PTSD and the combat soldier.

Infantry20guidons "To enhance care for soldiers suffering from PTSD, Gates announced that a security clearance form used throughout the U.S. government would be changed to free troops from an obligation to acknowledge combat-related mental-health care.

That change follows numerous studies that found troops suffering from post-traumatic stress after tours in Iraq and Afghanistan believed their security clearances, critical to their jobs, would be at risk if they sought care.

Question 21, which Gates called "infamous," asks applicants whether they have consulted a mental health professional in the past seven years. If the answer is "Yes," they must list details.

"It now is clear to people who answer that question that they can answer ‘No’ if they have sought help to deal with their combat stress in general terms," Gates told a news conference.

The form, known as the Questionnaire for National Security Positions, is used throughout the U.S. government, but the change initially affects only troops and the Pentagon’s civilian workforce.

RAND Corp estimated that 300,000 troops sent to Iraq and Afghanistan suffer from symptoms of PTSD or depression. Military studies have seen similar results. The Army in February said 17.9 percent of troops in Iraq and Afghanistan experienced acute stress, depression or anxiety in 2007."  Reuters


I guess we should ask what "in general terms" means.  Does that mean that if you felt like doing something specific about your inability to think or act like the civilians around you then you would have to report it?  You know, something like fighting in bars, or driving fast enough to forget where you are, or are not.  You know what I mean, something like that.  Like most people who know the green machine well, I am suspicious of such benevolent attitudes.  Why?  It is because the combat forces of the military, especially the ground combat forces exist to kill people and destroy things.  In the process of doing that the green machine uses soldiers up and makes them into "used people."  We all know that, don’t we fellahs?  Therefore this level of deep concern sounds strangely mommy-like.  The machine does not really like its broken parts.

Is the policy announced a good one?  Certainly.  Let’s see how it works in practise.  How many rising NCOs or officers headed upward on the fast track are going to risk what they have for Bob Gates’ opinion?  He will be gone soon, but the green machine will still be there, grinding along relentlessly.

On the other hand, it will be a problem if career soldiers are taught by the doctors and civilians that they are necessarily victims of PTSD and impaired by their experience of combat.  What will be the result of implying to professional sodiers that their metier automatically deforms them as human beings?  What are we going to do, put everyone returning from combat into therapy?

A lot of the attiudes taking hold in the USA on this subject originated in the Israel Defense Force (IDF) where it is practically an article of faith that even short periods of combat cause trauma requiring therapy.  I have discussed this with IDF veterans.  They generally agree that the circumstances of historic combat in the IDF are very different from those of US forces.  Most importantly, Israel has never fought a war in which sustained intensive combat over a long period of time has been the experience.  The sole exception might be said to be their war of independence.  They also do not fight far away from their homeland in expeditionary operations.  Lastly, they are a militia army, made up in the main of reservists.  These are civilians in uniform.  The IDF is more like the US Army National Guard than they are like what the US Army now calls "the active force" (Regular Army)

Sometimes our wars have, of necessity, required (and will continue to require) men and now women to accept protracted experience so utterly different from that of most civilians that we should be careful about making facile comparisons between the psychology of soldiers and those whom they guard.  pl

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23 Responses to PTSD and the combat soldier.

  1. Green Zone Cafe says:

    One interesting thing about the IDF is that they treat their soldiers with combat stress with cannabis as well as therapy.
    We kick them out with other than honorable discharges if they “piss hot.”
    A unit which has seen a lot of combat in its 12-15 month tour will see a lot of crazy things in the months after they come back – I’ve heard of bank robberies on post, burning down barracks and buildings in town, and worse.
    There is always a wave of soldiers who are “purged” with less than honorable discharges. Many of these could be rehabilitated with a pat on the back and a kick in the ass, but poor leadership and “zero tolerance” prevents that.
    There was a guy who was wounded and got the Silver Star for saving others in the Iraq invasion. After he got back he went AWOL and smoked pot.
    They kicked him out, too.

