Rachel MacNair has come up with a theory to bring peace. But it could turn soldiers into better killers.

Mind Field 

Rachel MacNair has come up with a theory to bring peace. But it could turn soldiers into better killers.

The limousine carried just one occupant as it rolled through sun-bleached Santa Monica, California: a short, plainly dressed woman with graying hair and a gap between her front teeth. The driver at the airport had held a sign with his passenger's name on it because he knew he would not recognize her. Rachel MacNair was not famous.

MacNair is a psychologist from Kansas City who has developed a volatile theory about how war affects the soldiers who fight it.

Nearly a year before her trip to Hollywood, MacNair had watched on television as the president stood on the deck of the USS Abraham Lincoln and declared that major combat operations in Iraq had ended.

In the months preceding the president's announcement, MacNair had paid attention to other news, too, such as when four soldiers (three of whom had served in a Special Forces unit in Afghanistan) had returned to their base in North Carolina and butchered their wives; two of the men then killed themselves. Other stateside suicides followed -- a 28-year-old specialist poisoned himself in a Kentucky hotel, a 36-year-old chief warrant officer shot himself in his family's Colorado home. Earlier this year, the Pentagon had sent Combat Stress Control teams to Iraq because soldiers there were killing themselves at an alarming rate.

This past July, MacNair was quoted discussing her theory in The New Yorker. A few weeks later, the Los Angeles Times referred to her as an expert on veteran psychology. And director David O. Russell wanted MacNair to be a pundit in his Iraq War documentary, Soldiers Pay. The filmmaker's 1999 movie Three Kings, a dark comedy about the first Gulf War, had earned critical praise; now Russell was spending $207,000 to make a 35-minute film with commentary from soldiers, a retired general, a Republican congresswoman and psychologists in an effort to provide a behind-the-scenes look at each cog in the American war machine.

MacNair sat in a Holiday Inn room facing a camera and one of the movie's co-directors. She wore a goldenrod-colored jacket she'd recently bought at a Goodwill thrift store. She'd sent ahead color-coded charts, but she didn't need to reference them. Speaking carefully, she parsed her research into sound bites.

It's common knowledge that some soldiers suffer from post-traumatic stress disorder, a chronic disease characterized by nightmares, skittish behavior, concentration problems, depression and violent outbursts. Experts say it is caused by the interplay of two things: exposure to traumatic events in which there are serious threats of injury or death to oneself or others; and, as the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders puts it, associated feelings of "intense fear, helplessness or horror" -- one must not only be exposed to a traumatic situation but also have an emotional response to it.

MacNair's research took commonly held beliefs about PTSD a step further. She argued that in war, the major stressor that causes PTSD isn't watching a buddy die or coming under heavy fire from enemies.

Instead, she believes, the key factor in PTSD is killing someone else. She calls her version of the malady "Perpetration Induced Traumatic Stress," or PITS.

Russell had cut a deal with Warner Bros. and planned to piggyback the documentary as an extra feature on a new Three Kings DVD. But in mid-August, Russell told The New York Times that he thought the film had a shot at influencing the November election. Warner Bros. subsequently branded it too political and dumped it. Russell and his co-directors scrambled for another sponsor, and in late September the film was picked up by the small, independent Cinema Libre Studios, which paired it with Robert Greenwald's Uncovered: The War in Iraq and released the package to indie theaters in places such as Los Angeles, San Francisco, Houston, Atlanta, New York and, for one day, the Rag Tag Cinema in Columbia, Missouri.

"She made really interesting contributions that we think are valid and should be part of the conversation of PTSD today," says Juan Carlos Zaldîvar, one of Russell's co-directors. "I would imagine that it's a very tricky subject for the Army to talk about killing, because we, as a Western society, condemn killing, and we have to have people trained to do a job, to kill as a job. It's a bigger moral issue that we bring them [soldiers] back into a society that still thinks killing is wrong, even though they have done it for us."

Though MacNair's PITS concept is just one aspect of Soldiers Pay, her articulation of the hero-murderer complex is useful fodder for anti-war campaigners.

