Attrition: Not Fit For Combat


July 8, 2010: Nine years of war have left over 5,500 U.S. troops dead and over 40,000 wounded, There have been over 100,000 badly hurt by accidents and disease. While most of the sick and wounded have been treated, and often discharged, there are now 13,000 active duty troops (over two percent of army strength) who cannot be sent to a combat zone because of injuries, illness or PTSD (post-traumatic stress disorder). Even in peacetime, there are some troops who have a �profile� that makes them ineligible for certain types of duty. But because of the large number of casualties in the combat zone (including injury and disease), and the need to keep experienced NCOs and troops with technical skills, the number of those with a profile is more than three times what it normally is in peacetime.

For the U.S. Army, this is not unexpected. Over a million American military personnel have gone to Afghanistan and Iraq since 2001, most of them army, and as more of them came back wounded, sick or injured, the number of people with a profile increased. This was particularly true with PTSD, which has become the most common reason for a profile that keeps troops out of combat.

But the army is also having a growing problem with soldiers who claim PTSD, when they actually have other psychological problems, usually ones they had as civilians (addiction, anger management). These troops are usually detected by staff, and other recovering soldiers, at the Warrior Transition Units, where troops needing long term recovery are sent. This is a sensitive subject, as the suspected PTSD pretenders, who may not be fooling fellow soldiers, can always find a sympathetic journalist.

A growing proportion of NCOs and officers are doing their third or fourth combat tours (in Iraq or Afghanistan). Thus a PTSD epidemic has been created by the unprecedented exposure of so many troops, to so much combat, in so short a time. Once a soldier has PTSD, they are no longer fit for combat, and many troops headed for Afghanistan are falling into this category. PTSD makes it difficult for people to function, or get along with others. With treatment (medication, and therapy), you can recover from PTSD. But this can take months or years.

Nearly a century of energetic effort to diagnose and treat PTSD (including much recent attention to civilian victims, via accidents or criminal assault), had made it clear that most troops eventually got PTSD if they were in combat long enough. During World War II, it was found that, on average, 200 days of combat would bring on a case of PTSD for American troops. After World War II, methods were found to delay the onset of PTSD (more breaks from combat, better living conditions in the combat zone, shorter combat tours, prompt treatment when PTSD was detected). That's why combat troops in Iraq and Afghanistan often sleep in air conditioned quarters, have Internet access, lots of amenities, and a two week vacation (anywhere) in the middle of their combat tour. This has extended their useful time in combat, before PTSD sets in. No one is yet sure what the new combat days average is, and new screening methods are an attempt to find out. But more troops appear to be hitting, or approaching, the limits.

What the army does know is that a large percentage of its combat troops have over 200 days of combat. Some have three or four times that. A major reason for army generals talking about the army "needing a break" (from combat) is the growing loss of many combat experienced troops and leaders (especially NCOs) to PTSD. The army won't give out exact figures, partly because they don't have much in the way of exact figures. They know how many troops have a medical profile preventing them from going overseas, but not a number of how many of their key combat leaders, especially NCOs, are at risk. It's expected that, over the next decade, the army will get a clearer picture of how well they have coped with PTSD, among troops who have, individually, seen far more combat than their predecessors in Vietnam, Korea or World War II.

This huge increase in PTSD research has revealed some new sources of PTSD. For example, there was the discovery that many troops, because of exposure to roadside bombs, and battlefield explosions in general, had developed minor concussions that, like sports injuries, could turn into long term medical problems. Often these concussions were accompanied by some PTSD.

The army is dealing with PTSD head on, believing that a lot of troops have experienced a lot of combat stress. Experience so far has shown that PTSD can be delayed, perhaps for a long time. When a soldier does come down with it, PTSD can often be treated, and its effects reversed. This has large ramifications for non-military medicine, for many civilians suffer from PTSD. That's because military recruits are screened for their ability to handle stress and resist PTSD. In the civilian community, there are far more people who can acquire PTSD after exposure to much less stress.





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