Maybe you've heard Chris Yarger's story before. It has become uncomfortably familiar. After serving his country in the Persian Gulf War of 1991, he returned home to Abilene to resume his work as a ranch hand. He began to experience fatigue, nausea, loss of balance, rashes, joint and muscle pain, insomnia, and memory loss. The symptoms had no apparent cause. A doctor told him he was depressed, and over the next three years he took a variety of antidepressants. But he didn't get any better. He lost sixty pounds, quit his job, applied for Social Security disability, and was turned down. In 1998 he finally obtained disability benefits from the Department of Veterans Affairs for an "undiagnosed illness," but not before he'd gone through the family savings and had to apply for food stamps.
"It would have been better if I had just been killed over there," says the 44-year-old Yarger with a caustic chuckle.
If Yarger sounds a little edgy, it's because he has spent the past decade in the crossfire of a fierce battle about the nature of his affliction—known most commonly as Gulf War Syndrome (GWS)—and, more generally, about just what constitutes a disease and who gets to decide. The process is often far more political than scientific. Public attitudes, morality, economics—all can play a role. AIDS is a classic example. It has always been the same deadly retrovirus. But since it emerged in the early eighties, it has been marginalized as a "gay virus"; then canonized as a politically correct cause célèbre; forgotten as an epidemic conquered by wonder drugs; and re-marginalized as a Third World plague—all in the course of twenty years. Similarly, politics have been played with conditions ranging from chronic fatigue syndrome to attention deficit disorder to drug addiction. (Remember too, that we used to call homosexuality a disease, and in some quarters, the debate rages on.)
Yarger's problem is that his government insists that what afflicts him and an estimated 100,000 other Gulf War vets is mostly in his head, even though some research indicates that it is the result of wartime exposures to various chemicals, ranging from the common insecticide DEET to sarin nerve gas. The government's position is that what Yarger has is not a "specific disease"—a third party that invades the body and affects "typical" people more or less the same way. Instead, he has what medical historian Robert Aronowitz called an "individual sickness," in which at least some of the illness has to do with the person afflicted, especially his or her psyche.
Not that the Department of Defense hasn't taken vets like Chris Yarger seriously. Indeed, it has opened a special office to oversee GWS, poured hundreds of millions of dollars into scores of studies that prove that the ailment is probably psychosomatic, and withstood a considerable amount of criticism defending that position. As it happens, most of that criticism has come from Texans: Dr. Robert Haley, an epidemiologist at the University of Texas Southwestern Medical Center at Dallas, has led research efforts, and Ross Perot, Sr., and Senator Kay Bailey Hutchison have led the battle of words to prove that GWS is, in fact, much more than a new variation of battle fatigue.
When I first began hearing about a Gulf War Syndrome, in 1993, the government was winning the argument. The complaints I heard from disabled vets who wanted me to write about their problems in getting treatment from VA hospitals were heartfelt, but the symptoms were so vague and various that they could have been non-service related; they also sounded a lot like the secondary effects of post-traumatic stress.
The issue became more contentious beginning in 1994, when Perot, having heard hundreds of such complaints himself, asked Southwestern Medical Center—to which he is an eight-figure donor—to develop some hard science on the cause of GWS. Haley, the chief of epidemiology there and a member of one of Dallas' more prominent medical families (his grandfather, father, and three brothers are also doctors), agreed to devise a primarily Perot-funded series of studies centered on 250 Navy reservists who had served all over the Gulf War theater.
At the time, Haley believed that the vets' problems were probably emotional. But the government studies troubled him. It seemed that doctors were just recording symptoms and not trying to find a pattern or a cause. So he imposed what epidemiologists call a "case definition"—just a hypothesis. He then obtained from the reservists detailed epidemiological histories, including their chemical exposures during the war, and compared them to a group of healthy veterans to see how they differed. Sure enough, when he analyzed the raw data with a sophisticated computer program, he found that the seemingly meaningless jumble of symptoms actually fell into three coherent syndromes, all known to result from neurotoxic damage. Moreover, the symptoms tended to afflict vets who had been exposed to three chemical agents present in the Gulf War theater: insect repellents and flea collars; sarin nerve gas, to which some vets were reportedly exposed when U.S. bombers destroyed an Iraqi chemical weapons storage area early in the war; and a third substance called pyridostigmine bromide (PB), which, ironically, the soldiers had taken as an immunization against nerve gas. In the course of delineating these syndromes, Haley claimed that he also eliminated other potential chemical exposures—the infamous oil rig fires—and more important, stress, as causes of the syndromes.
Any one of the chemical exposures alone might not prompt the full range of symptoms, Haley found. But together they seemed to be responsible for a disorder known as organophosphate-induced delayed polyneuropathy, in which chemical toxicity inhibits the actions of an enzyme critical to nervous system function. Haley advanced his work on other vets, including Chris Yarger. He identified the area of the brain affected—the left basal ganglia near the brain stem, an area that regulates such functions as balance and sleep—by performing magnetic resonance spectroscopy on some vets. Finally, he determined that the sick vets probably had a