Psychiatric Casualties: How and Why the Military Ignores the Full Cost of War Mark C. Russell | Charles Figley Columbia University Press, 2021. ISBN: 0231187769

• Published date: 01 December 2023
• Author: Mason Bennett
• Date: 01 December 2023
• DOI: http://doi.org/10.1002/wmh3.537

DOI: 10.1002/wmh3.537

BOOK REVIEW

Psychiatric Casualties: How and Why the

Military Ignores the Full Cost of War

Mark C. Russell | Charles Figley

Columbia University Press, 2021. ISBN: 0231187769

Because the U.S. military's most valuable resource is its soldiers, it would make sense for it

to provide its soldiers with the best care possible. While such care is often provided to

address physical ailments, psychiatric issues often are ignored. In their book Psychiatric

Casualties: How and Why the Military Ignores the Full Cost of War, physicians Mark C.

Russell and Charles Figley explain why this happens by showing a dilemma the military

faces with mental health.

The military has two options. First, it can support soldiers by acknowledging the

psychological damages of war and committing to supporting soldiers in their healing.

However, this comes at the risk of losing soldiers, bankrupting the military, and ultimately

harming the military's war‐fighting mission. The second option is to support the military by

ignoring the issue and avoiding responsibility for the consequences. This will save the

war‐fighting mission yet sacrifice the individual soldier as cycles of behavioral health issues

are perpetuated. Both authors, army veterans, and experts on military psychology provide a

comprehensive and damning case that the military has a culture and policies that offer harm

instead of healing for soldiers' mental health.

Russell and Figley dredge up a staggering amount of evidence to support this claim,

starting with a short history of wars from the Crimean War to modern‐day conflicts. They

show how the military learns valuable lessons about psychiatric care, and then ignores

them, only to be unprepared and relearn them at the start of the next war.

The second chapter shows why we care that psychiatric care is inadequate. Not only

does it affect individuals' mental well‐being, but also their physical health, their family

relationships, and society. Every year 200,000 service members retire to civilian life

(Lawrence, 2018). Veteran mental health is vital to public health as it affects divorces,

ever‐increasing military suicide rates, skyrocketing costs of care, drug use, homelessness,

and more. Getting care for military mental health can have great positive impacts on the

health of our society.

The authors present 10 “Dark‐Side Strategies,”or ways the military perpetuates its

mental health problems. The first “Dark‐Side Strategy" details how the military vilifies mental

illness, characterizing it as weakness or moral failure. The second strategy is abuse at the

hands of the legal system, which leads to incarceration or even execution of soldiers who

need psychiatric care. The third strategy uses shame and humiliation to subdue mental

illness. Fourth, the military simply ignores the psychiatric toll that war inflicts.

The fifth strategy is to purge weakness through such tactics as rejecting potential

soldiers with a history of parental divorce, shyness, or repeating a grade. According to the

authors, the military largely ignores the fact that these screening tests are ineffective and

that the highest predictor for war‐stress injury is the length of combat exposure. The sixth

World Med. & Health Policy. 2023;15:702–703.wileyonlinelibrary.com/journal/wmh3702

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