Soldiers Face Stresses of War

PTSD is often defined as the sequence of any traumatic experience that causes horror, terror, helplessness or intense fear. Although I have personally served in combat only during the current conflict and have no first-hand knowledge of the traumas of conflicts past, it seems to me that despite differences in terrain, tactics and mission, the experiences of war have always caused horror, terror, helplessness and intense fear. And they always will.

So, as clinicians, our goal is always to find the most effective way to ease our patients' pain after these experiences. I hope that, in the current conflict, the stigma involved in asking for that help has been reduced, even if only a little, from 40 years ago. If that is true, perhaps we are finding a way to deal with the effects of war after all.

This is a tough question to address. Posttraumatic Stress Disorder (PTSD) did not appear as an official diagnosis until 1980. The symptoms of PTSD have been described throughout much of recorded history, but the syndrome was not made a diagnosis until 1980. Much of the research regarding asymmetrical warfare and PTSD did not come about until after 1980. The experience of trauma is a part of the human condition, and the risk of severe, prolonged trauma is much greater in war. No matter how realistic the military trains, it cannot fully prepare soldiers for the stress of combat operations. We are starting to understand the link between trauma, brain function, and stressors in greater terms. Our ability to diagnose and treat PTSD and related MH issues is better than it has ever been, but more needs to be done.

I think the current conflict is different than the Vietnam conflict in that (1) the draft allowed access to a huge number of potential soldiers, (2) the tours were 12 months long and then the soldier was finished (unless he signed up for an additional tour), and (3) replacements were done individually for the most part. Operation Iraqi Freedom and Operation Enduring Freedom have experienced (1) extended tours beyond 12 months, (2) the pool of soldiers to draw upon is extremely small compared to the Vietnam conflict, so entire units (and their soldiers) are returning to the combat zone again and again, (3) soldiers are being sent back to the states, expected to refit, train-up, and prepare to return to combat while trying to reconnect with families and friends. This sets up a cognitive disconnect, where the brain is being told to "calm down and return to normal," even as soldiers are re-exposed to training environments and daily reminders that they are going to go back to combat. The stressors, in my clinical opinion, are different. In the history of the U.S. military, this is the first time that we have rotated soldiers in and out of a combat zone, in a cyclical fashion. Some of the Mental Health syndromes we are seeing as a result are very different in some respects than in the past.