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From the archives

The (Other) October Crisis

A new book revisits one of Canada’s most traumatic and telling moments

Model Behaviour

A Haida village as seen in a windy city

Liberal Interpretations

Making sense of Justin Trudeau and his party

Afghanistan’s Price

By downplaying PTSD, our government makes soldiers and their families bear the costs of war

Alison Howell

Last year, I had the opportunity to live and do research in the United States as a Fulbright scholar. I was there to conduct research on the ways in which the U.S. military was dealing with post-traumatic stress disorder, in order to compare this approach with that of the Canadian Forces. As part of my activities at Brown University, I became a member of the Eisenhower Study Group, a team of economists, anthropologists, experts in political science and international relations, human rights activists, legal experts and journalists working together to assess the costs of the wars to the U.S., Iraq and Afghanistan, in both financial and human terms, not the least of which being the psychological impacts on veterans and soldiers returning from war. (The extensive resulting report can be found at <>. See also Daniel Trotta’s “Cost of War at Least $3.7 Trillion and Counting.” Reuters, June 29, 2011. <>.)

Some might question whether we can learn anything from the American experience about how to treat our soldiers and veterans experiencing mental health difficulties. After all, the U.S. military and veterans administration has been wracked with any number of problems, such as high rates of PTSD, suicide, and drug and alcohol abuse among its soldiers, while the denial of veterans’ benefit and disability claims has also persisted. Comparatively, Canada might seem like a model of good military mental health care.

Tom Pokinko

Yet my sense is that, as the Costs of War project demonstrates, the broad range of costs connected to war fighting is being confronted far more in the United States than it is in Canada, and that the debate over the wisdom of the wars in Afghanistan and Iraq is much more robust south of the border. This may be because Canadian society is less thoroughly militarized. Canadians, if they are not serving in the Forces, if they are not family members of those who do or if they do not live near a military base, seem to have been able to put the war in a box. So, while poll after poll showed that for several years the majority of Canadians opposed the combat mission in Afghanistan, we seem to have decided to “grin and bear it” and mount very little opposition.

(See, for instance, “Britons and Canadians Oppose Afghan War; Americans Evenly Divided,” a poll published by Angus Reid in March 201, “Political Landscape Frozen: Canadians Continue to Oppose Both the Afghanistan Mission and an Extension,” a poll published by EKOS in April 2010; and “Support Wanes for Afghan Mission: Poll,” a report of a Canadian Press/Decima Research poll in the Toronto Star, published on July 13, 2007.)

Canadians have been complacent. It seems to me that Americans are capable of somewhat more introspection concerning the wars, perhaps precisely because they are willing to admit that they have, indeed, been at war. In Canada, we have been living with our heads in the sand. Consider that in 2006, several years into the war, a full 70 percent of Canadians still believed that our military was engaged in a peacekeeping mission in Afghanistan. (See the Strategic Counsel’s “Perceptions and Views of Canadian Armed Forces Troops in Afghanistan,” March 2006) Our shared belief in “Canada the good” has blinded us to the nature of the Canadian mission in Afghanistan, and, as a result, to the full extent of its costs. We have been a country at war, and it has been a long and deadly war.

With the return of Canadian soldiers from Kandahar, and in the month of Remembrance Day, it is time to assess the costs of Canada’s war in Afghanistan, so that we can decide how to deal with its aftermath and also make informed public decisions about the wisdom of military engagement in the future. This is not to say that Canada is not still militarily engaged in Afghanistan. After all, almost a thousand Canadian troops are now deployed, alongside civilian police, as part of Canada’s continued mission to train Afghan National Security Forces in Kabul, Mazar-e-Sharif and Herat. All the more reason that Canadians should reflect on what our war in Afghanistan has cost us and, given these costs, whether we can or should pursue a foreign policy marked by major military deployments in the future.

Often, we think of the costs of war solely in financial terms. For Canada, these costs have been enormous. According to a 2008 report by the Office of the Parliamentary Budget Officer, expenditures related to Canada’s war in Afghanistan were projected to mount to between $14 billion and $18 billion by this year. This projection is a very conservative estimate, as it excludes military expenditures not specifically allocated to the war in Afghanistan. The report itself acknowledges that these figures underestimate the total costs, citing a dearth of reliable data, due in no small part to the lack of transparency in financial reporting on the part of the Department of National Defence and other related departments.

