Morale: Coping With Combat Fatigue


April 24,2008: The U.S. Army sees increased "dwell time" (how many months spent at their U.S. base for every month spent in a combat zone) as a partial cure for combat fatigue, and a major boost for morale. Currently, because of last year's surge campaign in Iraq (the addition of five more brigades in Iraq and extension of tours from 12 to 15 months), troops spend a bit less than a month at home for each month in combat. This year, the dwell time will return to one month at home for each one in combat. By 2009, it will be 1.5 at home for each one in combat. Eventually, the army wants to get dwell time up to three months for each one in combat. But it may be 5-10 years before that is possible.

The stress of repeated trips to combat zones like Iraq and Afghanistan is having an effect on American troops, as mental health professionals expected. Currently, for every soldier killed in combat, at least one is sent back to the United States because of severe PTSD (post-traumatic stress disorder), and several others are treated in the combat zone for less severe cases. During World War II, PTSD was an even more serious problem. In the European Theater, 25 percent of all casualties were disabling PTSD cases. In the Pacific Theater, the rate varied widely, depending on the campaign. In some of the most intense fighting, like Okinawa in 1945, PTSD accounted for over a third of all wounded. In Iraq, less than ten percent of the wounded are PTSD.

The stress of combat, and how to deal with it, has been a hot research topic since World War II. The war on terror is unique because it is sending more troops into combat, for longer periods, than ever before. As expected, the more time troops spend in combat, the more likely they are to suffer from disabling degrees of stress. The troops who have been in combat are being closely monitored by mental health professionals, more so than at any other time in history.

There are two major theories to dealing with the stress. On one hand, if troops can stay at their stateside base for 18-24 months between 12 month tours, or 12 months between six month tours, they will recover sufficiently to deal with another bout with combat. Research indicates that the six month tours are easier to recover from. With email and easy communications with people in the combat zone, the shorter tours do not waste as much time, getting the lay of the land, as in the past. Thus the shorter tours are more effective than in the past, where troops had to spend their first few months just getting to know who was who and what was what. Units know a year or more that they are going over there, and who they are going to replace. The two units now get in touch months before the relief, and bring the new crew up to date with written reports, pictures and even videos. This preparation is also believed to lessen the development of PTSD.

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, which is now fifteen months. 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. A recent survey of troops who had served in Iraq and Afghanistan, found half of them still had some mental or physical health problems six months after returning from overseas.

Then there's the money factor. Combat pay and re-enlistment bonuses for combat troops provides a temptation to ignore stress symptoms and stay in a combat job. There are plenty of non-combat jobs you can transfer to, and for many of those, there are also large re-enlistment bonuses. This problem largely affects senior NCOs, who take a decade or more to develop, and provide essential combat leadership. Given the experience and maturity of these men, problems are not expected. But the army and marines have to keep a close watch, because it's a unique situation and no one is sure how it will all turn out. Currently, it appears that many combat veterans with hundreds of days in action, may be transferred to non-combat jobs, before they become permanently impaired. This was a practice used, informally, as far back as World War II.




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