  2. Unfortunately, GATE’s fix while well-intentioned reflects the lack of knowledge and disconnects prevalent in high-ranking appointees on personnel security issues. While Title 5 of the CFR defines “National Security Positions” not Title 10 or 32, meaning OPM controls not necessarily any other authority, the problem goes back to E.O. 10450 issued so Eisenhower did not have to personnally remove the security of Dr. Robert Oppenhiemer. Derogatory background info has always been collected. Question is how is that adjudicated by the system. If collected often misused in an abusive, destructive manner. Perhaps White House Counselor Vince Foster’s death was also related to this same Q#21. When will the SYSTEM get it that the personnel security system is broken and misused by those who run it to hold and wield bureacratic power.This has almost nothing to do with the reality of personnel security and EO 10450 should have been revised long ago.

  3. condfusedponderer says:

    It’s not just the Army. US drug policy is overzealous and counter productive. As far as pot is concerned: When I weigh the benefits of some pot smoking kids against pot smoking kids with a wrecked life because of a criminal record (think of mandatory sentencing, ‘three strikes’ and such), I prefer the former. It isn’t worth it.
    Same for drinking in the US. You are allowed to join the army with 18 or so years, and entitled to risk your life and limb – but are not considered mature enough to buy yourself a beer? Or to be out on the street after midnight? Preposterous.
    Little anecdote: A few years back, I was on an informal party down in the park at the river at night, where a friendly Florida exchange student, 18 then (and perpetually drunk, then), matter-of-factly told me about curfew, drinking age of 21, clutched his beer, and passionately maintained that, no doubt, the US is a free-er country than Germany.
    Having smoked pot certainly is no reason for a dishonourable discharge. Disciplinary action I could understand. I can comprehend people who, after getting through war, might want to alter their state of mind. From what In was told, the WW-II survivors in Germany drank a lot. That’s normal, I presume.
    The drug war has to be fought real tough, so there will be consequences beyond mere dishonourable discharge. So I expect that in case of a dishonourable discharge some veteran benefits are forfeited, no? Not to mention that any psychological problems he might report, but didn’t already, either because he expected to cope with it alone, or wanted to re-enlist where this might be a problem, will be attributed to his reckless drug consumption, no? And of course he will have a problem finding a job – all of which cumulatively can be summed up as being way out of proportion considering the (lack of) severity of the offence.
    Anyway before I go totally off topic, let me just refer to this interesting lecture on US drug policy on the Miller Center Forum, where former cop Jerry Cameron makes some noteworthy points:

  4. condfusedponderer says:

    Of course, I meant GZC.

  5. JfM says:

    While there are certainly many returning veterans from Iraq and Afghanistan who suffer readjustment and have protracted issues needing therapy, I find the vogue trend of characterizing most returnees as suffering from PTSD disingenuous. Is this new generation so fragile that a majority truly needs professional attention upon return? Again, I do not denigrate their service or the harshness of their experience, but rather wonder about this mass treatment approach done by the well-intended mental health community. Please recall the several million men who returned from extended combat duty-many 2 or 3 straight years away- after WW2, got off the boat and commenced to build the nation we have today. Head tune-ups with this, the reputed ‘greatest generation’ were virtually non-existent. My generation, the Vietnam bunch, got little such attention save those with substance abuse demons. History shows the Vietnam vets-some 3 million of us- have been pretty darned productive, highly successful, and overwhelmingly well readjusted. Thank you very much!
    Again, some from today’s conflicts need and deserve succor. All have earned our support, respect and consideration. But a support system that actively recruits sufferers by selling all returnees suffer from PTSD does today’s veteran a disservice.

  6. Cold War Zoomie says:

    Therefore this level of deep concern sounds strangely mommy-like.
    Considering the current problems in recruiting, this could be a pragmatic way of making sure retention stays as high as possible rather than motherly concern.
    We’ve spoken before here at SST about all the branches being much more lenient with drinking and screwing around years ago. The pendulum swung from one extreme to the other. Now the people who need to blow off steam the most cannot because of this Zero Tolerance mentality GCZ mentions. I go out to Ft. Huachuca on business every now and again. They don’t even have an enlisted club there! The retired Army guys I work with regularly out there told me that this Zero Tolerance mentality has gone way overboard.
    When I was in Hawaii on business a Reserve LTC told us how fed up he is and that he’s decided to call it quits. The policies from the 1990s are piling up in a really bad way.

