Saturday, November 29, 2008

Bases brace for surge in stress-related disorders

Original Link:

Some 15,000 soldiers are heading home to this sprawling base after spending more than a year at war in Iraq and Afghanistan, and military health officials are bracing for a surge in brain injuries and psychological problems among those troops.

Facing prospects that one in five of the 101st Airborne Division soldiers will suffer from stress-related disorders, the base has nearly doubled its psychological health staff. Army leaders are hoping to use the base's experiences to assess the long-term impact of repeated deployments.

The three 101st Airborne combat brigades, which have begun arriving home, have gone through at least three tours in Iraq. The 3rd Brigade also served seven months in Afghanistan, early in the war. Next spring, the 4th Brigade will return from a 15-month tour in Afghanistan. So far, roughly 10,000 soldiers have come back; the remainder are expected by the end of January.

Army leaders say they will closely watch Fort Campbell to determine the proper medical staffing levels needed to aid soldiers who have endured repeated rotations in the two war zones.

"I don't know what to expect. I don't think anybody knows," said Gen. Peter Chiarelli, vice chief of staff of the Army, as he flew back to Washington from a recent tour of the base's medical facilities. "That's why I want to see numbers from the 101st's third deployment."

What happens with the 101st Airborne, he said, will let the Army help other bases ready for similar homecomings in the next year or two, when multiple brigades from the 4th Infantry Division and the 1st Cavalry Division return.

Noting that some soldiers in the 101st Airborne units have been to war four or five times, Chiarelli said he is most worried the military will not be able to find enough health care providers to deal effectively with the troops needing assistance.

Many of the military bases are near small or remote communities that do not have access to the number of health professionals who might be needed as a great many soldiers return home.

More than 63,600 active duty Army soldiers have done three or more tours in Iraq or Afghanistan. That is a nearly 12 percent of the total number of soldiers who have deployed at least once. Roughly four in 10 soldiers who have gone to war have served more than one deployment - and that number is growing steadily.

One solution under discussion is the formation of mobile medical and psychological teams that can go to Army bases when they are expecting a surge in activity from returning units.

At Fort Campbell, the director of health services, Col. Richard Thomas, has roughly doubled his authorized staff of psychologists and behavioral specialists to 55 and is trying to hire a few more.

"I think we have enough staff to meet the demands of the soldiers here, but I could use more, and I'll hire more if I can," said Thomas. "I'll hire them until they tell me to stop."

He said he expects the increased staffing levels to last at least through next year.

For the first time, Thomas said, every soldier returning home will have an individual meeting with a behavioral health specialist and then go through a second such session 90 days to 120 days later.

The second one is generally the time when indications of stress surface, after the initial euphoria of the homecoming wears off and sleeplessness, nightmares, and other symptoms show up.

"We're seeing a lot of soldiers with stress related issues," he said. "They're not bipolar or schizophrenic. But they're deploying three and four times and the stress is tremendous. They're having relationship issues, financial issues, marital problems - all stress related."

According to Dr. Bret Logan, deputy commander for managed care at the base, extended war zone stints that have lasted as long as 38 months over the course of the wars in Afghanistan and Iraq have taken a severe toll.

More than 3,000 of the 15,000 troops returning home, Logan estimated, probably will experience headaches, sleep disorders, irritability, memory loss, relationship strains or other symptoms linked to stress disorder.

Medical staff at Fort Campbell say they also worry that there will be a new surge of suicides - an escalating problem in recent years, largely related to the stresses of war.

Jon Soltz, an Iraq war veteran and chairman of, said more soldiers will have stress-related problems, and the military must be vigilant in diagnosing and treating post-traumatic stress disorder to head off more serious issues.

"The longer you are there (at war), the more PTSD you're going to see. You wonder when it's going to be your time," he said.

Each returning soldier is evaluated through a seven-day reintegration program. It includes medical checkups, tests, lectures on suicide prevention and relationships, and other sessions to help them transition back into life at the base and with their families.

During his visit to Campbell, Chiarelli took a spin on one of the base's simulators, which are used for soldiers having neurological or stress problems. The simulator can be used to test soldiers' reflexes or as a way to work someone back into everyday situations.

