New Pentagon figures released to NPR show that since the United States invaded Iraq, officers have kicked out far more troops for having behavior issues that are potentially linked to post-traumatic stress disorder than they did before the war.
The numbers raise troubling questions about how the military is handling mental-health issues.
NPR has reported that servicemen and women who come home with serious mental-health problems, such as PTSD, often can't get the medical treatment they need.
And some commanders, in fact, have kicked troubled troops out of the military instead of trying to help them.
Until now, NPR reports have included anecdotal evidence, because the Pentagon has not released detailed statistics.
Rise in Personality Disorder and Misconduct Dismissals
NPR asked the U.S. Army and the U.S. Marine Corps to disclose how many troops have been discharged by their commanders in recent years and why.
The Marine Corps has not provided statistics.
But an Army chart, which NPR recently received, shows that since the United States invaded Iraq:
-- Commanders have discharged almost 20 percent more soldiers for "misconduct" than they did in the same period before the war;
-- Commanders have discharged more than twice as many soldiers for "drug abuse" (a subset of the "misconduct" category);
-- Commanders have discharged almost 40 percent more soldiers for "personality disorder."
In all, the Army has kicked out more than 28,000 soldiers since the war in Iraq began on the grounds of personality disorder and misconduct.
Those statistics "trouble me," says Stephen Xenakis, a psychiatrist and retired brigadier general who used to help run the Army medical system.
"It raises questions," he says. "Are we doing the right thing by the soldiers?"
Behaviors Linked to PTSD
Xenakis and other mental-health specialists who work with the military say the Army's statistics seem to corroborate what many former soldiers and Marines have told NPR.
Those servicemen's and women's records show that after they came home from Iraq or Afghanistan, and were diagnosed with PTSD or other mental health disorders, they started breaking Army rules and, in some cases, the law — from not showing up for formation and going AWOL, to using illegal drugs.
Xenakis and other specialists say those kinds of behaviors are common among soldiers with mental disorders like PTSD.
"That's exactly how those problems would show up," Xenakis says. "Drinking, drugs ... (the soldiers) medicate themselves. They say 'Why should I keep my uniform all starched and neat when I just buried two of my buddies?'"
Yet, the troops NPR has interviewed had trouble getting intensive medical treatment. Instead, their commanders discharged them for "misconduct," which means the soldiers lost some or all of their military benefits.
The Army chart obtained by NPR — showing increased rates of "misconduct" and especially "drug abuse" — is consistent with those anecdotal accounts.
Personality Disorder: 'Deeply Stigmatizing Diagnosis'
Some mental-health specialists are especially worried that commanders and military medical staff are abusing the diagnosis of "personality disorder," which commanders have used to discharge some soldiers who were also diagnosed with PTSD.
Psychiatrist Jonathan Shay, who has been studying combat veterans for more than 20 years at the Department of Veterans Affairs and other institutions, criticizes the use of personality disorder partly because it's a "deeply stigmatizing diagnosis," he says.
Shay says that when the military diagnoses soldiers with personality disorder, it is saying, in effect, that fighting in the war didn't cause their mental health problems.
"It's saying, in essence, you're rotten and have been rotten since childhood," he says.
If true, Shay wonders, why didn't Army doctors diagnose such a serious and deep-rooted psychological ailment when they were recruiting the prospective soldier?
Avoiding Paying Disability Benefits?
Shay says the Army's statistics, showing that discharges for "personality disorder" have increased in recent years by almost 40 percent, suggest that the military may be abusing the diagnosis because doing so is convenient.
Under the Army's rules, it takes a commander months to expel soldiers on the grounds that they can't function due to PTSD — and the military has to pay the soldier disability benefits.
But if a psychiatrist diagnoses a solider with a "personality disorder," the base can discharge him or her in less than two weeks without paying any disability.
"It troubles me that it appears that sometimes, mental-health professionals are ready to be the willing servants of the command," Shay says.
He worries that military doctors are telling commanders, in effect, "'If you want me to get this kid out quickly, I'll do it. It doesn't matter how much I have to bend my own conscience or bend the facts to do it.'"
NPR submitted requests to five spokesmen at the Pentagon and U.S. Army to interview a top official about these issues. These requests were not granted.
Medical specialists who reviewed the statistics stress that the Army's numbers don't prove that commanders are getting rid of soldiers who developed mental-health problems in the war. But they say the figures should prompt the military to do much more research.