Bilukha, C. A. Gotway Crawford, et al. 2004. “Mental Health, Social Functioning, and Disability in Postwar Afghanistan.” JAMA: The Journal of the American Medical Association 292: 575–584.
