We live in a country of 350 million people. At any given time, around 1.2 million people serve in the military, or about a third of a percent of the general population. Of that third of a percent, the "tooth to tail" ratio is 8:1 (150k), but "tooth" is combat arms which includes artillery, tankers, cav, engineers etc. Even within the Infantry there are mortarmen, mechanized, anti-tank squads etc. It's hard to say for certain, but the number of dudes in the military whose job it is to kick the doors and shoot the faces is likely no more than 50k at a given time. Of that, only a minority will deploy and a minority of those see combat. In the twenty years of war in Iraq and Afghanistan, the military has awarded right about 77k CIBs and 47k Purple Hearts out of 2-3 million total deployed over that time. Obviously, there is some overlap between those awards.
For the uninitiated, the Combat Infantryman Badge is intended to identify those members of the infantry who have actually "close(d) with and destroy the enemy with direct fires.", and the PH is known colloquially as the Enemy Marksmanship Badge. But there are some caveats. For reasons I will explain, the numbers we pull from awards like this are likely a high-end estimate, rather than a minimum, but counting the Marine 0300s and whoever all else could push the numbers up a bit.
The CIB is awarded at the company level, and only in the Army. This means if one dude in an infantry company (~100 men) gets in a firefight, the whole company gets their CIB. Much of the fighting these days is very small unit engagements, so it is quite common for only a few squads or teams in a CIB company to have actually seen the combat. OTOH, more people than infantry get into shooting scrapes, I know a couple cooks with multiple engagements just because they used to volunteer to fill out patrols that were short on people. Given the nature of the conflict, a lot of people who weren't infantry, or even combat arms have seen combat. However, if they do, it's usually because of bad luck or the military ran out of infantry to do that job. It's impossible to say definitively given the data available to me at the moment, but I very much doubt the total number exceeds the number of infantrymen with CIBs. Lots of cav guys saw action as route security, lots of random MOS people got blown up en route or pressed into some role they weren't trained for. But the guys who do the job day in and day out of locating, fixing and killing the enemy is a rather select group.
So too the Purple Heart has gone to a lot of people who don't do that sort of job. Mortars dropped into a FOB can hit anyone, and roadside IEDs don't care if you're on the road to take water to an outpost or heading out on a raid. But they are more common among the people who are in the most dangerous situations more regularly.
Let's bring it all those numbers and assumptions together for a moment, because I'm describing a group of people who are very, very abnormal, and very far out on the distribution tail of the violence bell curve. Let's round up to make the math easy and account for POGs and Marines and call it a hundred thousand men over twenty years (and yes, to the closest approximation, it is all men). It's three ten thousandths of one percent of the general population. That's the high estimate, the real number could be significantly lower still. And the number who deploy multiple times is much, much lower.
When American foreign policy decides some poor dirt farmers on the other side of the globe need some freedom in their lives, maybe one ten thousandth of one percent of the population is who gets sent to do the actual violence of empire. I am one of those men. I have a CIB and a purple heart. Within the rarified community of professional actual soldiers, I am a small fish in a tiny pond. I was not special forces (or, technically I was briefly, but not really). I was a reasonably high-speed infantryman with a penchant for guns who worked himself into a sniper platoon in a fairly trash unit. I made sergeant, ate an IED and got med-boarded out of the military. A short, somewhat spicy but relatively unremarkable military career for an infantryman.
Much of what the general public hears about combat, even "first hand accounts" is not from people who actually do this job. As I have hopefully established, this is a very small, very highly selected and very abnormal group of people. Most of what you read ore hear in war accounts is from the middle classes, which in the military means officers. Officers are not soldiers. They are managers of soldiers. During conscription, it was at least possible for a southern gentleman of letters like Eugene Sledge or a Junker scion like Junger to write an account of actual enlisted combat, if unlikely. In today's volunteer military, this is almost never the case. The venn diagram of actual front-line soldiers and people who can write competently in an educated manner for general consumption is essentially two separate circles. These are not generally guys with college degrees, because if they had one they'd be an officer. There are exceptions, but we'll perhaps get into that at another time.
This hopefully will go some way to explaining my arrogance in writing about the topic. IQ and violent tendencies tend to be negatively correlated, and I am way out on the right tail of of the distribution on both. If that seems self-aggrandizing, rest assured that neither has done me any good.
So who are these men? Who carries the torch of empire into the barbarian wastes of the Korangel? Who sits behind the machine gun of a HMMWV? Who donkey-kicks the doors off their hinges and plunges into the black interior following the blinding light of his Surefire? Who sits in a ditch for three days waiting to shoot a retarded teenager whose dad got paid $200 to have him drop an IED in a pothole?
