August 15, 2007: The U.S. Navy has to deal with combat fatigue again. The navy hasn't had much trouble with combat fatigue (or PTSD, post-traumatic stress disorder) since World War II. Back then, thousands of sailors confronted horrific situations when their ships were hit by Kamikazes (Japanese manned suicide aircraft) or heavy enemy fire, and spent hours or days struggling with fire, explosions and torn up crewmen, as they fought to save their ships.

Better diagnostic tools, and lots of media attention, are making PTSD a lot more visible. The condition was first noted after the American Civil War (1861-65). That war was one of the first to expose large numbers of troops to extended periods of combat stress. The symptoms, as reported in the press a century and a half ago, were not much different from what you hear today. At the time, affected veterans were diagnosed as suffering from "Irritable Heart" or "Nostalgia." Symptoms noted included fatigue, shortness of breath, palpitations, headache, excessive sweating, dizziness, disturbed sleep, fainting and flashbacks to traumatic combat situations.

In World War I, the condition was called "Shell Shock," and the symptoms were the same, although there was more attention paid to vets who jumped and got very nervous when they heard loud noises. In World War II and Korea the condition was called "Combat Stress Reaction." Same symptoms. After Vietnam, the term PTSD became popular, until it evolved into what we currently think of as PTSD.

It was during World War II that researchers discovered that most troops were likely to develop debilitating PTSD after about 200 days of combat (that is, the stress of having your life threatened by enemy fire). Israel noted another interesting angle to PTSD after the 1982 war in Lebanon. This conflict went on longer than previous wars, and used a larger number of older reserve troops. The older soldiers, especially reservists, tended to be more prone to coming down with PTSD. This was probably due to the fact the full time soldiers are constantly conditioned to deal with stress.

Currently, the navy first noted PTSD problems with their construction engineer units, or Sea Bees. These guys were often operating under fire, or in areas where they were frequently fired on. By 2005, a special "Transition Center" was established in Kuwait, where Sea Bees could spend a few days unwinding from their months of stress. There were mental health personnel there, but mainly it was a place for the sailors to get used to being without weapons 24/7, or the risk of being killed. Those who felt they had some PSTD issues, could get help before they headed home. As was learned as long ago as World War I, if you treat PTSD early on, it's much less of a problem later. Some of the sailors are reservists, or or older veterans, and combat has always been harder on this group. Moreover, having served with the army, been exposed to ground combat, and carried a weapon for months and months, made these sailors quite different from the other sailors they will serve with when they return to the navy. It all takes a little getting used to.

The success of the Sea BeesTransition Center led the navy to funnel all its Iraqi "augmentees" through it. Each year, thousands of sailors serve as individual, or small unit, "augmentees" for the army in Iraq. This takes some of the workload off the army, which is doing most of the fighting in the war on terror. While many of the sailors spend their entire tour in well guarded bases, others are outside the wire, on the roads, and sometimes under fire. The stress can get to you. Others help guard prisoners, or search for and destroy roadside bombs. The 3-5 days spent decompressing in Kuwait, before flying home, is meant to make getting home a better experience for the sailors, and their families.