October 7, 2011: The U.S. Army and the U.S. Marine Corps continue seeking ways to deal with PTSD (Post Traumatic Stress Disorder). One of the latest efforts is a marine program that uses a civilian program called Mind Fitness. This is a series of mental exercises developed to reverse the ill effects of stress. When the marines came across Mind Fitness, the program had already treated 35,000 people, with an 85 percent success rate. Initial tests with marines showed a similar rate of effectiveness. Now the marines are rolling out the program (20 hours of training spread over two months) on a wider scale, and the other services are looking into it.

The American military has, over the years, developed a set of guidelines for how to recognize the symptoms of combat fatigue (or PTSD). That was accompanied by efforts to find treatments. With all the attention PTSD has gotten in the media in the last five years, troops are more willing to seek treatment, or at least admit there is a problem. While extreme cases of PTSD are pretty obvious, it's the more subtle ones that are being sought now. These are easier to cure if caught early. But this causes problems with troops who are tagged as a "subtle case" and disagree with the diagnoses. Most soldiers still believe that, once you are tagged, you won't be left alone by all those new specialists who only want to help you. Mind Fitness training seems to work particularly well with the subtle cases.

But there is another problem, in that there are several sources of PTSD. For example, there was the discovery that many troops, because of exposure to roadside bombs, and battlefield explosions in general, had developed minor concussions that, like sports injuries, could turn into long term medical problems. Often these concussions were accompanied by some PTSD. The VA (U.S. Veterans Administration, which cares for injured veterans) is particularly interested in knowing about a soldier's prior exposure to roadside bombs. The troops like to point out that PTSD is made worse by having too little time back home between combat tours, and this part of the problem has been addressed. But the subtle long-term effects are still only partially understood.

The major problem is that most people eventually get PTSD if they are in combat long enough. This has been confirmed by nearly a century of energetic efforts to diagnose and treat PTSD (including much recent attention to civilian victims, traumatized by accidents or criminal assault). During World War II, it was found that, on average, 200 days of combat would bring on a case of PTSD. After World War II, methods were found to delay the onset of PTSD (more breaks from combat, better living conditions in the combat zone, prompt treatment when PTSD was detected). Military historians note that successful, and often popular, commanders throughout history have paid attention to the physical well-being of the troops, all in the name of "maintaining morale."

That's why combat troops in Iraq and Afghanistan often sleep in air conditioned quarters, have Internet access, lots of amenities, and a two week vacation (anywhere) in the middle of their combat tour. It was also discovered, quite by accident, that the troop habit of playing violent video games, in between bouts of real combat, reduced combat stress. Mental health practitioners tested the use of violent video games for their PTSD patients, and found out that it worked.

The PTSD problem is felt most frequently among combat NCOs. Most of the troops are in for one enlistment (usually four years) and then leave, usually without a severe case of PTSD. Similarly, junior officers get promoted out of jobs involving close combat, and officers in general are rotated between leadership and staff jobs. But NCOs spend all their time with the troops, except those few who get promoted to Sergeant Major (a largely staff job, as advisor to senior commanders.) The Sergeants Major were among the first to note the stress problems with career NCOs (squad and platoon leaders, as well as company 1st Sergeants.)

The only acceptable solution for the problem is to transfer the worst hit combat NCOs to non-combat jobs. This is a common sort of thing in the army and marines, where it's long been common for NCOs with physical conditions and injuries (resulting from the rigors of peace or wartime infantry service) to be offered transfers and retraining in less physically demanding jobs. Severe cases may also be offered a medical discharge (and disability pay). The loss of these skilled and experienced NCOs from combat units will result in more troops getting killed or wounded in combat. But that can happen anyway if you leave a stressed out NCO in action for too long. But the desire to cure PTSD, or at least greatly reduce its impact, has led to the search for drugs or therapies that actually work. Israeli researchers are working on drugs that appear to work, and therapies like video games and Mind Fitness do the job as well.

The army and marines are dealing with PTSD head on, believing that what happened in Iraq and Afghanistan, will happen again, and now is the time to get ready. Experience so far has shown that PTSD can be delayed, perhaps for a long time. When a soldier does come down with it, PTSD can often be treated, and its effects reversed. But not always. This has large ramifications for non-military medicine, for many civilians suffer from PTSD. That's because military recruits are screened for their ability to handle stress and resist PTSD. In the civilian community, there are far more people who can acquire PTSD after exposure to much less stress. What many troops wish the brass would understand is that, as recruits, they learned that stress was a major part of the job, and understood it more than the mental health mafia is willing to admit.