But MacNair developed the theory for use in a different political camp. Regardless of whether it's eventually accepted by the medical establishment, MacNair sees PITS as a political conversation starter that might someday help overturn Roe v. Wade.

When MacNair enrolled as a Ph.D. candidate in psychology and sociology at the University of Missouri-Kansas City in the late '90s, she sought to answer a seemingly simple question: How does the act of killing affect the killer?

"I was startled to find that we did not know how people responded to killing," she says. "There's a huge blind spot in the literature on this."

The "shell shock" afflicting some World War I veterans was thought to be physical, a lingering effect of blast waves. World War II veterans reporting "battle fatigue" were diagnosed with psychological problems, but some researchers classified nausea, shakes and involuntary bowel movements as normal reactions to combat. Limited studies done by the Centers for Disease Control, the American Legion and Columbia University found that Vietnam veterans suffered mental illness related to problems readjusting to civilian life.

For MacNair, Vietnam was the perfect petri dish: It involved close-quarters combat with soldiers who came face to face with those they killed.

At UMKC, MacNair solicited a copy of the National Vietnam Veterans Readjustment Study, the largest and most comprehensive statistical analysis of soldiers' reactions to war. Congressionally mandated in 1984, the study was performed by an independent survey firm and released by the Department of Veterans Affairs in 1990.

Tom Murtaugh, who coordinated the study, tells the Pitch that the data settled the question of whether vets' psychoses were real or peacenik propaganda.

After interviewing almost 1,700 American armed-forces veterans, researchers found that 50 percent of Vietnam vets suffered from mental problems. The rate of PTSD and other psychological problems was "often dramatically higher" among those directly exposed to combat. From the study came what is now the U.S. military's party line, that neurosis is a form of collateral damage. "[T]hose who were most heavily involved in war are those for whom readjustment was, and continues to be, most difficult," the report read.

MacNair decided to crunch her own numbers, breaking responses to the government's survey question ("Did you ever kill or do you think you killed someone in or around Vietnam?") into two categories: former soldiers who said they might have killed and those who said they hadn't.

Then, she looked at the percentage of PTSD-like symptoms each group reported. Her numbers showed that soldiers who said they had killed seemed much more likely to suffer psychological harm that those who said they had not, regardless of the battle intensity both groups had experienced.

MacNair concedes that researchers know of numerous wartime triggers for PTSD, but her theory is that killing someone is the most severe.

Murtaugh calls MacNair's work "groundbreaking" and has asked her to help design a follow-up study. And her efforts lured a standing-room-only crowd at an American Psychiatric Association meeting in August 2000, where MacNair shared a conference-room stage with two other PTSD authorities, Lt. Col. David Grossman (a Vietnam veteran and West Point psychologist) and William Chamberlain (who runs anger-management sessions for the VA's PTSD unit in New York).

Grossman's 1995 book On Killing cites a study by World War II historian Samuel Lyman Atwood Marshall, who interviewed troops after battle and concluded that only 15 percent to 20 percent of the men on the front lines had fired their weapons and that those who did often aimed high to avoid killing. Marshall said the reason wasn't cowardice; the men had stood their ground and performed other battle duties unwaveringly.

Grossman's position was similar to MacNair's. "Looking another human being in the eye, making an independent decision to kill him, and watching as he dies due to your action combine to form the single most basic, important, primal, and potentially traumatic occurrence in war," he had written in his book.

By Vietnam, troops had been retrained to shell entire battle areas rather than just to fire at specific targets. Ninety percent of men discharged their weapons -- supposedly at a ratio of 50,000 bullets for every one enemy soldier killed. MacNair discussed that evolution in combat strategy in her own book, Perpetration Induced Traumatic Stress: The Psychological Consequences of Killing, put out by Praeger Publishers, a textbook publishing company, in 2002. Recapping her research, she noted that such traumas have existed everywhere, in every culture and time period, not just in war. There are other risk groups to consider, she writes -- police officers who kill in the line of duty, prison executioners, abortion practitioners, even bullfighters and veterinarians who practice euthanasia. She supported her argument with a loosely connected series of anecdotes, referring to an NBC Dateline story about a police officer who committed suicide and to historical notes about the mental deterioration of Nazis after they had slaughtered Jews in concentration camps. She cited PTSD allusions from Dostoevsky's Crime and Punishment, Poe's The Tell-Tale Heart, Shakespeare's Macbeth and an episode of Star Trek Voyager.

