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March 28, 2005
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By Kirsten Scharnberg
Chicago Tribune
Stresses Of Battle Hit Female GIs Hard
VA study hopes to find treatment for disorder
NEW YORK -- On a mission just south of Baghdad over the winter,
a young soldier jumped into the gunner's turret of an armored Humvee
and took control of the menacing .50-caliber machine gun. She was
19 years old, weighed barely 100 pounds and had a blond ponytail
hanging out from under her Kevlar
helmet.
"This is what is different about this war," Lt. Col. Richard Rael,
commander of the 515th Corps Support Battalion, said of the scene
at the time. "Women are fighting it. Women under my command have
confirmed kills. These little wisps of things are stronger than
anyone could ever imagine and taking on more than most Americans
could ever know."
But today, two years after the start of an Iraq
war in which traditional front lines were virtually obliterated
and women were tasked to fill lethal combat roles more routinely
than in any conflict in U.S. history, the nation may be just beginning
to see and feel the effects of such service.
Thousands of women, like the male veterans of so many wars before,
are returning home emotionally damaged by what they have seen and
done. These female troops appear more prone to post-traumatic stress
disorder, or PTSD, than their male counterparts.
And studies indicate that many of these women suffer from more pronounced
and debilitating forms of PTSD than men, a worrisome finding in
a nation that remembers how many traumatized troops got back from
Vietnam and turned to drugs and violence, alcohol and suicide.
One children's book increasingly popular among military families
illustrates what the effects of this most recent war might mean
for society in the years and even decades to come: "Why Is Mommy
Like She Is? A Book for Kids About PTSD."
In the wake of such concerns, the Veterans Affairs Department has
launched a pioneering $6 million study of PTSD among female veterans.
It is the first VA study to focus exclusively on female veterans;
8 percent to 10 percent of active-duty and retired military women
suffer from PTSD.
"PTSD is a very real problem for women who serve in the military,"
said Paula Schnurr, one of the study's lead researchers and the
deputy executive director of the VA's National Center for PTSD in
White River Junction, Vt. "This study is specifically addressing
that, and we hope it will not only help us treat women coming home
from Iraq, but all those who have ever served and struggled with
PTSD in any conflict before."
The study's findings are not due until the end of the year, but
researchers already have made some startling discoveries that are
illustrative of the nature of PTSD among female veterans and of
the U.S. military.
According to Schnurr, data indicate that female military personnel
are far more likely than their male counterparts to have been exposed
to some kind of trauma or multiple traumas before joining the military
or being deployed in combat. That may include physical assault,
sexual abuse or rape.
"The speculation is that many of them are joining the military to
get away from adverse environments," said Schnurr, also a professor
of psychiatry at Dartmouth College, speaking of the nearly 216,000
U.S. women on active duty and the nearly 151,000 who are part of
the reserves and National Guard.
The implication of such a finding on PTSD research is considered
significant. Because most research indicates that a person is at
greater risk of developing PTSD--or developing more severe PTSD--when
he or she has had past traumas, many female troops are deploying
to war zones already heavily predisposed to react adversely to the
intense fear, killing and loss routinely encountered there.
"The evidence is conclusive," said Rachel MacNair, an expert in
the psychological effects of violence and PTSD. "The greater the
trauma in your life, the greater the symptoms of PTSD."
MacNair, however, focuses on another factor that she believes more
acutely affects the rate of PTSD among veterans of Iraq: whether
they have killed during their deployment.
In 1999, MacNair earned her doctorate at the University of Missouri-Kansas
City with a study that analyzed the data from the National Vietnam
Veterans Readjustment Study, a landmark congressionally funded project
that studied nearly 1,700 veterans.
Her findings were stark: Troops who had killed--or believed they
had killed--suffered significantly higher rates of PTSD than those
who had not.
"It is very clear that being shot at is traumatic, or losing your
buddy is traumatic, but the act of shooting and killing another
human being, something that goes against every instinct we have,
is the biggest trauma of all," said MacNair, who calls this kind
of PTSD "perpetration-induced traumatic stress."
That hypothesis by MacNair, who is strongly critical of the military,
is supported by history and by military experts.
S.L.A. Marshall, one of the earlier official Army historians, estimated
after studying World War II veterans that only 15 percent had fired
their weapons during battle. He asserted from his interviews with
soldiers that their failure in battle was because they were more
afraid of killing than of being killed. Other studies show that
even the most poorly treated prisoners of war had lower rates of
PTSD than front-line soldiers because the prisoners no longer were
in a position where they had to kill.
