Feelings of idleness and inutility aren’t unique to the home front, of course. They can also descend on a soldier while he or she is still in theater. Platoni notes that she spent the last quarter of her most recent tour on a quiet installation in northern Afghanistan, where the soldiers saw little combat. She suspects that’s precisely why she saw so much of them. “Monotony, boredom, a lack of value and meaning and purpose to your mission—these are factors,” she says. “Especially that loss of a sense of purpose: What am I doing here? I’m not suffering like my buddies in the south. There’s a tremendous feeling of guilt.”
It’s an agonizing paradox, but one that many mental-health professionals now entertain: Our troops may be in such horrible distress right now because the operational tempo of this war has slowed down, and they’re fighting—doing—less.
Chiarelli is sitting in the chow hall at Fort Stewart, having lunch with eleven soldiers who’ve just returned from Iraq. “When I was growing up in the Army,” he tells them, “if anyone wanted to see a psychiatrist or psychologist, they’d have to go to the fifth floor. So nobody wanted to go in the elevator and press five.” Everyone smiles nervously. It’s not every day that a four-star general joins you for burgers. “So now we have behavioral-health people in the primary-care clinics,” Chiarelli continues. “You don’t have to go to the fifth floor. But I know the stigma’s still there, believe me. How about screening?” Psychological evaluations are supposed to be mandatory. He’s checking to see if they’ve happened. “Have you had any screening since you’ve been back?”
He looks around the table. The soldier nearest him replies yes, he had one, but it was perfunctory. Chiarelli purses his lips. “Anyone else?”
The table’s silent for a few moments. Then a 26-year-old staff sergeant named Douglas Johnson, who just spent twelve months as a chaplain’s assistant in Mosul, speaks up. “I had some issues prior to deployment,” he says. “I had aggression, I had no patience with people. When I got back, they did another screening just to check on me. And it was pretty good.”
This answer seems to relieve Chiarelli. “Are you in a good place now?” he asks.
“Yes.” Paxil, an antidepressant.
“Is it helping?”
“Yes, sir. I can always tell the days I forget to take it.”
The group laughs. Then Chiarelli asks a more loaded question: “Anyone ever hear of those who are overmedicated?”
The group is silent again.
During Vietnam, soldiers famously used a combination of dope and Jimi Hendrix to chill out and psych up. Today’s soldiers essentially listen to both Prozac and Metallica to achieve the same balance. Drugs are very much part of the program—DOD-approved, the exact opposite of countercultural. Johnson, in fact, got his Paxil in a clinic in Mosul, three months before his tour was scheduled to end. “I was having some severe temper issues,” he told me, “and I had a brand-new baby waiting for me at home. I didn’t want to be one of those soldiers who wound up shaking a baby.” If he ever went on a mission and forgot his Paxil, he adds, he’d just ask his friend, who took it too: “It was pretty likely that someone was, if not on the same dose, then on something pretty close.”
Walk into any of the larger-battalion-aide stations in Iraq or Afghanistan today, and you’ll find Prozac, Paxil, and Zoloft to fight depression, as well as Wellbutrin, Celexa, and Effexor. You’ll see Valium to relax muscles (but also for sleep and combat stress) as well as Klonopin, Ativan, Restoril, and Xanax. There’s Adderall and Ritalin for ADD and Haldol and Risperdal to treat psychosis; there’s Seroquel, at subtherapeutic doses, for sleep, along with Ambien and Lunesta. Sleep, of course, is a huge issue in any war. But in this one, there are enough Red Bulls and Rip Its in the chow halls to light up the city of Kabul, and soldiers often line their pockets with them before missions, creating a cycle where they use caffeine to power up and sleep meds to power down.
Because of the value the Army places on mission focus, however, doctors in theater are generally reluctant to prescribe anything that could seriously compromise it. Rather, it’s when soldiers return home that prescription-drug use and abuse spikes sharply upward: Depression and boredom set in, suppressed pain surfaces with a vengeance, hypervigilance morphs into insomnia, and meds are very easy to access, because they’re the most expedient way to treat pain and distress. Roughly one in seven soldiers at Fort Hood were on antidepressants or antipsychotics alone at some point last year, according to USA Today—and those were just the soldiers the Army knew about, the ones who weren’t discreetly seeking treatment off-post in downtown Killeen. (Nor did that number include sleep meds, amphetamines, or painkillers.) More troubling, nearly one-third of all active-duty Army suicides in 2009 involved prescription drugs, according to the report released this summer. Some of the case histories Chiarelli sees are eerily reminiscent of the toxicology reports one reads after a celebrity suicide. (From a 2009 Salon story about the suicide of Timothy Ryan Alderman: “0.5 mg. of Klonopin for anxiety three times a day; 800 mg. of Neurotin, an anti-seizure medication, three times a day; 100 mg. of Ultram, a narcotic-like pain reliever, three times a day; 20 mg. of Geodon for bipolar disorder at noon and then another 80 mg. at night; 0.1 mg. of Clonidine, a blood-pressure medication also used for withdrawal symptoms, three times a day; 60 mg. of Remeron, for depression, once a day; and 10 mg. of Prozac twice a day.”)