October 31, 2007: Not since the 1970s has the U.S. Army and Marines had so many combat veterans on active duty. There are nearly 200,000 of them, many of them veterans of two or more tours in Iraq or Afghanistan. This is leading to more concern about the aftereffects of combat. This includes brain injuries from roadside bombs, or other explosions encountered in combat, and combat fatigue (or PTSD, post-traumatic stress disorder). Neither problem is new, but better diagnostic tools, plus political and media attention, are making it a lot more visible. This has resulted in better methods for dealing with it. But this has uncovered two particularly vexing problems. First, it's been difficult to get troops to seek treatment for subtle brain injuries or PTSD. Second, research, and practical experience, has shown that the best time to deal with both problems, is as soon as it shows up. This is not a problem with troops who have problems while they are still in the combat zone. For that reason, lots of mental health personnel are stationed as close to the fighting as possible.

Troops are increasingly willing to admit they have a problem. This is because it's becoming more common for troops with these problems to develop drinking or drug problems when they get home, or to have domestic and personality problems. These get the attention of friends and family. The military has noticed an increase in these problems among combat veterans, and let it be known that if you seek help, you will have a lot fewer career or legal problems. To provide the promised help, the military is setting up treatment operations at all bases, because many of those combat veterans get transferred to other units, or even non-combat jobs, when they come home from an overseas tour.

PTSD is an old problem in the military, and was first noted after the American Civil War. That war was one of the first to expose large numbers of troops to extended periods of combat stress. The symptoms, as reported in the press a century and a half ago, were not much different from what you hear today. At the time, affected veterans were noted as suffering from fatigue, shortness of breath, palpitations, headache, excessive sweating, dizziness, disturbed sleep, fainting and flashbacks to traumatic combat situations. Many of these symptoms were noted while troops were still in uniform. And if enough troops in a unit were showing the symptoms, the unit was described as "shaken," and not all that ready for combat.

It was during World War II that researchers began compiling lots of data on troops so affected. It was discovered that most troops were likely to develop debilitating PTSD after about 200 days of combat (that is, the stress of having your life threatened by enemy fire). But today there are other factors. Israel noted, after the 1982 war in Lebanon. That reservists were more sensitive to the aftereffects of combat. The Lebanon conflict used a larger number of older reserve troops, who tended to be more prone to coming down with PTSD. This was probably due to the fact the full time soldiers are constantly conditioned to deal with stress. While this is often referred, often derisively, as "military discipline," it has been known for thousands of years that such practices reduce stress and panic during combat. Apparently it reduces the chances of coming down with PTSD as well.

Israelis also began intensive research into PTSD around the same time, and have led the field ever since. Actually, in the last sixty years, there been a lot of progress in developing treatments for PTSD. The Germans and the British were very effective in their treatment of PTSD during World War II , and the U.S. adopted many of those techniques (recognize the condition for what it is, and treat the troops quickly and close to the front) after the war. The Germans and Brits were ahead of the US because of extensive experience with PTSD during World War I.

PTSD prevention is one reason U.S. and British troops today live so well in a combat zone (air conditioned sleeping quarters, good food, fast medical care, lots of amenities). This has probably extended the PTSD limit to 300 (or more) combat days. But U.S. troops can now accumulate that much action in two or three twelve month tours in Iraq or Afghanistan. The big issue now is getting troops to recognize PTSD as just another combat injury, and to get it treated as soon as possible, before it gets worse, or causes permanent damage. This campaign is making progress, but it's slow going. Mental illness scares people, always has, probably always will. But the troops in a combat zone tend to be mercilessly professional, and practical. If you don't fix things that break, that lapse can get you killed. This angle works with combat troops. But in this war, about a third of the affected combat veterans are people in combat support jobs (mainly those that run convoys through hostile territory.) Because these troops were drilled as intensively, as protection against combat stress, they get it worse, and are less likely to be surrounded by soldiers who understand what they went through.

Currently, about 400 soldiers a year are sent home from Iraq because of severe PTSD, and thousands have less serious bouts of PTSD, which are treated in Iraq, with the soldier soon returning to duty. There has not been any surge in PTSD injuries, and the stats seem to show that efforts to deal with PTSD quickly, and on the spot, are having an impact.