"We don't know whether he was or was not on any medicines, which is why [his attorney] has asked to be provided the list of medications," said Richard Adler, a Seattle psychiatrist who is consulting on Bales' defense.
While there was some early, ad hoc use of psychotropic drugs in the Vietnam War, the modern Army psychiatrist's deployment kit is likely to include nine kinds of antidepressants, benzodiazepines for anxiety, four antipsychotics, two kinds of sleep aids, and drugs for attention-deficit hyperactivity disorder, according to a 2007 review in the journal Military Medicine.
Some troops in Afghanistan are prescribed mefloquine, an antimalarial drug that has been increasingly associated with paranoia, thoughts of suicide and violent anger spells that soldiers describe as "mefloquine rage."
"Prior to the Iraq war, soldiers could not go into combat on psychiatric drugs, period. Not very long ago, going back maybe 10 or 12 years, you couldn't even go into the armed services if you used any of these drugs, in particular stimulants," said Peter Breggin, a New York psychiatrist who has written widely about psychiatric drugs and violence.
"But they've changed that.... I'm getting a new kind of call right now, and that's people saying the psychiatrist won't approve their deployment unless they take psychiatric drugs."
Military doctors say most drugs' safety and efficacy is so well-established that it would be a mistake to send battalions into combat without the help of medications that can prevent suicides, help soldiers rest and calm shattered nerves.
Fueling much of the controversy in recent years, though, are reports of a possible link between the popular class of antidepressants known as selective serotonin reuptake inhibitors (SSRIs) — drugs such as Prozac, Paxil and Zoloft, which boost serotonin levels in the brain — and an elevated risk of suicide among young people. The drugs carry a warning label for those up to 24 — the very age of most young military recruits.
Last year, one of Culp's clients, Army Pfc. David Lawrence, pleaded guilty at Ft. Carson, Colo., to the murder of a Taliban commander in Afghanistan. He was sentenced to only 121/2 years, later reduced to 10 years, after it was shown that he suffered from schizophrenic episodes that escalated after the death of a good friend, an Army chaplain.
Deeply depressed and hearing a voice he would later describe as "female-sounding and never nice," Lawrence had reportedly feared he would be thrown out of the Army if he told anyone he was hearing voices — a classic symptom of schizophrenia. Instead, he'd merely told doctors he was depressed and thinking of suicide. He was prescribed Zoloft, for depression, and trazodone, often used as a sleeping aid.
The voices got worse, and Lawrence began seeing hallucinations of the chaplain, minus his head. Eventually, Lawrence walked into the Taliban commander's jail cell and shot him in the face.
"They give him this, and they send him out with a gun," said his father, Brett Lawrence.
Up until the Burke case, there had been few if any recent rulings exonerating military defendants claiming to be incapacitated by medications.
Burke's case may have marked a turning point. Four Army doctors concluded that he wasn't mentally responsible for his actions — a finding none of them would have made had he been merely drunk.
"Three drinks over an entire evening is not enough to black somebody out, but I don't remember 99% of what happened over the rest of that evening," Burke said in an interview. "It was kind of like I was misfiring on the cylinders."
Both the American Psychological Assn. and the American Psychiatric Assn. in a 2010 congressional hearing urged the Army to stay the course on psychotropic drugs.
The real danger, said the psychologists' spokesman, M. David Rudd, dean of the college of social and behavioral science at the University of Utah, is if soldiers are frightened out of access to potentially life-saving medication.
The Army surgeon general's office said no one without specific approval is allowed to go on deployment using psychotropic drugs, including antidepressants and stimulants, until they've been stabilized. Soldiers who need antipsychotic agents are not allowed to go to combat.
But are those precautions enough? Julie Oligschlaeger said her son, Chad, a Marine corporal based at Twentynine Palms, came home from his second tour in Iraq in 2007 complaining of nightmares and hallucinations. He was taking trazodone, fluoxetine, Seroquel, Lorazepam and propranolol, among other medications.
"I didn't realize how many pills he was on until it was too late," said Oligschlaeger. "He sometimes would slur his words, and I would think, 'OK, are you drinking? What is going on?' And he'd say, 'Oh, I'm taking my pills, and I'm taking them when I'm supposed to.' I never thought to look."
In 2008, two months before Chad was scheduled to get out of the Marines, start college, and marry his fiancee, the young corporal was found dead on the floor of his room in the barracks. An autopsy concluded the death was accidental due to multiple-drug toxicity — interactions among too many drugs.
At the memorial service, Oligschlaeger looked her son's commander in the eye and reminded him that Chad had waited in vain for a bed in a combat stress treatment facility. "I asked him, 'Why didn't you have your eyes on your Marine?'" she said. "He didn't answer me. He just stood there with his hands behind his back. And he looked at me."