The total financial costs are likely to be closer to the $28 billion projected by a 2008 Rideau Institute report. While it is difficult, if not impossible, to pin down precise numbers, we do know that, even adjusting for inflation, Canadian military budgets have almost doubled over the last ten years, and that the costs associated with a given war actually mount with the passing years. As veterans age, and require more support and care, the costs associated with a deployment rise, most often 30 to 40 years into the future.

In considering the financial costs of the war, however, we should not forget the human costs. So far, 157 members of the Canadian Forces have been killed, as have a diplomat, a journalist and two aid workers. Nearly 2,000 have sustained physical injuries. Citing these numbers does not begin to do justice to the human costs for the families, friends and communities of those who have died or been injured.

Perhaps the most futile attempt to capture the human costs of war in numerical terms concerns PTSD prevalence rates among soldiers and veterans. The Canadian Forces have claimed to have a relatively low rate of PTSD (figures ranging from 3 percent to 6 percent are often cited) compared to the U.S. military, where the most commonly accepted studies have placed the rate within the range of 5 percent to 20 percent, with some studies suggesting a rate to upward of 60 percent. The supposedly relatively low rate of PTSD in the Canadian Forces is often cited as an indication that mental health care for soldiers and veterans is largely adequate. This is highly problematic, however, because PTSD statistics are particularly difficult to compare, due in large part to differences in the ways in which such studies are conducted. In fact, the military does not keep track of the actual number of soldiers or veterans diagnosed with PTSD—despite a recommendation by the former Canadian Forces ombudsman to do so that dates back almost ten years. Even if such statistics were kept, they would only reflect those diagnosed with the disorder and would exclude those who have not sought medical treatment, or whose experience does not fit perfectly with the diagnosis, or who may be denied the diagnosis so as to curb compensation claims.

Beyond these technical issues, there is a problem with reducing the experience of war to a mental disorder—to a medical problem, experienced by individuals. War is a very social and political phenomenon. The rhetoric surrounding military PTSD is that it is lamentable, but unavoidable. Not so. High rates of PTSD are directly linked to deployments; that is, PTSD is an effect of the decision to go to war, and the main way to prevent PTSD among soldiers and veterans is to demilitarize our foreign policy. Poll after poll showed that more and more Canadians became opposed to our military involvement in Afghanistan, especially as the death toll increased and the detainee scandal came to light. Opposition grew among the Canadian public as Canadians were able to more fully assess the human impacts of the war on both our military members, as well as on the people of Afghanistan, where between 12,000 and 14,000 Afghan civilians have been killed directly in the war, 15 percent of them children. And the rate of civilian deaths continues to rise, not fall.

Because the costs associated with veterans’ care are high and will continue to grow, we need to watch carefully that cost-cutting measures are not taken at the expense of veterans and soldiers, of their families or the Canadian public more broadly. Funnelling veterans into the public healthcare system is detrimental to veterans, who often need more urgent or more specialized care than can be provided in the public system. This also strains the healthcare system while off-loading a central cost of the war from the federal defence budget onto provincial healthcare budgets. Rather, defence spending could be directed toward veteran and soldier care, rather than remilitarization in the form, for example, of purchases of expensive equipment for the profit of private interests. The most controversial example of this may be the Harper government’s continued folly in forging ahead with the purchase of 65 F-35 stealth fighter-bomber planes from Lockheed Martin, despite projected ballooning lifetime costs from an original $9 billion to at least $30 billion. If the Afghanistan experience has taught us anything, it is that technological superiority far from guarantees victory, and that the purchase of fighter-bomber planes is inconsistent with the Canadian public’s desire to see its military forces withdraw from offensive military operations.

Military expenditures might be better directed at soldier and veteran care, in the aftermath of Afghanistan. We should thus be very wary of programs that cut costs in these areas, and that shift the duty of care for soldiers and veterans onto their communities and military families and onto soldiers and veterans themselves. Our record on these matters is increasingly tarnished.

Prior to the introduction in 2006 of the New Veterans Charter, the Pension Act granted veterans a monthly pension for life, the amount of which was tied to the severity of impairment a veteran was assessed as having, moving payments downward when their condition improved and upward if it deteriorated. The problem with this, according to the logic behind the NVC, was that it disincentivized veterans from pursuing rehabilitation activities. To remedy this a lump-sum payment up to $285,000 was introduced as compensation for injuries sustained in the line of duty (most payments are well below this maximum). What is less often acknowledged, however, is that such lump-sum payments also constitute a major limiting of the government’s liability; that is to say, this is a cheap alternative to providing lifetime pensions.

