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).
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
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.