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A New Generation of Combat Stress
A New Generation of Combat Stress


This article is provided courtesy of DefenseWatch, the official magazine for Soldiers For The Truth (SFTT), a grass-roots educational organization started by a small group of concerned veterans and citizens to inform the public, the Congress, and the media on the decline in readiness of our armed forces. Inspired by the outspoken idealism of retired Colonel David Hackworth, SFTT aims to give our service people, veterans, and retirees a clear voice with the media, Congress, the public and their services.

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January 21, 2004

[Have an opinion about the views expressed in this article? Sound off in the Hot Issues with Defensewatch Forum.]

By Patrick Hayes

It’s 0320 in Tikrit, Iraq – quiet, except for the slow deliberate movement of the Grunts on either side of the road. The street appears deserted and the patrol cautiously walks forward. The tension among the men is palpable. Suddenly, an explosion shakes the ground and men fall as the shockwaves and debris cover the street.

“Ambush!” Some of the soldiers are dead before their bodies hit the ground, some are screaming in agony. Automatic weapons fire comes from several locations and the troops not injured find cover and return fire.

In the life-or-death situation that seems to last hours, but may have only been a minute or two, the firefight has caused the death of three Americans, with seven others wounded.

An unusual scenario? No, not for combat troops. And certainly not for the Grunts fighting in Iraq and Afghanistan. For those who fight there, the sights and sounds of those confused and dangerous countries will never really go away.

Combat in any war produces physical casualties, ranging from minor wounds to permanent injuries, disfigurement or death. Not as obvious to the casual observer, the tension on a battlefield and the sudden bursts of combat can also leave other scars – psychological scars that are just as necessary to treat as are the physical wounds.

Since the Vietnam War, the psychiatric field has come to identify combat and other severe traumatic stress experiences, such as the civilian survivors of 9/11, as Post Traumatic Stress Disorder (PTSD), yet coming to some form of identification, acceptance and treatment has been a long road, especially for combat veterans.

Although stress-related symptoms were identified during the Civil War as “irritable heart” or “soldier’s heart”, the psychological trauma of combat was not really dealt with until World War I.

Cases of psychological trauma, nervous disorder, or emotional and physical shutdown, began to appear soon after the start of the war. However, in 1915 the first case of combat stress actually identified as “shell shock” was used to describe the symptoms of a British soldier who exhibited symptoms of extreme fear, shaking and blindness, although there was no visible physical cause. The soldier had become entangled in barbed wire on the battlefield and, as he struggled to free himself, he was bracketed by German artillery.

By today’s standards, given the nature of the meat-grinder on the Western Front, there seems little doubt that many, if not all, who survived the gruesome trench warfare suffered from some form of shell shock, whether it was later reported or not. Although The British and American governments made an attempt to treat the returning soldiers, British records of the exact number in did not survive. By 1919 in the United States, 38 percent of all hospitalized veterans suffered combat-related mental and nervous disorders.

In 1921, British Dr. Millais Culpin wrote an article in the Journal of Mental Science, stating, “Few of us expected a large number of men to be disabled by mental symptoms which would persist indefinitely after the war had ceased. Yet that is what is happening.”

By World War II, “psychiatric casualties” had increased by 300 percent, yet the nature of combat had changed from the static defense lines of World War I to the fast maneuvering by troops and heavy equipment. By then, what professionals were seeing was identified as “combat” or “battle fatigue” – evidenced by the 1,000-yard stare of many combat veterans. However, the emphasis of such problems was still placed on the individual’s makeup or character, or the unit’s level of cohesion and discipline in combat.

By 1947, the Veterans Administration reported that the number of combat veterans receiving pensions for psychiatric disabilities was 475,397. Of those, 286,000 were classified as “functional,” while the remainder were classified as having “organic” disorders. In addition to these, there were another 50,662 veterans with psychiatric disorders who were confined to VA hospitals.

During the Korean War, the official attitude was that mental breakdowns in combat were to be dealt with quickly and that the combatant should then be returned to the line. The rapid response seemed to work. In Korea, only six percent of evacuations were for psychiatric reasons, compared to World War II, when 23 percent of evacuations were psychiatric casualties.

