The War on Terror’s Lingering Pain

Yves here. Co-founder of the Costs of War Project, therapist and military spouse Andrea Mazzarino describes below how America’s protracted nation-breaking in the Middle East has done tremendous human and material damage not just there, but here as well. Some of our price has come via increasingly threadbare social safety nets and crumbling infrastructure, as the collapse yesterday of an elevated section of I-95 attests. But members of the armed services are also in considerable pain, physical and psychological. And because most servicemembers live apart from civilians, it’s easy for most Americans to remain ignorant. The officialdom has clearly been complicit, however, via barring press coverage of returning war dead.

Moreover, since modern war feature fewer deaths compared to injuries due to faster evacuations and better field hospitals, there are proportionately far more who are severely injuerd than before (including severely concussed due to having their heads bounced around the inside of armored vehicles under attack). But we don’t hear much about that either.

By Andrea Mazzarino. Originally published at TomDispatch

It couldn’t be stranger when you think about it. This country has been at war nonstop since September 12, 2001. It’s poured our taxpayer dollars — an estimated $8 trillion of them — down the sinkhole of those disastrous wars. The two biggest ones in Afghanistan and Iraq are officially over, though the U.S. still has 2,500 troops in Iraq and hundreds more (as well as private contractors) in neighboring Syria. Still, though we hear far less about it, the war on terror is ongoing. As Nick Turse has been reporting for years, for instance, the U.S. military continues to pour money and effort into war-on-terror-style military campaigns across significant parts of Africa, while terror groups only grow larger and more violent there, and yet who in this country even notices anymore?

Here, I suspect, is the reality of the situation: most Americans not connected to the U.S. military undoubtedly stopped thinking about the war on terror and its toll years ago — except at rare moments like during the disastrous collapse of the U.S.-backed Afghan government in August 2021 as this country was trying to withdraw its troops after two decades of failed war there. As has been true so often in these years, we generally neither pay significant attention to the damage we’re causing in distant lands nor to the damage we’ve caused ourselves in the process. Otherwise, how could it be possible that, during the recent debt-ceiling crisis, cuts were made to domestic programs, but the Pentagon budget, already larger than those of the next 10 countries combined, only continued to rise?

And yet, don’t think that, in the process, we haven’t damaged ourselves in all sorts of ways. Today, TomDispatch regular, co-founder of the Costs of War Project, therapist, and military spouse Andrea Mazzarino considers just what we did to ourselves in what might be considered a hidden campaign of… yes… self-inflicted terror. Tom

Americans in Pain

Confronting the Phantom Limbs of America’s Foreign Wars

America’s War on Terror, launched in response to the September 11, 2001, attacks on the World Trade Center and the Pentagon, has had a staggering impact on our world. The Costs of War Project at Brown University, which I helped found, paints as full a picture as possible of the toll of those “forever wars” both in human lives and in dollars. The wars, we estimate, have killed nearly one million people, including close to 400,000 civilians in Afghanistan, Iraq, and Pakistan alone. Worse yet, they sickened or injured several times more than that — leading to illnesses and injuries that, we estimate, resulted in millions of non-battlefield deaths.

And don’t forget that those figures include dead and wounded Americans, too. Most of us, however, have little awareness of any of this. If you live outside the archipelago of American military bases that extends across this country and the planet — an estimated 750 of them outside the U.S. on every continent except Antarctica — it’s easy enough not to meet stressed-out military service members and their families. It’s easy enough, in fact, not to grasp just how America’s wars of this century rippled out to touch military communities.

In recent times, those bases have become ever more difficult for the public to enter and often aren’t close to the cities where so many of us live. All of this means that, if you’re a civilian, the odds are you haven’t met the grieving spouses of the soldiers who never came home or the shaken children of the ones who did, forever changed, sometimes with amputated limbs or post-traumatic stress disorder (PTSD). I’m thinking of the ones with those far-off gazes and the pain they have to deal with in their heads, their limbs, their backs.

Personally, I find it overwhelmingly hard to write about such human-shaped holes in our disturbed world. That’s probably why the Costs of War Project has a 35-person (and counting) team of journalists, physicians, social scientists, and other experts to portion out the research and the pain that goes with it as they deal with the fact that the monumental death and injury counts they’ve produced are likely to be underestimates.

