'Nervous From the Service'

Military Psychiatry Revamps Old Tune

Along with the supplies and letters from home that finally caught up with the U.S. troops blazing across Iraq last week were comrades who feel up to the fight again after a bout of "combat stress."

Getting the battle-rattled back to their colleagues swiftly is a cornerstone of the military's program for tending to GIs' emotional well-being. New drugs have emerged even since the previous Gulf conflict, and the stigma of seeking help has lessened, but the basic protocol used today was set during World War I. Implementing it hasn't been easy this time around. "The front lines are more rapidly moving. That makes it harder to return people to their units," says Dr. Robert Ursano, chair of the psychiatry department at the Uniformed Services University of the Health Sciences.

U.S. success with "Rapid Dominance" has cut into the Pentagon's doctrine of "PIE"— proximity, immediacy, and expectancy. Troops are to be treated in close proximity to the front and their comrades; immediately, at the earliest stages of chronic distress; and with the expectation that they will recover and return to duty. "It re-establishes your place among friends and comrades and protects you from feelings of guilt and disappointment," says Ursano, who trained a sizable portion of the psychiatrists in the war zone. "It maximizes your belief in your ability to direct your behavior."

Troubled soldiers, like all patients, were once carted off to asylums. But during World War I, America began experimenting with having mental health professionals travel with the troops. Ursano says that radical approach had to be rediscovered in World War II—whose prolonged fighting inspired the jazz hit "Nervous From the Service"—but then it stuck, and spread. "PIE was the basis of the whole community mental health movement in the 1960s, that people could be treated in their own neighborhoods and surrounded by their families," he says.

Awareness of post-traumatic stress disorder among Vietnam veterans raised the priority on emotional health of soldiers, Ursano says, but even a victorious war caused psychic wounds. "Certainly Gulf War illness seems to have a stress component to it," he says.

Drugs to fight depression and anxiety, like Zoloft and Paxil, have advanced since then, and scientists continue experimenting with ways both to block fear and erase the effects of trauma. But doctors are wary of doling out pills when a brief period of rest and respite, or learning personal mental exercises, might be sufficient. "Some people have treated all psychiatric problems as if they were cancer when they might be like colds. That sense of an expectation of recovery allows people to have hope," he says. Or as a textbook of military medicine puts it, symptoms of battle stress are most often "normal reactions to abnormal conditions."

The Pentagon has 1,200 mental health professionals serving in combat stress units for the army, air force, and navy. Even the hardened marines turn to navy professionals for help.

If anyone personifies the risks of battle trauma today, it may be Private Jessica Lynch. She's under the care of Survival, Evasion, Resistance and Escape (SERE) psychologists, who specialize in former prisoners of war. We already know she has endured the ordeal of battle, and perhaps worse. As she lay in the Ramstein Air Base hospital in Germany, her dog tags were found in the home of a senior Baath Party official. That small discovery raised painful, and very public, questions about the circumstances in which her bones were broken and her flesh injured.

Were those dog tags a trophy taken in a sudden firefight, or evidence that the 19-year-old supply clerk from the army's 507th Maintenance Company was tortured at leisure afterward? Did Iraqi captors sexually abuse her as they did Major Rhonda Cornum (now a colonel), a P.O.W. in the Persian Gulf War? Will Lynch wrestle with "survivor guilt" over the loss of her eight comrades, including former roommate Private Lori Piestewa?

For some service members, the physical dangers aren't confined to the battlefield. Ursano says this war presents a new problem, the "burden of terrorism," since families at home can no longer be assumed safe. Pilots, whose errors kill the most civilians and who are among the more frequently captured, are now reluctant to reveal their names to reporters or captors for fear of reprisals, or the threat of reprisals, against loved ones. Some soldiers fear a more broadside revenge. "A big worry for our troops is a World Trade Center-type event," he says. "But that's also a motivator. They feel there's an actual threat to their country."

 
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