Longer-term benefits still exist if a veteran is able to prove that he or she is disabled or unable to work. Such benefits are conditional on the application for a rehabilitation program, designed to funnel them onto subsequent “career transition services,” with the aim of getting veterans off benefits and back to work in the civilian sector. Veterans have to apply to Veterans Affairs Canada for rehabilitation services within 120 days to be considered eligible, with many veterans reporting excessive red tape and the bureaucratic mentality of a private insurance company pervading VAC, involving concerted efforts to reduce benefits claims.

PTSD or other mental health difficulties make it especially challenging for soldiers to access these benefits, because they may not be diagnosed or suitably stable to file the necessary paperwork in 120 days, because their mental health difficulties are more challenging to document and because diagnosis can sometimes take more time than physical injuries.

These are precisely the problems that former Veterans ombudsman Pat Stogran raised last year, whereupon his tenure as ombudsman was not renewed. In the ensuing public controversy, the Harper government tabled Bill C-55, providing some relatively minor amendments to veterans’ benefits provisions, and claiming to invest $2 billion in veterans care. Yet that figure represents spending over the entire lifespan of veterans, while the actual amount invested over the next five years totals approximately $189 million—a far cry from the inflated $2 billion announcement. Although the Conservative government is ostensibly supportive of the military, it seems as though veterans’ care too closely approximates a social welfare policy. This may explain why paying between $9 billion and $30 billion to Lockheed Martin for stealth bombers seems like a reasonable expense, while veteran care is allocated a relatively paltry sum. In the meantime, the problems at VAC have not been seriously tackled, and a lack of meaningful consultation with veterans about their needs persists.

So, what happens when we do not take care of veterans, particularly those experiencing mental health difficulties? Recent reports have highlighted the growing problem of homelessness among veterans. Furthermore, just like cutbacks in civilian social programs, the burden gets passed on. In the context of the aftermath of our deployments to Afghanistan, it is soldiers, their family members and the public at large who bear the brunt. And this is not left to chance. Several strategies are used to shift the burden of care onto soldiers, their families, communities and public services. Let me outline two of these: those aimed at families and those aimed at soldier “resilience.”

Scholars researching the role of gender in military institutions have noted that women outside the military (such as soldiers’ wives and women who do paid sex work) are critical to the smooth functioning of military operations. This is especially true when it comes to ensuring the good mental health of soldiers. Military wives are relied on to provide unpaid, informal care for their husbands. We can speak about wives, specifically, because although military rhetoric often refers to families rather than wives, the language of spouses is euphemistic in a context where only about 15 percent of Canadian Forces personnel are women, and military men are more likely to be married than their female counterparts.

For decades, if not centuries, western military leadership was divided on the question of whether it preferred soldiers to be married or single, fearing the former would be slower to mobilize, while the latter would be more prone to moral lapses, such as drunkenness. This debate seems to be thoroughly settled in the Canadian Forces, however, and multiple military programs now specifically aim to keep soldiers in their family units (and, especially, in their marriages), most notably through assistance with post-deployment reintegration into the family unit. Of course, military wives and other family members want to help and support their loved ones. But what is troubling is the way in which this support is put to service in more than simply helping soldiers.

Consider the Canadian Forces course on “Basic Relationship Training,” aimed at giving military couples “relationship skills” such as communication or forgiveness. Its rationale is for soldiers to be operations-ready: the brochure for the program urges soldiers to recognize that “strong supportive relationships are paramount to your ability to remain mission-focussed,” or, in the words of one reporter who covered the launch of the program, “senior military brass recognize that happily attached soldiers are better fighters.” Wives are thus enlisted in maintaining the good mental health of soldiers for military purposes. This is unpaid work; moreover, it places undue pressure on military wives and families, while failing to acknowledge higher rates of domestic violence in military families.

The rationale for intervening with families is that it will ultimately improve the recovery of the soldier. Another Canadian Forces document states that “it is also considered helpful to involve them [i.e., wives] in order to avoid having them unconsciously sabotage the victim’s treatment.” Support by and for family members is often oriented toward instrumental purposes, and the aim of well-being can too easily be eclipsed by that of mission-readiness.

The same is true for resilience-oriented training in the Canadian Forces. The 2010 National Defence report on suicide prevention outlines a cautiously optimistic stance on resilience training, and the Canadian Forces has instituted several resilience training programs. It is also working with other NATO member countries to further develop a template for resilience training as a core aspect of a soldiers’ basic training. The central aim of the project? To harness the insights of positive psychology, cognitive behaviour theory and performance sports psychology to get soldiers to think more positively and manage their own stress, while also monitoring “buddies” for signs of stress. The purpose, then, is to get soldiers to take responsibility for their own stress levels, and to think positively about their roles and the broader missions in which they are involved.

