By Lesley Kipling
More than 15 percent of service members returning from Iraq and 11 percent of service members returning from Afghanistan have met the screening criteria for major depression, generalized anxiety, or post-traumatic stress disorder (PTSD)
"Now, they are in a war zone one day and they are back here the next day," said, Carolee Nisbet, a public affairs specialist at Fort Dix, NJ, one of several military bases where National Guard and Reserve soldiers out-process after serving in Iraq and Afghanistan.
"When you were in Baghdad you were going all the time, all day and half the night, the fatigue catches up with you. There are times when I've had problems concentrating, I'll have the 1000-mile stare," said Joseph Sharpe, a reservist who recently returned from a year-long deployment to Baghdad.
For soldiers who are injured in battle and sent home to recover, the need for emotional support is obvious. But tens of thousands of soldiers returning home appear physically the same as they did when they left, but emotionally are very different people.
"I felt like I wasn't the same person I was when I left and I didn't like it," said Liz Kamps, a National Guard soldier, explaining why she sought counseling after returning from Iraq.
More than 15 percent of service members returning from Iraq and 11 percent of service members returning from Afghanistan have met the screening criteria for major depression, generalized anxiety, or post-traumatic stress disorder (PTSD), according to a study by Col. Charles W. Hoge, a medical doctor at the Department of Psychiatry and Behavioral Sciences at Walter Reed Army Institute of Research.
The number may actually be higher because soldiers who were injured in combat and did not re-deploy with their units were unable to complete the study. The study, published in The New England Journal of Medicine last summer, surveyed 6,201 soldiers and Marines in the units most likely to see combat before, during and after deployment. The soldiers surveyed who showed signs of PTSD were more likely to have been in close-range combat. Many reported being responsible for the death of enemy combatants and/or knowing someone who was seriously injured or killed.
Although soldiers surveyed in Iraq showed a higher rate of PTSD than those in Afghanistan, the report found, "The linear relationship between the prevalence of PTSD and the number of fire fights in which a soldier had been engaged was remarkably similar among soldiers returning from Iraq and Afghanistan, suggesting that differences in the prevalence according to location were largely a function of the greater frequency and intensity of combat in Iraq." These results are part of a longer ongoing study that will continue to monitor the mental health of soldiers.
Of the service members Hoe identified as having a mental disorder, less than half sought help. Service members reported a fear of being stigmatized for being unable to deal with their problems on their own.
Car roll Williams, a Vietnam veteran who promotes veterans programs at the American Legion, urges soldiers returning from combat to get help. "I would tell them, if they have concerns, to share them with other people, talk about it, and if you find yourself falling by the wayside, seek professional help," said Williams.
Studies of Vietnam veterans, which were not conducted until 10 to 20 years after the war, reported 15 percent of male soldiers still had symptoms of PTSD years later and 30 percent reported having symptoms at some point after the war.
The lack of sleep, high levels of stress, long deployments, and cyclorama operations are very stressful on a soldier, even those not in regular fire fights. The mental strain of living in a combat environment, referred to as combat stress, doesn't immediately subside when a soldier returns home. Instead, it is often compounded with the realization that an entire year has gone by and a lot has changed while the soldier was deployed.
"It has taken a while to re-adjust," said Shape, the returned reservist. "You're still thinking of the way things were when you left, and you come back and realize the people have moved on, you know, it's not the same. Sometimes, you wonder where your place is."
In the summer of 2002, five soldiers at Fort Bragg murdered their wives after returning from Afghanistan. Two of the soldiers also committed suicide. At that time, soldiers returning from fierce combat in Afghanistan received the same decompression training as soldiers in peacekeeping missions in Kosovo and Bosnia. But after the Fort Bragg murders, the Army re-vamped its entire program.
Now, before re-deploying, all soldiers should go through a Post-traumatic stress screening which includes questions about their sleep habits, anxiety levels, and other issues that serve as warning signs for post-deployment emotional problems. All soldiers receive a series of classes on suicide prevention, dealing with depression, and adjusting to family life before they re-deploy.
Even soldiers returning home for two weeks through the R&R program, meet with a military chaplain before they get on a plane and see their families. When the unit arrives back in the United States or its home station overseas, the classes are re-enforced. Some soldiers feel the classes are repetitive and have nicknamed them the "don't beat your wife class," but others find it useful.
