Let me share with you a heart-breaking letter from a PTSD mom in New Jersey named Sharon Eiflander. It perfectly illustrates a discussion we had several weeks ago in Philadelphia about the need to calculate the costs of going to war beforehand. As Sharon’s letter sadly demonstrates, this is something our government did not do. Here’s her story:

My son, Mark Joseph Eiflander is a Corporal in the USMC. He did his time, and has been home for the past 6 years. He is a Combat Vet, did 2 tours in Iraq and 1 tour in Afghanistan, he was a machine gunner.

Having Mark in harm’s way at that time, felt like living a nightmare. However, he did come home “bodily” safe, but the son that left, was not the son that returned.

A year after his return, he went to a VA hospital for pain in his back and legs. He was given, practically, a lifetime supply of codeine, Percocet and they were actually mailing them to our home. PTSD was not discussed. Mark would wake up screaming in the middle of the night, not willing to explain what he was dreaming about.

Over time, Mark became heavily addicted to pain medication, which led to other addictions. He was living on our couch at the time. Unable to hold a job, keep a relationship, live a normal existence. Last year, he jumped out of a moving vehicle on the NJ Parkway with no shoes. We found him, and could not get him into a VA Hospital. We took him to Red Bank where they admitted him in the psychiatric ward. They discharged him a week later.

My husband took him to the VA in East Orange on an emergency basis. They did admit him into the psychiatric ward for a week then to Building 4 (addictions) after that. The facility is horrendous. After a week, everyone on that unit developed foot fungus. This was caused because of the fact when they showered, they were standing in backed up water. The facility was covered with black mold. They were put on medication. His feet are still scarred.

Mark was told when he left East Orange that he would then have to go to Lyons. He had heard some horror stories about there, he did not want to go. He wanted to go to a VA in Virginia. He was told, there was no room, he would have to be discharged, come home and wait for his turn. They could not keep him in East Orange, there was no room.

He, reluctantly, went to Lyons, afraid of what might happen if he came home. In the 4 days he was there, there were 3 overdoses in his unit, drugs coming in from people who had outside connections. Someone stole everything out of his room. He walked out. We found out a week later he was gone.

His problems continued to escalate. He came back home. Tried AA, NA. Nothing worked. He got to the point, he was unrecognizable. He never slept, never ate. We begged him to call East Orange again. He did, but was told there was a 4-month wait. He begged and said he would not make it that long. He called them every day. Finally, about 5 months ago, they had an opening.

Mind you during all of this time, he was arrested numerous times for drug related chargers, and at one point, on the parkway, begged the police officer to shoot him! He even tried to go for the officer’s gun, in hopes he would get shot.

So, here we were, back in East Orange. Nothing had changed. Except the fact that we knew we were losing our son. While there, he was trying to make arrangements to go to the VA in Hawaii, looking for a geographical change. They said they couldn’t help him get in there. Somehow, he developed a contact in Hawaii. While in East Orange, he developed a severe tooth ache. Was told that the “in house” dentist was booked for weeks. The pain was so unbearable, Mark pulled the tooth out himself! A few days later, he knew it was infected. They took him to the ER on premises. Dr. examined him and said yes there was an infection. Would prescribe antibiotics. While the Dr. entered Mark’s information into the computer, he realized Mark was from Building 4. He yelled to the nurse “This one is from Building 4” I cannot give him a RX. The nurse yelled back “I am tired of those addicts coming up here pretending they are sick just to get drugs” Mark was mortified. Then there was a security guard right there who said “Hey, you can write me a few scripts while you are at it”

Disgraceful. Mark went back into his shell. Feeling like everything was his fault, wanting to die. And, at times, we thought he was going to.

He somehow made arrangements when his 29 days was up in East Orange, to go to the facility in Hawaii. We thought it was a bit drastic, but we were desperate. When he got to the facility, I believe his name was not on the list. Now he is in Hawaii, with nowhere to go. He lost his wallet, had no ID.

He said he made some friends, is happy, not using. We have to believe him.

Absurd is not even close to describing this. How can we send 20-year-old boys over there, have them come home, and treat them like it was all for nothing? Turn them into drug addicts so they don’t have to deal with them, and making them feel like nothing.

I could stand in the middle of the street and scream if I thought just one single person would listen. I would sit on the steps of the White House, if I thought someone would listen.

Look at the number of our men and women who do not survive. Sure, physically, they survived their tour, but then die at their own hands. I don’t know if Mark will ever be the same. Why can’t our vets get the same benefits our Congressmen and Senators get????? Lifetime benefits. Why can’t a Vet walk into a pharmacy, and not have to pay a single penny?? Why does it cost a vet, out of pocket, $6000 a week to get help at a private facility??

Right now, and I am afraid forever, is a day to day struggle for Mark, and all of our vets. Isn’t there something, and I mean something drastic that can be done??? Don’t they deserve that? Sure a “thank you” on the street is nice. But there needs to be something or someone who will fight for them, the same way they fought for us!!!

