March 23, 2009: For the first time since World War II, Germany has had to deal with soldiers suffering from PTSD (post-traumatic stress disorder). Last year, 245 German soldiers, who had served in war zones (including Afghanistan), were classified as PTSD casualties. The year before, there were only 83 PTSD casualties. While the 3,400 German troops in Afghanistan are not allowed to go looking for a fight, they are increasingly getting attacked by the Taliban, or whoever is the bad guy where the German troops are. This causes stress. Just the thought of it can be stressful. In the last three years, some 62,000 German troops have been stationed in combat (or peacekeeping) zones, where they can be exposed to traumatic events.

During that same period, the U.S. had about half a million troops in combat zones, and they are usually looking for the bad guys. But things have calmed down since the peak year of combat, 2007, when 904 Americans died in Iraq (and 117 in Afghanistan). In that year, there were about 14,000 American PTSD casualties.

It's not the prospect of getting killed that causes the stress, but rather the constant state of alertness required to survive in combat. Death and injury is always a factor in military life. Over the last 25 years, the U.S. Army has always lost one or two thousand dead each year to accidents, disease and suicide (in that order). That meant about two troops per thousand died each year. In Iraq, the risk of getting killed or wounded in combat was 2-3 percent for a one year tour, in the worst years.

It was during World War II that researchers began compiling lots of data on troop stress and its effects. It was 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). But today there are other factors. Israel noted, after the 1982 war in Lebanon. That reservists were more sensitive to the aftereffects of combat. The Lebanon conflict used a larger number (than previous wars) of older reserve troops, who tended to be more prone to coming down with stress disorders. This was probably due to the fact the full time soldiers are constantly conditioned to deal with stress. While this is often referred, often derisively, as "military discipline," it has been known for thousands of years that such practices reduce stress and panic during combat. Apparently it reduces the chances of coming down with stress problems as well.

In Iraq, army combat troops often get 200 days of combat in one 12 month tour, which is more than their grandfathers got during all of World War II. And some troops are returning for a third tour in Iraq. The army has found ways to avoid the onset of stress problems (better accommodations, email contact with home, prompt treatment for any problems), but many troops are headed for uncharted territory, and an unprecedented amount of time in combat. Thus new programs to spot stress related problems, as early as possible, and new treatments as well. The stress angle has been more intensively studied in Iraq than in any previous war. Naturally, the more you look, the more you find.

The German military has been looking at what the U.S. has been doing to treat its much larger number of PTSD casualties. Many of the American techniques were acquired from the Germans after World War II, during which Germany suffered more than ten times as many casualties as the United States. But the Germans were much more successful at treating PTSD during World War II. However, after the war, the German attitude towards military matters changed. Rather than being an honored profession, the military was seen as little more than a necessary evil. Germans still make good soldiers, but the nation as a whole is reluctant to fight, or spend a lot of money planning for problems like PTSD.