Healers of hidden wounds

Goal: Military counselors and therapists are shadowing U.S. troops in Iraq to try to minimize long-term effects of post-traumatic stress disorder.

Medicine & Science

April 14, 2003|By Dennis O'Brien | Dennis O'Brien,SUN STAFF

Combat leaves many wounds. Some soldiers will heal and go on. Others will sustain injuries that change their lives. And some will be haunted by physical and psychological problems induced by the fear, grief and sheer horror of war.

To minimize long-term suffering, hundreds of military therapists and counselors have been shadowing U.S. combat troops in Iraq. Their tactic has been to step in quickly when troops need help and get them back to their units as soon as possible.

"We see them as soldiers having a normal amount of stress in an abnormal situation," said Maj. Timothy Patterson, an Ohio psychiatrist and a reservist stationed in Iraq.

The doctors' ultimate goal is to prevent an ailment that has become a major concern once the shooting stops: post-traumatic stress disorder.

Known as shell shock in World War I and battle fatigue in World War II, post-traumatic stress afflicts an estimated 5.2 million Americans, causing sleeplessness, depression, nightmares and flashbacks. It may not show up until years after the event.

"It's like someone put a ton on bricks on top of you and you can't move and nothing matters -- nothing," said Harry Metzler, 59, of Lexington Park, a former Army sergeant who served with a mortar unit in Vietnam's Iron Triangle in 1965 and 1966.

Although it can be the result of any violent episode, the disorder hits combat veterans like Metzler particularly hard. Studies show that a third of the nation's 3 million Vietnam veterans have been afflicted.

Military efforts to combat stress aren't new, either. Combat stress units have been part of U.S. and foreign military forces since World War I.

Army research showed that front-line counselors in the Korean War helped large numbers of soldiers keep fighting, according to Dale Smith, a professor of medical history at the Uniformed Services University of the Health Sciences.

Because the symptoms may not appear until long after discharge, the Korean research doesn't prove any long-term benefit from quick intervention, but Army and civilian doctors believe that's the case.

"It's like being thrown off a horse: The best treatment possible is to be able to get back on," said Charles Figley, a psychology professor and trauma expert at Florida State University.

A soldier's chances of being afflicted depend on the length of exposure to combat, its intensity and the soldier's role, Smith said. Many suffer from guilt about the deaths they've caused, or the fact that they survived while comrades died.

To deal with the issue at its source, the Army trains soldiers to recognize the signs of combat stress among their comrades.

"It could be something as simple as all of sudden, no longer doing their job well, or not bothering to comb their hair or wash their face," said Lt. Col. Irma Cooper, a nurse who leads an 85-member combat stress unit.

If they show signs of stress, soldiers may get informal counseling from a therapist, who lends a friendly ear and tells them that what they're feeling is normal. The therapy could be as simple as breathing exercises for relaxation, or week of rest in a mobile hospital near the front. But in all cases, soldiers remain in uniform and are reminded they will return to their units.

"We want them to think of themselves as soldiers, not patients," Cooper said.

Returning troops to duty quickly helps them avoid the feeling that they can't handle combat, a stigma they might carry for the rest of their lives, said Lt. Col. Elspeth Cameron Ritchie, an Army psychiatrist. "They'll come out knowing they were put back with their unit, back with their `buds' and that they withstood the war and they can say they got through it."

Soldiers and Marines bond with their comrades and often feel guilty if they have to leave them because of injuries, experts say. On the hospital ship USNS Comfort, a Marine wounded when a rocket struck his vehicle in Nasiriyah in southern Iraq cried when told his leg injury would keep him from returning to his unit.

Even so, some veterans express doubt that soldiers will volunteer their problems to counselors -- particularly in the days after a prolonged battle or the death of a friend.

"The whole military culture is based on denial of any problems like that," said Rick Weidman, who was in an Army intelligence unit in Vietnam and is president of Vietnam Veterans of America. "If people report intrusive memories or anything like that, their military career is done."

But therapists insist that the sessions are confidential and no stigma is attached to them.

"Most of the time we'll be a welcome relief," Cooper said.

Front-line stress therapy for U.S. troops was largely shelved in Vietnam because doctors were so busy dealing with drug and alcohol problems.

"I think they went over there prepared to have combat stress casualties, but they didn't see them," Ritchie said.

Many Vietnam vets did not develop post-traumatic stress until they returned home.

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