Interview published in the Oregonian, September 27, 2011

Question: You speak of the rising rate of Post-Traumatic Stress Disorder, alcohol use and those sort of symptoms in the military. What do you see is driving that?

Answer: It’s become to some extent, a politicized concern with a dubious policy approach. The reality of it is we’ve got a military which took on a decade’s worth of combat with the smallest Army since 1939.

The combat stress is there and add to that 51,000 killed or wounded and many with pretty significant injuries, many of whom wouldn’t have survived an earlier war.

One of the things that’s clinically measureable is TBI (traumatic brain injury) and I think it hasn’t been talked about enough. Basically somebody detonates 300 kilograms of homemade explosives and you survive because you’re in an MRAP vehicle and you’re wearing body armor and blast glasses, but you end up with either significant or devastating brain injury. It’s an invisible wound, but it’s a real one caused by direct enemy action.

Q: Sometimes hard to diagnose.

A: It is. When you’re looking at somebody with physical injuries that are immense and sometimes TBI, which you can’t see, … That’s a population where PTSD is just another diagnosis. I mean it’s there. It’s automatic.

Kids coming out of combat, with multiple combat tours, have been under stress, they do act a little crazy. It takes them a little time to acclimatize.

But for some number, whether it’s for underlying mental health, pre-existing drug and alcohol abuse or other factors, some of them exhibit longer-term disorder. And therein lies the problem.

So PTSD a little bit tricky and in the middle of all it are some of the most awful phonies I have ever encountered in my life. It is beyond belief. I personally have run into professional PTSD patients. Just shameful beyond belief.

Q: It certainly obscures the real issue for the rest of us.

A: Absolutely. I want the VA to focus on the devastated veteran population I want to go through acute care and then chronic care. And where we’ve got long-term injuries, have an appropriate therapy program. But basically, people get better.

The best soldier I ever saw, he was a platoon sergeant at age 21, has never recovered from the war because he’s never found anything else at that level of excitement and value and importance.

American soldiers exposed to intense combat, generally speaking aren’t damaged by it. They’re made more powerful.

Q: Oregon isn’t an active duty state, although we’ve had guys go multiple times. But our state National Guard has a higher-than-average toll of suicide. About half of those were people who never deployed. So I’m mystified by that. And I also wonder how meaningful it is to say they’re military suicides when they’re basically drilling once a month.

A: One of my friends is Dr. Sally Satel. One of her big deals as a psychiatrist is don’t ever set somebody up to think they’re permanently impaired. You don’t ever tell them that, for God’s sakes.

The Army to some extent has gone utterly sensitive on suicide. We’ve linked it in some ways, perhaps unintentionally, to soldiers being the victims of a war.

(A doctor at Walter Reed told me) “It doesn’t really matter to us if you’re a National Guard soldier and you’ve never deployed, you came in with a drug and alcohol problem, you came in with underlying health disorders, but we’ve got you now and you’re exhibiting symptoms of distress, we’ve got to listen to you and try to make you better.” What we don’t want to do is say it’s related in some way to this war, because, in many cases, it isn’t.

The primary cause of suicide in young soldiers is alcohol abuse, away from home, frequently tied to rejection by significant other and access to guns. And that drives our rate up.

Q: Let me seek a bridge to another subject. You’re talking about drug abuse. The linkage to your national security presentation might be Mexico. Is the threat there more imminent than most people in this country think?

A: I’m intensely political, but absolutely nonpartisan. What I’m going to try to do is influence public policy, and what’s going to happen is abject denial by the Obama administration that there’s a problem on the border and vicious attacks by the Republicans. It’s going to turn into a partisan issue. (McCaffrey is scheduled to testify to the Senate on the subject Oct. 14.)

But I’m here to tell you I’ve been watching that border since before 1996 as a Southcom commander. We have a problem and the federal government’s in denial.

The Mexican cartels are in more than 300 cities around the country. They are the dominant organized crime capability in the U.S. They are in multi criminal activities, primarily 700 metric tons of cocaine, the principal manufacturers of methamphetamine, hundreds of metric tons of high-THC content marijuana. But they’re also human smuggling, prostitution, they’re intimidating the rural populations of the U.S.-Mexican frontier. They live in a war zone where dozens of people with automatic weapons and night vision goggles cross the frontier at night. They tell them to get off their land and stop clearing brush. Multigenerational farmers are selling and moving away.

Their foot soldiers in the United States tend to be gangs. In Texas, we said it’s 18,000 gang members and they’re primarily recruited in Texas prisons and they’re lubricated with bunches of money and they act as shooters for them.

The Border Patrol is undermanned. There is completely inadequate federal law enforcement presence on the frontier. And we’ve got to do something about it.

Q: I see that you don’t see legalization as a way to turn the economics around.

A: The legalization argument amuses me. Usually it’s an intellectual argument that on cursory examination falls apart. Nobody in their right minds wants to legalize drugs. It absolutely doesn’t work.

Pot is already decriminalized in the United States. As a general statement, you can’t get arrested for personal possession of pot, prosecuted and locked up.

We essentially don’t criminally prosecute addicts in general. If you’re a heroin addict in downtown Portland, we’re not going to lock you up because you have two grams of heroin on you; we’re going to lock you up because you broke into my car.

Part of it is we know that if you make substances less available, and then more expensive, and if you stigmatize them by saying it’s criminal to sell them, drug use goes down. That’s the deal.