In addition to the physical casualties US ground troops are incurring, there are the just as debilitating psychological casualties as well. The US Army is alarmed about the growing number of active and veteran soldiers who have PTSD or will be possible future victims of it. The New York Times reports that a recent study by the US Army surgeon general's Mental Health Advisory Team shows that "among combat troops sent to Iraq for the third or fourth time, more than one in four show signs of anxiety, depression or acute stress,” which are signs of Post Traumatic Stress Disorder (PTSD). Considering the fact that the Army will have to send more soldiers than ever back to Iraq on multiple tours has the Army concerned about the long term effect on not just the soldiers themselves, but on the Army as a whole and its ability to defend US interests in the world. In other words, tactical combat stress in Iraq is becoming a matter of strategic concern for the Department of Defense.
Every war takes its toll on the men who fight in it. Some wars more than others, however. The type of combat and the terrain soldiers are fighting in, along with the motives for fighting seem to have a direct effect on how many and what kind of psychological stress soldiers will suffer from.
The type of combat engaged in Iraq is a guerrilla war in an urban setting. Without a doubt the worst combination of factors a soldier can be up against. Urban combat is the most deadly terrain for an attacking army. It is as close and personal as war can get. It also requires great speed and violence of action. Life or death can be decided in a matter of seconds, if that long. Since the guerrillas will be operating amongst civilians either by force or willingly, civilians will be killed and possibly in greater numbers than combatants. Women and children will also be caught in the crossfire and killed either by accident or as a tactical necessity.
The enemy is unknown and most of the time unseen. He leaves improvised explostive devices that kill anonymously, he attacks from inside crowds that protect him, he attacks where and when least expected. He can even be a she. The soldier can never fully trust anybody not to be a combatant in an urban guerrilla war. This feeling of always being in a combat situation wherever they go is a constant stress factor. In a war without a discernable frontline, combat and the potential to become a casualty is a 24 hours a day, 360 degree reality.
Besides combat, other factors are: a civilian population that does not welcome foreigners, an unpopular war with an open-ended mission, a lack of predictability and an alien culture with different norms.
The NY Times report continues, "the range of symptoms reported by soldiers varies widely, from sleeplessness and anxiety to more severe depression and stress. To assist soldiers facing problems, the Army has begun to hire more civilian mental health professionals while directing Army counselors to spend more time with frontline units.” At last the Army is beginning to accept the fact that PTSD is a real casualty inducing phenomena and the best way to heal it is to be where it happens and when it happens, in the combat zone with the combat troops.
