Frontline Care for 'At Risk' Soldiers

By Jonathan Finer
Washington Post Foreign Service
Thursday, June 8, 2006

FORT BENNING, Ga. -- Over the course of a year in Iraq, the 3rd Brigade of the U.S. Army's 3rd Infantry Division saw action in some of the country's most violent places, insurgent strongholds such as Ramadi in the west and Baqubah in the north. By the time the brigade's 4,000 members returned home in January, as many as 800 had been flagged as potentially "at risk" in a psychological screening process conducted in Iraq, according to commanders and medical personnel.

Yet four months after their return, fewer than 80 are still in treatment. Psychologists here attribute what they call a relatively small number of persistent psychological issues to an unprecedented program of battlefield therapy and follow-up care, including having mental health experts assigned to most brigades and combat stress experts deployed for the first time to frontline bases throughout Iraq.

Composed of soldiers who are also trained therapists, the combat stress teams are often sent immediately to debrief soldiers in the hours after a patrol, firefight or bomb attack. They seek to identify those who may need treatment months before they return home, pulling some out of their units for two to seven days of group therapy sessions, video games and sitting by the pool at a cushy compound in Baghdad's fortified Green Zone.

"The point is to get at some of these issues before they start to fester back here," said Capt. Christopher Hansen, 33, of Jamestown, N.D., a psychologist assigned to the 3rd Brigade. "In Vietnam, nobody did much about this stuff until it was too late."

The most comprehensive psychological study of Iraq war veterans -- completed in 2004 as the insurgency was still gaining strength -- found that about 18 percent suffered from post-traumatic stress disorder (PTSD), a constellation of physical and psychological symptoms first diagnosed among soldiers who served in Vietnam.

Partly in response to the troubled generation of Vietnam veterans still under treatment in government hospitals, there has been an unprecedented commitment of resources for helping soldiers of the Iraq conflict cope with psychological conditions, both on the battlefield and upon their return.

But high rates of stress-related disorders remain a major concern of military commanders and doctors treating soldiers. Combat stress was mentioned last week as one possible explanation for the alleged killing by U.S. Marines of 24 unarmed Iraqi civilians in the town of Haditha last year. The slayings reportedly followed a roadside bomb attack that killed a Marine.

"It's stress, fear, isolation, and in some cases, they're just upset," said Brig. Gen. Donald M. Campbell Jr., a spokesman for U.S. forces in Iraq, when asked why such killings take place. "They see their buddies getting blown up on occasion, and they could snap."

Among the symptoms of PTSD, Hansen said, are irritability, insomnia, occasional flashbacks to traumatic incidents, anxiety and depression. But violence, including battlefield retaliations, rarely result from stress, he and other experts on the condition said.

"People don't kill other people because they are stressed," Hansen said. "Can it make them cranky or impulsive? Sure. But pinning these things on PTSD is simply not scientific. This condition does not cause otherwise normal people to commit crimes."

"Combat stress is not an excuse," said Col. Dan Kessler, 45, of Latrobe, Pa., the 3rd Brigade's deputy commander. "Discipline and leadership are the bedrock of any organization, and that should overcome whatever these guys go through."

The Veterans Affairs Department's National Center for PTSD, in White River Junction, Vt., lists dozens of potential "effects of traumatic experiences," from drug and alcohol abuse to gastrointestinal problems. Violence is not mentioned.

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