Sunday, March 11, 2007

The dark underbelly

of the dark underbelly. The Walter Reed scandal is monstrous, of course; and most of the problem is being attributed, not to primary healthcare, but to long-term care. This is the true belly of the beast in this situation.

It wasn't really so long ago (Horton Foote ably included a character in "Places in the Heart," a movie set in a Texas I almost remember) when blind people were considered useless to society. I have a recording of a song about the battle of Gallipoli where the narrator recounts losing both his legs and laments the price of war, because he is virtually worthless. Society has adjusted, and people missing limbs are not only not looked upon as objects of pity, they can be objects of political scorn and smear. Such is progress.

But we have, as a society (and therefore helped individuals) adjusted to those who lose limbs. Early in the war (it seems "early" now, anyway), cable news was filled with "uplifting" stories about wounded soldiers recieiving titanium limbs and physical therapy, always in clean, sterile settings free of black mold and rat droppings and surrounded by several caring, professional medical care personnel. Now we have a different picture.

But we still don't have the whole picture. The number of wounded from this war is staggering, but we knew that. In late 2006 the number was reported to be 20,000, which is nearly 7 times the number killed, and the number of wounded in March are already over half of what the number was in February. The worst problem is, many of these wounded are wounded as Bob Woodruff was wounded: in the head. Thanks to advances in science, many soldiers who would have died of their injuries are instead surviving. But, as the testimony has shown, the military medical care system simply is not ready to handle such survivors. If the military is not ready, is American society?

This is a society where we still argue about whether health insurance should cover mental health care, and to what extent. The kind of injuries are are talking about now are a new wrinkle in the question of the human psyche and how we approach the questions of will and responsibility. Too many people think the "insanity defense" in a murder case means the defendant did it, but he's not responsible because he was "crazy." Now we will have thousands of soldiers whose injury is completely invisible, even to them, and the desire to blame them for being "crazy" will be strong. There is no phantom limb syndrome for a loss of brain funtion, no visible scars or obviously missing body parts to elicit our sympathy or understanding, not even a social system which accomodates the wheel-chair bound or those with articifial legs or arms. but not those with psychic, or even organic brain, wounds. These wounds are injuries which perplex even the injured, which have a more material foundation than "post-traumatic stress disorder," and yet is less well or widely understood.

This is going to be the ongoing legacy of George W. Bush and Dick Cheney and everyone else who championed this war, but won't pay any price for their decisions. This is the dark underbelly of the dark underbelly of the veterans' and soldier's care scandal swirling around Walter Reed hospital right now. NPR calls it "purgatory." I can only imagine those people suffering from it, suffering from those injuries for the rest of their lives, would describe it instead, as hell.

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