As I write this, my chest tightens and my breath gets short, reminding me that some realities are impossible to contemplate without a physical reaction. And I begin to understand why so many Americans, including those not in the military — an estimated 50 million in fact! — experience chronic pain. New York Times columnist Nicholas Kristof is writing a stunning series of pieces reporting on what many in the public-health world term “diseases of despair” like depression, suicidality, and addiction. A significant portion of those Americans don’t have injuries that are detectable via X-rays, CT scans, MRIs, or the like. Often, pain is linked with major depression, other symptoms of PTSD, or anxiety. Something is happening in the minds of Americans that’s not easily traceable in the body because its causes may lie in our wider world. 

The Costs of War on the Homefront

Know one thing: in the U.S., so many of us do feel the painful results of our disastrous distant wars of this century, whether we know it or not. For instance, ever more Americans attend crumbling, understaffed schools, drive on roads in disrepair, and go to hospitals and health clinics (not just Veterans Administration ones with their seemingly endless waiting lists!) that don’t have enough doctors and mental-health therapists to meet our needs. Arguably, a major culprit is the war on terror. To take just one example, we could have fully staffed and equipped our whole healthcare system and made it significantly more pandemic resilient had we spent just a fraction of the $8 trillion or more this country put out for our foreign wars.   

And the sting of war on our society doesn’t end with decrepit infrastructure, but extends to civil liberties and human rights. For example, our police are armed to the teeth with military-grade weaponry and other equipment provided by an overfed Pentagon and in this century have grown more aggressive towards unarmed people here at home.

And believe me, pain from American war-making is felt elsewhere, too, often all too directly in the dozens of countries around the world where the U.S. arms and trains militaries, continues to fight counterinsurgency wars, and runs prisons and intelligence operations. There are the air strikes and shootings, the father or brother who can no longer be the breadwinner because he was collateral damage in a drone strike, the millions of displaced and malnourished people — many of them mothers with children — in countries where Washington has supported authoritarian regimes in questionable counterinsurgency wars. 

Pain That Is Difficult to Trace

Given global events since those 9/11 attacks, it shouldn’t be surprising that pain is so frequently experienced by people in our military communities. Somewhere between 31% and 44% of active-duty American soldiers report chronic pain of some sort. That’s significantly higher than in the general population. And no surprise in this either: veterans are about 40% more likely to report chronic pain than non-veterans.

Chronic pain is, in fact, part of a category of neurological conditions that ranks as the fifth most common source of disability for service members treated at on-installation clinics and hospitals. Worse yet, military pain-related diagnoses have been growing. Back pain, neck pain, knee pain, migraines, and chest pain are becoming the norm.

As a military spouse and a therapist who has treated many soldiers and veterans, I’ve all too often observed how such pain, while sometimes untraceable to a visible source, is all too real — real enough, in fact, to immobilize some soldiers, or even keep them from successfully stringing together sentences. (And while I’ve seldom found that commonly recommended medication treatments truly alleviate such pain in a sustainable way, I have watched it subside over time thanks to the sorts of things that also boost mental health — talk therapy, exercise, and deepening friendships.)

Of course, military communities aren’t the only places where such pain is commonplace. It’s also experienced all too often by poor Americans without college degrees, especially women and people of color — in other words, the most vulnerable slices of our American pie.

The portraits in Kristof’s pieces reveal some surprising findings about pain. First, the amount of pain you experience depends not just on the physical injury that may show up on an X-ray or CT scan or, in the case of soldiers, the wound you got, but on what you think and feel. Two-thirds of people with depression have unexplained chronic pain, for example. Doctors have even discovered that some people reporting knee pain have no discernable anatomical problem.

By the same token, the brain has a certain ability to heal or ameliorate pain. In some cases, through the use of “mirror therapy,” people have been able to ease pain from an amputated limb or “phantom limb” by looking repeatedly at the intact one and somehow creating the impression that they’re okay.

Some people, military or not, with chronic depression, anxiety, or PTSD symptoms like exaggerated startle reflexes or sleep problems experience greater sensitivity to pain if they get physically injured again. Their brains, it turns out, have been trained by trauma to believe something’s wrong with their bodies.

