As an internist at New York's Mount Sinai Hospital, Dr. Stephanie Santos is used to finding odd things in people's stomachs. So last spring when a young man, identifying himself as an Iraq-bound soldier, said he had accidentally swallowed a pen at the bus station, she believed him. That is, until she found a second pen. It read 1-800-GREYHOUND. Last summer, according to published reports, a 20-year-old Bronx soldier paid a hit man $500 to shoot him in the knee on the day he was scheduled to return to Iraq. The year before that, a 24-year-old specialist from Washington state escaped a second tour of duty, according to his sister, by strapping on a backpack full of tools and leaping off the roof of his house, injuring his spine.
Such cases of self-harm are a "rising trend" that military doctors are watching closely, says Col. Kathy Platoni, an Army Reserve psychologist who has worked with veterans of Iraq and Afghanistan. "There are some soldiers who will do almost anything not to go back," she says. Col. Elspeth Ritchie, the Army's top psychologist, agrees that we could see an uptick in intentional injuries as more U.S. soldiers serve long, repeated combat tours, "but we just don't have good, hard data on it." Intentional- injury cases are hard to identify, and even harder to prosecute. Fewer than 21 soldiers have been punitively discharged for self-harm since 2003, according to the military. What's worrying, however, is that American troops committed suicide at the highest rate on record in 2007—and the factors behind self-injury are similar: combat stress and strained relationships. "It's often the families that don't want soldiers to return to war," says Ritchie.
Soldiers have long used self-harm as a rip cord to avoid war. During World War I, The American Journal of Psychiatry reported "epidemics of self-inflicted injuries," hospital wards filled with men shot in a single finger or toe, as well as cases of pulled-out teeth, punctured eardrums and slashed Achilles' heels. Few doubt that the Korean and Vietnam wars were any different. But the current war—fought with an overtaxed volunteer Army—may be the worst. "We're definitely concerned," says Ritchie. "We hope they'll talk to us rather than self-harm."