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If you know of the infamous face slap in the film Patton, you know that war-related psychiatric problems have long provoked controversy and sometimes been blamed on cowardice. It doesn’t help that what’s collectively known as "post-traumatic stress disorder" (PTSD) doesn’t show up on X-rays, brain scans, or blood tests.
Actually, "old blood and guts" applied the slapping treatment twice. But his brilliance and aggressiveness saved countless American and even German lives.
Thus the authors of a July 1 New England Journal of Medicine study performed a vital service by being the first to assess the mental health of troops immediately after their tours rather than years later. Further, they were the first to collect information before the stress occurred. Finally, they showed that the worry of stigmatization prevented 40 percent of those who needed help from seeking it. The researchers, from the Walter Reed Army Institute of Research, surveyed more than 6,000 Army and Marine infantry either before or soon after they deployed. Before, about 5 percent of respondents met the strict criteria for PTSD – about the same percentage as in the U.S. general population. After completing their tour, about 6 percent of Afghanistan veterans and twice that number of Iraq vets were diagnosed with the stress disorder.
There was a general correlation between the amount of combat and level of stress disorder; almost a fifth of the troops with the stress disorder reported being in more than five firefights. But it’s not just combat that causes the disorder, and the conflict in Iraq is tailor-made to mess with a soldier’s head.
It’s a guerrilla war in which soldiers frequently die without warning from remotely detonated explosive devices. In Vietnam, our troops often complained that the enemy couldn’t be seen. But in Iraq, it may well be that the enemy isn’t even there.
When there is face-to-face combat, attacks are usually instigated by the enemy; 92 percent of respondents reported being attacked or ambushed, the study found. Soldiers see the suffering of innocent civilians everywhere because they are the enemy’s main target; three-fourths of respondents said they observed ill or injured women or children they couldn’t help.
But that’s hardly the end of it.
Forty percent of our Iraq troops are from National Guard and Reserve units (though they weren’t part of this study.) While they are performing admirably, many just weren’t psychologically prepared for war. Not that anybody is exempt from PTSD, a large portion of the troops in the study were from the crack 82nd Airborne Division.
We also have many soldiers in support units that may have expected war, but not up close and personal. This led to the fiasco in which Jessica Lynch’s maintenance battalion couldn’t defend itself because it failed to keep its weapons clean.
Viet vets: They served us then; they serve us now.
Want more? It’s been almost a century since we’ve fought an enemy that doesn’t take prisoners – unless to murder them. And it must be tough to literally risk your neck for people who often spit on you because they’re convinced you’re there to colonize them.
Yet the worst mental enemy in war is uncertainty. In Vietnam and Desert Storm you knew when you’d be leaving. But President Bill Clinton slashed the Army from 18 divisions to 10 and President Bush won’t expand it. Thus we’re both stretching reserves to the breaking point and bitterly disappointing troops who were told they’d soon be home with their families.
Yet there is good news. The casualty rates for the Iraq and Afghan wars are tiny compared to previous wars. Restoring somebody’s psyche is rather easier than raising the dead. Further, we’ve come a long way from the Patton treatment. Indeed, there’s a government center devoted exclusively to studying and treating PTSD.
And although Vietnam vets also had a high stress disorder rate, the representation of the vet who "goes postal" with an automatic rifle, is an addict, or can’t keep a job that doesn’t involve holding a cardboard sign is a media myth.
Viet vets are as successful, if not more so, in virtually every way than those who didn’t serve. Indeed, all vets – combat and otherwise – give society a special group of people with different perspectives than non-vets.
Our troops can face down and defeat any enemy, including the mental demons of war. Then they will provide a rich source of tough, motivated civilians for decades to come.