Common diagnoses that have seeped into household parlance tend to reinforce this notion for many. Medical categories like fibromyalgia and irritable bowel symptom make pain sound as though it’s related to something tangible, except that all too often, it’s “just” pain.

It’s hardly a surprise anymore that the go-to treatment for pain in America is opioids, and look where that’s left us — with an epidemic of addiction and deaths to the tune of tens of thousands of lives lost yearly. Somehow, that approach to dealing with pain brings me back to the way the U.S. fought “terrorism” after the 9/11 attacks — with our own brand of terror (war!) globally and, indeed, it not only proved all too addictive but so much more costly to us and so many others on this planet than the original blow.

The Phantom Limb of American Society

If this comparison seems kind of out there to you, that’s my point. The problems experienced by Americans in pain are often all too hard to pin down, because at least in part they derive from survival guilt at having watched fellow soldiers getting blown to pieces by improvised explosive devices, or your parents dying from Covid because their jobs as janitors didn’t allow them to quarantine, or intense loneliness in a pandemic that made high school a virtual solo performance for all too many students. And get this: you don’t even need to go through one of those nightmarish scenarios personally to be in pain. Just hearing about economic insecurity in our world can exacerbate whatever aches you have.

This makes me wonder what it was like for so many to watch the recent coverage of Congress reaching the precipice over whether to raise the debt ceiling so that the government could pay its bills. How did it affect already struggling people to contemplate imminent economic catastrophe in the form of potentially soaring interest rates, inflation, job loss, and potential cutoffs in social services like healthcare? As a therapist who relies heavily on state-funded health insurance for my income and whose spouse is a soon-to-be veteran, I can’t help but scoff at congressional representatives who claim to be supporting our military by insisting on raising already astronomic Pentagon funding yet higher, while trying to gut the very systems that would let even a family as privileged as mine make ends meet once a soldier finishes his or her service.

Now look a little farther out if you want to be anxious. Most Americans don’t realize that our forever wars have been funded almost entirely by borrowing. A fundamental reason why we have to talk about a debt ceiling and continue to borrow ever more money to pay bills like those due for Medicare, Medicaid, and food stamps is war. One key reason why we need to worry at all about making college graduates start paying their exorbitant loans back again is… yes, our debts from war-making. Notice a theme here?

Of course, war means that the remedies for pain that have proven to be most effective in the long run are not as available to those who experience the most pain. Exercise, certain types of talk therapy, and community are key and yet can be all too sparsely available to those working multiple jobs and struggling to pay their bills, not to mention those being shipped from base to base amid the grinding pace of military life.

In the meantime, military families and veterans are left to pay the costs of war directly via just about every kind of stress and distress imaginable. I remember someone I knew at one military post. A person of color and a veteran of the Vietnam war, he’d often be outside his house in the early mornings and evenings, smoking weed in order to alleviate leg pain that was untraceable to any particular injury. What he did talk about frequently were his painful memories of shooting at rural, dark-skinned villagers in Vietnam who resembled his own farmworker family in the U.S. when he was growing up. Trauma and pain were his frequent travel companions and yet the source of his pain remained unidentifiable in his small, fit body.  

As then-President Donald Trump had banned or suspended the entry of people from eight different majority Muslim nations (as well as other refugees) to this country, I knew life wasn’t easy for him. He was, after all, often mistaken for a Muslim, called racial slurs, and told by passersby to go back where he came from. And even so many years later, that veteran and all too many soldiers like him may still not find a healthy part of our country to look at in order to convince themselves that life indeed will be okay.

Yes, there are all too many sick parts of our land, including a shaky social safety net, the hate and violence that continue to spread, and the long lines to get anywhere near a doctor or therapist. Contemplating all of this can be like gazing at a phantom limb that still smarts, even as so many of the original injuries — from 9/11 to our disastrous military response to it — seem all too forgettable to so many of us. Sad to say, but it’s vital that we remember the costs of war not only for ourselves but for those millions of people out there who experienced the — in every sense — wounds we inflicted in the name of an injured America in our nightmarish war on terror. Otherwise, don’t be surprised if we do it again.