How such findings translate to the Iraq war is clear. Unlike previous
conflicts, where women rarely were pulling the triggers or running
the weaponry that left enemies dead on the battlefield, they routinely
are doing so in Iraq, as Lt. Col. Rael pointed out on that cold
December day on the outskirts of Baghdad.
On top of that they are being taken prisoner, as was Pvt. Jessica
Lynch during the initial invasion; they, like their male counterparts,
are being constantly mortared and ambushed by a guerrilla insurgency;
and they are watching fellow troops go home grievously wounded or
dead in numbers not seen since the war in Vietnam.
Killing 'tips the scales'
"It all adds up," said MacNair, "but the act of having killed does
seem to be the factor that tips the scales in favor of PTSD."
Of the nearly 245,000 veterans returning from Iraq and Afghanistan,
almost 12,500 have been to VA counseling centers for readjustment
problems and symptoms of PTSD. In addition, a study in The New England
Journal of Medicine found that up to 17 percent of troops returning
from Iraq were suffering from PTSD or other readjustment problems.
So far no statistics have been released detailing how many of these
patients are women, but numerous support groups have sprung up specifically
for women with PTSD. In one Internet chat group, Sisters Bound by
Honor, women struggling with PTSD talk with one another about their
experiences.
Yet the women who most need counseling to help them deal with what
they witnessed in Iraq and Afghanistan--like their male counterparts--are
the most unlikely to seek it.
A Defense Department study of combat troops returning from Iraq
found that soldiers and Marines deeply suffering from PTSD and readjustment
problems were not likely to seek help because of the stigma such
an act might carry. In the study, 1 in 6 veterans acknowledged symptoms
of severe depression and PTSD, but 6 in 10 of the same veterans
feared their commanders and fellow troops would treat them differently
and lose confidence in them if they sought treatment for their problems.
That seems especially true of women, who have fought for years to
be assigned positions in the Army that once were off-limits to them.
A number of female Iraq war veterans suffering from PTSD declined
to be interviewed for this article.
Alert to early need
Still, former Army
Lt. Col. Dave Grossman, who taught psychology at West Point and
wrote the book "On Killing," which closely documented the link between
killing and PTSD, believes the treatment of PTSD among the veterans
of Iraq could be the most effective in combat history. Using an
analogy to obesity, he said that after past wars, only those traumatized
soldiers "who were 400 pounds overweight got attention or treatment."
"But now," Grossman said, "we are so sensitive to PTSD and its effects
that we can notice the person who is the equivalent of just 20 or
so pounds overweight, and we can help them then, long before they
have the psychiatric equivalent of high blood pressure and heart
attack."
The study of female veterans suffering from PTSD may be just such
a start. The study includes hundreds of women and aims, among other
things, to discover which clinical treatments are most effective
for women with the disorder.
Half of the women will be treated through prolonged exposure therapy,
in which each woman will be guided for 10 weeks through vivid remembering
of the traumatic event or events until her emotional response decreases
through "habituation." Schnurr, one of the study's directors, compares
habituation to the way city dwellers grow immune over time to loud
noises such as police sirens or car alarms.
"The goal is that the memory of the traumatic event is no longer
as startling, as terrifying, when it comes," she said.
The other half of the women will be treated with what is known as
"present-centered therapy," a treatment that focuses on helping
a patient deal with her current life challenges rather than the
memory of past traumas.
"Both therapies are appropriate and helpful to some degree," Schnurr
said, "but we expect that the prolonged exposure will be the most
effective. If that is the case, I think we will begin using that
treatment much more--and more effectively--in the years to come."
Although the goal of the study is to determine which therapies work
best for women suffering from PTSD, experts agree that if the study
is conclusive it eventually may be applied to tens of thousands
of Iraq war veterans, male and female alike.
"It is our hope that we can find ways to help these women," Schnurr
said. "But, more than that, we are hoping to draw some conclusions
that can help us in the treatment of PTSD across the board. That
means men and women, soldiers and Marines, those who are suffering
for reasons having nothing to do with combat at all."
©2005 DefenseWatch. All opinions expressed
in this article are the author's and do not necessarily reflect those
of Military.com.
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