  7. condfusedponderer says:

    That the pendulum has swung back is probably a reflection of US drug policy at the time in general. It is only that in the armed forces, which after all has to set a shining example, so the zero-tolerance policy was implemented in especially zealous way.
    Such policies, once entrenched, are hard to reverse.

  8. wehaveseenthisb4 says:

    Ya’ know folks, being married to a Vietnamese, it is amazing to me that after the experience of fighting one war in a foreign land and an alien culture, we believed we could do it again, but this time successfully, without putting our western-based mental health in serious jeopardy … again. Insurgent wars are mind-bending affairs. Insurgent wars constantly require us to violate our western codes of valor and honor. The staggering contradictions of these psy conflicts can indeed be damaging to ones psyche. Rand says 20% return suffering from depression and/or PSTD. One-thousand vets attempt suicide a month and 18 a month are successful. There is something going on here gentlemen and it has nothing to do with what tough guys we are. It has everything to do with being human. The act of war is an abnormal mental state, sure it must be done for defensive purposes. However, to deliberately elect to send a western cultured army, like ours, 6 to 8,000 miles from home, into a climate/terrain which is utterly foreign and into a culture/religion which is truly alien to us is not like sending them to Europe. Rather it requires our troops to live in unfamiliar climates and landscapes while trying to distinguish between good guys and bad guys who hide among civilians (who often support them), while being constantly on alert for ambushes and roadside bombs. To not accept the fact, that these abhorrent experiences, in a totally foreign environment, are not damaging to the participants mental health, is really to deny reality and the psy research that confirms it. When will we ever learn? There are some fights we just should not pick. Violence is the result of incompetence … we need to find another way, for the mental welfare of our military and our country. I’d recommend viewing the Sec Defs statements from this perspective as well.

  9. wehavebeenhereb4 says:

    Apologies, citation omitted:
    “Violence is the result of incompetence”, Issac Asimov.

  10. W. Patrick Lang says:

    The question for me is — Have YOU seen this before? Being married to a Vietnamese does not qualify you as experienced.
    “The act of war is an abnormal mental state.” Maybe, maybe not. That depends on whether or not you accept the received wisdom of the social sciences “community” about this. pl

  11. Green Zone Cafe says:

    Another consideration is that as the war has progressed, the prevalence of PTSD-like symptoms become more widespread in the forces in Iraq and Afghanistan. In 2003 everyone was pretty fresh, things were new and hopeful. Now, anyone who was in the forces in 2003 and still in now has seen at least two tours (more for the 7 month USMC deployments). The effect is cumulative.
    It’s also present in the private security gunslingers. In 2003, they were drawn from ex-SOF guys in their 30s and 40s: mature and rested. Now, they are drawn from the guys who have already done 2 or more tours with Rangers, USMC and others. Not exactly a fresh and relaxed bunch, in my opinion. Result: Nisoor Square.
    There’s a book to be written on the subject of PTSD among the Iraqis, too. I’m sure cultural factors are different, but I am amazed at what they have to put up with just living in Iraq, not to mention any baggage an individual might have from the Iran-Iraq war, the Gulf War and uprising and the day-to-day terror of the Saddam regime.
    For example, I know a Shia guy who was in the trenches against Iran for seven years, the Kuwait war, the mutiny and uprising, the retaliation, and then was an interpreter for the Americans before he left Iraq. Now that’s some heavy experience.

  12. Montag says:

    Israeli soldiers are basically glorified policemen now. Their main job is not to fight enemy armies but to boss Palestinian civilians around. This can have a devastating effect upon their psyche all its own. Witness the stories of gratuitous inhumanity that Israeli soldiers are telling now. One young Ultra-Orthodox Jewish woman explained her excercise of her legal exemption from military service by saying that she didn’t want to waste 18 months of her life pushing Palestinian women around or serving coffee to generals.
    Israel’s Lebanese Morass of 1982-2000 was farther away than you might think. One soldiers’ ditty went:
    Aircraft come down from the clouds
    Take us far to Lebanon
    We shall fight for Mr. Sharon
    And come back, wrapped in shrouds.

