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Good or Bad News? Media Coverage of Soldiers: Focus on Behavioral Health in Iraq During OIF 05-07

Appendix 3

GOOD OR BAD NEWS? MEDIA COVERAGE OF SOLDIERS: FOCUS ON BEHAVIORAL HEALTH IN IRAQ DURING 

Operation Iraqi Freedom 05-07

JEFFREY S. YARVIS, PhD,* and ELSPETH CAMERON RITCHIE, MD, MPH†

INTRODUCTION

BASICS OF interactING WITH the MEDIA

ISSUES AND CONCERNS WITH BEHAVIORAL HEALTH REPORTING ON IRAQ

Suicide Rates in the Army

Baghdad ER

Haditha

SUMMARY

*Lieutenant Colonel, Medical Service Corps, US Army; Chief, Behavioral Health, Department of Psychiatry, Borden Pavilion, Walter Reed Army Medical 

Center, 6900 Georgia Avenue NW, Washington, DC 20307; formerly, Director of Social Work, Uniformed Services University of the Health Sciences, 

Bethesda, Maryland

†

Colonel, US Army (Retired); formerly, Psychiatry Consultant to the Army Surgeon General, and Director, Behavioral Health Proponency, Office of The 

Surgeon General, Falls Church, Virginia; currently, Chief Clinical Officer, District of Columbia Department of Mental Health, 64 New York Avenue 

NE, 4th Floor, Washington, DC 20002
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INTRODUCTION

The mental health of soldiers during the wars in Iraq 

and Afghanistan has generated ongoing media interest, focusing on major issues such as suicide, administrative discharges, psychiatric medications, fitness to 

deploy, care of wounded soldiers, and traumatic brain 

injury. This appendix provides some basic guidance for 

interacting with the media, followed by a discussion 

of media coverage during a specific period of time. 

Questions raised include: Does the media’s portrayal 

of soldiers with mental illnesses present the public 

with an accurate picture? How does the representation 

of the behavioral health of soldiers affect behavioral 

health operations? 

This appendix explores the possible operational 

impact of negative portrayals of soldiers with mental 

illnesses, using examples from Operation Iraqi Freedom (OIF) 05-07, through discussions of sensitive 

behavioral health issues such as suicide, portrayals of 

the combat environment to the public via documentaries such as Baghdad ER, and controversial events 

such as the killings in Haditha. In some cases media 

reporting can magnify the stigma experienced by 

soldiers with behavioral health problems, in addition to affecting the practices of military behavioral 

health. In other cases, the media can shed light on 

problems that need to be, and indeed are, addressed 

by military behavioral healthcare providers and 

policy makers.

BASICS OF INTERATING WITH THE MEDIA

Members of the media often approach military 

behavioral healthcare providers. If approached by a 

journalist, the first rule for the provider is to contact 

the public affairs office (PAO). PAO staff will handle 

negotiations with the media, and decide if it is an appropriate interaction. If an interview is approved, the 

interviewee should be prepared for surprise questions 

and always remember that quotations can be taken out 

of context. If giving a lecture, the speaker should keep in 

mind that media are often in the audience. Again, PAO 

staff should provide guidance for any public speaking 

or media interactions by military practitioners.

ISSUES AND CONCERNS WITH BEHAVIORAL HEALTH REPORTING ON IRAQ

During OIF 05-07, the war in Iraq entered its fourth 

year. Like all wars, the Iraq War is an extremely complex set of ever-changing dynamics. The battlefield has 

evolved considerably since US forces first invaded Iraq 

in 2003, changing from largely combat operations during the first months into civil-military endeavors since 

then. During this time the enemy had also evolved 

from organized Iraqi forces into varying militias, including some foreign fighters. Over 1,100 tribes live 

in the country; tribal territories often extend beyond 

Iraq’s national boundaries. Other nation states also put 

external pressure on Iraq. Various religious and ethnic 

groups compete for scarce resources in the Bedouin 

cultural tradition. Privateers and black-marketers 

make a living in chaotic social and economic circumstances. Iraqi politicians maintain different views about 

the best way to govern. Despite this complex and 

evolving environment, media reports have sometimes 

given a simplified impression that the ongoing conflict 

results from sectarian violence between the Sunni, 

Shia, and Kurdish groups. 

Combat stress or behavioral health assets were positioned throughout Iraq to help soldiers negotiate their 

way through these complex operational and emotional 

terrains. During OIF 05-07, the ongoing war in Iraq 

affected behavioral healthcare in two important ways. 