With occupational therapist Eileen Hayes watching over his shoulder, Chiarelli adeptly negotiated the city streets, sudden turns and other obstacles moving at him on the small screen.

The simulators said Logan, put patients in high stress scenarios to test their decision-making ability while under duress.

While soldiers have been routinely deploying for 15-month tours, most Marines serve about seven months and airmen deploy for about four months, although some may serve for tours of six months or longer.

Late this past summer, Pentagon leaders ordered a change, saying any soldier who deployed in August or after would serve 12-month tours. Army leaders say they want to reduce that to nine months, but doing so will be difficult considering the strains of fighting two wars at once.

Logan said that some 85 percent of those soldiers with stress disorder symptoms will recover with the help of some treatment or medication. But the other 15 percent will require more intensive help.

Friday, November 14, 2008

Franklin Delano Obama?

Original Link:

By Paul Krugman

Suddenly, everything old is New Deal again. Reagan is out; F.D.R. is in. Still, how much guidance does the Roosevelt era really offer for today’s world?

The answer is, a lot. But Barack Obama should learn from F.D.R.’s failures as well as from his achievements: the truth is that the New Deal wasn’t as successful in the short run as it was in the long run. And the reason for F.D.R.’s limited short-run success, which almost undid his whole program, was the fact that his economic policies were too cautious.

About the New Deal’s long-run achievements: the institutions F.D.R. built have proved both durable and essential. Indeed, those institutions remain the bedrock of our nation’s economic stability. Imagine how much worse the financial crisis would be if the New Deal hadn’t insured most bank deposits. Imagine how insecure older Americans would feel right now if Republicans had managed to dismantle Social Security.

Can Mr. Obama achieve something comparable? Rahm Emanuel, Mr. Obama’s new chief of staff, has declared that “you don’t ever want a crisis to go to waste.” Progressives hope that the Obama administration, like the New Deal, will respond to the current economic and financial crisis by creating institutions, especially a universal health care system, that will change the shape of American society for generations to come.

But the new administration should try not to emulate a less successful aspect of the New Deal: its inadequate response to the Great Depression itself.

Now, there’s a whole intellectual industry, mainly operating out of right-wing think tanks, devoted to propagating the idea that F.D.R. actually made the Depression worse. So it’s important to know that most of what you hear along those lines is based on deliberate misrepresentation of the facts. The New Deal brought real relief to most Americans.

That said, F.D.R. did not, in fact, manage to engineer a full economic recovery during his first two terms. This failure is often cited as evidence against Keynesian economics, which says that increased public spending can get a stalled economy moving. But the definitive study of fiscal policy in the ’30s, by the M.I.T. economist E. Cary Brown, reached a very different conclusion: fiscal stimulus was unsuccessful “not because it does not work, but because it was not tried.”

This may seem hard to believe. The New Deal famously placed millions of Americans on the public payroll via the Works Progress Administration and the Civilian Conservation Corps. To this day we drive on W.P.A.-built roads and send our children to W.P.A.-built schools. Didn’t all these public works amount to a major fiscal stimulus?

Well, it wasn’t as major as you might think. The effects of federal public works spending were largely offset by other factors, notably a large tax increase, enacted by Herbert Hoover, whose full effects weren’t felt until his successor took office. Also, expansionary policy at the federal level was undercut by spending cuts and tax increases at the state and local level.

And F.D.R. wasn’t just reluctant to pursue an all-out fiscal expansion — he was eager to return to conservative budget principles. That eagerness almost destroyed his legacy. After winning a smashing election victory in 1936, the Roosevelt administration cut spending and raised taxes, precipitating an economic relapse that drove the unemployment rate back into double digits and led to a major defeat in the 1938 midterm elections.

What saved the economy, and the New Deal, was the enormous public works project known as World War II, which finally provided a fiscal stimulus adequate to the economy’s needs.

This history offers important lessons for the incoming administration.

The political lesson is that economic missteps can quickly undermine an electoral mandate. Democrats won big last week — but they won even bigger in 1936, only to see their gains evaporate after the recession of 1937-38. Americans don’t expect instant economic results from the incoming administration, but they do expect results, and Democrats’ euphoria will be short-lived if they don’t deliver an economic recovery.

