Did Robert Bales suffer a Dissociative Fugue?

Sgt. Robert Bales has been almost universally described by his friends and family to be a wonderful, warm person. Sgt. Bales' best friend growing up was a handicapped boy, and he is a loving husband and father. Is this the type of person who murders seventeen innocent Afghanis? It is nearly impossible to believe that a person who has such a long record of being so kind and so empathic can suddenly exhibit such sociopathic behavior. The mainstream media says he simply "snapped" under the stress, but in the world of clinical psychology there is a diagnosis that fits this particular set of behaviors; a diagnosis which is more specific than "Traumatic Brain Injury" (TBI) or "Post Traumatic Stress Disorder" (PTSD). It is called a "Dissociative Fugue".

A dissociative fugue is a rare psychological event characterized in the DSM-IV-TR (the Diagnostic and Statistical Manual of Mental Disorders) by sudden travel away from work or home, amnesia, and often a drastic change in or loss of identity. Typical episodes last a few hours or days, but in extreme cases sufferers have remained in the fugue state for years, creating entire new lives for themselves, during which they do not remember their previous lives. When they finally "snap out of it", they are left with only vague memories of their "new" lives. (Bales’ attorney has mentioned that Bales is experiencing memory problems.) They turn around and go back home. It is very rare that a person experiences more than one episode in his or her life.

Dissociative fugue is more common in those who have PTSD or recently suffered an extremely traumatic event. Just days before, Sgt. Bales had witnessed a close friend of his lose a leg in a bombing. This is on top of the Bales' financial and marital troubles, and after suffering an injury to his own foot. Bales was in extraordinary circumstances and emotionally vulnerable.

Suicide rates in our military are rising rapidly and are statistically linked to the number of tours of duty served. This administration gives a lot of lip-service to identifying and treating PTSD and other mental illnesses as early as possible to prevent these sorts of tragedies. Typically, though, one of two things tends to happen: either the soldier is too proud to truly reveal the depth of the emotional injury he or she is suffering, or the soldier is given an anti-depressant. Anti-depressants only work on a portion of the population, and the kind of intensive psychotherapy needed to face the complexity of one’s emotional issues is impossible to deliver in a military setting.

I am not saying definitively that this is Sgt. Bales’ diagnosis, nor am I saying there is no justice to be served. I am, however, saying that PTSD and TBI are complicated diagnoses that commonly occur alongside other diagnoses, and Dissociative Fugue is a diagnosis worth exploring, as many of the diagnostic criteria seem to fit Bales' behavior and circumstance.

We need to find a different way to address mental illness in our military. The average human psyche is ill-equipped to handle four tours of duty. Long-term, constant exposure to extremely high stress is breaking our beloved troops and we owe it to them to find ways to care for them. I believe, as a nation, we are coming to see mental health as being every bit as important as physical health to our troops. We are asking far too much of our young men and women.

So let's put a cap on the number of tours of duty a soldier is allowed to serve. Let's implement more thorough screening. Let's give more opportunities for leave to those who are suffering the worst. And when our soldiers return home, let's provide them with the best mental health care we have. I believe that if more interventions were in place for the mentally ill in the military, had we been paying closer attention, then this massacre would not have happened. Let's see that this doesn't happen again.