U.S. Tries Combat Stress Program

April 27, 2004

The U.S. military is treating combat stress in Iraq with preventive measures as close to the front as possible, a new approach it hopes will reduce stigma and quickly return troops to their posts. 

Navy doctors who treat Marines and sailors have opened regional centers in Iraq where troops can receive counseling, warm meals, a shower and clean clothes during stays that last a maximum of three days. 

"It's a new concept," said Capt. Robert L. Koffman, a Navy psychiatrist and division medical officer working with troops at Camp Fallujah. "Previously, the individual might have been referred to the rear, and we know that's the worst thing to do. 

"We don't take the warrior out of the war and send them to a hospital. The whole premise is not to stigmatize." 

The Army's thinking now is much the same, said Jaime Cavazos, a spokesman for the Army Medical Command at Fort Sam Houston in San Antonio, Texas. 

"Ideally, what we try to do is get the soldier away from the front, but not so far away from the element that he no longer feels a part of it," Cavazos said. 

In previous wars, soldiers disabled by combat stress usually were evacuated from the battlefield to hospitals at the rear or closer to home, and rarely returned to their units, according to an Army study released last month. Of those treated close to their units, nearly all returned, the study found. 

The new system lifts the onus of embarrassment from soldiers under stress, according to Koffman. Instead of expecting victims to turn themselves in, commanders order them to one of the rest centers if they become unable to do their jobs. 

"We do not want to pathologize combat stress," Koffman said, so a rest center is "nothing like a clinic. Individuals are not patients." 

Combat stress, in Koffman's view, is a straightforward medical problem. He defines it as "a relatively normal reaction by a normal person to an abnormal, horrific situation." 

In recent months, the Navy has sought to build awareness of combat stress and encourage sufferers to seek help. Last year, such efforts did not exist in Iraq. 

"Individuals had to find mental-health workers once they were sick," Koffman said. "Very few of them sought help." 

The Army's study found that almost half its soldiers in Iraq did not know where to turn for help. 

The Navy has also expanded its definition of wartime stress to include noncombat situations. 

"We no longer restrict combat-stress reaction to those that occur in combat," Koffman said. "There was an artificial boundary between combat stress and operational stress." 

Koffman, who is about to publish a study on combat stress among U.S. troops in Iraq, declined to give figures for its occurrence in Iraq or to describe specific cases. 

Combat stress is not well-understood. Troops on the attack feel more in control, which reduces stress, even when casualties are high, Koffman said. As combat proceeds, stress cases actually decline for a time because individuals become more competent and experienced in battle. 

Siege warfare, such as the stalemate in Fallujah, might prove more stressful for troops than open battle. 

During World War II, doctors tried to predict which soldiers would suffer from combat stress, but the effort failed. The key, Koffman speculated, may be a combination of personality and combat experience. 

"There's no real indicator," Koffman said. 

Koffman, 52, has served 20 years in the Navy and studied combat stress since the first Persian Gulf War, in 1991. 

Last year he rode into Iraq with U.S. troops, in part to experience battlefield fear and stress again. Recently he borrowed a rifle and ammunition to help provide security for the convoy that carried him from Baghdad to Camp Fallujah during the high point of attacks on convoys in early April. 

Holding an M-16 and crouching shoulder to shoulder with a Marine corporal, Koffman helped watch for attackers from behind the wall of sandbags in a seven-ton truck rolling down a dangerous highway. 

"If something happens, I want to contribute," he said. 

The convoy was delayed four hours when a bomb was found in the road, but the convoy was otherwise unharmed. 

Copyright 2004 Philadelphia Inquirer. 
Published in the Military Insider Newsletter
www.military.com