The consideration of Service Members’ experiences in the theater of war is a far more complex process than one would assume. In the words of one veteran interviewee, “War is the best and the worst that humanity has to offer. It has periods of satisfaction and heroism, and periods of the most grotesque and unimaginable experiences. The trick for the war veteran is to be able to negotiate that experience” (Steve Robinson, Veteran and Consultant, ONE Freedom).
Variations in Experience: Returning veterans’ experiences in Iraq and Afghanistan are many and varied, depending on a number of factors that might include:
Urban Warfare: Henderson (2006) noted that technological advances now make it possible to fight 24 hours a day, leaving no built-in “down-time” to decompress and return stress systems to balance. He also cited the special nature of urban warfare, which:
In the words of Padin-Rivera (2006), “Much of the violence has no uniform. Any civilians can be dangerous. Everything is a possible weapon” (Padin-Rivera, 2006, p. 10).
Conditions in the War Zone: The Department of Veterans Affairs (2004) provided a comprehensive list of conditions under which Service Members operate, including the following.
Chronic high levels of discomfort:
Disruption and confusion:
The realities of combat:
The realities of an insurgency war:
Stress-system responses to these conditions:
Sleep Deprivation and Fatigue: According to the Army’s Mental Health Advisory Team’s 2006 report, “...a considerable number of Soldiers and Marines are conducting combat operations every day of the week, 10-12 hours per day seven days a week for months on end. At no time in our military history have Soldiers or Marines been required to serve on the front line in any war for a period of 6-7 months, let alone years, without a significant break in order to recover from the physical, psychological, and emotional demands that ensue from combat” (MHAT, 2006, p. 76).
One Iraq war veteran interviewee reported experiencing a lack of restorative sleep, sometimes for days, weeks, or months, with perhaps one hour’s shallow sleep each night. Contributors to sleep deprivation can include constant mortar attacks, sleeping (or attempting to sleep) in a truck, “24/7” military duties, and sleeping on high alert (Armstrong, Best, and Domenici, 2006). Sleep deprivation reduces blood flow to the brain, increasing the likelihood of a number of neurological challenges, including depression (Amen, 2008).
According to Scaer and colleagues (2008), the physical fatigue associated with carrying large quantities of supplies and protective gear can also add to the risk of post-deployment stress effects. Carrying 80-100 pounds of body armor and gear often leads to chronic contraction of anterior (front) core muscles (e.g., the psoas muscles that extend from the lower spine over the pelvis and hip—the very muscles involved in the dissociative “freeze” response. This may play a role in storing trauma in the body’s procedural memory (Scaer et al., 2008).
The need for rapid redeployment also tends to compound both the fatigue and the risk. According to the Mental Health Advisory Team, “We know from findings from the Walter Reed Army Institute of Research (WRAIR) Land Combat Study that the mental health status of Soldiers has not ‘re-set’ after returning from combat duty in Iraq and before they are applied again to Iraq” (MHAT, 2006, p. 77).
Military Sexual Trauma: The Iraq War Clinicians Guide describes military sexual trauma as including both sexual harassment and sexual assault in military settings. It can happen to either gender, and the perpetrator can be of the opposite or the same gender. It generally occurs within the Unit, a closed community in which there is little privacy and the victim and perpetrator must meet on a regular basis (VA, 2004). According to Lighthall (2008), military sexual trauma can have devastating effects throughout the Unit and throughout Service Members’ stress systems, because it shatters the Unit cohesion that is so essential to survival and resilience (Lighthall, 2008).
Effects of the Surge: Given the relative decrease in violence during the troop Surge that began in Iraq in Summer, 2007 (Farrell and Oppel, 2008), one might hope that the level of post-deployment stress effects would have decreased as well during that time. OIF veterans interviewed have expressed both their hope and their doubts that this is true, given that:
The Iraq War Clinician Guide also notes that even light or minimal exposure to violence can engender post deployment effects: “… clinicians need to be careful not to minimize reports of light or minimal exposure to combat. They should bear in mind that in civilian life, for example, a person could suffer from chronic PTSD as a result of a single, isolated life-threat experience (such as a physical assault or motor vehicle accident)” (VA, 2004, p. 25).
Next: Positive Experiences in the Theater of War
The material on all of the Clinical Pages is taken directly from the draft version of Finding Balance After the War Zone: Considerations in the Treatment of Post-Deployment Stress Effects, a manual under development for the Great Lakes Addiction Technology Transfer Center and Human Priorities. This draft is copyright © 2008, Pamela Woll. Reprint permission is universally granted, but attribution is requested.
Click here for References and Other Resources.
Click here to link to a PDF file of the current version of the clinician’s manual draft.
Click here to link to a PDF file of the accompanying booklet for veterans.
