Combat stress being treated closer to front

By Patrick Peterson
Knight Ridder News Service

FALLUJAH, Iraq — The U.S. military is treating combat stress in Iraq the way it treats Iraqi sand flies: matter-of-factly, with preventive measures and as close to the front as possible.

"The whole premise is not to stigmatize," said Capt. Robert L. Koffman.

"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 prior U.S. wars, soldiers disabled by combat stress usually were evacuated from the battlefield to hospitals at the rear or closer to home. Such soldiers 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 recuperation centers if they become unable to do their jobs.

"We do not want to pathologize combat stress," Koffman said, so a recuperation 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 didn't 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 didn't know where to turn for help.

The Navy has also expanded its definition of wartime stress to include non-combat 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's 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 isn't 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," he said.

Koffman, 52, has served 20 years in the Navy and studied combat stress since Operation Desert Storm, 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, Capt. Koffman, an officer one rank below admiral, helped watch for attackers from behind the wall of sandbags in a 7-ton truck rolling down a dangerous highway.

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

The convoy was delayed four hours when an improvised explosive device was found in the road, but the convoy was otherwise unharmed.