"It shows that it's not some modern idea. It's been there throughout history," she says of the PITS concept. That her theory presented the foundation for a wide-scale platform against violence was no surprise. Before enrolling at UMKC, MacNair had made a career of confrontational activism.

MacNair has other statistics -- on her rap sheet. She has been arrested for civil disobedience 17 times -- 7 for protesting nuclear armament, 5 for protesting nuclear power plants and 5 for protesting an abortion clinic.

She was raised on political doctrine. Her father was a preacher and theologian, as was her grandfather (who was arrested at a civil rights sit-in in Alabama) and her great-grandfather (who proselytized in Thailand). Her mother heard Martin Luther King Jr. give his "I Have a Dream" speech in Washington, D.C., in 1963. MacNair spent her early childhood bouncing throughout the Midwest as her father chased lectern and pulpit work; MacNair's parents divorced in the late '60s, and she and her mother moved to Kansas City, settling in a bungalow with a big front yard near the Nelson-Atkins Museum of Art. MacNair's mother told her she could be whatever religion she wished.

On Sundays, MacNair joined Quakers who met in a basement apartment on 39th Street. The apartment also served as a classroom for a UMKC Communiversity course called "Non-Violent Actions for Peace," a class MacNair took in 1972, at age 13.

While other girls her age were forming social cliques, she was learning about coalitions. With the United Farm Workers, she picketed grocery stores and passed out fliers to boycott lettuce and grapes. A few years later, she joined a now-defunct local chapter of the War Resisters League and staged die-ins, lying down and playing dead at midtown parks. She became a vegetarian at 16 and helped affix "Under Protest" stickers to draft registrations at the downtown post office.

By taking summer classes, MacNair graduated from Paseo High School in three years. She didn't date. She never played sports. She doesn't remember a prom.

"I remember deciding at age 14 that this teenage bit was for the birds and I was going straight to adulthood," she says.

She went on to earn a degree in peace and conflict studies from Earlham College, a Quaker school in Indiana. There, MacNair joined the American Friends Service Committee, the activist arm of the Quakers. In the late '70s, she landed the activist's equivalent of a job -- full-time protesting. Joining an anti-nuclear coalition, she began caravaning to nuclear power plants and weapons facilities across the nation. To build her credibility, she got ticketed at the Russian Embassy during a United Nations special session for disarmament. "I knew from doing vigils in Kansas and whatnot that the first question people were going to ask was, 'What about the Soviets?'" and I wanted to say, 'Yeah, I protested them, too.'"

She slept in church basements, wore shirts that read "Better Active Today than Radioactive Tomorrow" and collected arrest citations.

To make ends meet, MacNair worked a series of "bread jobs," such as installing home insulation. She had a short gig as a librarian at UMKC's Linda Hall Library but was forced to quit after someone discovered that she'd slipped Hiroshima brochures inside books being shipped to Bendix Corporation, a Kansas City plant that made non-nuclear components for nuclear weapons.

By her mid-20s, MacNair's definition of violence had expanded to include abortion. She joined Consistent Life, a peace organization that espoused the belief that the arms race, abortion, capital punishment, euthanasia, poverty, racism and war were all forms of violence. In college, MacNair says, she had been generally pro-choice, but Consistent Life offered a philosophy on violence that would let her reconcile all of her issues.

In 1984, she rose to prominence when she was elected president of the 1,000-member group Feminists for Life at its national convention in Omaha. She held the post for the next ten years, working out of an office at 47th Street and Troost, until the anti-abortion group relocated to Washington, D.C.

She left the picket lines in 1985, after becoming pregnant from an anonymous donor through in vitro fertilization. She had no car and lived in her childhood home with her mother and brother (as she does today, with her son). "It is deliberately old-fashioned," MacNair says. "I believe in extended family. We support each other well." The living arrangement was convenient and simplistic. She could challenge the world at large, then retreat to a nurturing environment.

