Attrition: Israel Deals With A Stress Epidemic

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January 13, 2017: At the end of 2016 an Israeli court convicted an Israeli soldier (Elor Azaria) of manslaughter for killing an immobilized terrorist in March 2016. Soldiers and police are usually given the benefit of the doubt in situations like this, but Israel puts those accused of unjustified violence on trial or at least conducts an investigation and publishes detailed results. But this time there was a rare conviction and it has divided Israel. In part this is because many, if not most, adult Israeli males have spent some time providing security from Islamic (usually Palestinian) terrorists and are personally familiar with the stress and uncertainty of such situations. Palestinians have a different attitude. Palestinian leaders praise (and pay cash rewards to) any Palestinian who kills Jews (including women and children). Palestinians often use foreign aid (mostly from the West) to cover the cost of these rewards and pensions (for imprisoned killers and wives of dead ones). All that may count for something when it comes to Israeli public opinion but Israeli courts tend to stick to the immediate facts. That’s where it got interesting in the Azaria case.

The incident occurred in when two Palestinians used knives to attack Israeli soldiers and were shot dead, one immediately and the other later because a soldier (Azaria) suspected the wounded Palestinian was about to detonate explosives. Azaria was later arrested and accused of murder because an officer had already checked the wounded Palestinian for explosives. The arrest of the Israeli soldier caused a media and political controversy among Israelis who saw the arrest as a political stunt to appease foreign critics of Israeli security practices and the reality, to most Israelis, of how Palestinian leaders regularly broadcast lies about Israel to encourage such attacks. For example, Palestinian media regularly features accusations that Israel, not ISIL (Islamic State in Iraq and the Levant) was responsible for recent terror attacks in Europe and for the creation of ISIL itself.

All the media uproar encouraged threats against the friends and family of Azaria. What was missed in all this was the fact that the Palestinians were victims of cynical and relentless Palestinian government propaganda praising, rewarding and encouraging suicidal attacks against Israelis and that was something that has been causing an increasing amount of stress among Israeli security forces who spend month after month facing the daily threat of another attack. Many Israeli veterans thought Azaria was probably another victim of combat stress, something Israelis have had to deal with more and more since the 1980s. The military does not like to discuss the combat stress too much because a lot of bad behavior by soldiers in combat situations is a common symptom of soldiers who have been under too much stress for too long. Some troops can handle a lot of this stress while others turn out to have little ability to cope and get killed or act unpredictably. Historically a lot of friendly fire casualties are inflicted by stressed out troops who have lost touch with reality and fire at anyone who is armed (and thus a potential threat). Veterans rarely talk about this with each other much less with non-vets or the media. There are a lot of things about combat veterans won’t talk about for years, if ever and not all of them are technically illegal.

The Azaria incident, a soldier killing a wounded and unarmed attacker, is more common than the military, in general, would like to admit. So is combat stress or, as it is now called; PTSD (post-traumatic stress disorder). This became a major problem during World War I and by the time World War II began most armies that had seen a lot of action during World War I had made preparations to more effectively deal with those driven into an unstable and unpredictable state by too much time in combat.

PTSD continues to be a problem in Israel because of the constant threat of Islamic terrorism. Although Israel shut down a major Palestinian terror campaign in 2005 there were deadly aftereffects. Since 2005 Israel has lost more troops to suicide than to combat. These suicides are largely driven by stress and Israel has taken the lead in searching for ways to identify and treat PTSD. This is all about detecting troops with PTSD and to what degree they have it. In addition to suicide, Israeli researchers have found that stress (the major cause of PTSD) made troops less vigilant, not, as conventional wisdom long held, more vigilant. A lot of stress tended to make troops zone out, as a way to cope. Some troops did buckle down and become more alert under stress but not the majority. Lack of vigilance in a combat zone is a major source of death, injury, and getting yelled at. It’s long been known the troops who have been in combat often won’t talk about it. Many of these veterans are more often depressed, often to the point of suicide or, more rarely, attacking and killing others.

Since World War II several other aspects of PTSD have been discovered. Israel noted, after the 1982 war in Lebanon, that reservists were more sensitive to the aftereffects of combat. The Lebanon conflict used a larger (than previous wars) number 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 been referred to, 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. This led to new programs to spot stress related problems as early as possible. This also led to the development of new treatments for these stressors.