First, enough time had elapsed by then for military 

leaders to be aware of outcomes and problems that 

had arisen from OIF I (the first rotation) and OIF II (the 

second rotation). Consequently, new policies involving 

the behavioral health community were initiated (ie, 

suicide prevention, use of psychiatric medications; 

see Chapter 25, Suicide Prevention, and Chapter 

10, Psychiatric Medications in Military Operations, 

respectively, for further discussion of these topics). 

Secondly, the length of the conflict and the number of 

casualties had generated increasing media interest in 

the war and in behavioral health services available to 

soldiers. Although it is impossible to determine to what 

extent the media influenced the day-to-day operations 

of behavioral health providers, the increased scrutiny 

did concern military leadership. This translated into 

greater cognizance of behavioral health activities. 

The media has covered wars since the advent of 

print journalism. With the introduction of motion 

pictures, war coverage reached larger audiences 

throughout World War II. During this period, as well 

as during the Korean War, most of the video reporting of the war was seen in movie theaters. It was not 

until Vietnam that images of war were televised into 

the homes of the US populace. This footage, however, 

was generally edited at a network before it was aired 
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because the media lacked the capability of a live feed 

from the battlefield. Beginning with the Persian Gulf 

War (1990–1991), however, journalists were able to 

send live feeds from their embedded positions directly 

to television broadcasts. Commanders and politicians 

had virtually no time to review what might be broadcast, and in many cases heard of issues raised by the 

media only after they had been aired. 

The following three issues—suicide, Baghdad ER, 

and Haditha—all of which involved situations during 

OIF 05-07, will be examined as they were reported by 

the media and acted upon by the military. Neither the 

nature of recent advances in media technology nor the 

media’s effect on public opinion has been fully measured. However, it is not difficult to imagine that media 

coverage of behavioral health could have operational 

impacts and affect the behavior of soldiers. Mention 

Abu Ghraib or Haditha and one will elicit a wide range 

of reactions, from well informed to hearsay, from those 

responding. It is then that one can sense the true power 

and influence the media can have. The positive impact 

of this phenomenon is that the military often gains the 

attention and the political support it needs to address 

important psychological health needs of soldiers, for 

example, suicides in the Army.

Suicide Rates in the Army

Various media sources began reporting in 2003 that 

Army suicide rates were on the rise and that those 

soldiers deployed to Iraq and Kuwait experienced the 

greatest increase.1

 Although Army suicide statistics 

remained lower than for comparable age groups in the 

civilian population, the Army surgeon general, Lieutenant General James Peake, said that “any suicide is 

something we worry about and want to stop.”2 Despite 

the trend data being consistent with the civilian sector, 

recommendations were immediately implemented, 

including augmenting the Army’s suicide prevention 

program and making behavioral healthcare more accessible to soldiers in combat and other high-stress 

environments. However, media reports, such as the 

articles on suicide, may alter mission focus and influence military behavioral health resources by diverting 

limited assets to respond to the reporting. 

The Army’s first mental health survey ever conducted in a combat zone took place in 2003 (see 

Chapter 5, Walter Reed Army Institute of Research 

Contributions During Operations Iraqi Freedom and 

Enduring Freedom, in this volume, for a more detailed 

discussion of the survey process). At the request of the 

commanding general, Combined Joint Task Force-7 of 

the US Central Command established and dispatched 

the first Mental Health Advisory Team (MHAT) to 

survey and provide recommendations on OIF-related 

behavioral health services. A team of 12 military and 

civilian psychiatrists, psychologists, social workers, 

and combat-stress experts surveyed 756 soldiers in Iraq 

between late August and early October 2003. They also 

surveyed behavioral health and medical care providers, unit leaders, and unit ministry staffs. The survey 

was conducted when conditions were at a low point: 

at the end of a very hot summer, before much of the 

infrastructure that created more comfortable living 

conditions had been put in place, and before most soldiers knew when they would redeploy to their home 

stations. The team leader of this first MHAT, Colonel 

Virgil Patterson, said one in four soldiers surveyed 

reported moderate or severe emotional, alcohol, or 

family problems. More than half reported low or very 

low morale. 