"I experienced many of the things they said we could expect upon arrival. It helped me feel like the decompression process was normal," said Kamps, who served as a prison guard in Iraq. "I was always on my guard [in Iraq], because of the close contact I had with the prisoners and the fear of being attacked," she continued, explaining why it has been difficult for her to adjust to civilian life.
Active-duty soldiers returning from combat go through a seven-day re-integration program immediately after they arrive at their home station. During this period, soldiers work a half-day schedule where they can set up medical appointments, take care of finances, and receive training on dealing with the stresses they may be facing trying to adjust to life at home. This schedule also enables the commanders to observe their soldiers for three or four hours a day and identify soldiers who are having difficulty adjusting or who show signs of depression.
National Guard and Reservists receive the same classes, but because in many instances the demobilization stations are often not in their home state, a number of them are unable to go home at night and ease into family life.
**Sharpe was critical of the training that he received when he re-deployed. He received classes on military benefits and had a physical but said there "was not enough emphasis on mental health care." Sharp has kept in contact with many of the soldiers he served with in Iraq and said many of them want counseling but don't know where to turn.
When questioned about the lack of information about mental health, Army spokeswoman Nesbit suggested that the information is presented but the soldiers occasionally just don't see the relevance of the information because they are too focused on getting home. "The only thing they want to do when they get here is to go home; it is difficult to get people to pay attention," Nisbet said.
Deployments are also very stressful on the families who've had to create a daily routine without their deployed soldier. During the deployment, a soldier's spouse takes on additional responsibilities in the home such as finances, household repairs, disciplining of children, and other day-to-day activities. Some spouses feel overwhelmed by the responsibility, causing anxiety, stress and occasionally, substance abuse. Others thrive on the additional responsibility and are not eager to relinquish it when the deployed soldier returns home, experts say.
Even though family members are excited to see their loved one home safe, reunions can often be awkward and tense as everyone adjusts to the changed family dynamics. Having the service member home 24 hours a day after being gone for 12 months can be extremely stressful even in the most loving families. That is why counselors say that having three or four hours apart at the outset helps with the adjustment period. Family members are also encouraged to attend classes offered by the unit's Family Support Groups to prepare them for the adjustments that will need to be made when the soldier returns home, Nisbet said.
National Guard and Reserve soldiers face one challenge their active-duty comrades usually avoid: When part-time soldiers do return home, they may have little interaction with other soldiers and sometimes feel like they are the only ones going through the emotional adjustments.
Single soldiers face an additional strain because they have no set support structure, said David Keith, the director of military service at Military OneSource, an independent agency contracted by the Department of Defense to provide counseling and other assistance to soldiers and their families. Single soldiers, especially those in the Guard or reserves, who may not return to civilian jobs right away, may have little social interaction with others, feeling that they no longer fit in.
"I felt a bit isolated, like the rest of the world around me went on with their lives the past year," said Kamps. "I felt like I was sent to another planet and lost a year of my life." Isolation, loneliness, and culture shock are common experiences for single soldiers after extended deployments.
Another problem is that the small day-to-day activities of civilian life can seem boring, mundane and insignificant to a soldier returning from combat, according to Army One Source officials.
" I've felt like I've had a bit of a chip on my shoulder and I've gotten upset when people have complained about little things," said Kamps.
Many soldiers expressed frustration that Americans seem more concerned about who will win the latest reality TV show then they are about the soldiers in Iraq.
"It seems like the majority of the population doesn't give a darn. We've got men and women overseas dying. See, Americans have always been blessed, they've never experienced war on the homeland," said Williams.
Soldiers who do make an effort to interact with civilians after they return are often faced with questions such as, "Did you kill anyone over there?" or "Did you ever get shot at?" Davis, who has been asked these questions by acquaintances at school, finds these questions very personal and inappropriate.
Deployed soldiers have very little time to themselves, have virtually no privacy and go through each day with an agenda usually planned by their superiors. For some returned soldiers, the biggest challenge is just figuring out what to do with all their free time.
"Getting up in the morning and not really having something to do, no PT, no formations," explained Andrew Davis, an Army Reserve specialist, "planning things out was tough."