  13. jr786 says:

    I would think the 18 year Israeli occupation of Lebanon provided mountains of information on the results of being an unwanted presence in a hostile environment.
    At this point, over 5 years into the occupation of Iraq, I have yet to read of any meaningful cross-cultural interactions between ordinary Iraqis (Muslim Arab) and American soldiers. I’d be grateful if anyone could provide me a reference to any studies or reports on American/Iraqi interactions, other than the usual Petraeus drinking tea with tribal leaders nonsense.

  14. Babak Makkinejad says:

    Fight to a Finish
    The boys came back. Bands played and flags were flying,
    And Yellow-Pressmen thronged the sunlit street
    To cheer the soldiers who’d refrained from dying,
    And hear the music of returning feet.
    ‘Of all the thrills and ardours War has brought,
    This moment is the finest.’ (So they thought.)
    Snapping their bayonets on to charge the mob,
    Grim Fusiliers broke ranks with glint of steel,
    At last the boys had found a cushy job.
    . . . .
    I heard the Yellow-Pressmen grunt and squeal;
    And with my trusty bombers turned and went
    To clear those Junkers out of Parliament.
    Siegfried Sassoon

  15. Neil Richardson says:

    Dear COL Lang,
    At least from anecdotal evidence it appears we are losing promising captains and SNCOs who’ve done multiple tours. Whether the deciding factors were family hardship or PTSD, I have no idea. What seems clear though is that when we have a near 100% promotion rate to 0-3 in three years in the Army, I just don’t know if we are preparing the service for the long term challenges. Certainly in times of war combat arms have rapid promotion rates, but a lot of that has to do with the expansion of personnel base not to mention the inevitable combat attrition. However when I see such promotion rates across the board without a corresponding increase in the force size, I have serious doubts about whether the current approach to solving retention rate challenges aren’t creating long term institutional problems.
    IIRC the Army had suffered a similar crisis in Vietnam in the late 1960s when the Regular commissioned officers and SNCOs left the service after multiple tours. In my own experience, the early years of the AVF were challenging times as we were always struggling to find enough quality no matter what monetary inducements were offered. As GEN Meyer said, it’s rather easy to break an army but awfully difficult to rebuild it. I’m rather torn about the PTSD issue as I have trouble defining a “functional” soldier in wartime. What motivates a kid on the line to re-up after a tough tour? Is it unit cohesion? I’m skeptical as it many don’t return with the same unit the second, third time. Is it monetary inducement? When the British Army transitioned to a professional force after the National Service, they had a lot of problems signing up more than what they called “the Foreign Legion hard core”. If the United States is set on engaging in “small wars” for the foreseeable future, do we adopt a regimental system a la the British Army before the Boer War (or perhaps the US Army in the Plains Indians Wars)? Obviously I have no idea what is the best course for the service as the Army gave COHORT a half-hearted try. What bothers me though is that we are obviously not going to ask serious questions about the future of the Army in a national debate.
    I’m curious though on the effect of unit cohesion and PTSD. Intuitively it seems to me a soldier has a better chance of “functioning” with PTSD when he is in the company of friends and comrades he trusts. Logistically and operationally, this is probably a pipedream but would it make a difference if a unit rotated back together to the previous area of operation in Iraq or Afghanistan? It seems the USMC Combined Action Platoon program has been cited as a possible model for COIN, but doesn’t this require retention of institutional knowledge (especially pertaining local culture and terrains)? I guess what I am asking is how do we avoid fighting a one year war (heaven forbid) ten times in the face of possible challenges like PTSD and falling retention rate of perhaps right individuals.
    For those of us who’ve volunteered for service generation after generation, I think we have a support structure in our families who at least have some understanding of what many of us have experienced. Whether it’s a silent nod or just a friendly pair of ears who’d let us describe something without passing judgment IMHO does more to help a person re-center, but I do understand my view might be a minority one.