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  1. Acacia

    we generally neither pay significant attention to the damage we’re causing in distant lands nor to the damage we’ve caused ourselves in the process. Otherwise, how could it be possible that, during the recent debt-ceiling crisis, cuts were made to domestic programs, but the Pentagon budget, already larger than those of the next 10 countries combined, only continued to rise?

    I will go out on a limb here and say that many NC readers at least probably have been paying attention to this, and are well aware of the general points being made in this article. The question, I would submit, is what can be said to those who not only don’t pay attention but think that supporting the status quo against Trump, Putin, etc. is somehow more important than making it a top priority to ruthlessly slash the Pentagon budget and begin to re-prioritize health care, education, infrastructure, etc. etc.? I personally have lost track of the number of times I’ve tried to talk with somebody about the war machine, only to find that what really obsesses them happens to be whatever the media has told them this month (mean tweets from the Orange man, etc.). What’s needed are not simply statistics that can be waved away, but lines of argument that work to persuade more and more people that support for the Empire’s war machine is bipartisan and they need to withdraw all support from any pols who don’t platform against the Empire.

    1. OnceWere

      Seems to me, as an outsider looking in, that the powers-that-be in the USA have their system of managed consent well and truly dialled in. Mass popular dissatisfaction – Occupy Wall Street, the Tea Party, Black Lives Matter – gets its 15 min of fame – and then as if by magic drifts away after achieving nothing, not even really leaving an infrastructure that the next popular uprising could build on. Even if you managed to find the arguments that convinced a million people to march on the Pentagon, chanting “Down with the DoD”, I’m not convinced it would change anything.

      1. tevhatch

        Recently I find I am constantly recommending “We the Elites; Why the US Constitution Serves the Few” by Robert Ovetz. The system is working as planned.

  2. cnchal

    > if you’re a civilian, the odds are you haven’t met the grieving spouses of the soldiers who never came home or the shaken children of the ones who did, forever changed, sometimes with amputated limbs or post-traumatic stress disorder (PTSD). I’m thinking of the ones with those far-off gazes and the pain they have to deal with in their heads, their limbs, their backs.

    No, I haven’t met them personally but according to ABC news they are happy cripples, grateful for a TV station that gives them 15 seconds of fame. David Muir – awww shucks, look at that happy child seeing their crippled dad for the fist time in years, ain’t America Strong? . . . or Great.

    1. digi_owl

      Verhoeven was likely closer to the truth than Heinlein ever got.

      And the movie was released before 9/11…

  3. Petter

    The defender is the aggressor. The USA spends an enormous sum on “defense.”
    Von Clauzewitz – The attacker wants Peace, the defender wants War.
    Reading René Girard’s Battling to the End.

    1. Adam Eran

      How about changing the name from “Dept. of Defense” to “Dept. of Attack”

      Wasn’t Confucius’ first order of business to “rectify the names”?

      1. tevhatch

        It’s original name up until after WW2 was Department of War (until 1947). … Maybe the name change inspired Orwell to write Nineteen Eight-Four, published in 1949?.

  4. jackiebass63

    The word war is powerful in getting people to accept things they would normally reject. That is why you see the term War on… is used so often.

  5. The Rev Kev

    Gunna go off at a tangent here. This whole thing did not start with 9/11 but went back over a decade earlier to the fall of the USSR. It’s like saying that the NATO-Ukraine war only started in February 2022 – and ignore all the deaths and battles of the previous eight years. The so-called war on terror was only a manifestation of the attempt to extend American hegemony well into the 21st century and those wars in the Middle east were all about seizing control of oil production and crushing countries that might have resisted. And it is still being attempted. The truth is that those in Washington could care less about the killed the wounded, the injured soldiers. To them, they are expendable assets and when through death or injury are of no further use, are ignored as much as possible. And it is the neocons that are at the heart of this.

    But if you are talking about damage, consider this. Suppose the neocons had fizzled out or had never taken off. Think about all the trillions of dollars of resources that could have been spent on to climate change and re-configuring the economy to respond to it. We were starting to make such moves back in the 90s. But we know it never happen because the neocons sucked up all those resources and all the focused attention in a grab for power to enrich themselves through empire building. And now we are in the 2020s and we are still ill-prepared for climate change as it change around us with more fires, floods and the like which will have a bigger death toll eventually. So I cannot help but wonder what would have happened in a timeline where the neocons did not seize power but that we were able to deal with more serious problems like climate change, overpopulation, resource depletion, etc.

