Combat fatigue (or PTSD, post-traumatic
stress disorder) is nothing new, but better diagnostic tools, plus political
and media exploitation, are making it a lot more visible. This has resulted in
better methods for dealing with it. But this has uncovered two particularly
vexing problems. First, only about a third of the troops with PTSD will seek
treatment. Second, research, and practical experience, has shown that the best
time to deal with PTSD is as soon as it shows up. That spotlights another
problem, that PTSD usually first manifests itself while troops are still in the
combat zone, if not in combat itself. This has meant stationing lots of mental
health personnel as close to the fighting as possible. Getting troops to
acknowledge that PTSD is just another combat injury has proved difficult. But
there is progress, albeit slow, in getting the troops to report problems they
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. Many of these symptoms
were noted while troops were still in uniform. And if enough troops in a unit
were showing the symptoms, the unit was described as "shaken," and not all that
ready for combat.
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. Again, the symptoms were noted among troops still in the
trenches. But many senior commanders thought shell shocked soldiers who refused
to fight were cowards or shirkers. Many of these men were shot for refusing to
fight. But many medical officers saw what was really going on, and began
developing ways to diagnose and treat PTSD.
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 began compiling
lots of data on troops so affected. 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).
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. Israelis also began
intensive research into PTSD around the same time, and have led the field ever
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 quickly and 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. The beg issue now is getting troops to recognize PTSD as just
another combat injury, and to get it treated as soon as possible, before it
gets worse, or causes permanent damage. This campaign is making progress, but
it's slow going. Mental illness scares people, always has, probably always will.
But the troops in a combat zone tend to be mercilessly practical. If you don't
fix things that break, that lapse can get you killed.
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. There has not been any surge in PTSD injuries, and the
stats seem to show that efforts to deal with PTSD quickly, and on the spot, are
having an impact.