But she found less peace at Quaker meetings, which had become a nexus for activists from numerous anti-war groups. At the meetings, members sat in silence until they were moved to speak about any pressing issue.

"Somebody would make a comment, and she would feel morally outraged about it and stand up and say, 'I want to make it clear. There's another point of view of this,'" says fellow Quaker Don McClain. "I felt she was taking advantage of the process."

Others remember her using the forum to stump. "At that time, she was out of sync with nearly everyone at the meeting," one member says.

After her son was born, MacNair strapped him to her chest and resumed protesting, this time at the Planned Parenthood clinic at 45th Street and Troost. The clinic was known nationally as a flash point, recalls Peter Brownlie, the current CEO of Planned Parenthood in Overland Park, who at the time was managing a Planned Parenthood in Texas.

The organization put up a wrought-iron fence to keep the swell at bay, and patients were ushered inside by volunteer chaperones, at least one of whom was a member of MacNair's Quaker group. Bullhorns blared, and neighbors complained about the near-constant ruckus. Threatened by a Missouri law that would deny state funding to family-planning centers that performed abortions, Planned Parenthood officials moved the Troost surgical center to Overland Park.

MacNair knew that protesting abortion was different from protesting war. Because the act of "violence" was initiated by women themselves, not by an enemy, showing pictures of bloody fetuses risked alienating her audience. So MacNair carried a sign with a generic message: "Abortion Hurts Women." Whereas her Vietnam-era pamphlets had illustrated the atrocities of Hiroshima, her leaflets now focused on the positives of keeping a child and included pictures of healthy babies.

"We felt women who were getting abortions were being cheated," she says. Abortion, she says, is a method of "discriminating against unborn children by treating them as if they aren't even human." It helps classify women as "reusable sex objects," she says, and encourages irresponsible men.

As MacNair's attachment to anti-war and anti-abortion protest groups proliferated, her boundaries among friendships, religion and political statements blurred.

"I don't really think she fit in," says Lynn Cheatum, a member of PeaceWorks who has worked with the War Resisters League, the American Friends Service Committee and the Kansas City Interfaith Peace Alliance, which MacNair also helped organize. "I'm not knocking her. I'm just saying I don't really think she fit in."

MacNair says the tension at Quaker meetings was palpable. "I got guff being pro-life. I got guff in a way that startled me. I got guff in a way that startled other Quakers ... I was really taken aback, because these were peace people, especially the Quakers, who prided themselves on being open-minded, and I called them on it," she says. "I felt intimidated."

In 1996, she retreated to UMKC as a Ph.D. candidate. She hoped to find academic proof of her belief that abortion was violence toward women.

"I wasn't going to be a pacifist. I was going to be a scientist," she says. MacNair knows the numbers -- the month-by-month increase in soldiers' deaths, the unexpectedly high U.S. casualty rate since Iraq gained sovereignty. And she knows that most of the fighting is close-quarters combat, with battles pitched on street corners.

The Army trains its soldiers to dehumanize their enemies. In the "Combat Training With Pistols" section of Army Field Manual FM 23-35, war-zone shooting is called "target engagement." The current Field Manual 22-51: Leader's Manual for Combat Stress Control and the VA's Iraq War Clinician Guide, released this past June to address the psychological impact of killing in error, list coping techniques for soldiers troubled by killing civilians or other Americans. But the Army's textbook War Psychology doesn't list killing the enemy on its list of 20 "Combat Stress Factors," which include fatigue, fear of death, maiming and loss of fellow soldiers. Dated February 6, 2004, the Clinicians Guide PTSD test asks only one four-part question:

Have you ever had any experience that was so frightening, horrible, or upsetting that, in the past month, you: Have had any nightmares or thought about it when you did not want to? Tried hard not to think about it; went out of your way to avoid situations that remind you of it? Were constantly on guard, watchful, or easily startled? Felt numb or detached from others, activities or your surroundings?