    1. Arizona Slim

      And here’s something that has always bothered me about the fall of the USSR: Where was the 1990s equivalent of the Marshall Plan? In essence, the former Soviet Union was allowed to fall on its face.

      OTOH, after WWII, the former Allied powers did help Germany and Japan rebuild.

      1. Grebo

        The Marshall Plan (rebuild) replaced the Morgenthau Plan (impoverish) because the US realised it needed West Germany to keep the pressure on the USSR.

        Once the USSR collapsed the US was certainly not going to rebuild Russia, instead Russia got the New Morgenthau Plan (aka Shock Therapy) to grind its face into the dirt.

        Likewise with Japan. Recall the Russo-Japanese War.

  6. David in Friday Harbor

    Andrea Mazzarino and the Costs of War Project are always worth reading.

    Why is our nation so cruel? I suspect that the social isolation of being raised by screens from a young age strangles the development of empathy. Other people’s agency and emotions have no meaning. The Hollywood/Silicon Valley hallucination is that others may be killed, maimed, or starved without consequences, or failing that simply switched-off.

    America is now a nation ruled by sociopaths. One of the most tragic failures of the American republic is how its electoral and academic processes have evolved to concentrate the most ruthless and self-entitled of these sociopaths in positions of power.

    1. digi_owl

      Something i read recently makes me wonder if USA has always been a cruel nation, all the way back to the first boat load of puritans.

      Because apparently the puritan way of dealing with grievances can still be found today in the US military courts-martial.

      1. David in Friday Harbor

        Yes, I do believe that all human beings are born cruel. This is the Freudian id vs. ego development. Human history is a litany of horrors and suffering imposed by one group upon another. The Toltecs and Aztecs were particularly awful in this regard, but read accounts of the industrial-grade suffering inflicted by and under the Imperial Japanese Army, the Nazis, or the Bolsheviks — the nauseating details of which were sanitized during the Cold War. Cruelty has to be civilized out of us.

        I have to agree that cruelty was firmly rooted in America from the beginning, from the Salem Witch Trials through slave-markets and forced-breeding, slaughter of the indigenous survivors of Columbian Exchange’s epidemics, down to today’s petty mass incarceration and normalization of mass-shootings and vagrancy. However, I do think that the current sociopathy of Elite Impunity and Forever War is a more recent phenomenon layered over our sad history.

        1. David in Friday Harbor

          I assume you’re replying to digi_owl, but maybe it’s this Texas A&M doctoral dissertation that was later published in book form?


          Interesting discussion about how the military uses “bad apple” theory to dodge the issue of collective guilt for war crimes.

  7. Susan the other

    The old saying about herbs, that the antidote always grows next to the poison, is something we have come to disregard emotionally. I’d just submit that within the military itself there are solutions to the military culture. The military is the place to start. I doubt HR McMaster had a clear image of his idea when he suggested “cooperative competition” as the solution to warfare and destruction. But therein probably lies the antidote. What is necessary here is replacing destruction with construction which sounds simplistic, like so much pontification, but in fact “construction” is the sea change we are looking for. It is the thing we can “monetize” to make things function globally – that thing we glibly refer to as “the economy”. It is easily as complex as destruction but far more rewarding. And quite possibly progressively cheaper because of all the positive synergies we can create and maintain. But, where do we begin? If Ukraine was a testing ground, it has been a disaster.

    1. Michael.j

      I totally agree. In that regard IMHO, the one thing we can do is agree to address the common problem, ie our looming extinction, and admit that we are in the Anthropocene. This means we must attempt to engineer our way out on an international basis, as we’re already past many tipping points.

      One initial step is to repurpose a massive CO2 producing sink hole, the MICIMAT, into something productive and less destructive, and work together for survival.

      We have no other choice, but a short march into oblivion.

      While I understand the Jackpot paradigm, I do not want to go down without a fight.

      Oh, as people are most likely aware, the poetic Chris Hedges, wrote a marvelous piece over on Consortium News, of addressing the extinction problem.

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