Recent events concerning hostilities with Iraq have raised the question, "Can we as psychiatrists speak out about foreign policy, and if so, under what circumstances and in what ways?" We would like to share our position on this question and why we believe that, as experts in psychology, human emotions, behavior, and mental distress, psychiatrists are compelled to participate in the debate.

First, we know about the psychological and social consequences of war and trauma. War places combatants, witnesses, and survivors at risk for various mental disturbances: posttraumatic stress disorder (PTSD), depression, stress-related psychosis, anxiety, neuropsychiatric consequences of exposure to neurotoxic agents, exacerbation of preexisting psychiatric illness, and so forth. Families of combatants and other survivors must deal with grief and bereavement, as well as societal dislocation and distress. War increases the likelihood of enemy retaliation, which in turn exacerbates public anxiety and dysphoria. If retaliatory acts occur, there will be predictable increases in PTSD and depression. War diverts government spending to the military and enlarges the budget deficit. Higher military budgets often result in reductions in domestic social programs, such as mental health services, unemployment insurance, public assistance, Medicaid, and Social Security supports.

Second, the decision to go to war is complex and susceptible to irrationality. As experts in coping with adverse situations, we can help evaluate such decisions by providing a focus on the emotions, motivations, expectations, and understanding involved.

Our psychiatric expertise qualifies us to predict the tragic psychosocial consequences of war and to consider the decisions leading to war. Policymakers and the U.S. public need to understand the decisions leading to war and the possible consequences when considering whether to support our leaders in their efforts to initiate, continue, or expand warfare.

Editor’s note: There are 50 original signatories to this letter. Anyone wishing to see the names of the signatories can contact Carl I. Cohen, M.D., at cohenhenry@aol.com or Psychiatric News at pnews@psych.org.