After media reports on suicide began appearing, 

military behavioral health experts found themselves 

adding one additional task to their already significant duties: to maintain current and accurate data on 

suicide in theater and remain prepared to respond to 

media reports. For example, in 2003 the Baltimore Sun

ran an article with the title “Army’s Suicide Rate Has 

Outside Experts Alarmed,” and the follow-on subtitle of “Most died serving in Iraq after major combat 

phase.”3

 Similar reports were carried by most of the 

major news networks and papers. Later articles used 

language similar to that used by the Baltimore Sun in 

2003. For example, the Hartford Current noted in 2007 

that the “Army continues to struggle with suicides,” 

and the “2006 Rate Of Self-Inflicted Deaths In Iraq 

Could Exceed Record Set In 2005.”4 Since OIF 05-07, 

an upward trend in suicide rates in active duty military has occurred, as discussed further in Chapter 25, 

Suicide Prevention, in this volume.

Baghdad ER

The 2006 HBO (Home Box Office) documentary 

Baghdad ER was a graphic and emotional account 

of the realities of war through the emergency room 

experiences of a combat support hospital. At the very 

outset of Baghdad ER, the producers pointed out that 

90% of soldiers wounded in Iraq survive—the highest 

survival rate in American military history. (During OIF 

05-07, survival rates exceeded 96%.5

)

Visual documentaries can serve as powerful reminders or “triggers” for soldiers who have been 

exposed to the sights, sounds, and smells of combat 

injuries; Baghdad ER was such a harsh reminder of the 

brutal realities of war. Military officials were allowed 

to preview the documentary and proactively prepare 

for its impact. The Army surgeon general at the time, 
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Lieutenant General Kevin Kiley, recommended that 

Army medicine plan for the effect that Baghdad ER 

might have on those who saw it. Said Kiley, “This film 

will have a strong impact on viewers and may cause 

anxiety for some soldiers and family members.”6 He 

noted that, “some may have strong reactions to the 

medical [surgical] procedures such as the amputation of a limb.”6

 Kiley said military medical treatment 

facilities should be ready to assist troops and family 

members who might be upset after watching the film. 

He suggested that behavioral health facilities should 

extend their treatment hours and reach out to the 

troops proactively.6 Kiley recognized that families and 

soldiers with ongoing psychological difficulties might 

have additional behavioral healthcare needs after the 

program aired. There were no known negative effects 

from viewing the program, although this was not systematically studied. From conversations with viewers, 

one of the authors (ECR) reported positive response 

to the program.

Haditha

Additional media interest in the military in Iraq 

came in the wake of the killing of 23 Iraqis on November 19, 2005, in Haditha, a city in the western 

Iraq province of Al Anbar. It was alleged that the 

killings were retribution for the attack on a convoy 

of US Marines with an improvised explosive device 

that killed Lance Corporal Miguel Terrazas.7

 A Marine 

Corps communiqué initially reported that 15 civilians 

were killed by the bomb’s blast and 8 insurgents were 

subsequently killed when the Marines returned fire 

against those attacking the convoy. However, evidence 

provided by the media contradicted the Marines’ account.7

 According to these media reports, at least 15, 

and allegedly all, of those killed were noncombatant 

civilians and were killed by the Marines.

Discussing the events in Haditha, psychiatrist 

Robert Jay Lifton explains that, “atrocity is a group 

activity.”8

 Therefore, he wrote, “[t]o attribute the likely 

massacre at Haditha to ‘a few bad apples’ or to ‘individual failures’ is poor psychology and self-serving 

moralism.”8 Lifton says that the Haditha incident can 

be understood as what he calls “an atrocity-producing 

situation”—which he defines as 

one so structured, psychologically and militarily, that 

ordinary people, men or women no better or worse 

than you or I, can commit atrocities....Recognizing 

that atrocity is a group activity, one must ask how individual soldiers can so readily join in. I believe they 

undergo a type of dissociation that I call doubling—

the formation of a second self. The individual psyche 

can adapt to an atrocity-producing environment by 

means of a sub-self that behaves as if it is autonomous and thereby joins in activities that would otherwise seem repugnant.8

In environments where sanctioned brutality becomes the norm, homicidal ideation and homicidal 

impulses, dormant in most individuals, are likely 

to be expressed.9 The violent energy of the group 

becomes such that an individual soldier who questions it could by turned against by his or her peers. 

(For example, a Vietnam veteran who had been at My 

Lai told this author [JY] that he had refused to fire 

and pointedly lowered the barrel of his gun to the 

ground.) To resist intense group pressure requires a 

combination of conscience and moral courage, the 

very qualities that the military seeks to instill in soldiers as “core values.” 