During the Korean War, the term “section eight” was widely used to describe cases of psychological combat trauma, but it was becoming clear that, rather than the individual, the psychological trauma was caused by situational stresses related to the combat experience and had little or nothing to do with the character of the individual soldier.

One example of the level of combat stress can be roughly defined between those who served in World War II and Vietnam. For a combat soldier in World War II who served for four years, the average time spent in actual combat was approximately 40 days. By comparison, Grunts in Vietnam spent an average of about two-thirds of their 12- or 13-month tours – over 250 days – in combat.

By the time Vietnam became more than an advisory command and American troops were taking up much of the combat role, the psychological trauma of almost constant combat took on new significance. In a 1972 New York Times article, Dr. Chaim Shatan initially identified it as “Post Vietnam Syndrome,” a term few liked, particularly veterans. By 1980, the American Psychiatric Association had agreed on the more general term of “Post Traumatic Stress Disorder”.

A congressional report published in 1990 stated that 480,000 (15 percent) of the total 3.15 million Americans who served in Vietnam were, 15 years after the war, still suffering from combat-related psychological problems. The report also concluded that over 960,000 men and 1,900 women who had served in Vietnam, had suffered PTSD symptoms at some time in their lives.

It is now widely believed that adding to the trauma for combat troops returning from Vietnam was the individual nature of the war. Pentagon policies that shipped each individual soldier to the war alone and returned him back to the United States alone, usually by air – often increased his sense of alienation and anger. This stood in sharp contrast to the previous wars of the 20th century, when combat troops went to war and returned as a unit with their buddies, usually on ship, where they had time to talk with their comrades and reduce stress levels before landing in the United States.

Even with that difference, veterans counselors say that over the past few years, they have been seeing more veterans from World War II and Korea show up with undiagnosed PTSD, in addition to Vietnam veterans.

Now there is another generation of combat veterans from the first Gulf War, Bosnia, Afghanistan and Iraq. And there will be others. Whether they admit it or not, many returning troops will have symptoms of PTSD. One obvious example was the spate of domestic murders at Fort Bragg in 2002, where four soldiers murdered their wives. Three of the men had recently returned from combat in Afghanistan. A fifth incident involved the murder of a Special Forces major, whose wife shot him in the chest as he slept.

For those who may feel the symptoms of PTSD and those who live with a veteran who may show symptoms, there are many ways to get help. The symptoms of Post Traumatic Stress Disorder often include the following:

* Either chronic or intense bouts of severe depression;

* Feelings of isolation and the avoidance of others, including family members, and especially crowded situations;

* Rage, or fits of anger, which can quickly turn violent;

* The avoidance of memories and the feelings they bring back;

* Guilt at surviving when others did not;

* Feelings of anxiety, especially when confronted by loud noises, certain smells, or the sound of helicopters;

* Sleep disorders and nightmares;

* Flashbacks or uncontrolled memories of combat;

* Difficulty in concentrating;

* Hyper vigilance, or protective, even survival activities.

From the outside looking in, especially for a veteran with PTSD seeking help, the organizational structure of the VA may seem overwhelming. However, there are many places to start. One is the local Vet Center. Other organizations include the American Legion, the Veterans of Foreign Wars and the Vietnam Veterans of America.

If there are indications of PTSD, the counselor will assist the veteran in filing a claim with the VA. In order to help that claim through the system, the veteran can sign a temporary power of attorney enabling a veteran’s support organization, such as the Disabled American Veterans, the Paralyzed Veterans of America and others act for him, with the right to monitor the progress of the individual’s case and, if needed, push it along.

Once the file has been reviewed, probably within eight to 12 weeks, an appointment will be made for the veteran to visit the VA hospital and speak with a psychiatrist. This is not as daunting as it sounds. They are there to assist the veteran and provide the necessary support, should PTSD be confirmed.

Whether the veteran senses he has PTSD or not, he should visit a veteran’s counselor at the Vet Center and bring his DD214 separation form.

Sometimes it might be as simple as talking to the counselor. Many combat veterans need to get over the John Wayne image of biting the bullet. If there’s a wound, be it physical or psychological, it needs to be treated and there are people who can and will help. .

Patrick Hayes is a Senior Editor of DefenseWatch. He can be reached at gyrene@sftt.org.

©2004 DefenseWatch. All opinions expressed in this article are the author's and do not necessarily reflect those of Military.com.



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