Israeli researchers also found markers in the blood that indicated someone has PTSD. This was long suspected but had to wait until techniques and technology capable of detecting such markers was available. Other researchers found that patients suffering from PTSD, along with other forms of mental distress (substance abuse, depression, chronic pain) had different brain images (provided by CT scans) than those with just PTSD. Research is also showing that PTSD is a distinct form of mental distress. For example, research turned up the fact those who had killed someone in combat were 40 percent more likely to show symptoms of PTSD or similar symptoms found in those who suffered concussions from roadside bombs.

Many troops, because of exposure to roadside bombs and battlefield explosions in general, have developed minor concussions that, like sports injuries, can turn into long term medical problems. Often these concussions were accompanied by some PTSD. Further research documented the connection between concussions, and other brain trauma, and some forms of PTSD.

There is a PTSD epidemic right now, created by (for the Americans) the unprecedented exposure of so many troops to so much combat in so short a time. For the Israelis PTSD is caused by thousands of reservists being called up each year for security duty along with young conscripts who are spending a lot of time in stressful situations known to cause PTSD. This security duty means you have to continually handle particularly stressful encounters with Arabs or nervous Israeli civilians. But what is actually happening is the discovery that much of what is thought to be PTSD is actually physical injuries (to the brain) that can now be detected (with more precise instruments like MRI and blood tests) and often treated. Thus it is becoming clear that there are several different conditions here, all with similar PTSD symptoms but not with similar effects on the brain. Each strain of PTSD will require a different type of cure. Finding these cures is increasingly important, since better diagnostic capabilities has made it possible to more frequently, and accurately, diagnose PTSD.

None of these discoveries is going to cure PTSD but they are examples of how new technology (how to easily measure neurosteroids in the brain and cheaper and easier brain scans) has made it possible to isolate the physical factors operating in PTSD patients. That kind of incremental success results in better treatments for PTSD. Success in this endeavor can be measured, in part, by reductions in the suicide rate among troops.

PTSD has been around for as long as humans have been exposed to terrifying situations. But only since the 1980s has there been a lot of scientific research on the subject. It is now known that about twelve percent of people exposed to a traumatic situation (combat, car crash, whatever) will eventually develop psychological problems (can't sleep or concentrate, plus irritability, nightmares, and flashbacks) months after the trauma. Until the development of tests that accurately identified those most likely to develop PTSD you had to watch everyone if you wanted to identify the PTSD victims. The new blood test will make it easier to treat PTSD victims, who can, in most cases, have their PTSD cured or minimized if they get the right treatment quickly enough.

Palestinian leaders are less concerned about stress than about staying in power. As a result Palestinian media regularly and blatantly encourages suicidal attacks against Israeli soldiers and civilians using any means available. Many veteran Israeli officers, NCOs and emergency medical personnel believe it is only a matter of time before a wounded Palestinian attacker uses some other weapon to harm soldiers or medical personnel. Islamic terrorism experts find that doubtful as it is more likely that if Palestinian suicide attackers had more access to explosives they would simply use them against Israeli soldiers or police. But the lack of such activity indicates that Palestinian leaders are aware of the fact that attacks using explosives tend to kill more innocent (Moslem) civilians than soldiers or police. Nevertheless the fear among the frontline security and medical personnel is real and this arrest of an Israeli soldier brought this problem into the open. Actually it’s an old problem with combat troops, where the policy of “it is safer to just shoot to kill” is often tolerated and combat veterans don’t talk about it. But cheap video cameras and cell phones have made it impossible to keep things like this quiet.

Outside of Israel there have been similar incidents, especially in Afghanistan and Iraq. In 2010 two British Royal Marine Commandos (a 25 year old captain and a 34 year old sergeant) were court martialed. The sergeant, a 17 year veteran, was dismissed from the marines. The captain's career is ruined because of the conviction. The charge was beating a man caught trying to plant a roadside bomb. The Afghan suffered a split lip (requiring four stitches) a cut on his forehead (no stitches) and two loose teeth. A marine military policeman caught the sergeant beating the Afghan and the captain was in overall charge of the operation.

Such disciplinary action is not restricted to British forces. Three U.S. Navy SEAL commandos were prosecuted for hitting an Iraqi terrorist they captured in 2009. The Iraqi was responsible for the murder of four civilian security contractors in Fallujah six years ago, and many other atrocities since. The SEALs are accused to punching the prisoner in the stomach.

These prosecutions are meant to discourage troops from using unnecessary force on hostile forces. Such violent incidents are often seized on by the mass media and become political problems for government officials and military commanders. The easiest way to placate the media is to punish some of the troops involved in roughing up the enemy.

 


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