Signature Wounds: The Untold Story of the Military's Mental Health Crisis by David Kieran

Author:David Kieran
Language: eng
Format: epub
Publisher: NYU Press
Published: 2019-04-01T23:00:00+00:00

A person can sit in front of a computer and do the test and then it will generate a score, but it doesn’t mean anything, because that person may have gotten drunk the night before, they may have been sleep deprived, or because they were anxious about deployment, or they may have gotten into a fight with their wife, or they may have just been perfectly on point that particular day.219

Hoge and others thus believed that developing a usable baseline score requires averaging together the results of several tests. “ANAM baselines do not capture a true baseline,” a 2011 Army history of the program complained. “Traditional ANAM research studies found ANAM to be effective by giving the subject multiple practice runs in order to establish their baseline.”220 In fact, the history explained, a 2009 study had recommended that subjects take the test twice “and [that medical officials should] use the second run as the baseline for future comparisons.”221 This presented the Army with a logistical problem in that having every soldier take a cognitive exam twice before deployment was probably not feasible, given all of the other tasks and screenings required to render a soldier deployable and the short turnaround time on which units were operating. In Hoge’s view, however, there was also a problem from the standpoint of good science, which is that the more a soldier takes the test, the higher his score is likely to be.222 The ANAM was adopted, then, over the Army’s skepticism of its value. The Traumatic Brain Injury Task Force’s report, for example, noted that “the provisions forwarded in this bill may not be valuable, or even possible.”223 In the end, Hoge’s assessment of the ANAM was even more blunt: “Basically, the test is completely worthless.”224

Nonetheless, the Army was by 2008 bound by law to conduct the testing. In August, Schoomaker issued Operations Order 08-65, announcing that “USAMEDCOM supports establishment of ANAM pre-deployment baseline testing for comparison to post-injury testing as one of the tools available for the assessment, management, and return-to-duty decisions for Service members with a traumatic brain injury/concussion.”225 By the end of September, the Army had built the infrastructure to conduct baseline testing of deploying troops and to retest those who had been injured, with a plan for more complete testing beginning in October.226 But in issuing the order for the regional medical centers to begin standing up the training, identifying units that should be screened and so on, the AMEDD also made clear that, although it would dutifully carry out the initiative, its skepticism remained intact: “The ANAM has not been validated for use as a screening tool for pre-deployment or post-deployment populations. The results serve as stand-alone data to be made available for comparison with future neurological assessments.”227

That skepticism may have informed Schoomaker’s November 2008 order directing the Army to cease post-deployment testing.228 Over the next few years, this decision would be criticized by researchers and in the media. To Leanne Young, for example, “It just seemed unconscionable

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