  16. Mike Etts says:

    Sounds to me like Gates has made an expedient decision based on staffing needs. That is, it is better to retain career minded people who sought help, rather then accepting more ex-felons.
    For some light reading about PTSD from a producer of war documentaries, try Ben Shephard’s “A War of Nerves.” It’s a critical view of psychiatry, suggesting that it can reward malingerers and make people worse off. His conclusion implies that long ship journeys home, well lubricated with alcohol and song, was enough “treatment” for most veterans. Depends on the veteran, I would say.
    There should not be a standard treatment plan for all veterans. To combine all soldiers in a single group is to ignore key factors in the ability to manage traumatic stress. One factor is whether the veteran in question was raised to be “securely attached,” as they will fare far better than those who are insecurely attached. This point of view has a deep well of research to back it, but will be subject to dismissive quips like “Oh, so mommy didn’t treat you right, huh?”
    There is a growing body of knowledge arising from clinicians who specialize in working with trauma survivors, e.g., Bessel van der Kolk, Dr Bruce Perry, Babette Rothschild, Dr Judith Hermann and others. I doubt Gates will consult with any of them, which is a loss for all involved.
    People entering a war are carrying a personal history with them. All things being equal, those who go in vulnerable will be more likely to suffer from PTSD. It makes sense to have perfunctory testing of returning veterans and more in-depth testing for those who express difficulties in adjusting. Yes, Ben Shephard is right, a few malingers will game the system. But should we deny care to deserving vets based on that?

  17. avedis says:

    JfM, One tends to hear comments like yours (re; the greatest generation being immune to PTSD) to often.
    Let’s get it straight. In prolonged campaigns – like Okinawa – WW2 Marines suffered nearly as many psychiatric casualties (evacauted for) as they did KIA and WIA.
    This is fact. Sorry if it deflates any mythology that you hold dear.

  18. Mad Dogs says:

    Totally OT here, but would love to read your take on this piece on Time’s website entitled “How Much Did Rumsfeld Know?” from General Ricardo Sanchez’ memoir.
    Particularly interesting is Time’s focus on the masse abandonment “redeployment” from the field by CENTCOM and CFLCC staffs in May/June 2003 leaving General Sanchez in charge with his V Corp operational/tactical staff, and the apparent fact that no one, including Rumsfeld knew or had ordered such an exit.

  19. Arun says:
    Annihilation of the spirit. The game does not appear to be worth the candle. What is seen through the explosions is that this, no less than any other war, is not a moral war. Greek against Greek, against Persian, Roman against the world, cowboys against Indians, Catholics against Protestants, black men against white — this is merely the current phase of an historical story. It is war, and to believe it is anything but a lot of people killing each other is to pretend it is something else, and to misread man’s instinct to commit murder.

  20. anna missed says:

    The army obviously has a big problem with this PTSD. As mentioned above the reasons are many, and most are symptomatic of how the war in Iraq&Afghanistan have been prosecuted, most especially the strobe light like repeat deployments.
    The real problem with PTSD though is that once afflicted, the condition is usually chronic. So it makes some sense for the condition to be “normalized” and treated within the services as opposed to “purging” them into civil society. Because the government is going to be paying for them (in disability %’s) for a long long time anyway.

  21. wehaveseenthisb4 says:

    Resource materials on the subject:
    Study: 300,000 vets have depression or PTSD
    Invisible Wounds of War
    Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery
    Lawsuit: V.A. Failed To Prevent Suicides
    Suicide Epidemic Among Veterans

  22. Pale Rider says:

    Sure–they can strike Question 21, but as anyone knows, the most important ones–Questions 27, 28, and 29–are about ANY kind of “illegal drug use” and the number one item detailed is marijuana. And Question 30 asks about alcohol and whether or not use of alcohol led to any kind of counseling,
    Seems to me, they can strike Question 21, confident they will catch anyone who has PTSD who “self-medicates” with marijuana or alcohol, and as we know from the data, sufferers of PTSD have to self-medicate with whatever they can find while they await treatment in a very slow system and while they go through a phase of getting their various life issues under some kind of control.
    The medications that go with that treatment have always been of interest on the clearance paperwork as well–meaning, if you were prescribed valium or some other form of legitimate drug for treatment, you had to disclose that in detail as well. So I hope they end the scrutiny of counseling AND they end the scrutiny of asking what medications were used to treat the PTSD.
    They’re playing a game. They don’t care if you went to marriage counseling. They WANT TO KNOW if you had a prescription, if you self-medicated for a time with whatever you could find, etc.

  23. Babak Makkinejad says:

    US military is investigating and researching using a network of sensors to collect physilogical (and possibly psychological) data from each and every soldier.
    With proper calibration, this data can be mined and later used in making promotion decisions.

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