WASHINGTON - The paradox of war is that the fittest risk becoming the most disabled. The public response to this is itself tragically ironic.
Those who prepare for war are public investments; their bodies are war machines, idealized and adulated. Yet those who return from war are receiving neither the public investment nor support they deserve.
The Bush administration, for one, is in something of denial. President Bush, in his speech at Fort Bragg, N.C., last month, implied that the best way to honor all those who have fallen in Iraq and Afghanistan is to complete the mission. But the real costs of the war on those who fight, and on the families who send their loved ones to fight, was never mentioned.
It is assumed by this administration, and by many of us as well, that soldiers are stoic warriors. They are tough and enduring. But the best kind of stoicism has its limits, and no soldier is fully bulletproof or immune to the aftermath of war. Those who return from war, maimed and psychologically wounded, are in need of our compassion and dollars. Yet they are not getting it.
The Army's medical system, particularly Walter Reed Medical Center in Washington, is overwhelmed with the returning casualties. It is running out of hospital beds and pushing out soldiers before optimal care has been given. The needs of many are dire. In this war, soldiers are surviving wounds that would have killed them in Vietnam.
The public seems aware, albeit squeamish, of those who return from war with missing limbs. What few know is that the signature injury of this war is brain trauma. One report indicates that doctors at Walter Reed see twice as many traumatic brain injuries as limb injuries. The brain injuries are typically caused by blasts from improvised explosive devices that literally rock the brain and cause it to swell.
According to the May 19 issue of The New England Journal of Medicine, two-thirds of soldiers who endure such blasts suffer traumatic brain injuries. Symptoms can range from brain swelling, headaches and dizziness to cognitive impairment, mood changes, depression, anxiety and impulsiveness. Some of the symptoms overlap with those of posttraumatic stress disorder.
What is particularly disturbing is that some returning soldiers, with brain and limb injuries, are being pressured to take a discharge from the Army because they can no longer "adequately perform" their assigned duties. For soldiers, discharge can mean the end, not just of a career of service to which they are committed but of adequate benefits and care.
All this is a reminder that the stoicism of soldiers is not limitless. Stoicism comes to us from the ancients, from Greeks and Romans writing from the 2nd century B.C. to the 2nd century A.D. The attraction of stoicism is that it draws a bright stripe between what is within our control and what is outside.
Only that which is within our control - our reason and virtue - is a genuine part of our happiness. This leaves the body, our health and wealth, our friends and loved ones, outside. But most of us know that we are too connected to our bodies, too attached to our loved ones, to put these fully outside the circle of our well-being. They are goods that matter, and our happiness cannot leave them behind.
It is time that the troops we send to war come home with the assurance that their bodies and minds will not be left behind. Surgeon General Richard H. Carmona reported recently that 30 percent of returning troops are showing signs of war trauma, including anxiety, depression and nightmares. It would be shameful if their anxiety extended to worries about adequate medical care.
Nancy Sherman is author of Stoic Warriors: The Ancient Philosophy behind the Military Mind.