The economic lesson is the importance of doing enough. F.D.R. thought he was being prudent by reining in his spending plans; in reality, he was taking big risks with the economy and with his legacy. My advice to the Obama people is to figure out how much help they think the economy needs, then add 50 percent. It’s much better, in a depressed economy, to err on the side of too much stimulus than on the side of too little.

In short, Mr. Obama’s chances of leading a new New Deal depend largely on whether his short-run economic plans are sufficiently bold. Progressives can only hope that he has the necessary audacity.

Depression Economics Returns

Original Link:


The economic news, in case you haven’t noticed, keeps getting worse. Bad as it is, however, I don’t expect another Great Depression. In fact, we probably won’t see the unemployment rate match its post-Depression peak of 10.7 percent, reached in 1982 (although I wish I was sure about that).

We are already, however, well into the realm of what I call depression economics. By that I mean a state of affairs like that of the 1930s in which the usual tools of economic policy — above all, the Federal Reserve’s ability to pump up the economy by cutting interest rates — have lost all traction. When depression economics prevails, the usual rules of economic policy no longer apply: virtue becomes vice, caution is risky and prudence is folly.

To see what I’m talking about, consider the implications of the latest piece of terrible economic news: Thursday’s report on new claims for unemployment insurance, which have now passed the half-million mark. Bad as this report was, viewed in isolation it might not seem catastrophic. After all, it was in the same ballpark as numbers reached during the 2001 recession and the 1990-1991 recession, both of which ended up being relatively mild by historical standards (although in each case it took a long time before the job market recovered).

But on both of these earlier occasions the standard policy response to a weak economy — a cut in the federal funds rate, the interest rate most directly affected by Fed policy — was still available. Today, it isn’t: the effective federal funds rate (as opposed to the official target, which for technical reasons has become meaningless) has averaged less than 0.3 percent in recent days. Basically, there’s nothing left to cut.

And with no possibility of further interest rate cuts, there’s nothing to stop the economy’s downward momentum. Rising unemployment will lead to further cuts in consumer spending, which Best Buy warned this week has already suffered a “seismic” decline. Weak consumer spending will lead to cutbacks in business investment plans. And the weakening economy will lead to more job cuts, provoking a further cycle of contraction.

To pull us out of this downward spiral, the federal government will have to provide economic stimulus in the form of higher spending and greater aid to those in distress — and the stimulus plan won’t come soon enough or be strong enough unless politicians and economic officials are able to transcend several conventional prejudices.

One of these prejudices is the fear of red ink. In normal times, it’s good to worry about the budget deficit — and fiscal responsibility is a virtue we’ll need to relearn as soon as this crisis is past. When depression economics prevails, however, this virtue becomes a vice. F.D.R.’s premature attempt to balance the budget in 1937 almost destroyed the New Deal.

Another prejudice is the belief that policy should move cautiously. In normal times, this makes sense: you shouldn’t make big changes in policy until it’s clear they’re needed. Under current conditions, however, caution is risky, because big changes for the worse are already happening, and any delay in acting raises the chance of a deeper economic disaster. The policy response should be as well-crafted as possible, but time is of the essence.

Finally, in normal times modesty and prudence in policy goals are good things. Under current conditions, however, it’s much better to err on the side of doing too much than on the side of doing too little. The risk, if the stimulus plan turns out to be more than needed, is that the economy might overheat, leading to inflation — but the Federal Reserve can always head off that threat by raising interest rates. On the other hand, if the stimulus plan is too small there’s nothing the Fed can do to make up for the shortfall. So when depression economics prevails, prudence is folly.

What does all this say about economic policy in the near future? The Obama administration will almost certainly take office in the face of an economy looking even worse than it does now. Indeed, Goldman Sachs predicts that the unemployment rate, currently at 6.5 percent, will reach 8.5 percent by the end of next year.

All indications are that the new administration will offer a major stimulus package. My own back-of-the-envelope calculations say that the package should be huge, on the order of $600 billion.

So the question becomes, will the Obama people dare to propose something on that scale?

Let’s hope that the answer to that question is yes, that the new administration will indeed be that daring. For we’re now in a situation where it would be very dangerous to give in to conventional notions of prudence.