Davis, 22, enlisted in the Army Reserve when he was 17. In 2001, he put off his first semester of college to attend required military training. Afterwards, he began studying English and political science at the University of Massachusetts in January 2002, and was able to complete one year before being called to active duty for service in Iraq. Davis served as an intelligence analyst at the military headquarters in Baghdad.
He was eager to return to school when he re-deployed home last spring. But back on campus he discovered that many of his friends were on the verge of graduation and he was still barely a sophomore. He felt he no longer fit in with his college peers, and decided not to return to U Mass, instead transferring to Harvard Extension to attend a continuing education program.
"I really don't want to be around 18- or 19-year-olds," Davis explained. "Their opinions are totally based on what they've learned in class and not on what they've learned in life. It's hard to talk to people like that because they have no real perspective."
The 24-hour news cycle can put an additional strain on soldiers and their families both during and after the deployment. Soldiers who want to move on are faced with images of Iraq and soldiers dying everyday on television.
"One of the biggest challenges is the fact that news coverage is live," said Keith, the One Source director. "Family members seeing events unfold are often worried that their loved one could be involved in the latest set of attacks. With instant messages and cell phones, soldiers and their families can be in constant communication, which can lead to additional stress and expectations, he added.
Sharpe, a civil affairs soldier who worked closely with the Iraqi people to provide training, equipment and guidance to private banks throughout the country, often worked with journalists covering events such as the the national money exchange when all the old Iraqi currency with Saddam's image was phased out and a new currency was distributed.
"A lot of what was printed was inaccurate because [journalists] really didn't have time to investigate and get a clear picture of what they were trying to cover," said Sharpe. Now that he is home, he said he is critical of the media for failing to highlight the successes in Iraq.
"It seems like they're focusing on the things that cause someone to have a strong reaction, all the graphics and explosions [on television news]," Sharpe said. Sharpe is not alone in his reaction; Davis said he has become so frustrated with television news that he has stopped watching it altogether.
"The way [TV newscasters] talk about people as if they are sort of action figures, or it's a TV show. They try to make it more exciting the way they talk about soldiers dying," said Davis. Now, he reads the newspaper and watches Comedy Central's "The Daily Show" to keep abreast of current events.
For Kamps, who served honorably as a prison guard at Abu Ghraib prison, the newscasts of prisoner abuse allegations felt like a personal attack. Kamps returned to the United States just as the infamous photos of guards abusing Iraqi detainees made national news.
"It was the only circumstance in my life where I felt like my pride was taken from me. I felt like I made a positive difference in my dealings with the Iraqi people and the scandal took that away," Kamps said.
Most of the symptoms of combat stress that soldiers experience are emotional responses, but nearly everyone interviewed shared the same physical response to loud noises.
"We missed getting blown up a couple of times, so when I hear a loud noise I jump," said Sharpe, explaining that his compound in the Green Zone was bombed regularly. "We had one [mortar round] that landed right outside our area, the building shook and all the windows broke," he added, recounting his experience in Baghdad. Davis thought that he was doing okay until the Fourth of July. "I couldn't listen to the fireworks," Davis said. The repetitive explosions were overwhelming and Davis said he had to leave the festivities.
In Iraq, the explosions became so constant that many soldiers were eventually conditioned to ignore them unless they were extremely close. Kamps experienced explosions on a weekly and sometimes daily basis. "I became used to hearing the explosions to the point which it didn't bother me as much. However, I have had a great deal of trouble dealing with loud noises since returning.
Most soldiers with minor combat stress will feel more "normal" over time, experts say. But for soldiers and family members who need counseling, the Department of Defense has contracted with Military OneSource to provide counseling. Soldiers and family members can call a toll-free number and speak with a councilor, 24 hours a day, or schedule up to six free counseling sessions with a social worker in their community through the program. (The Military OneSource toll-free number is 1-800-342-9647 in the United States, and for international calls, toll-free at 1-800-3429-6477.)
The soldiers interviewed all expressed confidence that things would get easier but added they realize that their long deployments have had an impact on their mental health. "It interrupts your life," Davis said.
©2005 DefenseWatch. Guest Contributor Lesley Kipling served as a U.S. Army officer from 1999-2004, including service as a brigade signals officer in Operation Iraqi Freedom, where she received the Bronze Star medal. She is now completing a masters degree in journalism at American University, and can be reached at firstname.lastname@example.org. All opinions expressed in this article are the author's and do not necessarily reflect those of Military dot com