In short, they're degens. Poor and working class kids, half of which aren't old enough to buy beer. Mostly rural whites and hispanics. Roughly a quarter are from Texas alone. The South more generally provides well over half, maybe two thirds of the total. Most of the rest are from the Midwest and West. They self select. These are guys who asked to be in the Infantry, and survived the training and indoc. Nobody winds up on the pointy end of the spear by accident. It's the worst job in the military, so the people who volunteer for it are driven by very different considerations to most. It's also the highest status within the violence hierarchy.
It's a weird group. There's a lot of immigrants, not all of them hispanic. A surprising number of professional soldiers from other countries come to the US just for the action. If you're just itching for a fight but are born somewhere too peaceful, coming to the US will greatly increase your likelihood of getting into the shit. I've met British Marines, African princes, a German seminarian who dropped out to join the US infantry. There's some tiny minority communities that are heavily overrepresented though still small in total numbers, like Native Americans, the Samoans, the Hmong and the Sikhs. East asians are rare, and black Americans, while overrepresented in the military generally, are underrepresented in this part but still common.
We are united by a few characteristics, most generally the privileging of suffering as a badge of honor, physical violence, and a death wish. One does not join the Infantry to live a quiet life to a ripe old age. Mostly, I think we want to fuck around and find out. Like the movie says, how much can you know about yourself if you've never been in a fight? I had a lot of reasons for joining up, but I think the most basic was a desire to test myself and find out if I had what it took to face another man in mortal combat. To "see the elephant", or any of the other thousand euphemisms we use for fighting and killing our fellow men. To take the ultimate risk.
A recruit can get all the benefits of military service in a safer and more sustainable career. The infantry chews up men, minds and bodies, training alone eliminates hundreds of thousands. A twenty-five year old infantryman is probably middle management, a thirty-year old is probably out of the field as a platoon sergeant. The incessant road marching ruins feet, ankles and knees. The heavy packs wreck spines and shoulders. The heat, cold, wet and sleep deprivation cull the sensitive and the civilized. The social aggression removes the timid and the hazing removes the bitches.
There's an old glib saying that captures the esprit of the group. "The cowards never started and the weak quit along the way. That just leaves us.".
As a composite character, I give you the US infantryman. He is nineteen or twenty years old, grew up in a trailer park, has a kid or two with women he's not married to, is married to a woman with kids that are not his. He'll be divorced in a year. His family are construction workers, nurses, truck drivers, retail workers, garbage collectors, heavy machine operators, drug dealers, petty criminals, major criminals. He is dumber than average, hated school, has never read a book not assigned in class. He's been in jail multiple times, and probably will be again, mostly for low level stuff like underage drinking, vandalism and fighting. He binge drinks and smokes when in garrison, dips in the field. He gets in fistfights on a regular but extended basis with members of his own unit, in group conflict with other units, or with civilians on liberty. His politics, if he has any, are somewhere to the right of Genghis Khan. He drives a pickup truck, a Mustang, or a heavily riced-out import and is dead broke most of the time. He is, in short, perilously close to the underclass of our society, and there's a lot of crossover. His life is boredom, fear, pain and the brotherhood of those who live in fear and pain. His values are foreign, rude and frightening to those not of his group.
He is the world elite of the violent class. The modern equivalent of a knight, loaded down with many years' wages' worth of technology, weapons and armor. Far better trained, supplied and equipped than his adversaries. The big stick that the world hegemon swings in the anarchic world of international politics. The very tip of the spear. The point of empire.
In our modern peaceful society, that point has become very fine indeed.
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Notes -
1: Better than most psychologically, but physically worse unless they were super in shape.
2: SOF has a much higher floor, but there's overlap there.
3: Couldn't say, that dude was one of my drill sergeants when I went in. Good dude, nearly broke my neck for running in the stairwell once.
4: Another of my drill sergeants had a masters in microbiology from some ivy league school. He rode a Harley and dipped the biggest chaw I ever did see. That was a man loved his job.
5: More effective than average, just because they didn't make the dumbest class of mistakes. No effect on their psychological fitness that I could see.
6: War changes a man, and a lot of it changes him a lot. They strike me as having become something both a bit more and a bit less than completely human. Like a guru or a hooker.
I'm interested, as someone in the healthcare field, to hear your take on whether being exposed to the kind of shit you see in hospitals also changes people. I hope I'm not insulting you here.
Not at all. I think it very much does. There's a stereotype about soldiers and nurses for a reason. We both have a bone-deep understanding of life and death, and an urge to blow off the steam that the repression necessary to operate with that knowledge produces. We have perspective on the rest of our lives that most do not.
It's not exactly the same, but it is parallel.
