March 26, 2007: The current concern about combat fatigue (or PTSD, post-traumatic stress disorder) is nothing new, but better diagnostic tools, and political exploitation, are making it a lot more visible. PTSD was first noted after the American Civil War. 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 "Post-Traumatic Stress Syndrome" became popular, until it evolved into 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 an 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. 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 PTSD as well.

After the 1991 Gulf War, and today as well, a new variation has become popular, one that puts more emphasis on non-mental diseases. This situation was first noted during World War II, when soldiers returning from the Pacific battlefields later turned up in Veterans hospitals with unfamiliar physical symptoms. This was later found to be the result of diseases that doctors in temperate zone countries were unfamiliar with. Veterans who served in the Middle East and Afghanistan are having the same problem. The Department of Defense knew as long ago as the 1970s (spurred by Vietnam experience) that there were probably a number of unknown diseases lurking about in the Middle East. Doctors who treated expatriates working in the Persian Gulf had already reported some of these conditions, especially among non-natives who spent a lot of time out in the uninhabited (except by exotic bacteria and viruses) areas. It is now known that stress, like the stress of being in a combat zone, can reduce the effectiveness of a persons immune system and make them more susceptible to all manner of unfamiliar diseases.

There been a lot of progress in developing treatments for PTSD. The Germans and the British were very effective in their treatment of PTSD during World War II , and the U.S. adopted many of those techniques (recognize the condition for what it is, and treat the troops close to the front) after the war. The Germans and Brits were ahead of the US because of extensive experience with PTSD during World War I.

PTSD prevention is one reason U.S. and British troops live so well in a combat zone (air conditioned sleeping quarters, good food, fast medical care, lots of amenities). This has probably extended the PTSD limit to 300 (or more) combat days. But U.S. troops can now accumulate that much action in two or three twelve month tours in Iraq or Afghanistan. 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.