Posted on 02/28/2003 8:00:36 AM PST by Stand Watch Listen
WASHINGTON -- If U.S. troops storm into Iraq, swarms of psychiatrists and other mental health specialists will go with them to help keep soldiers from shattering under the shock and trauma of war -- and to treat those who succumb.Though such Combat Stress Control teams are not always welcomed by field commanders, the U.S. military hierarchy is sharply attentive to the age-old problem of "shell shock" or battle fatigue. The condition can afflict troops encountering their first explosive clash of combat, and even hardened soldiers can crumble under the weight of unrelieved fighting.
Battle fatigue can mean debilitating anxiety, memory loss and paralysis, or even psychopathic behavior such as drug abuse, desertion or killing or raping civilians, U.S. combat experience shows. On previous battlefields, half or more of all casualties were mental cases and many thousands more went undiagnosed, experts say.
War with Iraq could be more intensely stressful to American troops than anything the U.S. military has faced since Vietnam, some observers believe: more chaotic and confusing; more risky; and perhaps, with anti-war demonstrations around the world, morally ambiguous. Much of the fighting could be in booby-trapped urban areas crowded with civilians. Operations would run continuously day and night, under constant threat that Saddam Hussein would use chemical or biological weapons or even a radiological "dirty bomb."
Treating combat stress casualties and returning them to service quickly is not just compassionate, but a practical necessity. It can also be a tricky management problem. Offering some soldiers a three-day pass to the rear for rest and relaxation can cause resentments or even a stampede. And those who have broken under stress are not always welcomed back by their units who must trust one another with their lives.
But psychological casualties are unavoidable.
"War is one of the most traumatic events people can participate in," said Army Lt. Col Spencer J. Campbell, one of the military's foremost practical authorities on battle fatigue and a veteran of 20 months of close-quarter combat.
"I look at combat stress differently from just theory," he said in an interview.
Campbell was an enlisted Marine in 1968 when his reconnaissance patrol ran into a North Vietnamese company on Hill 881 North overlooking the besieged Marine base at Khe Sanh. A three-hour battle ensued. "At the end, half of my patrol was killed, and everybody (else) was wounded," he said.
Recuperating from shrapnel wounds before he returned to Vietnam for a second combat tour, Campbell set about learning why some troops are more resilient than others. That led eventually to a doctorate in clinical social work and a second military career in combat stress prevention.
"My personal opinion is that individuals must have some kind of faith in something bigger than themselves, because in close combat you get to the point of accepting the inevitability of your own death and then something else has to take over," Campbell said.
He and many others hold to the view of a 19th century French infantry officer, Charles Ardant du Picq, who believed that courage under fire is like a well: Water may be drawn from it, but eventually it will run dry and must be allowed to refill. Experts say courage is replenished by a soldier's trust in his leaders and his buddies, his confidence in his own and his unit's competence, his belief in the cause -- and his immediate sense of well-being. Soldiers who are cold, wet, exhausted and hungry are more vulnerable to combat fatigue than those who are dry, warm, rested and fed.
That is why the Pentagon invests so much in attractive field rations and comfortable field gear, and why the U.S. military spends more time in stressful field training than any other military in the world, defense officials say.
Combat exercises at the Army's National Training Center at Fort Irwin, Calif., and the Joint Readiness Training Center at Fort Polk, La., deliberately replicate the "fog of war" in which troops struggle against mechanical breakdowns, bad weather, fatigue and stress to build self-confidence and forge close ties.
But any soldier in combat, rested or not, can suddenly fall victim to common battlefield conditions that the U.S. Army manual on battle fatigue says can trigger psychological problems: sleep loss, dehydration, overwork, noise, vibration, blast, fumes, poor hygiene and cumulative exposure to danger and death.
Deeper trauma can be caused by the requirement in combat to suppress normal emotions of compassion, horror, guilt, tenderness and grief, said Jonathan Shay, a staff psychiatrist for the Veterans Affairs Department, a military consultant and author of two books on combat trauma.
Campbell, from his own combat experience, adds that a prime cause of battle fatigue is the shock to a religious person who experiences the unrelieved cruelty and inhumanity of war.
Under murderous German fire at Omaha Beach on D-Day, some men found the personal grit to forge ahead while others "sat on the sands staring into space, seemingly seeing and hearing nothing -- they did not even stir to find cover," the noted military historian and Army officer S.L.A. Marshall once recalled.
Once during World War II, Marshall was put to work screening officers who had broken down in combat, looking for leaders who could be refit and sent back into action. He examined 353 officers, selecting only 27. But all of them, he later recounted, "were intelligent, earnest Americans. They were not cowards, but there were pressures to which they could not be conditioned."
About 40 percent of the 4,800 American casualties evacuated from Guadalcanal in 1942 suffered from disabling mental problems, according to Defense Department records.
Experience indicates that up to two-thirds of psychological casualties can be returned to service after several days' supervised recuperation, if they are not suffering severe trauma.
The teams of psychiatrists, psychiatric social workers and occupational therapists being sent to the Persian Gulf -- the Pentagon could not provide a precise count -- will augment medics in teaching such stress management techniques as physical and mental relaxation, meditation and team-building. Medics and all combat leaders are trained to recognize symptoms of battle fatigue.
"The point is to keep stress from brewing up to the point where people start to become dysfunctional," said Col. James W. Stokes, combat stress control officer for the Army's medical command in San Antonio.
Once the fighting erupts, the job becomes neuropsychiatric triage -- sorting out serious psychiatric cases from simpler forms of battle fatigue. "Someone who's lost his memory could be sleep-deprived or suffering from a blood clot in the brain from a concussion," Stokes said.
Serious neurological cases are evacuated to the rear; simple cases of combat fatigue get food and rest, and occupational therapists begin retraining them to remind the soldiers that their skills will keep them safe.
The problem for tactical field commanders in this approach is obvious. As they struggle to hold their men together under fire, it can't help to have a team from Combat Stress Control offering to take away anxious soldiers for a hot shower, hot food and a clean bed.
"The problem is, if you evacuate people for stress, you start to see more and more stress cases," Stokes acknowledged. "More people will show up, and they are not faking it."
As a result, he said, "very often the commanders' perception is that we are going to somehow corrupt their soldiers, to give them ideas, to take them away, creating this attractive treatment so that everybody wants his three days of relaxation."
Though military policy is to return battle fatigue casualties to service as quickly as possible, they are not always welcomed back by their original units.
"If a soldier becomes dysfunctional because of stress, his unit considers it a dishonorable failure -- `He didn't have the right stuff and so we're better off without him' kind of feeling," Stokes said.
"Our job is to counter that idea -- that a good soldier will be good again."
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