Stress Taking Toll on Foreign Service

By Robin Wright
Washington Post Staff Writer
Wednesday, June 20, 2007

At least 40 percent of State Department diplomats who have served in danger zones suffer some symptoms of post-traumatic stress disorder, Steven Kashkett, vice president of the American Foreign Service Association, said in congressional testimony yesterday.

Troubling medical and psychiatric symptoms have become a growing problem for Foreign Service personnel in recent years, particularly among those exposed to deadly violence in countries such as Iraq and Afghanistan, where diplomats often work and live among U.S. troops, Kashkett told a House Foreign Affairs subcommittee.

Unlike members of the military, however, diplomats are not well equipped for war environments. Most get only a two-week anti-terrorism course as preparation.

"Foreign Service officers, while accustomed to serving their country overseas under extremely difficult conditions, are not soldiers and are not trained for combat," Kashkett told the subcommittee on the Middle East and South Asia. "Yet in Iraq, they are often directly exposed to conditions of war [with] which they may not always be well adapted to cope." Some 2,000 diplomats have volunteered to serve in Iraq since 2003, he said.

The State Department has provided limited help for diplomats under duress. After the U.S. Embassy in Baghdad requested mental health services in 2003, the department sent two psychiatrists to assess the environment. In 2004, one psychiatrist joined the U.S. medical team in Baghdad but was moved the next year to Amman, Jordan, and replaced by a social-work counselor, State's medical director, Laurence G. Brown, told the panel.

Numbers are still hard to determine. Based on anecdotal information, the State Department's Office of Medical Services finds that diplomats commonly suffer from stress-related problems but "very few" have full-blown symptoms of PTSD, Brown said. Fewer than 20 have had their medical clearance changed due to PTSD, he said.

This month, however, the State Department launched the first survey of all State personnel who have served since 2002 in "unaccompanied posts," or areas deemed so dangerous that family members are not allowed. The one-month survey is being carried on the department's internal Web site, and responses are anonymous. So far, half of the respondents said they experienced irritability and unusual hostility, and 35 to 52 percent said they suffered from one or more symptoms common to PTSD -- including social withdrawal, isolation, apathy, insomnia and anxiety -- during or after their assignments.

"Preliminary results from the State Department survey suggest that it may affect some 40 percent or more, similar to what has been reported for the U.S. military," Kashkett told lawmakers.

"The stresses at unaccompanied posts like Saudi Arabia, Haiti, Lebanon and places in Africa are not as great as those in the two war zones," Kashkett said later in an interview. "If you selected only those people whose unaccompanied tours were in war zones, these results would very likely be higher. Our perception is that this is a much more pervasive problem among Foreign Service employees returning from service in Iraq than most people realize."

In Iraq, many Foreign Service personnel have been exposed to frequent incoming fire in the Green Zone and sleep in vulnerable aluminum trailers, he told the subcommittee. Others live on forward operating bases in the midst of combat areas, while members of the provisional reconstruction teams are embedded with mobile combat units and are as susceptible to roadside explosives and attacks as U.S. troops, Kashkett said.

In 2004, the State Department instituted outbriefings for diplomats on their return from Iraq. But the sessions do not offer counseling or psychotherapy for PTSD symptoms, Brown told the committee.

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