A Troubling Return for Iraq Vets

Wired and tired combatants often overwhelmed by stress of war

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HealthDay Reporter

WEDNESDAY, Aug. 11, 2004 (HealthDayNews) -- It has been three decades since American soldiers endured the shock of sustained ground combat in Vietnam and the emotional scars that kind of war inflicts.

But mental health professionals coast to coast are bracing for a new wave of soldiers overwhelmed by the unique stresses of war, as troops start to return from Iraq.

"Returning soldiers often feel they have been destroyed by their exposure to combat," said Dr. Alison Sheridan, a former Army psychiatrist now in private practice in Concord, Mass.

"They've seen mutilated bodies, their close friends have been killed or maimed. They've had experiences they can't share with their family members or close friends, some of which may be shameful to the soldier because they felt afraid or experienced traumas that continue to terrorize them," she added.

Sheridan expects that many U.S. service personnel returning from Iraq and Afghanistan will experience a range of problems that their predecessors who fought in the Vietnam know all too well.

Indeed, there are already signs of such struggles.

A just-released military survey of paratroopers who were part of the Iraq invasion found that 17.4 percent of the soldiers have post-traumatic stress disorder (PTSD) symptoms.

The survey of 1,300 soldiers of the 82nd Airborne Division's 2nd Brigade was taken three months after they returned to Fort Bragg, N.C., after a year in Iraq, according to a Fayetteville Observer report.

"The numbers are looking more and more like Vietnam," Capt. Jill Breitbach, chief of psychology services for the 82nd, told the newspaper. A national survey of Vietnam veterans in 1988 determined that about 15 percent had PTSD at the time, according to wire reports.

And they are also in line with research in a recent issue of the New England Journal of Medicine that found soldiers returning home from Iraq and Afghanistan are burdened with a range of mental health problems.

Some 15.6 percent to 17.1 percent of those who had been in Iraq met the screening criteria for major depression, generalized anxiety or PTSD, compared to 11.2 percent who returned from Afghanistan and 9.3 percent who had not yet been deployed to Iraq, the researchers found.

The research, which included interviews with approximately 6,200 soldiers, is significant for several reasons, including how early some of the information-gathering is taking place.

"They are actually getting information while people are still in the theater of operations," said Dr. Matthew Friedman, executive director of the Department of Veterans Affairs' National Center for PTSD, a professor at Dartmouth Medical School, and author of an editorial that accompanied the study.

In addition, Friedman said, the researchers have obtained "predeployment" data, giving them something to compare post-combat figures to.

"What's important about getting this data is that we can actually gauge how much of the reported psychiatric symptoms can be pinpointed as resulting from deployment to Iraq or Afghanistan," Friedman said. After the Persian Gulf War of 1990-91, it was impossible to tell how many of the unexplained medical problems cropped up during combat because there was no baseline, he added.

But equally worrisome, the researchers found, was that only 38 percent to 45 percent of service personnel who met the criteria for a mental disorder expressed interest in receiving help, and only 23 percent to 40 percent of those people sought professional help.

"The most disturbing thing, in my opinion, is the stigma, and people who are most severely affected are the ones least likely to seek treatment," Friedman said.

"We can help them," he added. "We can help them right away."

Soldiers returning to stateside military posts or to their civilian lives often experience many or all of the symptoms of PTSD, including intense, unspecific anxiety; sleep disturbances; jumpiness; flashbacks; and, under some conditions, states of profound disorientation or confusion. Major depression is a common complication, too.

Karl D. LaRowe is a clinical social worker and trainer with PESI HealthCare in Eau Claire, Wisc. "Men and women in combat face intense pressures because they can't get away from the need to stay constantly alert," he explained. "They have to be constantly prepared to react to dangerous, deadly events."

"This state of perpetual watchfulness releases adrenaline that preps the body to make a 'fight-or-flight' response. Constant exposure to adrenaline wires the body, which stimulates the brain, which in turn ups the adrenalin load, creating a hormonal short circuit. The result is a state of highly alert exhaustion."

LaRowe says it's common for soldiers coming home to remain hyper vigilant because their nervous systems have been physically altered by war.

"Returning soldiers are wired and tired," he said. "And it's not only the soldiers, but the members of their families -- spouses, children, parents -- and close friends who are likely to be affected."

Sheridan said people particularly close to soldiers before they left for Iraq may tend to bear the brunt of the transition.

"In casual encounters with acquaintances or strangers, men and women who have recently served in a war zone usually don't show evidence of the stresses they may be experiencing," she said. "It's in the intimate relationships where the symptoms and problems come out, often exacerbated by feeling they can no longer talk about feelings and emotional issues with the persons closest to them."

Sheridan and LaRowe agreed that many returning soldiers experiencing PTSD tend to "self-medicate" using alcohol or other drugs. This can extend and complicate the recovery from war-related emotional trauma.

And that recovery can take a long time -- and may never completely arrive, according to Sheridan.

"Peer group support can be very useful for men and women who have been traumatized by their military experiences," she explained. "Such support is often much more available and accessible to individuals who return to military bases in military communities, where there may well be hundreds of people to whom they can talk about their emotional and social circumstances."

"It's more difficult for the activated reservist who returns to his home, family and community and loses contact with others who have been exposed to the realities of daily combat and have experienced the death, destruction and chaos of war," Sheridan added.

More information

The National Center for PTSD has more on the war in Iraq.

SOURCES: Alison Sheridan, M.D., former Army psychiatrist, Concord, Mass.; Karl D. LaRowe, LCSW, clinical social worker and trainer, PESI HealthCare, Eau Claire, Wisc.; Matthew Friedman, M.D., Ph.D., executive director, Department of Veterans Affairs' National Center for PTSD; Aug. 10, 2004, Fayetteville Observer

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