Is post-traumatic stress disorder (PSTD) more prevalent in modern times than in earlier wars? If so, why? What can we do to prevent and treat it? As our troops return from Iraq, we must do better than we did with the veterans from Vietnam.
Here are some amazing numbers about one unit’s experience with PSTD: a letter by Michael Ingham from the June 2008 issue of the Marine Corps Gazette:
For most of 1967 I was a Marine rifle platoon commander in 1st Battalion, 1st Marines in Vietnam. At the end of my service I left the Marine Corps, as did about 98 percent of the junior enlisted men who served under me. About 10 years ago an effort began to locate and reconnect Marines who had served together in my platoon in 1967. That effort has produced some startling results and suggests some additional points germane to the article, “Mental Health Training in the Armed Forces,” by SSgt Joseph A. Starbuck (MCG, April 2008).
First let me give you the numbers. We have located 73 men who served in the platoon (Marines and corpsmen) from January through November 1967. Of the 73, 12 were killed in action, and 18 (roughly 30 percent) have died since leaving the military — many of them at unusually young ages. Of the 44 still alive, the vast majority is on full posttraumatic stress disorder (PTSD) disability. While as accurate as we can get them, these numbers need to be taken with some caution.
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Most of those still alive have sought and received aid from the Department of Veterans Affairs (VA). In most cases it took years of torment to get there. In talking to surviving relatives of those who have died since leaving the Service, it is obvious that most of them died after years of struggling with the symptoms of PTSD (with Agent Orange as a contributor.)
The article cited above states that studies show that up to 30 percent of combat veterans suffer from PTSD. Based on the experience of this small unit, the number is more like 75 or 80 percent of infantrymen. The Marine Corps needs to more aggressively intervene while it still has control of the Marine. The VA will tell you that once discharged, veterans tend not to show up asking for help until they are far down the PTSD road.
The Marine Corps has a deeply ingrained tradition of taking care of its own. If my platoon is any indicator, that tradition needs to be extended to recognize and address more accurately the long-term cost to the individual Marine of serving in combat.
Other articles about this topic
- “Invisible Wounds of War“, RAND (2008) — “Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery”
- “America’s Medicated Army“, Time, 5 June 2008 — About the growing use of anti-depressants by US army personnel. Also see my post about this article.
- “VA testing drugs on war veterans” – The Washington Times and ABC News, 18 June 2008
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My experience talking with former members of my (VN) infantry company would confirm the above. Very common for vets to have waited decades before finally checking in to the VA. What is least understood by the public (along with those affected) is that PTSD is a chronic condition, that doesn’t diminish with time, especially if allowed to fester with vice.
I fully expect the Iraq/Afghan vets to be plagued with PTSD, perhaps worse than the VN era vets if not mostly because of the yo-yo multiple deployments, then the simple mind rotting proposition of doing the endless dirty work of an unpopular occupation army in an ungrateful foreign culture.
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Fabius Maximus replies: Thank you for sharing your experience on this.
One thing that would buttress units against PTSD in units that served in Iraq and Afghanistan is the comparative stability of personnel policies compared to the Vietnam era. Now that units are deployed, instead of individuals, Iraq and Afghanistan vets are better able to rely on the cohesion and support structures that come with being in that deployed unit.
Of course this is highly dependent on the strength of the Command Climate in our deployed units. Crappy units will deal with PTSD in a crappy way. Good, cohesive units will deal with it comparatively better. As with almost anything in the military, this depends on personal leadership by the NCOs and officers of our units–only by their ability to create an open, accepting, and purifying command climate in post-deployment periods can PTSD be mitigated, identified, and treated.
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Fabius Maximus replies: Agree on all points. However, I suspect that the rate of PTSD will be far higher from our current wars than in Vietnam (even after adjusting for the difference in reporting and diagnostic regimes).
These reasons, plus those involving the people who actually live in the places where war occurs, should give us pause. I think the entire American attitude towards war, emotionally, is in need of a serious reconfiguration. I recall in the lead-up to the Iraq misadventure, cable TV news was lugubriously honoring the men and women about to go to war with large wall displays of photographs and deeply felt expressions of feeling from their families. Nothing wrong with that, and plenty of justification for it. Absent, though, was any sense of the inevitable tragedies to follow, that many of the young people pictured would not return at all, or would have damage to the mind and body that would be grotesque and irreversible. Not to mention the civilians, of course.
War is a tragedy, an economic debacle unless accompanied by massive theft and genocide, a failure of reason, a last resort. Whatever positive support is provided to anyone before such a thing takes place should be seriously tempered in a mature way that anticipates what is really going to happen. The mood of this country before a war should be somber, serious, unified, and dedicated to a quick victory, always bearing in mind that a better alternative should have been found.
Van Crevald’s book “Fighting power” (buried in my office somehwere,so this is from memory) the US rates during WW2 were astounding (combat fatigue as they called it then). Partially it was the poor, at the time, man management, soldiers were just kept on the front line until they were wounded, died or cracked. Replacements were fed in piecemeal. All part of the attritional warfare model that Marshall, Eisenhower, Bradley and Patton subscribed to then.
There have been improvements, especially after Vietnam, but the tempo is now much higher, and the tours of duty much longer nowadays. Plus the type of combat in Iraq and increasingly Afghanistan, is stressful and brutalising. Basically you can only keep people of the front line for so long.
I once met a US guy in Scotland who had just finished serving in Vietnam (a long time ago). Young guy, really nice guy. After a few (many actually) beers he told a story about seeing a young girl being shot. The look in his eyes as he told it was haunting. I hope he got over his demons and has lived a good life since then, but I suspect that he always sees that little girl rolling over and over as the bullets hit her. Heck the image still haunts me now and then and I was only told about it!
The people who send others off to war have a lot to answer for.
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Fabius Maximus replies: Has anyone seen comparisons of “combat fatigue” with PTSD? They seem quite distinct, from what little I know.
Also, why do you say “but the tempo is now much higher, and the tours of duty much longer nowadays” vs. WWII? I would say the opposite, by a large margin.
Fabius regarding your last comment to Old Skeptic — I think you are wrong for most mainline US units in WWII v. today, especially if you exclude the Marines.
Operation Torch and the North Africa campaign saw 6 US divisions engaged in combat for less than 9 months
Husky saw 6 US divisions engaged for 6 more weeks of intense combat
The Italian Front had roughly 9 US divisions in combat for 24 months
Normandy to V-E day had between 5 and 60 or so US divisions fought for roughly 9 months.
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Fabius Maximus replies: These things are subjective, and I have no solid data. But I believe that the intensity of the sustained combat of front-line troops in WWII has few equivalents (not no equivalents) to current experience in Iraq. For example, the casualty rates today are a fraction of front-lines units in WWII — which often reached 100% during their tour of duty.