In July, a study by The New England Journal of Medicine showed that one-fourth of U.S. troops show symptoms of major depression, anxiety or full-blown PTSD -- 16 percent from the Iraq theater and 11 percent from Afghanistan. Fewer than half of those diagnosed with a mental disorder have sought care, according to the study. There's no way to compare these numbers with statistics from the Vietnam War; the National Vietnam Veterans Readjustment Study was implemented ten years after those troops had returned. But the data looks especially bleak when coupled with a March Department of Defense survey that showed suicide rates among soldiers in Iraq are a third higher than the average among soldiers stationed elsewhere.

Col. Thomas Burke, the director of mental-health policy for the Department of Defense, tells the Pitch he is unfamiliar with MacNair's work and declines to comment on her theory. But he has said in interviews that the military chooses not to discuss the morality of killing when training soldiers.

In the dining room of her bungalow, framed, yellowed portraits of MacNair's ancestors hang opposite her computer desk. Recently, she downloaded a copy of form DD 2796, the post-deployment health assessment issued by the Department of Defense.

The survey asks basically the same questions posed after Vietnam, still avoiding the point-blank query "Did you kill someone?"

"Now's the time to find out not only what they did but under what circumstances and how many," MacNair says. Does shooting a sniper differ from firing on a family running a roadblock? Do reservists respond to bloodshed differently from enlisted men? Does engaging the target make a soldier a walking mental time bomb?

Getting the proper clearance to ask those questions presents MacNair with a bureaucratic paradox: Researchers must publish their findings in professional journals to be taken seriously by the medical establishment and government policy makers, but if the government doesn't ask the proper questions, MacNair has no data to compose a study.

The National Vietnam Veterans Readjustment Study follow-up, which might provide that data and which should have been implemented last year, has stalled because the project's administrators have asked for bids from survey companies willing to do the work cheaper, says the VA's Murtaugh.

Meanwhile, the United States is conducting its biggest ground action since Vietnam, armed with the same old questions.

"It's not that people are arguing it [the theory] -- they're ignoring it," MacNair says. "So far, no one has hopped up to prove me wrong."

So far, there's been little incentive to prove her wrong.

Matthew Friedman, the executive director of the Department of Veterans Affairs National Center for PTSD and a professor of psychiatry and pharmacology and toxicology at Dartmouth Medical School, wrote the editorial accompanying The New England Journal of Medicine study. Because psychotherapy and prescription drugs have improved, he writes, and because soldiers are being welcomed home as heroes rather than as killers, their readjustments may not be as traumatic as those suffered by soldiers returning from Vietnam. He tells the Pitch that there are lingering questions about whether reservists and National Guard troops with less-rigorous training will develop mental illness more often than enlisted soldiers. But from a clinical perspective, he says, because the treatment for PTSD is the same across the board, looking for individual PTSD triggers is pointless.

If MacNair can prove otherwise, her research might have vastly unintended consequences: Her theory could help the military train soldiers to be better killers.

That much is clear at the Kansas City VA Medical Center. There, Dr. Hemant Thakur's small office is decorated with pictures of former patients and snapshots of himself in fatigues in Guatemala. Formed in the '80s in direct response to veterans' mental-health complaints, his PTSD clinical team now serves more than 1,000 veterans from different wars -- soldiers who charged the beach on D-Day, Blackhawk commandos in Somalia, Special Forces operatives who carried out covert missions -- and gains, he says, 40 new patients a month. Now he's working with 45 combat veterans from Iraq.

One of the first questions Thakur asks in private interviews is whether a soldier has a confirmed kill.

"It is a known fact that killing somebody is a traumatic event," Thakur says. "If the Army wants someone to fight a war, then they have to train them to kill someone."

For the most part, MacNair has decided to leave the physical statements to her Vietnam-era colleagues and the new generation of activists.

But on September 8, when the death toll for U.S. troops in Iraq had reached 1,000, she stood at another peace vigil at Mill Creek Park. An amber sunset streaked the Plaza skyline as sedans and sport-utility vehicles zoomed past.

There were new numbers: 865 members of the armed forces had died in the 14 months since the president had declared the end of major combat operations. The body count since the return of sovereignty to Iraq last June: 150.

MacNair stood among a dozen demonstrators, mostly members of the KC Iraq Task Force, who held anti-Bush signs. She wore a black dress with a black scarf wrapped around her forehead, her mourning outfit.

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