Combat Stress System to Come Under New Focus

by Larry Kaplow

Amid the patrols, searches, training of Iraqi counterparts and the usual tedium of soldiering, many U.S. troops in Iraq are also trying to manage their mental health. Modern warfare today means an Army in which sleeping pills and anti-depressants are dispensed by medical units to help keep troops functioning in a war in which the forces are stretched thin. It’s not uncommon, Army psychologists have said, for soldiers to threaten others or themselves. There are procedures, like confiscating weapons and imposing around-the-clock suicide watches, to prevent danger. Now the shocking shooting spree by a U.S. soldier who killed five of his comrades at a combat stress center is placing new emphasis on the military mental health system, and the challenges of convincing some soldiers to use it.

The Pentagon today announced that the soldier, Sgt. John M. Russell is in custody facing a charge of aggravated assault and five counts of murder. After being flagged by commanders for stress problems about a week ago, the military said, Russell was ordered to a combat stress clinic at Camp Liberty (abutting his home base, Camp Victory). His weapon had already been taken from him. According to published reports, he apparently had an altercation with someone there and used another person's gun to kill two officers who were staff members in the clinic and three soldiers who happened to be there at the time. It’s the worst reported case of a soldier attacking his own troops since the war started. In addition to the criminal investigation, the Army has ordered a complete review of its mental health system.

The mental health infrastructure in Iraq has been growing throughout the war. The shooting yesterday took place at one of four “restoration centers” in Iraq, where soldiers can bunk temporarily or get outpatient care along with therapy. There are about 40 other combat stress teams on location with troops around the country. Their phone numbers are posted on bulletin boards, handed out by chaplains and commanders. But commanders acknowledge the system has problems, different doctrines and techniques have been tried.

As an Army psychologist explained to me a few years ago, there are competing interests between mental health and war fighting. One of the biggest is that soldiers and officers still look at therapy as a sign of weakness. Secondly, the goal is “unit cohesion,” that is, keeping the soldier at work rather than sending him or her home. Medicines can be prescribed but, as soldiers are sent back to the field, they don’t have the follow-up they need to monitor their condition--or make sure they don’t hand out the pills to others.

The hope for the troop was that as the violence in Iraq subsided and tours of duty were shortened, stress would decrease. But in some cases, simply being connected through the Internet to family back home has been enough to cause problems--the psychiatrist told me of one case in which a wife back home had posted photos of her and her new boyfriend on the Web to torment her soldier husband. And a recent USA Today story posited that boredom may increase stress.

The psychiatrist told me that it was especially hard to get officers to seek help because they feared it would impede their career or undermine their reputations. He tried to argue that it would help them avoid career-ruining incidents. The words seemed apt today as Maj. Gen. Daniel P. Bolger talked about the military’s efforts to get people to go for help. “It’s particularly challenging for a fellow like Sgt. Russell. He’s a non-commissioned officer,” Bolger said. “He’s in a leadership capacity and to make that trip down there is a tough decision for him or his chain of command to make, but we’re willing to make it.”