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The Spokesman-Review Newspaper
Spokane, Washington  Est. May 19, 1883

Opinion

Healing the wounds of combat

Paula J. Caplan The Washington Post

In 1996, in his late 20s, Robert joined the Army Reserve to get help with college tuition. The reserve’s demands weren’t much of a hardship — until 9/11, when his life was turned upside down. First assigned to full-time duty as an airport guard, he was sent to Kabul eight months later. In Afghanistan, he counted the minutes until he could get back home. But when he did, half a year later, he found himself “all at sea.”

The people around him, he felt, “acted like I’d never left. For them, nothing was different.” His feelings of turmoil were exacerbated by an uneasy sense that he had no right to them, as his unit had been shot at only once.

When he couldn’t shake feelings of depression after nearly a year at home, his sister finally suggested that he see a therapist. It seemed like the obvious solution to her, and I can see why. After all, we sent many Vietnam and Gulf War vets behind psychotherapists’ doors to deal with their anguish, and we’ve come to think it’s the best thing to do. Unfortunately, in our over-psychologized society, we’ve also come to think that it’s the only thing to do.

We’ve failed to learn what the vets of previous wars have taught us – that although therapists clearly help some soldiers, there is only so much emotional damage from war they can fix. Leaving this work to psychotherapists alone may be not only harmful to the soldiers but also dangerous for us as a nation, because it helps hide the consequences of combat, making it easier for us to go to war again the next time.

Simply sending frightened, angry soldiers off to therapists conveys disturbing messages: that we don’t want to listen, that we’re afraid we’re not qualified to listen, and that they should talk to someone who gets paid to listen. But it’s important for the rest of us to let returnees know that we don’t consider them weak or crazy for having problems.

According to U.S. Army reports, the suicide rate for American soldiers in Iraq is 17.3 per 100,000, nearly five times the rate for the Gulf War and 11 percent higher than for Vietnam. As of March this year, seven soldiers had committed suicide after returning from Iraq. Clearly, the emotional casualties of this war are already extremely high, and it is likely that the longer troops remain in Iraq and Afghanistan, the worse they will get.

Many soldiers’ first instinctive response to witnessing the horrors of war is to repress their feelings and never talk about them. Traditional prescriptions for men to be tough intensify the expectation that, no matter how soldiers suffer, they should handle it alone. As more women take on combat roles, the same expectations apply to them. So, having seen a buddy blown to bits or realizing that they have killed an Iraqi child, many soldiers choose to suffer in silence.

Help for traumatized troops must really begin on the battlefront. Yet the military’s response has been largely inadequate, even misguided. When soldiers have breakdowns in combat, military therapists give them a little rest and a chance to talk with a counselor, then send them back into the fray, rationalizing that this helps prevent “survivor guilt.”

But sending psychologically fragile soldiers back into combat is wrongheaded; they’ll likely feel guilt no matter what. Instead, therapists should advise commanding officers that these are the last people who should be sent back into battle. They should also seek ways to help the soldiers handle survivor guilt, such as pointing out that their deaths would not guarantee that others would live.

One military program, called Operational Stress Control and Readiness, or OSCAR, provides treatment in combat zones that includes antidepressant medication, usually Prozac. Though no one would begrudge a soldier anything that might dull the terror of combat, the truth is that the feelings they experience don’t disappear and will have to be dealt with eventually. And there’s something Brave-New-World-like about sending people into situations where they’re endangered and feel helpless, and then when they crack, giving them drugs to change their brain chemistry so they can return to battle.

The military touts its debriefings for soldiers heading home. With these programs, which often last 10 days or fewer, it hopes to decrease the violent behavior some soldiers exhibit when they get back home. The Army increased its counseling after three soldiers back from fighting in Afghanistan were accused of killing their wives in 2002. Returnees are alerted that they may have nightmares and short tempers, reminded that their wives have been making all the decisions and may not want to give up that power, and warned that their young children might not recognize them. That’s a good beginning, but for many, the debriefings are inadequate.

Every one of us needs to shoulder a bit of the burden of helping our soldiers and our returning civilians with their reentry into ordinary life. In June, I was at the bank when I heard a customer with red crew-cut hair boast, “We were with the 82nd that got Saddam.” When the bank teller expressed awe, the soldier retreated a little, saying, “Well, I didn’t actually see him. But some of our guys did.” Another customer said, “Thanks for keeping us safe,” and the soldier straightened up and boomed out that he was headed for Afghanistan soon. “Gonna get bin Laden,” he declared loudly.

As he walked past me on his way out, I remarked quietly that I was frightened for him. His straight-as-a-board posture vanished, and he said, “I got stabbed in Iraq. We’re sitting ducks. And it’s weird being home. Can’t stop watching my back.” Given a chance to voice anything other than the expected bravado, out came his natural feelings of vulnerability.

A recent study in the New England Journal of Medicine showed that 38 percent of soldiers thought to be mentally ill did not trust therapists, 50 percent worried that seeing one could harm their careers and a full 65 percent feared being seen as weak. Realistically, these barriers to therapy won’t be overcome anytime soon.

So we citizens must accept the social responsibility of telling returnees not only that we will listen but that we will listen for as long as they want to talk about how it felt to be over there and how it feels to be back. We need to tell them not to censor themselves for fear of upsetting us, offending our sensibilities, making us feel helpless to help them or making us angry at them. If we fail to do this, then we become complicit in concealing some of war’s most devastating consequences. And to refuse to face these fully is to increase the chances that we will go to war again.