March 24, 2007:
The U.S. Army has been studying
combat fatigue (or PTSD, post-traumatic stress disorder) a lot more these days.
Currently, about 400 soldiers a year are sent home from Iraq because of severe
PTSD, and thousands have less serious bouts of PTSD, which are treated in Iraq,
with the soldier soon returning to duty.
What the army is up against is something they
discovered during World War II. Back then, PTSD was called combat fatigue, and it
was a serious problem. In the European Theater, 25 percent of all casualties
were serious PTSD cases. In the Pacific Theater, the rate varied widely,
depending on the campaign. In some of the most intense fighting, like Okinawa
in 1945, it accounted for over a third of all wounded.
The statisticians examined all those medical
records and discovered that few soldiers went more than 200 days in combat
without suffering a severe case of combat fatigue. Actually, the number of days
a soldier could survive in combat, before feeling the effects of PTSD varied
from 100-200. There were exceptions, as PTSD vulnerability, like everything
else, occurred according to a bell-shaped curve. There were some troops who had
severe anxiety attacks, and other PTSD symptoms after only a week or two of
combat. On the other extreme, there were men who never seemed to suffer any
PTSD symptoms. It was later discovered that, as with most things, genetics and
brain chemistry played a large part in the ability of some people to be virtually
immune to PTSD. But there's still no PTSD vaccination, and lots of PTSD
victims.
PTSD was less of a problem during Korea and
Vietnam, because troops usually served only one 13 months tour in the combat
zone. It was for the Korean War that the "12 month tour of duty" was invented
(to spread the pain around, otherwise a smaller number of troops would have
stayed there, "for the duration.") But Iraq is different. The lower casualty
rates have meant that a lot of troops are going back for multiple tours of
duty. Thus, the army and marines are now faced a large number of troops hitting
the 200 days of combat "wall". Based on past experience, that should mean more
cases of serious combat fatigue. That results in troops dangerous to themselves
and those around them.
In Iraq and Afghanistan, the army has found ways to
delay the onset of PTSD by providing better living conditions, and equipment
that makes combat less dangerous. The army also provides some leave time during
the tour, which allows the soldiers some time outside of Iraq, and even a visit
with his family back home. This has delayed hitting the wall, not eliminated
it. Troops may be able to handle 300, or more, days of combat. But many troops
are sensing that they are approaching the wall, and transferring out of combat
jobs, or not reenlisting. The numbers are not great, but it is a trend. You
cannot ignore the long term impact of combat fatigue.