Maybe you could ask @self_made_human; he's an Indian physician. I don't know if he's an attending yet, but he most definitely saw some shit - and probably a little more of it per unit of time than his American counterparts. For what it is worth, I'm a fourth-year medical student at an American teaching hospital.
For what it is worth, I have never been to war, served in the military, or ever had anyone try to kill me. Other than maybe three fistfights growing up - all of which I either drew or lost - I haven't been exposed to violence. I've never feared for my life at the hands of another human being. My father was a peacetime military officer that grew up in a very rough neighborhood and managed to claw his way out; that experience left him with scars that he carries to this day, nearly fifty years later.
I guess I'd like to muse on what I saw so far in the healthcare field, the effects it had on me personally, and the effect that I've observed it having on my classmates and friends, some of whom are more senior to me and who are residents. One of them is already an attending. It is not at all a traumatic or painful experience for me to put into words. However: Scott Alexander himself - no slouch in the writing department - wrote in his blog entry Who By Very Slow Decay about the kinds of things that went on in hospitals. What I saw was rather similar, but more incurable disease and fewer elderly people with dementia. He believed, and correctly I might argue, that he was not up to the task of attempting to describe what he saw in words. I'm trying to do so, and I don't mind - I even enjoy it - but I'm not the writer that Mr. Alexander is, and Mr. Alexander is not the poet that Wilfred Owen or Oscar Wilde were.
I wouldn't want to bore you with cliched or inadequate descriptions of the kind of Hell that hospitals are; Scott's done a better job of that than I. I'll say that as time goes on, healthcare providers, hell pretty much anyone exposed to the healthcare industry for any length of time, become basically slightly cheerful nihilists. They're not cynical, more like nihilistic in the sense described by Camus. The more that you know about what is happening to the patients, the more or faster that happens - but a nurse's aide who works for a couple years also experiences the kind of transformation I'm talking about.
I've tried to describe it - especially the experience of rotating through a pediatric cancer ward. I've always come up short, but the best way I've come up with is this: Imagine being a combat medic. But: unlike real-world combat medics, you get to work in a magic suit that is damn near bulletproof. The personal risk that you deal with is relatively low. Maybe if you're rather unlucky you'll get punched in the face by a parent once a decade or so. Usually security deals with this kind of thing effectively. You also get to eat three meals a day, work maybe eight or twelve hours a day in a comfortable, temperature-controlled hospital, and go home every night to sleep in your own bed.
You see the good, the bad, and the ugly of humanity. Dipshit parents trying to take their kids, being treated for a type of cancer with an excellent prognosis and an 85 percent chance of surviving five years, a 70 percent chance of full cure...out of the hospital for "treatment" with essential oils and herbal remedies that will ensure their death within two months. Parents trying but failing in a noble, sad, gross, admirable way to shield their kids from the reality of their impending death. Children, twelve years old, never letting on how bad things truly are. Doctors becoming nihilistic and weeping in between patients. None of us had the skill with words to describe it, and I know this description like every other I have tried to attempt has fallen short. I am not Wilfred Owen reincarnated, and it would take someone with his skill to describe the things we saw.
If there is a God, the Almighty works in ways beyond our understanding, or else set the universe in motion and does not intervene in human affairs, or does so maybe once or twice in a thousand years.
A more metaphysical musing: War and disease are Gnon's prosecution lawyers. They decide, or make the case: This person should die, that person should be maimed for life, this person will be exhausted and fatigued for a year and a half but mostly recover. The healthcare system are the defense attorneys: they say "Not today, not here". As I understand the practice of lawyers, often the prosecution and the defense make deals, are friendly, understand what is likely. Something similar obtains in healthcare - healthcare providers have a pretty fair idea of the ultimate course of a disease, and do their best to keep patients aware of the outcomes that can be had. I know next to nothing about the day to day practice of law, but if this guy is anything like the average public defender, doctors for the most part operate in a pretty similar way.
I am not saying that the average physician is some kind of brilliant hotshot badass; I think that the medical profession gained an awful lot of status by being essentially the delivery system for the advances that university researchers and research doctors managed to produce: germ theory, vaccination, antibiotics. More than a few attendings have essentially said that physicians were more or less a kind of very well-paid tradesman working on very expensive machines, and that the lion's share of healthcare advances came from germ theory, vaccination, and antibiotics plus obstetric care. Everything else was just marginal gains and window dressing.
You bet: https://old.reddit.com/r/medicine/s/qo3AMUGnhe
I can't imagine an American doctor sees a tenth of this unless they volunteer to go to Haiti or something along those lines.
That being said, I work in far more upscale places these days, while I'm studying for the psychiatry entrance exams for the UK. You shouldn't expect much of a difference in terms of quality of care or amenities at that level, even if you compare it to the US or the rest of the West.
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