War on terror veterans exhibiting post-traumatic stress

By: ANNE RILEY-KATZ - Staff Writer | Saturday, August 7, 2004 9:33 PM PDT ∞

The toll war takes on troops goes by many names. In World War I, it was battle fatigue. In the Second World War, it was shell shock. Today, it's post-traumatic stress syndrome.

A recent study published in the New England Journal of Medicine suggests the consequences of combat are not bypassing the men and women who are fighting in Afghanistan and Iraq.

Of 6,210 Marines and soldiers surveyed in the study, one in eight reported symptoms of the medically recognized mental condition, including withdrawal from friends and family, overanxiousness, nightmares, flashbacks and angry behavior.

Fewer than half said they will seek help, the study said.

The study, headed by Dr. Charles Hoge, chief of psychiatry at Walter Reed Army Institute of Research in Washington, D.C., was conducted last year, a few months after the units returned from Iraq or Afghanistan.

Hoge suggested there was "significant risk" of mental problems among those studied and some big barriers to them receiving care.

Experts in treating battle-scarred troops suggested that the relative youth and inexperience of the troops and their uncertainty about their roles were among key reasons for their symptoms.

Dr. Paula Schnurr, deputy executive director for the National Center for Post Traumatic Stress Disorder in Vermont, said that troops' disillusionment with the U.S. role in Iraq may be significant.

"I think that people expected to be playing more of a peacekeeping role and are not," Schnurr said. "In fact, the situation is very dangerous. People not expecting to be in combat are."

Steve Ryan, an Oceanside therapist who has worked extensively with veterans, said combat troops often have a difficult time adjusting to a nonviolent setting.

"When the rah-rahs and congratulations die down, these guys are stuck with their wounds and their memories," Ryan said.

Ryan said he believed the study's statistics on the number of troops with symptoms to be lower than the number that will eventually be affected by the disorder.

"I suspect there is more (than the study indicates)," Ryan said. "The symptoms may not happen right away."

The survey

The journal said it surveyed four groups, including members of Marine battalions who served six months in Iraq, and members of Army brigades before they deployed and after they served six months in Afghanistan or eight months in Iraq.

The study showed that about 17 percent of the respondents reported suffering from post-traumatic stress disorder, depression or anxiety. The rate for those who served in Afghanistan was about 12 percent. Before deployment, the rate of such problems among those surveyed was 5 percent, about the same as the general U.S. population, according to the study.

The study asked soldiers about specific combat experiences; not surprisingly, the chief factor for those with stress disorders was having had to kill someone.

The study showed that 38 percent to 40 percent of troops who are suffering some form of mental trauma as a result of their combat experiences would seek treatment.

Officials at the Camp Pendleton Marine Corps Base just north of Oceanside said they were working hard to make sure that the more than 14,000 Marines deployed to Iraq from Camp Pendleton, most with no previous combat experience, know that help is available.

"Because Iraq is the first extended ground combat since Vietnam, (post-traumatic stress syndrome) is new to some of the people," said Lt. Cmdr. Elizabeth Burns, who works with Camp Pendleton's counseling services. "I think there are very few active-duty troops who served in Vietnam, so we've got a whole new military culture that doesn't have that combat experience. Some reaction is certainly to be expected."

Burns said Marines feeling symptoms of stress are being encouraged at all levels to seek assistance.

"Returning troops need to know that it's not a sign of weakness to seek help, it's a sign of strength," Burns said.

Hard to compare

Though post-traumatic stress syndrome was not formalized as a medical condition until 1980, the disorder and other combat-related symptoms among military personnel are nothing new.

"Records show that soldiers as far back as the Civil War exhibited symptoms of what we now know as PTSD," Schnurr said.

Studies done years after the Vietnam and Persian Gulf wars showed the rate of those with the syndrome at the time was 15 percent for Vietnam veterans and 2 percent to 10 percent for Gulf War veterans, Schnurr said.

Schnurr said that a 1997 study showed that 15 percent of Vietnam veterans still suffered some symptoms.

"(Post-traumatic stress disorder) in combat veterans can be very long lasting," Schnurr said. "The documented prevalence in older veterans groups tends to be lower, but they were not studied when they returned."

However, Hoge said that a lack of similar data made comparison with other war veterans difficult.

"The studies on earlier combat veterans were done years after they got home, even with Desert Storm veterans," Hoge said. "We don't have good data that can be directly compared with our data, which was collected three to four months after troops returned."

Who gets help?

Those troops who said they were unlikely to seek help cited concerns about their careers and peer perception, the journal reported.

"We know that women seek mental health services more readily than males do," study chief Hoge said in a telephone interview. "With the military being largely male, and young males in particular, it is not a culture of help-seeking. But that may be purely a demographic reflection."

Escondido resident Edward Wilus is one local Vietnam veteran who eventually had to get help. When he returned to the United States in 1967 after two years in Vietnam, he said he thought life would be business as usual.

"I just tried to forget about the war," Wilus said. "But in later times it started creeping up on me."

Wilus, who served in the Army's 173rd Airborne Brigade, said he was short-tempered, had trouble sleeping and experienced frequent nightmares.

"I was an entirely different person when I came back," he said. "Making friends was much more difficult after I came back, because after the war you could emotionally not afford to have friends, because if you made friends (at war) and they got killed, a part of you died with them."

Treatment and prevention

Hoge said a variety of options exists for the treatment of post-traumatic stress, including prescribed medications and group or individual therapy. Success with treatment depends of the individual, but usually one or more options prove effective, Hoge said.

In addition to chaplains, who are often used as confidants and deployed with each unit, there is one psychiatrist and a handful of psychologists currently deployed to Iraq, Burns said.

For returning troops, Camp Pendleton offers several treatment options, including 12-week group counseling sessions and individual counseling sessions, Burns said.

"They need to know they are not alone, and this is not the end of their career," Burns said. "Combat stress is manageable and treatable and they can continue with their career."

Despite the options available, Ryan said the military needs to reassess the treatments available to combat veterans and returning troops.

"I think the way it's dealt with is getting better, though marginally so," Ryan said. "The system really needs to be looked at."

Hoge said one of the study's purposes was to increase awareness of and educate people about the disorder.

"With this study, what we hope to do is get the word out there that the earlier that you come in for treatment, the better off you'll be," Hoge said. "Hopefully, we can reduce the rate of chronic symptoms down the road."

Contact staff writer Anne Riley-Katz at (760) 731-5799 or ariley-katz@nctimes.com.

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