William Holmes’ recent research was inspired by a New Yorker story.

In the spring of 2004, Holmes read Seymour Hersh’s disturbing story on American soldiers’ abuse of Abu Ghraib prison detainees. Just a few months later, Holmes, an assistant professor of medicine and epidemiology in Penn’s School of Medicine, embarked on a study of veterans’ levels of tolerance for detainee abuse, with funding from a VA Health Services development award.
“This is right in the [area] of what it is that I do.”

Holmes, who is also an investigator at the Center for Health Equity Research and Promotion at the VA Medical Center, studies the relationship between sexual abuse in young civilian men and adult risky behavior.

In his study, Holmes presented 351 veteran volunteers with three scenarios of abuse, taken directly from Hersh’s article on the American soldiers’ abuse of Abu Ghraib detainees. In the first scenario, the subject was forced to be naked and put in a cell with no toilet or water for several days. In the second, the subject, with a hood over his head, was forced to form a “pyramid” with other naked detainees and was photographed with a smiling American soldier. In the final and most graphic scenario, detainees were forced to remove their clothes, were beaten with dogs present and then raped with a broomstick. “It’s pretty dramatic and pretty awful,” says Holmes. After each scenario, Holmes also described the abuse as being soldier-initiated, commander-ordered or deemed “wrong” by a whistleblower soldier.

The results, published in the February 2007 issue of Military Medicine, were disturbing: Only 16 percent of veterans exhibited a zero tolerance for detainee exposure and deprivation, 31 percent indicated zero tolerance for detainee exposure and sexualized humiliation and only 48 percent had zero tolerance for detainee rape.

In the study, “zero tolerance” indicated the veterans believed the abuse should never have been allowed.Veterans were less tolerant of soldier-initiated abuse than of orders from a commanding officer, and, surprising to Holmes, were most tolerant of abuse when it was characterized as “wrong” by whistleblowers. “It is indicative of what you are consistently taught to do within the military,” says Holmes, explaining the whistleblower figure. “The military structure really needs to depend on group cohesion.” The presence of a dissenter may not be seen as in keeping with the military structure.

Holmes found that depression, post traumatic stress disorder (PTSD) and gender make a big difference in results. Male veterans were 4 to 20 times more tolerant of abuse than women, while veterans diagnosed with depression or comorbid depression/ PTSD exhibited a tolerance for abuse that was two to three times greater than those diagnosed with neither disease.

Holmes explains that people with PTSD and comorbid depression can experience terrible flashbacks and become hyper-vigilant to avoid a situation similar to the one that traumatized them, while depression alone may minimize the energy one has for weighing arguments for and against abuse. The veterans surveyed served mainly in Vietnam, but the study also included Persian Gulf and Iraq and Afghanistan war vets. Two-thirds of those surveyed had seen war zone combat.

Holmes emphasizes that all soldiers were directly asked at the end of the questionnaire if they were upset or suicidal and needed to speak with someone, and about 12 percent did talk with professionals. Some soldiers even wanted to speak with Holmes about some of their behavior. “I don’t really know what the answer is for people who have done this sort of behavior,” says Holmes. “My sense was—there was a wellspring of painfulness in a lot of the veterans.”

Holmes is quick to point out that his results may not reflect the attitudes of all veterans—or even be representative of all active duty military. He does believe strongly that “the work should be replicated in active duty military,” since soldiers who have lower levels of tolerance could, for example, be prevented from serving as prison guards.