Previously, Lifton explained his concept of atrocity-producing situations during a lecture about the 

possible torture of prisoners at Abu Ghraib.8

 In such 

situations, Lifton explained, although individuals 

are responsible for their own actions, when attempting to assign blame for atrocities it is perhaps more 

instructive to examine the conditions and examples 

set by higher commanders. When the rules of engagement do not appear to apply, or when ambiguities 

exist about what means may be used to achieve a 

“worthy” end, soldiers are less likely to adhere to the 

values that the military has sought to instill within 

them. Likewise, stress results from not knowing 

who the enemy is, not feeling safe, and witnessing 

evil. Cumulatively, these situations can contribute 

to behaviors that at times might exceed the rules of 

engagement. Additionally, the rules are sometimes 

difficult for a soldier to apply in the heat of battle or 

under circumstances outside normal soldier experiences or training. This explanation does not purport 

to dismiss the notion of accountability; however, it 

speaks to the process of “pathologizing” a new generation of soldiers. 

Politics, social control, and mental health have 

long been tied together. For instance, diagnostic terms 

can reflect the bias of people and the times, such as 

“hysteria”—a term inherently biased against women. 

“Mental health” has been used both to limit civil 

rights and to advocate for civil rights. The former was 

discussed in the writings of the psychiatrist Thomas 

Szasz,10 who suggested in 1961 that “mental illness” 

and the threat of being institutionalized were the 

means by which societies controlled those who strayed 

from the common morality. He advocated for the rights 

of those who had been institutionalized, setting in motion a movement that resulted in the release of many 

previously confined patients.10
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Good or Bad News? Media Coverage of Soldiers: Focus on Behavioral Health in Iraq During OIF 05-07

SUMMARY

Behavioral healthcare in the military differs from 

the civilian practice in one distinct way: military behavioral health providers are tasked to conserve the 

fighting strength of the military. Thus, although they 

treat individuals, their focus is on the overall institution. Military providers accomplish their mission 

by caring for both US military personnel and their 

families. These providers, however, can be distracted 

by the situations that inevitably arise when complex 

mental health issues are reported in a simplified manner. The media can bring attention to areas indeed 

needing corrective action; however, the media can 

also sensationalize stories, as evidenced by titles like 

“Potent Mixture: Zoloft & a Rifle.”11

The accurate presentation of behavioral health data 

is essential to combat and operational stress policy and 

doctrine; however, when data are misunderstood or 

reported out of context, they can undermine popular 

support for soldiers and potentially impact soldiers’ 

mental health. Possible areas of operational consequences due to media coverage include changing 

policies on evacuation of behavioral health casualties, 

limiting use of psychotropic medication in theater, 

and lessening the trust in clinician “instincts.” This 

operational impact has been termed the “CNN [Cable 

News Network] effect” and is seen as a double-edged 

sword—a “strategic enabler” and a potential operational risk.12

It is difficult to quantify the operational impact or 

strategic effect the media can have on behavioral health 

planning and execution. However, it is clear that the 

media are powerful forces shaping the environment 

in which behavioral health practitioners can work. 

Therefore, clinicians must be proactive as scientistpractitioners to demonstrate the efficacy of their 

practices, to plan effective battlefield interventions and 

operations for combat and operational stress control, 

and to assist with screening and surveillance of the 

service members within the scope of their responsibility. The media can also play a crucial role in drawing 

needed attention to situations in the military affecting 

soldiers in both garrison and operational settings. This 

unique convergence of two professional communities 

can contribute to conserving the fighting strength, 

which is, of course, the mission of all members of the 

military medical community.

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4, 2010.

2. Miles D. Army suicide rate in combat zones elevated. American Forces Press Service. March 26, 2004. Available at: http://

usmilitary.about.com/cs/terrorism/a/arsuicide.htm. Accessed August 4, 2010.

3. Martinez M. Army’s suicide rate has outside experts alarmed: most died serving in Iraq after major combat phase. 

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August 4, 2010.

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9. Kirkland FA. Honor, combat ethics, and military culture. In: Beam TE, Sparacino LR, eds. Military Medical Ethics. Vol 

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11. Kauffman M, Chedekel L. Potent mixture: Zoloft & a Rifle. Hartford Courant. May 16, 2006. Available at: http://www.

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