Reading Sharon’s letter makes realize how we have failed her son, as well as the 2.6 million young men and women our government has sent to fight in Iraq and Afghanistan – and then conveniently forgotten after they have returned home.

And it brings home a discussion that we had at the Center for Ethics and the Rule of Law at the University of Pennsylvania. About 30 of us (military commanders, mental health professionals, legal scholars and a couple of journalists) were invited to consider what should be the legitimate costs of going to war.

There seemed to be widespread agreement that mental health treatment should be planned for before going to war, but calculating those costs can be difficult. Vets have higher rates of alcoholism, drug addiction, joblessness, homelessness, incarceration and suicide than the general population. But how can you calculate those costs to our society.

Even worse, as a couple of philosophers pointed out, how can you calculate the human toll? How can you begin to calculate the cost to the Eiflander family – or to the families of the millions of vets?

I have no answers. And it’s obvious that our government has none. But we all should.

Finally, the Eiflander family is desperate for help. Anyone with suggestions can reach Sharon Eiflander at this email address: “Sharon Eiflander” <eiflandersharon@gmail.com>

If a soldier’s brain has been so traumatized by combat that he cannot control some of the things that he does, how can he be held legally accountable for his actions?

But then again, how can he not?

“Do we have the legal and moral right to judge and sentence soldiers who have diminished capability due to actions taken on behalf of the American public?” asked University of Pennsylvania Law Professor Stephen Morse, who is also a prominent forensic psychologist, during a PTSD conference hosted by the Center for Ethics and the Rule of Law in Philadelphia.

Morse’s questions were highlighted by the observation of Dr. Bessel van der Kolk that “after combat, vets have to live with an altered neural network.” For more on van der Kolk’s lecture on neurobiology, see my previous post.

Let’s start, as Morse did, by looking at the legal definition of what is needed to be liable for one’s actions.

Morse said that all crimes include the requirement of being a “voluntary act” (i.e., an intentional action or omission) done in a state of reasonably intact consciousness. That provides a basis for being acquitted or convicted of murder, for example. Thus, if a defendant is in a state of divided or disassociated consciousness, the act requirement is not met and the defendant will be acquitted. Such cases are relatively infrequent.

But how else does the law deal with impaired consciousness?

In 46 states and in the federal system, there is also a plea of not guilty by reason of insanity if the defendant’s mental disorder produces a sufficient cognitive deficit or, in a minority of states, a control deficit.

How should the law deal with PTSD, a disorder in which the victims are operating with a reasonably intact consciousness until something triggers in some sufferers an altered state of consciousness? Should this be treated as a cognitive or control deficit in appropriate cases?

For example, smells go directly to the amygdala, the limbic brain’s fight-or-flight center. I know a vet in Montana whose flashbacks were probably triggered by a nearby oil refinery that produced odors that reminded him of diesel fumes in his Iraqi forward operating base. During one of those flashbacks, he tackled a mailman, pinned him to the ground, and was screaming for his rifle. The vet’s consciousness seems clearly to have been altered in this case.

There are vets’ courts in some states, but not all states, that accept a vet’s diminished capacity. So the system is unfair to vets without that option.

I remembered a former Army Ranger who created a disturbance on an airliner. The prosecutor and the defender worked out a deal for him to plead guilty to a misdemeanor, then be sentenced to treatment in a VA hospital. But judges have considerable discretion in sentencing, which also makes the outcome unfair for others.

Professor Morse had a suggestion. He proposed a fourth plea, in addition to innocent, not guilty by reason of insanity, or guilty. That would be a plea of guilty, but not fully rational, which would give the legislatures or the courts an option for reduced sentences. Sufferers from PTSD who met the voluntary act requirement and who were not sufficiently affected to succeed with an insanity defense would then have a genuine opportunity to present a claim that they had diminished rationality and diminished culpability.

At one point, our discussion shifted to atrocities like revenge killings that could lead to moral injuries. Would they also be considered as not fully rational?

That led to heated discussion, with one former Army judge advocate insisting there was no such thing and demanding a retraction of the charge. But three other Army commanders also weighed in on the issue.

One said he had pored over the records from Abu Ghraib and was appalled to find how many soldiers from how many different units had employed enhanced interrogation techniques (like waterboarding).

Another military prosecutor said he had seen cases in Iraq in which American soldiers should have been charged with war crimes since there was compelling evidence they had shot civilians and planted weapons near the bodies. Instead, he said, they were charged with Article 15s and busted one rank in the unlikely event they were convicted.

And another commander said atrocities are still a minority of what soldiers do, but that they are a significant minority and greater than most people realize.

This seminar was made up of top military personnel, legal scholars and mental health experts, with a couple of journalists thrown in for good (or bad) measure. So we debated the issue at some length, without resolution.

Finally, one of the participants summed it up for all of us, saying, “I think we’re all morally conflicted for what we are sending soldiers out to do, what we are willing for forgive them for, and what they can forgive themselves for.”