When three Minnesota National Guardsmen died in a roadside bombing in February, their home towns grieved in the usual way. Flags flew at half-staff. Streets were renamed in honor of the fallen. And neighbors spoke of a war brought home in painful relief.
But the soldiers who were left behind -- a company of about 150 builders, farmers, policemen and students -- still had 10 months remaining on their year-long deployment. And haunted by the deaths of men some had known since childhood, they had to find a way to carry on. So before the unit even held a memorial service, the commanding officer called in the specialists: a combat stress control team from the Army's 55th Medical Company out of Indianapolis, whose slogan is "serving the best by controlling the stress."
A group of trained therapists, led by a lieutenant colonel who is also a clinical psychologist, debriefed each soldier individually, and encouraged them in group sessions to share their feelings about the incident and their memories of the dead.
"They showed us it's okay to actually talk about this, to not just clam up," said Capt. Troy Fink, 35, the commanding officer and only full-time soldier in Delta Company of the 1st Battalion, 151st Field Artillery Regiment, which is based in Morris, Minn. "I've still got some guys who hurt pretty bad. I hurt some days. It's important to maintain that certain image in front of my soldiers, but sometimes we all need a release."
From the shell shock first diagnosed among trench warriors in World War I to the post-traumatic stress disorder (PTSD) that afflicts thousands of Vietnam and Persian Gulf War veterans, the toll modern warfare has taken on the psyche of combatants has been well documented. An estimated one in six troops returning from duty in Iraq experienced symptoms of major depression, anxiety or PTSD, according to a New England Journal of Medicine study published last year.
Now, the U.S. military has intensified efforts to mitigate the impact of traumatic experiences on the mental health of its troops.
Combat stress control teams are deployed at six U.S. bases across Iraq, tasked with identifying front-line soldiers suffering from early symptoms of PTSD, a condition that causes a range of psychiatric and physical symptoms, from violent flashbacks to difficulty sleeping. The battalion's headquarters in Baghdad's heavily fortified Green Zone serves as an oasis for overwhelmed fighters, who are pulled out of the field for three to seven days of counseling, classes on psychological disorders and relaxing by the pool at one of Saddam Hussein's palaces.
"In Vietnam there was no preventative aspect of dealing with these things. People had to keep moving and do their job. Then they got back and everything hit them all at once," said Capt. Anthony Bruni, 33, a reservist with the 55th Medical Company, who has a private therapy practice in Pittsburgh. "It's still the nature of the business that they have to return to work, but we try to validate their feelings and reactions -- to let them know it's normal to be affected by what they do and see."
The initiative also challenges stereotypically stoic, grin-and-bear-it soldiers by encouraging them to seek out help in an attempt to ward off more serious problems down the road.
"Everyone in the Army is macho. Everyone's familiar with the story of General Patton slapping the soldier in the hospital for being a coward and not wanting to go back to the front lines," said Capt. Paul Judge, whose Delta Company, Task Force 4-64 guards the checkpoint on Baghdad's 14th of July Bridge that has come under frequent attack. "But at the same time, there is a balance. If you don't get some of these things out, they just keep building up."
On a recent afternoon at the 55th Medical Battalion's headquarters -- a former Hussein guesthouse with a sandy volleyball court in the front yard, high-speed Internet connections and a vast library of movies and books -- seven soldiers on leave from their units sat in a dimly lit room for lectures on relaxation techniques, PTSD and conflict resolution.
Blow Pops and lemon-flavored Girl Scout cookies were scattered on tables. A reporter was permitted to attend on the condition that none of the patients be directly interviewed or identified. At one point during a talk about sleep, the soldiers spread out on the floor for deep-breathing exercises that left many in the room snoring.
Down the hall, Lt. Andrea Patrick explained a board game she designed called Combat Stress Monopoly." Players draw cards printed with questions about what they had learned in their classes and land on spaces marked with such directions as "You survive an attack, move one space ahead," or "You have an argument with your family member on the phone, lose a turn."
"We put it in a game format to test what they have learned while they are here," she said. "It's useful and also fun."
But, later, the discussions of soldiers' combat experiences were pointed and raw.
"How many of you have experienced flashbacks?" asked Sgt. Kara Loveland, 24, from Janesville, Wis., as she handed out a sheet labeled My Symptoms that asked soldiers to rate the frequency and severity of such occurrences as nightmares or angry outbursts.
"This is my second deployment, and I only had nine months in between," said an Army medic. "When I try to sleep, I've got to go through the battles all over again, running out to pick up my fellow soldiers with rounds flying around. You don't have time to clean your mind and you're right back out there. And as soon as a dead person comes into the aid station all demolished, it all comes back."
"What does your commanding officer tell you when something like that happens?" Loveland asked.
"They don't care," the medic said. "You go outside, drink a few [non-alcoholic] beers, smoke a few cigarettes and roll on."
"You have to talk yourself down. Find a safe haven for yourself or else you'll just keep going for hours and hours," Loveland told him. "Think about what your flashback is trying to tell you. Distract yourself."
Lt. Col. Kathy T. Platoni, a psychologist from Beaver Creak, Ohio, said that unit commanders often resisted allowing their soldiers time away from training for stress treatment.
"Our main purpose is to help people get back to the field, and we get more than 90 percent of them back out so they can do their jobs," she said. "But sometimes the command just doesn't support it. You schedule something and no one shows up. It's not always easy, but you just have to fight your way in."
Fink, the Minnesota National Guard captain, said he recognized the need to comfort his unit immediately after his soldiers were killed. Less than four months ago, they were driving through Baghdad in a convoy when a Humvee driver lost control of his vehicle and it flipped.
As a helicopter was evacuating the wounded, an explosion tore through soldiers standing nearby. The three who died -- Sgt. Jesse Lhotka, Staff Sgt. David Day, and Lt. Jason Timmerman -- were in their early twenties and had each been married less than a year.
"We are a tightknit group. We all come from the same part of the state, a lot of us work together or went to school together," Firk said. "It really is like a family. That's what it is. Which is why they took this so hard."
Staff Sgt. Ryan Erp, 24, who was monitoring the radios at the base when he heard the blast, said it did not sink in until the damaged vehicles returned on tow trucks. "I saw the Humvee and realized they were not coming back," he said.
Two days later he sat in a session with other soldiers and two combat stress specialists.
"They asked us to talk about what we remembered about the guys," he said. "Jesse and I graduated from high school together. I met Sgt. Day over here, but we lived only 10 miles apart back home. He got to be a good friend. I told them how every time he'd tell a joke, he'd screw it up and say 'Ah, you had to be there.' "
Spec. Jacob Veldhouse said the hardest part was knowing that he could have died. Five minutes before the explosion, Timmerman had asked him to take over his spot in the gun turret of an armored Humvee. When the bomb detonated, Timmerman was standing on the ground exposed, while Veldhouse was hit with just a pea-size piece of shrapnel.
"I think about that day every day," said Veldhouse, 22. "Yes, talking about it helps. But you don't really get over it. It's not like it will ever go away."