While notions of self-help and of responsibility may carry positive connotations in civilian contexts, in military contexts the story is different, because soldiers, as employees of the federal government, do a job that, while on deployment, involves high levels of risk. One of the central techniques of positive psychology, on which resilience training is based, is the notion of “not catastrophizing”—of reorienting your thinking to view things in a positive light, or, as the jargon would have it, to accept new realities and avoid negative self-talk or “thinking traps.” But in Afghanistan, and in Kandahar in particular, Canadian soldiers have been in the midst of what might rightly be called a catastrophe: the number of civilian deaths, the intense poverty in much of the country and the seemingly endless nature of the conflict give us strong indications that “catastrophizing” is not an unreasonable response to being deployed in Afghanistan, where soldiers will often have seen and done catastrophic things.

If the ultimate aim of resilience programs is military effectiveness, then soldier well-being is in danger of being reduced to an instrument of military strategy. The NATO project, to which Canada is a main contributor, cites the maintenance of operational readiness and performance as a main objective of resilience training. There is a fine line between helping soldiers help themselves for their own benefit and demanding that they self-help in order to be ready for redeployment. For now, the Canadian Forces are not wholly endorsing widespread resilience training, which is all the rage in the U.S. Army, the Australian Defence Force and other western militaries. We would do well to be very wary of such fads.

Words like “family” and “resilience” often have positive associations. When we hear them in a military context, however, we need to proceed with caution because they raise serious questions about responsibility and the duty of care for soldiers and veterans experiencing difficulties.

Only veterans themselves can tell us exactly what kinds of support they need and want. Beyond immediate and long-term veterans’ needs, there are also pressing public concerns, not only about the off-loading of the costs of war onto soldiers, their families and the public healthcare system, but also about broader conceptions of mental illness, health and responsibility. Historically, innovations in military settings, particularly in war times, have spread into civilian contexts. The ways in which soldiers have been granted or denied rights and services have often served as a template for the treatment of civilians, in particular shaping the form of our welfare state. If soldiers are being denied appropriate benefits, pensions and health care, this does not bode well for other citizens. Will resilience also be demanded of civilians who seek public services? Veterans, and their treatment, are like canaries in a coal mine. Cutbacks in veterans’ benefits suggest a deepening neoliberalism, a worrying trend for any Canadian concerned about pensions, employment insurance, disability benefits or health care.

For these reasons, we need to assess the impacts of war, so as to judge whether we should be invested in the use of force as a solution to global problems. In posing these questions we need not slip into a lack of empathy for soldiers, veterans, their families and communities. Far from it. We know this: when public support for a war is low, as it was with the U.S. war in Vietnam, veterans tend to have more troubled experiences of mental health and reintegration. In the post-Vietnam era, this has made us shy of asking tough questions about the necessity of war. At the same time, however, the need to assess the costs of Canada’s recent war is critically important—precisely because these costs are borne not only by the Canadian public as a whole, but also by soldiers and veterans. These Canadians have paid the price of their country’s involvement in the Afghan war—sometimes with their lives and often with their health, both physical and mental. It seems imperative, then, to assess these costs in order not only to deal with these issues but also to make informed decisions about potential future military engagements.

We are in the midst of a continued push to remobilization, evidenced through investment in military technology such as the F-35s, as well as in the defence budget more generally, which, despite government statements to the contrary, continues to grow. Yet in this push, the interests of soldiers and veterans are being obscured, and questions about what it would mean to truly wind down the intense militarization that Canada has pursued over the last ten years also get sidelined.

Instead, we need to start thinking through what it means to demobilize—not only by giving veterans the help they need to reintegrate into civilian life, but by demobilizing Canadian society more broadly. In order to do this, though, we need to admit that we were mobilized in the first place, and that Canada has been a country at war for the better part of a decade: a very prolonged war indeed. Only then can we confront our collective amnesia and take seriously the possibility that we can demilitarize our foreign policy, and ourselves.

Alison Howell is a research fellow at the Humanitarian and Conflict Response Institute at the University of Manchester in the United Kingdom. She is the author of Madness in International Relations: Psychology, Security and the Global Governance of Mental Health, recently published by Routledge.

Related Letters and Responses

Deborah Cowen Toronto, Ontario