Are Afghans Unable to Beat the Taliban Because of Clinical Depression?S

Maybe the reason that the Afghan counterinsurgency has been such a flop is that the people there are too traumatized and depressed to make nation-building work.

That's the controversial conclusion of an Air Force colonel who recently spent a year in Afghanistan as the head of a reconstruction team. In an unpublished paper, Col. Erik Goepner, currently serving as a military fellow at the Center for Strategic and International Studies, argues that the Afghan counterinsurgency was all-but-doomed before U.S. troops ever landed there. The reason, he writes, is "the high rate of mental disorders" in Afghanistan and other fragile states. Pervasive depression and post-traumatic stress disorder leads to a sense of "learned helplessness" among the people. And that makes it next-to-impossible to build up the country's economy and government.

Goepner's argument has a gut-level appeal, observers of Afghanistan like Joshua Foust of the American Security Project say. But Goepner relies almost exclusively for his psychological data on a 2009 study-of-studies (.pdf) in the Journal of the American Medical Association, Foust complains. That's not a strong enough foundation to make such broad conclusions about Afghanistan and every other insurgent battlefield.

"It's an interesting but unsupported argument that needs a lot more support and data to be credible," Foust says.

That JAMA paper finds that conflict-torn countries have average PTSD rates of 30% or higher - compared to just 5% in the rest of the world. That's a six-fold difference between populations who are under the stress of war and those that are not. The results for depression were largely the same.

"If an American unit had PTSD and depression rates of 30% or higher, it would likely be declared combat ineffective," Goepner writes. "When we conduct COIN (counterinsurgency) in weak and failed states, we are supporting a government and security force that is likewise combat, or perhaps more appropriately, mission ineffective. Mentoring and training them to a sufficient level of legitimacy and effectiveness is incredibly difficult, particularly so in the timeframes likely required by domestic political considerations at home."

The question is how reliable those statistics about trauma and depression really are. The 181 surveys summed up in the JAMA paper largely rely on surveys of the population. That's a legendarily imprecise way of gauging mental health. Moreover, those surveys stretch all the way back to 1980 - a time when the understanding of PTSD was quite a bit different than it is today. And there's nothing in the paper that explicitly links all this trauma to whether governments under attack fail or succeed.

Afghan officials, however, say the figures match what they see. "Two out of four Afghans suffer from trauma, depression and anxiety - they make up some 50 percent of the population," the director of the health ministry's mental health department told Agence France-Presse in January. "They are in trauma mainly because of three decades of war, poverty, family disputes and migration issues."

Goepner first introduced his argument in March at a Brookings Institution panel (full disclosure: I was the moderator). And it was meant not as a broadside against the Afghan mission - but against all counterinsurgencies, which he believes are "almost impossible" to successfully wage.

Not only are counterinsurgents faced with the Sisyphean task of motivating a population that's inclined to feel that their contributions will never amount to anything. "For the insurgents," Goepner writes, "the high rates of PTSD and depression provide a benefit … making the population more susceptible to intimidation and the belief that they themselves are incapable of changing things for the better. While this does not endear the insurgents to the population, it does keep the environment unstable and insecure over time, which is often an insurgent goal."

What that means for the American military is pretty basic, Goepner argues. Avoid counterinsurgencies unless its an absolute do-or-die situation. And if you launch that kind of war, plan to stay a long, long time. Fragile psyches make for fragile institutions; it takes years, maybe decades, to shore them up.

Only seize and hold terrain where you plan to provide security around-the-clock. "Touch-and-go U.S. or host nation presence sets the population up for increased insurgent intimidation," Goepner writes. "No security or government presence is preferable from the population's perspective to only having some security and presence."

Finally, make sure you bring a whole gang of psychiatrists to the battlefield. With populations so traumatized by war, you're going to need them.

Image by Noah Shachtman


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